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Background: Traumatic carotid artery thrombosis is uncommon and it usually results from penetrating injuries and less commonly secondary to blunt trauma. It can lead to delayed clinical presentation, which leads to delay in the diagnosis. Soldiers in combat scenario also can present with such an illness, which results from varied modes of injuries. Our case illustrates an unusual cause of carotid thrombosis., Case Presentation: Our patient is a 37-year-old soldier who developed neck pain and headache following a 5 km training run with rifle on the shoulder and subsequently developed left upper limb weakness and evaluation revealed extracranial right internal carotid thrombosis. He was managed with anticoagulants and antiplatelets with complete resolution of the thrombosis and complete recovery of the weakness., Conclusion: Blunt trauma to the neck in the form of carrying a rifle for a prolonged duration can result in injury to the carotid vessels leading to delayed neurological presentation. Educating the troops regarding such a mode of illness will prevent such a catastrophic nature of vascular injury resulting in ischaemic stroke., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Purpose: Focal cortical dysplasia (FCD) is one of the most common causes of drug resistant epilepsy. Our aim was to evaluate the role of presurgical noninvasive multimodality imaging techniques in selecting patients with refractory epilepsy and focal cortical dysplasia for epilepsy surgery and the influence of the imaging modalities on long-term seizure freedom., Materials and Methods: We performed a retrospective analysis of data of 188 consecutive patients with FCD and refractory epilepsy with at least 2 years of postsurgery follow-up. Predictors of seizure freedom and the sensitivity of neuroimaging modalities were analyzed., Results: MR imaging showed clear-cut FCD in 136 (72.3%) patients. Interictal FDG-PET showed focal hypo-/hypermetabolism in 144 (76.6%); in 110 patients in whom ictal SPECT was performed, focal hyperperfusion was noted in 77 (70.3%). Focal resection was the most common surgery performed in 112 (59.6%). Histopathology revealed FCD type I in 102 (54.3%) patients. At last follow-up, 124 (66.0%) were seizure-free. Complete resection of FCD and type II FCD were predictors of seizure freedom. Localization of FCD on either MR imaging or PET or ictal SPECT had the highest sensitivity for seizure freedom at 97.5%. Among individual modalities, FDG-PET had the highest sensitivity (78.2%), followed by MR imaging (75.8%) and ictal SPECT (71.8%). The sensitivity of MR imaging to localize type I FCD (60.8%) was significantly lower than that for type II FCD (84.8%, P < .001). Among 37 patients with subtle MR imaging findings and a focal FDG-PET pattern, 30 patients had type I FCD., Conclusions: During presurgical multimodality evaluation, localization of the extent of the epileptogenic zone in at least 2 imaging modalities helps achieve seizure freedom in about two-thirds of patients with refractory epilepsy due to FCD. FDG-PET is the most sensitive imaging modality for seizure freedom, especially in patients with type I FCD., (© 2019 by American Journal of Neuroradiology.)

Quality protein maize (QPM) is nutritionally improved maize which has twice the amount of lysine and tryptophan than normal maize. The present study evaluated the effect of different proteins namely egg white proteins (EWP), casein, whey protein isolate, soy protein isolate (SPI) on characteristics of gluten free QPM based muffins. QPM muffins without any added protein served as control and muffins prepared using wheat and EWP served as reference. Effect of addition of different proteins on pasting properties revealed that the thermal stability of QPM flour increased as indicated by decrease in breakdown viscosity. The effect of added proteins on QPM muffin-making properties was evaluated for rheology of batter and physicochemical, texture, color and sensory characteristics of muffins. Dynamic rheology showed that storage modulus (G') and loss modulus (G″) of batter with SPI was the highest while batter with EWP showed lowest value. QPM-EWP muffins were softer, chewy and springier and had more specific volume than control muffins and were comparable to reference muffins. Inclusion of all proteins increased L* values (lightness) and decreased a* (redness/greenness) and b* (yellow/blueness) values of QPM based muffins. Sensory analysis revealed that gluten free QPM muffin prepared from EWP were acceptable with a sensory score of 7.97 which was comparable to reference muffins (8.03)., Competing Interests: Compliance with ethical standardsThe authors declare that they have no conflict of interest.

Present study was undertaken to optimize the process conditions for development of food grains (maize, defatted soy flour, sesame seed)-banana based nutritious expanded snacks using extrusion processing. Experiments were designed using Box-Behnken design with banana pulp (8-24 g), screw speed (300-350 rpm) and feed moisture (14-16% w.b.). Seven responses viz. expansion ratio (ER), bulk density (BD), water absorption index (WAI), protein, minerals, iron and sensory acceptability were considered for optimizing independent parameters. ER, BD, WAI, protein content, total minerals, iron content, and overall acceptability ranged 2.69-3.36, 153.43-238.83 kg/m 3 , 4.56-4.88 g/g, 15.19-15.52%, 2.06-2.27%, 4.39-4.67 mg/100 g (w.b.) and 6.76-7.36, respectively. ER was significantly affected by all three process variables while BD was influenced by banana pulp and screw speed only. Studied process variables did not affected colour quality except 'a' value with banana pulp and screw speed. Banana pulp had positive correlation with water solubility index, total minerals and iron content and negative with WAI, protein and overall acceptability. Based upon multiple response analysis, optimized conditions were 8 g banana pulp, 350 rpm screw speed and 14% feed moisture indicating the protein, calorie, iron content and overall sensory acceptability in sample as 15.46%, 401 kcal/100 g, 4.48 mg/100 g and 7.6 respectively.

