Short communications published online in the British Journal of Oral and Maxillofacial Surgery during 2010-2011.

The British Journal of Oral and Maxillofacial Surgery (BJOMS) publishes many types of papers including original articles, review articles, and short communications. Many of the latter are isolated case reports of rare or interesting diseases or of difficult or unexpected complications. While case reports are sometimes considered to be of little educational or clinical value, and as such do little to advance medical knowledge, they do have an important role, and many trainees begin their publishing careers writing such papers. There is increasing pressure for space in paper medical journals and, for this reason, some journals either limit or do not publish short publications in print copy but instead put them online. Using established criteria, we previously evaluated all 142 short communications published in the BJOMS during 2008-2009 and found that 48% of them had little or no educational value. As a result, the editorial board of BJOMS took the decision to publish most short communications online only. We have now analysed 48 short communications that were published online only during 2010-2011. Most (80%) were single case reports that covered virtually the whole remit of the specialty, and over half (56%) were published by authors based in the UK. While many of these papers did not add important new information to existing knowledge, these types of article are clearly of value both for trainees and for experienced surgeons. We think that these should continue to be supported as, in addition to their educational value, they are an excellent way for trainees to start to write.

Oral and maxillofacial surgery: "publication hot spots" in the United Kingdom.

We aimed to evaluate the number of articles in the British Journal of Oral and Maxillofacial Surgery (BJOMS) written by consultants and trainees within deaneries in the UK. We reviewed the authorship of articles published between January 2010 and July 2011, and subdivided them by deanery and first author. In total, 76 full length articles were published (30 written by consultants and 46 by trainees), and half came from the London, Wessex, and Mersey deaneries. Technical notes were mostly written by trainees; 5 of the 22 published came from London. A total of 38 short communications were published; most were from the Wessex (21%), Yorkshire and Humber (29%), and Mersey (13%) deaneries, and in 32% a consultant was first author. A league table of all publications showed that most came from Wessex (n=25), Mersey (n=23), and Yorkshire and Humber (n=23). Most publications by trainees came from Wessex (n=20), followed by Yorkshire (n=18) and London (n=11). The study shows that the amount of published material varies considerably between oral and maxillofacial surgery (OMFS) units in the UK. To realise their ambitions, potential trainees with an interest in research and publications may consequently find the best support in these deaneries.

The BioCAT undulator beamline 18ID: a facility for biological non-crystalline diffraction and X-ray absorption spectroscopy at the Advanced Photon Source.

The 18ID undulator beamline of the Biophysics Collaborative Access Team at the Advanced Photon Source, Argonne, IL, USA, is a high-performance instrument designed for, and dedicated to, the study of partially ordered and disordered biological materials using the techniques of small-angle X-ray scattering, fiber diffraction, and X-ray absorption spectroscopy. The beamline and associated instrumentation are described in detail and examples of the representative experimental results are presented.

[Application of a preoperative evaluation model in patients undergoing elective abdominal surgery]. / Aplicación de un modelo de evaluación preoperatoria en pacientes operados de cirugia abdominal electiva.

We used a preoperative evaluation model based on the clinical history in order to determine the clinical characteristics of the patients. We also estimated the prevalence of asymptomatic disease in ASA1 patients and described the frequency of diagnosis that motivated suspension of the surgery during the preoperative time. Another purpose was to establish the perioperative complications according to the risk index and to detect the medical reasons for suspension of surgery during hospitalization. A total of 777 patients having an indication of surgery were evaluated in this program. Only 507 completed the preoperative evaluation. Of these, 57.79%, had at least one known disease or were diagnosed by their clinical history. Preoperative tests were indicated according to age in ASA1 patients. Complementary studies were indicated in relationship to the history and physical examination in ASA2 and ASA3 patients. After the evaluation, 27 surgeries were suspended: 21 were considered high risk, 2 suffered unknown active infections, and 4 ASA1 patients had severe asymptomatic anemia. A total of 328 patients were admitted for surgery. In 5 of these patients the anesthesiologist stopped the procedure in the operating room. The causes were acute decompensations of known pathologies. There were no complications or deaths related to unknown diseases and no patients died from cardiopulmonary or metabolic complications. In ASA1 patients, there were no complications related to this evaluation. This study allowed us to determine the clinical status of the patients and in consequence high-risk surgeries were canceled. In admitted patients a few surgeries were canceled for clinical reasons. This program probably decreased patient morbimortality, unnecessary hospitalization and costs.

Effects of a significant-other observer on neuropsychological test performance.

