Detection of deposited drill cuttings on the sea floor - A comparison between underwater hyperspectral imagery and the human eye.

We surveyed the deposition of drill cuttings on the seafloor along a transect at eight drilling locations in the south-western Barents Sea and Norwegian Sea, comparing traditional visual surveying methods and underwater hyperspectral imagery (UHI). The locations range from newly-drilled to around 30 years post-drilling. The visual assessments detected deposited drill cuttings to extend to around 150-200 m from the drilling location at recently drilled sites and generally less than 50 m at older locations. Quantitative UHI analyses of relative change in the spectral signature of the sediments with increasing distance from the drilling location mostly showed a change-over to conditions resembling undisturbed sediments at approximately similar distances as the visual assessments. Biological faunal community analyses also reflected these trends. The UHI-based detection of drill cuttings thus in general supported the results of visual assessments and potentially could be further developed as a method for automated surveying of drilling sites.

Effect on the mechanical properties of human and bovine dentine of intracanal medicaments and irrigants.

BACKGROUND: Evidence is lacking concerning the suitability of using bovine dentine in endodontic research. This study compared the mechanical properties of human and bovine root dentine using endodontic medicaments and irrigants. METHODS: Standardized human and bovine dentine bars were allocated to six experimental groups (n = 15): calcium hydroxide paste (Calasept® Plus); Odontopaste® ; 0.5% and 1% NaOCl gels; 1% and 4% NaOCl solutions. The bars were exposed to the materials for 7 days and then immediately subjected to a three-point bend test and Vickers microhardness test. Data were analysed using analysis of variance with Fisher's pairwise comparisons, with P < 0.05. RESULTS: Human dentine displayed a significantly higher modulus of elasticity (P = 0.001), higher microhardness (P < 0.001), and lower flexural strength (P = 0.004) compared with bovine dentine. Calcium hydroxide and Odontopaste® did not result in a significant change to the mechanical properties of human dentine. In human dentine, 0.5% NaOCl gel caused a significant decrease in flexural strength (P < 0.001) and microhardness (P = 0.02). CONCLUSIONS: Bovine dentine was a suitable substrate relative to human dentine. The use of a 0.5% or 1% NaOCl gel as an intracanal medicament is not supported by this study.

Exercise Interventions for Preserving Physical Function Among Cancer Survivors in Middle to Late Life.

The purpose of this review was to evaluate randomized controlled trials aiming to preserve the functional status, i.e. physical capabilities, of middle-aged and older cancer survivors through a structured, physical exercise intervention. The study team performed a thorough search of the literature using six online databases. This literature search limited included studies to randomized controlled trials which implemented a structured physical activity intervention for middle- and older-aged adults diagnosed with cancer. Studies were also required include at least one objective measure of physical function as a dependent outcome. This literature search yielded thirty-eight studies. The majority of the literature reviewed was successful in improving several functional outcomes including time needed to rise from a chair or distance covered during the six-minute walk test. A large number of published trials also suggest that exercise is effective in decreasing fatigue. However, a lack of trials investigating outcomes in older populations (≥ 65 years) was noted in this review. The results of this review suggest that a structured exercise program may be physically beneficial for middle-aged to older cancer survivors. Particularly, such interventions could preserve the functional status of cancer patients and, consequently, improve their long-term health outcomes. Future implications include further investigation into strictly older cancer patient populations, as outcomes related to exercise might differ between older and middle-aged adults.

Effects of a One-Year Physical Activity Program on Serum C-Terminal Agrin Fragment (CAF) Concentrations among Mobility-Limited Older Adults.

OBJECTIVES: C-terminal Agrin Fragment (CAF) has been proposed as a potential circulating biomarker for predicting changes in physical function among older adults. To determine the effect of a one-year PA intervention on changes in CAF concentrations and to evaluate baseline and longitudinal associations between CAF concentrations and indices of physical function. DESIGN: Ancillary study to the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P), a multi-site randomized clinical trial designed to evaluate the effects of chronic exercise on the physical function of older adults at risk for mobility disability. SETTING: Four academic research centers within the U.S. PARTICIPANTS: Three hundred thirty three older adults aged 70 to 89 with mild to moderate impairments in physical function. INTERVENTION: A 12-month intervention of either structured physical activity (PA) or health education promoting successful aging (SA). MEASUREMENTS: Serum CAF concentrations and objectives measures of physical function - i.e. gait speed and performance on the Short Physical Performance Battery (SPPB). RESULTS: The group*time interaction was not significant for serum CAF concentrations (p=0.265), indicating that the PA intervention did not significantly reduce serum CAF levels compared to SA. Baseline gait speed was significantly correlated with baseline CAF level (r = -0.151, p= 0.006), however the association between CAF and SPPB was not significant. Additionally, neither baseline nor the change in CAF concentrations strongly predicted the change in either performance measure following the PA intervention. CONCLUSION: In summary, the present study shows that a one-year structured PA program did not reduce serum CAF levels among mobility-limited older adults. However, further study is needed to definitively determine the utility of CAF as a biomarker of physical function.

