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Background: Emerging evidence suggests that non-olfactory tissues and cells can express olfactory receptors (ORs), however, the exact function of ectopic OR expression remains unknown. We have previously shown in mouse models that a unique cooperation between interferon-γ (IFN-γ) and lipopolysaccharide (LPS) drives the activation of pulmonary macrophages and leads to the induction of pathogenic responses in the respiratory tract. Further, through gene array studies, we have shown that activation of macrophages by these molecules results in the selective expression of a number of ORs. In this study, we validated the expression of these ORs in mouse airway and pulmonary macrophages in response to IFN-γ and LPS (γ/LPS) stimulation, and further explored the effect of odorant stimulation on macrophage function. Methodology/Principal Findings: OR expression in airway and pulmonary macrophages in response to IFN-γ, LPS or γ/LPS treatments was assessed by microarray and validated by q-PCR. OR expression (e.g. OR622) on macrophages was confirmed by visualization in immunofluoresence assays. Functional responses to odorants were assessed by quantifying inflammatory cytokine and chemokine expression using q-PCR and cell migration was assessed by a modified Boyden chamber migration assay. Our results demonstrate that eight ORs are expressed at basal levels in both airway and pulmonary macrophages, and that γ/LPS stimulation cooperatively increased this expression. Pulmonary macrophages exposed to the combined treatment of γ/LPS+octanal (an odorant) exhibited a 3-fold increase in MCP-1 protein production, compared to cells treated with γ/LPS alone. Supernatants from γ/LPS+octanal exposed macrophages also increased macrophage migration in vitro. Conclusions/Significance: Eight different ORs are expressed at basal levels in pulmonary macrophages and expression is upregulated by the synergistic action of γ/LPS. Octanal stimulation further increased MCP-1 production and the motility of macrophages. Our results suggest that ORs may mediate macrophage function by regulating MCP-1 production and cell migration. © 2013 Li et al.

Background 20–30% of patients with asthma have neutrophilic airway inflammation and reduced responsiveness to steroid therapy. They often have chronic airway bacterial colonisation and Haemophilus influenzae is one of the most commonly isolated bacteria. The relationship between chronic airway colonisation and the development of steroid-resistant neutrophilic asthma is unclear. Objectives To investigate the relationship between H influenzae respiratory infection and neutrophilic asthma using mouse models of infection and ovalbumin (OVA)-induced allergic airways disease. Methods BALB/c mice were intratracheally infected with H influenzae (day 10), intraperitoneally sensitised (day 0) and intranasally challenged (day 12–15) with OVA. Treatment groups were administered dexamethasone intranasally during OVA challenge. Infection, allergic airways disease, steroid sensitivity and immune responses were assessed (days 11, 16 and 21). Results The combination of H influenzae infection and allergic airways disease resulted in chronic lung infection that was detected on days 11, 16 and 21 (21, 26 and 31 days after infection). Neutrophilic allergic airways disease and T helper 17 cell development were induced, which did not require active infection. Importantly, all features of neutrophilic allergic airways disease were steroid resistant. Toll-like receptor 4 expression and activation of phagocytes was reduced, but most significantly the influx and/or development of phagocytosing neutrophils and macrophages into the airways was inhibited. Conclusions The combination of infection and allergic airways disease promotes bacterial persistence, leading to the development of a phenotype similar to steroid-resistant neutrophilic asthma and which may result from dysfunction in innate immune cells. This indicates that targeting bacterial infection in steroid-resistant asthma may have therapeutic benefit.

