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ObjectiveThe cytokine profile of human milk may be a key indicator of mammary gland health and has been linked to infant nutrition, growth, and immune system development. The current study examines the extent to which mammary epithelium permeability (MEP) is associated with cytokine profiles during established lactation within a sample of US mothers.MethodsParticipants were drawn from a previous study of human milk cytokines. The present analysis includes 162 participants (98 Black, 64 White) with infants ranging from 1 to 18 months of age. Levels of cytokines were determined previously. Here we measure milk sodium (Na) and potassium (K) levels with ion-selective probes. Two approaches were used to define elevated MEP: Na levels ≥10 mmol/L and Na/K ratios greater than 0.6. Associations between maternal–infant characteristics, elevated MEP, and twelve analytes (IL-6, IL-8, TNFα, IL-1β, FASL, VEGFD, FLT1, bFGF, PLGF, EGF, leptin, adiponectin) were examined using bivariate associations, principal components analysis, and multivariable logistic regression models.ResultsElevated MEP was observed in 12 and 15% of milk samples as defined by Na and Na/K cutoffs, respectively. The odds of experiencing elevated MEP (defined by Na ≥ 10 mmol/L) were higher among Black participants and declined with older infant age. All cytokines, except leptin, were positively correlated with either Na or the Na/K ratio. A pro-inflammatory factor (IL-6, IL-8, TNFα, IL-1β, EGF) and a tissue remodeling factor (FASL, VEGFD, FLT1, bFGF, PLGF, adiponectin) each contributed uniquely to raising the odds of elevated MEP as defined by either Na or the Na/K ratio.ConclusionThis exploratory analysis of MEP and cytokine levels during established lactation indicates that elevated MEP may be more common in US populations than previously appreciated and that individuals identifying as Black may have increased odds of experiencing elevated MEP based on current definitions. Research aimed at understanding the role of MEP in mammary gland health or infant growth and development should be prioritized.

Background: Previous research suggests individual-level socioeconomic circumstances and resources may be especially salient influences on mortality within the broader context of social, economic, and environmental factors affecting urban 19th century mortality. Objective: We sought to test individual-level socioeconomic effects on mortality from infectious and often epidemic diseases in the context of an emerging New England industrial mill town. Methods: We analyze mortality data from comprehensive death records and a sample of death records linked to census data, for an emergent industrial New England town, to analyze infectious mortality and model socioeconomic effects using Poisson rate regression. Results: Despite our expectations that individual resources might be especially salient in the harsh mortality setting of a crowded, rapidly growing, emergent, industrial mill town with high levels of impoverishment, infectious mortality was not significantly lowered by individual socio-economic status or resources.

Average yield of wheat (Triticum aestivum L.) and barley (Hordeum vulgare L.) in the high rainfall cropping zone (>750 mm) of south Western Australia from 1996 to 2001 was 2.5 t/ha. This is far below the water-limited potential yield (water losses of 110 mm, transpiration efficiency of 20 kg/ha.mm) of 6?8 t/ha. Nutrition of the cereal crops has been regarded as one constraint to reaching the potential yield, although grain yield increases (responses) under conventional management practices (a series of full cultivation operations) have been inconsistent. Three experiments, with a total of five trial sites conducted over two seasons, were carried out to test the response of wheat and barley to fertiliser applications of nitrogen (N), phosphorus (P), potassium (K), sulfur (S) and trace elements (TE). Various combinations of nutrients were applied. These ranged from no fertiliser (nil), to farmer practice (N at rates at 34?82 kg/ha, P at 3?17 kg/ha, K at 0?50 kg/ha and S at 4?11 kg/ha), to nutrients calculated to supply the needs of a 6?8 t/ha cereal crop (N, P, K, S, TE). The aim was to determine whether the supply of non-limiting levels of crop nutrients could raise yields to the potential yield as determined by seasonal rainfall. In the drier seasons experienced in 2001 and 2002 at Arthur River and Cranbrook, with growing season rainfall (May?November) up to about 350 mm, it was possible to raise grain yields to levels at or above the calculated rainfall-limited potential with increased nutrition (4.2 t/ha for barley and 4.5 t/ha for wheat). However, in the wetter environment of Boyup Brook in 2002, where seasonal rainfall was greater than 500 mm, extra nutrition by itself was not sufficient to reach the water-limited potential, even where the yields were increased from 3.5 to 5.2 t/ha for wheat and from 3.9 to 4.5 t/ha for barley. Further experimentation is required to clarify the factors limiting responses to nutrition when the growing season rainfall is greater than 500 mm and thus allow greater confidence in extrapolating these results in the high rainfall cropping zone of Western Australia. In wheat, the highest profits were obtained from the complete fertiliser strategy (N, P, K, S, TE). However, for barley, the greatest profits were not obtained with the highest grain yields and fertiliser strategies due to decreased grain quality. [ABSTRACT FROM AUTHOR]

