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We developed an accelerated virtual reality (VR) suprathreshold hemifield perimetry algorithm, the median cut hemifield test (MCHT). This study examines the ability of the MCHT to determine ptosis severity and its reversibility with an artificial improvement by eyelid taping on an HTC Vive Pro Eye VR headset and the Humphrey visual field analyzer (HVFA) to assess the capabilities of emerging technologies in evaluating ptosis.In a single visit, the MCHT was administered along with the HVFA 30-2 on ptotic untaped and taped eyelids in a randomized order. The primary end points were a superior field visibility comparison with severity of VF loss and VF improvement after taping for MCHT and HVFA. Secondary end points included evaluating patients' Likert-scaled survey responses on the comfort, speed, and overall experience with both testing modalities.VR's MCHT superior field degrees visible correlated well for severe category margin to reflex distance (r = 0.78) compared with HVFA's (r = -0.21). The MCHT also demonstrated noninferiority (83.3% agreement; P = 1) against HVFA for detection of 30% or more superior visual field improvement after taping, warranting a corrective surgical intervention. In comparing hemi-VF in untaped eyes, both tests demonstrated relative obstruction to the field when comparing normal controls to severe ptosis (HVFA P0.05; MCHT P0.001), which proved sufficient to demonstrate percent improvement with taping. The secondary end point of patient satisfaction favored VR vision testing presentation mode in terms of comfort (P0.01), speed (P0.001), and overall experience (P0.01).This pilot trial supports the use of MCHT for the quantitative measurement of visual field loss owing to ptosis and the reversibility of ptosis that is tested when conducting a presurgical evaluation. We believe the adoption of MCHT testing in oculoplastic clinics could decrease patient burden and accelerate time to corrective treatment.In this study, we look at vision field outputs in patients with ptosis to evaluate its severity and improvement with eyelid taping on a low-profile VR-based technology and compare it with HVFA. Our results demonstrate that alternative, portable technologies such as VR can be used to grade the degree of ptosis and determine whether ptosis surgery could provide a significant superior visual field improvement of 30% or more, all while ensuring a more comfortable experience and faster testing time.

Strong sexual selection by receivers can lead to the evolution of elaborate courtship behaviors in signalers. However the process by which receivers sample signalers and execute mate choice under complex signaling conditions—and thus the realized strength of sexual selection—is poorly understood. Moreover, receivers can vary in condition, which can further influence mate sampling strategies. Using wild female frogs we tested two hypotheses at the intersection of these important problems: that some of the individual variation in mate sampling is explained by (1) the reproductive urgency hypothesis, which predicts that receivers in a more urgent reproductive state will sample mates less and/or (2) the reproductive investment hypothesis, which predicts that receivers that have invested less in the current reproductive effort will sample mates less. Eastern gray treefrogs, Hyla versicolor, were collected in amplexus and repeatedly tested for phonotaxis behavior using a dynamic playback assay. To evaluate if hormonal mechanisms explained variation in the mate sampling, three steroid hormones, estradiol, progesterone, and corticosterone, were collected using a noninvasive water-borne hormone assay, validated for this species in the present study. Finally, we measured clutch size (investment) and the duration of time required for each female to oviposit after being reunited with their male mate (urgency). We found repeatability in many of the behaviors, including mate sampling. We found that females with higher concentrations estradiol and corticosterone made quicker choices, and that females with higher progesterone sampled mates more. We also found that female frogs in a more urgent reproductive state had lower concentrations of progesterone and estradiol, thereby providing the first evidence of a relationship between gonadal hormones and reproductive urgency. Collectively we found some support for the reproductive urgency but not the investment hypothesis. Thus, even though a female frog’s reproductive readiness is a highly transient life history stage, fine scale variation in her reproductive timeline could mitigate the strength of directional selection.

Paper presents hardware improvements, step by step, besides to software refinements for the fluorescent labelled cytokines detection, associated to bacterial meningitis diagnosis. The hardware optimization firstly concerns the implementation of a versatile hardware device with the possibility to obtain the finally best solution. The software refinement includes Monte Carlo combined with denoising algorithms. The logistic curve extracted from fluorescent labelled cytokine images, reduces the error vector from 629 to 2.4, offering the best set of parameters.

