An assessment of surgery core rotation quality at osteopathic medical schools.

CONTEXT: Osteopathic medical schools have traditionally placed a heavy emphasis on the field of primary care. While graduating osteopathic students continue to pursue family medicine, internal medicine, and pediatrics at higher rates than their allopathic counterparts, it is unknown whether students feel that surgical rotations are held to similar standards. OBJECTIVES: The purpose of this study was to assess osteopathic medical student opinions of the quality of their surgical clerkships and to determine if good or poor experiences influenced their decision to continue pursuing surgery. METHODS: After Institutional Review Board approval, a voluntary and anonymous Qualtrics survey was sent to all nationally registered members of the American College of Osteopathic Surgeons, Medical Student Section (ACOS-MSS) in their final 2 years of medical school. Analyses were conducted utilizing R statistical software. RESULTS: A total of 345 responses were recorded from the Qualtrics survey sent to 2182 ACOS students from the national registry (response rate of 15.8 %). Students who found a mentor during their surgical rotations were more likely to consider a surgical career after they completed their rotations (odds ratio [OR]=1.43, p=0.003). Students at academic sites had more opportunities for research than those at community hospitals (p=0.019). Most students responded that they were still considering surgery as a career after rotation completion; a significant portion (OR=0.36, p<0.001) responded that they were no longer interested. CONCLUSIONS: Medical students are most likely to review a surgical rotation favorably if they can connect with a mentor while on rotation. Osteopathic medical schools may benefit from instituting mentorship programs for students interested in surgery, as well as ensuring that their students have ample opportunity for research.

The Effects of Single Accreditation and Pass/Fail Licensing Exams on Osteopathic Medical Students Applying to Surgical Residency Programs.

OBJECTIVE: To examine the effects of single accreditation and pass/fail licensing exams on osteopathic (DO) medical students applying for surgical residency. DESIGN: Electronic surveys were distributed to 1509 program directors (PD) in 10 surgical specialties. PDs were separated into 2categories based on their program's accreditation status prior to single accreditation: formerly accredited by the American Osteopathic Association (AOA) or not accredited by the AOA. Separate chi-squared and binomial tests were used to determine statistical differences between PDs in each category and within each surgical specialty. SETTING: Voluntary, anonymous, electronic survey. PARTICIPANTS: Three hundred survey responses were received (response rate 19.8%) and 234 responses were included in statistical analyses. Sixty-six responses were excluded because the survey was incomplete, the survey was not completed by a PD, or the PD indicated disqualification of DO applicants from matching at that program. RESULTS: The majority of PDs in both categories recommend or require that DO students take both United States Medical Licensing Examination (USMLE) Step1 [Χ2 (2, N = 234) = 8.939, p = 0.011] and USMLE Step 2 CK [Χ2 (2, N = 234) = 4.161, p = 0.125] despite pass/fail outcomes only on Step 1 and Level 1. When deciding whom to interview, PDs in both categories highly ranked USMLE Step 2 CK scores and letters of recommendation (LOR). Formerly-AOA-accredited programs highly ranked COMLEX-USA Level 2 scores (p = < 0.001) and completion of an audition rotation (p = 0.001). Non-AOA-accredited programs highly ranked the Medical Student Performance Evaluation (MSPE) (p = < 0.001) and clerkship grades/evaluations (p = 0.001). CONCLUSIONS: Significant differences exist in programs despite single accreditation. DO applicants should take both USMLE Step 1 and Step 2 CK to be considered competitive for any surgical specialty. Additionally, DO students should prioritize formerly-AOA-accredited programs for audition rotations.

Relevance of copper transporter 1 and organic cation transporters 1-3 for oxaliplatin uptake and drug resistance in colorectal cancer cells.

