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Context Understanding migratory species’ habitat selection is complicated by variation in movement strategies. Stable-isotope analysis provides a powerful tool to investigate such variation. Aims We used acoustic telemetry and stable-isotope analysis to better understand the movement strategies of Port Jackson sharks. Methods We compared the δ13C and δ15N values of fin tissue from acoustically tracked individuals that undertook three distinct movement strategies. Hierarchical cluster analysis was then used to cluster movement strategies of a larger sample of sharks on the basis of δ13C and δ15N values. Key results Tracked individuals that remained in Jervis Bay were enriched in 13C, compared with those that migrated south after the breeding season. Individuals were assigned to six clusters and δ13C and δ15N values indicated that migrating males and females may utilise different geographical areas or niches during the non-breeding season. Conclusions By using stable isotope analysis and acoustic telemetry, we identified distinct groups of Port Jackson sharks with similar broad-scale movement strategies. Implications These variable movement strategies may lead to different reproductive fitness advantages on an individual and population level, having implications for the broader ecosystem, given the important role mesopredators play in southern reef marine ecosystems.

Peer reviewed: True, Posttraumatic stress disorder (PTSD) is a devastating condition, for which there are few pharmacological agents, often with a delayed onset of action and poor efficacy. Trauma-focused psychotherapies are further limited by few trained providers and low patient engagement. This frequently results in disease chronicity as well as psychiatric and medical comorbidity, with considerable negative impact on quality of life. As such, off-label interventions are commonly used for PTSD, particularly in chronic refractory cases. Ketamine, an N-methyl-D-aspartate (NDMA) receptor antagonist, has recently been indicated for major depression, exhibiting rapid and robust antidepressant effects. It also shows transdiagnostic potential for an array of psychiatric disorders. Here, we synthesize clinical evidence on ketamine in PTSD, spanning case reports, chart reviews, open-label studies, and randomized trials. Overall, there is high heterogeneity in clinical presentation and pharmacological approach, yet encouraging signals of therapeutic safety, efficacy, and durability. Avenues for future research are discussed.

The increase in enrollment in online programs for K–12 students, including students with disabilities, requires teachers to consider how to provide effective online instruction. Although schools may offer students a fully online curriculum, teachers serve an essential role in supporting students with disabilities in meeting (a) learning goals of the online curriculum and (b) individual needs as outlined in the individualized education program (IEP). Because students with disabilities often need targeted instruction to meet their academic and behavioral needs, teachers should consider integrating small group synchronous instruction to supplement fully online curricula. This article provides teachers with guidance on how to select appropriate online tools and technology to increase opportunities to respond throughout the main components of explicit instruction (i.e., modeling, guided, and independent practice).

Carbon dioxide’s (CO2) ability to reach the supercritical phase (7.39 MPa and 304.15 K) with low thermal energy input is an advantageous feature in power generation design, allowing for the use of various heat sources in the cycle. A small-scale supercritical carbon dioxide (sCO2) power cycle operating on the principle of a closed-loop Brayton cycle is currently under construction at The University of Texas at San Antonio, to design and develop a small-scale indirect-fired sCO2 Brayton cycle, acquire validation data of the cycle’s performance, and compare the cycle’s performance to other cycles operating in similar conditions. The power cycle consists of four principal components: A reciprocating piston compressor, a heating source, a reciprocating piston expander to produce power, and a heat exchanger to dissipate excess heat. The work explained in the present manuscript describes the theory and analysis conducted to design the piston expander, heating source, and heat exchanger in the cycle. Theoretical calculations indicate that using sCO2 for the Brayton cycle generates 4.5 kW of power with the inlet pressure and temperature of 17.23 MPa and 358.15 K to the piston expander. Based on the fully isentropic conditions, the thermal efficiency of the system is estimated to be 12.75%.

Key Points Question What is the 90-day outcome for patients with stroke presenting with an Alberta Stroke Program Early Computed Tomography Score (ASPECTS) of 2 to 5 who underwent mechanical thrombectomy? Findings In this multicenter cohort study of 2345 patients presenting with an intracranial internal carotid artery or M1 occlusion who underwent mechanical thrombectomy, 213 [9.1%] had an ASPECTS of 2 to 5, and 22% of these patients achieved favorable 90-day outcomes (modified Rankin scale score of 0-2). Patients who achieved successful recanalization were nearly 5 times more likely to achieve favorable outcomes compared with patients who had unsuccessful recanalization. Meaning This study suggests that patients with a low ASPECTS on presentation may achieve 90-day functional independence after mechanical thrombectomy if they achieve successful recanalization., Importance Limited data are available about the outcomes of mechanical thrombectomy (MT) for real-world patients with stroke presenting with a large core infarct. Objective To investigate the safety and effectiveness of MT for patients with large vessel occlusion and an Alberta Stroke Program Early Computed Tomography Score (ASPECTS) of 2 to 5. Design, Setting, and Participants This retrospective cohort study used data from the Stroke Thrombectomy and Aneurysm Registry (STAR), which combines the prospectively maintained databases of 28 thrombectomy-capable stroke centers in the US, Europe, and Asia. The study included 2345 patients presenting with an occlusion in the internal carotid artery or M1 segment of the middle cerebral artery from January 1, 2016, to December 31, 2020. Patients were followed up for 90 days after intervention. The ASPECTS is a 10-point scoring system based on the extent of early ischemic changes on the baseline noncontrasted computed tomography scan, with a score of 10 indicating normal and a score of 0 indicating ischemic changes in all of the regions included in the score. Exposure All patients underwent MT in one of the included centers. Main Outcomes and Measures A multivariable regression model was used to assess factors associated with a favorable 90-day outcome (modified Rankin Scale score of 0-2), including interaction terms between an ASPECTS of 2 to 5 and receiving MT in the extended window (6-24 hours from symptom onset). Results A total of 2345 patients who underwent MT were included (1175 women [50.1%]; median age, 72 years [IQR, 60-80 years]; 2132 patients [90.9%] had an ASPECTS of ≥6, and 213 patients [9.1%] had an ASPECTS of 2-5). At 90 days, 47 of the 213 patients (22.1%) with an ASPECTS of 2 to 5 had a modified Rankin Scale score of 0 to 2 (25.6% [45 of 176] of patients who underwent successful recanalization [modified Thrombolysis in Cerebral Ischemia score ≥2B] vs 5.4% [2 of 37] of patients who underwent unsuccessful recanalization; P = .007). Having a low ASPECTS (odds ratio, 0.60; 95% CI, 0.38-0.85; P = .002) and presenting in the extended window (odds ratio, 0.69; 95% CI, 0.55-0.88; P = .001) were associated with worse 90-day outcome after controlling for potential confounders, without significant interaction between these 2 factors (P = .64). Conclusions and Relevance In this cohort study, more than 1 in 5 patients presenting with an ASPECTS of 2 to 5 achieved 90-day functional independence after MT. A favorable outcome was nearly 5 times more likely for patients with low ASPECTS who had successful recanalization. The association of a low ASPECTS with 90-day outcomes did not differ for patients presenting in the early vs extended MT window., This cohort study uses data from the Stroke Thrombectomy and Aneurysm Registry to investigate the safety and effectiveness of mechanical thrombectomy for patients with large vessel occlusion and an Alberta Stroke Program Early Computed Tomography Score of 2 to 5.