Paper presents firstly the principle of fluorescent detection to be implemented for rapid diagnosis of bacterial and non-bacterial meningitis. The acquired image by the mobile phone equipped with adapted lens is prepared by special techniques including denoising, emphasizing the useful signals, highlight and setting thresholds. Secondly, the prepared image is cropped in individual matrix's and converted in black and white tones submitted for original processing algorithm implemented in MathLab. The implemented processing algorithm extract the model parameters to identify the meningitis type. Application was implemented on the android mobile phone and can be used in emergencies cases for rapid decisions. The acquired images can also be sent by mobile phone to emergency point management data base stored and sent for more precise investigations in specialised laboratories.

A 10-year survivorship of 100% was reported for patients with PFC cruciate-retaining prostheses. Beyond 10 years, we observed additional polyethylene wear likely related to thin liners gamma-irradiated in air and were concerned this wear might predispose to implant construct failure. We therefore determined (1) the functional scores at a minimum of 15 years followup, (2) rates of radiographic failure, (3) overall revision rates, and (4) mode of failure after 10 years and the fate of the revised implants. We retrospectively reviewed 75 patients with 101 press-fit condylar posterior cruciate-retaining prostheses. At a minimum followup of 15 years, 35 patients (47 knees) were living and evaluated clinically. No patients were lost to followup. There were no revisions during the first 11 years and six reoperations subsequently were performed in five patients (6% overall rate of revision but 12.8% in patients who survived more than 15 years). Three of six revisions had concerning liner wear at 10 years and all six were revised for polyethylene wear. Polyethylene exchange was performed in four of the five patients who underwent revisions, all of whom were doing well at an average of 7.2 years (range, 4.7–9.1 years) after the revision procedure. At long-term followup, the overall revision rate remained low (6%). For patients surviving 15 years or more, the rate of revision was 12.8% and all revisions were secondary to aseptic sequelae of polyethylene wear. All revisions occurred more than 10 years after the initial procedures. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Descriptive kinetics of synthesis of tetraacetylethylenediamine by acylation of diacetylethylenediamine with acetic acid anhydride was examined. The apparent rate constants of the process were obtained, and a mathematical model adequately describing the process was constructed.

Nucleofilic reaction of a series of α-bromocarboxylic acids with hydrazine and dimethylhydrazine is studied. High reactivity of α-bromocarboxylic acids is revealed and a series of α-hydrazinoarboxylic acids and N-(1-carboxyalkyl)-N,N-dimethylhydrazinium bromides are synthesized.

The reactions of 1,1-dimethylhydrazine, methylhydrazine, and hydrazine hydrate with 5-aryl-2-chloromethyl-1,3,4-oxadiazoles were studied. The structures and compositions of the final products were confirmed by 1H NMR spectroscopy and elemental analysis.

The reactions of methylhydrazine and hydrazine hydrate with chlorinated pyridazines and pyridazones were studied.

Using the technology of ethyl alcohol production as an example, a scheme of the transformation of admixed components in rectifying columns was considered and procedures for the minimization of negative side processes by chemical and instrumental-technological methods were offered.

Synthesis of biheterocyclic thiazole-amonooxadiazoles, the potential biologically active compounds is developed. Regularities of transformations and physico-chemical characteristics of intermediates and final compounds are revealed.

Acetylation of 5-aryltetrazoles, 5-(5-methyl-2-furyl)tetrazole, and 5-(1,5-dimethyl-2-pyrrolyl)tetrazole with chloroacetyl chloride was studied.

Sequential immunization with mycobacterial antigen Ag85B-expressing DNA andMycobacterium bovisbacille Calmette-Guerin (BCG) was more effective than BCG immunization in protecting againstMycobacterium tuberculosisinfection. Depletion of the CD8+T cells in the immunized mice impaired protection in their spleens, indicating that this improved efficacy was partially mediated by CD8+T cells.

