Search

Introduction: Ectopic gastrointestinal varicosities are defined as dilated portosystemic collateral veins that may localize anywhere in the gastrointestinal tract outside the gastroesophageal region. Ectopic colonic varices can be considered idiopathic when other etiology that related to portal hypertension or portal vein thrombosis have been excluded., Case Presentation: A forty-five-year-old female patient has been under treatment for histopathologically confirmed ulcerative colitis since the age of 17. In her forties, the patient developed worsening hematochezia leading to severe anemia. Routine colonoscopy was performed which confirmed extensive rectosigmoid varices. A thorough investigation did not confirm any underlying causes, such as portal hypertension or cirrhosis., Discussion: The selective percutaneous transhepatic mesenteric angiography, which is recommended as a diagnostic and therapeutic option, was not performed because the interventional radiologists did not consider embolization feasible. Laparoscopic rectosigmoid resection with high ligation of the inferior mesenteric vein led to complete remission of hematochezia. The final histological examination confirmed ectopic rectum and sigmoid varices, and ulcerative colitis was ruled out., Conclusions: Lower gastrointestinal bleeding from the colonic varices is very rare, with only a few cases reported in the literature. In the idiopathic form, the prognosis is very good, given the absence of other underlying diseases causing portal hypertension. Ectopic varices present a clinical challenge as they are difficult to diagnose and localize. There are currently no clear guidelines for diagnosis and therapy, and recommendations are based on different case reports. Idiopathic cases can be treated effectively by resection of the affected bowel segment., Competing Interests: Declaration of competing interest The study sponsor (University of Debrecen, Hungary) has no involvement in data collection and analysis, and in the writing of the manuscript., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Cattle ranching is an economic activity responsible for the loss of large extensions of tropical dry forest around the world. Several studies have demonstrated that the use of inadequate practices of this activity in tropical forests (e.g., fire, agrochemicals, and lack of rotational grazing systems of cattle in pastures) have negative consequences on dung beetle diversity and their ecological functions. In the present study, the influence of the cattle ranching duration gradient on the diversity of dung beetles and seed removal was evaluated. This study was carried out in pastures with different times of establishment of cattle ranching (between 4 and 40 years) in a tropical dry forest of Mexico. Overall, the species richness of dung beetles was similar along the gradient of grazing ages. However, the diversity of common (q1) and dominant (q2) species decreased and was associated with an increasing abundance of exotic species and a decreasing abundance of native species. Seed removal was mainly carried out by four beetle species, among which the exotic species Digitonthophagus gazella was the most important. The results establish that the duration of cattle ranching primarily influences the composition of dung beetle communities, as reflected in changes in the structure and function of their assemblages in the pastures. Although native dung beetles persist at low abundances along this gradient, the consequences of land use changes are undeniable in other similar ecosystems where these species could definitively disappear.

Urbanization is among the main factors of ecosystem transformation and threats to global biodiversity. Urban green spaces provide multiple services, being important for biodiversity and human well-being. However, the relationship between green spaces and forest birds has been scarcely studied in the Global South. In this work, we used citizen science data (eBird) to assess the variation in the species richness and composition of forest birds in two types of public urban green spaces characterized by different vegetation composition and management: parks and reserves. In general, reserves had more native and unmanaged vegetation than parks. We selected parks and reserves located in the coastal area of the Metropolitan Area of Buenos Aires, Argentina. Sampling effort was considered as the number of checklists for each site. The database allowed information to be extracted from 12 sites and 33 species. The most common species were the Green-barred Woodpecker ( Colaptes melanochloros ), the Narrow-billed Woodcreeper ( Lepidocolaptes angustirostris ), and the White-crested Tyrannulet ( Serpophaga subcristata ). Bird species richness was higher in reserves than in parks and was positively related to sampling effort. The forest bird species composition varied according to the type of green area and sampling effort. Species composition showed a significant nestedness, with the least rich sites being a subset of species from the richest sites. Reserves and sites with the highest sampling effort concentrated all species. The results obtained show the importance of urban reserves in the conservation of forest birds.

This study assessed the halophyte species Limonium spathulatum (Desf.) as a possible source of natural ingredients with the capacity to inhibit enzymes related to relevant human health disorders and food browning. Extracts using food-grade solvents such as water and ethanol were prepared by maceration from dried L. spathulatum leaves. They were evaluated for in vitro inhibition activity of enzymes such as acetylcholinesterase (AChE) and butyrylcholinesterase (BChE), α-glucosidase, tyrosinase and lipase, related to Alzheimer's disease, type-2-diabetes mellitus, skin hyperpigmentation, and obesity, respectively. These extracts were also appraised for in vitro acute toxicity on tumoral and non-tumoral cell lines and their chemical composition by high-performance liquid chromatography coupled with electrospray ionization mass spectrometry (HPLC-ESI-MS/MS). The extracts were more effective towards BChE than AChE. The best results were obtained with the hydroethanolic and water extracts, with IC 50 values of 0.03 mg/mL and 0.06 mg/mL, respectively. The hydroethanolic extract had the highest capacity to inhibit α-glucosidase (IC 50 : 0.04 mg/mL), higher than the positive control used (acarbose, IC 50 = 3.14 mg/mL). The ethanol extract displayed the best inhibitory activity against tyrosinase (IC 50 = 0.34 mg/mL). The tested samples did not inhibit lipase and exhibited low to moderate cytotoxic activity against the tested cell lines. The hydroethanolic extract had a higher diversity of compounds, followed by the ethanol and water samples. Similar molecules were identified in all the extracts and were mainly hydroxybenzoic acids, hydroxycinnamic acids, and flavonoids. Taken together, these results suggest that L. spathulatum should be further explored as a source of bioactive ingredients for the food, cosmetic, and pharmaceutical industries.

