MRI and CT findings of infected cephalhaematoma complicated by skull vault osteomyelitis,transverse venous sinus thrombosis and cerebellar haemorrhage

We present the CT and MRI findings of an 8-day-old infant with an infected cephalhaematoma complicated by skull osteomyelitis, venous sinus thrombosis and left cerebellar haemorrhage.     

Talking medicine: a course in medical humanism--what do third-year medical students think?

OBJECTIVE: The early 1990s sparked an interest in organized medicine to reclaim and re-evaluate how it promotes professionalism among physicians. The American Board of Internal Medicine (ABIM) launched Project Professionalism as a means to define and evaluate professionalism as a component of clinical competence. The course "Talking Medicine" was developed to create a series of small-group discussions on humanism and professionalism where students can reflect on the process of becoming a physician and share personally or ethically difficult and rewarding cases with each other. We asked students to define these concepts and use these definitions to spark small-group discussion. DESCRIPTION: "Talking Medicine" is predicated on the belief that humanism and professionalism come to students and others through understanding a number of core concepts and relationships complemented by self-reflection. "Talking Medicine" offers a consistent (every other week for ten weeks) opportunity to share experiences in small groups (six to eight students), facilitated by two preceptors, in a format driven by students' experiences. Although the focus is on students' experiences, readings are provided on basic topics and contexts in humanism and professionalism (e.g., end-of-life care, mistakes, spirituality in medicine, and boundaries between patients and doctors). Also, at the beginning of each internal medicine clerkship we asked students to define humanism and professionalism anonymously on sheets of paper to be handed to the preceptors. DISCUSSION: "Talking Medicine" began in summer 2000. We hope to expand it to other institutions. We surveyed students and found 94% felt "very" or "somewhat" comfortable in the course. Seventy-three percent of students reported that the course increased their "connectedness" to classmates, and 61% favored its occurring during all rotations. Fifty-nine percent reported that their interest in caring for patients improved, and 53% reported their interest in internal medicine as a field improved. Answers to open-ended questions highlighted the importance of "Talking Medicine" as a forum to connect with others-both students and faculty. Despite this course's focus during an internal medicine clerkship, students see a broader definition of professionalism than the ABIM; the student's definitions were similar in many ways to the Group of Educational Affairs definition of professionalism. Third-year medical students focus more on tolerance of difference (e.g., race, socioeconomic status, and varying health beliefs), and the importance of collegiality and collaboration in the new environment of patient care. Their vantage point early in training allows them to look critically at the profession they are joining and view its shortcomings and strengths. Future work is needed that focuses on how these definitions change as students' progress through fourth year, into residency, and finally continuing medical education. Nevertheless, we suggest that "Talking Medicine" may be most effective in helping classmates connect to and learn from each other, thereby setting a foundation for changes in how they interact with patients.     

The dynamics of germinal centre selection as measured by graph-theoretical analysis of mutational lineage trees

We have developed a rigorous graph-theoretical algorithm for quantifying the shape properties of mutational lineage trees. We show that information about the dynamics of hypermutation and antigen-driven clonal selection during the humoral immune response is contained in the shape of mutational lineage trees deduced from the responding clones. Age and tissue related differences in the selection process can be studied using this method. Thus, tree shape analysis can be used as a means of elucidating humoral immune response dynamics in various situations.     

A collection of 33 novel human mtDNA homoplasmic variants

Mitochondria are involved in cellular energy production via oxidative phosphorylation and this function may be damaged by any mutation in mitochondrial DNA (mtDNA). To identify novel mtDNA mutations, we have developed a program to systematically screen the entire mitochondrial genome in a large number of individuals with clinical and/or morphological features of mitochondrial dysfunction, but still no genetic diagnosis. The sequence-data were obtained with an automated rapid system, which gave us a series of information: in the eleven mitochondrial genomes analyzed we observed the presence of 33 differences from the revised Cambridge Reference Sequence (Andrews et al., 1999), but they were all homoplasmic in the patients' tissues analyzed (skeletal muscle and blood), suggesting that they are unlikely to be primarily pathogenic though they may be co-responsible in the determination of the disease. This work can therefore help complete the already ample mtDNA polymorphism existent database.     