Summary We prospectively compared sputum induction with bronchoalveolar lavage (BAL) in HIV positive patients presenting with acute respiratory episodes and also assessed the effects of using an experienced respiratory physiotherapist on the diagnostic yield from induced sputum. One hundred and fifty-one consecutive patients underwent sputum induction, in 96 the procedure was supervised by nursing and medical staff with no specific expertise (group 1); in 55 patients a physiotherapist supervised sputum induction (group 2). Nine patients refused BAL having undergone sputum induction. Of the remaining 142 patients sputum induction failed (no sample expectorated) in 28 patients (25 from group 1 and three from group 2), the sample was inadequate (the material expectorated was not from the lower respiratory tract) in 29, and was adequate in 85 patients. Pneumocystis carinii was diagnosed in 82 patients (51 from group 1 and 31 from group 2). The sensitivity of induced sputum for the diagnosis of P. carinii was 13 % and of BAL was 77 %. In the subgroup of patients with an adequate induced sputum sample, the sensitivity of induced sputum was 28 % and of BAL was 73 %. Of the remaining 60 patients, 27 had other diagnoses made by induced sputum and BAL (eight patients), BAL only (15 patients) and induced sputum only (four patients). Eleven patients had bronchitis and responded to oral antibiotics. In 22 patients induced sputum and BAL were negative; alternative diagnoses were established by lung biopsy or by culture of blood, urine or CSF. During sputum induction, 15 patients had nausea and vomiting, eight became dyspnoeic, three had intractable cough and one developed acute bronchoconstriction; 17 patients found the procedure unpleasant. Compared with BAL, induced sputum has a lower diagnostic yield for P. carinii and other pathogens. Use of experienced, dedicated personnel increases the number of successful attempts at sputum induction but does not increase the diagnostic yield. Fibreoptic bronchoscopy and bronchoalveolar lavage remain necessary for patients with negative results from induced sputum and those whose disease course is at variance with the diagnosis made by sputum induction.

This is a brief review of (i) Carmeli's method of formulation and quantization of fields in terms of functions over the group SU(2); (ii) Work by Barut, Carmeli and the present author on applications of the method to Maxwell's equations, Weyl's equation, Dirac's equation and the linearized equations of General Relativity.

This paper describes a framework for the intelligent control of industrial manipulators. The structure is designed to allow a robotic system to take full advantage of the improved sensing capabilities and more powerful languages that are now becoming available. The framework consists of two layers of hierarchy for the coordinated control of multi-jointed industrial manipulators. The low level control mechanism, responsible for servoing each joint, is adaptive to both manipulator dynamics and payload changes. The individual low-level joint controllers are integrated and coordinated by the high level control structure. Together, the two levels provide a versatile basis for manipulator control. This basis forms a complete structure, and is suited for interfacing with yet higher level intelligent systems such as task planners, high level languages, and environment sensitive path planners.

Pneumocystis jirovecii is the cause of Pneumocystis pneumonia (PCP) in humans. Isolates of P. jirovecii obtained from patients in Harare, Zimbabwe were genotyped at the superoxide dismutase locus. High genotypic similarity to isolates of P. jirovecii obtained from patients in London, UK was observed. These data provide additional support for the hypothesis that P. jirovecii is genetically indistinguishable in isolates from geographically diverse locations.

Background: Patients who do not return for follow-up after total knee arthroplasty are often assumed to have had a worse outcome. We postulated that the Internet may be useful for locating patients who do not return for follow-up. The purpose of this study was to compare outcomes between patients who attended prescribed postoperative appointments and those who did not. Methods: We retrospectively reviewed the outcomes for 161 patients (200 knees) at a minimum of five years after a total knee replacement. All patients who had had no contact of any type with their surgeon in any manner beyond six months following the date of the surgery were classified as not having returned for follow-up. When patients could not be located with use of all available information in their chart, a standardized Internet search algorithm was employed with use of readily available and free search engines. Results: Thirty patients with thirty-five treated knees met the definition of not returning for follow-up. Thirteen patients could not be located with use of the contact information given at their last visit. All were located with use of the Internet. None of the patients had had knee surgery elsewhere. The reasons for not adhering to the prescribed postoperative regimen were identified. The group had improved Knee Society pain and function scores compared with the preoperative values, and the patients were not significantly different from those who did return for follow-up. Conclusions: The patients who did not attend follow-up appointments in this series had not had any additional surgery and did not have any significant differences in measured outcome variables when compared with patients who had complied with a follow-up protocol. The Internet proved to be a valuable tool for locating patients who had not returned for follow-up postoperatively.