Parasites are integral members of the global biodiversity. They are useful indicators of environmental stress, food web structure and diversity. Ectoparasites have the potential to transmit vector-borne diseases of public health and veterinary importance and to play an important role in the regulation and evolution of host populations. The interlinkages between hosts, parasites and the environment are complex and challenging to study, leading to controversial results. Most previous studies have been focused on one or two parasite groups, while hosts are often co-infected by different taxa. The present study aims to assess the influence of environmental and host traits on the entire ectoparasite community composition of the rodent Akodon azarae. A total of 278 rodents were examined and mites (Mesostigmata), lice (Phthiraptera), ticks (Ixodida) and fleas (Siphonaptera) were determined. A multi-correspondence analysis was performed in order to analyze interactions within the ectoparasite community and the influence of environmental and host variables on this assembly. We found that environmental variables have a stronger influence on the composition of the ectoparasite community of A. azarae than the host variables analyzed. Minimum temperature was the most influential variable among the studied. In addition, we found evidence of agonistic and antagonistic interactions between ticks and mites, lice and fleas. The present study supports the hypothesis that minimum temperature plays a major role in the dynamics that shape the ectoparasite community of A. azarae, probably through both direct and indirect processes. This finding becomes particularly relevant in a climate change scenario., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Cotton (Gossypium hirsutum) is a billion-dollar crop in regional New South Wales (NSW) and Queensland, Australia. Fusarium wilt (FW) caused by Fusarium oxysporum f. sp. vasinfectum (Fov) is an economically important disease. Initial disease losses of up to 90% when the disease was first detected resulted in fields being taken out of cotton production. The disease is now well-managed due to the adoption of highly resistant varieties. However, annual disease surveys recently revealed that the disease dynamic has changed in the past few seasons. With relatively mild and wet weather conditions during the 2021/22 growing season, FW was detected in eight surveyed valleys in NSW and Queensland, with the disease incidence as high as 44.5% and 98.5% in individual fields in early and late seasons, respectively. Fov is genetically distinct and evolved from local Fusarium oxysporum strains. Additionally, the pathogen was reported to evolve rapidly under continuous cotton cropping pressure. However, our knowledge of the genetic composition of the prevailing population is limited. Sequences of the translation elongation factor alpha 1 (TEF1) revealed that 94% of Fusarium isolates recovered from FW-infected cotton were clustered together with known Australian Fov and relatively distant related to overseas Fov races. All these isolates, except for nine, were further confirmed positive with a specific marker based on the Secreted in Xylem 6 (SIX6) effector gene. Vegetative compatibility group (VCG) analyses of 166 arbitrarily selected isolates revealed a predominance of VCG01111. There was only one detection of VCG01112 in the Border Rivers valley where it was first described. In this study, the exotic Californian Fov race 4 strain was not detected using a specific marker based on the unique Tfo1 insertion in the phosphate (PHO) gene. This study indicated that the prevalence and abundance of Fov across NSW and Queensland in the past five seasons was probably independent of its genetic diversity.

We are responding to the comment by Dommerholt and Gerwin that we have reverse-defined "myofascial trigger point" (MTrP) and "contracture/contraction knot." In attempting to maintain philosophical agreement with specific and implied aspects of their integrated hypothesis of trigger-point formation (namely a MTrP being ischemic and hypoxic), we referred to the MTrP as the small hyperechoic signal rather than the larger hypoechoic (and therefore hyperperfused) structure surrounding it. It was never our intent to re-define nor contribute to confusion. In making this concession with respect to Dommerholt and Gerwin's preferred nomenclature, however, we must instead now reconcile what we image as a hypoechoic (and therefore hyperperfused) MTrP with it being concurrently hypoxic.

The objective of the present study was to reconstruct the biogeographic history of the monophyletic group Leptodactylus fuscus . We carried out two complementary historical biogeographic approaches: one estimates the ancestral areas with the statistical dispersion and vicariance method (S-DIVA). The other detects disjoint distributions among sister groups, which provides information about barriers that separate populations through a spatial analysis of vicariance (VIP method). For that, we used a database of species presence records and a topology of a phylogenetic cladogram, both obtained from updated published data that incorporates the current phylogenetic, taxonomic and distributional arrangements for the group. For the analysis of ancestral areas, the following areas of the L. fuscus group distribution were used: the Carribean, Chacoan, Parana, Amazonian and North American in Pacific subregions. The optimal reconstruction obtained with S-DIVA showed five vicariance events, two extinctions and 50 dispersals. The spatial analysis of vicariance revealed 19 disjointed sibling nodes and two distributions on nodes removed in the consensus tree. The results suggest that the ancestor of the Leptodactylus fuscus group occupied large areas within the Amazon and Chacoan subregions. Due to several dispersal events, the ancestor distribution range may have expanded to the Caribbean subregion. This expansion could have occurred during wetter periods, when forests were more extensive, which would have allowed the invasion of open habitats within humid forest systems. It is important to note that ecological factors and marine transgressions that occurred during the Miocene could have had a great influence on the current distribution of the group.

Nepeta baytopii is a poorly studied, endemic Nepeta species ( Lamiaceae ) of Turkey. For the first time, the biological activities (antioxidant, enzyme inhibition, and cytotoxicity properties) of the hexane, ethyl acetate, methanol, water/methanol, and water extracts and essential oil prepared from N. baytopii aerial parts were assessed. Hydro-methanol (41.25 mg gallic acid equivalent (GAE)/g) and water extracts (50.30 mg GAE/g), respectively showed the highest radical scavenging (94.40 and 129.22 mg Trolox equivalent (TE)/g, for 2,2-diphenyl-1-picrylhydrazyl radical and 2,2-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid radical scavenging assays) and reducing (229.37 and 129.55 mg TE/g, for ferric-reducing antioxidant power and cupric-reducing antioxidant capacity assays) capacities in vitro. An interestingly high inhibition was observed for ethyl acetate extract against butyrylcholinesterase (10.85 mg galantamine equivalent/g). The methanol extract showed high cytotoxicity (31.7%) against HepG2 cells. Caryophyllene oxide was identified in high concentrations in the essential oil (39.3%). Luteolin and apigenin and their derivatives were identified from the methanol and water extracts. The results obtained from this study highlighted that the abundance of highly bioactive compounds from Nepeta baytopii ensures the multiple biological activities of the tested extracts, and this suggests a potential use in the pharmaceutical and nutraceutical fields, and therefore should be investigated further.

The emergence of the COVID-19 pandemic and subsequent public health emergency (PHE) have propelled telemedicine several years into the future. With the rapid adoption of this technology came socioeconomic inequities as minority communities disproportionately have yet to adopt telemedicine. Telemedicine offers solutions to patient access issues that have plagued urology, helping address physician shortages in rural areas and expanding the reach of urologists. The Centers for Medicare & Medicaid Services have adopted changes to expand coverage for telemedicine services. The expectation is that telemedicine will continue to be a mainstay in the health care system with gradual expansion in utilization., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2021 Elsevier Inc. All rights reserved.)

