[Neonatal hyperthyroidism: A sometimes challenging diagnosis]. / L'hyperthyroïdie néonatale : un diagnostic parfois difficile.

Graves disease complicates two pregnancies out of 1000 and when it is known before pregnancy, it warrants careful monitoring of the fetus and the newborn. We report on a case of neonatal hyperthyroidism, which revealed a previously unknown maternal thyroid disease. In this situation, neonatal signs can be misinterpreted, delaying the diagnosis. Neonatal hyperthyroidism is, however, a therapeutic emergency because of the risk of cardiac and neurological complications. The neonatologist must identify thyroid disease in the absence of a maternal history in order to promptly start therapy.

Development of a virtual reality training curriculum for phacoemulsification surgery.

PURPOSE: Training within a proficiency-based virtual reality (VR) curriculum may reduce errors during real surgical procedures. This study used a scientific methodology to develop a VR training curriculum for phacoemulsification surgery (PS). PATIENTS AND METHODS: Ten novice-(n) (performed <10 cataract operations), 10 intermediate-(i) (50-200), and 10 experienced-(e) (>500) surgeons were recruited. Construct validity was defined as the ability to differentiate between the three levels of experience, based on the simulator-derived metrics for two abstract modules (four tasks) and three procedural modules (five tasks) on a high-fidelity VR simulator. Proficiency measures were based on the performance of experienced surgeons. RESULTS: Abstract modules demonstrated a 'ceiling effect' with construct validity established between groups (n) and (i) but not between groups (i) and (e)-Forceps 1 (46, 87, and 95; P<0.001). Increasing difficulty of task showed significantly reduced performance in (n) but minimal difference for (i) and (e)-Anti-tremor 4 (0, 51, and 59; P<0.001), Forceps 4 (11, 73, and 94; P<0.001). Procedural modules were found to be construct valid between groups (n) and (i) and between groups (i) and (e)-Lens-cracking (0, 22, and 51; P<0.05) and Phaco-quadrants (16, 53, and 87; P<0.05). This was also the case with Capsulorhexis (0, 19, and 63; P<0.05) with the performance decreasing in the (n) and (i) group but improving in the (e) group (0, 55, and 73; P<0.05) and (0, 48, and 76; P<0.05) as task difficulty increased. CONCLUSION: Experienced/intermediate benchmark skill levels are defined allowing the development of a proficiency-based VR training curriculum for PS for novices using a structured scientific methodology.

EMS systems in Malta.

This article describes how emergency medicine, a new and growing speciality in Malta, has developed and the way emergency care, including pre-hospital care, is delivered in a small island state. The training programme for Emergency Medicine Specialists is highlighted. The author also comments on the future development of emergency care in Malta.

Tear lipid layer thickness and ocular comfort with a novel device in dry eye patients with and without Sjögren's syndrome.

BACKGROUND: To measure changes in tear-film lipid-layer thickness (LLT) and symptoms in patients with dry eye symptoms with and without Sjögren's syndrome after using a novel device. The device is designed to promote release of meibomian sebum into the tear film by delivering latent heat to the eyelids. STUDY DESIGN: Two prospective, controlled, randomised, observer-masked, single-intervention studies. METHODS: Two independent studies were conducted in a major university hospital in the South West of England. The first study involved 24 patients with dry eye symptoms without Sjögren's [the PDE study] and the second study involved 31 patients with dry eye symptoms and Sjögren's syndrome (the SS study). The PDE study was randomised into two groups. Group I (12 patients) underwent 10 min of treatment with the activated device and Group II (12 patients) had no treatment. The SS study was similarly randomised into Group I (17 patients) and Group II (14 patients). The LLT and subjective alterations in ocular comfort of each subject were assessed prior and immediately after 5 and 30 min subsequent to the 10-min period. In the SS study, a further assessment was carried out at 60 min. RESULTS: In the PDE study, treated patients exhibited a bilateral increase of LLT at 5 min (right eyes, 1.2 levels, p<0.0005; left eyes, 1.0 levels, p<0.0005, Mann-Whitney) and at 30 min (right eyes, 0.7 levels, p<0.005; left eyes, 0.6 levels, p<0.005). Mean symptom scores improved in the treated group compared with the control group at 5 min (treatment group, +2.0; control group, +0.2; p<0.05) and 30 min (treatment group, +2.8; control group, +0.4; p<0.015). In the SS study, treated patients exhibited a bilateral increase of LLT, 5 min (right eyes, 0.5 levels, p<0.009; left eyes, 0.5 levels, p<0.005, Monte Carlo 2-tailed), 30 min (right eyes, 0.5 levels, p<0.007; left eyes 0.5 levels, p<0.002) and 60 min (right eyes, 0.3 levels, p<0.1; left eyes, 0.3 levels, p<0.05). There was no change in any of the control patients in any of the assessments. With regard to symptom scores, the mean change at 5 min measured +0.8 in the treatment group and remained relatively unchanged at +0.1 in the control group (p<0.1). At 30 min, this change measured +1.3 in the treatment group and +0.1 in the control group (p<0.03) and at 60 min, the change measured +1.5 in the treatment group and remained at +0.1 in the control group (p<0.02). CONCLUSION: Meibomian therapy with this novel device increases LLT and ocular comfort in patients with dry eye symptoms with and without Sjögren's syndrome.