This study measured body image disturbances of individuals in a residential weight loss program who were identified as having binge-eating disorder (BED) traits. The study population (N=97) was a convenience sample of 74 men (76%, mean age=51.0) and 23 women (24%, mean age=49.6) in the program who completed the Eating Questionnaire-Revised (EQ-R), the Attitudes About Weight and Dieting (AAWD), the Physical Appearance State and Trait Anxiety Scale (PASTAS): State Version, and the Contour Drawing Rating Scale (CDR). Fifty-five individuals reported having binge traits (57%) while 42 (43%) had no binge traits. Individuals with the binge traits had a significantly higher BMI than nonbinge trait individuals (P=.008). The binge trait group scored higher on the total AAWD (P=.004), the AAWD factor "Fear of Fat" (P=.002), the total PASTA (P=.001), and the PASTA factor "Weight" (P=.001) than the nonbinge trait group. Logistic regression analysis indicated that the odds of having a binge trait were 1.44 times more likely for a person at a given score on the PASTA subscale Weight vs. a person at a score of 5 units less. Feelings of being unable to control eating among individuals seeking weight control is associated with several characteristics related to body image. Individuals showing greater concern about weight and dieting and specifically greater fears of becoming fat were more likely to have a problem with binge eating than those without these concerns. The results of this study suggest that a negative body image is an important factor to consider when treating individuals indicating binge-eating traits.

Isolates of Pneumocystis jiroveci from sulfa-exposed and nonexposed patients from London, United Kingdom, and Harare, Zimbabwe, were genotyped. At the dihydropteroate synthase (DHPS) locus, there was evidence of selection pressure from sulfa drug exposure, and reversal of DHPS genotype ratios occurred when selection pressure was absent or was removed.

The opportunistic fungal pathogen Pneumocystis carinii is a frequent cause of pneumonia in immunocompromised hosts. In this study, we have compared the DNA sequences of a portion of the mitochondrial large-subunit rRNA gene of P. carinii (an informative locus showing up to 27% differences among isolates of P. carinii from human-, rat-, mouse-, ferret-, rabbit-, and horse-infected lungs) obtained from human-derived isolates from widely disparate geographical areas, including Britain, the United States, Brazil, and Zimbabwe. A single-base polymorphism which varied among samples was identified. Apart from this nucleotide, the DNA sequences of all samples were identical. The sequences of the British samples were shown to be stable over a period of 4 years. These data suggest that there is relatively low genetic diversity among isolates of human-derived P. carinii from different global regions.

To investigate the role of MHC class I restricted CD8(+) T cells in host defense to M. tuberculosis, peripheral blood mononuclear cells (PBMC) from healthy BCG-vaccinated donors and untreated pulmonary tuberculosis (TB) patients in The Gambia were stimulated for 6 days with M. bovis BCG or M. tuberculosis and the CD8(+) T cell response analyzed. Intracellular FACS analysis of cytokine production by CD8(+) T cells showed that IFN- gamma and TNF- alpha production were greatly reduced in TB patients compared to healthy controls. IL-4-producing CD8(+) T cells were detected in TB patients, a phenotype absent in controls. Collectively, these data suggest that an alteration in the type 1/type 2 cytokine balance occurs in CD8(+) T cells during clinical tuberculosis, and that this may provide a surrogate marker for disease.

There is increasing evidence to implicate a role for CD8(+) T cells in protective immunity against tuberculosis. Recombinant vaccinia (rVV) expressing Mycobacterium tuberculosis (MTB) proteins can be used both as tools to dissect CD8(+) T-cell responses and, in attenuated form, as candidate vaccines capable of inducing a balanced CD4(+)/CD8(+) T-cell response. A panel of rVV was constructed to express four immunodominant secreted proteins of MTB: 85A, 85B and 85C and ESAT-6. A parallel group of rVV was constructed to include the heterologous eukaryotic tissue plasminogen activator (tPA) signal sequence to assess if this would enhance expression and immunogenicity. Clear expression was obtained for 85A, 85B and ESAT-6 and the addition of tPA resulted in N-glycosylation and a 4-10-fold increase in expression. Female C57BL/6 mice were immunised using the rVV-Ag85 constructs, and interleukin-2 and gamma-interferon were assayed using a co-culture of immune splenocytes and recall antigen. There was a marked increase in cytokine production in mice immunised with the tPA-containing constructs. We report the first data demonstrating enhanced immunogenicity of rVV using a tPA signal sequence, which has significant implications for future vaccine design.

Intracellular flow cytometry analysis of perforin production by CD8+T cells showed levels were greatly reduced in tuberculosis (TB) patients compared to healthy controls. Reduced cytotoxic-T-lymphocyte activity was also obtained with CD8+T cells from TB patients compared to healthy controls in The Gambia. A change in antigen recognition was noted between the two groups of donors: in addition to recognition of Ag85A and Ag85B, as seen in healthy donors, a prominent ESAT-6 response was found in TB patients.