Background: 20-30% of patients with asthma have neutrophilic airway inflammation and reduced responsiveness to steroid therapy. They often have chronic airway bacterial colonisation and Haemophilus influenzae is one of the most commonly isolated bacteria. The relationship between chronic airway colonisation and the development of steroid-resistant neutrophilic asthma is unclear. Objectives: To investigate the relationship between H influenzae respiratory infection and neutrophilic asthma using mouse models of infection and ovalbumin (OVA)- induced allergic airways disease. Methods: BALB/c mice were intratracheally infected with H influenzae (day 10), intraperitoneally sensitised (day 0) and intranasally challenged (day 12-15) with OVA. Treatment groups were administered dexamethasone intranasally during OVA challenge. Infection, allergic airways disease, steroid sensitivity and immune responses were assessed (days 11, 16 and 21). Results: The combination of H influenzae infection and allergic airways disease resulted in chronic lung infection that was detected on days 11, 16 and 21 (21, 26 and 31 days after infection). Neutrophilic allergic airways disease and T helper 17 cell development were induced, which did not require active infection. Importantly, all features of neutrophilic allergic airways disease were steroid resistant. Toll-like receptor 4 expression and activation of phagocytes was reduced, but most significantly the influx and/or development of phagocytosing neutrophils and macrophages into the airways was inhibited. Conclusions: The combination of infection and allergic airways disease promotes bacterial persistence, leading to the development of a phenotype similar to steroid-resistant neutrophilic asthma and which may result from dysfunction in innate immune cells. This indicates that targeting bacterial infection in steroid-resistant asthma may have therapeutic benefit.

Background: Viral and bacterial respiratory tract infections in early-life are linked to the development of allergic airway inflammation and asthma. However, the mechanisms involved are not well understood. We have previously shown that neonatal and infant, but not adult, chlamydial lung infections in mice permanently alter inflammatory phenotype and physiology to increase the severity of allergic airway disease by increasing lung interleukin (IL)-13 expression, mucus hyper-secretion and airway hyper-responsiveness. This occurred through different mechanisms with infection at different ages. Neonatal infection suppressed inflammatory responses but enhanced systemic dendritic cell:T-cell IL-13 release and induced permanent alterations in lung structure (i.e., increased the size of alveoli). Infant infection enhanced inflammatory responses but had no effect on lung structure. Here we investigated the role of hematopoietic cells in these processes using bone marrow chimera studies. Methodology/Principal Findings: Neonatal (

While it is clear that companies are under an obligation to comply with the rules, they are largely free to decide how to go about their compliance efforts. Ingrid Breit, Jeroen Capiau, Andrew Essilfie (DG Comp)

Background Preterm premature rupture of membranes (PPROM) is a leading cause of perinatal morbidity and mortality. Amnioinfusion aims to restore amniotic fluid volume by infusing a solution into the uterine cavity. Objectives The objective of this review was to assess the effects of amnioinfusion for PPROM on perinatal and maternal morbidity and mortality. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2011). Selection criteria Randomised trials of amnioinfusion compared to no amnioinfusion in women with PPROM. Data collection and analysis Three review authors independently assessed trials for inclusion. Two review authors independently assessed trial quality and extracted data. Data were checked for accuracy. Main results We included five trials but we only analysed data from four studies (with a total of 241 participants). One trial did not contribute any data to the review. Transcervical amnioinfusion improved fetal umbilical artery pH at delivery (mean difference 0.11; 95% confidence interval (CI) 0.08 to 0.14; one trial, 61 participants) and reduced persistent variable decelerations during labour (risk ratio (RR) 0.52; 95% CI 0.30 to 0.91; one trial, 86 participants). Transabdominal amnioinfusion was associated with a reduction in neonatal death (RR 0.30; 95% CI 0.14 to 0.66; two trials, 94 participants), neonatal sepsis (RR 0.26, 95% CI 0.11 to 0.61; one trial, 60 participants), pulmonary hypoplasia (RR 0.22; 95% CI 0.06 to 0.88; one trial, 34 participants) and puerperal sepsis (RR 0.20; 95% CI 0.05 to 0.84; one trial, 60 participants). Women in the amnioinfusion group were also less likely to deliver within seven days of membrane rupture (RR 0.18; 95% CI 0.05 to 0.70; one trial, 34 participants). These results should be treated with circumspection as the positive findings were mainly due to one trial with unclear allocation concealment. Authors' conclusions These results are encouraging but are limited by the sparse data and unclear methodological robustness, therefore further evidence is required before amnioinfusion for PPROM can be recommended for routine clinical practice.