Skin- and gut-homing molecules on human circulating γδ T cells and their dysregulation in inflammatory bowel disease.

Changes in phenotype and function of γδ T cells have been reported in inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC). Dysregulation of lymphocyte migration plays a key role in IBD pathogenesis; however, data on migratory properties of γδ T cells are scarce. Human circulating γδ T cells from healthy controls (n = 27), patients with active CD (n = 15), active UC (n = 14) or cutaneous manifestations of IBD (n = 2) were characterized by flow cytometry. Circulating γδ T cells in healthy controls were CD3(hi) and expressed CD45RO. They expressed gut-homing molecule ß7 but not gut-homing molecule corresponding chemokine receptors (CCR)9, or skin-homing molecules cutaneous lymphocyte-associated antigen (CLA) and CCR4, despite conventional T cells containing populations expressing these molecules. CCR9 expression was increased on γδ T cells in CD and UC, while skin-homing CLA was expressed aberrantly on γδ T cells in patients with cutaneous manifestations of IBD. Lower levels of CD3 expression were found on γδ T cells in CD but not in UC, and a lower proportion of γδ T cells expressed CD45RO in CD and UC. Enhanced expression of gut-homing molecules on circulating γδ T cells in IBD and skin-homing molecules in cutaneous manifestations of IBD may be of clinical relevance.

Development of a standardized low-dose double-blind placebo-controlled challenge vehicle for the EuroPrevall project.

BACKGROUND: Double-blind placebo-controlled food challenge (DBPCFC) is the gold standard for diagnosing food allergy. Standardized materials and protocols are essential for comparing DBPCFC results for multicentre studies such as EuroPrevall. This required the development and piloting of a standardized vehicle and low-dose protocol for confirming food allergy and determination of minimum eliciting doses (MEDs). METHODS: A low-dose DBPCFC protocol was developed, with eight titrated protein doses from 3 µg to 1 g. This was delivered using a simple, microbiologically stable food base incorporating allergenic food ingredients manufactured at three sites and centrally distributed to clinical centres. Allergen blinding was assessed by a professional sensory testing panel using a triangle test. Homogeneity and allergen content were confirmed by ELISA and clinical efficacy was assessed in a pilot study, using celeriac and hazelnut as exemplars. RESULTS: Celeriac and hazelnut ingredients were sufficiently blinded in the dessert. The dessert meals were successfully piloted with hazelnut in allergy clinics in Spain, the Netherlands and Italy and with celeriac and hazelnut in Zurich. The challenges elicited a range of subjective and objective reactions ranging in severity from mild itching of the oral mucosa to bronchospasm. CONCLUSIONS: A standardized challenge vehicle proven to sufficiently blind processed, powdered hazelnut and celeriac ingredients and that can be reproducibly manufactured has been developed. This pilot study shows that the vehicle is promising for the confirmation of food allergy and determination of MEDs in adults and children with body weight >28.8 kg (approximately 7-11 years old).

Systematic review: the use of nitrous oxide gas for lower gastrointestinal endoscopy.

BACKGROUND: Nitrous oxide gas (N(2)O) has been proposed as an alternative to intravenous (i.v.) analgesia in patients undergoing lower gastrointestinal endoscopy. AIM: To perform a systematic review of randomized studies where N(2)O was compared against control in patients undergoing either flexible sigmoidoscopy or colonoscopy. METHODS: Electronic databases were searched; reference lists were checked and letters were sent to authors requesting data. Methodological quality was assessed. Data were tabulated on the duration and difficulty of the procedure, quality of sedation and speed of patient recovery. RESULTS: A total of 11 studies were identified containing 623 patients. No differences were seen between groups for duration, difficulty of procedure or complications. Patient-reported pain was similar for N(2)O when undergoing flexible sigmoidoscopy vs. no sedation and when undergoing colonoscopy vs. i.v. sedation. Differences in delivery of N(2)O were identified. In all studies, N(2)O was associated with a more rapid recovery than i.v. sedation. CONCLUSION: For patients undergoing colonoscopy, N(2)O provides comparable analgesia to i.v. sedation. The rapid psychomotor recovery with N(2)O enables quicker patient discharge and removes the need for a patient to be chaperoned. Benefit was not seen from N(2)O in patients undergoing flexible sigmoidoscopy possibly because it was delivered on demand rather than continuously.