Communication within healthcare settings is often a subject of contention for patients' families at the best of times; however, contention was greatly magnified in the United Kingdom by restrictions on hospital visitations during the early stage of the COVID-19 pandemic. To support communication between families and patients, a central London hospital introduced the role of the family liaison officer (FLO). This study was designed to evaluate the rapid implementation of the FLO and to explore potential for it to become a standard role. Semi-structured interviews were conducted with five FLOs and seven colleagues who had worked alongside them between April and June, 2020. Two versions of the role emerged based on FLOs' previous background: clinical (primarily nurses) and pastoral (primarily play specialists). The FLO became a key role during the pandemic in facilitating communication between patients, clinical teams, and families. Challenges associated with the role reflect the speed in which it was implemented. It was evident to those in the role, and clinicians who the role was supporting, that it had potential to help improve hospital communication and the work of healthcare staff beyond the pandemic., Competing Interests: Conflict of interest: The authors declare no conflict of interest., (©Copyright: the Author(s).)

Ictal bradycardia and asystole are rare, but potentially serious complications of epileptic seizures. We present a case series of three such patients diagnosed through our syncope service. For two patients, treatment with anticonvulsant therapy alone achieved symptom control. The third patient was initially managed with permanent pacemaker insertion due to detection of a significant ventricular pause. He subsequently developed more pronounced symptoms suggestive of seizure.Ictal asystole can cause significant diagnostic challenge and management strategies remain controversial due to the overlap in presentation to cardiology and neurology services. The number of patients affected is low, impeding the formulation of an evidence base for treatment. We propose multidisciplinary working facilitated by a specialist syncope service as a means of recognising and treating this condition more effectively., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Accurate estimation of motion in fluoroscopic imaging sequences is critical for improved frame interpolation/extrapolation, tracking of surgical instruments, and Digital Subtraction Angiography (DSA). The projection of multiple transparent objects undergoing multiple complicated deformations in 3D onto a single 2D view makes this motion estimation problem quite challenging and ill-suited to existing techniques used in medical image analysis. We propose a novel method for jointly decomposing the observed image into a set of additive layers each associated with its corresponding smooth nonlinear deformation, which together model the non-smooth motion observed in the projection images across several frames. A total variation based regularization penalty is used to incorporate the known structure of the input frames for well posedness of the layer separation problem. We present the use of this model for frame interpolation and artifact reduction in DSA. Results are included from synthetic and real clinical datasets.

Study Design: Open interventional MRI techniques were used to investigate the intervertebral mobility of the lumbar spine in subjects with isthmic and degenerative spondylolisthesis. The findings were compared with those in a published database of subjects with no history of low back pain., Objective: To investigate patterns of intervertebral mobility in subjects with spondylolisthesis to determine the level of spinal instability in this population., Summary of Background Data: Subjects with spondylolisthesis have been considered to present with a special form of spinal instability. Consequently, this condition is frequently managed by spinal fusion. However, confusion exists regarding whether there is excessive motion at the level of the defect., Methods: For this study, 29 subjects presenting to spinal clinics with spondylolisthesis (15 isthmic and 14 degenerative) were recruited and compared with an existing database of control subjects. The motion characteristics of these subjects in flexed and extended positions were investigated using interventional open MRI of known precision. In all the subjects, the level of resting pain, the grade of slip, and the level of the defect were noted., Results: No mobility differences, in terms of both angular and translational motion, were found between the subjects with spondylolisthesis and those with no history of low back pain, suggesting that subjects with spondylolisthesis do not present with either instability or hypermobility., Conclusion: A spondylolytic defect does not lead to detectable instability or hypermobility in the lumbar spine.

