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Although the blinding eye disease glaucoma is more common in people of African ancestry, previous genetic studies predominantly involved European subjects. In this issue of Cell , O'Brien et al. report a genome-wide association study for glaucoma in individuals of African ancestry, showing overlap with European studies and refining an African polygenic risk score. [ABSTRACT FROM AUTHOR]

Glioblastoma, the most dangerous and aggressive type of CNS tumor, appears resistant to many chemotherapy drugs. In the patient-derived glioma cell lines NULU and ZAR, which exhibit drug-resistant phenotypes, we investigated the effect of combined AE (Aloe-emodin) and TMZ (temozolomide) and found a significant additive inhibitory effect on cell growth and a promising cytotoxic effect on both cell lines compared to treatment with single agents. We also examined the effect of combined AE and TMZ treatment on the drug-resistance protein MGMT. The results suggest that using AE combined with traditional drugs restores drug resistance in both primary resistant cell lines (NULU and ZAR). Furthermore, migration assays and scratch tests showed that the combined use of AE and TMZ can slow down the colony formation and migration of glioblastoma cells. These convincing results suggest that AE could be a natural adjuvant agent to potentiate the effects of traditional drugs (TMZ) and overcome drug resistance in glioblastoma cells. [ABSTRACT FROM AUTHOR]

Isoginkgetin (Iso) is a natural bioflavonoid isolated from the leaves of Ginkgo biloba, this natural substance exhibits many healing properties, among which the antitumor effect stands out. Here we tested the effect of Iso on the growth of U87MG glioblastoma cells. Growth curves and MTT toxicity assays showed time and dose-dependent growth inhibition of U87MG after treatment with Iso (15/25 µM) for 1, 2, and 3 days. The cell growth block of U87MG was further investigated with the colony formation test, which showed that iso treatment for 24 h reduced colony formation. The present study also aimed to evaluate the effect of Iso on U87MG glioblastoma cell migration. The FACS analysis, on the other hand, showed that treatment with Iso 15 µM determines a blockage of the cell cycle in the S1 phase. Further investigation shows that Iso treatment of U87MG altered the protein pathways of homeostasis including autophagy and apoptosis. The present study demonstrated, for the first time, that Iso could represent an excellent adjuvant drug for the treatment of glioblastoma by simultaneously activating multiple mechanisms that control the growth and migration of neoplastic cells. [ABSTRACT FROM AUTHOR]

Importance Educating parents to recognize signs of eye disease and consult a healthcare professional is critical to timely diagnosis, intervention and outcomes. Background: We evaluate the effectiveness of an eye‐health information pamphlet on parents' level of concern and help‐seeking intention should they hypothetically observe leukocoria or strabismus in their child. Design Double‐blind, randomized controlled trial conducted at a metropolitan antenatal outpatient clinic. Participants: In total, 518 pregnant women were enrolled in the study. Methods: After completing a study‐specific, pre‐test survey describing hypothetical clinical scenarios at baseline, participants were randomly assigned to receive a pamphlet on either paediatric eye health (intervention) or infant play (control). The post‐test survey was sent by email 2 weeks after baseline. Main outcome measures: A change in the parents' level of concern if they observed leukocoria or strabismus and a change in their help‐seeking intention if they hypothetically observed leukocoria or strabismus in their child. Results: Of the 518 women, 382 (73.7%) completed the post‐test survey. At follow‐up, women who received the intervention were more likely to report a higher level of concern if they observed leukocoria (OR 1.711 [CI: 1.176‐2.497] P =.005]) and were less likely to delay help‐seeking (OR 0.560 [CI 0.382‐0.817] P =.003). No change in the level of concern for strabismus was identified between the groups; however, at follow‐up, women who received the intervention were less likely to delay help‐seeking (OR 0.318 [CI 0.125‐0.806] P =.016). Conclusion and relevance: Providing parents with relevant, evidence‐based information can significantly improve their knowledge and positively influence help‐seeking intentions if leukocoria or strabismus are observed. [ABSTRACT FROM AUTHOR]

In this study, a liquid chromatographic method was developed for the fast determination of lincomycin, polymyxin and vancomycin in a preservation solution for transplants. A Kinetex EVO C18 (150 × 4.6 mm, 2.6 µm) column was utilized at 45 ◦C. Gradient elution was applied using a mixture of mobile phases A and B, both including 30 mM phosphate buffer at pH 2.0 and acetonitrile, at a ratio of 95:5 (v/v) for A and 50:50 (v/v) for B. A flow rate of 1.0 mL/min, an injection volume of 20 µL and UV detection at 210 nm were used. A degradation study treating the three antibiotics with 0.5 M hydrochloric acid, 0.5 M sodium hydroxide and 3% H2O2 indicated that the developed method was selective toward lincomycin, polymyxin, vancomycin and their degradation products. Other ingredients of the preservation solution, like those from the cell culture medium, did not interfere. The method was validated with good sensitivity, linearity, precision and accuracy. Furthermore, lincomycin, polymyxin and vancomycin were found to be stable in this preservation solution for 4 weeks when stored at −20 ◦C. [ABSTRACT FROM AUTHOR]

• Exposure to weather shocks reduces school enrolment in rural areas. • Children are at high risk of being withdrawn from school when shocks occur. • School feeding programmes increase school enrolment when weather shocks occur. • Positive impacts of school feeding when shocks occur are high for older children. • School feeding programmes help sustain school enrolment in the context of weather shocks. Emerging evidence suggests that rural children, especially older girls in low-income countries, are at risk of being withdrawn from school when adverse weather-related events occur. Identifying actions that mitigate the adverse effects of weather shocks on schooling, therefore, is critical for sustaining equitable human capital formation. In this paper, we use four waves of household and community panel survey data, merged with long-term, spatially explicit rainfall data to investigate whether access to school feeding programmes (SFP) in Malawi supports primary school enrolment when negative rainfall shocks occur. We find some evidence that access to SFP increases enrolment for older children when their households experience anomalously low rainfall conditions compared to those without SFP. The positive associations of SFP on enrolment persist when we consider historical shocks over longer periods. When we disaggregate by sex, however, there are no differentials. The findings suggest that SFPs, already a common intervention in many contexts, may have modest potential for improving primary school completion rates, educational advancement and human capital formation in the context of a rapidly changing climate. [ABSTRACT FROM AUTHOR]

With a worldwide incidence estimated at 8-15 per 100,000 population a year, idiopathic sudden sensorineural hearing loss (ISSHL) is a common clinical finding for otologists. There is a shortage of information on the clinical factors capable of predicting hearing recovery and response to therapy. The aim of the present study was to retrospectively investigate the prognostic value of clinical variables in relation to hearing recovery, in a cohort of 117 consecutive patients with ISSHL. Clinical parameters (signs, symptoms, comorbidities and treatments) and audiometric data were analyzed with univariate and multivariate statistical approaches for prognostic purposes to identify any correlation with hearing recovery, also expressed according to the Wilson criteria. Univariate analysis showed that age and hypertension were significantly related to hearing outcome ( p = 0.004 and p = 0.015, respectively). Elderly patients and those with hypertension were at higher risk of experiencing no hearing recovery (OR = 3.25 and OR = 2.89, respectively). Age was an independent prognostic factor on multivariate analysis ( p = 0.007). Tinnitus as a presenting symptom showed a trend towards an association with hearing recovery ( p = 0.07). The treatment regimen, the time elapsing between the onset of symptoms and the start of therapy ( p = 0.34), and the duration of the treatment ( p = 0.83) were unrelated to recovery on univariate analysis. Among the parameters considered, only age was significantly and independently related to hearing outcome. There is a need for well-designed, randomized clinical trials to enable an evidence-based protocol to be developed for the treatment of ISSHL. [ABSTRACT FROM AUTHOR]

Deep neck infections (DNI) spread along fascial planes and involve neck spaces. Very few studies have investigated potentially prognostic factors using multivariate statistical models. Our aim was to analyze 282 consecutive cases of DNI using multivariate (logistic) statistical models to identify independent significant factors influencing prognosis in terms of complications and long-term hospitalization (>6 days). In our series, only involvement of more than one neck space was independently significant in prognosticating complications of DNI (odds ratio [OR] 2.46). The presence of comorbidities (OR 2.13), non-odontogenic sites of origin (OR 1.88), leukocyte counts above 11.0 cells × 10/L at presentation (OR 3.57), and the need for both medical and surgical treatments (OR 4.66) was significantly and independently prognostic of long hospital stays. Multivariate analysis can distinguish between risk factors and their relative contribution to outcome. The few published studies using multivariate models to analyze DNI prognosis considered quite large cohorts, but no clinical variables persistently revealed an independent significant prognostic role. This evidence seems to underscore the complex interdependence of several clinical variables in contributing to DNI prognosis, and the heterogeneity of the diagnostic/therapeutic approaches adopted. [ABSTRACT FROM AUTHOR]