Factors influencing the incidence and prevalence of food allergy.

Food allergy is an increasing problem in Europe and elsewhere and severe reactions to food are also becoming more common. As food allergy is usually associated with other forms of allergic sensitisation it is likely that many risk factors are common to all forms of allergy. However the potential severity of the disease and the specific public heath measures required for food allergy make it important to identify the specific risk factors for this condition. Food allergy is unusual in that it often manifests itself very early in life and commonly remits with the development of tolerance. Hypotheses that explain the distribution of food allergy include specific genetic polymorphisms, the nature of the allergens involved and the unique exposure to large quantities of allergen through the gut. Progress has been made in developing more specific and testable hypotheses but the evidence for any of these is still only preliminary. Further collaborative research is required to develop an appropriate public health response to this growing problem.

Kiwifruit allergy: actinidin is not a major allergen in the United Kingdom.

BACKGROUND: Actinidin has previously been reported as the major allergen in kiwifruit. Objectives To investigate the relevance of actinidin in a well-characterized population of UK patients with kiwifruit allergy. METHODS: To identify the allergens in kiwifruit, using Western blots, we examined the IgE-binding patterns of 76 patients with a history of kiwifruit allergy, 23 of who had had a positive double-blind, placebo-controlled food challenge. In addition, IgE binding to purified native actinidin was studied in 30 patients, and to acidic and basic isoforms of recombinant actinidin in five patients. Inhibition of IgE binding to kiwifruit protein extract by purified native actinidin was investigated by both inhibition immunoblots and inhibition ELISAs using pooled sera. RESULTS: Twelve protein bands in kiwifruit protein extract were bound by IgE. A protein band with a molecular weight of 38 kDa was the major allergen recognized by 59% of the population. IgE did not bind to actinidin in the kiwifruit protein extract, or to purified native or recombinant forms of actinidin during Western blotting. Pooled sera bound to kiwifruit protein extract but not purified actinidin on ELISA, and pre-incubating sera with actinidin did not inhibit IgE binding to kiwifruit protein extract on immunoblot or ELISA. CONCLUSION: A novel 38 kDa protein, not actinidin, is the major allergen in this large study population. Identification of major allergens in one patient group is therefore not necessarily reproducible in another; therefore, major allergens should not be defined until there is a sufficient body of data from diverse geographical and cultural populations.

Perceptions of facial aesthetics in two and three dimensions.

The aims of this study were to investigate whether the preferred facial relationship chosen by professionals and the general public is Class I and to ascertain whether viewing two-dimensional (2D) or three-dimensional (3D) images had any effect on the ranking of facial attractiveness. Orthodontists (n = 47), maxillofacial surgeons (n = 25) and members of the general public (n = 78) assessed 2D and 3D facial scans of two males and two females that had been morphed to produce five images reflecting different skeletal patterns: Class I, mild and moderate Class II, and mild and moderate Class III. Each assessor placed the images in rank order of preference, after viewing alternate 2D and 3D image formats for each face. The data were analysed using logistic regression. In 2D, professionals (orthodontists and maxillofacial surgeons) chose Class I as the preferred facial image more frequently than the general public for only one of the four faces. However, in 3D format they chose Class I as the preferred facial image for some subject faces more, and others less, frequently when compared with the general public. The gender of the assessor was not significant when assessing the preferred facial relationship for Class I images in either 2D or 3D formats. The oldest assessors (56+ years) were significantly less likely than the younger age groups to select Class I as the preferred facial relationship in both 2D and 3D. In summary, there was too great a degree of variation to say that a difference between 2D and 3D facial images was evident.

Corticotropin-releasing factor 1 receptor-mediated mechanisms inhibit colonic hypersensitivity in rats.

The potential relationship between stress and irritable bowel syndrome (IBS) symptomatology suggests a possible role for stress-mediating hormones, such as corticotropin-releasing factor (CRF), in the altered perception of stimuli in IBS patients. In previous studies, Wistar-Kyoto (WKY) rats with genetic indices of high anxiety demonstrated colonic hypersensitivity coupled with a high basal level of CRF within the central nervous system. In the current study we tested the hypothesis that a selective, non-peptide CRF1 receptor antagonist, antalarmin, would inhibit hypersensitivity in the WKY rat colon. Colonic sensitivity was determined by monitoring a visceromotor behavioural response during innocuous levels of colorectal distention (30 mmHg). In high anxiety WKY rats we found that antalarmin (20 mg kg-1, i.p.) significantly decreased the visceromotor response induced by colorectal distention. In a second study central administration (i.c.v.) of CRF was used to induce colonic hypersensitivity in lower anxiety Fischer 344 (F-344) rats, and in this model, antalarmin significantly inhibited the CRF-induced colonic hypersensitivity. In summary, a selective CRF1 receptor antagonist, antalarmin, inhibits colonic hypersensitivity apparent in WKY rats or in F-344 rats given a central administration of CRF. Our findings suggest that CRF1 receptor antagonism may represent a novel therapeutic approach for the treatment of IBS.