The risk of generation of acid drainages in the tailings of the Pan de Azúcar mine that closed its activities more than three decades ago, was evaluated through biooxidation studies using iron- and sulfur-oxidizing extremophilic leaching consortia. Most of tailings showed a high potential for generating acid drainage, in agreement with the results from net acid generation (NAG) assays. In addition, molecular analysis of the microbial consortia obtained by enrichment of the samples, demonstrated that native leaching microorganisms are ubiquitous in the area and they seemed to be more efficient in the biooxidation of the tailings than the collection microorganisms. The acid drainages detected at the site and those formed by oxidation of the tailings, produced a significant ecotoxicological effect demonstrated by a bioassay. These drainages, even at high dilutions, could seriously affect a nearby Ramsar site (Laguna de Pozuelos) that is connected to the Pan de Azúcar mine through a hydrological route (Cincel River).

Loud mechanical sounds with a communication role are called sonations. Male Subtropical Doraditos (Pseudocolopteryx acutipennis) exhibit five conspicuously modified primaries suspected of sonating. Here we (1) describe feather modifications, (2) describe three different territorial/aggressive contexts for these sounds: one-perch aerial displays (1PADs), two-PADs, and Chukrut pursuits, (3) investigate the kinematics of the most common display (1PADs) and the physical mechanisms of sonation using synchronized high-speed video and audio, and (4) assess the roles of modified wing feathers in all contexts by experimental manipulation in four individuals. Primaries p3-p7 were modified in adult males but not in females: p3 was pointed with a reduced distal third to the outer vane; p4 and p5 were slim and falciform with pointed tips curved outwards; p6 was broad, massive, and subtly S-shaped, with a spatulate tip; and p7 was large with the distal third of the outer vane abruptly reduced, and the inner vane with a shallow concave sub-apical emargination. One-PADs consisted of perched short nasal introductory syllables accelerating until the bird performed a super-rapid circular flight of ∽15 cm in diameter from and to the same branch, during which two syringeal syllables and three mechanical syllables were given (chik… chik…. chik-chik frrrottt). The syllables were produced during rapid downstrokes by fluttering feathers and were bisonic, being conformed by two simultaneous main tonal, flat, narrow band sounds: a low-pitched note (f0 ∽1 kHz) and a high-pitched note (f0 ∽3.7 kHz). Primary p7 is the necessary and sufficient sound source of the low-pitched note (removal of p7 caused the sound to disappear) and p3 is the sound source of the high-pitched note, being necessary but perhaps not sufficient (removal of p3 caused the sound to disappear); the other modified feathers seem involved in different roles related to either producing the sonation (p4 and p5 interacting with p3) or allowing it (p6 raising dorsally letting p7 flutter freely; removal of p6 did not affect sound production). The specialized shape of p6 might be compromised to allow sonation of p7 without losing flight functionality. Sonations in Subtropical Doraditos occupy the position of the vocal flourish in the songs of other Pseudocolopteryx suggesting the evolutionary replacement of vocal by mechanical sounds. We propose that wing songs in flying birds may be constrained to occur in temporally broken patterns due to intrinsic features of flapped flight and structurally constrained by the demands of creating an airfoil., (© The Author(s) 2020. Published by Oxford University Press on behalf of the Society for Integrative and Comparative Biology. All rights reserved. For permissions please email: journals.permissions@oup.com.)

Background: Neuropathy and vasculopathy can lead to costly and debilitating complications in people with diabetes. The purpose of this study was to evaluate, at an organizational level, uptake of practices included in a diabetic foot care clinical pathway and associated resources. This research focused on patients at low and moderate risk in Alberta, Canada between 2014 to 2019., Methods: Serial surveys (2014, 2019) of practices related to screening and care of the feet of people with diabetes. Surveys were administered using a combination of targeted and snowball sampling in order to assess the impact of the clinical pathway first implemented in 2015. The pathway focused on screening, assessment and referral of patients from primary care. High-risk foot teams (HRFT) were established at six sites to provide increased access to specialty care. Comparative statistics were performed to assess differences in footcare practices between 2014 and 2019 using two-tailed Fisher's exact test or Chi-square test., Results: Respondents (n = 104, 2014 and n = 75, 2019) included personnel from primary health care, home care and long-term care, acute and emergency care, specialty clinics, diabetes-specific programs and private contractors. The proportion of primary care and home care/long-term care (HC/LTC) sites providing screening increased significantly (p < 0.05). A significant increase in the proportion of sites providing assessment for patients designated as moderate risk also increased from 35% (34 out of 96 sites) to 55% (36 out of 65 sites) (p < 0.05), particularly with respect to vascular assessment, and the proportion of sites reporting appropriate follow-up intervals according to the pathway recommendation was also improved., Conclusion: Provision of a clinical pathway for diabetic foot care along with education and resources led to increased screening in primary care and HC/LTC settings in Alberta, Canada. HRFT provided primary healthcare providers with an important option for referral and also provided increased expertise for procedures such as vascular assessment for patients with moderate risk of ulceration. This comprehensive model has the potential to reduce progression of foot problems and overall health services utilization. Further analyses of outcomes such as incident lower limb amputation and long-term cost-effectiveness of pathway implementation are underway.