The present study examined the effects of a third-party observer on neuropsychological test performance in a sample of 30 university students seeking evaluation for learning disability. A significant-other (defined as a parent, sibling, close friend, spouse, or partner) observed portions of a neuropsychological testing session. Subjects were administered a battery of tests, including seven repeatable measures, chosen to assess diverse neuropsychological functions. In the presence of an observer, performance deficits were found on tests of attention, speed of information processing, and verbal fluency. An observer had no effect on tests of cognitive flexibility or motor speed. Our results suggest that the validity of test results may be compromised by the presence of an observer.

Autopsy consent practice at US teaching hospitals: results of a national survey.

BACKGROUND: Autopsy rates continue to fall despite the enduring benefit of the procedure to families and medical science, yet there are few data about the consent process itself. OBJECTIVE: To evaluate the current practice of obtaining autopsy consent, by assessing the consent forms currently in use, the knowledge and attitudes of chief residents on the procedure, and the expert opinion of pathologists in those institutions. DESIGN: Cross-sectional survey. SETTINGS AND PARTICIPANTS: One hundred twenty-seven US teaching hospitals. RESULTS: Of all autopsy consent forms we surveyed, 84.7% contained 7 of 10 elements recommended by the College of American Pathologists. Only 7.1% of institutions supplied educational materials for the physician, as recommended by the College of American Pathologists. Overall, 50.1% of chief residents reported deficiencies in their knowledge of the autopsy procedure. Correspondingly, greater than 74.5% felt that educational materials would be beneficial for physicians and the family. Finally, 93.3% of chief residents believed that a limited autopsy should be offered to families, while 68 (90%) of 76 pathologists at these institutions believed that limited autopsies are an unsatisfactory alternative to the complete procedure. CONCLUSIONS: Chief residents at US teaching hospitals reported substantial deficiencies in their knowledge about autopsy and desire more training on the consent process. Autopsy consent forms are often lacking information that might help physicians and families in making an educated choice about autopsy. Teaching institutions need to reevaluate the training for the autopsy consent practice.

Design of a vacuum-compatible high-precision monochromatic beam-position monitor for use with synchrotron radiation from 5 to 25 keV.

The Structural Biology Center beamline, 19ID, has been designed to take full advantage of the highly intense undulator radiation and very low source emittance available at the Advanced Photon Source. In order to keep the X-ray beam focused onto the pre-sample slits, a novel position-sensitive PIN diode array has been developed. The array consists of four PIN diodes positioned upstream of a 0.5 microm-thick metal foil placed in the X-ray beam. Using conventional difference-over-the-sum techniques, two-dimensional position information is obtained from the metal foil fluorescence. Because the full X-ray beam passes through the metal foil, the true beam center-of-mass is measured. The device is compact, inexpensive to construct, operates in a vacuum and has a working range of 8 mm x 10 mm that can be expanded with design modifications. Measured position sensitivity is 1-2 microm. Although optimized for use in the 5-25 keV energy range, the upper limit can be extended by changing metals or adjusting foil thickness.

Aplicación de un modelo de evaluación preoperatoria en pacientes operados de cirugia abdominal electiva. / [Application of a preoperative evaluation model in patients undergoing elective abdominal surgery]

We used a preoperative evaluation model based on the clinical history in order to determine the clinical characteristics of the patients. We also estimated the prevalence of asymptomatic disease in ASA1 patients and described the frequency of diagnosis that motivated suspension of the surgery during the preoperative time. Another purpose was to establish the perioperative complications according to the risk index and to detect the medical reasons for suspension of surgery during hospitalization. A total of 777 patients having an indication of surgery were evaluated in this program. Only 507 completed the preoperative evaluation. Of these, 57.79

, had at least one known disease or were diagnosed by their clinical history. Preoperative tests were indicated according to age in ASA1 patients. Complementary studies were indicated in relationship to the history and physical examination in ASA2 and ASA3 patients. After the evaluation, 27 surgeries were suspended: 21 were considered high risk, 2 suffered unknown active infections, and 4 ASA1 patients had severe asymptomatic anemia. A total of 328 patients were admitted for surgery. In 5 of these patients the anesthesiologist stopped the procedure in the operating room. The causes were acute decompensations of known pathologies. There were no complications or deaths related to unknown diseases and no patients died from cardiopulmonary or metabolic complications. In ASA1 patients, there were no complications related to this evaluation. This study allowed us to determine the clinical status of the patients and in consequence high-risk surgeries were canceled. In admitted patients a few surgeries were canceled for clinical reasons. This program probably decreased patient morbimortality, unnecessary hospitalization and costs.

The M.ADP.Pi state is required for helical order in the thick filaments of skeletal muscle.