Laparoscopic procedures in pregnancy.

As the applications of laparoscopy for general surgical procedures expanded in the 1990s, pregnancy was initially considered a contraindication. Several case reports have suggested the safety of laparoscopy in pregnancy. Previous clinical studies indicate a higher fetal mortality may exist and advised caution. To evaluate the fetal outcome of laparoscopic procedures in pregnant patients at our institution, we retrospectively reviewed the medical records between 1991 and 1997 and identified 21 pregnant patients who underwent either a laparoscopic (n = 12) or open (n = 9) procedure. Appendectomies, cholecystectomies, and diagnostic laparoscopies were performed. Specific variables including age, length of procedure, hospital stay, duration of parenteral analgesic use, gestational age at the time of surgery and delivery, O2 saturation and EtCO2 during surgery, APGAR scores, and birth weights were compared between the two groups. Laparoscopic procedures during pregnancy resulted in shorter hospital stays (34 hours versus 91 hours; P = 0.01), less use of parenteral narcotic analgesics (5 hours versus 29 hours; P = 0.05), and no prolongation of operative times (51 minutes versus 63 minutes; P = 0.20). In addition, laparoscopy was performed at earlier gestational ages (12 weeks versus 29 weeks; P = 0.001). There was one miscarriage 7 days after a laparoscopic cholecystectomy early in the 1st trimester that was not statistically significant. Our experience did not show a higher incidence of fetal loss when comparing laparoscopic to open procedures in pregnant patients.

Coronary care nurses' clinical decision making.

Increasing acuity of hospitalized persons with cardiac disease places great demands on nurses' decision-making abilities. Yet nursing lags in knowledge-based system development because of limited understanding about how nurses use knowledge to make decisions. The two research questions for this study were: how do the lines of reasoning used by experienced coronary care nurses compare with those used by new coronary care nurses in a representative sample of hypothetical patient cases, and are the predominant lines of reasoning used by coronary care nurses in hypothetical situations similar to those used for comparable situations in clinical practice? Line of reasoning was defined as a set of arguments in which knowledge is embedded within decision-making processes that lead to a conclusion. Sixteen subjects (eight experienced and eight new nurses) from coronary care and coronary step-down units in a large, private, teaching hospital in Minnesota, USA, were asked to think aloud while making clinical decisions about six hypothetical cases and comparable actual case. One finding was that most subjects in both groups used multiple lines of reasoning per case; but they used only one predominantly. This finding highlighted the non-linear nature of clinical decision making. Subjects used 25 predominant lines of reasoning, with intergroup differences on six of them. Where there were differences, experienced nurses used lines of reasoning of lower quality than did new subjects. The type variability in lines of reasoning suggested that multiple pathways should be incorporated into knowledge-system design. One implication of the variability in subjects' line of reasoning quality is that nurses at all levels of expertise are fallible and could benefit from decision support. The finding that subjects tended to use similar lines of reasoning for comparable hypothetical and actual cases was modest validation of subjects' performance on hypothetical cases as representing their decision making in practice. Consequently, there was support for using simulations and case studies in teaching and studying clinical decision making.

A comparison of the perception of facial profile by the general public and 3 groups of clinicians.

Orthodontists and maxillofacial surgeons frequently plan orthognathic treatment to produce an "ideal" Class I occlusion and skeletal relationship. The aim of this study was to investigate whether the preferred facial profile chosen by orthodontists, maxillofacial surgeons, dental students, and members of the general public conformed to a Class I profile. Photographs were taken of 2 male and 2 female adult subjects with Class I profiles, and by means of a computer program the images were manipulated to produce Class II, Class III, and long face profiles. The orthodontists, surgeons, dental students, and members of the general public ranked each group of 4 photos in order of their attractiveness. Orthodontists and maxillofacial surgeons were found to be significantly more likely to choose a Class I skeletal relationship as the most attractive profile. A significant difference was found between orthodontists and dental students (P < 0.01) and between orthodontists and the general public (P < 0.001) with regard to the assessment of the Class I profile as the most attractive, when all 4 subjects were considered. Similar results were noted for maxillofacial surgeons. Whether the assessor was an orthodontist, maxillofacial surgeon, or a member of the general public was found to be significant when examining subjects 1 (female) and 3 (male). The sex of the assessor was also a significant factor for subject 3 (male), where female assessors were more likely to rank the Class I profile as most attractive (P < 0.05).