Background Clinicopathological research has focused on identifying molecular and biological prognostic factors for laryngeal carcinoma ( LSCC) treated with post-operative radiotherapy ( RT). The aim of this study was to assess the prognostic importance of anti-apoptotic proteins survivin and B-cell lymphoma-2 ( Bcl-2) in a series of patients with LSCC who had primary surgery followed by RT. Methods Thirty-three consecutive patients who underwent primary surgery followed by RT were considered. Survivin nuclear and cytoplasmic expressions and Bcl-2 expression were determined immunohistochemically. Results The loco-regional recurrence rate was significantly higher among LSCC patients with a nuclear survivin expression >10.0% ( P = 0.029), and their disease-free survival ( DFS) was shorter than in cases whose nuclear survivin expression was ≤10.0% ( P = 0.002). DFS was significantly shorter in cases with a Bcl-2 expression >2.0% than in those whose Bcl-2 expression was ≤2.0% ( P = 0.035). Conclusions Nuclear survivin expression and Bcl-2 expression warrant further investigation as potential predictive biomarkers to enable individualized treatments (e.g. post-operative chemo-radiotherapy instead of RT alone for patients whose LSCCs strongly express nuclear survivin or/and Bcl-2). This preliminary evidence justifies the design of new studies on the association of agents targeting survivin and Bcl-2 with conventional chemotherapeutic agents and RT for advanced LSCC. [ABSTRACT FROM AUTHOR]

Conclusions. A large series confirmation may suggest elective neck dissection in cN0 MASPIN-negative oral squamous cell carcinomas (SCCs). Re-activated nuclear MASPIN in association with anti-angiogenic or cytotoxic drugs may be extremely effective in the treatment of laryngeal SCC. Objectives. MASPIN is a serpin showing a unique tumour-suppressing activity. Despite the significant incidence of head and neck SCC (HNSCC), a limited number of studies has considered MASPIN's role in these malignancies. This review focuses on the attempts to translate MASPIN's HNSCC suppressive properties toward a diagnostic/prognostic tool and a novel carcinoma therapy. Methods. A systematic literature review was performed to investigate available evidence about MASPIN subcellular localization and biological role in HNSCC. Results. Five studies have investigated MASPIN's expression in oral SCC. Most of them concluded that low or absent MASPIN cytoplasmic expression was more frequent in oral carcinomas with lymph node metastases. Only our group evaluated MASPIN's role in laryngeal SCC. Higher nuclear MASPIN expression was found in patients without SCC recurrence and was significantly associated with longer disease-free survival. Micro-vascular density was lower in laryngeal carcinomas with MASPIN nuclear staining. The relation between MASPIN and M30-assessed apoptosis in laryngeal SCC supports the hypothesis of an important apoptosis-sensitizing effect of nuclear MASPIN. [ABSTRACT FROM AUTHOR]

Conclusions . All the discussants of our questionnaire agreed that the price of tracheoesophageal (TE) prostheses was too expensive for developing countries. The problem could be addressed in terms of international laws regarding companies' patent rights. TE prosthesis manufacturers from rich countries could move their manufacturing in part to developing countries. High production standards could allow TE prostheses to be exported to developed countries. Another approach to the problem may be based on a partnership between non-profit-making Western laryngological societies with specific medical and technical prosthetic know-how and local manufacturers. The aim of this cooperation could be the low-cost production of advanced TE prostheses in the developing countries. Objectives . In communities in the developing world, most laryngeal and hypopharyngeal carcinomas are diagnosed at advanced stages and require total laryngectomy. Prosthetic TE voice restoration is the method of choice for voice rehabilitation after total laryngectomy in developed countries. Unacceptably high costs are a significant limitation to Third World use of TE voice prostheses. The aims of this paper are to discuss the consequences of the high costs of TE prostheses in developing countries with head and neck surgeons working in Third World hospitals and to propose how European and American laryngological societies can promote TE speech in the developing countries. Material and methods . A questionnaire was given to a group of expert head and neck surgeons working in developing countries and their answers and suggestions discussed. [ABSTRACT FROM AUTHOR]

Conclusions . All the discussants of our questionnaire agreed that the price of tracheoesophageal (TE) prostheses was too expensive for developing countries. The problem could be addressed in terms of international laws regarding companies’ patent rights. TE prosthesis manufacturers from rich countries could move their manufacturing in part to developing countries. High production standards could allow TE prostheses to be exported to developed countries. Another approach to the problem may be based on a partnership between non-profit-making Western laryngological societies with specific medical and technical prosthetic know-how and local manufacturers. The aim of this cooperation could be the low-cost production of advanced TE prostheses in the developing countries. Objectives . In communities in the developing world, most laryngeal and hypopharyngeal carcinomas are diagnosed at advanced stages and require total laryngectomy. Prosthetic TE voice restoration is the method of choice for voice rehabilitation after total laryngectomy in developed countries. Unacceptably high costs are a significant limitation to Third World use of TE voice prostheses. The aims of this paper are to discuss the consequences of the high costs of TE prostheses in developing countries with head and neck surgeons working in Third World hospitals and to propose how European and American laryngological societies can promote TE speech in the developing countries. Material and methods . A questionnaire was given to a group of expert head and neck surgeons working in developing countries and their answers and suggestions discussed. [ABSTRACT FROM AUTHOR]

Our primary aim was to use nasal cytology to compare a group of woodworkers with a group of unexposed subjects to see whether wood dust exposure correlates with specific patterns of inflammatory or infectious rhinitis. A secondary aim was to seek any differences in nasal symptoms or nasal cytology between workers exposed to softwood vs hardwood dust, thereby comparing the inflammatory harmful potential of the two woods. Among 117 woodworkers at factories in the Veneto region (Italy), 40 exposed to either softwood or hardwood dust were assessed by means of a questionnaire, nasal cytology, and personal wood dust sampling, and compared with 40 unexposed controls. Woodworkers reported significantly more nasal symptoms than controls ( p = 0.0007). The woodworker group's nasal smears contained significantly more neutrophils ( p < 0.00001) and lymphocytes ( p = 0.02) than the control group's. The softwood workers had significantly lower levels of personal exposure to wood dust than the hardwood workers ( p = 0.04); there were no significant differences in age, history of cigarette smoking, or period of exposure between these two sub-cohorts of woodworkers. A statistical trend indicated that softwood workers had more eosinophils ( p = 0.05) and lymphocytes ( p = 0.05) in their rhinocytograms. Nasal cytology revealed chronic inflammatory rhinitis in a significant proportion of woodworkers' enroled in this study. It also suggested a different harmful potential for softwood and hardwood dust. Nasal cytology could prove useful in screening woodworkers for chronic inflammatory rhinitis. Further investigations are needed to examine the role of different types of wood dust in nasal inflammation. [ABSTRACT FROM AUTHOR]

Background X-linked retinoschisis ( XLRS) is a leading cause of juvenile macular degeneration associated with mutations in the RS1 gene. XLRS has a variable expressivity in males and shows no clinical phenotype in carrier females. Design Clinical and molecular characterization of male and female individuals affected with XLRS in a consanguineous family. Participants Consanguineous Eastern European- Australian family Methods Four clinically affected and nine unaffected family members were genetically and clinically characterized. Deoxyribonucleic acid ( DNA) analysis was conducted by the Australian Inherited Retinal Disease Register and DNA Bank. Main Outcome Measures Clinical and molecular characterization of the causative mutation in a consanguineous family with XLRS. Results By direct sequencing of the RS1 gene, one pathogenic variant, NM_000330.3: c.304 C > T, p. R102 W, was identified in all clinically diagnosed individuals analysed. The two females were homozygous for the variant, and the males were hemizygous. Conclusion Clinical and genetic characterization of affected homozygous females in XLRS affords the rare opportunity to explore the molecular mechanisms of XLRS and the manifestation of these mutations as disease in humans. [ABSTRACT FROM AUTHOR]

