Bronchiolar Emphysema: A Report of a Necropsied Case of Diffuse Bronchiolectasis and Review of the Literature

Bronchiolar emphysema is a rare, insidious, progressive, bilateral pulmonary fibrosis with diffusion defect. Death follows in five to 10 years after the onset of symptoms because of respiratory failure, cor pulmonale or pneumothorax. In the 20 cases reviewed, the lungs typically showed bosselation of their pleural surfaces, giving the appearance and consistency of a liver involved by Laennec''s cirrhosis. Cross sections showed honeycombing chiefly along the lung margins. Microscopically, cystic dilatation of terminal bronchioles was present, with obliteration of the remaining peripheral lung tissue by a dense pulmonary fibrosis. Hyperplasia of smooth muscle and elastica was prominent.Bronchiolar emphysema is a clinicopathologic entity, the etiology of which is unknown and likely multiple. Bronchiolectasis and superimposed recurrent infection are essential in its pathogenesis. Thickening of alveolar walls may play a decisive role in determining the characteristic site of the bronchiolar dilatation.     

Bronchitis in Bristol

Eleven autopsied cases of bronchiolar emphysema are reported. In all, both lungs were involved. Their pleural surfaces were finely bosselated, presenting an appearance resembling that of the liver in Laennec''s cirrhosis. The lungs were firm, they cut with increased fibrous resistance, and the cut surfaces were honeycombed with cysts.Microscopically, the cysts originated in terminal bronchioles. Their walls were thickened with fibrous tissue, elastic fibres and prominent smooth muscle. Areas of lung parenchyma were replaced by fibrous tissue rich in elastic fibres.The etiology of this disease is unknown. Inherent weakness of the myoelastic wall of the respiratory bronchiole, hypoplasia of the distal segment of the respiratory unit, and superimposed recurrent respiratory infections probably are essential in its pathogenesis. The pulmonary changes cause interference with hemorespiratory gaseous exchange.Death was due to respiratory failure in seven cases, to cardiac failure in three and to superimposed staphylococcal pneumonia in one.     

Transmission modes and the evolution of feminizing symbionts

Vertically transmitted symbionts can distort their host's reproduction to increase their own transmission. In Wolbachia and some other symbionts, a particular distortion of this sort is feminization, whereby genetic males, which cannot transmit symbionts, are converted during development into functional females, which do transmit symbionts when they reproduce. In this work, we propose a model to study how feminization intensity (i.e. penetrance) can evolve under different ecological constraints in WZ/ZZ hosts. More specifically, our model incorporates both imperfect vertical and horizontal transmission modes. The model shows that for most parameter values feminizing symbionts drive genetic females to extinction, which in turn favours the evolution of maximum feminization penetrance. Once genetic females are extinct, the actual value of feminization penetrance never depends on the efficiency of vertical transmission. Instead, the model shows that in conditions where the reproductive rate is high at demographic equilibrium, higher feminization levels are favoured. One consequence of this can be, for example, that evolutionarily stable feminization penetrance increases with the host's natural death rate, just as the virulence is predicted to do with the host's natural death rate in classic epidemiological models. Finally, we found that horizontal transmission had no impact on how feminization penetrance evolved when genetic females were extinct. However, horizontal transmission can permit genetic females to coexist with symbionts and, in this case, we demonstrate that the presence of genetic females selects symbionts for lower feminization penetrance.     

Was Young's syndrome caused by exposure to mercury in childhood?

OBJECTIVE--To determine whether the incidence of chronic sinusitis, bronchitis, or bronchiectasis in men with obstructive azoospermia (Young''s syndrome) has fallen in men born after 1955 when calomel (mercurous chloride) was removed from teething powders and worm medication in the United Kingdom. DESIGN--A prospective study of aetiological factors in subfertile men with epididymal obstruction operated on between 1975 and 1993. SETTING--Central London. SUBJECTS--274 men with obstructive azoospermia undergoing epididymovasostomy; date of birth was recorded and illness in childhood, persistent nasal or respiratory symptoms, and previous urinary or genital infection were asked about. MAIN OUTCOME MEASURE--Site of epididymal block and association with possible aetiological factors, related to date of birth. RESULTS--146 men had hold up in the head of the epididymis (capital blocks): 119 (82%) had Young''s syndrome, and 11 gave a definite history of pink disease (mercury intoxication) in childhood. 128 had obstruction lower down towards the tail of the epididymis (caudal blocks): 64 (50%) had a history of genital or urinary infection, and only three had Young''s syndrome; none had had pink disease. The incidence of Young''s syndrome fell significantly from 114 (50%) of 227 men born up to 1955 to eight (17%) of 47 men born since then. CONCLUSIONS--The decline in incidence of Young''s syndrome in those born after 1955 is similar to that observed with pink disease, suggesting that both conditions may have had a similar aetiology--mercury intoxication.     

