Spontaneous malformations in squirrel monkey [Saimiri sciureus] fetuses with emphasis on cleft lip and palate.

Gross examination of a group of surviving and nonsurviving squirrel monkeys has revealed a high incidence of cleft lip and cleft primary palate defects with an associated anophthalmia. These defects, as well as single incidences of diaphragmatic aplasia, scoliosis, internal hydrocephalus, and funnel chest, are noted or described and discussed with reference to sex and parentage.     

Abnormal structure of type II collagen in a patients with funnel chest

The electrophoretical analysis and CNBr-peptide mapping of the collagens, isolated from the costal cartilage of 30 patients with non-classified and syndromal forms of pex excavatum (funnel chest) (27 patients) and pex carinatum (3 patients) was carried out. In case of one patient with the nonclassified form of funnel chest the electrophoretical mobility of CB 9.7-peptide was found to be decreased. The electrophoretical mobilities of other peptides are not markedly changed. The data obtained allow one to suggest the mutation causing the defect in the region about 160 amino acid residues distant from the C-end of alpha 1 (II) chain of type II collagen of the patient.     

A new method of reconstruction for pectus excavatum that preserves blood supply and costal cartilage.

We began in 1982 to use a modified Ravitch procedure that preserves the blood supply to the sternum to correct funnel chest deformities, but there were some problems such as postoperative paradoxical respiration, chest wall irregularity, and palpable heart beat. To resolve these problems, the concept of Jensen's procedure was incorporated into the authors' previous method. In Jensen's method, only a small portion of the deformed cartilages is resected, and almost all of them are preserved. A preformed stainless steel strut is used for chest wall stabilization. The authors preserved the costal cartilages in a manner similar to Jensen's, but the anterior chest wall was stabilized with miniplates and Kirschner wires instead of a large retrosternal strut. The xiphoid process with the lower end of the sternum was detached and moved cephalad. None of the patients developed respiratory failure postoperatively. Although the follow-up periods were short, satisfactory results were obtained with no recurrence of the deformities. The main advantages of our procedure are (1) basic blood supply to the chest wall is preserved, (2) stability of corrected chest wall is maintained with miniplates and Kirschner wires without a large metallic strut, and (3) preserved costal cartilages make the chest wall rigid and the incidence of respiratory failure low. We conclude that this method is simple and produces satisfactory results with a rigid chest wall.     

Clinical Features and Gene Mutations of Lung Cancer Patients 30 Years of Age or Younger

Purpose

Few studies examining the clinical features and gene mutations in lung cancer patients 30 years of age or younger have been published. A trend towards increasing morbidity has been noted in young patients; thus, an urgent need exists to explore this subgroup of patients.

Methods

Patients aged ≤30 years with pathologically diagnosed lung cancer were retrospectively evaluated. We reviewed the clinical features, gene mutations and prognosis of each patient.

Results

Forty-one patients were included in this study. The mean age was 26.4±3.5 years. Cough, tightness/dyspnea and chest pain were common symptoms, and 58.5% of patients presented with advanced stages of lung cancer. Adenocarcinoma was the predominant histologic type noted in these young patients. Masses and nodules were the dominant imaging features observed upon lung computed tomography (CT). Thoracic lymphadenopathy occurred very frequently in these patients. Five of 6 patients with echinoderm microtubule-associated protein-like 4 (EML4)-anaplastic lymphoma kinase (ALK) gene fusions presented solid masses with no ground-glass opacity (GGO) and thoracic multifocal lymphadenopathy. Six of 22 (27.2%) cases contained EML4-ALK gene fusions. In addition, 5 of 22 (22.7%) patients harbored epidermal growth factor receptor (EGFR) mutations, and 2 of 17 patients exhibited KRAS and ROS1 gene mutations. The median survival times were 44.2 months for patients with early stage disease and 8 months for patients with advanced NSCLC disease. The one-year and 5-year survival rates were 56.6% and 38.6%, respectively.

