The development and evaluation of a nested PCR assay for detection of Neospora caninum and Hammondia heydorni in feral mouse tissues

The development of a novel nested polymerase chain reaction is described and used for detecting the presence of Neospora caninum and Hammondia heydorni DNA in DNA extracted from feral rodent tissues. A unique strategy was used for design of an assay that could be adapted for detecting DNA from more than one member of Toxoplasmatinae simultaneously with a minimal number of additional steps. The level of sensitivity described for this assay is comparable to real time-PCR and other nested PCR assays. Twenty-eight of 104 feral mice tested positive for N. caninum in at least one tissue (the brain, heart or liver) studied. In this study, eight instances are reported where the brain tested negative to N. caninum while at least one other tissue was positive. This suggests that prior studies, which screened only the brain, describe prevalence levels that are under-represented. None of 54 mouse brains tested positive for H. heydorni DNA. This suggests that mice are rarely infected by H. heydorni although this hypothesis needs to be explored further. Data obtained in the current study suggest that N. caninum is a common parasite of feral rodents which may be important in the epidemiology of the disease.     

Detection of upper tract urothelial neoplasms: sensitivity of axial, coronal reformatted, and curved-planar reformatted image-types utilizing 16-row multi-detector CT urography

Background  The purpose of our study was to determine the sensitivity of 16-row multi-detector computed tomography urography (CTU) axial, coronal reformatted, and curved-planar reformatted image-types for upper tract urothelial neoplasm detection. Methods  Twenty-one CTU examinations were identified that contained one or more pathology-proven upper tract urothelial neoplasms during our study period. Two readers independently reviewed 1.25 and 2.5 mm axial, coronal reformatted, and curved-planar reformatted excretory phase CTU images. Each reader then documented the location and appearance of lesions suspicious for upper tract urothelial neoplasm. These results were correlated with relevant endoscopic/surgical procedure notes as well as pathology results. Results  Reader #1 detected 72%, 63%, 75%, and 72% of the known 32 upper tract urothelial neoplasms using 1.25 mm axial, 2.5 mm axial, coronal reformatted, and curved-planar reformatted image-types, respectively. Reader #2 detected 72% of the known neoplasms using each of the four image-types. No significant difference in sensitivity between image-types was identified. After combining the results for all four image-types, readers #1 and #2 had overall sensitivities of 94% and 91%. Conclusions  Axial, coronal reformatted, and curved-planar reformatted image-types have similar sensitivities for the detection of upper tract urothelial neoplasm in 16-row multi-detector CTU. Reviewing multiple image-types increases the sensitivity of urothelial lesion detection.     

Carer-driven dementia education for professionals

The pilot project described here took the form of action research, focusing on dementia awareness education for nurses on acute wards and in accident and emergency departments. An essential feature of the educational package was the involvement of four carers, each of whom described specific experiences. Their accounts were recorded on DVD and presented in the education sessions, which the carers also attended to add comments and answer questions. Feedback from the nurses was positive with all of them claiming new awareness and understanding of patient and carer needs. The education sessions are to be continued with other nurses.     

Is antimicrobial therapy needed to manage uncomplicated skin and soft-tissue abscesses?

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections occur across a wide spectrum of epidemiologic groups, which range from medically underserved urban dwellers to professional athletes. CA-MRSA primarily causes skin and soft-tissue infections but it can also cause severe invasive disease, including necrotizing pneumonia and necrotizing fasciitis. In light of CA-MRSA's proclivity to cause skin and soft-tissue abscesses and its capacity to inflict severe illness, investigators have been prompted to revisit the question of whether adjunctive antimicrobial therapy is necessary in the management of uncomplicated abscesses. This article evaluates the findings of a recently published randomized, double-blind, placebo-controlled trial that aims to determine whether 'standard-of-care' antimicrobial therapy is needed after adequate surgical incision and drainage of uncomplicated skin and soft-tissue abscesses.     