Argentina is known for having one of the most extensive areas with high arsenic (As) concentration in groundwater in the world. These areas correspond to two geological provinces, the Altiplano-Puna plateau and the Chaco-Pampean plain. In this large territory, there are some specific environments where the As concentration in groundwater is lower, and in some cases within the recommended limits for drinking water. In our study, we analyze and interpret the low As concentrations reported for the Lerma valley, the easternmost intermontane basin of the Cordillera Oriental, located between the aforementioned high‑arsenic areas. The groundwater from this valley is used for the consumption of >600.000 inhabitants in the city of Salta and nearby towns. The incipient geological development of the valley since the late Miocene and the subsequent tectonic and climatic evolution favored low As concentrations with respect to the Altiplano-Puna plateau and the Chaco-Pampean plain. The high-energy sedimentary environments that characterized the area during Plio-Quaternary times and the composition of the sediments have controlled the characteristics of the multilayered aquifer. Moreover, the absence of geogenic As sources, climate, high rain infiltration rate, near neutral pH, redox conditions, and wells construction with screens settled in coarse productive layers favor groundwater of good quality. The geological and tectonic evolution of the Lerma valley could be extrapolated to other similar valleys in NW Argentina and can be a useful tool for exploration of good quality groundwater. This is of high importance in Latin American territories with high As concentration in groundwater such as Argentina., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Purpose: NRG Oncology conducted a phase II trial to assess the antitumor activity and tolerability of copanlisib, a selective inhibitor of PIK3CA, in persistent or recurrent endometrial carcinoma harboring hotspot PIK3CA mutations., Patients and Methods: Eligible patients had endometrial cancer with endometrioid, serous or mixed histology, a somatic PIK3CA gene mutation, measurable disease, and GOG performance status ≤2. Treatment consisted of IV copanlisib (60 mg weekly, day 1, 8 and 15 of 28-day cycle) until disease progression or prohibitive toxicity. The primary endpoints of the study were objective tumor response as assessed by RECIST 1.1 and to determine the nature and degree of toxicity of copanlisib as assessed by CTCAE version 4. The study used a 2-stage group sequential design., Results: Eleven patients were enrolled onto stage I of the treatment trial. Five patients had endometrioid, four serous and two had a tumor of mixed histology. The most common PIK3CA mutation was Q546X (n = 3) in exon 9. The most common grade 3 or 4 AE was hyperglycemia. No grade 5 adverse events were reported. No clinical responses were detected. Six patients had a best overall response of stable disease. Of 11 who initiated treatment, 10 progressed on treatment. One patient with stable disease on copanlisib withdrew from treatment secondary to relocation. The median progression-free survival (PFS) was 2.8 months; at 6 months 27% were alive, progression-free. The median overall survival (OS) was 15.2 months. Due to the lack of CR/PR continuation of accrual to the second stage of accrual was not warranted., Conclusion: Copanlisib is well tolerated but has limited activity as a single agent in this population., Competing Interests: Dr. Santin received research grants from Puma, Immunomedics, Gilead, Synthon, Merck, Boehringer-Ingelheim, Genentech and Tesaro and consulting fees from Merck and Tesaro. Dr. Filiaci reports grants from NIH, during the conduct of the study as well as grants from the GOG Foundation, outside of the submitted work. Dr. O’Cearbhaill reports personal fees from Clovis, personal fees from Tesaro, personal fees from GlaxoSmithKline, outside of the submitted work. Dr. Ratner reports other support received for serving on the Tesaro Advisory Board as well as the Genentech Advisory board which she wishes to disclose. Dr. Mathews reports grants from National Cancer Institute, during the conduct of the study. Dr. Gunderson reports other from Clovis, other from Cordgenics, other from Agenus, outside of the submitted work. All other co-authors have no conflicts of interest to disclose., (© 2020 The Authors.)

Los Pozuelos is a closed basin in the Puna region of NW Argentina, Central Andes. This is a semi-arid region where closed basins are the most important feature for the hydrologic systems. The center of the basin is occupied by a fluctuating playa lake called Los Pozuelos lagoon, which constitutes a UNESCO Biosphere Reserve. This is one of the most populated closed basins in the Argentinian Puna and residents use groundwater for drinking and cooking. Lowest concentrations of As and dissolved solids are in the headwaters of the rivers (1.46-27 μg/L) and the highest concentrations are in the lagoon (43.7-200.3 μg/L). In groundwater, arsenic concentrations increase from the outer ring aquifer (3.82-29.7 μg/L) composed of alluvial-alluvial fan sediments to the inner lacustrine aquifer (10-113 μg/L) that surround the playa lake. Moreover, high concentrations of As during the dry season (90.2 and 113 μg/L), Na/K mass ratios (0.2 and 0.3), and formation of Na-rich efflorescent salts suggest that high evaporation rates increases As concentration, while rainwater dilutes the concentration during the wet season. As(V) is the dominant species in all the water types, except for the lagoon, where As(III) occasionally dominates because of organic matter buildup. There are at least three potential sources for As in water i) oxidation of As sulfides in Pan de Azúcar mine wastes, and acid mine drainage discharging into the basin; ii) weathering and erosion of mineralized shales; iii) weathering of volcanic eruptive non-mineralized rocks. Because it is a closed basin, the arsenic released from the natural and anthropogenic sources is transported in solution and in fluvial sediments and finally accumulates in the center of the basin where the concentration in water increases by evaporation with occasional enhancement by organic matter interaction in the lagoon., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Chronic diseases have an impact on and can change the lives of the persons affected by them. This study examines how a disease can influence patients' daily lives, the strategies they adopt to cope, and their experiences of support. The study focuses on four chronic diseases: asthma-allergy, cancer, diabetes mellitus, and inflammatory rheumatic arthritis., Methods: The study has a qualitative design and includes 41 transcribed in-depth interviews and a content analysis., Results: The participants' new life situation was changed for a very long time or forever, and this was not a voluntary choice. The new life situation comprised the following themes: life-changing-the disease could be a turning point in a negative or positive way, strategies-designed to create ways of coping with daily tasks to find a good quality of life, and support-that could be obtained from the participants' private network or the healthcare professionals., Conclusions: The patients had to make changes in their daily life, and these could bring about different feelings and restrict activity. Healthcare professionals need more knowledge of the process of coping with such life-changing matters and what could strengthen patients and give a sense of empowerment in their lives., Competing Interests: The authors declare no conflicts of interest.

Purpose: To determine the impact of expectant management surveillance for patients at risk for squamous cell carcinoma of the anus (SCCA)., Methods: Adult patients at risk for anal cancer, specifically those with human immunodeficiency virus (HIV) or known human papilloma virus (HPV) infections (anal dysplasia, anogenital warts, cervical dysplasia, or cervical cancer), underwent expectant management surveillance with targeted therapy of only grossly abnormal or symptomatic anoderm lesions. A retrospective analysis investigated the SCCA incidence in these surveilled populations and in the general population patients without known HIV or HPV infection., Results: There were 452 incident SCCA in a population of 5,978,510 patients (mean follow-up per patient of 5.4 years). Four hundred ten cancers (90.7%) developed in 5,750,501 HIV-negative patients without documented history of HPV infection (cumulative incidence 0.007%). In at-risk patient populations, the cumulative incidence was 0.69% in patients with anal dysplasia (6 out of 872 patients), 0.14% in HIV+ patients (8 out of 5626 patients), and less than 0.1% in the remaining at-risk groups: cervical cancer (1 out of 1168 patients), cervical dysplasia (14 out of 125,604 patients), and genital warts (14 out of 94,739 patients)., Conclusions: Expectant management surveillance, with targeted treatment for symptomatic or abnormal lesions, is an effective strategy for the diagnosis of anal cancer in at-risk patient populations. In this study, most patients who developed anal cancer had no known risk factors. A screening strategy for the general population needs to be further delineated.