Ecballium elaterium: an in vitro source of cucurbitacins.

Biomass and secondary metabolite accumulation were assayed on a wide range of auxins, cytokinins and their combinations using Ecballium elaterium callus tissue. The best combination was that consisting of alpha-naphthalene acetic acid (NAA) and benzylamino purine (BAP) (1 mg/l of medium, each). NAA and BAP were set up in a grid to determine concentrations that produced the best callus as regards fresh and dry weights and yield of cucurbitacins, particularly cucurbitacin E. The best combination for callus proliferation consisted of 5 mg/l NAA and 5 mg/l BAP, reaching a peak at week 5. For cucurbitacin production, an optimum yield was obtained at week 3 with 5 mg/l NAA.

Anaerobic stress induces the transcription and translation of sucrose synthase in rice.

Sucrose synthase activity increased in 2-day-old rice (Oryza sativa) seedlings submitted to anaerobic stress. Likewise, both denaturing and native Western blot analysis detected a rise in the cellular concentration of sucrose synthase protein. Significantly higher steady-state levels of sucrose synthase mRNA, as determined by Northern blots and by the ability of total RNA to direct in vitro synthesis of sucrose synthase, were also induced by anaerobic treatment. Analysis of run-on transcripts showed increased transcription of sucrose synthase genes as early as 60 minutes after initiation of anaerobic stress. Together, these results indicate that sucrose synthase is a typical anaerobic protein in rice.

Oxidative phosphorylation by mitochondria extracted from dry sunflower seeds.

The role of mitochondria in the phosphorylation of ADP to ATP in the early steps of seed germination has been studied. Mitochondria were extracted from dry sunflower (Helianthus annuus) seeds. Adenylate kinase-dependent ATP synthesis was inhibited by p(1),p(5)-di(adenosine-5')pentaphosphate. Synthesis of ATP was observed with the different substrates: citrate, alpha-ketoglutarate, succinate, malate, pyruvate or NADH. This synthesis was activated by cytochrome c, and inhibited by cyanide, oligomycin, carbonyl cyanide p-(trifluoromethoxy)phenylhydrazone, and carboxyatractyloside. The ATP/O values with succinate were 0.85 and 1.2 in the absence or presence, respectively, of cytochrome c. Electron micrographs showed that mitochondria of dry tissues have different structures when observed in situ or in vitro after aqueous extraction, suggesting that profound changes occurred after the contact with the aqueous medium. These results confirm previous data obtained in vivo showing that mitochondria present in dry seeds are able to synthesize ATP as soon as the seeds are rehydrated.

Artefactual Origins of Cyclic AMP in Higher Plant Tissues.

A highly sensitive radioimmunoassay has been used to determine the levels of adenosine 3',5'-cyclic monophosphate (cAMP) in five higher plants (Lactuca sativa, Helianthus annuus, Oryza sativa, Pinus pinaster, Nicotiana tabacum). Particular attention was paid to the three main sources of errors in the characterization of cAMP in plants: presence of interfering substances in plant tissues; possible artefactual formation of cAMP from endogenous ATP during extraction, purification, and assay; and microbial origin of cAMP. In all the tested tissues, the cAMP level was below the detection limit of 0.5 picomole per gram fresh weight, a value much lower than those reported for similar materials of the same species in many previous studies. This result is not in favor of cAMP-dependent regulations in higher plants.