ANOTHER "PARABEN PARADOX"

Background. To test the reliability and reproducibility of the patch test with a paraben mix, we added a second paraben mix allergen to our standard tray and compared the results achieved with these two allergens. Methods. Two hundred and fifteen consecutive patients, undergoing patch testing with a standard series, were simultaneously tested with an additional paraben mix (i.e., each patient was tested with two paraben mix allergens) supplied by two different companies. Results. Twelve patients (5.6%) showed a positive reaction to one or two paraben tests. Five patients showed a positive reaction to one paraben test (paraben-a), and five others to the second paraben test (paraben-b). Only two patients out of 12 with positive reactions to parabens showed a reaction with both of the two parabens. The parabens appear to be overrepresented in our study compared to other series. There was no correlation between the results of the tests with the two different parabens used Conclusions. Patch testing with a paraben mix cannot be considered an appropriate and reliable method for detecting paraben allergies. T is recommended to test routinely with a paraben screening series instead of the paraben mix.     

Mycetoma formation in Trichophyton rubrum infection

An adult male patient with a chronic Trichophyton rubrum infection of the feet, toe nails and groin, for 15 years, developed on the dorsum of the right foot a tumour with draining sinuses. Histological examination of tissue from the growth revealed granulomatous inflammation with abscesses containing granules characteristic of mycetoma. T. rubrum was cultured from skin scrapings and toe nails. The concurrent complete clearing of the superficial lesions and the mycetoma during treatment with griseofulvin, as well as the disappearance of complement fixing antibodies against T. rubrum antigen, indicate that this hitherto unreported complication of a dermatophyte infection may be related and may not be coincidental to the infection.     

Signal Transduction Pathways in Enhanced Microvascular Permeability

We have been investigating the molecular mechanisms underlying pathophysiological regulation of microvascular permeability on isolated venules and cultured venular endothelial monolayers. Physiological approaches have been employed in combination with molecular analyses to probe the signal transduction pathways leading to enhanced microvascular permeability. A newly developed technique of protein transfection into cells and intact microvessels enables the correlation of functional reactions and signaling events at the molecular level in a direct and specific fashion. The results indicate that inflammatory mediators increase microvascular permeability via intracellular signaling pathways involving the activation of phospholipase C, cytosolic calcium, protein kinase C, nitric oxide synthase, guanylate cyclase, and protein kinase G. In response to the signaling stimulation, complex biochemical and conformational reactions occur at the endothelial structural proteins. Specifically, myosin light‐chain activation‐mediated myosin light‐chain phosphorylation can result in cell contraction. VE‐cadherin and β‐catenin phosphorylation may induce dissociation of the junctional proteins and their connection to the cytoskeleton, leading to a loose or opened intercellular junction. Focal adhesion phosphorylation and redistribution further provide an anchorage support for the conformational changes in the cells and at the cell junction. The three processes may act in concert to facilitate the flux of fluid and macromolecules across the microvascular endothelium.     

The Role of Parents in Public Views of Strategies to Address Childhood Obesity in the United States

Policy Points

• The American public—both men and women and those with and without children in the household—holds parents highly responsible and largely to blame for childhood obesity.
• High attributions of responsibility to parents for reducing childhood obesity did not universally undermine support for broader policy action. School-based obesity prevention policies were strongly supported, even among those viewing parents as mostly to blame for childhood obesity.
• Americans who viewed sectors outside the family (such as the food and beverage industry, schools, and the government) as helping address childhood obesity were more willing to support a wider range of population-based obesity prevention policies.

Context

The public''s views of parents’ behaviors and choices—and the attitudes held by parents themselves—are likely to influence the success of efforts to reverse obesity rates.

Methods

We analyzed data from 2 US national public opinion surveys fielded in 2011 and 2012 to examine attributions of blame and responsibility to parents for obesity, both among the general public and parents themselves, and we also explored the relationship between views of parents and support for obesity prevention policies.

Findings

We found that attribution of blame and responsibility to parents was consistently high, regardless of parental status or gender. Support for policies to curb childhood obesity also did not differ notably by parental status or gender. Multivariable analyses revealed consistent patterns in the association between public attitudes toward parents’ responsibility and support for policies to curb childhood obesity. High parental responsibility was linked to higher support for school-targeted policies but generally was not associated with policies outside the school setting. Attribution of greater responsibility to entities external to children and their parents (schools, the food and beverage industry, and the government) was associated with greater support for both school-targeted and population-based obesity prevention policies.

Conclusions

Our findings suggest that the high attribution of responsibility to parents for reducing childhood obesity does not universally undermine support for broader policy action. But appealing to parents to rally support for preventing obesity in the same way as for other parent-initiated social movements (eg, drunk driving) may be challenging outside the school setting.     

The Institutional Effects of Incarceration: Spillovers From Criminal Justice to Health Care

Context

This study examines the spillover effects of growth in state-level incarceration rates on the functioning and quality of the US health care system.

Methods

Our multilevel approach first explored cross-sectional individual-level data on health care behavior merged to aggregate state-level data regarding incarceration. We then conducted an entirely aggregate-level analysis to address between-state heterogeneity and trends over time in health care access and utilization.

Findings

We found that individuals residing in states with a larger number of former prison inmates have diminished access to care, less access to specialists, less trust in physicians, and less satisfaction with the care they receive. These spillover effects are deep in that they affect even those least likely to be personally affected by incarceration, including the insured, those over 50, women, non-Hispanic whites, and those with incomes far exceeding the federal poverty threshold. These patterns likely reflect the burden of uncompensated care among former inmates, who have both a greater than average need for care and higher than average levels of uninsurance. State-level analyses solidify these claims. Increases in the number of former inmates are associated simultaneously with increases in the percentage of uninsured within a state and increases in emergency room use per capita, both net of controls for between-state heterogeneity.