Autonomous underwater vehicles (AUVs) have shown great promise in fulfilling surveillance, scavenging, and monitoring tasks. Traditional gliders and streamlined AUVs are designed for long-term operational efficiency in expansive environments but are limited in cluttered spaces due to their shape and control authority; agile AUVs can penetrate cluttered or sensitive environments but are limited in operational endurance at large spatial scales. This paper presents the dynamic modeling and control design of an underwater hull capable of actuating its shape morphology. The prototype hull incorporates flexible, buckled fiberglass ribs to ensure a rigid shape that is actuated by modulating the length of the body’s semi-major axis. We represent the vehicle shape using a single control input actuating the vehicle’s length-to-diameter ratio. Hydrodynamic modeling of the flexible hull suggests that dynamic shape actuation can modulate the mass and drag properties of the hull to improve control of the vehicle’s forward speed. Using tools from nonlinear control theory, this paper presents the derivation of a shape-actuating autonomous control algorithm regulating the vehicle speed to a time-varying reference speed, subject to the actuator limits. The theoretical control results are illustrated using numerical simulations of the vehicle model.

Maternal recognition of pregnancy (MRP) describes the prevention of luteolysis via the early conceptus. By prolonging the presence of the corpus luteum (CL), the conceptus ensures an environment capable of supporting pregnancy. In mares, MRP is enigmatic; the horse is one of few domesticated species wherein the MRP signal has yet to be discovered. Equine conceptus mobility throughout the uterine horns, termed migration, is known to be essential for pregnancy establishment. However, while the MRP signal in several other species is conceptus-derived, such a signal has yet to be observed from the equine embryo. We hypothesize that the migration of the equine conceptus itself activates MRP, potentially through epithelial sodium channel (ENaC). ENaC has been previously detected in multiple equine organs, observed in the uteri of various mammalian species, and also found to be upregulated during preimplantation in mice. However, neither the presence of ENaC within the mare uterus nor its potential involvement with the equine pregnancy has been researched. The aim of this study was 1) to determine if ENaC was present within the endometrium of the mare uterus and 2) to describe the location of ENaC if observed. Estrus synchronization was completed in mares (n = 14) during peak breeding season. Mares were subsequently blocked by age and breed and then placed into one of 2 groups: control mares (C; n = 7) and treatment mares (T; n = 7). Transrectal ultrasonography (US) was completed in all mares daily when one or more ovarian follicles reached 25 mm. When a mare had a 35 mm or larger follicle present, she received 2,000 international units of human chorionic gonadotropin intramuscularly to induce ovulation (OV) and US continued daily. Additionally, T mares were artificially inseminated (AI) with fresh, extended semen every day until the day after OV and were subsequently checked for pregnancy 12 d post-OV. C mares had the cervix manually manipulated the day after OV to replicate physical stimulation that occurs to the cervix when AI; however, no semen was deposited in C mare reproductive tracts. Endometrial biopsies were collected from all mares before OV, after OV, and during early pregnancy (when applicable) and samples were then processed for ENaC immunohistochemistry analysis. ENaC protein was immunodetected in all C and T mare endometrial samples and was localized to both uterine luminal epithelium and uterine glands. While further analysis will be conducted to quantify endometrial ENaC expression in C versus T (open versus pregnant) mares, the present histological data confirms that ENaC is present within the equine uterus.

Autonomous underwater vehicles (AUVs) have shown great promise in fulfilling surveillance, scavenging, and monitoring tasks, but can be hindered in expansive, cluttered or obstacle ridden environments. Traditional gliders and streamlined AUVs are designed for long term operational efficiency in expansive environments, but are hindered in cluttered spaces due to their shape and control authority; agile AUVs can penetrate cluttered or sensitive environments but are limited in operational endurance at large spatial scales. This paper presents the prototype testbed design, modeling, and experimental hydrodynamic drag characterization of a novel self-propelled underwater vehicle capable of actuating its shape morphology. The vehicle prototype incorporates flexible, buckled fiberglass ribs to ensure a rigid shape that can be actuated by modulating the length of the semi-major axis. Tools from generative modeling are used to represent the vehicle shape by using a single control input actuating the vehicles length-to-diameter ratio. By actuating the length and width characteristics of the vehicle’s shape to produce a desired drag profile, we derive the feasible speeds achievable by shape actuation control. Tow-tank experiments with an experimental proto-type suggest shape actuation can be used to manipulate the drag by a factor between 2.15 and 5.8 depending on the vehicle’s operating speed.

Objectives As pelvic inflammatory disease (PID) aetiology is not completely understood, we examined the relationship between select novel bacteria, PID and long-term sequelae. Methods Fastidious bacterial vaginosis (BV)-associated bacteria ( Sneathia (Leptotrichia) sanguinegens , Sneathia amnionii , Atopobium vaginae and BV-associated bacteria 1 (BVAB1)), as well as Ureaplasma urealyticum and Ureaplasma parvum were identified in cervical and endometrial specimens using organism-specific PCR assays among 545 women enrolled in the PID Evaluation and Clinical Health study. Risk ratios and 95% CIs were constructed to determine associations between bacteria, histologically confirmed endometritis, recurrent PID and infertility, adjusting for age, race, gonorrhoea and chlamydia. Infertility models were additionally adjusted for baseline infertility. Results Persistent detection of BV-associated bacteria was common (range 58% for A. vaginae to 82% for BVAB1) and elevated the risk for persistent endometritis (RR adj 8.5, 95% CI 1.6 to 44.6) 30 days post-cefoxitin/doxycycline treatment, independent of gonorrhoea and chlamydia. In models adjusted for gonorrhoea and chlamydia, endometrial BV-associated bacteria were associated with recurrent PID (RR adj 4.7, 95% CI 1.7 to 12.8), and women who tested positive in the cervix and/or endometrium were more likely to develop infertility (RR adj 3.4, 95% CI 1.1 to 10.4). Associations between ureaplasmas and PID sequelae were modest. Conclusions To our knowledge, this is the first prospective study to demonstrate that S. sanguinegens , S. amnionii , BVAB1 and A. vaginae are associated with PID, failure of the Centers for Disease Control and Prevention-recommended treatment to eliminate short-term endometritis, recurrent PID and infertility. Optimal antibiotic regimens for PID may require coverage of novel BV-associated microbes.