Inter-subject variability in the use of two different neuronal networks for reading aloud familiar words

Cognitive models of reading predict that high frequency regular words can be read in more than one way. We investigated this hypothesis using functional MRI and covariance analysis in 43 healthy skilled readers. Our results dissociated two sets of regions that were differentially engaged across subjects who were reading the same familiar words. Some subjects showed more activation in left inferior frontal and anterior occipito-temporal regions while other subjects showed more activation in right inferior parietal and left posterior occipito-temporal regions. To explore the behavioural correlates of these systems, we measured the difference between reading speed for irregularly spelled words relative to pseudowords outside the scanner in fifteen of our subjects and correlated this measure with fMRI activation for reading familiar words. The faster the lexical reading the greater the activation in left posterior occipito-temporal and right inferior parietal regions. Conversely, the slower the lexical reading the greater the activation in left anterior occipito-temporal and left ventral inferior frontal regions. Thus, the double dissociation in irregular and pseudoword reading behaviour predicted the double dissociation in neuronal activation for reading familiar words. We discuss the implications of these results which may be important for understanding how reading is learnt in childhood or re-learnt following brain damage in adulthood.     

Reliability of measuring sciatic and tibial nerve movement with diagnostic ultrasound during a neural mobilisation technique

Diagnostic ultrasound provides a technique whereby real-time, in vivo analysis of peripheral nerve movement is possible. This study measured sciatic nerve movement during a "slider" neural mobilisation technique (ankle dorsiflexion/plantar flexion and cervical extension/flexion). Transverse and longitudinal movement was assessed from still ultrasound images and video sequences by using frame-by-frame cross-correlation software. Sciatic nerve movement was recorded in the transverse and longitudinal planes. For transverse movement, at the posterior midthigh (PMT) the mean value of lateral sciatic nerve movement was 3.54 mm (standard error of measurement [SEM] +/- 1.18 mm) compared with anterior-posterior/vertical (AP) movement of 1.61 mm (SEM +/- 0.78 mm). At the popliteal crease (PC) scanning location, lateral movement was 6.62 mm (SEM +/- 1.10 mm) compared with AP movement of 3.26 mm (SEM +/- 0.99 mm). Mean longitudinal sciatic nerve movement at the PMT was 3.47 mm (SEM +/- 0.79 mm; n = 27) compared with the PC of 5.22 mm (SEM +/- 0.05 mm; n = 3). The reliability of ultrasound measurement of transverse sciatic nerve movement was fair to excellent (Intraclass correlation coefficient [ICC] = 0.39-0.76) compared with excellent (ICC = 0.75) for analysis of longitudinal movement. Diagnostic ultrasound presents a reliable, noninvasive, real-time, in vivo method for analysis of sciatic nerve movement.     

Lipomatous lumbar mass with an attached digit and associated split cord malformation

BACKGROUND: A male infant was born with a digit attached to a skin-covered lumbar lipomatous mass and an underlying split cord malformation. METHODS: Surgical removal of the mass was performed at four months-of-age. By this time the digit had grown a nail and imaging and histology showed ongoing development of articulated phalanges. RESULTS: The lipomatous mass contained a long bone, a clavicle- and scapula-like structure and a variety of other mature germ layer derivatives. These features raised a number of diagnostic considerations, including: mature teratoma, hamartoma, rudimentary parasitic twin, lipomyelomeningocele and dorsal accessory limb. CONCLUSIONS: Based on review of the literature, the authors hypothesize that there is a pathogenetically related spectrum of skin-covered dorsal mass lesions, often associated with spinal dysraphism. These consist of a major lipomatous component and a variety of mature germ layer derivatives that can vary widely in their degree of anatomical organization from case to case.     

Psychological responses to cardiac diagnosis: Changes in illness representations immediately following coronary angiography

Objective

Coronary angiography is a commonly used diagnostic test for ischemic heart disease. Little is known, however, about how undergoing the procedure impacts on the ways in which individuals perceive their illness. We sought to explore patients' reactions to an angiogram in terms of changes in symptom appraisal, perceived consequences of their condition, and patients' illness concern and emotional response to their condition after the receiving diagnostic results.

Methods

The Brief IPQ was administered to patients undergoing a diagnostic coronary angiogram (N=57) before and immediately following the procedure. Changes in illness representations were then compared between patients diagnosed with diseased arteries and patients with normal arteries.

Results

We found that the number of symptoms patients associated with their condition, illness consequences, and illness emotion decreased for patients receiving normal results but remained unchanged for patients receiving results showing diseased arteries. Illness concern decreased significantly for both patient groups.

Conclusions

The results demonstrate that diagnostic results can have clear and immediate effects on how patients' view and emotionally respond to their symptoms. The results also suggest that patients cognitively prepare themselves to receive an unfavorable diagnosis and the pattern suggests those receiving normal results modify their perceptions in a positive direction rather than those receiving an unfavorable diagnosis.