Unlabelled: Hertz's theory of contact stresses was applied to predict the splitting of guar seeds during uni-axial compressive loading between 2 rigid parallel plates. The apparent modulus of elasticity of guar seeds varied between 296.18 and 116.19 MPa when force was applied normal to hilum joint (horizontal position), whereas it varied between 171.86 and 54.18 MPa when force was applied in the direction of hilum joint (vertical position) with in moisture content range of 5.16% to 15.28% (d.b.). At higher moisture contents, the seeds yielded after considerable deformation, thus showing ductile nature. Distribution of stresses below the point of contact were plotted to predict the location of critical point, which was found at 0.44 to 0.64 mm and 0.37 to 0.53 mm below the contact point in vertical and horizontal loading, respectively, depending upon moisture content. The separation of cotyledons from each other initiated before yielding of cotyledons and thus splitting of seed took place. The relationships between apparent modulus of elasticity, principal stresses with moisture content were described using second-order polynomial equations and validated experimentally., Practical Application: Manufacture of guar gum powder requires dehulling and splitting of guar seeds. This article describes splitting behavior of guar seeds under compressive loading. Results of this study may be used for design of dehulling and splitting systems of guar seeds., (© 2012 Institute of Food Technologists®)

Gall bladder distension with acute viral acalculous cholecystitis is a rare event in pediatric cases with a high incidence of perforation, gallbladder necrosis and mortality. We report a two and a half year old female child presenting with fever, vomiting, pain abdomen, mild hepatosplenomegaly and tenderness in right hypochondrium. Laboratory investigations revealed hyperbilirubinemia and elevated alkaline phosphatase, but there was no evidence of bacterial or parasitic infection. Serology for viral hepatitis suggested acute Hepatitis A infection. Ultrasonographically, distended inflamed gallbladder without calculous was observed. Finally acute acalculous cholecystitis due to Hepatitis A virus was diagnosed and the child responded to the conservative management.

Branchial apparatus consists of six pairs of mesodermal arches. Invagination of endoderm from inside and ectoderm from outside are known as pharyngeal pouch and branchial clefts respectively. Incomplete fusion of these structure lead to formation of branchial sinus/ fistula. Anomoly of second arch is commonest and manifests as Branchial sinus. We present such a case in a 18 years old boy.

We report a virtual Compton scattering study of the proton at low c.m. energies. We have determined the structure functions P(LL)-P(TT)/epsilon and P(LT), and the electric and magnetic generalized polarizabilities (GPs) alpha(E)(Q2) and beta(M)(Q2) at momentum transfer Q(2)=0.92 and 1.76 GeV2. The electric GP shows a strong falloff with Q2, and its global behavior does not follow a simple dipole form. The magnetic GP shows a rise and then a falloff; this can be interpreted as the dominance of a long-distance diamagnetic pion cloud at low Q2, compensated at higher Q2 by a paramagnetic contribution from piN intermediate states.

Dermoid cysts are commonly found through out the body . In the oral cavity, though rare, dermoids commonly present sublingually. Typically, they present as slow growing masses, causing elevation of the tongue, interference with speech and swallowing. We report a case of sublingual dermoid cyst in a two years old female child.

We have previously shown that mitochondrial-aconitase binds specifically to the 3' terminal 42 nucleotides of the Murine hepatitis virus (MHV) RNA along with three additional proteins of 70, 58 and 40 kDa to form a stable RNA-protein complex. Supershift and western blot assays have identified these three proteins as mitochondrial HSP70 (mtHSP70), HSP60, and HSP40. A series of co-immunoprecipitation assays have established that these four MHV RNA binding proteins are associated, even in the absence of MHV RNA. However, the presence of a synthetic RNA containing the sequence bound by these four proteins does increase the amount of co-precipitated protein, in particular the amount of HSP60 which is brought down with antibodies directed against HSP40 and mtHSP70. We have provided evidence for the interaction of these four proteins with the 3' end region of MHV RNA in infected cells by a series of immunoprecipitation RT-PCR assays. We believe it is likely that MHV RNA interacts with m-aconitase prior to its import into mitochondria in cooperation with extra-mitochondrial mtHSP70, HSP60, and HSP40.

We have measured the proton recoil polarization in the 4He(e-->,e(')p-->)4H reaction at Q(2)=0.5, 1.0, 1.6, and 2.6 (GeV/c)(2). The measured ratio of polarization transfer coefficients differs from a fully relativistic calculation, favoring the inclusion of a medium modification of the proton form factors predicted by a quark-meson coupling model. In addition, the measured induced polarizations agree reasonably well with the fully relativistic calculation indicating that the treatment of final-state interactions is under control.

The ratio of the electric and magnetic form factors of the proton G(E(p))/G(M(p)), which is an image of its charge and magnetization distributions, was measured at the Thomas Jefferson National Accelerator Facility (JLab) using the recoil polarization technique. The ratio of the form factors is directly proportional to the ratio of the transverse to longitudinal components of the polarization of the recoil proton in the elastic e(-->)p---> e(-->)p reaction. The new data presented span the range 3.5< Q(2)< 5.6 GeV(2) and are well described by a linear Q(2) fit. Also, the ratio sqrt[Q(2)] F(2(p))/F(1(p)) reaches a constant value above Q(2) = 2 GeV(2).