Conclusions

Increased gene mutation frequencies are noted in these very young lung cancer patients. This finding indicates that the detection of gene mutations in these patients is important and will help to determine the appropriate targeted therapy.     

Radiologic diagnosis of pathologic pulmonary changes in ischemic heart disease]

Combined chest x-ray investigation was performed in 187 CHD patients. Different pulmonary changes were noted in postinfarction and atherosclerotic cardiosclerosis as a result of congested effects in lesser circulation: they depended upon a stage of disturbed circulation (the more circulatory decompensation was noticeable, the more marked were changes in lesser circulation). Pulmonary and cardiac changes in patients with postinfarction cardiosclerosis were more frequent and marked.     

The three syndromes of fat embolism: pulmonary manifestations.

The clinical course and radiographs of 30 patients with fat embolism syndrome were reviewed. In all cases the classic triad of neurologic dysfunction, respiratory insufficiency, and petechiae were present. Three responses to embolized fat were noted. The hyperacute response was seen in two patients with paradoxical embolization of fat to the systemic circulation. A "classic response" was noted in 18 patients with transient respiratory compromise and variable radiographic findings. The two deaths in the group responding in the classical manner were attributed to massive pulmonary emboli. The third response, noted in ten patients, consisted of a chest radiograph compatible with pulmonary edema in the clinical setting of the adult respiratory distress syndrome. In this group the degree of respiratory dysfunction and pulmonary damage correlated with the development of disseminated intravascular coagulation. Pathologic correlations are presented and the mechanisms by which embolic fat produces tissue damage are discussed.     

Cumulative funnel plots for the early detection of interoperator variation: retrospective database analysis of observed versus predicted results of percutaneous coronary intervention

Objective To use funnel plots and cumulative funnel plots to compare in-hospital outcome data for operators undertaking percutaneous coronary interventions with predicted results derived from a validated risk score to allow for early detection of variation in performance.Design Analysis of prospectively collected data.Setting Tertiary centre NHS hospital in the north east of England.Participants Five cardiologists carrying out percutaneous coronary interventions between January 2003 and December 2006.Main outcome measures In-hospital major adverse cardiovascular and cerebrovascular events (in-hospital death, Q wave myocardial infarction, emergency coronary artery bypass graft surgery, and cerebrovascular accident) analysed against the logistic north west quality improvement programme predicted risk, for each operator. Results are displayed as funnel plots summarising overall performance for each operator and cumulative funnel plots for an individual operator’s performance on a case series basis.Results The funnel plots for 5198 patients undergoing percutaneous coronary interventions showed an average observed rate for major adverse cardiovascular and cerebrovascular events of 1.96% overall. This was below the predicted risk of 2.06% by the logistic north west quality improvement programme risk score. Rates of in-hospital major adverse cardiovascular and cerebrovascular events for all operators were within the 3σ upper control limit of 2.75% and 2σ upper warning limit of 2.49%.Conclusion The overall in-hospital major adverse cardiovascular and cerebrovascular events rates were under the predicted event rate. In-hospital rates after percutaneous coronary intervention procedure can be monitored successfully using funnel and cumulative funnel plots with 3σ control limits to display and publish each operator’s outcomes. The upper warning limit (2σ control limit) could be used for internal monitoring. The main advantage of these charts is their transparency, as they show observed and predicted events separately. By this approach individual operators can monitor their own performance, using the predicted risk for their patients but in a way that is compatible with benchmarking to colleagues, encapsulated by the funnel plot. This methodology is applicable regardless of variations in individual operator case volume and case mix.     

Behind the folding funnel diagram

This Commentary clarifies the meaning of the funnel diagram, which has been widely cited in papers on protein folding. To aid in the analysis of the funnel diagram, this Commentary reviews historical approaches to understanding the mechanism of protein folding. The primary role of free energy in protein folding is discussed, and it is pointed out that the decrease [corrected] in the configurational entropy as the native state is approached hinders folding, rather than guiding it. Diagrams are introduced that provide a less ambiguous representation of the factors governing the protein folding reaction than the funnel diagram.     