The thick filaments of mammalian and avian skeletal muscle fibers are disordered at low temperature, but become increasingly ordered into an helical structure as the temperature is raised. Wray and colleagues (Schlichting, I., and J. Wray. 1986. J. Muscle Res. Cell Motil. 7:79; Wray, J., R. S. Goody, and K. Holmes. 1986. Adv. Exp. Med. Biol. 226:49-59) interpreted the transition as reflecting a coupling between nucleotide state and global conformation with M.ATP (disordered) being favored at 0 degrees C and M.ADP.P(i) (ordered) at 20 degrees C. However, hitherto this has been limited to a qualitative correlation and the biochemical state of the myosin heads required to obtain the helical array has not been unequivocally identified. In the present study we have critically tested whether the helical arrangement of the myosin heads requires the M.ADP.P(i) state. X-ray diffraction patterns were recorded from skinned rabbit psoas muscle fiber bundles stretched to non-overlap to avoid complications due to interaction with actin. The effect of temperature on the intensities of the myosin-based layer lines and on the phosphate burst of myosin hydrolyzing ATP in solution were examined under closely matched conditions. The results showed that the fraction of myosin mass in the helix closely followed that of the fraction of myosin in the M.ADP.P(i) state. Similar results were found by using a series of nucleoside triphosphates, including CTP and GTP. In addition, fibers treated by N-phenylmaleimide (Barnett, V. A., A. Ehrlich, and M. Schoenberg. 1992. Biophys. J. 61:358-367) so that the myosin was exclusively in the M.ATP state revealed no helical order. Diffraction patterns from muscle fibers in nucleotide-free and in ADP-containing solutions did not show helical structure. All these confirmed that in the presence of nucleotides, the M.NDP.P(i) state is required for helical order. We also found that the spacing of the third meridional reflection of the thick filament is linked to the helical order. The spacing in the ordered M.NDP.P(i) state is 143.4 A, but in the disordered state, it is 144. 2 A. This may be explained by the different interference functions for the myosin heads and the thick filament backbone.

Relative bradycardia and lymphopenia in patients with babesiosis.

The medical records of 17 patients with babesiosis were reviewed. Nine of 17 patients (52.9%) presented with fever (temperature, > 101 degrees F), and 8 of the 9 patients (88.9%) had relative bradycardia. Four of the nine patients (44.4%) had morning temperature spikes during initial hospitalization. As revealed by laboratory analysis, 13 of 17 patients (76.5%) with babesiosis had lymphopenia, and 5 of 17 patients (29.4%) had rouleaux formation in their peripheral blood smears. These newly described clinical and laboratory findings represent additional clinical and laboratory features that may be used as diagnostic clues in the differential diagnosis of babesiosis.

How X-ray Diffraction with Synchrotron Radiation Got Started.

The need to record low-angle-scattering X-ray fibre diagrams from muscle with millisecond time resolution drove the use of synchrotron radiation as an X-ray light source. The first smudgy diffraction patterns were obtained from a slice of insect flight muscle. Out of this grew the EMBL Outstation at DESY.

Energy-resolving X-ray fluorescence detection using synthetic multilayers.

The potential of synthetic multilayers for energy-resolving the X-ray fluorescence in X-ray absorption fine structure (XAFS) experiments is discussed. Two detection systems, one using curved multilayers and the other using graded multilayers to select X-ray fluorescence photons, have been designed to cover a wide energy range with a usefully large solid angle. Such a detector will be more advantageous than the barrel-like crystal-array detector because of the unique properties of synthetic multilayers, such as larger horizontal acceptance angles and bandwidth. In addition, the detector should be much simpler to construct and readily accommodates energy changes, especially the detector using graded multilayers. Comparison of the multilayer array detector with conventional detectors, such as ionization chambers and conventional 13-element Ge detectors, shows that the proposed system will be superior, particularly with the increased photon fluxes available from insertion devices and with decreased sample concentration, since this detection system eliminates the ;bad' photons before they enter any X-ray detector. Consequently, the X-ray detector proper for this system does not suffer from the incident-count-rate bottleneck common to current X-ray fluorescence detectors with energy resolution by signal processing. Thus, this new fluorescence detection system will provide tremendous opportunities for XAFS measurements on dilute systems, such as biological systems, at third-generation synchrotron sources.

Normalizing the crossover effect: enhancement of cognitive attentional processing in schizophrenia.

Thirty male schizophrenic subjects and 20 male control subjects were administered both the classic Rodnick and Shakow reaction time (RT) procedure and a modified experimental procedure using a balanced design in an attempt to enhance cognitive attentional processing and inhibit the crossover effect in schizophrenic patients. The experimental procedure increased the number of predictable trials, provided more information about the task and presented the regular trials in a simple ascending order. Analysis of the RT data showed the typical early schizophrenic crossover and late normal crossover on the standard task, while schizophrenic patients in the experimental condition showed a new finding of statistically significant normalization of the early crossover effect. The results support Shakow's theory of attentional set deficit in schizophrenia and in conjunction with previous findings suggest that separate neuropsychological mechanisms of cognitive preparatory attention and a more automatic form of vigilance attention may, respectively, underlie the regular and irregular procedures of the traditional RT task.