Background Our primary endpoint was to use nasal cytology to compare woodworkers with unexposed subjects to see if wood dust exposure correlates with specific patterns of inflammatory or infectious rhinitis. A secondary endpoint was to identify any differences in the exposed group's nasal symptoms or nasal cytology by years of exposure or personal exposure levels. Methods Ninety-two woodworkers and 90 controls were assessed using a questionnaire and nasal cytology (on nasal mucosa obtained by scraping). Wood dust exposure was investigated using personal sampling methods. Results Woodworkers reported significantly more nasal symptoms than controls ( p < 0.00001). The woodworkers' nasal smears revealed more neutrophils ( p = 0.001) and significantly higher mean neutrophil scores ( p = 0.001) than control smears. Lymphocytes were also found more often in the woodworkers' rhinocytograms (statistical trend, p = 0.06). Neutrophilic rhinitis was diagnosed more frequently in the exposed workers than in controls (chi-square = 5.97, p < 0.05). Woodworkers with lymphocytes in their nasal smears had been exposed to wood dust for longer periods of time (statistical trend; p = 0.06). No differences in nasal symptoms or cell counts emerged when woodworkers were stratified by levels of personal exposure. Conclusion Nasal cytology should be further investigated in woodworkers before considering it a screening method for identifying woodworkers with chronic inflammatory rhinitis. [ABSTRACT FROM AUTHOR]

Cardiorespiratory effects, quality of induction, depth of anaesthesia and quality of recovery were compared in pigs anaesthetised with 8 mg/kg ketamine, 20 µg/kg dexmedetomidine and 0.2 mg/kg methadone (KDM, n  = 18) or 8 mg/kg tiletamine–zolazepam and 0.2 mg/kg methadone (TZM, n  = 9). Anaesthesia with KDM was partially reversed in nine animals with 0.2 mg/kg atipamezole (KDM at ). Sedation was observed earlier in the TZM group (47.2 ± 25.3 s) than the KDM group (91.5 ± 37.4 s). Sternal and lateral recumbency were achieved earlier in the TZM group (76.3 ± 36.5 s and 132.1 ± 30.5 s, respectively) than in the KDM group (149.1 ± 58.7 s and 249.2 ± 84.0 s, respectively). PaO 2 , SaO 2 and PaO 2 :FiO 2 were lower in the TZM group (68.7 ± 4.1 mmHg, 93.4 ± 1.4% and 327.2 ± 19.9 mmHg, respectively) than in the KDM group (80.4 ± 5.9 mmHg, 95.7 ± 1.0% and 380.4 ± 25.6 mmHg, respectively). Fshunt and P (A-a) O 2 were higher in the TZM group (24.0 ± 11.8% and 31.4 ± 3.8 mmHg, respectively) than in the KDM group (13.4 ± 3.2% and 20.7 ± 7.4 mmHg, respectively). Times from drug injection to first head movements, sternal recumbency and standing/walking were significantly shorter in the KDM group (45.1 ± 10.5, 48.4 ± 12.6 and 54.4 ± 17.8 min, respectively) than in the TZM group (57.8 ± 11.4, 93.1 ± 14.2 and 165.7 ± 56.6 min, respectively). The median recovery score was higher in the TZM group than in the KDM noat and KDM at subgroups. Both drug combinations provided adequate anaesthesia for minor procedures lasting about 30 min, but TZM was associated with a poor recovery and oxygenation. [ABSTRACT FROM AUTHOR]

A three-month-old female Rottweiler puppy was referred for intravascular correction of a previously identified cor triatriatum dexter. Echocardiography confirmed the presence of a hyperechoic membrane that divided the right atrium into a cranial and caudal chamber. A foramen in this membrane allowed the blood to flow from the caudal to the cranial chamber. Balloon dilation of the defect under transthoracic echocardiographic guidance was scheduled for the following day. The dog was premedicated with 0.5 µg/kg sufentanil and 0.2 mg/kg midazolam administered intravenously. General anaesthesia was induced with 2 mg/kg propofol and maintained with inhaled isoflurane in oxygen; at the same time, a constant rate infusion of 0.5 µg/kg/h sufentanil was administered by means of an infusion pump. Uneventful ventricular and supraventricular tachyarrhythmias developed during the placement of catheters and balloon dilation. At the end of procedure, when the guide wire and balloon catheter were removed, normal sinus rhythm was observed. To the authors' knowledge, no previous reports have described the anaesthetic management of a balloon dilation procedure for cor triatriatum dexter in dogs. [ABSTRACT FROM AUTHOR]

A three-month-old female Rottweiler puppy was referred for intravascular correction of a previously identified cor triatriatum dexter. Echocardiography confirmed the presence of a hyperechoic membrane that divided the right atrium into a cranial and caudal chamber. A foramen in this membrane allowed the blood to flow from the caudal to the cranial chamber. Balloon dilation of the defect under transthoracic echocardiographic guidance was scheduled for the following day. The dog was premedicated with 0.5 μg/kg sufentanil and 0.2 mg/kg midazolam administered intravenously. General anaesthesia was induced with 2 mg/kg propofol and maintained with inhaled isoflurane in oxygen; at the same time, a constant rate infusion of 0.5 μg/kg/h sufentanil was administered by means of an infusion pump. Uneventful ventricular and supraventricular tachyarrhythmias developed during the placement of catheters and balloon dilation. At the end of procedure, when the guide wire and balloon catheter were removed, normal sinus rhythm was observed. To the authors’ knowledge, no previous reports have described the anaesthetic management of a balloon dilation procedure for cor triatriatum dexter in dogs. [ABSTRACT FROM AUTHOR]

Objective To evaluate the feasibility and efficacy of noninvasive continuous positive airway pressure (CPAP) administered with a pediatric helmet in healthy dogs recovering from general anesthesia. Design Randomized, cross-over, clinical study. Setting University teaching hospital. Animals Fifteen healthy female, client-owned dogs recovering from general anesthesia following elective ovariohysterectomy. Interventions All dogs received the same standardized anesthetic protocol (acepromazine, morphine, propofol, and isoflurane in oxygen). After extubation, a pediatric helmet was placed on all dogs and connected to a venturi valve supplied with medical air. In all patients, the gas flow was set to 50 L/minute and the FiO2 to 0.21. Dogs received the following sequence of treatments, each lasting 20 minutes: 0 CPAP (pre-CPAP), CPAP of 5 cm H2O (CPAP), and again 0 CPAP (post-CPAP). Measurements and Main Results During the entire study, the following data were collected: pressure and FiO2 inside the helmet, mean arterial pressure, respiratory rate, heart rate, sedation score (0 = awake, 10 = deep sedation), and tolerance to the helmet (0 = excellent, 4 = poor). At the end of each phase, an arterial blood sample was sampled. As compared with the pre-CPAP and the post-CPAP periods, during the CPAP period, the PaCO2, alveolar-arterial oxygen gradient (P[A−a]O2), and respiratory rate significantly decreased. The PaO2 was higher at CPAP (105.6 ± 4.0 mm Hg) compared with pre-CPAP (80.6 ± 6.9 mm Hg) and post-CPAP (86.7 ± 5.8 mm Hg). Tolerance and sedation scores during the CPAP period were not different from those in the pre-CPAP and post-CPAP periods. Conclusions Noninvasive CPAP applied through a helmet is a feasible and effective supportive technique in dogs recovering from general anesthesia. [ABSTRACT FROM AUTHOR]