The primary objective of the study was to estimate the levels of technical efficiency in small scale maize production in the Mfantseman Municipality of Ghana using the Stochastic Frontier Approach. The study also attempted to determine some socio-economic characteristics and management practices which influence technical efficiency in maize production. Responsiveness of yield to production inputs was also estimated by computing input elasticities. The marginal value product for fertilizer, labor and seed were also calculated. Finally, the marginal physical products, average physical products, relative efficiency of resource use and the returns to scale of input use were calculated. Results indicated that the mean technical efficiency of small scale maize production in the study area is 58%; however, this ranges from 17 to 99%. There is distinct and inter gender variability in technical efficiency in the maize producing villages. In addition, the number of years of school the farmer has had in formal education, age of the farmer, household size, and off – farm income activities of the farmer impact on technical efficiency. The estimated marginal physical products showed that, ceteris paribus, each additional unit use of maize seed increased output by 31 kg (0.31 bags). Fertilizer also increased output by 12 kg (0.12 bags) and labor increased output by 29 kg (0.29 bags). Lastly the estimated return to scale is 1.49 indicating increasing returns to scale of maize production in the study area. Key words: Stochastic, production, frontier, technical efficiency, Mfantseman.

Uranium mill tailings from northern Saskatchewan, Canada contain elevated levels of As and Ni. The potential mobilization of these elements from the tailings management facilities to regional groundwater systems is an environmental concern for the uranium mining industry. In this study, electron microprobe analysis and synchrotron-based microfocussing X-ray fluorescence mapping and absorption spectroscopy (μ-XRF; μ-XAS) were used to identify and characterize the chemical composition of As-, Ni-, and Fe-bearing mineral phases at the micron scale in mine tailings samples from the Deilmann Tailings Management Facility (DTMF) located at the Key Lake mill of Cameco Corp. in northern Saskatchewan, Canada.

Medical and surgical disorders in pregnancy can be can be quite challenging for the obstetrician gynaecologist even in resource rich countries. Reaching an accurate diagnosis and admininstering appropriate management can be difficult in the presence of an on-going pregnancy. The importance of involving specialist from other disciplines (multidisciplinary care) cannot be overemphasized. We present an interesting case of perforated duodenal ulcer in a pregnant patient, review the literature ,discuss the differential diagnosis and evaluate the management principles for this rare condition.

Medical and surgical disorders in pregnancy can be can be quite challenging for the obstetrician gynaecologist even in resource rich countries. Reaching an accurate diagnosis and admininstering appropriate management can be difficult in the presence of an on-going pregnancy. The importance of involving specialist from other disciplines (multidisciplinary care) cannot be overemphasized. We present an interesting case of perforated duodenal ulcer in a pregnant patient, review the literature ,discuss the differential diagnosis and evaluate the management principles for this rare condition.

Uranium (U) mill tailings in northern Saskatchewan, Canada, contain elevated concentrations of molybdenum (Mo). The potential for long-term (10,000 years) mobilization of Mo from the tailings management facilities to regional groundwater systems is an environmental concern. To assist in characterizing long-term stability, X-ray absorption spectroscopy was used to define the chemical (redox and molecular) speciation of Mo in tailings samples from the Deilmann Tailings Management Facility (DTMF) at the Key Lake operations of Cameco Corporation. Comparison of Mo K near-edge X-ray absorption spectra of tailings samples and reference compounds of known oxidation states indicates Mo exists mainly as molybdate (+6 oxidation state). Principal component analysis of tailings samples spectra followed by linear combination fitting using spectra of reference compounds indicates that various proportions of NiMoO(4) and CaMoO(4) complexes, as well as molybdate adsorbed onto ferrihydrite, are the Mo species present in the U mine tailings. Tailings samples with low Fe/Mo (708) and high Ni/Mo (113) molar ratios are dominated by NiMoO(4), whereas those with high Fe/Mo (708) and low Ni/Mo (113) molar ratios are dominated by molybdate adsorbed onto ferrihydrite. This suggests that the speciation of Mo in the tailings is dependent in part on the chemistry of the original ore.