The Influence of Chronic and Situational Social Status on Stereotype Susceptibility

We tested whether stereotypical situations would affect low-status group members'' performance more strongly than high-status group members''. Experiment 1 and 2 tested this hypothesis using gender as a proxy of chronic social status and a gender-neutral task that has been randomly presented to favor boys (men superiority condition), favor girls (women superiority condition), or show no gender preference (control condition). Both experiments found that women’s (Experiment 1) and girls’ performance (Experiment 2) suffered more from the evoked stereotypes than did men''s and boys’ ones. This result was replicated in Experiment 3, indicating that short men (low-status group) were more affected compared to tall men (high-status group). Additionally, men were more affected compared to women when they perceived height as a threat. Hence, individuals are more or less vulnerable to identity threats as a function of the chronic social status at play; enjoying a high status provides protection and endorsing a low one weakens individual performance in stereotypical situations.     

“Sicca Complex” in Liver Disease

Sixty-three patients with liver disease were studied for the presence of the components of Sjögren''s syndrome. The “sicca complex” (that is, patients without arthritis) was detected in 42% of patients with active chronic hepatitis, 72% with primary biliary cirrhosis, and 38% with cryptogenic cirrhosis. One patient with active chronic hepatitis and one with primary biliary cirrhosis had rheumatoid arthritis. No evidence of Sjögren''s syndrome was detected in seven patients with alcoholic cirrhosis. It is suggested that the sicca complex and autoimmune liver disease may be part of a systemic disorder in which immunological mechanisms are concerned in the pathogenesis.     

Men's Preferences for Women's Femininity in Dynamic Cross-Modal Stimuli

Men generally prefer feminine women''s faces and voices over masculine women''s faces and voices, and these cross-modal preferences are positively correlated. Men''s preferences for female facial and vocal femininity have typically been investigated independently by presenting soundless still images separately from audio-only vocal recordings. For the first time ever, we presented men with short video clips in which dynamic faces and voices were simultaneously manipulated in femininity/masculinity. Men preferred feminine men''s faces over masculine men''s faces, and preferred masculine men''s voices over feminine men''s voices. We found that men preferred feminine women''s faces and voices over masculine women''s faces and voices. Men''s attractiveness ratings of both feminine and masculine faces were increased by the addition of vocal femininity. Also, men''s attractiveness ratings of feminine and masculine voices were increased by the addition of facial femininity present in the video. Men''s preferences for vocal and facial femininity were significantly and positively correlated when stimuli were female, but not when they were male. Our findings complement other evidence for cross-modal femininity preferences among male raters, and show that preferences observed in studies using still images and/or independently presented vocal stimuli are also observed when dynamic faces and voices are displayed simultaneously in video format.     

Gendered perceptions on infant feeding in Eastern Uganda: continued need for exclusive breastfeeding support

Background

In resource-poor settings, HIV positive mothers are recommended to choose between 'Exclusive breastfeeding' (EBF) or 'Exclusive replacement feeding' (ERF). Acceptability, Feasibility, Affordability, Sustainability and Safety (AFASS) has been the World Health Organization (WHO)'s a priori criteria for ERF the last ten years. 'AFASS' has become a mere acronym among many workers in the field of prevention of mother-to-child transmission of HIV, PMTCT. Thereby, non-breastfeeding has been suggested irrespective of social norms. EBF for the first half of infancy is associated with huge health benefits for children in areas where infant mortality is high. But, even if EBF has been recommended for a decade, few mothers are practicing it. We set out to understand fathers' and mothers' infant feeding perceptions and the degree to which EBF and ERF were 'AFASS.'