The nematode parasites can cause mechanical injuries such as irritation or atrophy of tissue and occlusions of the digestive tract, blood vessels or other ducts in their hosts. Some species belonging to the family Camallanidae have been the focus of histopathological studies because they lacerate the host´s intestinal wall with their buccal capsule. In this study, we describe the histopathological effects produced by Procamallanus (Spirocamallanus) pintoi in the small fish Corydoras micracanthus from Lesser River, in the northwest of Argentina, South America. The samples were processed with routine histology techniques. At light microscopy, specimens of P. (S.) pintoi were observed occupying the lumen of the gut. The histopathological sections revealed damage to the host intestine with the total destruction of the mucosa and submucosa, observed mainly in the region which is surrounding the buccal capsule of parasites. Moreover, an inflammatory reaction was observed with lymphatic accumulations in the affected tissue. This kind of degenerative and necrotic changes in the mucosa could affect negatively the absorption function of the host intestine, which may have adverse effects of the health status of fish. The present study provides the firs data about the histopathological effects of P. (S.) pintoi in C. micracanthus.

Body-size is significantly correlated with the number of vertebrae (pleomerism) in multiple vertebrate lineages, indicating that somitogenesis process is an important factor dictating evolutionary change associated to phyletic allometry and, consequently, species fitness and diversification. However, the role of the evolution of extreme body sizes (dwarfism and gigantism) remains elusive in snakes, mainly with respect to postnatal ontogeny in dietary preferences associated with evolution of gigantism in many lineages. We described herein a new species in the highly diversified and species-rich genus Atractus on the basis of four specimens from the southeastern slopes of the Ecuadorian Andes. The new species is morphologically similar and apparently closely related to two other allopatric giant congeners (A. gigas and A. touzeti), from which it can be distinguished by their distinct dorsal and ventral coloration, the number of supralabial and infralabial scales, the number of maxillary teeth, and relative width of the head. In addition, we discuss on the ontogenetic trajectories hypotheses and dietary specializations related to evolution of gigantism in the goo-eaters genus Atractus.

The aquatic-to-terrestrial shift in the life cycle of most anurans suggests that the differences between the larval and adult morphology of the nose are required for sensory function in two media with different physical characteristics. However, a better controlled test of specialization to medium is to compare adult stages of terrestrial frogs with those that remain fully aquatic as adults. The Ceratophryidae is a monophyletic group of neotropical frogs whose diversification from a common terrestrial ancestor gave rise to both terrestrial (Ceratophrys, Chacophrys) and aquatic (Lepidobatrachus) adults. So, ceratophryids represent an excellent model to analyze the morphology and possible changes related to a secondary aquatic life. We describe the histomorphology of the nose during the ontogeny of the Ceratophryidae, paying particular attention to the condition in adult stages of the recessus olfactorius (a small area of olfactory epithelium that appears to be used for aquatic olfaction) and the eminentia olfactoria (a raised ridge on the floor of the principal cavity correlated with terrestrial olfaction). The species examined (Ceratophrys cranwelli, Chacophrys pierottii, Lepidobatrachus laevis, and L. llanensis) share a common larval olfactory organ composed by the principal cavity, the vomeronasal organ and the lateral appendix. At postmetamorphic stages, ceratophryids present a common morphology of the nose with the principal, middle, and inferior cavities with characteristics similar to other neobatrachians at the end of metamorphosis. However, in advanced adult stages, Lepidobatrachus laevis presents a recessus olfactorius with a heightened (peramorphic) development and a rudimentary (paedomorphic) eminentia olfactoria. Thus, the adult nose in Lepidobatrachus laevis arises from a common developmental 'terrestrial' pathway up to postmetamorphic stages, when its ontogeny leads to a distinctive morphology related to the evolutionarily derived, secondarily aquatic life of adults of this lineage., (© 2017 Wiley Periodicals, Inc.)

The potential for use of polymers in controlled drug delivery systems has been long recognized. Since their appearance in the literature, a wide range of degradable and non-degradable polymers have been demonstrated in drug delivery devices. The significance and features of ethylene-vinyl acetate (EVA) copolymers in initial research and development led to commercial drug delivery systems. This review examines the breadth of EVA use in drug delivery, and will aid the researcher in locating key references and experimental results, as well as understanding the features of EVA as a highly versatile, biocompatible polymer for drug delivery devices. Topics will include., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background Gonorrhoea occurs at high levels in young Aboriginal and Torres Strait Islander people living in remote communities, but there are limited data on urban and regional settings. An analysis was undertaken of gonorrhoea testing and positivity at four non-remote Aboriginal Community Controlled Health Services participating in a collaborative research network., Methods: This was a retrospective analysis of clinical encounter data derived from electronic medical records at participating services. Data were extracted using the GRHANITE program for all patients aged 15-54 years from 2009 to 2013. Demographic characteristics and testing and positivity for gonorrhoea were calculated for each year., Results: A total of 2971 patients (2571 Aboriginal and/or Torres Strait Islander) were tested for gonorrhoea during the study period. Among Aboriginal and/or Torres Strait Islander patients, 40 (1.6%) tested positive. Gonorrhoea positivity was associated with clinic location (higher in the regional clinic) and having had a positive chlamydia test. By year, the proportion of patients aged 15-29 years tested for gonorrhoea increased in both men (7.4% in 2009 to 15.9% in 2013) and women (14.8% in 2009 to 25.3% in 2013). Concurrent testing for chlamydia was performed on 86.3% of testing occasions, increasing from 75% in 2009 to 92% in 2013. Factors related to concurrent testing were sex and year of test., Conclusions: The prevalence of gonorrhoea among young Aboriginal and/or Torres Strait Islander people in non-remote settings suggests that the current approach of duplex testing for chlamydia and gonorrhoea simultaneously is justified, particularly for women.