Mouse hepatitis virus (MHV), a member of the Coronaviridae, contains a polyadenylated positive-sense single-stranded genomic RNA which is 31 kb long. MHV replication and transcription take place via the synthesis of negative-strand RNA intermediates from a positive-strand genomic template. A cis-acting element previously identified in the 3' untranslated region binds to trans-acting host factors from mouse fibroblasts and forms at least three RNA-protein complexes. The largest RNA-protein complex formed by the cis-acting element and the lysate from uninfected mouse fibroblasts has a molecular weight of about 200 kDa. The complex observed in gel shift assays has been resolved by second-dimension sodium dodecyl sulfate-polyacrylamide gel electrophoresis into four proteins of approximately 90, 70, 58, and 40 kDa after RNase treatment. Specific RNA affinity chromatography also has revealed the presence of a 90-kDa protein associated with RNA containing the cis-acting element bound to magnetic beads. The 90-kDa protein has been purified from uninfected mouse fibroblast crude lysates. Protein microsequencing identified the 90-kDa protein as mitochondrial aconitase. Antibody raised against purified mitochondrial aconitase recognizes the RNA-protein complex and the 90-kDa protein, which can be released from the complex by RNase digestion. Furthermore, UV cross-linking studies indicate that highly purified mitochondrial aconitase binds specifically to the MHV 3' protein-binding element. Increasing the intracellular level of mitochondrial aconitase by iron supplementation resulted in increased RNA-binding activity in cell extracts and increased virus production as well as viral protein synthesis at early hours of infection. These results are particularly interesting in terms of identification of an RNA target for mitochondrial aconitase, which has a cytoplasmic homolog, cytoplasmic aconitase, also known as iron regulatory protein 1, a well-recognized RNA-binding protein. The binding properties of mitochondrial aconitase and the functional relevance of RNA binding appear to parallel those of cytoplasmic aconitase.

Hepatitis E virus (HEV) causes enterically transmitted epidemic and sporadic viral hepatitis affecting millions of people in the developing world. Different geographical isolates of HEV show a high degree of homology at the nucleotide and amino acid levels. The approximately 7.2 kb RNA genome has three open reading frames of which ORF1 is predicted to code for the viral nonstructural polyprotein. The expression, processing and properties of the nonstructural ORF1 polyprotein have not been reported so far. In this study, the complete HEV ORF1 was reconstructed from overlapping fragments amplified by polymerase chain reaction (PCR) of total RNA isolated from the bile fluid of a rhesus monkey experimentally infected with HEV isolate from an epidemic. The complete assembled ORF1 was sequenced using HEV specific primers. The ORF1 polyprotein was expressed in E. coli, in a cell free translation system and in HepG2 cells, and was characterized by western blotting and immunoprecipitation using acute phase patient serum as well as polyclonal antibodies raised against defined parts of the ORF1 polyprotein. The nonstructural polyprotein of HEV was expressed as a 186 kDa protein. No processing was observed into discrete units, either in-vitro based on a kinetic analysis, or in HepG2 cells based on immunoprecipitation., (Copyright 2000 Wiley-Liss, Inc.)

Background: Hepatitis E virus (HEV) is responsible for most of the hepatitis epidemics in the developing world and it frequently affects young adults. Therefore, common perception is that it does not affect children., Methods: A group of 20 school children (13 years old) were possibly exposed to hepatitis E virus infection during a 2 day trekking trip. Epidemiological and clinical information was correlated to the presence of the hepatitis E virus genome and antibodies to HEV structural and non-structural proteins found in the blood of the children, using polymerase chain reaction and line immunoassay techniques., Results: Ten children developed icteric hepatitis, seven prodrome-like illness without jaundice while three remained asymptomatic. Immunoglobulin M (IgM) antibodies to open reading frame (ORF)2 protein (pORF2) were detected in all 19 children tested, whereas 11 and 10 of the children were positive for IgM antibodies against ORF1 (pORF1) and ORF3 (pORF3) proteins, respectively. The rate of HEV infection was found to be 85%. Viraemia was observed in 11 children and was present in four of the seven anicteric patients (55%) compared with six of the nine (66%) icteric patients. One child without any symptom also had viraemia., Conclusions: The data obtained indicate a high susceptibility of children for HEV infection and a frequently prolonged viraemia in those infected.

The profiles of patients with fulminant hepatic failure (FHF) from developing countries have not been reported earlier. The current study was conducted prospectively, at a single tertiary care center in India, to document the demographic and clinical characteristics, natural course, and causative profile of patients with FHF as well as to define simple prognostic markers in these patients. Four hundred twenty-three consecutive patients with FHF admitted from January 1987 to June 1993 were included in the study. Each patient's serum was tested for various hepatotropic viruses. Univariate Cox's regression for 28 variables, multivariate Cox's proportional hazard regression, stepwise logistic regression, and Kaplan-Meier survival analysis were done to identify independent predictors of outcome at admission. All patients presented with encephalopathy within 4 weeks of onset of symptoms. Hepatotropic viruses were the likely cause in most of these patients. Hepatitis A (HAV), hepatitis B (HBV), hepatitis D (HDV) viruses, and antitubercular drugs could be implicated as the cause of FHF in 1.7% (n= 7), 28% (n= 117), 3.8% (n= 16), and 4.5% (n= 19) patients, respectively. In the remaining 62% (n= 264) of patients the serological evidence of HAV, HBV, or HDV infection was lacking, and none of them had ingested hepatotoxins. FHF was presumed to be caused by non-A, non-B virus(es) infection. Sera of 50 patients from the latter group were tested for hepatitis E virus (HEV) RNA and HCV RNA. In 31 (62%), HEV could be implicated as the causative agent, and isolated HCV RNA could be detected in 7 (19%). Two hundred eighty eight (66%) patients died. Approximately 75% of those who died did so within 72 hours of hospitalisation. One quarter of the female patients with FHF were pregnant. Mortality among pregnant females, nonpregnant females, and male patients with FHF was similar (P > .1). Univariate analysis showed that age, size of the liver assessed by percussion, grade of coma, presence of clinical features of cerebral edema, presence of infection, serum bilirubin, and prothrombin time prolongation over controls at admission were related to survival (P < .01). The rapidity of onset of encephalopathy and cause of FHF did not influence the outcome. Cox's proportional hazard regression showed age > or = 40 years, presence of cerebral edema, serum bilirubin > or = 15 mg/dL, and prothrombin time prolongation of 25 seconds or more over controls were independent predictors of outcome. Ninety-three percent of the patients with three or more of the above prognostic markers died. The sensitivity, specificity, positive predictive value, and the negative predictive value of the presence of three or more of these prognostic factors for mortality was 93%, 80%, 86%, and 89.5%, respectively, with a diagnostic accuracy of 87.3%. We conclude that most of our patients with FHF might have been caused by hepatotropic viral infection, and non-A, non-B virus(es) seems to be the dominant hepatotropic viral infection among these patients. They presented with encephalopathy within 4 weeks of the onset of symptoms. Pregnancy, cause, and rapidity of onset of encephalopathy did not influence survival. The prognostic model developed in the current study is simple and can be performed at admission.