Methods

Eight focus groups with 81 informants provided information for inductive content analysis. Four groups were held by men among men and four groups by women among women in Mbale District, Eastern Uganda.

Results

Two study questions emerged: How are the different feeding options understood and accepted? And, what are men's and women's responsibilities related to infant feeding? A mother's commitment to breastfeed and the husband's commitment to provide for the family came out strongly. Not breastfeeding a newborn was seen as dangerous and as unacceptable, except in cases of maternal illness. Men argued that not breastfeeding could entail sanctions by kin or in court. But, in general, both men and women regarded EBF as 'not enough' or even 'harmful.' Among men, not giving supplements to breast milk was associated with poverty and men's failure as providers. Women emphasised lack of time, exhaustion, poverty and hunger as factors for limited breast milk production. Although women had attended antenatal teaching they expressed a need to know more. Most men felt left out from health education.

Conclusion

Breastfeeding was the expected way to feed the baby, but even with existing knowledge among mothers, EBF was generally perceived as impossible. ERF was overall negatively sanctioned. Greater culture-sensitivity in programs promoting safer infant feeding in general and in HIV-contexts in particular is urgently needed, and male involvement is imperative.

Trial Registration

The study was part of formative studies for the ongoing study PROMISE EBF registered at http://clinicaltrials.gov (NCT00397150).     

Scleroderma and Primary Biliary Cirrhosis

Two cases of scleroderma and primary biliary cirrhosis are described. One had systemic sclerosis with primary biliary cirrhosis of six years'' duration at the stage of ductular proliferation. The other had the C.R.S.T. syndrome (calcinosis, Raynaud''s phenomenon, sclerodactyly, and telangiectases) with primary biliary cirrhosis at the florid stage. Several similar cases were found in a review of other reports, and it is suggested that the association may be due to a common “autoimmune” process.     

Like or Dislike? Affective Preference Modulates Neural Response to Others' Gains and Losses

Previous studies have demonstrated that the brain responds differentially to others'' gains and losses relative to one''s own, moderated by social context factors such as competition and interpersonal relationships. In the current study, we tested the hypothesis that the neural response to others'' outcomes could be modulated by a short-term induced affective preference. We engaged 17 men and 18 women in a social-exchange game, in which two confederates played fairly or unfairly. Both men and women rated the fair player as likable and the unfair players as unlikable. Afterwards, ERPs were recorded while participants observed each confederates playing a gambling game individually. This study examines feedback related negativity (FRN), an ERP component sensitive to negative feedback. ANOVA showed a significant interaction in which females but not males displayed stronger FRNs when observing likable players'' outcomes compared to unlikable ones''. However, males did not respond differently under either circumstance. These findings suggest that, at least in females, the neural response is influenced by a short-term induced affective preference.     

Pneumococcal bacteraemia: 325 episodes diagnosed at St Thomas's Hospital.

Three hundred and twenty five episodes of pneumococcal bacteraemia occurred at St Thomas''s Hospital during 1970-84, accounting for 13.3% of all episodes of bacteraemia. Twice as many cases occurred in male as in female patients, and common predisposing factors included chronic chest disease, alcoholism, haematological malignancies, cirrhosis, and sickle cell anaemia. Mortality was 28.6% overall but only 11.8% among patients who received antibiotic treatment for at least 24 hours. Most patients (261) had pneumonia, 26 had meningitis, and eight were children with occult bacteraemia. The commonest serotype of pneumococcus in adults was type 3 (39 episodes), and these strains were associated with a high mortality. Other factors determining a fatal outcome included underlying disease (such as cirrhosis, malignancy, and chronic chest disease) and extrapulmonary infection. Almost half the survivors were treated for 10 days or less and became afebrile within 48 hours.     