Aim To determine the incidence and predictors of glaucoma following surgery for congenital and infantile cataract in an Australian population. Design Retrospective cohort study. Participants Infants (<12 months) having had lens extraction between January 1992 and May 2006, from two tertiary referral centres. Methods Children with uveitis, anterior segment dysgenesis, aniridia, retinopathy of prematurity, and lens subluxation were excluded. Potential predictors of incident glaucoma were examined using Cox proportional hazards regression with adjustment for clustering between eyes. Main Outcome Measures Incidence and predictors of secondary glaucoma. Results One hundred and forty-seven eyes of 101 patients (46 bilateral cataract; 55 unilateral cataract) were included, with median follow-up of 9.9 years (range 1.2-18.9 years). Cumulative incidence of glaucoma was 32.0% for eyes ( n = 47) and 30.7% ( n = 31) for subjects. Incidence was higher in children with bilateral cataract (38.9 vs. 17.1%, p = 0.004). There were 3.9 cases of glaucoma per 100 person years of follow-up, the incidence rate being highest for surgery performed in the first month of life. Children with glaucoma had longer median follow-up (11.8 vs. 9.3 years, p = 0.005). Risk of glaucoma decreased with increasing months of age at operation: hazard ratio 0.79, 95% confidence interval 0.69-0.91, p = 0.001. Median visual acuity was worse in children with unilateral cataract ( p < 0.001). Conclusions We identified an increased risk of glaucoma when cataract surgery was performed in younger infants, and in those with bilateral cataract. As glaucoma may develop over a decade following lens extraction, life-long surveillance is needed to prevent glaucoma-associated vision loss. [ABSTRACT FROM AUTHOR]

Background Angiogenin ( ANG) is a member of the ribonuclease superfamily and of medical interest largely because it supports the growth of primary and metastatic malignancies. This study is the first to investigate the potential role of ANG in tongue carcinoma neo-angiogenesis and cancer cell proliferation. Methods Angiogenin expression (in carcinoma cells and endothelial intratumor vessel cells), CD105-assessed micro-vessel density (MVD), and MIB-1 expression were correlated with prognostic parameters in 28 primarily consecutively operated pT1-T2 tongue carcinomas (squamous cell carcinoma [SCC]). Whenever feasible, a computer-based image analysis system was used for the immunohistochemical reaction analysis. Results No significant correlations emerged between ANG expression in the tongue carcinoma cells or endothelial intratumor vessel cells and tongue SCC recurrence rate or disease-free survival ( DFS). ANG expression was also unrelated to CD105-assessed MVD or MIB-1 expression. Conversely, CD105-assessed MVD correlated directly with recurrence rate ( P = 0.02) and DFS was significantly shorter in cases with CD105-assessed MVD >167 micro-vessels/mm2 than in those with CD105-assessed MVD ≤167 micro-vessels/mm2 ( P = 0.042). Conclusions Our results support the hypothesis that CD105-assessed MVD would be a valuable parameter for predicting which patients with tongue SCC are at greatest risk of disease recurrence. Despite our study results, the role of ANG in tongue carcinoma warrants further investigation in larger series. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the postoperative analgesic effects of robenacoxib and buprenorphine alone or in combination, in cats after ovariohysterectomy. Thirty healthy cats were randomly assigned to receive buprenorphine (0.02 mg/kg, n = 10; GB), robenacoxib (2 mg/kg, n = 10; GR) or their combination at the same dosages (n = 10; GBR) SC. After 30 min cats were sedated with an IM administration of medetomidine (0.02 mg/kg) and ketamine (5 mg/kg). General anaesthesia was induced with propofol and after intubation was maintained with isoflurane. Before premedication and at 1, 2, 3, 4, 6, 8, 12 and 24 h after extubation, pain and sedation were assessed using a simple descriptive pain scale, ranging from 0 (no pain/no sedation) to 4 (intense pain/ deep sedation). If the pain score was ⩾3, rescue analgesia was provided using buprenorphine (0.02 mg/kg) administered IM. Pain score was higher in GB at 2, 3, 4, 6 and 8 h compared to baseline and compared to GBR at the same study times. Moreover, the pain score was also higher in GB compared to GR at 2, 3, 4 and 6 h. Pain score was similar at all study times between GR and GBR. Sedation at 1 and 2 h was higher than baseline values in all groups. Cats in GB received rescue analgesia more often than cats assigned to GR or GBR. Robenacoxib was an effective analgesic drug in cats up to 24 h after ovariohysterectomy. The addition of buprenorphine did not provide any additional analgesic effects compared to robenacoxib alone. [ABSTRACT FROM AUTHOR]

RATIONALE: In the presence of increased chest wall elastance, the airway pressure does not reflect the lung-distending (transpulmonary) pressure. OBJECTIVE: To compare the physiological effects of a conventional open lung approach titrated for an end-inspiratory airway opening plateau pressure (30 cm H2O) with a transpulmonary open lung approach titrated for a elastance-derived end-inspiratory plateau transpulmonary pressure (26 cm H2O), in a pig model of acute respiratory distress syndrome (HCl inhalation) and reversible chest wall mechanical impairment (chest wall and abdomen restriction). METHODS: In eight pigs, physiological parameters and computed tomography were recorded under three conditions: 1) conventional open lung approach, normal chest wall; 2) conventional open lung approach, stiff chest wall; and 3) transpulmonary open lung approach, stiff chest wall. MEASUREMENTS AND MAIN RESULTS: As compared with the normal chest wall condition, at end-expiration non aerated lung tissue weight was increased by 116 ± 68 % during the conventional open lung approach and by 28 ± 41 % during the transpulmonary open lung approach (p < .01), whereas cardiac output was decreased by 27 ± 19 % and 22 ± 14 %, respectively (p = not significant). CONCLUSION: In this model, the end-inspiratory transpulmonary open lung approach minimized the impact of chest wall stiffening on alveolar recruitment without causing hemodynamic impairment. [ABSTRACT FROM AUTHOR]

Angiogenesis is a hallmark of cancer, fundamental to its growth. The 'angiogenic switch' occurs when pro-angiogenic factors are not balanced by anti-angiogenic factors. A correlation between angiogenic properties and oncological prognosis (for laryngeal squamous cell carcinoma (LSCC) too) was first hypothesized in the 1990s. An exhaustive literature review was performed to investigate available data on angiogenesis markers and their biological role and therapeutic potential in LSCC. The prognostic significance of microvascular density in LSCC was investigated with endothelial targets, e.g. CD105, CD34, and CD31. Epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), VEGF receptor 2, angiogenin, hypoxia-inducible factor 1, and other biological markers were also studied. Only anti-EGFR therapy has been approved by the USFood and Drug Administration (FDA) for head and neck carcinoma in recent years, while several agents interfering with VEGF and its receptors are being studied. Experimental findings indicate that anti-CD105 monoclonal antibodies efficiently inhibit tumor angiogenesis. There are two main ways to approach the vascular profile of solid malignancies: by inhibiting new vessel formation (anti-angiogenic therapy) or selectively damaging neoplastic vessels (vascular targeting therapy). In advanced LSCC, both these strategies seem promising and warrant further preclinical and clinical investigation. [ABSTRACT FROM AUTHOR]

Cancer is common in the elderly, who may also be frail, which can complicate the choice of the best therapeutic approach. We sought to examine whether the serine-threonine kinase mTOR, a 'master switch' in cancer cells that modulates metabolism, the cell cycle, and apoptosis, might help in clinical decision-making. The aim of the present study was thus to assess the potential prognostic role of mTOR in elderly patients with laryngeal carcinoma (LSCC). mTOR expression was determined immunohistochemically in 54 consecutive elderly (65years old) patients with LSCC. On univariate analysis, nodal involvement and pathological stage correlated strongly with the elderly LSCC patients' prognosis in terms of disease recurrence rate and disease-free survival (DFS). Patients whose mTOR expression was >35.3% had a significantly higher recurrence rate (p=0.003) and shorter DFS (p=0.013). In the multivariate model, N status (p=0.001) and mTOR expression (p=0.026) maintained an independent prognostic significance in relation to DFS. mTOR probably influences the aggressive LSCC phenotype in elderly patients and its expression in elderly LSCC cases can be considered a prognostic marker potentially useful for identifying patients at higher risk of disease recurrence, and N0 patients at higher risk of recurrence who may benefit from more aggressive treatment. Since rapalogs (as mTOR inhibitors) might have an effect on LSCC, further investigations are needed to ascertain these agents' role in therapeutic strategies for advanced LSCC in elderly patients. [ABSTRACT FROM AUTHOR]