Under oxic aqueous conditions, two-line ferrihydrite gradually transforms to more thermodynamically stable and more crystalline phases, such as goethite and hematite. This temperature- and pH-dependent transformation can play an important role in the sequestration of metals and metalloids adsorbed onto ferrihydrite. A comprehensive assessment of the crystallization of two-line ferrihydrite with respect to temperature (25, 50, 75, and 100 °C) and pH (2, 7, and 10) as a function of reaction time (minutes to months) was conducted via batch experiments. Pure and transformed phases were characterized by X-ray diffraction (XRD), X-ray absorption near-edge spectroscopy (XANES), atomic force microscopy (AFM), and scanning electron microscopy (SEM). The rate of transformation of two-line ferrihydrite to hematite increased with increasing temperature at all pHs studied and followed first-order reaction kinetics. XRD and XANES showed simultaneous formation of goethite and hematite at 50 and 75 °C at pH 10, with hematite being the dominant product at all pHs and temperatures. With extended reaction time, hematite increased while goethite decreased, and goethite reaches a minimum after 7 days. Observations suggest two-line ferrihydrite transforms to hematite via a two-stage crystallization process, with goethite being intermediary. The findings of this study can be used to estimate rates of crystallization of pure two-line ferrihydrite over the broad range of temperatures and pH found in nature.

A numerical taxonomic study was conducted to investigate the patterns of morphological and phenological variations in 45 okra accessions from different agroecological zones of Ghana dur-ing the rainy season of 2005. The results of the study showed that there were two main phenetic groupings of okra accessions in Ghana based on both 14 quantitative and 17 qualitative mor-phological and phenological characteristics. These two phenetic groupings could be tentatively linked to the taxonomic descriptions of A. esculentus and A. caillei accessions. Morphological and phenological characters like stem diameter, leaf length, petiole length, fruit positions and days to flower opening were identified as diagnostic characters that could be used to separate okra accessions in Ghana into A. esculentus and A. caillei. The study also indicated that there was a weak agroecological adaptation among the 45 okra accessions and therefore agroecologi-cal origins of the various accessions could not be used as one of the criteria in the development okra core collection in Ghana.

The aim of this study was to examine the folk criteria used by farmers to name their local okra varieties and also to assess the taxonomic significance of vernacular names in the identification and classification of these okra varieties in Ghana. Forty two okra accessions and their vernacu-lar names were obtained from PGRRI, Bunso for the study. The various vernacular names of okra accessions were taxonomically analysed by determining their linguistic meanings, their folk criteria and their folk classification. The folk classification of the different okra accessions were then compared with numerical classification of the same set of accessions of another study based on their quantitative and qualitative morphological characteristics. Based on the taxonomic analyses, the 42 vernacular names of okra accessions in Ghana consisted of languages like Twi, Ewe, Dagbani and Krobo and were also based on folk criteria such as morphology, fruit charac-ters, names of persons or locality, maturity periods and culinary properties. Folk classification of the 42 okra accessions produced 8 different taxonomic groupings which contrasted with numerical classification of the same set of okra accessions. Thus, vernacular names of okra accessions in Ghana could not be used as the sole criterion in the identification and estimation of okra diversity because of the low degree of consistency between the two different methods of classification.