Unlabelled: Low back pain (LBP) is a common problem in elite oarsmen. The relevance of spinal and pelvic flexibility to good rowing technique and the incidence of LBP is unclear., Purpose: The aim of this study was to investigate patterns of spinal and pelvic mobility in a group of elite oarsmen with and without a history of LBP., Methods: Twenty elite oarsmen were recruited into this study, including nine with no history of spinal problems, four with a current spinal problem, and the remainder with a history of LBP. Subjects were scanned using an interventional magnetic resonance imaging (MRI) scanner. Four key stages of the rowing stroke were simulated within the scanner, and sagittal images of the lumbar spine and sacrum were obtained. From these images intersegmental motion was determined along with the angle of lordosis and position of the lumbar spine and sacrum., Results: Different mobility trends were seen; oarsmen with no history of LBP demonstrated the greatest mobility in their lower lumbar regions (at the L5/S1 level in the catch position 7.5 degrees +/-1.3 in normals; 4.8 degrees +/-1.2 in previous LBP groups; and 2.8 degrees +/-5.5 in current LBP group) and the lowest rotation of their pelvis (level in the catch position 13.9 degrees +/-11.2 in normals; 16.1 degrees +/-6.8 in previous back pain groups; and 15.2 degrees +/-11.2 in current back pain group). In contrast, those with either current or previous LBP presented with a hypomobility of their spine which appeared to be compensated for by increased pelvic rotation., Conclusions: Marked differences were observed in the motion characteristics of these 3 groups of oarsmen. At present it is not known if these changes are causative or effect.

Objectives: To investigate the trunk strength of elite rowers and the impact of low back pain on these measures in order to determine if asymmetries or weakness were present., Methods: Twenty two elite rowers were recruited: 13 reported previous low back pain, five current low back pain, and the remainder had no history of low back pain. All subjects were scanned during simulated rowing in an interventional open magnetic resonance imaging scanner. In each simulated rowing position, axial scans were obtained at the level of the L4-5 and L5-S1 disc interspace to determine the cross sectional area of the posterior trunk muscles., Results: Considerable differences were observed between the three groups of rowers. In contrast with expectations and previous literature, the trunk muscles of rowers with low back pain had significantly larger cross sectional areas (p<0.001). No left/right asymmetries were observed and no differences between oarside and non-oarside in terms of muscle cross sectional area., Conclusion: These findings suggest that low back pain in rowers does not arise as a result of muscle weakness.

Assessment of spinal intersegmental motion has been a focus for research and has depended on radiographic techniques. Radiographic techniques are limited because of ionizing radiation exposure, magnification errors, and image quality. Interventional magnetic resonance scanners, however, allow dynamic imaging in the scanner in different positions. Twelve healthy subjects were scanned using a General Electric Signa SP10 open interventional magnetic resonance scanner. Subjects were scanned while they were in the supine position and during sitting in flexed and extended positions. Measurements of lumbar curvature and intersegmental motion were made from the sagittal images obtained. The results showed that it was possible to obtain repeatable measures of intersegmental rotation and translation from open magnetic resonance images of the spine in flexed and extended positions. These measures of motion are in agreement with previous data and suggest that the greatest motion occurs at the L4-L5 level. The use of interventional magnetic resonance imaging for assessing lumbar intersegmental mobility seems promising.

Data on the prevalence, magnitude and causes of blindness and severe visual impairment in children are needed for planning and evaluating preventive and curative services for children, and for planning special education and low vision services. Prevalence data can be obtained from a variety of different sources, each of which has limitations. The available data suggest that there may be a ten-fold difference in prevalence between the wealthiest countries of the world and the poorest, ranging from as low as 0.1/1000 children aged 0-15 years in the wealthiest countries to 1.1/1000 children in the poorest. In this paper, the available data are reviewed and the epidemiological methods and findings are discussed.

We report a case of chronic myeloid leukaemia initially presenting with a vitreous haemorrhage associated with bilateral retinal and optic disc neovascularization. The literature is briefly reviewed and the probable reasons for the observed microcirculatory disturbances are discussed.