Antiretroviral prophylaxis of perinatal HIV-1 transmission and the potential impact of antiretroviral resistance

Since 1994, trials of zidovudine, zidovudine and lamivudine, and nevirapine have demonstrated that these antiretroviral drugs can substantially reduce the risk of perinatal HIV-1 transmission. With reductions in drug price, identification of simple, effective antiretroviral regimens to prevent perinatal HIV-1 transmission, and an increasing international commitment to support health care infrastructure, antiretrovirals for both perinatal HIV-1 prevention and HIV-1 treatment will likely become more widely available to HIV-1-infected persons in resource-limited countries.In the United States, widespread antiretroviral usage has been associated with increased antiretroviral drug resistance. This raises concern that drug resistance may reduce the effectiveness of perinatal antiretroviral prophylaxis as well as therapeutic intervention strategies. The purpose of this article is to review what is known about resistance and risk of perinatal HIV transmission, assess the interaction between antiretroviral resistance and the prevention of perinatal HIV-1 transmission, and discuss implications for current global prevention and treatment strategies.     

A compilation of chiropractic and complementary/alternative medicine (CAM) data from public-use national surveys: report on a health-services research resource for the chiropractic and CAM scientific community

BACKGROUND: Federally funded national surveys are routinely conducted to provide reliable, valid, and relevant data on health and health care, and these "public-use" survey data are typically made available for further study by the wider scientific community. The full potential for using such data to examine the delivery, utilization, organization, and costs of chiropractic or complementary/alternative (CAM) health care remains largely untapped. OBJECTIVE: To report on a project that identifies and indexes public-use survey databases that contain explicit reference to chiropractic and CAM health care, and compiles that information into a web-based resource for the scientific community. METHODS: Review of database source collections. RESULTS: The utility and efficiency of secondary analyses as a cost-effective research strategy are well appreciated within the larger health-services research community, creating many possible opportunities for productive cooperative research endeavors across scientific disciplines. CONCLUSION: The Chiropractic and Complementary/Alternative Compilation User's Manual is available for free download at http://w3.palmer.edu/carber/manualhome.asp, or by following the links at the Palmer Center for Chiropractic Research homepage.     

Identification of a novel DNase I hypersensitive site within the far upstream region of the human HLA-DRA gene

The class II products of the major histocompatibility complex have a distribution restricted to certain tissues and cells. For instance, they are constitutively expressed by B lymphocytes, but not by resting T lymphocytes. In this study, we report the identification of a novel DNase I hypersensitive site within a putative regulatory region of the human HLA-DRA gene, the so-called far upstream region. This hypersensitive site was present in the genome of the DRalpha-positive human B-lymphoid Raji cell line, and absent in the DRalpha-negative T-lymphoid Jurkat cell line. In addition, this hypersensitive site was also present in transgenic B lymphocytes isolated from the murine transgenic line TG 53, carrying a single integrated copy of the human HLA-DRA gene per haploid genome. The correlation between DRA expression and the presence of this far upstream hypersensitive site suggests novel long distance chromatin remodeling mechanisms possibly shared by human and murine class II genes.     

A strategy for detection of known and unknown SNP using a minimum number of oligonucleotides applicable in the clinical settings

Detection of unknown single nucleotide polymorphism (SNP) relies on large scale sequencing expeditions of genomic fragments or complex high-throughput chip technology. We describe a simplified strategy for fluorimetric detection of known and unknown SNP by proportional hybridization to oligonucleotide arrays based on optimization of the established principle of signal loss or gain that requires a drastically reduced number of matched or mismatched probes. The array consists of two sets of 18-mer oligonucleotide probes. One set includes overlapping oligos with 4-nucleotide tiling representing an arbitrarily selected "consensus" sequence (consensus-oligos), the other includes oligos specific for known SNP within the same genomic region (variant-oligos). Fluorescence-labeled DNA amplified from a homozygous source identical to the consensus represents the reference target and is co-hybridized with a differentially-labeled test sample. Lack of hybridization of the test sample to consensus- with simultaneous hybridization to variant-oligos designates a known allele. Lack of hybridization to consensus- and variant-oligos indicates a new allele. Detection of unknown variants in heterozygous samples depends upon fluorimetric analysis of signal intensity based on the principle that homozygous samples generate twice the amount of signal. This method can identify unknown SNP in heterozygous conditions with a sensitivity of 82% and specificity of 90%. This strategy should dramatically increase the efficiency of SNP detection throughout the human genome and will decrease the cost and complexity of applying genomic wide analysis in the context of clinical trials.