The recombinant chimeric human parainfluenza virus type 1 vaccine candidate, rHPIV3-1cp45, is attenuated, immunogenic, and protective in African green monkeys

A recombinant live-attenuated chimeric human parainfluenza virus type 1 (HPIV1) candidate vaccine was previously generated by replacing the fusion (F) and hemagglutinin-neuraminidase (HN) glycoprotein open reading frames (ORFs) of the HPIV3 candidate vaccine, rHPIV3cp45, with those of wild-type HPIV1. Previously, this recombinant chimeric virus, designated rHPIV3-1cp45, exhibited a greater level of the temperature sensitivity of replication in vitro and a greater level of attenuation of replication in the respiratory tract of immunized hamsters when compared to its HPIV3cp45 parent virus. In the present study, rHPIV3-1cp45 was evaluated for its level of attenuation and efficacy in African green monkeys (Cercopithecus aethiops), a primate in which both HPIV1 and HPIV3 wild-type viruses replicate efficiently. The rHPIV3-1cp45 candidate vaccine was as restricted in replication in the upper and lower respiratory tract as its thoroughly characterized rHPIV3cp45 parent indicating that the attenuating mutations present in the rHPIV3cp45 backbone specified an appropriate level of attenuation of rHPIV3-1cp45 for primates. The level to which rHPIV3-1cp45 replicated in the respiratory tract of African green monkeys was also sufficient to induce a strong immune response to HPIV1 and provided protection against challenge with wild-type HPIV1. These results provide a basis for further evaluation of this HPIV1 candidate vaccine in humans.     

Electrocardiographic findings predict short-term cardiac morbidity after transient ischemic attack

BACKGROUND: Current guidelines recommend the use of electrocardiography (ECG) in the evaluation of transient ischemic attack (TIA), but the data supporting its value in acute management are sparse. OBJECTIVE: To determine whether ECG findings are useful as independent predictors of short-term cardiac or neurologic complications after TIA. METHODS: We included patients who presented to 1 of 16 emergency departments of a health maintenance organization in northern California and received a diagnosis of TIA from March 1, 1997, through February 28, 1998, for a 90-day follow-up. A cardiac event was defined as a hospitalization or a death due to myocardial infarction, ventricular arrhythmia, heart failure, or unstable angina. RESULTS: Among the 1327 patients with TIA for whom ECG findings were available for diagnostic coding, cardiac events occurred in 2.9%, strokes in 10.9%, recurrent TIAs in 13.7%, and deaths in 2.6% during 90-day follow-up. The ECG findings disclosed a new diagnosis of atrial fibrillation in 28 (2.3%) of the 1200 patients with no history of this condition. The 90-day risk for a cardiac event was greater in those who had any abnormal ECG findings (4.2% vs 0.6%; P<.001). This association remained significant after adjustment for medical history and examination findings (odds ratio, 6.9; 95% confidence interval, 1.6-29.5; P =.009). Left ventricular hypertrophy, atrial fibrillation, and atrioventricular conduction abnormalities were each independently associated with more than doubling of the risk. The ECG abnormalities were not associated with risk for stroke or death. CONCLUSIONS: Short-term cardiac morbidity is substantial after TIA. Electrocardiographic findings disclose new atrial fibrillation in a significant portion of patients with TIA and can identify a group of patients at a substantially higher risk for short-term cardiac events.     

Gold occlusal surfaces and organic occlusion in denture construction

When this technique is used in denture construction, the forces applied to the residual ridges are only vertical, eliminating horizontal movement of the denture bases. The occlusal tables may be kept small in width, and the cutting ridges can be sharpened to achieve maximum chewing efficiency with minimum force. The cuspfossa relationship tends to centralize the mandible in harmony with the temporomandibular joints and muscles.     

Relationship of necrosis and tumor border to lymph node metastases and 10-year survival in carcinoma of the breast.