The aetiological agents responsible for, and the outcome of, acute liver failure were investigated prospectively in 44 children (29 males, 15 females) attending a tertiary health care facility in India. The children were between the ages of 2 months and 13 years. Studies for viral infections and other etiologies could be carried out in 40 patients. Specific aetiological labels were possible in 35 (87.5%) patients. Thirty (75%) had evidence of acute viral hepatitis. Acute hepatitis E virus (HEV) infection was found in a total of 18 children, with hepatitis A (HAV) in 16, hepatitis B in 5, and C in 1. Seven had isolated infection with hepatitis E, five with A, and four with B. Nine had both E and A infection. Superinfection of HEV was observed in a child with Indian childhood cirrhosis (ICC). Acute HEV infection was confirmed by immunoblot assay in all the patients and in eight of these, HEV-RNA was also detected in the serum. HAV was involved in 37.5% of cases with isolated infection in 10% (4 of 40). The aetiological factors associated with acute liver failure, apart from HAV and HEV, were other hepatotropic viruses (22.5%), Wilson's disease (5%), ICC (5%), and hepatotoxic drugs (7.5%). In five patients, no serological evidence of acute viral hepatitis could be found, neither did the metabolic screen yield any result. It was observed that enterically transmitted hepatitis viruses (HAV and HEV) were associated with 60% of acute hepatic failure in children. Mixed infection of HAV and HEV formed the single largest aetiological subgroup. In developing countries, where hepatitis A and E infections are endemic, severe complications can arise in the case of mixed infection. This may contribute to most of the mortality from acute liver failure during childhood.

The longitudinal growth and development of the soft tissue drape for boys and girls with long and short vertical patterns was examined from age 7 to 17 years. The sample was taken from the Denver Growth Study and consisted of 32 subjects who were selected on the basis of their percentage of lower anterior vertical face height. All subjects were of northern European ancestry, and none had undergone orthodontic treatment. The sexual dimorphism was evident as anticipated for several soft tissue measurements. The boys showed continued growth through age 16 years in contrast to the girls who attained the adult size of the soft tissue integument around 14 years. A significant difference between vertical facial patterns was reported for all soft tissue variables with the exception of the soft tissue thickness at A point and the upper lip height. The boys and girls with long vertical patterns exhibited a thicker and longer soft tissue drape for the most variables when compared with those with short facial patterns. These soft tissue differences are believed to be compensatory mechanisms in long-face subjects, which may attempt to mask the vertical dysplasia, thereby producing a more normal facial profile. Individual growth assessments revealed that the perioral soft tissues follow a pattern similar to that of the mean group patterns. The subjects with long vertical facial patterns experienced their pubertal growth spurt earlier than the short-face subjects. This may have clinical implications in the timing of orthodontic intervention and treatment.

Objective: To review golf-related ocular injuries, which account for 1.5% to 5.6% of all sports injuries., Methods: During 8 years (1986 to 1994), a retrospective review of sports-related trauma was performed at the Medical College of Wisconsin, Milwaukee. Eight blunt ocular injuries (four ruptured globes and four globes without rupture) caused by golf-related activities were identified. The four ruptured globes caused by golf-related trauma accounted for 1.2% of all penetrating injuries and/or ruptured globes and 11.7% of sports-related injuries., Results: A golf ball projectile was the mechanism of injury in six patients, while two patients were struck with a gold club. The four patients with ruptured globes had an initial visual acuity of light perception or worse, and three globes were subsequently enucleated, while one was prephthisic. In the four trauma cases without rupture, surgical intervention was required to achieve anatomic stability, with final visual acuities ranging from 20/25 to 20/40., Conclusions: The incidence of ocular injuries caused by golf-related trauma is low compared with that for other sports-related injuries. Although the prognosis for ruptured globes occurring in this setting remains extremely guarded, blunt trauma without rupture caused by a golf-related injury is associated with a more favorable visual and anatomic outcome.

Hepatitis E virus (HEV) is responsible for a majority of sporadic and epidemic viral hepatitides in India and other developing countries. Even though the genomes of four geographically distinct strains of HEV have been cloned and sequenced, the Indian strain of HEV remains largely uncharacterized. We have cloned and sequenced about 2.2 kb of the HEV genome constituting the structural region from an Indian strain of HEV. The nucleotide and amino acid sequences show a high degree of conservation with sequences from other HEV strains. Open reading frames (ORF) 2 and 3 were expressed in Escherichia coli as N-terminal hexahistidine epitope fusions. The purified proteins were then used in an immunoblot assay to evaluate the antibody status in sera from individuals from an area of high-level HEV endemicity. The anti-ORF2 antibodies were found to be nonspecific and could not be correlated to clinical disease. The immunoglobulin M anti-ORF3 was found to be specific for the presence of acute disease. The implications of these findings in HEV diagnosis and vaccine development are discussed.