The goals of direct paternal care among a South Amerindian population

Human males are remarkable among mammals in the level of investment they provide to their wives and children. However, there has been debate as to the degree to which men actually invest and through which fitness pathways the benefits of familial investment are realized. Much of the previous research exploring these issues has focused on men's roles as providers, but few have explored correlates of men's direct parental care. Although this is reasonable given men's parental emphasis on provisioning, the providing of direct care is more straightforward with a clear provider and recipient and little ambiguity as to the care‐giver's intent. Here, we explore contextual correlates of men's direct care among the Tsimane of Bolivia to determine the extent to which such care is patterned to enhance its effectiveness in increasing child wellbeing and the efficient functioning of the family. We also explore whether Tsimane fathers provide care in ways that enhance the positive effect it has on the wife's perception of the care provider. Overall, we find that Tsimane men appear responsive to the needs of children and the family, but show that there is little evidence that men respond to factors expected to increase the impact that men's care has on their reputations with their wives. Am J Phys Anthropol 2009. © 2009 Wiley‐Liss, Inc.     

Is risk of Kaposi's sarcoma in AIDS patients in Britain increased if sexual partners came from United States or Africa?

OBJECTIVE--To determine whether the risk of Kaposi''s sarcoma in patients with AIDS is increased by sexual contact with groups from abroad with a high incidence of Kaposi''s sarcoma. DESIGN--Analysis of risk of Kaposi''s sarcoma in patients with AIDS, according to country of origin of their sexual partners. SETTING--United Kingdom. PATIENTS--2830 patients with AIDS reported to the Communicable Disease Surveillance Centre and the Communicable Disease (Scotland) Unit up to March 1990, of whom 566 had Kaposi''s sarcoma. MAIN OUTCOME MEASURES--Percentage of patients with AIDS who had Kaposi''s sarcoma. RESULTS--537 of 2291 homosexual or bisexual men (23%) with AIDS had Kaposi''s sarcoma; 10% (14/135) of the men and women who acquired HIV by heterosexual contact had Kaposi''s sarcoma. None of the 316 subjects who acquired HIV through non-sexual routes had Kaposi''s sarcoma. Kaposi''s sarcoma was more common among homosexual men whose likely source of infection included the United States (171/551, 31%) or Africa (9/34, 26%) than among those infected in the United Kingdom (119/625, 19%) (p less than 0.05). CONCLUSION--The data suggest that Kaposi''s sarcoma is caused by a sexually transmissible agent which was introduced into the British homosexual population mainly from the United States [corrected].     

CIRRHOSIS OF THE LIVER—Clinical Course in 2,377 Patients at San Francisco General Hospital

The records of 2,377 patients with Laennec''s cirrhosis were reviewed for the period 1947-1957. The chief presenting symptom was ascites in 46 per cent, bleeding in 23 per cent, coma in 18 per cent, jaundice in 9 per cent, and both jaundice and ascites in 4 per cent. Nearly half of the patients died during the period under study—one-third from hepatic failure, one-third from gastrointestinal bleeding, and one-third from other causes, most of which were related to alcoholism.Massive gastrointestinal bleeding occurred in 21 per cent of the patients at some time in their clinical course, and in the 10 per cent of these in whom ulcer was demonstrated, one-fifth died as a result of the hemorrhage. Of those presumed to be bleeding from esophageal varices, 64 per cent died at the first hemorrhage and 10 per cent at subsequent hemorrhages; 85 per cent of all those who bled from varices were dead at the end of one year, and 91 per cent were dead at the end of three years.The survival curve of a group of patients who bled once and were good operative risks but had received no operative treatment was compared to the survival curve for entire group who survived the first hemorrhage. The three-year survival in the good risk group was 47 per cent; for the group as a whole it was 30 per cent. The difference in mortality rate was primarily due to an increased number of deaths from hepatic failure in the combined group, whereas 60 per cent of the good risk group died of recurrent gastrointestinal hemorrhage.As 86 per cent of those who were to die of gastrointestinal bleeding did so at the first hemorrhage, it was concluded that any decided improvement in the salvage rate achievable by operation must come from some means of diagnostic forecast of the likelihood of bleeding, with resort to prophylactic operation in such cases.     

Wilson's disease: a common liver disorder?