The pathologic findings of 330 patients with invasive carcinoma of the breast who were followed for 10 years after radical mastectomy was reviewed. The presence or absence of necrosis and the character of the border of the tumor were two factors which were observable in all cases. Necrosis in the carcinoma was associated with a higher mortality rate, a higher incidence of axillary node metastases, and a higher mortality rate in patients with axillary node metastases than were primary carcinomas without necrosis. Tumors with necrosis and a root border showed significantly more aggressive behavior than did those tumors with a rounded border and no necrosis.     

Cosmesis with bilateral mammoreduction for conservative breast cancer treatment

Over 7 years, 57 women with breast cancer underwent lumpectomy and bilateral mammoreduction. Physical complaints about large or lax breast shape were the predominate rationale. Two patients were immediately lost to follow-up, 55 patients remained and were followed every 3 months for an average of 1.6 years. This is the largest series traceable by computer and literature search. Chart review and patient examination in this retrospective review were utilized as the basis for data within the article. Collated notes from patients' doctors were assessed, as well as documented patient responses to the procedure. Pictures without head/face for identifiers were taken of the patients. Chart data were collected by clinicians, but were reviewed blindly by a statistician. The overall control and cosmesis rates as well as alleviation of heavy breast problems were noted. Only 6% of women had fair to poor cosmetic results; the majority (82%) had excellent to good results. Women with very large breasts or markedly relaxed breast tissue of concern to the patients proved optimal candidates for lumpectomy of cancer and bilateral mammoreduction in the conservative treatment of these cancers. There was a significant reduction in the physical complaints of the patients as well. For women with very pendulous or extremely large breasts, lumpectomy and bilateral mammoreduction may prove to be the optimal course of action.     

Noncompliance with Behavioral Recommendations Following Bariatric Surgery

Background: Bariatric surgery has been increasingly utilized for treatment of severe obesity. Although initial weight loss following surgery is almost completely assured, little is known about long-term out-come and patient compliance with post-surgical behavioral recommendations for diet and exercise that would improve outcome. The purpose of this study was to examine the rate of noncompliance with behavioral recommendations and to identify the incidence of psychological concerns following bariatric surgery. Method: Subjects were identified from an active clinical data-base of prospective clinical follow-up of all bariatric surgery patients. 100 consecutive patients who underwent Roux-en-Y gastric bypass were identified, and a chart review was conducted at 6 and 12 months postoperatively to gather demographic data and identify the prevalence of noncompliance identified in monthly follow-up visits. Also, patients were asked about depression, relationship/sexual concerns, and medical complications. Results: 81 women and 19 men were followed for 1 year. The majority of patients reported noncompliance in at least one area, with lack of exercise and snacking being most frequently cited (41%, 37% respectively overall). Most patients were compliant with eating protein first and avoiding sodas. At 12 months follow-up, 12% reported depression, 4% reported sexual concerns and 2% reported relationship problems. Also, 9% reported having experienced some medical complication related to their surgery. Conclusion: Noncompliance with behavioral recommendations is pervasive following bariatric surgery, with lack of exercise being the most likely area of noncompliance. Because of the importance of compliance with behavioral recommendations for the successful outcome of bariatric surgery, further research is warranted to further clarify the factors that impact long-term outcome and to design interventions to improve compliance.     

Significant spinal injury resulting from low-level accelerations: a case series of roller coaster injuries