We report the first beam-target double-polarization asymmetries in the γ þ nðpÞ → π− þ pðpÞ reaction spanning the nucleon resonance region from invariant mass W ¼ 1500 to 2300 MeV. Circularly polarized photons and longitudinally polarized deuterons in solid hydrogen deuteride (HD) have been used with the CEBAF Large Acceptance Spectrometer (CLAS) at Jefferson Lab. The exclusive final state has been extracted using three very different analyses that show excellent agreement, and these have been used to deduce the E polarization observable for an effective neutron target. These results have been incorporated into new partial wave analyses and have led to significant revisions for several γnN* resonance photocouplings.

We report the first beam-target double-polarization asymmetries in the γ+n(p)→π^{-}+p(p) reaction spanning the nucleon resonance region from invariant mass W=1500 to 2300 MeV. Circularly polarized photons and longitudinally polarized deuterons in solid hydrogen deuteride (HD) have been used with the CEBAF Large Acceptance Spectrometer (CLAS) at Jefferson Lab. The exclusive final state has been extracted using three very different analyses that show excellent agreement, and these have been used to deduce the E polarization observable for an effective neutron target. These results have been incorporated into new partial wave analyses and have led to significant revisions for several γnN^{*} resonance photocouplings.

Background Although the etiology of preeclampsia is not well understood, it has been suggested that excessive systemic inflammation may lead to oxidative stress, promoting the endothelial dysfunction characteristic of preeclampsia. Few prospective studies have examined the role of infection, an immune system stimulator, as a risk factor for preeclampsia. Methods We conducted a longitudinal study of the relationships between Chlamydia trachomatis (CT), Chlamydophila pneumoniae (CP), cytomegalovirus (CMV), herpes simplex virus (HSV) and preeclampsia among 509 preeclamptic cases and 336 normotensive controls nested within the Danish National Birth Cohort study. Antibodies were analyzed at a first prenatal visit (mean 17.0weeks) and at a late second/third trimester study visit. Prenatal infections were identified as IgG/IgM seroconversion or a fourfold rise in IgG antibody titers. Multiple regression models were adjusted for maternal age, BMI, smoking status, and time between blood draws. Results CT infection was associated with preeclampsia (OR adj 1.6, 95% CI 0.7, 3.6), severe preeclampsia (OR adj 1.8, 95% CI 0.6, 5.3), and preeclampsia resulting in preterm birth (OR adj 1.7, 95% CI 0.6–4.9) or birth of a small for gestational age infant (OR adj 2.1, 95% CI 0.6, 7.5), although CT infection was uncommon ( n =33, 4.0%) and associations were not statistically significant. CP, CMV, and HSV infection were not associated with preeclampsia. Conclusions Women with serological evidence of prenatal CT infection were more likely to develop preeclampsia, although infection was infrequent and confidence intervals were wide. Studies in populations at higher risk for STIs are needed to corroborate this association.

The development of insecticide resistance in insect pests of crops is a growing threat to sustainable food production, and strategies that slow the development of resistance are therefore urgently required. The insecticide synergist piperonyl butoxide (PBO) inhibits certain insect detoxification systems and so may delay the evolution of metabolic resistance. In the current study we characterized resistance development in the silverleaf whitefly, Bemisia tabaci, after selection with either a neonicotinoid (thiacloprid) or pyrethroid (alpha-cypermethrin) insecticide alone or in combination with PBO. Resistance development was significantly suppressed (60%) in the line selected with alpha-cypermethrin + PBO compared to the line selected with alpha-cypermethrin alone. RNA sequencing (RNAseq) analyses revealed an increase in frequency of a knock-down resistance mutation but no differentially expressed genes were identified that could explain the sensitivity shift. No significant difference was observed in the level of resistance between the thiacloprid and thiacloprid + PBO selected lines, and RNA sequencing (RNAseq) analyses revealed that the cytochrome P450 monooxygenase CYP6CM1, known to metabolize neonicotinoids, was significantly upregulated (10-fold) in both lines. The findings of this study demonstrate that PBO used in combination with certain insecticides can suppress the development of resistance in a laboratory setting; however, the mechanism by which PBO supresses resistance development remains unclear.

Introduction Circulating immune markers may be associated with preeclampsia but further investigations in early pregnancy and among preeclampsia subtypes are warranted. We examined immune markers in 208 preeclamptic women and 411 normotensive controls. Methods Our study was nested within the Collaborative Perinatal Project. A total of 242 women had first trimester serum samples and 392 had second trimester serum samples. Preeclampsia was defined as hypertension >20 weeks of gestation with proteinuria or pulmonary edema, oliguria, or convulsions. Preterm preeclampsia was defined as preeclampsia with delivery less than 37 weeks of gestation. Associations between immune markers RANTES, interleukin (IL)-6, IL4, IL5, IL12, IL10, IL8, IL1-beta, interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha and beta, transforming growth factor (TGF)-beta and preeclampsia were explored using a modified version of cox regression developed to address data with non-detectable levels. Models were adjusted for body mass index, gestational age of blood sampling, fetal sex, smoking, socioeconomic status and maternal age. Results In first trimester samples, IL-12 was associated with preeclampsia (p = 0.0255). IFN-gamma (p = 0.0063), IL1-beta (p = 0.0006), IL5 (p = 0.0422) and TNFr (p = 0.0460) were associated with preterm preeclampsia only. In second trimester samples, IL1-beta was associated with preeclampsia (p = 0.0180) and term preeclampsia (p = 0.0454). After correction for multiple comparisons, only IL1-beta remained associated with preterm preeclampsia in the first trimester (p = 0.0288). Discussion Elevated first trimester IL1-beta appears to be associated with preterm preeclampsia. However, few associations were observed in the second trimester. Systemic immune markers alone may not be useful for preeclampsia prediction.

Histopathologic validation of a PET tracer requires assessment of colocalization of the tracer with its intended biologic target. Using thin tissue section autoradiography, it is possible to visualize the spatial distribution of the PET tracer uptake and compare it with the distribution of the intended biologic target (as visualized with immunohistochemistry). The purpose of this study was to develop and evaluate an objective methodology for deformable coregistration of autoradiography and microscopy images acquired from a set of sequential tissue sections.Tumor-bearing animals were injected with 3'-deoxy-3'-(18)F-fluorothymidine ((18)F-FLT), (14)C-FDG, and other markers of tumor microenvironment including Hoechst 33342 (blood-flow surrogate). After sacrifice, tumors were excised, frozen, and sectioned. Multiple stacks of sequential 8 μm sections were collected from each tumor. From each stack, the middle (reference) sections were used to obtain images of (18)F-FLT and (14)C-FDG uptake distributions using dual-tracer autoradiography. Sections adjacent to the reference were used to acquire all histopathologic data (e.g., images of cell proliferation, hematoxylin and eosin). Hoechst images were acquired from all sections. To correct for deformations and misalignments induced by tissue processing and image acquisition, the Hoechst image of each nonreference section was deformably registered to the reference Hoechst image. This transformation was then applied to all images acquired from the same tissue section. In this way, all microscopy images were registered to the reference Hoechst image. The Hoechst-to-autoradiography image registration was done using rigid point-set registration based on external markers visible in both images.The mean error of Hoechst to (18)F-FLT autoradiography registration (both images acquired from the same section) was 30.8 ± 20.1 μm. The error of Hoechst-based deformable registration of histopathologic images (acquired from sequential tissue sections) was 23.1 ± 17.9 μm. Total error of registration of autoradiography images to the histopathologic images acquired from adjacent sections was evaluated at 44.9 μm. This coregistration precision supersedes current rigid registration methods with reported errors of 100-200 μm.Deformable registration of autoradiography and histopathology images acquired from sequential sections is feasible and accurate when performed using corresponding Hoechst images.