A numerical taxonomic study was conducted to investigate the patterns of morphological and phenological variations in 45 okra accessions from different agroecological zones of Ghana dur-ing the rainy season of 2005. The results of the study showed that there were two main phenetic groupings of okra accessions in Ghana based on both 14 quantitative and 17 qualitative mor-phological and phenological characteristics. These two phenetic groupings could be tentatively linked to the taxonomic descriptions of A. esculentus and A. caillei accessions. Morphological and phenological characters like stem diameter, leaf length, petiole length, fruit positions and days to flower opening were identified as diagnostic characters that could be used to separate okra accessions in Ghana into A. esculentus and A. caillei. The study also indicated that there was a weak agroecological adaptation among the 45 okra accessions and therefore agroecologi-cal origins of the various accessions could not be used as one of the criteria in the development okra core collection in Ghana.

The main aim of this study was to explore and describe the circumstances on the ground concerning employability of Environmental Science (ES) graduates in Botswana and to provide evidence that would either confirm or refute claims that graduates in Botswana, in general, are not employable. The second aim of this study was to describe whose role it is to enhance the employability of graduates. Furthermore it was also the aim of this study to investigate whether or not employability audits could be used as a quality assurance mechanism to ensure the employability of graduates in Botswana. These issues were investigated using the contextual framework of employability which explains the quality of higher education in relation to employability of graduates. This research reports on the findings of a case study of the Environmental Science programme offered by the Department of Environmental Science at the University of Botswana which was conducted in June 2012. The study revealed and confirmed gaps among ES graduates in the knowledge, skills and competencies required for the world of work. As a result of these gaps, ES graduates were found not be immediately employable without further on the job training. This created a lot of discontent among employers interviewed. The study concluded that higher education should go beyond providing education for the general development and well-being of individuals and address issues related to employability of graduating students. Conflicts in the possible roles of higher education and industry in enhancing the employability of ES graduates in terms of the changing expectations of the world of work were identified. The study highlighted the possible role of employability audits in enhancing employability not only of ES graduates but all other graduates in Botswana. Furthermore the study recommended that employability audits should be introduced in the tertiary education system of Botswana as a quality assurance mechanism. It further recommended collaboration and partnership with industry as key to the success of any measures put in place for the enhancement of the employability of graduates in Botswana.

Pregnancy masks the signs and symptoms of intestinal obstruction. A high index of suspicion is required for proper and timely diagnosis.A 26-year-old, primiparous woman, 32 weeks pregnant, presented with a 1-day history of pain in the upper abdomen. The pain was sudden in onset and was mostly in the epigastric region. Initially the patient was managed conservatively on the suspicion of gastritis, but she did not respond. Subsequent abdominal ultrasound suggested intestinal obstruction. The decision for laparotomy was made. On entering the abdominal cavity, examination of the intestine revealed volvulus of the jejunum with a complete twist at the base of the mesentery and around 20 cm of bluish black, foul-smelling, infarcted and necrosed bowel.Resection of the infarcted bowel was done with primary end-to-end anastomosis of the remaining part. The patient made an uneventful recovery and delivered a male infant vaginally at 41 weeks.

Asthma is a common inflammatory disease of the airways. Current therapies alleviate symptoms but do not treat the disease. We aim to develop effective immunomodulatory therapies (IMTs) for asthma that target the underlying causes of disease based on Streptococcus pneumoniae (Spn). The effect of Spn IMT on the development of asthma [allergic airways disease (AAD)] was determined in mice. Killed Spn was administered before, during or after ovalbumin sensitization, and the subsequent development of AAD was assessed. IMT attenuated T cell cytokine production, goblet cell hyperplasia, airways hyperresponsiveness (AHR), and eosinophil numbers in the blood, bronchoalveolar lavage fluid and peribronchial tissue. This indicates the potential of Spn as an IMT for asthma.