Oxaliplatin is a routinely used drug in the treatment of colorectal cancer. However, development of resistance is a major hurdle of the chemotherapy success. Defects in cellular accumulation represent a frequently reported feature of cells with acquired resistance to platinum drugs. Nevertheless, the mechanisms of oxaliplatin uptake and their role in oxaliplatin resistance remain poorly elucidated. The aim of this study was to investigate the relevance of copper transporter 1 (CTR1) and organic cation transporters 1-3 (OCT1-3) for oxaliplatin uptake and resistance to the drug in sensitive and oxaliplatin-resistant ileocecal colorectal adenocarcinoma cells. Co-incubation with copper(ii) sulfate, a CTR1 substrate, significantly decreased oxaliplatin accumulation but not cytotoxicity in both cell lines. Pre- as well as co-incubation with the OCT1 inhibitor atropine led to a significant reduction in oxaliplatin accumulation in sensitive but not in resistant cells. However, oxaliplatin cytotoxicity was also decreased in the presence of atropine in both cell lines. Cimetidine, an inhibitor of OCT2, induced a significant reduction in the cellular accumulation and potency of oxaliplatin in sensitive and resistant cells. An inhibitor of OCT3, decynium-22, had no influence on oxaliplatin accumulation and cytotoxicity in either cell line. No differences in the transporter expressions were observed between the cell lines, drug-treated or not, either at the mRNA or protein levels. A fluorescent oxaliplatin derivative CFDA-oxPt co-localized with CTR1, OCT1 and OCT2 in sensitive cells, but only with CTR1 and OCT2 in the resistant cell line. Our results suggest that oxaliplatin is transported into the cell by CTR1 in both cell lines. However, contribution of CTR1-mediated uptake to resistance seems unlikely. Uptake of oxaliplatin via OCT1 appears to take place in the sensitive but not in the resistant cell line underscoring the transporter relevance for oxaliplatin resistance. OCT2 is likely to be involved in the uptake of oxaliplatin to a similar extent in both cell lines suggesting no major contribution of this transporter to resistance. In contrast, OCT3 appears to be irrelevant for oxaliplatin transport into the cell and resistance.

The efficacy of antisense-based construct for inducing resistance against Croton yellow vein mosaic virus in Nicotiana tabacum.

Begomoviruses have increased pathogenicity because of their adaptation to a wide host range; consequently, these viruses cause a major loss to agroeconomic crops worldwide. In this study, we designed a gene construct representing an antisense coat protein gene. We also analyzed the efficacy of the induced resistance against Croton yellow vein mosaic virus (CrYVMV) affecting papaya in Nicotiana tabacum plants. Positive control plants developed typical leaf curl symptoms, whereas transgenic plants were symptomless. Moreover, the key component (i.e., short interfering RNA) of the antisense pathway was upregulated in transgenic plants. This finding demonstrates the activation of the gene silencing mechanism in transgenic plants. Thus, these results confirm that our construct is functional and effectively induces transient resistance against CrYVMV infections.

Time to endoscopy and outcomes in upper gastrointestinal bleeding.

BACKGROUND: Upper gastrointestinal bleeding (UGIB) is a common problem associated with significant morbidity and mortality. Previous studies show that immediate endoscopies do not affect outcomes in patients; however, endoscopic interventions have evolved. The present retrospective review of endoscopies performed at a large teaching hospital assessed the timing of endoscopy with respect to the morbidity and mortality of UGIB. METHODS: Diagnostic billing codes were used to assess all inpatients of gastroenterologists at the University Hospital of the London Health Sciences Centre, London, Ontario, from July 2004 to June 2006, using a centralized data recording system. Time to endoscopy (within 6 h, 6 h to 24 h and beyond 24 h) were compared for the outcomes of mortality, need for surgery and transfusion requirements. RESULTS: From July 2004 to June 2006, there were 502 upper endoscopies performed for the indication of suspected UGIB and 375 for overt acute nonvariceal UGIB. Approximately 10% of cases revealed variceal bleeding. When comparing endoscopy within 6 h with endoscopy at 6 h to 24 h, there were no significant differences in mortality, need for surgery (OR 3.6 and 2.8, respectively, compared with endoscopy beyond 24 h) or transfusion requirements. Even when assessing the group that received endoscopic hemostasis, time to endoscopy was not associated with better outcomes. Multivariate analysis did not demonstrate any advantages for early endoscopy (less than 6 h) compared with endoscopy within 24 h. CONCLUSIONS: Most patients with acute gastrointestinal bleeding can be effectively managed with endoscopy within 24 h.

Infectivity of the cloned components of a begomovirus: DNA beta complex causing chilli leaf curl disease in India.