Summary: Cancer is common in the elderly, who may also be frail, which can complicate the choice of the best therapeutic approach. We sought to examine whether the serine–threonine kinase mTOR, a “master switch” in cancer cells that modulates metabolism, the cell cycle, and apoptosis, might help in clinical decision-making. The aim of the present study was thus to assess the potential prognostic role of mTOR in elderly patients with laryngeal carcinoma (LSCC). mTOR expression was determined immunohistochemically in 54 consecutive elderly (⩾65years old) patients with LSCC. On univariate analysis, nodal involvement and pathological stage correlated strongly with the elderly LSCC patients’ prognosis in terms of disease recurrence rate and disease-free survival (DFS). Patients whose mTOR expression was >35.3% had a significantly higher recurrence rate (p =0.003) and shorter DFS (p =0.013). In the multivariate model, N status (p =0.001) and mTOR expression (p =0.026) maintained an independent prognostic significance in relation to DFS. mTOR probably influences the aggressive LSCC phenotype in elderly patients and its expression in elderly LSCC cases can be considered a prognostic marker potentially useful for identifying patients at higher risk of disease recurrence, and N0 patients at higher risk of recurrence who may benefit from more aggressive treatment. Since rapalogs (as mTOR inhibitors) might have an effect on LSCC, further investigations are needed to ascertain these agents’ role in therapeutic strategies for advanced LSCC in elderly patients. [ABSTRACT FROM AUTHOR]

A bstract Background: To develop, implement and evaluate a telemedicine model to reduce glaucoma blindness through the early detection of undiagnosed glaucoma in high-risk individuals. Design: Prospective study, private ophthalmology practice and public outpatient clinics in Tasmania. Participants: One hundred and thirty-three individuals with primary open-angle glaucoma were invited to enrol their first-degree relatives (FDRs) to undergo an eye examination. Within the study period, 211 FDRs were available for examination. Methods: A registered nurse was trained to perform the required assessments. Clinical data were entered into a purpose-built database, converted to a portable document format and graded offsite by an ophthalmologist to determine the presence, absence or risk of developing glaucoma. Participants were notified of the grading result and recommendations for review. Main Outcome Measures: Incidence of undiagnosed glaucoma in a high-risk population. Results: Previously undiagnosed glaucoma was identified in 5% of those examined. For every 19 participants screened, one new case of previously undiagnosed case of glaucoma was identified. Additionally 15% of participants showed suspicious signs of glaucoma, and 6% had ocular hypertension. Conclusions: A telemedicine model is an efficient method for screening, grading and notifying participants of examination results. Nurses can be adequately trained to undertake the initial screening examinations, with grading of the results performed offsite by a suitably qualified ophthalmologist. Targeted screening for glaucoma increases the yield of identifying individuals with undiagnosed glaucoma or those at greatest risk. Cost efficiencies for this model of glaucoma screening should be further explored and implemented to prevent blindness from familial glaucoma. [ABSTRACT FROM AUTHOR]

Summary Background: Most patients affected with Duchenne muscular dystrophy (DMD) present with arrhythmias and cardiomyopathies. Drugs which potentially may induce tachycardia or hypertension could precipitate acute cardiac failure in these patients and should be avoided. Methods: Thirty anesthesia records of five experimental male golden retriever cross-bred dogs affected with X-linked muscular dystrophy (GRDM), a model of DMD, were retrospectively reviewed (DMD group). Anesthesia records were compared with those of 10 golden retriever dogs not affected with muscular dystrophy (control group). Records were excluded if dogs received anticholinergics or vasoactive amines. Anesthesia was induced with fentanyl followed by propofol, both intravenously. After orotracheal intubation, all dogs' lungs were mechanically ventilated. Anesthesia was maintained with infusion of fentanyl and propofol (DMD group) or isoflurane in oxygen (control group). Pure O [ABSTRACT FROM AUTHOR]

Marioni G, Staffieri A, Giacomelli L, Lionello M, Guzzardo V, Busnardo A & Blandamura S (2011) Histopathology [ABSTRACT FROM AUTHOR]

Psychiatric patient assaults are a serious community health hazard. Risk management strategies to identify common single precipitants have had limited value and this limitation has resulted in the emergence of multiple determinant studies. This 16-year retrospective study of assault precipitants in one, public sector mental health-care system assessed single common, immediate precipitants; the multiple clinical precipitants of history of violence, personal victimization, and substance use disorder (the violence triad); and both combined. Denial of services, acute psychoses, and excess sensory stimulation were the most common single precipitants. The multicomponent violence triad yielded greater association with subsequent assault than single precipitants. The combination of the violence triad and single precipitants did not yield statistically significant greater associations. Discussion of the clinical risk management implication, and methodological issues are presented. [ABSTRACT FROM AUTHOR]

J Oral Pathol Med (2011) : 55-60 Basaloid squamous cell carcinoma is an uncommon variant of squamous cell carcinoma (SCC). Angiogenin (ANG), a member of the ribonuclease super-family, is essential to tumor angiogenesis, but has also been implicated in tumor consolidation and proliferation. ANG expression was first investigated in 12 head and neck basaloid squamous cell carcinomas (HNBSCCs) and compared with a control group of 24 site- and stage-matched conventional SCCs to establish whether the supposedly more aggressive biological behavior of HNBSCCs might be ANG-related. No significant differences were found between HNBSCCs, and SCCs in terms of recurrence, disease-free survival (DFS), or overall survival rates. In HNBSCC, we identified a trend toward a significant inverse correlation between endothelial ANG expression and DFS (statistical trend, P = 0.08). Endothelial ANG expression did not differ significantly in HNBSCCs and SCCs. A high ANG expression in carcinoma cells was directly associated with pT in both the HNBSCC ( P = 0.04) and the SCC (statistical trend, P = 0.07) groups. ANG expression in carcinoma cells was significantly lower in HNBSCCs than in SCCs ( P = 0.005). All the biological mechanisms investigated to date, including ANG-mediated angiogenesis or cell proliferation, have failed to confirm that HNBSCCs have a more aggressive behavior than matched SCC. [ABSTRACT FROM AUTHOR]

Objective To compare the effects of two fractions of inspired oxygen (FiO2) (0.4 and 1) on lung aeration and gas exchange during general anaesthesia in cats. Study design Randomized, blinded, controlled study. Animals Thirty healthy, mixed breed, client owned female cats. Materials and methods Cats were premedicated intramuscularly with acepromazine (0.03 mg kg−1) and medetomidine (0.015 mg kg−1). Anaesthesia was induced with propofol (5 mg kg−1) and, after orotracheal intubation, maintained with isoflurane carried by either 100% oxygen (G100, n = 15) or an oxygen-air mixture with 40% oxygen (G40, n = 15). All cats were placed in dorsal recumbency and breathed spontaneously throughout the entire procedure. Following surgery (ovariectomy), a spiral computed tomography (CT) of the thorax was performed, arterial oxygen (PaO2) and carbon dioxide (PaCO2) tensions were measured and alveolar-arterial gradient of oxygen [P(A-a)O2] calculated. The CT images were analysed for lung aeration by the analysis of radiograph attenuations (Hounsfield units, HU), according to the following classification: hyperinflated area (−1000 to −900 HU), normally aerated area (−900 to −500 HU), poorly aerated area (−500 to −100 HU) and non-aerated area (−100 to +100 HU). The groups were compared using one-wayanova. Results Compared to G100, the normally-aerated lung area was significantly greater and the poorly-aerated and non-aerated areas were significantly smaller in G40. PaCO2 was similar in both groups. PaO2 and P(A-a)O2 were significantly higher in G100. In both groups, pulmonary atelectasis developed preferentially in the caudal lung fields. Conclusion In cats anaesthetised with isoflurane, the administration of an FiO2 of >0.9 significantly impaired lung aeration and gas exchange as compared to an FiO2 of 0.4. Clinical relevance An FiO2 of 0.4 may better preserve lung aeration and gas exchange in anaesthetised spontaneously breathing cats but monitoring is essential to ensure oxygenation is adequate. [ABSTRACT FROM AUTHOR]