Background Steroid-insensitive endotypes of asthma are an important clinical problem requiring effective treatments. They are associated with non-eosinophilic inflammatory responses and bacterial infections. Macrolide therapy is effective in steroid-insensitive endotypes, such as non-eosinophilic asthma, however the mechanisms of how they work is unknown. Objectives To determine the efficacy of macrolide and non-macrolide antibiotic treatments in infection-induced, severe, steroid-insensitive allergic airways disease (SSIAAD). Methods Mouse models of Chlamydia and Haemophilus lung infection-induced SSIAAD were used to investigate the effects of clarithromycin and amoxicillin treatment on immune responses and AHR in steroid-sensitive AAD and SSIAAD compared to dexamethasone treatment. Results Amoxicillin and clarithromycin had similar anti-microbial effects on infection. Amoxicillin did not suppress either form of AAD, but restored steroid sensitivity in SSIAAD by reducing infection. In contrast, clarithromycin alone widely suppressed inflammation and AHR in both steroid-sensitive and SSIAAD. This occurred through reductions in both Th2 responses that drive steroid-sensitive, eosinophilic AAD, and TNF-α and IL-17 responses that induce neutrophilic SSIAAD. Conclusions Macrolides have broad anti-inflammatory effects that are independent of their anti-microbial effects. The specific responses suppressed are dependent upon the responses that dominate during disease

BACKGROUND: Severe, steroid-insensitive (SSI) asthma is a substantial clinical problem. Effective treatments are urgently required, however, their development is hampered by a lack of understanding of the mechanisms that promote disease. SSI asthma is associated with respiratory infections and non-eosinophilic endotypes of disease, including neutrophilic asthma. OBJECTIVES: To develop and use mouse models of SSI neutrophilic asthma to investigate pathogenic mechanisms involving microRNA (miR)-21, phosphoinositide-3-kinase (PI3K) and histone deacetylase (HDAC)2 in order to identify new therapeutic approaches. METHODS: Novel mouse models of respiratory infection and ovalbumin-induced, SSI neutrophilic allergic airway disease (SSIAAD) in BALB/c mice were developed. The roles of infection-induced miR-21 expression and PI3K-dependent signalling in the lung were examined using a specific miR-21 inhibitor (antagomir-21) and the pan-PI3K inhibitor LY294002. RESULTS: Infection induced a miR-21-dependent, PI3K-mediated signalling pathway that decreased nuclear HDAC2 levels and promoted steroid-insensitive neutrophilic inflammation and airway hyper-responsiveness (AHR) in AAD. Inhibition of miR-21 or PI3K suppressed nuclear pAkt levels and restored HDAC2 levels and steroid sensitivity. CONCLUSIONS: We have identified a novel role for a miR-21/PI3K/HDAC2 signalling axis in SSIAAD. Our data highlights miR-21 as a novel target for treating this form of asthma.

Pathogenic bacterial infections of the lung are life threatening and underpin chronic lung diseases. Current treatments are often ineffective potentially due to increasing antibiotic resistance and impairment of innate immunity by disease processes and steroid therapy. Manipulation miRNA directly regulating anti-microbial machinery of the innate immune system may boost host defence responses. Here we demonstrate that miR-328 is a key element of the host response to pulmonary infection with non-typeable haemophilus influenzae and pharmacological inhibition in mouse and human macrophages augments phagocytosis, the production of reactive oxygen species, and microbicidal activity. Moreover, inhibition of miR-328 in respiratory models of infection, steroid-induced immunosuppression, and smoke-induced emphysema enhances bacterial clearance. Thus, miRNA pathways can be targeted in the lung to enhance host defence against a clinically relevant microbial infection and offer a potential new anti-microbial approach for the treatment of respiratory diseases., Author Summary MicroRNAs regulate pathogen recognition pathways by modulating translation. In the immune system, miRNAs have been identified as important regulators of gene expression programs, which regulate differentiation, growth and function of innate and adaptive immune cells. Using miRNA microarray, we demonstrated that lung miRNAs were differentially expressed following non-typeable Haemophilus Influenzae (NTHi) infection in mice. To study the role of a specific miRNA in macrophages, we used antagomir (chemically modified single-stranded RNA analogues, complementary to the target miRNA) to block miRNA function. Interestingly, inhibition of microRNA-328 in mouse and human macrophages increases microbicidal activity by amplifying phagocytosis and production of reactive oxygen species. Inhibition of mR-328 in the lung enhanced bacterial clearance in mouse models of immunosuppression and emphysema. Our study provides proof of principle that miRNA pathways can be targeted in the lung and offer a potential new anti-microbial approach for the treatment of respiratory infection.