The full-length genome of a begomovirus and its cognate DNA-beta satellite component associated with chilli leaf curl disease (ChLCD), originating from Varanasi, India, were cloned. Sequence analysis revealed that the viral genome (EF190217) is 2,750 bp and the DNA-beta satellite (EF190215) is 1,361 bp in length. Agroinoculation with partial tandem repeats of the viral genome along with the satellite induced symptoms typical of ChLCD in chilli and Nicotiana benthamiana. However, symptom expression was delayed and milder when the viral genome was agroinoculated alone in these hosts. Sequence comparisons revealed that the genome had the highest sequence identity (95%) with that of chilli leaf curl virus-PK[PK:Mul:98]. The DNA-beta satellite shared maximum sequence identity (88%) with a DNA-beta satellite associated with tomato leaf curl disease from Rajasthan (ToLCBDB-[IN:Raj:03]). These results demonstrate that ChLCD is caused by a complex consisting of the monopartite chilli leaf curl virus and a DNA-beta satellite component. This is the first experimental demonstration of Koch's postulates using cloned DNA molecules associated with chilli leaf curl disease.

Psychopharmacology of personality disorders: review and emerging issues.

Progress with the development of models and general principles of psychopharmacologic management of personality disordered patients is reviewed. Recent research using mood stabilizers and novel antipsychotics are discussed. The effects of these medications on impulsive aggressiveness are supported and the effects are evident early and are independent of the effects on mood, including depression. Research is needed with other personality disorders beyond just borderline personality disorder. Future research must develop measurable outcomes and delineate the causal and temporal relationships between the psychopathologic features of personality disorders.

Polymerase chain reaction in the diagnosis of tuberculosis.

OBJECTIVES: To evaluate efficacy of polymerase chain reaction (PCR), using the insertion sequence IS6110 as target for DNA, to detect Mycobacterium tuberculosis in body fluids of children with suspected tuberculosis (TB). SETTING: Hospitalized patients. METHODS: A comparison of PCR on body fluids, Acid Fast Bacilli staining (AFB), mycobacterial culture and clinical features, with special emphasis on central nervous system (CNS) TB was done over 18 month period. A total of 80 children were evaluated, 41 with probable TB disease and 39 controls. Cases were defined by specific clinical criteria. Controls included patients free of clinical TB. PCR was done on the clinical specimens and compared with clinical findings, radiological features, Mantoux (Mx) testing, AFB staining and culture on Lowenstein-Jensen (LJ) medium. RESULTS: Sensitivity of PCR in CSF samples was 100%, in gastric aspirate samples was 20% and in pleural fluid samples was 100%. CONCLUSION: PCR technique may become a valuable diagnostic tool for the diagnosis of tuberculosis in children especially in CNS TB.

Modeling the relationship between affective lability, impulsivity, and suicidal behavior in patients with borderline personality disorder.

This article reviews the concept of affective lability and suggests that new models are needed to characterize the relationship between affective states such as affective lability, impulsivity, and suicidal behavior. The association of affective lability, impulsivity, and suicidal behavior is most relevant to understanding the risk of suicide in individuals with borderline personality disorder. The relationship between affective lability and suicide might be explained as 1) a form of bipolarity, 2) a form of impulse dyscontrol, 3) a quantitative disorder of affect, or 4) an environmental reactivity. Our opinion of the relevant literature suggests that a quantitative disorder of affect accompanied by the inability to control these affects are the essential components leading to the risk of suicidal behavior. Characterizing the dyscontrol and high intensity of affect leads to a reconceptualization of depression in patients with borderline personality disorder and to a re-examination of the causal chain of events leading to suicidal behavior. The implications for clinical practice resulting from the proposed model are discussed.

Regeneration of pigeonpea (Cajanus cajan) from cotyledonary node via multiple shoot formation.

Plant regeneration, which is the major limiting factor for transformation of Cajanus cajan, has been obtained via multiple shoot formation from the cotyledonary node region of seedlings germinated on MS medium containing 2 mgl(-1) 6-benzylaminopurine. A mass of multiple shoot-initials formed at the axillary bud region of the cotyledonary node of the seedlings within two weeks. The cotyledonary node along with the mass of shoot-initials excised from the seedling, continued to form new shoot-initials on MS medium containing 6-benzylaminopurine (2 mgl(-1)) and supplemented topically with indole-3-acetic acid. The formation of new shoot-initials was also observed from the cotyledonary nodal explant, after cutting off its surface layers to completely remove the pre-existing shoot-initials and culturing it on 6-benzylaminopurine (2 mgl(-1)) containing medium. The shoots elongated rapidly on basal MS medium and rooted efficiently in MS medium supplemented with indole-3-butyric acid (0.5 mgl(-1)). The procedure described is efficient, and highly reproducible and a common response was observed for all the six varieties tested.