Objective--To evaluate the effects of 10 cm H2O of positive end-expiratory pressure (PEEP) on lung aeration and gas exchange in mechanically ventilated sheep during general anesthesia induced and maintained with propofol. Animals--10 healthy adult Bergamasca sheep. Procedures--Sheep were sedated with diazepam (0.4 mg/kg, IV). Anesthesia was induced with propofol (5 mg/kg, IV) and maintained with propofol via constant rate infusion (0.4 mg/kg/min). Muscular paralysis was induced by administration of vecuronium (25 pg/kg, bolus IV) to facilitate mechanical ventilation. After intubation, sheep were positioned in right lateral recumbency and mechanically ventilated with pure oxygen and zero end-expiratory pressure (ZEEP). After 60 minutes, 10 cm H2O of PEEP was applied for 20 minutes. Spiral computed tomography of the thorax was performed, and data were recorded for hemodynamic and gas exchange variables and indicators of respiratory mechanics after 15 (T15), 30 (T30), and 60 (T60) minutes of ZEEP and after 20 minutes of PEEP (TPEEP). Computed tomography images were analyzed to determine the extent of atelectasis before and after PEEP application. Results--At TPEEP, the volume of poorly aerated and atelectatic compartments was significantly smaller than at T15, T30, and T60, which indicated that there was PEEP-induced alveolar recruitment and clearance of anesthesia-induced atelectasis. Arterial oxygenation and static respiratory system compliance were significantly improved by use of PEEP. Conclusions and Clinical Relevance---Pulmonary atelectasis can develop in anesthetized and mechanically ventilated sheep breathing pure oxygen; application of 10 cm H2O of PEEP significantly improved lung aeration and gas exchange. [ABSTRACT FROM AUTHOR]

Despite advances in laryngeal squamous cell carcinoma (LSCC) treatment, patient survival has not improved in the last two decades. Novel, more effective strategies should be based on receptor-mediated LSCC-targeted therapy. The epidermal growth factor receptor (EGFR) is the most widely studied molecular target. MASPIN multifaceted anti-tumor effects have been rarely evaluated in LSCC. The aims of this study were to investigate EGFR and MASPIN expression and the role of sub-cellular MASPIN localization in LSSC. MASPIN and EGFR expression and the sub-cellular localization of MASPIN were assessed using a computerized image analysis system in 108 consecutive cases of operable LSCC. The rates of occurrence of lymph node metastases and recurrent disease were lower in patients with a nuclear pattern of MASPIN expression ( p = 0.004, p = 0.0028). As expected, the loco-regional recurrence rate was lower in N0 patients ( p = 0.009), but the disease recurrence rate was even lower in N0 patients with a nuclear localization of MASPIN ( p = 0.020). Disease-free survival was longer in cases of LSCC with a nuclear MASPIN pattern ( p = 0.003). The intensity of EGFR reactivity and the EGFR area fraction were unrelated to the clinico-pathological and prognostic parameters in LSCC. A nuclear MASPIN pattern is a promising prognostic indicator in LSCC, but further evidence is needed before elective neck dissection can be considered for cN0 LSCCs with a non-nuclear MASPIN pattern. Although a better understanding of the mechanisms behind sub-cellular MASPIN localization is mandatory, re-activating nuclear MASPIN in association with specific chemotherapeutic agents may be an important goal in the treatment of LSCC. [ABSTRACT FROM AUTHOR]

Background: To review visual acuity outcomes from paediatric traumatic cataract and examine the mechanisms by which they occur. Methods: A retrospective review of paediatric patients (aged less than 18 years) who underwent lens surgery following ocular trauma, between 1992 and 2006 at the Royal Children's Hospital and Royal Victorian Eye and Ear Hospital in Melbourne. Data collected included gender, mechanism of injury, wound type, age at injury, age at surgery, refractive rehabilitation, complications and visual acuity outcome. Results: A total of 74 patients (75% male) were identified over the 15-year period, representing an incidence of 4.9 cases per year. The mean age at injury was 7.5 years. Sixty-five cataracts (88%) followed a penetrating eye injury, whereas only nine patients (12%) developed cataract after known blunt trauma. Fourteen patients (19%) underwent lensectomy at the time of primary wound repair and 45 patients (61%) underwent primary intraocular lens (IOL) implantation. Visual acuity outcomes ranged from 6/5 to no perception of light. Twenty-five patients (34%) achieved 6/12 or better in the injured eye, 23 patients (31%) achieved between 6/15 and 6/60, and 14 patients (19%) had visual acuity of less than 6/60. Twelve patients (16%) were lost to follow-up. Conclusion: In a paediatric population, cataract formation as a result of trauma requiring lensectomy is not uncommon. Males are more likely to suffer from such injury. A variety of sharp and blunt objects are the primary mechanism by which the injury is sustained with variable visual outcomes. [ABSTRACT FROM AUTHOR]

Conclusions. Human papilloma virus (HPV) was associated with sinonasal inverted papilloma (SIP) in 14/20 (70%) patients with a prevalence of HPV 6/11; alterations of the cell cycle proteins were statistically significant. Objectives. We investigated SIPs relationships between HPV infection and aberrant expression of cell cycle proteins. Materials and methods. Twenty SIPs were evaluated for p53, p16INK4a, pRb, p21WAF1, p27Kip1, cyclin D1 and Ki-67 expression by immunohistochemistry. HPV was investigated by polymerase chain reaction (PCR). Results. HPV DNA was detected in 14/20 patients with inverted papillomas (IPs) (70%). The majority of tumours showed strong p16, p21, p27, pRb and cyclin D1 staining and little or no p53 expression. Tumours harbouring dysplasia were significantly more likely to be p53-positive and exhibit up-regulated p21 and p27, and showed altered intensity and distribution of reactive cells into and through the epithelium. Dysplastic epithelium was strongly reactive for p16 and the MIB 1 labelling index was almost 20%. These findings were associated with expression of p53 in the same zones. Comparing the p53 reactivity with the presence of HPV DNA, SIPs were stratified as follows: HPV + p53-, 12 (63.15%); HPV + p53+, 2 (10.52%); HPV - p53+, 3 (15.78%) and HPV - p53-, 2 (10.52%). Statistical analysis showed that HPV presence correlated with p53-positive immunostaining ( p=0.045). [ABSTRACT FROM AUTHOR]

Conclusions. Human papilloma virus (HPV) was associated with sinonasal inverted papilloma (SIP) in 14/20 (70%) patients with a prevalence of HPV 6/11; alterations of the cell cycle proteins were statistically significant. Objectives. We investigated SIPs relationships between HPV infection and aberrant expression of cell cycle proteins. Materials and methods. Twenty SIPs were evaluated for p53, p16INK4a, pRb, p21WAF1, p27Kip1, cyclin D1 and Ki-67 expression by immunohistochemistry. HPV was investigated by polymerase chain reaction (PCR). Results. HPV DNA was detected in 14/20 patients with inverted papillomas (IPs) (70%). The majority of tumours showed strong p16, p21, p27, pRb and cyclin D1 staining and little or no p53 expression. Tumours harbouring dysplasia were significantly more likely to be p53-positive and exhibit up-regulated p21 and p27, and showed altered intensity and distribution of reactive cells into and through the epithelium. Dysplastic epithelium was strongly reactive for p16 and the MIB 1 labelling index was almost 20%. These findings were associated with expression of p53 in the same zones. Comparing the p53 reactivity with the presence of HPV DNA, SIPs were stratified as follows: HPV + p53−, 12 (63.15%); HPV + p53+, 2 (10.52%); HPV − p53+, 3 (15.78%) and HPV − p53−, 2 (10.52%). Statistical analysis showed that HPV presence correlated with p53-positive immunostaining ( p=0.045). [ABSTRACT FROM AUTHOR]

Objective To test the hypothesis that subarachnoid administration of buprenorphine and lidocaine provides more intense and longer lasting perioperative analgesia with less side effects than xylazine and lidocaine in goats. Study design Randomized, blinded, controlled study. Study animals Ten healthy female goats randomly assigned to two groups of five animals each. Methods After sedation with acepromazine (0.1 mg kg−1) intravenously (IV), lidocaine 2% (0.1 mL kg−1) combined with either xylazine (0.05 mg kg−1; Group X) or buprenorphine (0.005 mg kg−1; Group B) were injected intrathecally at the lumbo-sacral junction prior to stifle surgery. Electrocardiogram, heart rate, direct systolic, mean, and diastolic arterial blood pressures, rectal temperature and arterial blood gases were recorded as were post-operative sedation and pain scores using a visual analogue and numeric rating scale, respectively. Data were analyzed with one-wayanova for repeated measures, one-wayanova, Friedman’s and Kruskal–Wallis tests as necessary ( p < 0.05). Results Surgery was successfully performed under both analgesia protocols. Total pain and sedation scores were significantly lower in the B as compared with X group from 3–24 hours and 30–120 minutes, respectively after subarachnoid drug administration (SDA). Heart rate and arterial blood pressures decreased post SDA and were consistently lower in X versus B ( p < 0.05). In B arterial blood gas parameters did not change post SDA, but in group X PaCO2 increased slightly within 15 minutes of SDA and remained elevated for at least 3 hours ( p < 0.05). Conclusion In these goats intrathecal administration of buprenorphine and lidocaine produced more profound and longer lasting analgesia with less sedation and hemodynamic and respiratory impairment than xylazine with lidocaine. Clinical relevance In these goats undergoing hind limb surgery, subarachnoid buprenorphine/lidocaine offered more intense and longer lasting analgesia than a xylazine/lidocaine combination, with less sedation and impairment of cardiopulmonary function. [ABSTRACT FROM AUTHOR]

The article presents an exploration into the dramatic-musical tradition of grand opera in pre-unification Italy during the early to mid 19th century. Details are given examining the cross-cultural influences of the form from different countries, particularly between France and Italy, and the political reception of the form within Italian culture. An overview of French grand opera which was adapted and performed in Italy is also given, highlighting ways in which the texts were altered or censored within the Italian political culture.