Purpose: To evaluate the contribution of toxins to the severity of Staphylococcus aureus endophthalmitis., Methods: Experimental endophthalmitis was established by injecting rabbit eyes with wild type S. aureus ISP479 and the isogenic attenuated strain, ISP546, defective in expression of the global regulator locus agr. agr regulates expression of at least 19 exoproteins that are potentially important in the pathogenesis of endophthalmitis. Infections were evaluated using electroretinography, slit lamp biomicroscopy, and histology. Two concentrations (approximately 10 and 1000 organisms) of bacteria were injected., Results: The agr- strain consistently resulted in slower loss of b-wave response when compared to the wild type strain, irrespective of inoculum size. Clinical signs were less severe among the agr- group at 24 and 48 hours when 10 organisms were injected. However, when the number of bacteria injected was increased to 1000, earlier onset of clinical signs was observed, with both groups showing maximum cell and flare and a white fundal reflex at 48 hours after infection. Histologic examination of eyes enucleated 36 hours after inoculation revealed that the wild type strain induced focal retinal destruction and mild vitritis, whereas eyes infected with the agr- strain remained completely normal. Histologic examination carried out when loss of B-wave response was 100% revealed that retinal changes for both groups could not be distinguished., Conclusions: These data indicate that toxin production by S. aureus contributes to severity of endophthalmitis by accelerating the rate of onset of retinal damage. Therefore, toxin-targeting therapies instituted early in the course of infection could preserve retinal function.

Objective: To study the feasibility of inducing a chorioretinal lesion under a previously placed scleral buckle by experimental transconjunctival diode laser photocoagulation., Methods: We performed transconjunctival diode laser photocoagulation in the peripheral retinas of seven pigmented rabbit eyes with a silicone exoplant (No. 42 band or No. 276 tire) and seven eyes without an exoplant. Each eye received burns with an intensity of grades 1 to 3 in different quadrants at varying power levels, with a 0.5-second duration and 650-micron spot size. Eyes were enucleated for histopathologic studies 1 day and 1 week after treatment., Results: Although the irradiance emitted through the No. 42 band and the No. 276 tire was attenuated by 17% and 23%, respectively, the range of threshold powers needed to produce grades 1 to 3 burns was similar between eyes with and without a silicone exoplant. At 1 day, full-thickness coagulative necrosis was observed in all lesions, except that the ganglion cell layer and inner nuclear layer were preserved in two of four grade 1 burns and the ganglion cell layer was intact in one of six grade 2 burns. Inner scleral changes were noted acutely in three of five grade 3 lesions. At 1 week, burns of all intensity grades showed a full-thickness atrophic chorioretinal lesion with inner scleral changes., Conclusions: Experimental transconjunctival diode laser photocoagulation through hard silicone elements reproducibly created a chorioretinal lesion with histopathologic findings similar to those of lesions obtained without these elements. Although retinal photocoagulative effects were prominent, inner scleral abnormalities were also observed histologically.

Background/aims: Hepatitis E virus (HEV) is associated with epidemic and sporadic hepatitis in developing countries. The disease is largely self-limited with no long-term sequelae. The source of HEV for maintenance of the disease in an endemic area is unknown. This study investigated the occurrence and duration of viremia in patients with acute sporadic HEV infection., Methods: In 26 of 37 patients with sporadic acute non-A, non-B viral hepatitis, HEV infection was diagnosed based on positivity for immunoglobulin M anti-HEV and/or presence of viremia as shown by reverse-transcription polymerase chain reaction. In 4 patients, fecal samples were analyzed for presence of virus using polymerase chain reaction. Multiple samples were studied at varying times in 20 patients., Results: Viremia was detected in 19 of 26 patients. Two patients had viremia in the absence of immunoglobulin M anti-HEV. Four patients had protracted viremia of 45-112 days' duration. One patient showed fecal virus shedding up to the 52nd day of illness., Conclusions: Protracted viremia and prolonged fecal shedding of HEV were shown in a small group of patients. These patients may serve as temporary virus carriers responsible for continuous contamination of the sewage water.

The relative value of an anti-hepatitis C virus (HCV) serological assay and reverse transcriptase-nested polymerase chain reaction assays (RT-PCR) were investigated for the constant 5' putative noncoding region of HCV for the diagnosis of HCV-associated chronic liver diseases in India. One hundred fifteen patients with biopsy proven chronic active hepatitis and 140 cases of cirrhosis of the liver were investigated for anti-HCV antibody using a second generation commercial enzyme-linked immunosorbent assay (ELISA). A proportion of these patients: 42 with chronic hepatitis and 27 with cirrhosis of the liver were analysed further for HCV RNA in the serum using RT-nested PCR assay. Thirty-three (12.9%) of the 255 patients were positive for anti-HCV antibody and 23 of 69 (33.3%) patients were positive for HCV RNA in serum. Fifteen of the 33 (45.5%) anti-HCV positive patients had HCV RNA in the serum. Eight of 36 (22.2%) HCV seronegative patients tested were found with HCV RNA. This indicates that the diagnosis of HCV infection is not possible if it is based solely on the available serodiagnostic tests. Inclusion of both assays improved the diagnostic efficiency, 18.8% (13/69) were negative for all virological markers associated with HBV and HCV infection. Since a majority of the chronic liver disease patients (143/255 [56%]) were seronegative for either HBV or HCV infection, it is significant that HCV RNA was detected in 38% (8/21) of a randomly selected group from these patients. The antibody assay and PCR were compared using interclass correlation (kappa statistics).(ABSTRACT TRUNCATED AT 250 WORDS)