A 26-year-old African-American man presented in full cardiac arrest at our institution. A victim of violent criminal assault, he had sustained gun shot wounds (GSW) to the left arm and left thoraco-abdomen. He underwent emergency left anterior thoracotomy with direct cardiac massage, control of hemorrhage, and removal of bullet fragments. His spontaneous heart beats and respirations were restored; however, immediate postoperative cardiac and respiratory complications were noted. An echocardiogram disclosed a pericardial effusion. His cardiopulmonary status dramatically improved and stabilized after pericardiocentesis (drainage of 1 L of serosanguineous pericardial fluid). Subsequently, he underwent exploratory laparotomy. A penetrating, bleeding liver injury was noted; hemostasis was obtained. A bile leak was not noted and a bullet was not found. He received multiple intraoperative transfusions. After surgery he remained in coma for 3 weeks. Although fully recovered from his chest and abdominal GSW, he was impaired because of mild to moderate anoxic encephalopathy. He presented again 40 months later because of the abrupt onset of fatigue, malaise, pruritus, right upper quadrant abdominal pain, fever, and jaundice. With the exception of mild chronic confusion, he had been asymptomatic. His family history disclosed a female dominant inheritance pattern for gallstones; by age 35, 100% of his known maternal female relatives were diagnosed with gallstones and/or cholecystitis. He had no known risk factors for hepatitis. He was receiving no prescribed medication and had no documented exposure to hepato-toxic substances. Physical examination revealed an icteric, well nourished, and well developed man in no acute distress. He had a low-grade temperature elevation (37.8° C); vital signs were normal. Surgical scars from his prior thoracotomy and laparotomy were noted. The abdomen was flat with epigastric and right upper quadrant tenderness. There was no palpable organ enlargement. The bowel sounds were normal. The digital rectal examination was normal and the fecal occult blood test was negative. The white blood cell count, hemoglobin, prothrombin time, electrolytes, and glucose were normal. The liver tests revealed the following: serum aspartate aminotransferase (AST) 123 U/L (normal range 15 to 37 U/L), serum alanine aminotransferase (ALT) 391 U/L (normal range 30 to 65 U/L), serum alkaline phosphatase (AP) 223 U/L (normal range 50 to 136 U/L), serum gamma-glutamyl transpeptidase (GGTP) 685 U/L (normal range 5 to 85 U/L), and total serum bilirubin 13.86 mg/dL (normal range 0 to 1.0 mg/dL) with a direct serum bilirubin 11.70 mg/dL (normal range, 0 to 0.3 mg/dL). Serologic tests for hepatitis A, B, and C were negative. A plain film abdominal x-ray showed a nonspecific bowel gas pattern and a bullet resting at the right upper quadrant. Real-time abdominal sonography revealed cholelithiasis, a 2 cm dilated bile duct without stones, and an ill-defined pancreas caused by the presence of intestinal gas. He refused surgery (laparoscopic and/or open cholecystectomy) but consented to diagnostic and therapeutic endoscopy. ERCP demonstrated a 2 cm dilated bile duct with a bullet freely floating within the dilated common hepatic duct (Fig. 1). A 1 cm endoscopic biliary sphincterotomy was performed. Initially, balloon catheter and Dormia basket bullet extractions failed. A hydrophilic (Glide) wire (Microvasive Inc., Watertown, Mass.) was inserted above and coiled around the bullet. A Glide wire directed balloon catheter was inflated near the cephalad-pointing bullet cone. Slow insertion of the inflated balloon catheter over the coiled Glide wire rotated the bullet on its axis 180 degrees such that the bullet’s cone pointed in a caudad direction (Fig. 2). This position allowed easy Dormia basket bullet extraction. The bullet fell from the Dormia basket into the descending duodenum. Subsequent Rothretrieval-net bullet capture was successful. The bullet was measured (9 mm diameter) and photographed (Fig. 3). The patient was seen in follow-up evaluation 2 and 1/2 weeks after CBD bullet extraction. Most of the previously elevated liver tests now had lower values: the total bilirubin decreased to 3.8 mg/dL with a direct bilirubin of 2.5 mg/dL; the AST and ALT declined to 38 U/L and 88 U/L, respectively; and the GGTP correspondingly dropped to 120 U/L. The AP was normal. All liver tests were normal at a 6-month follow-up evaluation. In addition, family members reported some clearing of his chronic confusion.