Objective--To compare the effect of 2 concentrations of oxygen in inspired gas (fraction of inspired oxygen [Fio2] 1.0 or 0.4) on pulmonary aeration and gas exchange in dogs during inhalation anesthesia. Animals--20 healthy dogs. Procedures--Following administration of acepromazine and morphine, anesthesia was induced in each dog with thiopental and maintained with isoflurane in 100% oxygen (100% group; n = 10) or a mixture of 40% oxygen and air (40% group; 10). Dogs were placed in dorsal recumbency and were mechanically ventilated. After surgery, spiral computed tomography (CT) of the thorax was performed and Pao2, Paco2, and the alveolar-arterial oxygen tension difference (P[A-a]o2) were assessed. The lung CT images were analyzed, and the extent of hyperinflated (-1,000 to -901 Hounsfield units [HUs]), normally aerated (-900 to -501 HUs), poorly aerated (-500 to -101 HUs), or nonaerated (-100 to +100 HUs) areas was determined. Results--Compared with the 100% oxygen group, the normally aerated lung area was significantly greater and the poorly aerated and nonaerated areas were significantly smaller in the 40% oxygen group. The time to CT (duration of surgery) was similar in both groups. Although Paco2 was similar in both groups, Pao2 and P[A-a]o2 were significantly higher in the 100% oxygen group. In both groups, pulmonary atelectasis developed preferentially in caudal lung fields. Conclusion and Clinical Relevance--In isoflurane-anesthetized dogs, mechanical ventilation with 40% oxygen appeared to maintain significantly better lung aeration and gas exchange than ventilation with 100% oxygen. [ABSTRACT FROM AUTHOR]

Any attempt to deal with the dramaturgy of French grand opéra cannot neglect the work of Eugène Scribe, who made a fundamental contribution to the definition of the genre. And yet, the answers to two basic questions are less obvious: how did Scribe plan the libretti for his grands opéras? are his texts characterized by structural constants - such as those in Italian opera at that time - or do each of them have an original structure? In order to clarify these issues, the essay proposes a re-reading of Scribe's greatest masterpieces from the "golden age" of the tradition (from the late 1820s to the 1840s): La Muette de Portici, Robert le Diable, Gustave III, La Juive, Les Huguenots, Dom Sébastien, Le Prop hète. The essay dissects the core dramatic ingredients (narrative schemes, characters and roles, dramatic objectives, tableaux); structural articulations (macro- and micro-forms); the arrangement of dramatic material; and, last but not least, the techniques used to create suspense - an element which is Scribe's fingerprint. We can approach Scribe's grand opéra style by contrasting it with two different operatic models: on the one hand, the dramaturgy of French serious opera before the tradition of Romantic grand opéra (e.g. Fernand Cortez by Jouy and Spontini), characterized by static conflicts and a low level of dramatic tension further slowed down by the insertion of ample ceremonial tableaux; on the other hand, the structure of Italian opera of the 1820s and 30s, for which the essay reconstructs the original marriage - first achieved by Romani - between the new formal structures crafted by Rossini and the dramatic models borrowed mainly from boulevard theaters. In particular, Scribe's grand opéra represents at the same time the synthesis and the transcendence of neo-classical tragédie and Italian opera. Scribe's objective becomes clear: to bring mélodrame to the Opéra for the new bourgeois public that had replaced the aristocratic one, and simultaneously to "ennoble" it (both the genre and the public), guaranteeing the past grandeur by resuming the five-act structure and choosing universal themes. In order to fill such a gigantic container, Scribe's strategy does not involve an expansion of dramatic material (as Jouy had done) but rather its intensification (as in the Italian approach). In essence, Scribe takes three basic steps: (a) he multiplies the basic elements: he doubles the plot intrigue and increases the number of characters, dramatic objectives, climaxes, scènes à faire and tableaux, also amplifying the functions of the latter; (b) he increases the suspense combining several different procedures and creating tension - especially through the massive use of dramatic irony - between sequences of short, middle, and long span (scene, act, entire opera); (c) he contrasts the centrifugal push of such disparate materials, both through a formal framework that projects the microstructure of the drama onto the macro-scale, and also through a series of unifying elements which give the composition an organic structure. The essay also deals with other aspects of Scribe's grand opéra: from the choice of underlying themes (such as the antagonistic view of history or the omnipresent motive of revenge), to the originality of the texts prepared for Meyerbeer (especially Robert le Diable) and the relationship between Scribe and Romantic culture (Hugo's theatrical works and the historical novel). The essay thus contradicts entrenched stereotypes about grand opéra: its incoherent structure, the slowness of its dramatic rhythm, the subordination of action to spectacle, and its incompatibility with Italian opera. At the same time it frees Scribe from the shadow of a hurried and serialized production.… [ABSTRACT FROM AUTHOR]

Conclusions: In order to confirm these preliminary results, a prospective double-blind study has been instituted in Padova University ENT Section to compare the efficacy of sulphurous-arsenical-ferruginous thermal water nasal irrigations vs isotonic sodium chloride solution nasal irrigations after functional endoscopic sinus surgery for chronic sinusitis. Objectives: Despite their widespread use, much uncertainty exists about the indications and therapeutic mechanisms of nasal thermal water inhalations in the treatment of sinonasal chronic disease. The aim of the present study was to evaluate the effects of sulphurous-arsenical-ferruginous thermal water inhalations on nasal respiratory flow, mucociliary transport, nasal cytology, and chemo-physics of nasal mucus in a group of consecutive patients with chronic sinonasal disease. Patients and methods: Thirty-seven patients with chronic sinonasal disease underwent a 12-day course of sulphurous-arsenical-ferruginous thermal water warm vapour inhalations (38°C) followed by nasal aerosol of the same thermal water (7 microns micelle). Results: This preliminary study showed that a course of sulphurous-arsenical-ferruginous thermal water inhalations determined a significant improvement in nasal flow and reduction of nasal resistance; a statistically significant reduction of mean mucociliary transport time, from pathologic to physiologic values, has also been shown. Statistical analysis of our data confirmed that the presence of nasal bacteria was significantly reduced by thermal water inhalations. [ABSTRACT FROM AUTHOR]

Background Carbon dioxide (CO2) embolism is a possible complication of capnoperitoneum during laparoscopic surgery. Experimentally induced venous CO2 embolism has been studied in pigs. In this paper we report a case of spontaneous CO2 embolism. Observations A 4-month-old Large White pig weighing 20 kg underwent experimental laparoscopic surgery under general anaesthesia. Monitoring consisted of pulse oximetry, capnography, airway pressure, electrocardiography, invasive arterial and central venous blood pressures, and arterial blood-gas analysis. Shortly after the start of laparoscopy and onset of CO2 insufflation, sudden decreases in end-tidal CO2 (Pe′CO2), haemoglobin saturation of oxygen (SpO2), systolic arterial blood pressure and heart rate were observed. Airway pressure increased and pulmonary compliance decreased simultaneously. Insufflation was immediately discontinued and epinephrine (2 mg IV), atropine (0.5 mg IV) and a 50 mL bolus of a polygeline solution were administered without effect. At this time arterial blood-gas analysis revealed a pH of 7.29 and a PaCO2 of 6.8 kPa (51.2 mmHg); PaO2 was 26.6 kPa (199.5 mmHg). After 4 minutes asystole occurred. Conclusions The sudden decrease of Pe′CO2 and lung compliance combined with the sudden decrease in systolic blood pressure, heart rate and a poor response to resuscitation suggest a case of fatal gaseous venous embolism. [ABSTRACT FROM AUTHOR]