Cigarette smoking protects against preeclampsia but increases the risk of small-for-gestational-age birth (SGA). Regarding body weight, the converse is true: obesity elevates rates of preeclampsia but reduces rates of SGA. The authors assessed the combined effects of smoking and weight among US women developing preeclampsia or SGA, studying 7,757 healthy, primigravid women with singleton pregnancies in 1959–1965. Smoking (never, light, heavy), stratified by prepregnancy body mass index (BMI (weight (kg)/height (m)2); underweight, overweight, obese), was examined in relation to preeclampsia and SGA. Among underweight (BMI

Interest in malingering has grown in recent years, and is reflected in the exponential increase in academic publications since 1990. Although malingering is more commonly detected in medicolegal practice, it is not an all-or-nothing presentation and moreover can vary in the extent of presentation. As a nonmedical disorder, the challenge for clinical practice remains that malingering by definition is intentional and deliberate. As such, clinical skills alone are often insufficient to detect it and we describe psychometric tests such as symptom validity tests and relevant nonmedical investigations. Finally, we describe those areas of neurologic practice where symptom exaggeration and deception are more likely to occur, e.g., postconcussional syndrome, psychogenic nonepileptic seizures, motor weakness and movement disorders, and chronic pain. Factitious disorders are rare in clinical practice and their detection depends largely on the level of clinical suspicion supported by the systematic collection of relevant information from a variety of sources. In this chapter we challenge the accepted DSM-5 definition of factitious disorder and suggest that the traditional glossaries have neglected the extent to which a person's reported symptoms can be considered a product of intentional choice or selective psychopathology largely beyond the subject's voluntary control, or more likely, both. We present evidence to suggest that neurologists preferentially diagnose factitious presentations in healthcare workers as "hysterical," possibly to avoid the stigma of simulated illness.

The IAEA uses extensively a variety of gamma radiation detectors to verify nuclear material. These detectors are part of standardized spectrometry systems: germanium detectors for High-Resolution Gamma Spectrometry (HRGS); Cadmium Zinc Telluride (CZT) detectors for Room Temperature Gamma Spectrometry (RTGS); and NaI(Tl) detectors for Low Resolution Gamma Spectrometry (LRGS). HRGS with high-purity Germanium (HpGe) detectors cooled by liquid nitrogen is widely used in nuclear safeguards to verify the isotopic composition of plutonium or uranium in non-irradiated material. Alternative cooling systems have been evaluated and electrically cooled HpGe detectors show a potential added value, especially for unattended measurements. The spectrometric performance of CZT detectors, their robustness and simplicity are key to the successful verification of irradiated materials. Further development, such as limiting the charge trapping effects in CZT to provide improved sensitivity and energy resolution are discussed. NaI(Tl) detectors have many applications—specifically in hand-held radioisotope identification devices (RID) which are used to detect the presence of radioactive material where a lower resolution is sufficient, as they benefit from a generally higher sensitivity. The Agency is also continuously involved in the review and evaluation of new and emerging technologies in the field of radiation detection such as: Peltier-cooled CdTe detectors; semiconductor detectors operating at room temperature such as HgI2 and GaAs; and, scintillator detectors using glass fibres or LaBr3. A final conclusion, proposing recommendations for future action, is made.

Study design The degenerative response of rat tail and lumbar intervertebral discs to a stab incision was evaluated. Objective To examine and compare the postinjury degenerative response of lumbar and tail discs. Summary of background data Although successful in larger animals, a stab incision for inducing disc degeneration in rats has not been evaluated. Rodents are desirable models for disc repair studies due to their low cost, ease of care, and fast healing times. Methods Lumbar and tail discs were exposed surgically and stabbed with a number 11 blade. Disc architecture, levels of IL-1beta, IL-6, and TNF-alpha, and biomechanical properties were analyzed. A functional disability secondary to multilevel lumbar disc injury was quantified and compared with that of rats undergoing sham surgery. Results Histologic evaluation of stabbed tail discs demonstrated a nucleus pulposus size decrease, anular collagen layer disorganization, and cellular metaplasia of anular fibroblasts to chondrocyte-appearing cells. Besides the continued presence of the stab injury tract, few changes were observed in the lumbar disc histology. Cytokine measurements indicated a transient peak in IL-1beta in tail discs 4 days following injury. No significant changes in IL-1beta, IL-6, or TNF-alpha were measured. No significant differences in biomechanical properties were observed between stab injury and sham surgery discs. Yet, despite insignificant differences in histologic, cytochemical, or biomechanical properties in the lumbar discs, the rats with lumbar stab injury had a significant decrease in walking ability 28 days after surgery. Conclusions Tail disc stab injury was successful in creating morphologic signs of degeneration and transient high concentrations of IL-1beta. However, the degenerative response in the lumbar discs was much slower, suggesting that site-specific factors, such as increased stability due to posterior elements and torso musculature, helped facilitate healing. Yet, functional assessment indicated that the rats were partially disabled by multiple lumbar injuries.

The objectives were to assess prediction strategies for pelvic inflammatory disease (PID). One thousand one hundred seventy women were enrolled based on a high chlamydial risk score. Incident PID over a median of 3 years was diagnosed by either histologic endometritis or Centers for Disease Control and Prevention criteria. A multivariable prediction model for PID was assessed. Women enrolled using the risk score were young single sexually active and often had prior sexually transmitted infections. Incident PID was common (8.6%). From 24 potential predictors significant factors included age at first sex gonococcal/chlamydial cervicitis history of PID family income smoking medroxyprogesterone acetate use and sex with menses. The model correctly predicted 74% of incident PID; in validation models correct prediction was only 69%. Our data validate a modified chlamydial risk factor scoring system for prediction of PID. Additional multivariable modeling contributed little to prediction. Women identified by a threshold value on the chlamydial risk score should undergo intensive education and screening. (authors)