The purpose of this study was to determine whether symphysis morphology could be used as a predictor of the direction of mandibular growth and to assess growth changes of the symphysis. Cross-sectional data included lateral cephalometric radiographs of 115 adults (58 women, 57 men) with the longitudinal sample a subset of 62 subjects (30 females, 32 males) at four age groups. The direction of mandibular growth was evaluated with seven cephalometric measurements that included Y-axis, SN to mandibular plane, palatal plane to mandibular plane, gonial angle, sum of saddle, articulare and gonial angles, percentage lower facial height, and posterior/anterior face height. The mandibular symphyseal dimensions studied were height, depth, ratio (height/depth), and angle. Symphysis morphology was found to be associated with the direction of mandibular growth, especially in male subjects with symphysis ratio having the strongest relationship. A mandible with an anterior growth direction was associated with a small height, large depth, small ratio, and large angle of the symphysis. Conversely, a posterior growth direction was associated with a large height, small depth, large ratio, and small angle of the symphysis. Symphysis dimensions continued to change until adulthood with male subjects having a greater and later occurring change compared with female subjects.

Hepatitis C virus (HCV) ribonucleic acid (RNA) was tested for in a group of 16 defined non-B chronic hepatitis patients using specific reverse transcription polymerase chain reaction (RT-PCR). These were chosen from amongst 56 biopsy proven cases of chronic hepatitis of which majority (40) were positive for hepatitis B virus infection. Hepatitis C virus RNA could be demonstrated in 12 (75%) of remaining 16 cases. These include all seven patients positive for antibody to HCV. Two of these patients had past history of blood transfusion and in another two the clinical course started with severe acute liver disease. This study establishes the association of HCV with severe liver disease. The clinical and biochemical profiles are also discussed. In view of limited sensitivity of the antibody assays it is justified to develop diagnostic testes based on local strains.

Hepatitis E virus (HEV), the causative agent of enteric non-A, non-B hepatitis, is a positive-stranded RNA virus. Because of the virus's inability to grow in culture, several nonhuman primates have been used for the propagation of HEV. Using strand-specific reverse transcription-polymerase chain reaction (RT-PCR), we demonstrate the presence of negative-stranded HEV RNA replicative intermediates in the livers of infected animals. This constitutes the first direct evidence of HEV replication in the liver of the infected animals and reinforces the validity of such a model to study HEV infection, disease pathogenesis, and immunity.

Non-A, non-B hepatitis viruses have been implicated as the etiological agent(s) in up to 60% of patients with fulminant hepatitis. These agents are reported to induce a higher mortality than other causes of fulminant hepatitis. Hepatitis E virus (HEV) and hepatitis C virus (HCV) at present constitute the major identifiable non-A, non-B hepatitis agents. Of these, HEV has been established as the sole cause of epidemic hepatitis in Afro-Asian countries, and fulminant hepatitis has been recorded during such epidemics. However, in sporadic cases, the etiological role of HEV in fulminant hepatitis has remained uncertain. The role of HCV in acute liver disease and fulminant hepatitis remains unclear. The present study was undertaken to investigate the association of HEV and HCV in patients with fulminant hepatitis by direct detection of the viral genome using reverse transcription-polymerase chain reaction (RT-PCR). Serum samples from 50 serologically identified non-A, non-B fulminant hepatitis cases negative for cryptic hepatitis B virus (HBV) infection examined via PCR were tested for HEV and HCV RNA using RT-PCR. For HEV primers from the nonstructural region (ORF-1) were used, and for HCV primers from the highly conserved 5' untranslated regions were used. The products were analysed using agarose gel electrophoresis and confirmed by hybridisation with radiolabelled internal oligonucleotide probes. HEV was detected in 31 (62%) of the 50 fulminant non-A, non-B hepatitis cases. In 18 (36%) cases, HCV RNA was detected. In 11 (22%) of the HCV cases, the HEV genome was also amplified. In 20 (40%) cases, HEV was detected alone.(ABSTRACT TRUNCATED AT 250 WORDS)

Purpose: A study was performed to evaluate corneal and anterior segment toxicity from short-term (24-hour) intravitreal use of perfluoro-n-octane., Methods: Forty aphakic, vitrectomized eyes of pigmented rabbits underwent intravitreal injection of either 0.5 ml of perfluoro-n-octane (Perfluoron; Infinitech, St. Louis, MO; treated) or 0.5 ml balanced saline solution (control). Perfluoron was allowed to remain in the vitreous cavity for 24 hours. Serial measurements of corneal pachymetry and pneumotonometry were performed at 1, 4, 12, and 24 hours after injection. After 24 hours, endothelial cell morphology and barrier function were evaluated., Results: No significant differences in corneal thickness or intraocular pressure were noted between the two groups at any of the time points studied, and no differences in endothelial cell density/hexagonality or endothelial cell barrier function were observed 24 hours after injection., Conclusions: In the absence of sustained corneal contact, no evidence of significant acute corneal or anterior segment toxicity was observed in response to short-term intravitreal perfluoro-n-octane in aphakic, vitrectomized rabbit eyes.