Purpose: To describe changes in the management of retinoblastoma in Victoria and to review the effect of newer, conservative treatments on preservation of eyes, visual outcome and mortality by comparing a similar group of patients treated over successive time intervals. Methods: A retrospective analysis of all cases of retinoblastoma diagnosed and treated in Victoria between 1956 and 2000 was conducted. Historical data on 77 cases previously published by O’Day et al. was used for the period 1956−1976 (series 1). Data on 88 cases recorded in the Royal Children's Hospital (Melbourne) Retinoblastoma Database was used for the period 1976−2000. The latter group was subdivided into those treated between 1976 and 1989 (series 2), prior to the advent of modern eye saving treatments, and those treated subsequent to their introduction from 1990 to 2000 (series 3). Results: In unilateral retinoblastoma, final enucleation rates for 1956−1976 (series 1) and 1976−1989 (series 2) were almost identical, being 98% and 97% of affected eyes, respectively ( P = 1.00). Despite the newer treatments used after 1990 (series 3), 88% of affected eyes were still enucleated, representing a statistically similar outcome to series 2 ( P = 0.33). In bilateral retinoblastoma, primary enucleation of the more involved eye was similar for series 1 (84%) and 2 (80%) but series 3 (41%) was substantially less than series 2 ( P = 0.04) following the increased use of conservative treatments. In series 3, 59% of more involved eyes were treated conservatively compared with 16% ( P = 0.007) and 20% ( P = 0.04) for series 1 and 2, respectively. Despite attempts at eye salvage, the failure rate was higher in series 3 (29%) yielding a final enucleation rate of 70%, which represented a modest downward trend in the numbers of eyes finally enucleated; 84% (series 1), 73% (series 2) and 70% (series 3) (test for trend, P = 0.33). Bilateral enucleation rates were significantly lower, from 36% and 30% in series 1 and 2, respectively, to 7% in series 3 (test for trend, P = 0.02). As a consequence, more eyes were preserved over time, being 20/50 (40%) in series 1, 15/30 (50%) in series 2 and 21/34 (62%) in series 3. Comparison of visual outcome was hampered by incomplete data in series 1 but it appeared series 2 and 3 achieved better visual acuities with 67% and 62% of preserved eyes in bilateral cases measuring equal to or better than 6/12. Mortality rates in all series were low, being 7.8% in series 1, 4.5% in series 2 and nil in series 3. Conclusions: Following the introduction of new conservative treatments, there has been an increase in preservation of eyes and improved visual outcome, and a dramatic decrease in numbers of bilateral enucleations without adversely affecting survival. [ABSTRACT FROM AUTHOR]

In recent decades, functional laryngeal surgery has become a widespread method of treating glottic and supraglottic neoplasms, since it ensures an oncological outcome comparable to that of radical surgery and functional results that are conducive to a good quality of life. The most common postoperative complaints for this type of surgery are swallowing disorders, which can thwart good surgical results, especially when severe. Five supracricoid laryngectomees with swallowing disorders unresolved by speech therapy were treated by percutaneous injection of botulinum toxin under electromyographic control. All patients presented marked improvement in their complaints. A single session of botulinum toxin type A treatment resolved the dysphagia in all cases. [ABSTRACT FROM AUTHOR]

Piezoelectric bone cutting has gained popularity in neurosurgical osteotomies due to perceived lower trauma compared to rotary instruments. However, histological confirmation of its decreased aggressiveness is lacking, hindering conclusive proof. This study compares the bony and neuro-meningeal invasiveness of piezoelectric craniotomy with high-speed drill techniques. Histological data from 21 sheep undergoing piezoelectric craniotomy and 19 sheep subjected to high-speed electric drill craniotomy were compared. Piezoelectric craniotomy utilized a 0.35 mm micro saw titanium nitride coated. Outcome parameters included the detection of the "smear layer," average osteoblast count per high-power field, and residual bone matrix for bony invasiveness assessment. Parameters for meningeal and brain parenchymal invasiveness included pachymeningeal and leptomeningeal injury, gliosis, and histiocytic infiltration. Statistical significance was determined at P < 0.05. Results showed the Piezo group had fewer frequent smear layers (P <0.001), higher residual bone matrix (P < 0.05), and greater osteoblast counts per high-power field (P < 0.05). Additionally, the Piezo group exhibited lower rates of leptomeningeal injury, cerebral gliosis, and histiocytic infiltration (P < 0.05). Piezoelectric craniotomy preserves residual osteoblast viability and leptomeningeal integrity while demonstrating lower rates of thermally induced gliosis and histiocytic infiltration compared to high-speed drills. This suggests the piezoelectric osteotome's minimal invasiveness in bone, meningeal, and brain tissue. [ABSTRACT FROM AUTHOR]

This study was designed as a randomized, placebo-controlled, double-blinded, cross-over trial performed to investigate the effects of a dietary supplement containing undenatured type II collagen (UCII®) and Boswellia Serrata on mobility, pain and joint metabolism in mild moderate osteoarthritis (OA) in dogs. A total of 60 dogs with mobility problems were evaluated and enrolled in the study. Seventeen of these dogs with mild/moderate OA were randomized to receive the product A (UCII® + Boswellia Serrata supplement–UCII®-BW) or product B (Placebo -PL), 1 chew per day for 8 weeks by oral route, and repeated in a crossover design after 4 weeks of washout period. All the subjects had veterinary evaluations during the trial and owners were requested to fill out a questionnaire on mobility impairment using the Liverpool Osteoarthritis in dogs scale (L.O.A.D.) at each time of the study. Objective tools were used to assess mobility, activity, and pain. Metabolomic analysis was performed on synovial fluid of most affected joint at the beginning and the end of the study. The results proved that UCII®+Boswellia serrata supplemented group over a period of eight weeks results in an improvement of mobility impairment, already at 4 weeks of administration, according to the owner´s evaluation. In contrast, its absence increased the risk of OA crisis and decreased the pain threshold on the most affected joint. Furthermore, the synovial fluid metabolic profile showed moderate differences between the beginning and the end of the supplementation period, with a particular influence associated to the time of UCII®-BW administration. [ABSTRACT FROM AUTHOR]

Demonstrates that tutorial interaction can be structured so that same-ability age mates can scaffold each other's higher order thinking and learning. Findings of studies conducted; Reference to some of the tutorial interactions which promote learning; Methodology used in study.

To compare the effects of three recruitment airway pressures (RP aw) on lung aeration and volumes in mechanically ventilated dogs during propofol anesthesia. Prospective, crossover randomized experimental study. A total of eight healthy anesthetized experimental Beagle dogs in dorsal recumbency. Dogs were mechanically ventilated with a tidal volume of 15 mL kg–1 and zero positive end-expiratory pressure and 100% oxygen. Three maneuvers consisting of a 30 second inspiration at RP aw s of 15 (RP aw 15), 25 (RP aw 25) and 35 (RP aw 35) cmH 2 O were performed randomly, 15 minutes apart. Changes in lung aeration and lung deformation were compared with end-expiratory baseline (before the application of each RP aw) and between- RP aw s using computed tomography scans and calculations of global lung strain. Between-group comparisons were performed with one-way anova for repeated measures followed by Tukey test for multiple comparisons. A p value < 0.05 was considered significant. The amount of nonaeration was minimal (<1%) at baseline and not different with the application of the RP aw s. The amount of hypoaeration and normoaeration during baseline decreased with all RP aw s (p < 0.001). There was no difference between RP aw s regarding hypoaeration (all p > 0.999), whereas normoaeration was higher at RP aw 15 than RP aw 25 and RP aw 35 (p < 0.009). Compared with baseline, the fraction of hyperaerated alveoli increased with each RP aw (p < 0.001) and was lower during RP aw 15 than RP aw 25 and RP aw 35 (both p ≤ 0.007). Global lung strain was lower during RP aw 15 than at higher RP aw (p < 0.001). A RP aw of 15 cmH 2 O for 30 seconds was the recommended RP aw because it was as effective at reversing hypoaeration as RP aw s of 25 and 35 cmH 2 O but with less hyperaeration and potential for overdistension of the lungs in this particular population of dogs with negligible atelectasis. [ABSTRACT FROM AUTHOR]