MAD analysis of FHIT, a putative human tumor suppressor from the HIT protein family.

BACKGROUND: The fragile histidine triad (FHIT) protein is a member of the large and ubiquitous histidine triad (HIT) family of proteins. It is expressed from a gene located at a fragile site on human chromosome 3, which is commonly disrupted in association with certain cancers. On the basis of the genetic evidence, it has been postulated that the FHIT protein may function as a tumor suppressor, implying a role for the FHIT protein in carcinogenesis. The FHIT protein has dinucleoside polyphosphate hydrolase activity in vitro, thus suggesting that its role in vivo may involve the hydrolysis of a phosphoanhydride bond. The structural analysis of FHIT will identify critical residues involved in substrate binding and catalysis, and will provide insights into the in vivo function of HIT proteins. RESULTS: The three-dimensional crystal structures of free and nucleoside complexed FHIT have been determined from multiwavelength anomalous diffraction (MAD) data, and they represent some of the first successful structures to be measured with undulator radiation at the Advanced Photon Source. The structures of FHIT reveal that this protein exists as an intimate homodimer, which is based on a core structure observed previously in another human HIT homolog, protein kinase C interacting protein (PKCI), but has distinctive elaborations at both the N and C termini. Conserved residues within the HIT family, which are involved in the interactions of the proteins with nucleoside and phosphate groups, appear to be relevant for the catalytic activity of this protein. CONCLUSIONS: The structure of FHIT, a divergent HIT protein family member, in complex with a nucleotide analog suggests a metal-independent catalytic mechanism for the HIT family of proteins. A structural comparison of FHIT with PKCI and galactose-1-phosphate uridylyltransferase (GaIT) reveals additional implications for the structural and functional evolution of the ubiquitous HIT family of proteins.

Assessment of differential attention mechanisms in seizure disorders and schizophrenia.

This study examines differential attention deficits in 19 temporal lobe epilepsy (TLE) patients, 15 generalized seizure patients (GSP), and 19 schizophrenic patients, compared to 20 normal controls. All participants were tested on a variable foreperiod reaction time (RT) task and continuous performance test (CPT). Temporal lobe epilepsy patients and schizophrenic patients show crossover deficits on the RT task requiring a conscious, effortful, preparatory motor set; while GSP show impairments on the CPT requiring vigilant, self-directed attention to external stimuli. The results suggest separate cortical and subcortical brain systems in the respective attentional deficits and in the etiologies of TLE, GSP, and schizophrenic disorders.

Atovaquone in the treatment of Babesia microti infections in hamsters.

The traditional therapy for the treatment of human Babesia microti infections has been the combination of clindamycin and quinine. However, in recent years, it has become apparent that some patients have not responded to this regimen. We became involved in the treatment of several cases of babesiosis in which atovaquone was used to treat this infection. Therefore, using the hamster model, we determined the efficacy of atovaquone alone as well as atovaquone plus azithromycin for the treatment of experimental babesiosis. Atovaquone (100 mg/kg/day) and atovaquone (100 mg/kg/day) with azithromycin (150 mg/kg/day) were effective agents for the treatment of experimental babesiosis in hamsters. When atovaquone was used as monotherapy recrudescences occurred. Organisms obtained from recrudescent animals, when inoculated into uninfected animals, proved to be unresponsive to atovaquone therapy, suggesting the emergence of drug resistance. Resistant organisms did not emerge in hamsters treated with the combination of atovaquone and azithromycin. Atovaquone should be considered in the therapeutic regimen of patients with babesiosis who have either failed standard therapy or have become intolerant to such therapy.

Multiple deficit theory of schizophrenia: incidence of markers vs. symptoms.

Forty schizophrenic, 20 affective-disordered, and 40 matched normal control subjects were compared on postulated marker and symptom measures of schizophrenic deficits in: (a) affect; (b) attention; (c) proprioception; and (d) thought. The schizophrenic group was significantly more impaired on all four vulnerability markers than were the other two groups, while the schizophrenic and affective-psychotic groups showed comparable impairments on three of the psychotic symptom deficits. The incidence of multiple marker deficits was significantly greater in the schizophrenic than in the affective group. The hypothesis of independence of marker deficits was supported by the absence of any significant correlations among markers in the schizophrenic sample. The data support the theory that independent markers of schizophrenic vulnerability may potentiate schizophrenic disorders when their incidence is concurrent and at deficit levels.