In two sibships 7 of 24 siblings were homozygous for Wilson''s disease. In family A, the largest kindred of this recessively inherited disease thus far reported, the proband presented with chronic active hepatitis, one sibling died of cirrhosis, a second had clinical evidence of chronic liver disease and two others had biochemical and histologic changes in liver biopsy specimens. In family B the proband had cirrhosis and portal hypertension and one sibling had biochemical and histologic evidence of liver disease. All six living patients had low serum concentrations of ceruloplasmin and copper and a high 24-hour urinary excretion of copper, which was greatly increased by administration of D-penicillamine. None showed neurologic abnormalities and only one had Kayser-Fleischer rings (detectable only by slit-lamp examination). Each patient had an erythrocyte sedimentation rate (ESR) of 8 mm/h or less. After 3 and 2 years, respectively, of D-penicillamine therapy the conditions of the two probands had improved. Liver function became normal in three siblings, and no abnormalities developed in the remaining one. Thus, since Wilson''s disease may present with chronic active hepatitis or cirrhosis with a normal ESR and without ocular or neurologic signs, it may be a more common cause of liver disease in young people than has been appreciated.     

The Impact of Perceived Social Power and Dangerous Context on Social Attention

Past research has shown that position in a social hierarchy modulates one''s social attention, as in the gaze cueing effect. While studies have manipulated the social status of others with whom the participants interact, we believe that a sense of one''s own social power is also a crucial factor affecting gaze following. In two experiments, we primed the social power of participants, using different approaches, to investigate the participants'' performance in a subsequent gaze cueing task. The results of Experiment 1 showed a stronger gaze cueing effect among participants who were primed with low social power, compared to those primed with high social power. Our predicted gender difference (i.e., women showing a stronger gaze cueing effect than men) was confirmed and this effect was found to be dominated by the lower social power condition. Experiment 2 manipulated the level of danger in the context and replicated the joint impact of gender and one''s perceived social power on gaze cueing effect, especially in the low danger context, in comparison to the high danger context. These findings demonstrate that one''s perceived social power has a concerted effect on social attention evoked by gaze, along with other factors such as gender and characteristics of the environment, and suggest the importance of further research on the complex relationship between an individual''s position in the social hierarchy and social attention.     

Voice pitch alters mate-choice-relevant perception in hunter–gatherers

In humans, voice pitch is thought to be a cue of underlying quality and an important criterion for mate choice, but data from non-Western cultures have not been provided. Here we test attributions to and preferences for voices with raised and lowered pitch in hunter–gatherers. Using a forced-choice playback experiment, we found that both men and women viewed lower pitched voices in the opposite sex as being better at acquiring resources (e.g. hunting and gathering). While men preferred higher pitched women''s voices as marriage partners, women showed no overall preference for voice pitch in men. However, women who were currently breastfeeding had stronger preferences for higher pitched male voices whereas women not currently breastfeeding preferred lower pitched voices. As testosterone is considered a costly signal associated with dominance, heritable immunity to infection and low paternal investment, women''s preferences potentially reflect a trade-off between securing good genes and paternal investment. Men''s preferences for higher pitched female voices are probably due to an evolved preference for markers of fecundity, reflected in voice pitch.     

Liver transplantation in patients with alcoholic cirrhosis: selection criteria and rates of survival and relapse.

OBJECTIVE--To evaluate the outcome of liver transplantation in patients with alcoholic cirrhosis with respect to selection criteria, survival, and evidence suggesting a return to harmful drinking. DESIGN--Nine year retrospective study. SETTING--Cambridge and King''s College Hospital liver transplant programme. SUBJECTS--24 Patients (three women, 21 men) with alcoholic cirrhosis. MAIN OUTCOME MEASURES--Survival, rehabilitation, and clinical and laboratory evidence of a return to harmful drinking after transplantation. RESULTS--15 Patients were selected for transplantation because of repeated admission to hospital for the complications of advanced portal hypertension despite abstinence, and six because they had a hepatocellular carcinoma superimposed on alcoholic cirrhosis. Three patients who were not abstinent received transplants. The one year survival rate was 66%, and of the 18 patients surviving at least three months, 17 had been rehabilitated. In three patients laboratory variables and histological examination of the liver suggested a return to drinking, though they did not admit to taking alcohol. These patients represented the only cases in the series that were not abstinent before transplantation. CONCLUSIONS--The survival and rehabilitation of patients who received transplants for alcoholic cirrhosis compared favourably with those of patients who received transplants for cirrhosis of other aetiology. The criteria for selection for liver transplantation in patients with alcoholic cirrhosis should include recurrent complications related to severe portal hypertension despite maximum medical treatment in addition to a minimum period of six months of abstinence before transplantation.