Relaxation folding and the principle of the minimum rate of energy dissipation for conformational motions in a viscous medium

A numerical simulation of the folding of a model polymer chain of 50 units with valence bonds of a fixed length and fixed valence angle values has been performed using the strong friction approximation. The rate of energy dissipation in the system has been analyzed for conformational motions along a trajectory determined by the equations of mechanics and the trajectories characterized by random and variable deviations from the mechanical path. The validity of the principle of the minimum average rate of the energy dissipation for the conformational relaxation of a macromolecule in a viscous medium has been demonstrated. A profile of the relaxation energy funnel for the folding of a macromolecular chain has been constructed. Slow and rapid stages of folding could be distinguished in the energy funnel profile; the final state was separated from the nearest conformations of the folded chain by an energy gap.     

Evaluation of captopril levels in chronic congestive heart failure, stages NYHA III and IV]

Thirty eight patients, aged between 25 and 81 years (mean age 56.9 years) with diagnosed chronic congestive heart failure of NYHA III and IV stages have been examined. The following phases of therapy have been distinguished depending on the used drugs: phase 0--digoxin in a daily dose of 0.25 mg and furosemide in a daily dose of 40-150 mg (mean value 72.4 mg) for 14 days; phase A1A2--nifedipine has been added in a daily dose of 40-80 mg (mean value 64.0 mg), lasting also for 14 days; phase B1B2--captopril (Lopirin--Squibb) has been added to the previous drugs in a daily dose of 25-150 mg (mean value 67.4 mg) in three divided portions for 28 days; phase C1C2--captopril has been withdrawn and drugs as in phase A1A2 have been administered for 14 days. Routine laboratory tests, ECG, a 24-hour ECG-records with Holter's technique, exercise ECG, chest X-ray, and 2D and M echocardiography were performed prior to and after 7 days as well as after each phase of the studies. A significant improvement in the left ventricle functioning assessed with Cubet's echo 2D has been observed in phase B1B2 in comparison with phase A1A2. These parameters have been the following: EF 42.61% vs 31.52%; CO 3.2 vs 2.9 L/min; SV 57.15 vs 44.24 mL (p < .001). Moreover, a decrease in heart volume (X-ray) from 1,145.25 mL to 1,088.25 mL, an increase in exercise tolerance (exercise ECG) in 52.6% of the patients, decrease in Lown's class in 11 out of 24 patients have been noted.(ABSTRACT TRUNCATED AT 250 WORDS)     

Biases in Trapping Larval Amphibians in Playa Wetlands

Abstract: Standardized, effective sampling methods are required to monitor amphibian population trends and community composition. Funnel traps have been used to ostensibly estimate species richness and relative abundance of larval amphibians. We tested whether funnel traps can be used to provide unbiased estimates of amphibian community composition in playa wetlands by comparing seining—dip netting and passive funnel-trapping results. Plains spadefoots (Spea bombifrons) were more prone to be captured in funnel traps whereas New Mexico spadefoots (S. multiplicata) were less likely captured by funnel traps than by seines and dip nets. In playas funnel traps should be used only for collecting specimens and not for estimating amphibian community composition.     

Lymphoid interstitial pneumonia.

A 19-year-old man presented with dyspnea, cough and chest pains; he also complained of nausea, anorexia and postprandial vomiting and reported a 10-kg weight loss. Generalized lymphadenopathy and some rales over both lung bases were noted and a chest radiograph showed bilateral nodular lesions. Persistent leukocytosis, thrombocytosis, proteinuria and anergy to a series of natural antigens were found. The diagnosis of lymphoid interstitial pneumonia was made from material obtained at open lung biopsy. Rapid but incomplete clearing of the lung lesions resulted from steroid therapy; the other abnormalities were corrected gradually, except for the proteinuria, which persisted. The clinical improvement and the ability to work and play have been maintained for the past 20 months.     