When bird populations spread, long-distance pioneering populations are often backfilled by a more slowly advancing front [1-3]. The Barn Swallow Hirundo rustica, a globally distributed passerine [4, 5], expanded its breeding range an exceptional 7,000 km when it began breeding 35 years ago in its regular wintering range in Argentina [6], subsequently expanding over 500 km from its starting point [7-11]. Trans-hemispheric breeding attempts have occurred previously in related swallows [12-14], but only this colonization has lasted. Comparative studies of birds show a remarkable diversity in patterns of change in migratory habits [15-21], and these Argentine-breeding swallows might retain ancestral patterns, breeding in Argentina but returning to North America for the austral winter. Feather isotopes from these birds are consistent with the alternative possibility that they migrate no farther than northern South America [22]. Because isotopic patterns cannot definitively distinguish these alternatives, we pursued a solar geolocator study [23, 24] to do so. Data from nine tagged birds show conclusively that Barn Swallows breeding in Argentina have rapidly changed their movements to migrate no farther north in austral winter than northern South America. The phenology of the annual cycles of molt, migration, and breeding for these Argentine-breeding swallows have all shifted by about 6 months, and we suggest that stimulatory day lengths and the proliferation of nesting substrates facilitated their colonization., (Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.)

Objectives: To evaluate the effect of implanted S-nitrosoglutathione (GSNO) coating polypropylene mesh in foreign-body response of rats., Methods: Thirty female rats underwent to subcutaneous implant of five polypropylene (PP) fragments: uncoated PP (control); PP polyvinylalcohol (PVA) coated and PP PVA + GSNO (1, 10 and 70 mMol) coated. After euthanasia (4 and 30 days), eight slides were prepared from each animal: hematoxylin-eosin (inflammatory response); unstained (birefringence collagen evaluation); TUNEL technique (apoptosis); and five for immunohistochemical processing: CD-31 (angiogenesis), IL-1 and TNF-α (proinflammatory cytokynes), iNOS (NO synthesis) and MMP-2 (collagen metabolism). The inflammation area, birefringence index, apoptotic index, immunoreactivity and vessel density were objectively measured., Results: Inflammatory reaction area at 4 days was 11.3, 15.2, 25.1, 17.1 and 19.3% of pure PP, PVA, GSNO 1, 10 and 70 mM, respectively, p = 0.0006 (PP × Others). At 30 days lower inflammatory area was observed in GSNO 10 and 70 mM compared to pure PP (5.3, 5.2 and 11.1%, respectively, p = 0.0001). Vessel density was higher for GSNO 1 mM (25.5%) compared to pure PP (19.6%) at 30 days only, p = 0.0081. Apoptotic index at 4 days was lower for GSNO 1 mM (49.3%) than pure PVA (60.6%), p = 0.0124. GSNO 10 and 70 mM reduced their apoptotic index at 30 days compared to 4 days (49.9 vs. 36.9 and 59.1 vs. 47.5%, respectively, p = 0.0397). Birefringence index, IL-1, TNF, MMP-2 and iNOS were not different., Conclusions: Depending on concentrations, GSNO can increase angiogenesis, reduce inflammation and apoptosis compared to pure PP, without impact on cytokine, collagen organization/metabolism and endogenous NO synthesis.

Sexual maturity involves the differentiation of the reproductive system, the maturation of germ cells, and the development of secondary sexual characteristics. Even though this topic has received much attention, little is known about the sequence of events that encompass reproductive maturation in anurans and what it could reveal about the developmental basis of life cycle evolution. The discovery of froglets of Pseudis minuta with incipient vocal sacs calling in breeding pools alongside several larger adult specimens with fully developed vocal sacs raised the question of the timing of sexual maturity in this species. Here we describe the sequence and timing of differentiation, development and maturation of the vocal sac apparatus and the testes in P. minuta (Anura, Hylidae), in order to establish a timeline of events leading to sexual maturity. Differentiation of the vocal sac apparatus begins at the final metamorphic stages, earlier than reported for other species, and the vocal sac acquires its final shape during the early postmetamorphic period. These modifications occur after gonadal differentiation, which begins early during the larval period and proceeds with a highly accelerated rate of development (e.g., secondary spermatids appear well before metamorphic climax), a situation reported previously for other anuran species only in the genus Pseudis. These results, together with a skeletochronological analysis showing that some calling specimens presented no lines of arrested growth, indicate acceleration in the timing of sexual maturity in Pseudis, and raise questions about the interdependence/decoupling during the development of the different components involved in reaching the adult stage., (Copyright © 2016 Elsevier GmbH. All rights reserved.)

Hastisetae are extremely elaborate and intricate insect setae that occur solely on dermestid larvae (Coleoptera: Dermestidae). The present work characterizes hastisetae found in mid-Cretaceous amber from Myanmar and compares them to hastisetae found on extant dermestid larvae. The presence of hastisetae in Myanmar amber shows that lineages of dermestid beetles had already developed hastisetae by the mid-Cretaceous and their presence allows us to follow the evolutionary development of this particular arthropod structure over the past 100 million years. Hastisetae attached to a parasitic wasp in the same piece of amber indicates that ancient dermestid beetles used their hastisetae for defense, similar to their function today., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

This article highlights the major vascular supply of the orbit and structures supplied by these vessels. Key anatomic principles are then reviewed as they pertain to endoscopic orbital surgery in order to avoid serious orbital hemorrhages. Next, preoperative planning and patient education are outlined as well as description of orbital compartment syndrome. This is followed by discussion of various techniques for managing orbital hemorrhage in the intraoperative and postoperative setting., (Copyright © 2016 Elsevier Inc. All rights reserved.)

The Neotropical frog genera Ceratophrys, Chacophrys and Lepidobatrachus form the monophyletic family Ceratophryidae. Although in- and out-group relationships are not fully resolved, the monophyly of the three genera is well supported by both morphological and molecular data. Much is known about the morphology of the ceratophryids, but there is little comparative information on how modification of a common ancestral developmental pathway played a role in shaping their particular body plans. Herein, we review morphological variation during ceratophryid ontogeny in order to explore the role of development in their evolution. The ceratophryids are collectively characterized by rapid larval development with respect to other anurans, yet the three genera differ in their postmetamorphic growth rates to sexual maturity. Derived traits in the group can be divided into many homoplastic features that evolved in parallel with those of anurans with fossorial/burrowing behaviors in semiarid environments, and apomorphies. Morphological novelties have evolved in their feeding mechanism, which makes them capable of feeding on exceptional large prey. Lepidobatrachus is unusual in having reduced the ecomorphological differences between its larvae and adults. As a result, both the larvae and the frog are similarly able to capture large prey underwater. Some unique features in Lepidobatrachus are differentiated in the tadpole and then exaggerated in the adult (e.g., the posterior displaced jaw articulation) in a manner unobserved in any other anurans.

