Coronal ring involvement in patients treated for unilateral coronal craniosynostosis

The etiopathology of the clinical entity normally referred to as unilateral coronal synostosis is commonly used to connote unilateral fusion of the frontoparietal suture. However, other sutures in the coronal ring may exhibit synostosis concomitant with or independent from frontoparietal synostosis and give rise to similar clinical phenotypes. This study retrospectively analyzes high-resolution computed tomographic data sets to determine patency of sutures within the coronal ring. Computed tomographic scan digital data from 33 infants who subsequently underwent surgical correction of unilateral coronal synostosis were assessed for sutural patency using Analyze imaging software. The frontosphenoidal suture was subdivided into intraorbital frontosphenoidal and extraorbital frontosphenoidal portions, and the patency of the frontoethmoidal suture was also assessed. Patients were sorted into two groups on the basis of the status of their frontosphenoidal sutures: group 1 had patent frontosphenoidal but synostotic frontoparietal sutures (n = 21) and group 2 had both frontosphenoidal and frontoparietal synostoses. Observer reproducibility was tested. The vertical and horizontal dimensions of the bony orbit and the endocranial base deflection angle were measured with the observer blinded with regard to sutural status group. Frontoethmoidal synostosis was not noted in any patients in either group. Two patients had no frontoparietal suture synostosis with isolated intraorbital frontosphenoidal and extraorbital frontosphenoidal suture closures. Suture diagnosis reproducibility was 99 percent. In group 1, the ipsilateral-to-contralateral vertical orbit dimension ratio averaged 1.11, whereas in group 2 it averaged 1.04 (p < 0.05). The ratio of horizontal orbit measurements was not significantly different between groups. In both groups, the endocranial base was deflected ipsilateral to the synostotic frontoparietal suture, with an average angle of 12 degrees in group 1 and 17 degrees in group 2 (p < 0.005). The extent of synostosis along the coronal sutural ring contributes to the dysmorphology of the orbit and the endocranial base deflection in patients whose clinical phenotypic diagnosis is unilateral coronal synostosis.     

Cotton Rat (Sigmodon hispidus) Signaling Lymphocyte Activation Molecule (CD150) Is an Entry Receptor for Measles Virus

Cotton rats (Sigmodon hispidus) replicate measles virus (MV) after intranasal infection in the respiratory tract and lymphoid tissue. We have cloned the cotton rat signaling lymphocytic activation molecule (CD150, SLAM) in order to investigate its role as a potential receptor for MV. Cotton rat CD150 displays 58% and 78% amino acid homology with human and mouse CD150, respectively. By staining with a newly generated cotton rat CD150 specific monoclonal antibody expression of CD150 was confirmed in cotton rat lymphoid cells and in tissues with a pattern of expression similar to mouse and humans. Previously, binding of MV hemagglutinin has been shown to be dependent on amino acids 60, 61 and 63 in the V region of CD150. The human molecule contains isoleucine, histidine and valine at these positions and binds to MV-H whereas the mouse molecule contains valine, arginine and leucine and does not function as a receptor for MV. In the cotton rat molecule, amino acids 61 and 63 are identical with the mouse molecule and amino acid 60 with the human molecule. After transfection with cotton rat CD150 HEK 293 T cells became susceptible to infection with single cycle VSV pseudotype virus expressing wild type MV glycoproteins and with a MV wildtype virus. After infection, cells expressing cotton rat CD150 replicated virus to lower levels than cells expressing the human molecule and formed smaller plaques. These data might explain why the cotton rat is a semipermissive model for measles virus infection.     