STUDY DESIGN: Thermal energy was delivered in vivo to ovine cervical discs and the postheating response was monitored over time. OBJECTIVES: To determine the effects of two distinctly different thermal exposures on biologic remodeling: a "high-dose" regimen intended to produce both cellular necrosis and collagen denaturation and a "low-dose" regimen intended only to kill cells. SUMMARY OF BACKGROUND DATA: Thermal therapy is a minimally invasive technique that may ameliorate discogenic back pain. Potential therapeutic mechanisms include shrinkage of collagenous tissues, stimulation of biologic remodeling, and ablation of cytokine-producing cells and nociceptive fibers. METHODS: Intradiscal heating was performed using directional interstitial ultrasound applicators. Temperature and thermal dose distributions were characterized. The effects of high (>70 C, 10 minutes) and low (52 C-54 C, 10 minutes) temperature treatments on chronic biomechanical and architectural changes were compared with sham-treated and control discs at 7, 45, and 180 days. RESULTS: The high-dose treatment caused both an acute and chronic loss of proteoglycan staining and a degradation of biomechanical properties compared with low-dose and sham groups. Similar amounts of degradation were observed in the low-dose and sham-treated discs relative to the control discs at 180 days after treatment. CONCLUSIONS: While a high temperature thermal protocol had a detrimental effect on the disc, the effects of low temperature treatment were relatively minor. Thermal therapy did not stimulate significant biologic remodeling. Future studies should focus on the effects of low-dose therapy on tissue innervation and pro-inflammatory factor production.

We retrospectively analyzed 42 hepatitis C virus (HCV)-infected patients who underwent cadaveric liver transplantation under two strategies of immunosuppression: (1) daily tacrolimus (TAC) throughout and an initial cycle of high-dose prednisone (PRED) with subsequent gradual steroid weaning, or (2) intraoperative antithymocyte globulin (ATG) and daily TAC that was later space weaned. After 36 ± 4 months, patient and graft survival in the first group was 18/19 (94.7%) with no examples of clinically serious HCV recurrence. In the second group, the three-year patient survival was 12/23 (52%), and graft survival was 9/23 (39%); accelerated recurrent hepatitis was the principal cause of the poor results. The data were interpreted in the context of a recently proposed immunologic paradigm that is equally applicable to transplantation and viral immunity. In the framework of this paradigm, the disparate hepatitis outcomes reflected different equilibria reached under the two immunosuppression regimens between the relative kinetics of viral distribution (systemically and in the liver) and the slowly recovering HCV-specific T-cell response. As a corollary, the aims of treatment of the HCV-infected liver recipients should be to predict, monitor, and equilibrate beneficial balances between virus distribution and the absence of an immunopathologic antiviral T-cell response. In this view, favorable equilibria were accomplished in the nonweaned group of patients but not in the weaned group. In conclusion, since the anti-HCV response is unleashed when immunosuppression is weaned, treatment protocols that minimize disease recurrence in HCV-infected allograft recipients must balance the desire to reduce immunosuppression or induce allotolerance with the need to prevent antiviral immunopathology. Copyright © 2005 by the American Association for the Study of Liver Diseases.

Background Multiple drug immunosuppression has allowed the near elimination of rejection, but without commensurate improvements in longterm graft survival and at the cost of quality of life. We have suggested that transplantation outcomes can be improved by modifying the timing and dosage of immunosuppression to facilitate natural mechanisms of alloengraftment and acquired tolerance. Study design Two therapeutic principles were applied for kidney transplantation: pretransplant recipient conditioning with antilymphoid antibody preparations (Thymoglobulin [Sangstat] or Campath [ILEX Pharmaceuticals]), and minimal posttransplant immunosuppression with tacrolimus monotherapy including "spaced weaning" of maintenance doses when possible. The results in Thymoglobulin- (n = 101) and Campath-pretreated renal transplantation recipients (n = 90) were compared with those in 152 conventionally immunosuppressed recipients in the immediately preceding era. Results Spaced weaning was attempted in more than 90% of the kidney transplant recipients after pretreatment with both lymphoid-depleting agents, and is currently in effect in two-thirds of the survivors. Although there was a much higher rate of acute rejection in the Thymoglobulin-pretreated recipients than in either the Campath-pretreated or historic control recipients, patient and graft survival in both lymphoid depletion groups is at least equivalent to that of historic control patients. In the Thymoglobulin-conditioned patients for whom followups are now 24 to 40 months, chronic allograft nephropathy (CAN) progressed at the same rate as in historic control patients. Selected patients on weaning developed donor-specific nonreactivity. Conclusions After lymphoid depletion, kidney transplantation can be readily accomplished under minimal immunosuppression with less dependence on late maintenance immunosuppression and a better quality of life. Campath was the more effective agent for pretreatment. Guidelines for spaced weaning need additional refinement.

This multicenter study was conducted to investigate the association of pelvic inflammatory disease (PID) and bacterial vaginosis. Participants were recruited from women who were attending family planning, health, gynecology, and sexually transmitted disease (STD clinics in 5 medical centers. Eligible patients were women not seeking care for STD, but who were considered at high risk for acquiring STDs according to an algorithm that weighed age, race parity, number of sexual partners, habit of douching, and a history. The vaginal swabs were self-collected. Participating patients were instructed in the use of a cotton swab to collect their vaginal specimens. At intervals of 6 to 12 months, the self-obtained specimens were examined for the characteristics of bacterial vaginosis. A vaginal microflora gram stain score of 7 to 10 was considered bacterial vaginosis. Women who developed pelvic pain or who were positive for Neisseria gonorrhoeae or Chlamydia trachomatis underwent a clinical examination and endometrial biopsy for detection of PID. A diagnosis of PID required the presence of histologic endometritis and/or pelvic pain and tenderness accompanied by either a fever of 101° F or higher, sedimentary rate greater than 15 mm/hr, elevated white blood count, or leukorrhea, mucopus, N. gonorrhea, or C. trachomatis in the lower genital tract. There were 1179 patients included in the analysis. The average follow up was 4 years. At the initial examination, 428 women had normal vaginal flora (36%), 280 had intermediate flora (29%), and 471 had bacterial vaginosis (40%). The baseline diagnosis was not associated with the rate of detection of PID over the 4 years of follow up. Nor was the development of PID significantly associated with age, race, education, income, smoking, sex during menses, condom use, or a history of STD or PID. Analyses according to various subgroups of patients (younger/older women, black/white women, women with/without a history of PID, with/without baseline gonococcal or chlamydia genital infection) found that only women who had a baseline report of 2 or more sexual partners in the previous 2 months and who had a baseline diagnosis of bacterial vaginosis were significantly more likely to have PID. An absence of hydrogen peroxide-producing lactobacillus was not associated with PID, even among the various subgroups. A baseline diagnosis of G. vaginalis or Gram-negative rod growth above 4 had no association with PID except in the subgroup of women who reported 2 or more sexual partners in the previous 2 months. Women with baseline diagnoses of N. gonorrhea or C. trachomatis were more likely to have PID.