With less than 3 g of estimated body mass, the early Eocene Minusculodelphis minimus Paula Couto (Mammalia, Metatheria, Jaskhadelphyidae) is one of the smallest mammals, living or extinct. It has alternatively been regarded as a didelphid or a derorhynchid "ameridelphian," or even as an eometatherian marsupial. Here, we describe a new species of Minusculodelphis coming from the same locality (Itaboraí Quarry, Brazil) and age (Itaboraian age) of the type species of the genus. It differs from M. minimus in its larger size and several dental characters. The new species offers data on the upper dentition and femur, which are unknown in the type species. Compared to other Paleogene metatherians, Minusculodelphis shows closer relationships with Jaskhadelphys, from the early Paleocene of Tiupampa, Bolivia, as well as with Kiruwamaq, from the late Eocene-early Oligocene of Perú. A cladistic analysis places all three genera within the family Jaskhadelphyidae (Metatheria, Order indet.), which includes small to tiny, insectivorous-like metatherians. We argue that insectivory (soft insects) is the best-supported diet for both species of Minusculodelphis, and that the most probable microhabitat for them was the understorey or leaf litter of tropical, rain forested environments.

Osteoclasts are multinucleated cells responsible for bone resorption. They are derived from the fusion of cells in the monocyte/macrophage lineage. Monocytes and macrophages can also fuse to form foreign body giant cells (FBGC). Foreign body giant cells are observed at the interface between a host and a foreign body such as implants during a foreign body reaction. Macrophages are attracted to the site of bone resorption and foreign body reactions by different cytokines. Chemokine (C-C) ligand-2 (CCL2) is an important chemotactic factor and binds to a receptor CCR2. In this study we investigated the importance of CCL2 and the receptor CCR2 in the formation of osteoclasts and FBGC. CCL2 mRNA was more highly expressed in giant cell culture than macrophages, being 9-fold and 16-fold more abundant in osteoclasts and FBGC respectively. Significantly fewer osteoclasts and FBGC were cultured from the bone marrow of CCL2 and CCR2 knockout mice, when compared to wild type. Not only were the number of giant cells reduced but there was a significant reduction in the number of nuclei and the size of these cells in the cultures of CCL2 and CCR2 knockout mice. Formation of osteoclasts and FBGC were recovered in cultures by addition of exogenous CCL2 to the media containing marrow cells from CCL2-/- mice. We conclude that CCL2 and its receptor CCR2 are important for the formation of osteoclasts and FBGC and absence of these genes causes inhibition of osteoclast and FBGC formation., (© 2015 Wiley Periodicals, Inc.)

The long head of the biceps has garnered increased attention and interest due to the high prevalence of pain that can be a primary condition or occur secondary to shoulder dysfunction. The successful treatment of biceps tendinopathy is dependent on an accurate diagnosis and recognizing all causative factors. The treatment program will be individualized with a rehabilitation program designed to restore strength and flexibility and restore normal tendon mechanics., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Periodontal disease is a chronic inflammation of the tooth supporting structures. It leads to bone and attachment loss which is irreversible. Extraction of horizontally impacted lower third molar (L3M) teeth may result in localized periodontal pockets at the distal aspect of the adjacent lower second molars (L2M). We present a case of a 21-year-old male who suffered from a swelling and pain around his lower right second molar following surgical removal of a mesioangular impacted lower right third molar. We showed that oral hygiene measures, surgical access, mixture of autogenous and synthetic bone graft, and guided tissue regeneration (GTR) were enough to control the problem.

Implicit cognition, or our unconscious thoughts and beliefs, is an important predictor of our behaviors and decisions. It also predicts outcomes related to physical and mental health at the level of the individual and influences the dynamics of the patient-physician relationship. This article outlines specific ways in which implicit measures of cognition predict vulnerabilities to adverse health and contribute to social disparities in health and discusses important future directions for this body of research., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Myofascial pain is one of the most common causes of pain. The diagnosis of myofascial pain syndrome (MPS) is made by muscle palpation. The source of the pain in MPS is the myofascial trigger point, a very localized region of tender, contracted muscle that is readily identified by palpation. The trigger point has well-described electrophysiologic properties and is associated with a derangement of the local biochemical milieu of the muscle. A proper diagnosis of MPS includes evaluation of muscle as a cause of pain, and assessment of associated conditions that have an impact on MPS., (Copyright © 2014 Elsevier Inc. All rights reserved.)

The reported prenatal detection rates (PDRs) for significant congenital heart disease (sCHD) have been suboptimal, even in the current era. Changes in prenatal ultrasound policy and training may lead to improved prenatal detection of sCHD. This study analyzed the results of a policy to assess fetal cardiac outflow tracts shown by screening prenatal ultrasound using the electronic medical record (EMR). During a 6-year period, fetuses and patients younger than 1 year with sCHD were identified. The EMR was used to gather detection and outcome data. As an internal control within the same health care system, the PDR of only the surgical cases was compared with that of a similar group in which documentation of the fetal cardiac outflow tracts was not standard policy. Among 25,666 births, sCHD was identified in 93 fetuses or patients, yielding an incidence of 3.6 per 1,000 births. The PDR was 74.1%. Detection after birth but before discharge was 20.4%, and detection after discharge was 5.4%. A significant improvement in the PDR of sCHD was found when a concerted effort was made to obtain fetal cardiac outflow tract views during pregnancy screening (59.3 vs. 28%). Within an integrated health care system and with the use of an EMR, a PDR of 74% can be obtained, and 94% of sCHD can be detected before discharge. A concerted program that includes documentation of fetal cardiac outflow tracts in the pregnancy screening can result in improved PDR of sCHD.

The incidence of the metabolic syndrome represents a spectrum of disorders that continue to increase across the industrialized world. Both genetic and environmental factors contribute to metabolic syndrome and recent evidence has emerged to suggest that alterations in circadian systems and sleep participate in the pathogenesis of the disease. In this review, we highlight studies at the intersection of clinical medicine and experimental genetics that pinpoint how perturbations of the internal clock system, and sleep, constitute risk factors for disorders including obesity, diabetes mellitus, cardiovascular disease, thrombosis and even inflammation. An exciting aspect of the field has been the integration of behavioral and physiological approaches, and the emerging insight into both neural and peripheral tissues in disease pathogenesis. Consideration of the cell and molecular links between disorders of circadian rhythms and sleep with metabolic syndrome has begun to open new opportunities for mechanism-based therapeutics.

