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A new fossil species of the genus Scutus (Scutus mirus n. sp.) is described from five Late Oligocene to Early Miocene (Waitakian to Altonian; 25.2–15.9 Ma) localities in the South Island, New Zeala...

Simple Summary: Patients with the rare cancer adrenocortical carcinoma are exposed to many symptoms and treatment side-effects. Research on how this can affect their health-related quality of life (HRQoL) is limited, however. This article includes the first assessment of HRQoL in a population-based cohort of patients with adrenocortical carcinoma with the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire and the newly developed disease-specific additional questionnaire ACC-QOL. The ACC-QOL has good psychometric properties in terms of validity, reliability, and responsiveness. Patients diagnosed more than 5 years ago reported a relatively good HRQoL compared with the Dutch reference population, but experienced residual fatigue and emotional problems. Patients after additional surgery reported a slightly lower HRQoL due to physical limitations. Patients who had recently received mitotane or chemotherapy reported a worse HRQoL and problems in many domains. This knowledge and the new disease-specific questionnaire can aid future research, side-effect monitoring, treatment guidance, and shared decision making. We aimed to develop a disease-specific adrenocortical carcinoma (ACC) health-related quality of life (HRQoL) questionnaire (ACC-QOL) and assess HRQoL in a population-based cohort of patients with ACC. Development was in line with European Organization for Research and Treatment of Cancer (EORTC) guidelines, though not an EORTC product. In phase I and II, we identified 90 potential HRQoL issues using literature and focus groups, which were reduced to 39 by healthcare professionals. Pilot testing resulted in 28 questions, to be used alongside the EORTC QLQ-C30. In Phase III, 100 patients with ACC were asked to complete the questionnaires twice in the PROFILES registry (3-month interval, respondents: first 67, second 51). Confirmatory factor analysis demonstrated the structural validity of 26 questions with their scale structure (mitotane side-effects, hypercortisolism/hydrocortisone effects, emotional effects). Internal consistency and reliability were good (Cronbach's alpha 0.897, Interclass correlation coefficient 0.860). Responsiveness analysis showed good discriminative ability (AUC 0.788). Patients diagnosed more than 5 years ago reported a good HRQoL compared with the Dutch reference population, but experienced residual fatigue and emotional problems. Patients who underwent recent treatment reported a lower HRQoL and problems in several domains. In conclusion, we developed an ACC-specific HRQoL questionnaire with good psychometric properties.

Fish otoliths are essential tools for reconstructing fossil teleost faunas. Here, we describe otoliths from estuarine to deep-water Late Oligocene localities in southern Zealandia. Thirty-one species are recognised including 14 new species and two new genera. New species are: Moringua waimumuensis n.sp., Heteroconger? mataura n.sp., Tonganago coplandi n.sp., Sardinops robinsoni n.sp., Lotella latidorsalis n.sp., Trachyrincus tewaewae n.sp., Eurypleuron debilis n.sp., Neobythites lindqvisti n.sp., Aotearichthys vestalis n.sp., Centroberyx worthyi n.sp., Krebsiella chattonensis n.sp., Lesueurina transoceana n.sp. and Micropercops pomahaka n.sp., a representative of a basal gobioid family (Odontobutidae) now restricted to fresh- and brackish waters of eastern Asia. The new otolith-based genera are: Aotearichthys n.gen. (Dinematichthyidae) and Tonganago n.gen. (Congridae). The diverse faunal association reflects the range of paleoenvironments from estuarine to deep marine allowing an unusually complet...

We report a patient who, despite significant cardiac disease and inappropriate therapy, endured continuous undiagnosed ventricular tachycardia (VT) for 5 days without hemodynamic deterioration. The two main reasons for the frequently missed diagnosis of VT are (1) the mistaken belief that VT cannot be well tolerated, and (2) ignorance of the many helpful electrocardiographic clues. Six precepts for avoiding misdiagnosis are enunciated.

To study the central processing mechanisms of sensory input from low threshold afferents to the spinal cord, we examined the excitatory response of single lumbar dorsal horn neurones to stimulation of hairs in the receptive field using a mechanically driven probe, and to activation of single hair follicle afferents using an intracellular current pulse to the cell bodies in the dorsal root ganglion. Experiments were done on anaesthetized, paralysed cats, spinalized at the L1 lumbar level. Responses of spinal neurones to two types of hair afferent input were characteristically different. The excitatory response to input from a single group II hair afferent (A beta; innervating guard hair follicle receptors) was multimodal, characterized by a small early depolarization followed by a sharp, large component with a slow, prolonged decay phase, whereas the response to input from a single group III hair afferent (A delta; innervating down hair follicle receptors) was unimodal. The unitary EPSPs in response to activation of group III hair afferents had a slower rise time and longer decay time constant than those in response to activation of group II hair afferents. When the receptive field of the afferent was located in the centre of the receptive field of the dorsal horn neurone, the gain of the central response was greater for the input from a single group II afferent (> 1) than that for the input from a single group III afferent (< 1). In the case of single group II hair afferents, when pairs of single action potentials or pairs of trains of action potentials were generated at intervals of 20 ms to 3 s, the response in the dorsal horn neurone to the second volley was markedly depressed at intervals of less than 2 s, without any apparent inhibition of the on-going rate of firing. The response to the second volley in single group III afferents was less depressed. This inhibition of the response to the second of a paired volley in single group II hair afferents was attenuated by administration of bicuculline, but not strychnine or naloxone. This indicates that the inhibition involves a GABAA-receptor-mediated mechanism. Bicuculline did not affect the late component of the response to single group II hair afferent input, but unmasked a late component of the response to mechanical stimulation of hairs.(ABSTRACT TRUNCATED AT 400 WORDS)

To the Editor: According to the Food and Drug Administration, trovafloxacin, a broad-spectrum quinolone antibiotic, has been associated with more than 100 cases of hepatic toxicity. Fourteen of the...

The paramount importance of differentiating the wide-QRS tachycardias is stressed, and the alarming frequency of errors made by practicing physicians and cardiovascular nurses is documented. The most common causes of error are outlined, of which the most important is ignorance of diagnostically helpful QRS morphology in the electrocardiogram (EKG). The QRS contours and polarity that are useful in diagnosis are described in detail and illustrated. Finally, certain compromises in electrode placement that may be necessary in the operating room are suggested.