Background: We investigated associations between HLA class II DQ alleles, chlamydial and gonococcal cervicitis, endometritis, and infertility among women with pelvic inflammatory disease (PID). Methods: Ninety-two women with clinical signs and symptoms of mild-to-moderate PID, enrolled in the PEACH Study, were evaluated. For all HLA class II DQ alleles with a prevalence of 10% or greater in the population, we assessed demographics, cervical infections, endometrial pathology, and fertility outcomes. Results: Chlamydial cervicitis, gonococcal cervicitis, endometritis, and infertility were all more common among women carrying the DQA *0301 allele after adjustment for race. Endometritis and infertility were somewhat less common (or pregnancy more common) among women carrying the DQA *0501 and DQB *0402 alleles. Conclusion: Among women with signs and symptoms of PID, carriage of the DQA *0301, DQA *0501, and DQB *0402 alleles altered the occurrence of lower genital tract infection, upper genital tract inflammation, and infertility.

To assess adherence to oral therapies in pelvic inflammatory disease (PID).Medication adherence to oral doxycycline therapy (100 mg) was measured using electronic event monitoring (EEM) among adult women with PID. Subjects (n = 91), who were predominantly black and with a high school or lower educational attainment, were randomly selected from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Study, a trial in which subjects were randomized to either (1). initial inpatient then outpatient or (2). fully outpatient treatment with doxycycline and cefoxitin. Summary statistics calculated within treatment groups and in the cohort as a whole included the percentage of administrations taken, percentage of days with correct dosage, percentage of days with no drug taken, time elapsed until the first drug holiday, and percentage of optimal dosing intervals.Study subjects took an average of 70% of prescribed doses, took the prescribed two daily doses for less than half of their outpatient days, took an unscheduled drug holiday for almost 25% of their outpatient days, and took only 16.9% of their doses within the optimal timing interval. In general, working, not bleeding with sex, and not drinking hard liquor were positively associated with measures of adherence. Adherence estimates were similar among women in the inpatient and outpatient groups after hospital discharge.The disturbing rates of time interval adherence, even after hospitalization, suggest the need to determine the effectiveness of antibiotic regimens involving shorter courses and longer dosing intervals.

The intervertebral disc is implicated as the source of low-back pain in a substantial number of patients. Because thermal therapy has been thought to have a therapeutic effect on collagenous tissues, this technique has recently been incorporated into several minimally invasive back pain treatments. However, patient selection criteria and precise definition of optimum dose are hindered by uncertainty of treatment mechanisms. The purpose of this study was to quantify acute changes in annulus fibrosus biomechanics after a range of thermal exposures, and to correlate these results with tissue denaturation. Intact annulus fibrosus (attached to adjacent vertebrae) from porcine lumbar spines was tested ex vivo. Biomechanical behavior, microstructure, peak of denaturation endotherm, and enthalpy of denaturation (mDSC) were determined before and after hydrothermal heat treatment at 37 degrees C, 50 degrees C, 60 degrees C, 65 degrees C, 70 degrees C, 75 degrees C, 80 degrees C, and 85 degrees C. Shrinkage of excised annular tissue (removed from adjacent vertebrae) was also measured after treatment at 85 degrees C. Significant differences in intact annulus biomechanics were observed after treatment, but the effects were much smaller in magnitude than those observed in excised annulus and those reported previously for other tissues. Consistent with this, intact tissue was only minimally denatured by treatment at 85 degrees C for 15 min, whereas excised tissue was completely denatured by this protocol. Our data suggest that in situ constraint imposed by the joint structure significantly retards annular thermal denaturation. These findings should aid the interpretation of clinical outcomes and provide a basis for the future design of optimum dosing regimens.

We describe the experiment and technology leading to a target plasma for the magnetized target fusion research effort, an approach to fusion wherein a plasma with embedded magnetic fields is formed and subsequently adiabatically compressed to fusion conditions. The target plasmas under consideration, field-reversed configurations (FRCs), have the required closed-field-line topology and are translatable and compressible. Our goal is to form high-density (1017 cm−3) FRCs on the field-reversed experiment-liner (FRX-L) device, inside a 36 cm long, 6.2 cm radius theta coil, with 5 T peak magnetic field and an azimuthal electric field as high as 1 kV/cm. FRCs have been formed with an equilibrium density ne≈(1 to 2)×1016 cm−3, Te+Ti≈250 eV, and excluded flux ≈2 to 3 mWb.

(2003). ON THE BEARING OF A LIVING TRADITION. Religious Education: Vol. 98, No. 4, pp. 503-510.

OBJECTIVE: To study how frequency, recentness, and reason for douching impact bacterial vaginosis-related vaginal microflora and the occurrence of cervical pathogens. Douching has been linked to bacterial vaginosis as well as to chlamydial cervicitis in some, but not all, studies. METHODS: A total of 1200 women at high risk for sexually transmitted infections were enrolled from five clinical sites around the United States. Cross-sectional, structured interviews were conducted and vaginal swabs were self-obtained for Gram stain, culture, and DNA amplification tests for Neisseria gonorrhoeae and Chlamydia trachomatis. RESULTS: Douching at least once per month was associated with an increased frequency of bacterial vaginosis. Those who douched recently (within 7 days) were at highest risk [odds ratio (OR) 2.1, 95% confidence interval (CI) 1.3, 3.1]. Douching for symptoms (OR 1.7, 95% CI 1.1, 2.6) and for hygiene (OR 1.3, 95% CI 1.0, 1.9) both related to bacterial vaginosis risk. The associations between douching and Gardnerella vaginalis, Mycoplasma hominis, and lack of hydrogen peroxide-producing lactobacilli were similar to those between douching and bacterial vaginosis. Gonococcal or chlamydial cervicitis was not associated with douching. CONCLUSION: Douching for symptoms or hygiene, particularly frequent or recent douching, was associated with bacterial vaginosis and bacterial vaginosis-associated vaginal microflora, but not with gonococcal or chlamydial cervicitis.

PEACH trial data were used to evaluate the relationship between subsequent sexually transmitted infection and recurrent pelvic inflammatory disease on infertility and chronic pelvic pain (CPP). Recurrent pelvic inflammatory disease was associated with an almost 2-fold increase in infertility and more than 4-fold increase in CPP. Subsequent sexually transmitted infection was associated with CPP, but not infertility.