We performed a retrospective study of 42 patients with penetrating ocular injury resulting from assault over a five-year period (1986 through 1991). Thirty-six patients were male (86%) and six were female, with a mean age of 29 years. Twenty-nine of 42 patients (70%) had consumed alcohol or used illegal drugs before their injury. Fists were the leading cause of injury (ten patients), followed by broken glass (nine patients). At least six months of follow-up was obtained on 40 patients (95%), with a mean follow-up of ten months. Ten (25%) patients had good visual outcome with final visual acuity of 20/40 or better. Twenty-five patients (63%) had final visual acuity of less than 5/200 at final follow-up. In this group with poor visual outcome, 12 patients (48%) underwent enucleation or evisceration (five primarily) because of extensive ocular damage. Five of 42 patients (12%) had visual acuity of no light perception, and eight (20%) had visual acuity ranging from light perception to counting fingers. The remaining five patients (12%) had final visual acuities between 20/100 and 5/200. Factors predictive of poor visual outcome were as follows: (1) initial visual acuity of light perception or worse; (2) injury by a blunt object; (3) posterior scleral lacerations (> 15 mm in length); and (4) presence of vitreous hemorrhage, retinal detachment, and prolapsed uvea. Penetrating ocular injury with posterior segment involvement caused by assaultive injury results in guarded visual outcome in most patients. Prevention of such injuries remains difficult.

Background: Penetrating ocular trauma is second only to cataracts as the most common cause of visual impairment in the United States; motor vehicle accidents are an important cause of injuries (ocular and non-ocular)., Methods: The files of 293 consecutive patients treated for a penetrating ocular injury over a 5-year period (1986 to 1991) were reviewed, and 10 (3.4%) were associated with a motor vehicle accident., Results: Median age was 27.5 years and median initial visual acuity was 20/200 (range, 20/30 to light perception). A sharp glass fragment penetrating the eye was the mechanism of injury in seven cases. A seatbelt was worn by only one patient. Six patients had a corneoscleral laceration, and two patients each had corneal and scleral lacerations. Primary repair of the laceration was solely performed in eight patients. Vitreous surgery was required in two cases, one with retained intraocular foreign bodies and one with a retinal detachment. The median follow-up period was 5 months, and 8 of 9 retinas remained attached at final follow-up. One patient died of unrelated causes. Final median visual acuity was 20/25 (range, 20/20 to hand motions)., Conclusion: Among patients in a large series of penetrating ocular injuries, the percentage of injuries due to motor vehicle accidents is low. The anterior segment is predominantly involved, and the final visual prognosis is favorable. Compulsory seatbelt legislation may reduce the frequency and morbidity of these accidents in the United States.

It is extremely important to pay attention to the person's growth pattern, and a distinction must be made in the selection of retention devices on the basis of the nature and the extent of dentofacial dysplasia (growth pattern). The nature and duration of retention should depend on the maturation status of the patient and on anticipated future growth. Retention guidance is necessary for adjustment of the dentition to late growth changes and maturation of neuromuscular balance. "Active retention" is a concept we accept as readily as the orthopedic surgeon does for his scoliosis patients. There is some merit in the philosophy of those clinicians who advocate permanent retention guidance. Without always being aware of the biomechanics of growth change, they are in fact carrying the patient through the active stages of growth with their retention appliances. Finally, one may philosophize that nothing about the human morphology is stationary. Aging is a well-documented process of change. Lifetime dentitional adjustment and changing dental relationships are known to all, even in otherwise healthy persons. Then why do we expect long-term stability in every case? The answer to the question of long-term stability is long-term retention--dynamic, not static.

This study contrasts the growth rates of the craniomaxillary and mandibular dimensions. Longitudinal data from lateral head cephalograms of 18 female subjects, between 3 and 18 years old, were used. All of the subjects had yearly cephalograms available and none had received orthodontic treatment. Four linear distances included anterior cranial base, maxillary length and mandibular length and four angular measurements included ANS-S-N, ANS-N-S, Gn-S-N and Gn-N-S. The mandible lagged in size by 4 years relative to anterior cranial base length and by 2 years relative to maxillary length at 5 years of age. There was an incremental gradient of growth from S-N downward to Ar-Pog such that dimensions successively showed a greater relative amount of growth during the entire period of development. The proportional displacement of nasion and anterior nasal spine maintained a constant S-N-ANS angle. The increase in angle S-N-Gn was due to proportionally greater increase in mandibular length relative to anterior displacement of nasion. The different rates of dimensional increments from anterior cranial base to mandible result in differential growth affecting the spatial relationship of maxilla and mandible in the sagittal plane. Skeletal discrepancies in maxillomandibular relationships between 4 and 10 years of age is a normal transient developmental characteristic.

The purpose of this study was to assess skeletal factors associated with the development of vertical facial disproportions. Angular measurements based on longitudinal lateral cephalometric radiographs of 16 male and 16 female subjects, from the ages of 4 through 18 years, were used. Subjects were selected on the basis of lower face height (ANS-Me) as a percentage of morphologic face height (N-Me). A single x-ray photograph at age 15 for the boys and 13.5 for the girls was used to classify each subject's occlusion as either open-bite or deep-bite. Sella-nasion/palatal plane, sella-nasion/mandibular plane, sella-nasion/anatomic occlusal plane, palatal plane/mandibular plane, and cranial base angle were analyzed statistically and graphically. It was found that (1) with the exception of sella-nasion/palatal plane and cranial base angles, all angular measurements demonstrated a progressive reduction throughout development in both open bites and deep bites; (2) the palatomandibular angle discriminated between open bites and deep bites throughout the developmental phase; (3) within each sex, typologic differences were evident in all angular measurements, with the exception of cranial base and occlusal plane; and (4) the cranial base angle demonstrated clear sexual dimorphism, and its magnitude was not associated with vertical dysplasia. The progressive reduction of angles in skeletal open bite reduced or maintained the magnitude of the imbalances, while the reduction of angles accentuated the skeletal deep bite with age. The inclination of the palatal plane and its constancy suggested that downward and backward rotation of the mandible in open bite subjects is precommitted in response to dentoalveolar compensatory changes with the center of rotation at the molars. The magnitude of the mandibular plane angle is not adequate for assessment of diagnostic or prognostic predictive value in determining the pattern of growth.