Role of ultrasonography in patients with normal oral cholecystogram.

The role of real-time ultrasonography was evaluated in 50 randomly selected cases with a strong clinical suspicion of gallbladder diseases and normal oral cholecystogram. Of these, 13(26%) cases showed abnormalities on ultrasonography.

Comparative study of ultrasonography and oral cholecystography in evaluation of gallbladder and biliary tract diseases.

50 cases, aged between 14-60 years, clinically suspected of gall-bladder and biliary tract diseases were evaluated by ultrasonography and oral cholecystography. Ultrasound with a preliminary radiograph of gallbladder region, proved to be more sensitive and reliable procedure than oral cholecystography. Besides providing ancillary information regarding adjacent anatomic structures, it also guided the surgeon to decide preoperatively about the mode of surgery to be employed. Further, from the present study it can be fairly concluded that ultrasound should be used as the primary screening technique for evaluating gallbladder and biliary tract diseases, after plain skiagram of the gallbladder region, since it is non-invasive, more sensitive than OCG and is devoid of use of contrast media and its toxicity.

A comparative study between hysterosalpingography and laparoscopy in case of infertility.

From the present study it can be concluded that both the procedures have their own importance and no one can substitute the other, in diagnosing all the diseases. HSG has been found to be more rewarding in cases of abnormalities of the lumen of uterus and fallopian tubes for their patency. On the other hand laparoscopy has been more rewarding for the abnormalities of the surface of uterus, fallopian tubes and ovaries. It is suggested that in all the cases of infertility both the procedures should be done and the HSG should be done first followed by laparoscopy.

Role of ultrasonography in non-visualised gallbladder on oral cholecystography.

Real-time ultrasonography was done in 30 cases of non-visualised gallbladder on oral cholecystography. Surgico-pathological correlation revealed that a specific diagnosis indicating true pathology is possible preoperatively on ultrasonography.

Aspirin and thymosin increase interleukin-2 and interferon-gamma production by human peripheral blood lymphocytes.

Interleukin-2 (IL-2) and interferon-gamma (IFN-gamma) have recently been added to the arsenal of synthetic biological response modifiers with important immunomodulatory activities. In this paper we have assessed the effects of acetylsalicylic acid (aspirin), thymosin alpha and thymosin fraction 5 (TF5), a partially purified calf thymic preparation, on production of IFN-gamma in vitro. Stimulation by oral aspirin of IL-2 and IFN-gamma production by peripheral blood lymphocytes (PBLs) was also studied in healthy human volunteers. Aspirin, thymosin alpha 1 and TF5 were all observed to enhance phytohemagglutinin (PHA)-stimulated production of IFN-gamma. Peak IFN-gamma production by PHA-stimulated PBLs was observed after 24 h of incubation with TF5 and after 72 h with aspirin. Stimulation by aspirin and TF5 required the presence of macrophages, and was additive and dose-dependent. The additive effects of aspirin and TF5 suggest that these agents act by different mechanisms. Oral administration of aspirin in normal volunteers significantly enhanced production of both IFN-gamma and IL-2. PHA-stimulated IFN-gamma production was greatest 24 h after aspirin ingestion; in contrast, IL-2 production was optimal 10 h after aspirin ingestion. These observations suggest that oral aspirin is an effective biological response modifier in humans and raise the possibility of a novel combination approach to immunomodulation involving cyclooxygenase inhibitors and thymosins.

Induction and differentiation of callus from embryos of Cocos nucifera L. by IAA-conjugates.

Calli from young embryos of Cocos nucifera L. were induced on B5 medium supplemented with IAA-conjugates (IAA-asp or IAA-ala) at a concentration of 2.0 mg/1 and callusing was increased by about 10% if both IAA-conjugates, IAA-asp and IAA-ala were added together. Differentiation of shoots and roots was achieved by transferring calli to B5 medium supplemented with either IAA-asp (2.0 mg/1)+Kn(2.0 mg/1) or NAA (2.0 mg/1). Complete plantlets were obtained on B5 medium supplemented with NAA (0.5 mg/1)+BAP (2.0 mg/1)+PVP (1.0 g/1).