The pollen beetle Meligethes aeneus is the most important coleopteran pest in European oilseed rape cultivation, annually infesting millions of hectares and responsible for substantial yield losses if not kept under economic damage thresholds. This species is primarily controlled with insecticides but has recently developed high levels of resistance to the pyrethroid class. The aim of the present study was to provide a transcriptomic resource to investigate mechanisms of resistance. cDNA was sequenced on both Roche (Indianapolis, IN, USA) and Illumina (LGC Genomics, Berlin, Germany) platforms, resulting in a total of ∼53 m reads which assembled into 43 396 expressed sequence tags (ESTs). Manual annotation revealed good coverage of genes encoding insecticide target sites and detoxification enzymes. A total of 77 nonredundant cytochrome P450 genes were identified. Mapping of Illumina RNAseq sequences (from susceptible and pyrethroid-resistant strains) against the reference transcriptome identified a cytochrome P450 (CYP6BQ23) as highly overexpressed in pyrethroid resistance strains. Single-nucleotide polymorphism analysis confirmed the presence of a target-site resistance mutation (L1014F) in the voltage-gated sodium channel of one resistant strain. Our results provide new insights into the important genes associated with pyrethroid resistance in M. aeneus. Furthermore, a comprehensive EST resource is provided for future studies on insecticide modes of action and resistance mechanisms in pollen beetle.

Objective: Careful detection and treatment of pelvic inflammatory disease are essential for the prevention of adverse sequelae. The purpose of this study was to evaluate the diagnostic test characteristics of clinical criteria for the diagnosis of pelvic inflammatory disease. Study Design: We performed a cross-sectional analysis of the baseline characteristics of 651 patients enrolled in a multicenter randomized treatment trial for pelvic inflammatory disease. Clinical and laboratory findings were recorded for all patients, and endometrial sampling was performed. We calculated sensitivity and specificity and performed receiver operating characteristic curve analysis and multivariate logistic regression, using histologic endometritis as the criterion standard. Results: The minimal criteria for pelvic inflammatory disease, as recommended by the Centers for Disease Control and Prevention, had a sensitivity of 83%, in comparison with a 95% sensitivity for adnexal tenderness ( P =.001). Of the supportive clinical criteria, the finding most highly associated with endometritis was a positive test result for Chlamydia trachomatis or Neisseria gonorrhoeae (adjusted odds ratio, 4.3; 95% confidence interval, 2.89-6.63). A multivariate logistic regression model indicated that combinations of criteria significantly improve the prediction of endometritis. Conclusion: Sensitivity can be maximized by using the presence of adnexal tenderness as a minimal criterion for the diagnosis of pelvic inflammatory disease, and supportive criteria are helpful in estimating the probability of endometritis. (Am J Obstet Gynecol 2001;184:856-64.)

Study design A biomechanical study of the compressive creep behavior of the human intervertebral disc before and after frozen storage. Objectives To determine whether frozen storage alters the time-dependent response of the intact human intervertebral disc. Summary of background data The biomechanical properties of the intervertebral disc are generally determined using specimens that have been previously frozen. Although it is well established that freezing does not alter the elastic response of the disc, recent data demonstrate that freezing permanently alters the time-dependent mechanical behavior of porcine discs. Methods Twenty lumbar motion segments from 10 human spines were harvested between 12 and 36 hours postmortem. The specimens were randomly assigned to one of two groups: Group 1 was tested promptly, stored frozen for 3 weeks, then thawed, and tested a second time; Group 2 was stored frozen for 3 weeks, thawed, and then tested. Each specimen was subjected to 5 cycles of compressive creep under 1 MPa for 20 minutes, followed by a 40-minute recovery under no load. After testing each specimen was graded on a degeneration scale. A fluid transport model was used to parameterize the creep data. Results There was no statistically significant effect of freezing on the elastic or creep response of the discs. The degree of pre-existing degeneration had a significant effect on the creep response, with the more degenerated discs appearing more permeable. Conclusions Frozen storage for a reasonable time with a typical method does not significantly alter the creep response of human lumbar discs. Freezing may produce subtle effects, but these potential artifacts do not appear to alter the discs' time-dependent behavior in any consequential way. These results may not apply to tissue kept frozen for long durations and with poor packaging.

Use of selective salpingography and fallopian tube recanalization has revolutionized the diagnosis and treatment of infertility. Selective salpingography, a diagnostic procedure in which the fallopian tube is directly opacified through a catheter placed in the tubal ostium, has been used since the late 1980s to differentiate spasm from true obstruction and to clarify discrepant findings from other tests. In fallopian tube recanalization, a catheter and guide wire system is used to clear proximal tubal obstructions. The recanalization procedure is simple for interventional radiologists to perform and is successfully completed in most patients (71%-92%). Pregnancy rates after the procedure have been variable, with an average rate of 30%. The combination of selective salpingography with fallopian tube recanalization has improved the overall management of infertility caused by tubal obstruction. The same catheterization technique used in fallopian tube recanalization is currently being explored for use in tubal sterilization.

BACKGROUND—Non-cardiac chest pain assessed by cardiologists in their outpatient clinics or by coronary angiography usually has a poor symptomatic functional and psychological outcome. Randomised trials have shown the effectiveness of specialist psychological treatment with those who have persistent symptoms, but such treatment is not always acceptable to patients and may not be feasible in routine clinical settings. OBJECTIVES—To describe a sample of patients referred to cardiac outpatient clinics from primary care in a single health district who were consecutively reassured by cardiologists that there was not a cardiac cause for their presenting symptom of chest pain. DESIGN—Systematic recording of referral and medical information of patients consecutively reassured by cardiologists. Reassessment in research clinic six weeks later (with a view to inclusion in a randomised trial of psychological treatment, which has been separately reported) and followed up at six months. SETTING—A cardiac clinic in a teaching hospital providing a district service to patients referred from primary care. PATIENTS—133 patients from the Oxfordshire district presenting with chest pain and consecutively reassured that there was no cardiac cause during the recruitment period; 69 had normal coronary angiograms and 64 were reassured without angiography. INTERVENTION—A subgroup (n = 56) with persistent disabling chest pain at six weeks were invited to take part in a randomised controlled trial of cognitive behavioural treatment. MAIN OUTCOME MEASURES—Standardised interview and self report measures of chest pain, other physical symptoms, mood and anxiety, everyday activities, and beliefs about the cause of symptoms at six week assessment; repeat of self report measures at six months. RESULTS—Patients had a good outcome at six weeks, but most had persistent, clinically significant symptoms and distress. Some found the six week assessment and discussion useful. The psychological treatment was helpful to most of those recruited to the treatment trial, but a minority (15%) of those treated appeared to need more intensive and individual collaborative management. Patients reassured following angiography were compared with those reassured without invasive investigation. They had longer histories of chest pain, more often reported breathlessness on exertion, and were more likely to have previously been diagnosed as having angina, treated with antianginal medication, and admitted to hospital as emergencies. CONCLUSION—These findings suggest a need for "stepped" aftercare, with management tailored according to clinical need. This may range from simple reassurance and explanation in the cardiac clinic to more intensive individual psychological treatment of associated underlying and often enduring psychological problems. Simple ways in which the cardiologist might improve care to patients with non-cardiac chest pain are suggested, and the need for access to specialist psychological treatment discussed. Keywords: non-cardiac chest pain; psychological problems; cognitive behavioural treatment