Bromination of isovaleric acid with bromine in the polyphosphoric acid mediumis was studied, regularities of the process including influence of the polyphosphoric acid composition were revealed, the process was shown technologically attractive for the organization of industrial manufacturing of α-bromoisovaleric acid.

ESAT-6 is an important T-cell antigen recognized by protective T cells in animal models of infection with Mycobacterium tuberculosis . In an enzyme-linked immunosorbent assay (ELISA) with overlapping peptides spanning the sequence of ESAT-6, monoclonal antibody HYB76-8 reacted with two peptides in the N-terminal region of the molecule. Assays with synthetic truncated peptides allowed a precise mapping of the epitope to the residues EQQWNFAGIEAAA at positions 3 to 15. Hydrophilicity plots revealed one hydrophilic area at the N terminus and two additional areas further along the polypeptide chain. Antipeptide antibodies were generated by immunization with synthetic 8-mer peptides corresponding to these two regions coupled to keyhole limpet hemocyanin. Prolonged immunization with a 23-mer peptide (positions 40 to 62) resulted in the formation of antibodies reacting with the peptide as well as native ESAT-6. A double-antibody ELISA was then developed with monoclonal antibody HYB76-8 as a capture antibody, antigen for testing in the second layer, and antipeptide antibody in the third layer. The assay was suitable for quantification of ESAT-6 in M. tuberculosis antigen preparations, showing no reactivity with M. bovis BCG Tokyo culture fluid, used as a negative control, or with MPT64 or antigen 85B, previously shown to cross-react with HYB76-8. This capture ELISA permitted the identification of ESAT-6 expression from vaccinia virus constructs containing the esat-6 gene; this expression could not be identified by standard immunoblotting.

Protective immunity toMycobacterium tuberculosisis poorly understood, but mounting evidence, at least in animal models, implicates major histocompatibility complex class I-restricted CD8+T cells as an essential component. By using a highly sensitive assay for single cell interferon γ release, we screened an array ofM. tuberculosisantigen-derived peptides congruent with HLA class I allele-specific motifs. We identified CD8+T cells specific for epitopes in the early secretory antigenic target 6 during active tuberculosis, after clinical recovery and in healthy contacts. Unrestimulated cells exhibited peptide-specific interferon γ secretion, whereas lines or clones recognized endogenously processed antigen and showed cytolytic activity. These results provide direct evidence for the involvement of CD8+cytotoxic T lymphocytes in host defense againstM. tuberculosisin humans and support current attempts to generate protective cytotoxic T lymphocyte responses againstM. tuberculosisby vaccination.

Importance Breast magnetic resonance imaging (MRI) is highly sensitive for detecting breast cancer. Low specificity, cost, and little evidence regarding mortality benefits, however, limit recommendations for its use to high-risk women. How breast MRI is actually used in community settings is unknown. Objective To describe breast MRI trends and indications in a community setting. Design, Setting, and Participants Retrospective cohort study at a not-for-profit health plan and multispecialty group medical practice in New England of 10 518 women aged 20 years and older enrolled in the health plan for at least 1 year who had at least 1 breast MRI between January 1, 2000, and December 31, 2011. Main Outcomes and Measures Breast MRI counts were obtained from claims data. Clinical indication (screening, diagnostic evaluation, staging or treatment, or surveillance) was determined using a prediction model developed from electronic medical records on a subset of participants. Breast cancer risk status was assessed using claims data and, for the subset, also through electronic medical record review. Results Breast MRI use increased more than 20-fold from 6.5 per 10 000 women in 2000 to 130.7 per 10 000 in 2009. Use then declined and stabilized to 104.8 per 10 000 by 2011. Screening and surveillance, rare indications in 2000, together accounted for 57.6% of MRI use by 2011; 30.1% had a claims-documented personal history and 51.7% a family history of breast cancer, whereas 3.5% of women had a documented genetic mutation. In the subset of women with electronic medical records who received screening or surveillance MRIs, only 21.0% had evidence of meeting American Cancer Society (ACS) criteria for breast MRI. Conversely, only 48.4% of women with documented deleterious genetic mutations received breast MRI screening. Conclusions and Relevance Breast MRI use increased steeply over 10 years and then stabilized, especially for screening and surveillance among women with family or personal history of breast cancer; most women receiving screening and surveillance breast MRIs lacked documented evidence of meeting ACS criteria, and many women with mutations were not screened. Efforts are needed to ensure that breast MRI use and documentation are focused on those women who will benefit most.