Recurrent epiretinal membranes (ERMs) causing macular pucker developed after surgical removal in seven eyes and were subsequently removed. A specimen was available for electron microscopic study from four of the seven primary operations and all seven of the repeat operations. The diagnostic associations for the primary cases included retinal holes or tears (four eyes), trauma, inflammation (one eye each). In one eye the membrane was idiopathic. The primary and recurrent ERM specimens contained similar cell types and structural characteristics but were not identical. No one cell type predominated in either primary or recurrent ERM. Compared with studies of idiopathic ERMs, myofibroblasts were present with increased frequency in recurrent membranes. Fibrocytes, fibrous astrocytes, and retinal pigment epithelial cells were also present in most specimens. Other features of both the primary and recurrent ERM specimens included the presence of cells with myoblastic differentiation, fragments of internal limiting membrane, new collagen, and nerve fiber elements.

A new photochemical method has been used to produce focal thrombosis and occlusion of the blood vessels on the surface of the myelin wings of rabbit retinas. Following intravenous injection of rose bengal, the vessels next to the disc on the nasal wing were exposed to filtered light (550 nm, the absorption maximum of rose bengal) for four minutes. As a control, the vessels on the temporal wing of each rabbit eye were exposed to filtered light for four minutes before the injection of rose bengal. Complete vascular occlusion was produced on the nasal wing in all eyes, with no visible alterations on the temporal wing. Progressive reopening of the arteries on the nasal wing was observed at three days, with reopening of the veins visible by seven days. Reperfusion of capillaries had occurred by 21 days. Light and electron microscopic examination of blood vessels on the nasal wing after light exposure with rose bengal showed disrupted endothelial cells in all exposed blood vessels and platelet aggregates in the arteries and arterioles. No morphologic abnormalities were observed in the temporal wings. This method should be useful in studying the effects of vascular occlusion in the retina and could lead to a new treatment modality for subretinal, iris, or corneal neovascularization.

The purpose of this study was to examine the patterns of facial growth development in subjects with skeletal open-bite and skeletal deep-bite faces. Longitudinal data based on lateral cephalometric radiographs of 16 male and 16 female subjects, ages 3 through 18 years, were used. These subjects were selected on the basis of lower face height as a percentage of total face height. Persons exhibiting extreme values were selected to create four groups with eight subjects in each group. Curves of absolute and incremental growth for total anterior face height, upper anterior face height, lower anterior face height, posterior face height, and ramal length were analyzed statistically and graphically. It was established that the anterior dimensions of the face demonstrated typologically divergent patterns of development in open- and deep-bite faces. Further, the posterior dimensions of the face did not discriminate between these two typological groups. The female open-bite subjects were earliest in the timing of the adolescent growth spurt, followed in succession by deep-bite female subjects, open-bite male subjects, and finally the deep-bite male subjects. The clinical implications of these observations pertain to the timing of orthodontic treatment, the length of retention period, and the prediction of adult occlusal status during the mixed dentition.

A new method of producing vascular occlusion, photochemical activation of intravenously injected rose bengal, was used to produce experimental thrombosis of the preretinal and choroidal blood vessels in rabbit eyes. Fluorescein angiography and light and electron microscopy were used to describe the resultant pathologic alterations over time. As early as one hour after treatment, the endothelium of both preretinal and choroidal blood vessels was severely damaged or completely obliterated, and platelet aggregates occluded the vascular lumina. Occlusion of the preretinal and choroidal blood vessels persisted for up to three days; however, endothelial regeneration and reperfusion had occurred in both vascular beds by seven days. In addition, the retinal pigment epithelium and myelin wings suffered ischemic damage. The retinal pigment epithelium began to recover by seven days, but the myelin wings appeared to be irreversibly damaged.

A longitudinal study of 32 individuals representing male and female open and deep bite was examined to determine the relationship between subjects who are characterized by proportionately large and small lower anterior face heights and adolescent facial growth spurts. Open bite individuals matured earlier than deep bite individuals. Morphologic differences between the groups were maintained during the adolescent growth spurt. Further studies are needed to examine the relationships between adolescent growth spurt to stature and somatotype.

Macrophages release a variety of arachidonic acid metabolites after treatment with various membrane triggers or particulate stimuli. We examined the role of phospholipase and lipoxygenase inhibitors in the modulation of superoxide production and tumor cytolysis by murine macrophages. Superoxide was induced by the soluble stimulus, phorbol myristate acetate (PMA), and the particulate stimulus, opsonized zymosan, and was measured by the reduction of ferricytochrome c with the use of a micro ELISA reader. Macrophage-mediated tumor cytolysis was induced by hybridoma-derived, macrophage-activating factor (MAF) and was quantitated by 51Cr release from P815 target cells. In both assays, 72-hr peptone-elicited macrophages were used. Dexamethasone, and to a lesser degree hydrocortisone, inhibited superoxide release and MAF-induced tumor cytolysis. Inhibition in the superoxide assay required pretreatment with corticosteroid. Only the gold compound, auranofin, inhibited superoxide when given simultaneously with stimulant. Other phospholipase inhibitors, including mepacrine and 4-bromophenacyl bromide, and several lipoxygenase inhibitors, including BW755c, nordihydroguaiaretic acid (NDGA), and 5,8,11,14-eicosatetraynoic acid (ETYA), failed to modulate either macrophage response at nontoxic concentrations. At the concentrations tested in the tumoricidal and superoxide assays, mepacrine and 4-bromophenacyl bromide inhibited the release of 14C-arachidonic acid from macrophages stimulated with opsonized zymosan. Our data strongly suggest that corticosteroids suppress macrophage superoxide production and tumoricidal function by a nonphospholipase-dependent mechanism.