In order to determine risk factors associated with the development of AIDS-associated lymphoma (AIDS-NHL) in individuals with haemophilia, we undertook a case-control study of 25 patients with AIDS-NHL identified prospectively in the multicentre Hemophilia Malignancy Study (HMS) and 100 haemophilia controls with AIDS matched 1:4 by age and date of AIDS diagnosis. Clinical, laboratory and lifestyle characteristics and blood product usage during the 2 years before seroconversion and AIDS or AIDS-NHL diagnosis were compared between cases and controls. AIDS-NHL cases had higher haemoglobin, platelets, %CD4 and white blood count, with the latter approaching significance, 5700 microL-1 vs. 4000 microL-1, P = 0.063. The proportion of cases receiving anti-retroviral treatment prior to diagnosis was similar to that of AIDS-controls, 72% vs. 86%, but a significantly lower proportion of cases had been treated with intravenous pentamidine, 4% vs. 26%, P = 0.048. There were no differences between cases and controls in prevalence of antibody to hepatitis B or hepatitis C, HIV-related symptoms, lifestyle characteristics, or in the type or amount of blood product usage. Thus, clinical, lifestyle characteristics, antiviral drug treatment and blood product usage appear to have little, if any, effect on the development of AIDS lymphoma in HIV(+) patients with haemophilia.

OBJECTIVE: Our purpose was to determine the accuracy of fetal fibronectin values for diagnosing ectopic pregnancies. STUDY DESIGN: We obtained vaginal swabs from women with pregnancies of ≤12 weeks' gestation to perform enzyme-linked immunosorbent assays for fetal fibronectin. Fetal fibronectin values were compared among groups categorized on the basis of clinical and laboratory criteria into (1) ectopic pregnancies, (2) threatened abortions, (3) incomplete/complete abortions, and (4) uncomplicated intrauterine pregnancies. RESULTS: Mean fetal fibronectin values ranged from 0.08 μg/mL in women with ectopic pregnancies to 0.33 μg/mL in women with threatened abortions. Comparing these two diagnostic categories, a negative fetal fibronectin test (at a cutoff level of 0.300 μg/mL) predicted ectopic pregnancy with a sensitivity of 94%, specificity of 28%, positive predictive value of 62%, and negative predictive value of 78%. CONCLUSION: Although fetal fibronectin is low in women with ectopic pregnancies, a negative test is not sufficiently sensitive and specific to be used clinically for the diagnosis of ectopic pregnancy. (Am J Obstet Gynecol 1998;179:697-702.)

A 10.5-year-old, castrated male shih tzu was presented for evaluation of weakness, pica, and pallor of the mucous membranes. A hemogram indicated an inflammatory leukogram and a regenerative anemia with spherocytosis and thrombocytosis. The dog responded well to conservative therapy for immune-mediated hemolytic anemia (IMHA). However, the thrombocytosis did not resolve. Serial hemograms were characterized by persistent thrombocytosis (platelet count, 577,000 to 1,200,000/microl) with abnormal platelet morphology. A systematic investigation ruled out causes of physiological and reactive thrombocytoses. A diagnosis of essential thrombocythemia was made by fulfilling the criteria of the Polycythemia Vera Study Group of the National Cancer Institute. The marked thrombocytosis was nonresponsive to hydroxyurea therapy. The dog remains healthy despite the marked increase in the number of circulating platelets. A review of causes of thrombocytoses in humans and animals is presented, and the criteria for diagnosis of essential thrombocythemia are examined.

A total of 403 women (aged 14-25 years) were surveyed to determine the association of psychosocial variables with risky sexual behaviors and sexually transmitted infections (STIs). Depression, stress, and low social support were associated with high-risk sexual behaviors and past STIs. When comparing adolescent women (aged 14-19) to young women (aged 20-25), the adolescents had stronger associations with the outcome variables.

Objective:Among all women with pelvic inflammatory disease (PID), prevention of adverse reproductive consequences appears to be similarly achieved by outpatient treatment and inpatient treatment. We assessed whether outpatient is as effective as inpatient treatment in relevant age, race, and clinica

In radiotherapy, PET images can be used to guide the delivery of selectively escalated doses to biologically relevant tumour subvolumes. Validation of PET for such applications requires demonstration of spatial coincidence between PET tracer uptake pattern and the histopathologically confirmed target. This study introduces a novel approach to histopathological validation of PET image segmentation for radiotherapy guidance.Sequential tissue sections from surgically excised whole-tumour specimens were used to acquire full 3D-sets of both histopathological images (microscopy) and PET tracer distribution images (autoradiography). After these datasets were accurately registered, a full 3D autoradiographic distribution of PET tracer was reconstructed and used to obtain synthetic PET images (sPET) by simulating the image deterioration induced by processes involved in PET image formation. To illustrate the method, sPET images were used in this study to investigate spatial coincidence between high FDG uptake areas and the distribution of viable tissue in two small animal tumour models.The reconstructed 3D autoradiographic distribution of the PET tracer was spatially coherent, as indicated by the high average value of the normalised pixel-by-pixel correlation of intensities between successive slices (0.84 ± 0.05 and 0.94 ± 0.02). The loss of detail in the sPET images versus the 3D autoradiography was significant as indicated by Dice coefficient values corresponding to the two tumours (0 and 0.1 at 70% threshold). The maximum overlap between the FDG segmented volumes and the extent of the viable tissue as indicated by Dice coefficient values, was 0.8 for one tumour (for the image thresholded at 22% of max intensity) and 0.88 for the other (threshold of 14% of max intensity).It was demonstrated that the use of synthetic PET images for histopathological validation allows for bypassing a technically challenging and error-prone step of registering non-invasive PET images with histopathology.

Background Regional recurrence remains a problem in the management of patients with metastatic malignant melanoma in the cervical lymph nodes and parotid. In this study, the influence of the number of positive nodes, extracapsular spread, and the use of adjuvant radiotherapy on regional control and survival were analyzed. Methods A non-randomized, prospectively documented series of 143 patients with histologically positive nodes in the neck or parotid was analyzed. There were 152 dissected necks or parotids: 45 of these received postoperative radiotherapy, 6 × 5.5 Gy fractions over 3 weeks; 107 were not irradiated. Results The regional recurrence rate was 6.5% in the irradiated group, compared with 18.7% in the non-irradiated group (p = .055). The irradiated group, however, had more extensive nodal involvement than the non-irradiated group: 65% had two or more positive nodes, and 48% had extracapsular spread, compared with 40% and 19%, respectively, in the non-irradiated group. Survival was significantly worse when there was extracapsular spread (p < .05) or multiple node involvement (p < .01). By multivariate analysis, the use of adjuvant radiotherapy was associated with a trend toward improved regional control (p = .065), but survival was not improved. Conclusions Adjuvant radiotherapy was associated with improved control of metastatic malignant melanoma in the neck and parotid; however, statistical significance was not reached. A prospective trial should be supported to clarify this question. © 1997 John Wiley & Sons, Inc. Head Neck19: 589–594, 1997.