Managed care has changed role expectations for front-line nurses. Roles now include outcome management, team coordination, and guardianship of patient's continuity along the continuum. Organizations are investing in leadership development training for non-management nurses in hopes that such competencies will enhance their value-added competitive edge, but data are needed to validate the value of such training to the organization. Authors report the self-perceived competencies in leadership understanding and ability (in a study of 87 participants) before and after leadership development training that focused on: planned change, communication, conflict, group dynamics, systems theory, and oppressed group behavior. Significant increases were reported in both understanding and ability to perform stated competencies both immediately after and 3 months after 3 days of training. Self-perceptions of both leadership understanding and ability before leadership training were higher for those with advanced degrees and/or those in management positions. However, some of these differences became insignificant after training.

Pneumocystis carinii pneumonia (PCP) is the major respiratory pathogen affecting HIV-infected individuals in the industrialized world. Clear advances have been made in prevention and treatment. This has resulted in a reduction in disease incidence and morbidity. Co-trimoxazole is still the drug of choice for prophylaxis and treatment. However, drug toxicity is a serious problem and the alternatives available, although of lower toxicity, are less efficacious. Thus, the search for an alternative agent is of key importance.

Prior to the development of chemotherapy, tuberculosis frequently progressed, unabated, to cause severe cavitary lung disease. Persons with tuberculosis expectorated large numbers of bacilli from pulmonary foci and these highly infectious secretions could then directly infect the mucosa of the respiratory and gastrointestinal tracts. Thus, common features included indolent ulcers of the tongue and mouth, frequent involvement of the larynx and middle ear, and severe gastrointestinal disease (Marshall, 1993).

In patients with HIV infection, non-typhoidal salmonellae are a recognised cause of bacteraemia. This association was initially demonstrated in the United States, but has more recently been found in Kenyan patients. This prompted us to review the cases of patients with enterobacteriaceae bacteraemia admitted to Parirenyatwa Hospital, Harare. Non-typhoidal salmonella bacteraemia as compared with typhoid fever was significantly more common in HIV infected patients than in non-HIV infected patients (p0.01). It was also a cause of bacteraemia in patients with other immuno-suppressive conditions and in some patients without identifiable risk factors.The case notes of patients with blood cultures positive for enterobacteriaceae were examined retrospectively over a 6-month period in Parirenyatwa Hospital, Harare, Zimbabwe. Speciation was possible for Salmonella typhi and shigellae only. Nontyphoidal salmonellae were serotyped. Salmonella or shigella bacteremia was identified in 51 patients. There were 14 isolates of S. typhi, 32 isolates of nontyphoidal salmonellae, and 5 isolates of shigellae species. The case notes of 38 patients could be identified for review, and of these HIV serology was available for 15 seropositive and 15 seronegative patients. The male to female ratio was approximately 3:1 for both groups and the mean age was 29.7 +or- 21. Nontyphoidal bacteremias as compared with typhoid fever were strongly associated with HIV seropositivity [p 0.01]. 3 out of 8 HIV-negative patients with nontyphoidal bacteremia had another underlying immunosuppressive disease [2 had myeloma and 1 patient had cirrhosis with complicating hepatoma]. 2 patients with nontyphoidal bacteremia whose HIV status was unknown also had another immunosuppressing disease [acute myeloid leukemia and idiopathic pancytopenia]. 13 out of 15 HIV-positive patients showed other signs of HIV infection [oral candida, herpes zoster, persistent generalized lymphadenopathy]. 3 out of 11 patients [27%] with typhoid died, while 11 out of 27 patients [40.7%] with nontyphi bacteremia died. Most strains of S. typhimurium were included in serogroup B, which accounted for 37% of nontyphoidal isolates. Earlier studies identified invasive salmonellosis in patients with other AIDS defining diseases. In Nairobi clinical features of HIV infection were found in 64% of bacteremic HIV-positive patients, but only 28% of patients fulfilled the CDC clinical case definition for AIDS. A more recent study from Nairobi demonstrated that S. typhimurium bacteremia is a common cause of intercurrent infection in HIV-positive tuberculous patients.