Play Behavior in Juvenile Golden Lion Tamarins (Callitrichidae: Primates): Organization in Relation to Costs

Play is a complex behavior that is widespread among vertebrates. Despite the potential benefits for the development of social, cognitive and motor skills, play behavior has costs: energy expenditure, and the risks of injury and predation. As the fitness benefits of play are presumably to be gained as adults, we expect young animals to minimize its immediate costs. Here, we describe play behavior in golden lion tamarins (GLTs) (Leontopithecus rosalia) and test cost-minimizing hypotheses. We collected data on play behavior and adult vigilance in nine groups (four wild and five supplemented, the latter deriving from a reintroduction) of wild-living lion tamarins (16 infants) in Brazil. Results showed that play occupied 3.8% of the activity budget, occurred during the hottest times of the day, and was characterized by being mainly social, involving partners of different ages, and sometimes different species. We found no differences in playing time between wild and supplemented groups. The lion tamarins played less in ‘dangerous’ substrates (canopy branches and forest floor), and more in ‘safe’ substrates (large branches and vine tangles), and favored playing in the center of the group over the periphery. The reproductive animals were vigilant during 78% of the time the infants were playing, and were mostly oriented away from the playing animals. The observed organization of play behavior suggests that juvenile GLTs minimize the risk of predation and accidental injuries, but do not seem to minimize energy expenditure and the risks of social injuries. The social-cognitive benefits acquired from experience of older partners during play may overcome the costs of the latter behavior, and because little time was spent in play, the energetic costs may be inconsequential.     

The Hepatitis C Cascade of Care: Identifying Priorities to Improve Clinical Outcomes

Background

As highly effective hepatitis C virus (HCV) therapies emerge, data are needed to inform the development of interventions to improve HCV treatment rates. We used simulation modeling to estimate the impact of loss to follow-up on HCV treatment outcomes and to identify intervention strategies likely to provide good value for the resources invested in them.

Methods

We used a Monte Carlo state-transition model to simulate a hypothetical cohort of chronically HCV-infected individuals recently screened positive for serum HCV antibody. We simulated four hypothetical intervention strategies (linkage to care; treatment initiation; integrated case management; peer navigator) to improve HCV treatment rates, varying efficacies and costs, and identified strategies that would most likely result in the best value for the resources required for implementation.

Main measures

Sustained virologic responses (SVRs), life expectancy, quality-adjusted life expectancy (QALE), costs from health system and program implementation perspectives, and incremental cost-effectiveness ratios (ICERs).

Results

We estimate that imperfect follow-up reduces the real-world effectiveness of HCV therapies by approximately 75%. In the base case, a modestly effective hypothetical peer navigator program maximized the number of SVRs and QALE, with an ICER compared to the next best intervention of $48,700/quality-adjusted life year. Hypothetical interventions that simultaneously addressed multiple points along the cascade provided better outcomes and more value for money than less costly interventions targeting single steps. The 5-year program cost of the hypothetical peer navigator intervention was $14.5 million per 10,000 newly diagnosed individuals.

Conclusions

We estimate that imperfect follow-up during the HCV cascade of care greatly reduces the real-world effectiveness of HCV therapy. Our mathematical model shows that modestly effective interventions to improve follow-up would likely be cost-effective. Priority should be given to developing and evaluating interventions addressing multiple points along the cascade rather than options focusing solely on single points.     

Paternal Care in New World Primates

Extensive parental care is well developed in several generaof New World primates (genera aCallicebus, Aotus, Callimico,Calltthrix, Cebuella, Leontopithecus, Saguinus) including mostof the indirect and direct paternal care behaviors describedby Kleiman and Malcolm (1981). Paternal care is correlated witha monogamous (and perhaps polyandrous) mating system and a smallgroup size. Additionally, in genera (e.g., Callithrix) whichhave a higher reproductive rate and tolerate a larger groupsize, subadult and juvenile offspring of the breeding pair andperhaps unrelated individuals may contribute substantially tothe rearing of infants. Both within and across genera, there is considerable variabilityin the type, quantity, and distribution of care provided bythe mother, father, and other individuals in the family group.The purpose of this presentation is to examine the basis ofthis variability and to evaluate the degree to which we canmake statements about the evolution of paternal care in thisprimate radiation. There are few field studies of those species of monogamous NewWorld primates which exhibit extensive paternal care. Thus,it is currently impossible to correlate the observed variabilityin paternal care with ecological factors. Also, the taxonomyof the New World primates is in flux which makes phylogeneticinterpretation difficult (Rosenberg, 1981). As a result, thefollowing discussion will be based mainly on results from captivestudies, and will be concerned with defining those factors thatcreate variability in observed levels of paternal care, bothwithin and across genera.