The circadian system is a key integrator of behavior and metabolism that synchronizes physiological processes with the rotation of the Earth on its axis. In mammals, the clock is present not only within the central pacemaker neurons of the hypothalamus, but also within extra-suprachiasmatic nucleus (SCN) regions of brain and nearly all peripheral tissues. Recent evidence suggests that the complex feedback networks that encompass both the circadian and metabolic systems are intimately intertwined and that disruption of either system leads to reciprocal disturbances in the other. We anticipate that improved understanding of the interconnections between the circadian and metabolic networks will open new windows on the treatment of sleep and metabolic disorders, including diabetes mellitus and obesity.

Background: Uterine torsion has been associated with a variety of adverse outcomes ranging from fetal distress to maternal death. Uterine torsion has also been reported in otherwise uncomplicated pregnancies., Cases: We report 2 cases of uterine torsion with abnormal anterior placentation identified at cesarean section, which had previously been disguised as posterior placenta previas., Conclusion: Given the increased risk of placenta accreta with an anterior placenta and prior cesarean scar, uterine position should be considered in the evaluation of a presumed posterior placenta, particularly with ultrasound findings suggestive of accreta such as placental lakes.

Background: Interleukin 4 (IL-4) is the central cytokine driving the differentiation of naive CD4(+) T helper (TH) cells into anti-inflammatory IL-4-producing TH2 cells. In contrast, IL-12/IL-23 promotes the development of TH1/TH17 immune responses that induce organ-specific autoimmune diseases such as psoriasis or multiple sclerosis., Objective: We focus on the potential of IL-4 and TH2 induction to treat inflammatory autoimmune diseases., Methods: Here, we summarize the basics for the establishment of the in vitro and in vivo conditions for the generation of TH2 immune responses, followed by various experimental data showing the therapeutic use of IL-4 for the therapy of autoimmune diseases. This data and early experiences with recombinant human IL-4 (rhIL-4) in the therapy of patients with cancer set the basis for the clinical introduction of rhIL-4 in the treatment of patients with psoriasis in a Phase I/II trial., Conclusion: IL-4 seems to act by inducing an anti-inflammatory phenotype and further clinical trials will explore the promising therapeutic potency of IL-4 in psoriasis during the upcoming era of biologics.

For decades, hemotoxicity has been considered as simply changes in peripheral blood parameters or morphological changes observed in the bone marrow as a result of drug administration. The effects are actually the result of the drug acting at a much earlier level in the blood-forming system, usually at the level of the lympho-hematopoietic stem cell or its immediate differentiating progeny. To detect these early cellular responses, highly sensitive, non-subjective and fully standardized in vitro high-throughput testing platforms have been developed that detect changes in intracellular ATP concentrations which are directly proportional to and predict the proliferative/cytotoxic response of different cell populations.

Objective: Occupational therapists are routinely involved in upper-extremity rehabilitation in persons with stroke. Recently we have reported that self-speech can be used to facilitate simple reach in young and older adults. The purpose of this study is to examine whether self-speech-induced facilitation of simple reach can be translated in persons with stroke., Method: Following a counterbalanced repeated-measure design, seven persons with right brain stroke performed reaching and placing a glass on a cabinet shelf under four concurrent speech conditions of vocalizing the word "yeah" with both hemiplegic and nonhemiplegic sides. These four conditions are self-vocalization, external vocalization, imaginary vocalization, and no vocalization. Consistent with our previous study, in this study we also recorded the movement kinematics of angular movement of the upper arm., Results: Reaching velocity was significantly higher under self-vocalization conditions compared to the reaching velocity under no vocalization or other vocalization conditions (p < .05). Motor performance in terms of velocity, nonhemiparetic side was significantly better than hemiparetic side (p < .05)., Conclusion: The results suggest that self-speech can be used in facilitating movements in patients with stroke. When working with patients with right hemispheric stroke, therapists might explore possibilities of using patient's self-speech to enhance the quality of movement performance.

Clinical data and experience to date have demonstrated that BoNT-A is an effective and well-tolerated therapy for the prevention of migraine and other headache disorders. It has a long duration of action that may last over 4 months with no systemic or serious AEs. Several issues remain to be defined, however, including dosing, location, and number of injections; optimal dilution of BoNT-A; specific headache types that respond best to BoNT-A; and long-term efficacy and safety. Data from ongoing well-designed trials that include a larger patient population investigating these issues may confirm a role for BoNT-A as a first-line agent for migraine prevention. Neurotoxin therapy is part of a broader headache management approach. Because the injection techniques for headache are unique and vary depending on the primary headache disorder being treated and the location and pattern of pain referral, the use of BoNT-A for headache is not simply an extension of its use for cosmesis. The use of BoNT-A in the overall management of primary headache disorders should be reserved for medical practitioners who not only have experience with BoNT-A injections, but possess the expertise in the diagnosis and management of complex headache disorders. Educating patients and addressing headache triggers and optimizing acute treatment improve the outcome of any preventive program.

A double-blinded placebo-controlled trial was performed to evaluate the use of steroid injections beneath the transverse carpal ligament in the treatment of carpal tunnel syndrome (CTS) refractory to nonsurgical therapy. Forty-three patients received 6 mg betamethasone and lidocaine and 38 patients received 1 ml saline placebo and lidocaine. The primary outcome measure was satisfaction with symptom relief. Thirty patients (70%) in the steroid-treated group were satisfied or highly satisfied compared with 13 (34%) of placebo-treated patients (P < 0.001). Patients receiving steroids also showed significant improvement in median nerve conduction parameters and scores on validated symptom/function questionnaires. Forty-six patients were treated with serial injections for recurrent CTS symptoms. After 18 months, 17 patients reported adequate symptom relief with steroid injection, and 18 patients with unsatisfactory symptom relief were referred for carpal tunnel release surgery. We conclude that although steroid injections are safe and effective for temporary relief of CTS, most patients will eventually require surgery for long-term control of their symptoms.

Neuronopathic Gaucher disease, classically divided into two types, can have a continuum of phenotypes, often defying categorization. Nine children had an intermediate phenotype characterized by a delayed age of onset but rapidly progressive neurological disease, including refractory seizures and oculomotor abnormalities. There was genotypic heterogeneity among these patients.