Abstract 4150 Introduction: Primary extranodal pancreatic non-Hodgkin lymphoma (PPL) makes up no more than 0.16–4.9% of pancreatic malignancies and less than 0.7% of non-Hodgkin's lymphomas (NHL). Since lymphomas involving the pancreas may have a similar clinical presentation to primary pancreatic adenocarcinoma, and often have a similar radiographic appearance, pancreatic lymphoma is often not diagnosed until surgical exploration or definitive surgery for presumed pancreatic cancer. Preoperative distinction of adenocarcinoma and PPL is critical as the management and prognoses of these malignancies are mutually exclusive. The rarity of PPL has made epidemiologic studies difficult to conduct. Methods: We queried our IRB-approved clinicopathologic database, derived from comprehensive tumor registry data at the Massachusetts General Hospital, for all adult patients diagnosed with PPL between 2000 and 2010. The database contains 5821 patients with mature lymphoid malignancies. Cases were included in the analysis if they met clinicopathologic criteria for PPL, defined as dominant disease presentation within the body of the pancreas. Forty-five patients were found to have pancreatic involvement at initial presentation of whom 31 (68.9%) on further investigation had a pancreatic primary and are included in the analysis. For each patient, we collected complete demographic information, clinical presenting features, histology, chemotherapy regimens, use of radiotherapy, and type of surgical biopsy performed. We also collected outcome data including results of interim and final restaging scans. Results: PPL represented 0.5% of all mature lymphomas seen at our institution. The median age at diagnosis was 60 yrs (range 20–91). There were 21 male and 10 female patients. Eighteen patients had Diffuse Large B Cell Lymphoma (DLBCL) (one with a focus of follicular lymphoma (FL) grade 3), two each had Burkitts Lymphoma, FL Grade 1–2, and mantle cell lymphoma (MCL), and one each had small lymphocytic lymphoma (SLL), Hodgkin Lymphoma, Marginal zone lymphoma, and peripheral T cell Lymphoma not otherwise specified. Three patients had NHL not otherwise specified (NOS). Of the 31 patients, 13 patients were stage 4E, 5 were stage 3E, 8 were stage 2E, and 5 were Stage 1E. Seventeen patients presented with jaundice. In 2 cases clinical history at presentation was unavailable. Elevated lactate dehydrogenase (LDH) level was present in 18 of 26 patients (69%) for whom laboratory values were available. B symptoms were present at diagnosis in 13 patients, absent in 17 patients, and unavailable in 1. Diagnosis was made in sixteen patients by fine needle aspiration (FNA), in nine patients by core needle biopsy, in two by incisional biopsies, and four patients were diagnosed after a definitive pancreaticoduodenectomy (Whipple procedure). Information on therapeutic regimen was available for 24 patients. One of these 24 patients was treated with primary radiotherapy without chemotherapy for a grade 1–2 primary pancreatic FL. Twenty-three patients had initial chemotherapy: 8 with R-CHOP, 5 with CHOP, 2 with CVP, and 1 each with CHOP-14, CVP × 1 then CHOP, R-CVP, R-EPOCH, R-CODOX-M/R-IVAC, R-CDOP and R-CP then R-CHOP. One patient was treated with chemotherapy not otherwise specified in the medical record. Four of these 23 patients received consolidative radiotherapy after initial therapy. Chemotherapy had significant efficacy with an overall response rate (ORR) of 75% in all chemotherapy treated patients (10 CR, 8 PR). Therapy information was available on 13 patients with DLBCL with an ORR of 85% (7 CR, 4 PR) to R-CHOP in 8 patients, CHOP in 3, and 1 each R-EPOCH and R-CDOP. One patient died of meningeal relapse of DLBCL despite therapy with R-EPOCH. For the entire PPL group at median follow-up of 28.5 months, the progression free and overall survivals are 48.4% and 64.5%, respectively. At a median follow-up of 33.4 months, the progression free and overall survivals for the DLBCL-PPL group are 50.0% and 66.7%, respectively. Discussion: PPL is a rare extranodal presentation of lymphoma accounting for 0.5% of lymphomas seen at a tertiary referral center. Pre-surgical diagnosis of PPL is critical to avoidance of unnecessary major surgery. The outcome of PPL approximates the outcome of DLBCL in other sites. An increased rate of CNS relapse was not seen with presentations in this extranodal site. Disclosures: Hochberg: Biogen Idec: Speakers Bureau; Genentech: Speakers Bureau; Enzon Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Amgen: Speakers Bureau; WorldCare: Membership on an entity's Board of Directors or advisory committees; Proventys: Consultancy.