Conclusions

Our analyses establish an intersection between systems of care and corrections, linked by inadequate financial and administrative mechanisms for delivering services to former inmates.     

Autoantibodies to M2 mitochondrial autoantigens in normal human sera by immunofluorescence and novel assays

Primary biliary cirrhosis (PBC) is characterized by the presence of antimitochondrial antibodies (anti-M2), directed against the E2 subunits of the 2-oxo-acid dehydrogenase complexes (2-OADC), chiefly pyruvate dehydrogenase complex (PDC-E2). We present here a detailed study, based on a large panel of normal sera, of the specificity of tests for anti-M2 by immunofluorescence and for anti-PDC by other assays for the diagnosis of PBC. The assays for anti-PDC included immunoblotting with bovine heart mitochondria, ELISA using recombinant PDC-E2 and an enzyme inhibition assay using purified porcine PDC. The positivity rates for normal sera were 0 (0/170), 2 (4/201), 1.5 (3/198) and 0% (0/186) for immunofluorescence, immunoblotting, ELISA and the enzyme inhibition assay, respectively. The seven positive reactions detected either by immunoblotting (n= 4) or ELISA (n= 3) were negative by the other three assays and in no instance did biochemical indices give any indication of chronic liver disease. Thus, as judged by reactivity with normal sera, the specificity of a positive test for the antibody to the major M2 autoantigen (PDC-E2) is 100% for immunofluorescence and the enzyme inhibition assay, 98% for immunoblotting and 98.5% for ELISA.     

股骨远端髁上-髁间骨折合并冠状面骨折

背景：孤立的股骨远端髁冠状面骨折（Hoffa骨折）十分罕见，其诊断困难，在治疗上也存在争议。股骨远端髁上骨折合并冠状面骨折也很少发生。此项研究的目的就是明确股骨远端髁上-髁间骨折合并股骨髁冠状面骨折的机率．并描述m这些损伤的影像学表现。方法：对189例患者的202个股骨远端髁上-髁间骨折进行临床和影像学回顾性评估。结果：在202个股骨远端髁上-髁间骨折中有77个（38．1％）诊断合并有冠状面骨折。在这些冠状面骨折中有59个（76．6％）只累及单髁，18个累及了股骨内和外髁累及单髁的冠状面骨折中有85％位于外髁。股骨远端开放骨折合并冠状面骨折的可能性是闭合骨折患者的2．8倍（95％可信区间，1．54～5．25）。在102个进行CT检查的膝关节中有47％被诊断出冠状面骨折，与其相比，在100个未行CT检查的膝关节中，其诊出率只有29％（p=0．008）。术前未被诊断出的10个冠状面骨折只是在术中固定股骨远端骨折时才明确诊断，且这些病例术前均未行过CT检查。结论：冠状面骨折经常与高能的股骨远端髁上-髁间骨折合并发生；在本研究中，合并冠状面骨折的发生率为38％。外髁较内髁更易受累。累及双髁的冠状面骨折也很常见，并且大多数冠状面骨折伴有开放伤口。加上了冠状面骨折的诊断使股骨远端髁上-髁间骨折的外科治疗的策略和方法发生改变，因此，术前对股骨远端损伤者，特别当合并有开放损伤时，竭力推荐进行CT扫描。     

Ablation of Ventricular Tachycardia with a Saline-Cooled Radiofrequency Catheter:

INTRODUCTION: In animal models, active cooling of the electrode during radiofrequency (RF) ablation allows creation of larger lesions, presumably by increasing the power that can be delivered without coagulum formation. These RF lesions have not been characterized in human myocardium in regions of infarction and scarring. METHODS AND RESULTS: Cooled-tip RF catheter ablation of ventricular tachycardias (VTs) was performed in two patients who had severe congestive heart failure and subsequently underwent cardiac transplantation. The first patient had four different monomorphic VTs. RF applications along the inferoseptal margin of a scarred region abolished all inducible VTs. The second patient had sarcoidosis involving the myocardium and four different inducible VTs. RF current applied at an inferobasal VT exit and at the right and left septa failed to abolish the VTs. The explanted hearts were examined at the time of cardiac transplantation 18 and 21 days later, respectively. Lesions extended to depths up to 7 mm, reaching clusters of myocardial cells deep to regions of fibrosis. Microscopically, the ablation sites contained coagulation necrosis with hemorrhage, surrounded by a rim of granulation tissue. CONCLUSION: Saline-irrigated RF catheter ablation produces relatively large lesions capable of penetrating deep into scarred myocardium.     

Plastic and reconstructive surgery in Uganda – 10 years experience

We describe our experience of working in plastic and reconstructive surgery in Uganda over the last 10 years. There is a high burden of disease, a health system that is under resourced, and few qualified physicians to provide healthcare for a principally rural population. Training the physicians of the future is essential. Prevention and early wound management needs to be emphasized for traumatic injuries including burns. Subsidized up-country visits by trained specialists with the appropriate equipment are required to provide a service for the rural poor. There appears to be a high mortality rate in babies with unrepaired cleft palate, probably due to feeding difficulties in an environment where intercurrent illness is common. We now offer nutritional support with early combined cleft lip and palate repair in these babies, a practice that has a high success rate and may be suited to other specialist units in the developing world.