Detecting and adjusting for small-study effects in meta-analysis

Publication bias and related types of small-study effects threaten the validity of systematic reviews. The existence of small-study effects has been demonstrated in empirical studies. Small-study effects are graphically diagnosed by inspection of the funnel plot. Though observed funnel plot asymmetry cannot be easily linked to a specific reason, tests based on funnel plot asymmetry have been proposed. Beyond a vast range of funnel plot tests, there exist several methods for adjusting treatment effect estimates for these biases. In this article, we consider the trim-and-fill method, the Copas selection model, and more recent regression-based approaches. The methods are exemplified using a meta-analysis from the literature and compared in a simulation study, based on binary response data. They are also applied to a large set of meta-analyses. Some fundamental differences between the approaches are discussed. An assumption common to the trim-and-fill method and the Copas selection model is that the small-study effect is caused by selection. The trim-and-fill method corresponds to an unknown implicit model generated by the symmetry assumption, whereas the Copas selection model is a parametric statistical model. However, it requires a sensitivity analysis. Regression-based approaches are easier to implement and not based on a specific selection model. Both simulations and applications suggest that in the presence of strong selection both the trim-and-fill method and the Copas selection model may not fully eliminate bias, while regression-based approaches seem to be a promising alternative.     

Efficacy of Fluon conditioning for capturing cerambycid beetles in different trap designs and persistence on panel traps over time

Fluon PTFE is a fluoropolymer dispersion applied as a surface conditioner to cross-vane panel traps to enhance trap efficiency for cerambycid beetles. We describe the results of three experiments to further optimize cerambycid traps of different designs and to test the effect of Fluon over time. We tested Fluon with Lindgren funnel and panel traps fitted with either wet or dry collection cups on catches of cerambycid beetles and how the effect of Fluon on panel traps persisted. Fluon-treated funnel traps with wet collection cups captured approximately 6x more beetles than the untreated funnel traps with wet collection cups. Untreated funnel traps with dry collection cups did not capture any beetles; however, Fluon-treated funnel traps with dry collection cups captured an average of four beetles per trap. Fluon-treated panel traps with wet collection cups captured approximately 9x more beetles than untreated panel traps with wet collection cups. Fluon-treated panel traps with dry collection cups captured approximately 11x more beetles than untreated panel traps with dry collection cups. The effect of Fluon on capturing cerambycid beetles did not decline after use in one or two field seasons. There was no significant difference in the number of beetles captured in freshly treated panel traps compared with traps that had been used for 1 or 2 yr. Fluon-treated traps captured nine species that were not captured in untreated traps. Conditioning both Lindgren funnel and panel traps with Fluon enhances the efficacy and sensitivity of traps deployed to detect exotic cerambycid species, or for monitoring threatened species at low population densities.     

Duration of chest pain associated with acute myocardial infarction: a predictor of long-term prognosis.

This paper describes 109 patients who had their first myocardial infarction and were then followed up for 3 to 8 years. The following data were collected at the time of the infarction: duration and severity of chest pain, type of infarction and peak SGOT (serum glutamic oxaloacetic transaminase) level. The duration of chest pain has previously been shown to correlate with infarct size. Duration of chest pain, age and peak SGOT level were found to be the most important predictors of survival. None of the other independent variables contributed further to survival when the effects of duration of pain, age and SGOT level were taken into account. However, there was a significant association between pain duration and functional status. These data suggest that the duration of chest pain during first myocardial infarctions is a predictor of long-term prognosis and probably of functional status.     