OBJECTIVES: To describe a cohort of significantly injured roller coaster riders and the likely levels of acceleration at which the injuries occurred, and to compare these data with contemporary efforts to define a lower limit of acceleration below which no significant spinal injury is likely to occur. DESIGN: A retrospective case series of roller coaster ride-induced significant spinal injuries. SETTING: Injury incident records and emergency medical service records for the Rattler roller coaster in San Antonio, TX, were evaluated for a 19-month period in 1992 and 1993. Medical records for the more significant injuries were also reviewed and the specific injuries were tabulated, along with the demographics of the cohort. PARTICIPANTS: There were 932,000 riders of the Rattler roller coaster, estimated to represent between 300,000 and 600,000 individual riders. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Injury incident reports and medical record review. RESULTS: It is estimated that there were a total of 656 neck and back injuries during the study period, and 39 were considered significant by the study inclusion criteria. Seventy-two percent (28/39) of the injured subjects sustained a cervical disk injury; 71% of these injuries were at C5-6 (15 disk herniations, 5 symptomatic disk bulges) and 54% were at C6-7 (11 disk herniations, 4 symptomatic disk bulges). In the lumbar spine, the most frequent injury was a symptomatic disk bulge (20% of the cohort), followed by vertebral body compression fracture (18%), and L4-5 or L5-S1 disk herniation (13%). Accelerometry testing of passengers and train cars indicated a peak of 4.5 to 5g of vertical or axial acceleration and 1.5g of lateral acceleration over approximately 100ms (0.1s) on both. CONCLUSIONS: The results of this study suggest that there is no established minimum threshold of significant spine injury. The greatest explanation for injury from traumatic loading of the spine is individual susceptibility to injury, an unpredictable variable.     

Efficient inhibition of in-stent restenosis by controlled stent-based inhibition of elastase: a pilot study

PURPOSE: It is proposed that local elastase inhibition could suppress the extracellular matrix (ECM) degradation and subsequent smooth muscle cell migration and limit subsequent in-stent restenosis. This study evaluated the effect of stent-based controlled elastase inhibition on restenosis after stent implantation in a rabbit model. MATERIALS AND METHODS: Biodegradable microspheres containing the potent elastase inhibitor alpha-1-antitrypsin (AAT) were prepared. Daily release of AAT from the microspheres was confirmed in vitro. The microspheres were loaded into stents with an abluminal polymer reservoir. Implantation of the stent with AAT microspheres and blank microspheres (control) was performed in the abdominal aortae of six rabbits in each group. After stent deployment, all stents were overdilated to 125% diameter. Stent-implanted arteries were harvested after 7 days (n = 3 each) or 28 days (n = 3 each). To assess the effect of local delivery of AAT, elastase activity and elastin content of the stent-implanted aortae were analyzed. As an endpoint, intima-to-media (I/M) ratio was determined in the 7-day and 28-day specimens. RESULTS: Significant inhibition of elastase was confirmed in treated vessels versus controls at 7 days after stent implantation (P < .05). This reduction in elastase activity was sufficient to afford early and late reduction of in-stent neointima. Plaque progression in the 28-day specimens decreased to 67% with elastase inhibition relative to controls (P < .05). CONCLUSION: Stent-based controlled release of elastase inhibitor may significantly reduce ECM degradation and might limit in-stent restenosis.     

Early intervention in first-episode psychosis

OBJECTIVE: Substantial delays in providing access to treatment in first-episode psychosis have been well documented. The present study examines the impact of strategies aimed at improving access and reducing delays. METHOD: A pilot community education campaign was conducted with the aim of reducing the duration of untreated psychosis (DUP) in a geographically defined intervention sector located in the northwestern region of Melbourne, Australia. Utilising a quasi-experimental design, a comparison sector with similar demographics was selected from another part of the north-western region. A mobile early detection team and the same treatment system served both sectors. RESULTS: While there was no significant difference between the mean DUP for intervention and comparison sectors, the distributional features of DUP between the two regions were significantly different. In the intervention sector, disproportionately more cases with very long DUP were detected. When a small number of outliers were removed, the mean and median DUP in the intervention sector was reduced. CONCLUSION: These findings highlight the complexity of treatment access and delay and suggest that efforts to reduce DUP may have two effects, not one. Firstly, a different sample of cases is treated through the detection of hidden "long DUP" cases that otherwise may have remained untreated. Secondly, the DUP for the remainder may indeed be reduced. More research with larger samples and more potent campaign strategies is clearly required. It may also be worth considering whether there is a safe and ethical way to undertake a RCT of early versus delayed antipsychotic treatment to perhaps settle the DUP debate once and for all.