An evaluation of common breast cancer gene mutations in a population of Ashkenazi Jews.

OBJECTIVES: In view of the recent reports of recurrent mutations in BRCA1 and BRCA2 in the Ashkenazi Jewish population, we have undertaken to assess the frequency of these mutations in this population attending for genetic counselling and risk assessment of familial breast cancer. DESIGN: Mutation screening for the 185delAG and the 5382insC mutations in BRCA1 and the 6174delT mutation in BRCA2 was performed on DNA samples from either subjects affected by breast or ovarian cancer or obligate gene carriers. The likelihood of the cancers being hereditary in each family was calculated. SUBJECTS: Blood samples were obtained from 26 affected subjects or obligate gene carriers from 23 Ashkenazi Jewish families, all with a history of either early onset breast or ovarian cancers, or multiple cases of breast or ovarian cancer. RESULTS: Twelve mutations have been identified in the 23 families (52%) of which eight (67%) were the 185delAG mutation, three (25%) were the 6174delT mutation, and one (8%) was the 5382insC mutation. While the majority of these mutations were identified in families with a greater than 50% probability of being hereditary under the CASH segregation model, three mutations were identified in families with a 35% or less probability. CONCLUSIONS: Genetic screening of the recurrent mutations in Ashkenazi Jewish families will lead to the availability of predictive testing in a reasonably large proportion, even if the family history of breast/ovarian cancer is not particularly strong. In our view it is possible to reassure high risk unaffected members of these families, if the screening is negative for these mutations, even if a sample from an affected member of the family is unavailable for previous screening.

Transthyretin Ile73Val is associated with familial amyloidotic polyneuropathy in a Bangladeshi family. Mutations in brief no. 158. Online.

Amyloidosis is characterised by the extraceullular deposition of certain different proteins in a distinctively abnormal fibrillar conformation. All types of amyloid fibril share remarkably similar structural and biophysical properties despite substantial chemical heterogeneity among their respective precursor proteins. Hereditary amyloidosis associated with genetically determined protein variants is rare, but is extremely important as a model for studying the pathogenesis of amyloidosis generally. We report a novel mutation of the transthyretin (TTR) coding for TTR Ile73Val which is associated with familial amylodotic polyneuropathy (FAP) in a Bangladeshi family. The mutation was detected by direct sequencing of the PCR-amplified TTR exons. It creates an additional Accl restriction exzyme site in exon 3, allowing confirmation of its presence by RFLP. Amyloid detected in sural nerve and colonic biopsies was shown to be composed of TTR by immunohistochemistry. The predominant clinical features were progressive autonomic and sensori-motor peripheral neuropathy, beginning at age 50 years. The proband's father and two siblings had similar illnesses. These findings indicate Val73 is an amyloidogenic variant of TTR.

The permselectivity of glomerular basement membrane can be compromised by glycation or by exposure to low levels of hypochlorite.

Earlier studies indicated that chemically crosslinking glomerular basement membrane (GBM) rendered it more permeable to water and to macromolecules. Here possible mechanisms for the introduction of crosslinks into GBM under pathological conditions were explored. Glycation with glucose and with fructose over periods of 2 wk (fructose) and 6 weeks (glucose) rendered the GBM more permeable to water and myoglobin as judged from in vitro ultrafiltration behaviour. The membranes were also made more permeable to serum following glycation. The permeation changes were shown to be dependent on glycoxidative reactions judging by their inhibition by EDTA and DTPA. Aminoguanidine also prevented glycation from altering the permeability of GBM. Fluorescence studies indicated the formation of bityrosine in glycated GBM. Studies with oxidants showed that while hydrogen peroxide superoxide and peroxynitrite had little effect on GBM, hypochlorite anion was capable of increasing GBM permeability to water, myoglobin, albumin and serum. Changes in permeation were induced by very low quantities of hypochlorite, well within the range of the amounts of hypochlorite formed by activated neutrophils. Thus glycoxidation, or oxidation by hypochlorite, are chemical mechanisms by which GBM permeability can be increased.

Care of patients undergoing immunoglobulin therapy.

Immunoglobulin infusion is becoming more widely used as treatment for a variety of conditions. This article describes the background and uses of immunoglobulin therapy and the nursing care of patients undergoing this treatment.