ON THE CYTOLOGY OF ANTHERIDIUM FORMATION IN THE FERN SPECIES ONOCLEA SENSIBILIS. I. CYTOLOGY OF CELL PLATE AND CELL WALL FORMATION

In the four-celled antheridium of the fern species Onoclea sensibilis a central spermatogenous cell is enveloped by a jacket of three cells. Starting from the base, the jacket comprises the cup-shaped basal cell, the ring cell—both of which encircle the spermatogenous cell—and the cap cell. The lower wall of the spermatogenous cell has the configuration of a funnel; its upper wall is dome shaped. The choice of whole antheridia for study instead of sectioned ones has, for the first time, made it possible to study the formation of the uniquely shaped antheridial cell plates step by step. The cell plate antecedent of the funnel wall has the configuration of a funnel. This conclusion conflicts with Davie's contention that this cell wall is oriented transversely at first and acquires funnel-shape secondarily. The present studies further show that the funnel cell plate forms from base to rim. This finding contrasts with a report that in another fern species this cell plate begins to form on one side of the initial and then proceeds circularly around it. The base of the funnel cell plate attaches to the basal wall of the antheridium initial in a separate event. The genesis of the dome-shaped upper wall of the spermatogenous cell is described for the first time.     

Relative performance of Lindgren multiple-funnel, Intercept panel, and Colossus pipe traps in catching Cerambycidae and associated species in the southeastern United States

In 2004, we evaluated the relative performance of 8-unit Lindgren multiple-funnel (funnel), Intercept panel (panel), and Colossus pipe (pipe) traps, baited with ethanol and ac-pinene lures, in catching saproxylic beetles (Coleoptera) in pine stands in northern Florida and western South Carolina. Panel traps were as good as, if not better than, funnel and pipe traps for catching Cerambycidae. In particular, more Monochamus titillator (F.) were captured in panel traps than in pipe and funnel traps. Of three species of Buprestidae captured in our study, most Buprestis lineata F. were caught in panel traps, whereas most Acmaeodera tubulus (F.) were caught in funnel traps. Catches of Chalcophora virginiensis Drury and the root-feeding weevils Hylobius pales Herbst an dPachylobius picivorus LeConte (Curculionidae) were unaffected by trap type. Among bark beetles (Curculionidae: Scolytinae), catches of Ips grandicollis (Eichhoff) were unaffected by trap type, whereas most Dendroctonus terebrans (Olivier) were caught in panel traps, most Hylastes salebrosus Eichhoff were caught in panel and pipe traps, and most Hylastes tenuis Eichhoff were caught in funnel traps. Among ambrosia beetles (Curculionidae: Scolytinae), panel traps caught the most Xyleborinus saxesenii (Ratzeburg), whereas pipe traps caught the most Xyleborus Eichhoff spp. More Xylosandrus crassiusculus (Motschulsky) and Dryoxylon onoharaensis (Murayama) were caught in panel and funnel traps than in pipe traps. Among bark beetle predators, more Platysoma Leach spp. (Histeridae) were caught in pipe and panel traps than in funnel traps, whereas most Lasconotus Erichson spp. (Zopheridae) were caught in funnel traps. Variation among trap performance for various species suggests that managers should consider more than one type of trap in their detection programs.     

Use of the kinetic treatment table to prevent the pulmonary complications of multiple trauma.

The kinetic treatment table (KTT) has been developed to prevent and treat complications of immobility. Because atelectasis and pneumonia may be related to immobility, we studied the effect of the KTT on the prevention and treatment of pulmonary complications in a prospective randomized study of 30 patients with severe traumatic injuries. All were receiving mechanical ventilation and were randomly assigned to treatment with a KTT or a conventional bed. Both groups received conventional medical-surgical therapy while pulmonary function, chest roentgenograms, and the presence or absence of lung infection were monitored for one week. In the patients who began the study with a clear chest roentgenogram, atelectasis and pneumonia were significantly less frequent in those treated with a KTT (P less than .05). Thus, the KTT can reduce pulmonary complications in selected patients with multiple trauma. The effect of this benefit on overall outcome is uncertain.