Study objectives: Airway neutrophil levels are increased in patients with severe asthma and during asthma exacerbations. Long-acting 2-agonists (LABAs), such as formoterol, reduce the number of asthma exacerbations. While 2-agonists may affect neutrophil function in vitro ,i t is uncertain whether they have effects on neutrophilic inflammation in asthmatic patients in vivo. Design: In a double-blind randomized crossover study, we evaluated the effects of 4 weeks of treatment with formoterol (Turbuhaler), 24 g bid, compared to placebo on sputum neutrophil numbers and interleukin (IL)-8 levels in asthmatic patients. Therapy with budesonide (administered via Turbuhaler), 400 g bid for 4 weeks, was added at the end as a “gold standard” antiinflammatory effect comparison. Patients: We studied 15 steroid-nao¨ve nonsmoking patients who ranged from 19 to 51 years of age and had mild persistent asthma. Results: Formoterol therapy significantly reduced sputum IL-8 levels and neutrophil numbers compared to placebo. There was a significant correlation between the reduction in sputum IL-8 levels and the number of neutrophils, indicating that formoterol may attenuate neutrophilic airway inflammation by inhibiting IL-8 production. Conclusions: Our data suggest that the LABA formoterol reduces neutrophilic airway inflammation in patients with mild asthma and that this might be beneficial in preventing asthma exacerbations. (CHEST 2005; 128:1936–1942)

Misoprostol is currently being used for induction of labour at or near term and also for termination of pregnancy. Its use without proven dosage regimens is possibly associated with an increase in the incidence of uterine hyperstimulation, preterm labour, induced abortion above 20 weeks' gestation, meconium-stained liquor in the latent phase of labour, fetal distress and cases of uterine rupture as demonstrated by these case reports and literature review. Its use for these purposes must be under controlled circumstances, using minimum doses. South African Journal of Obstetrics and Gynaecology Vol.11(1) 2005: 9-10

A high performance GaAsSb base, InP collector DHBT IC process has been developed for RF, microwave and telecommunications instrumentation. The GaAsSb process achieves f/sub T/ and f/sub max/ values of 185 GHz and 220 GHz respectively, at operating currents of J/sub c/= 1.5 mA//spl mu/m/sup 2/, with catastrophic on-state breakdown voltages of BVcbx = 9 V at J/sub c/= 1.3 mA//spl mu/m/sup 2/. Typical /spl beta/= 50. The MTTF values of > 1 /spl times/ 10/sup 6/ h at maximum operating conditions (T/sub j/ = 125 /spl deg/C, J/sub c/ = 2.0 mA//spl mu/m/sup 2/) are suitable for instrumentation-grade applications. The DHBTs are integrated with a 3-layer metal chassis including 2 resistor levels and an MIM capacitor. This IC technology is manufactured on a 3" production line for use in Agilent Technologies instrumentation products.

Advanced extrauterine pregnancy is a rare event and presents a challenge to the diagnostic and clinical management skills of every obstetrician. It is associated with significant maternal and fetal morbidity and mortality therefore early diagnosis is important. Prognosis appears good with appropriate pre-operative management and involvement of multi-disciplinary team. O & B Forum Vol.14(2) 2004: 29-33