Effects of Experimentally-Induced Sleep Fragmentation on Sleep and Sleepiness

The effects of two levels of sleep fragmentation on sleep and daytime sleepiness were investigated in young adult males. Experimental subjects were informed while awake that tones would be presented periodically throughout the night and that their task was to terminate the tone by taking a deep breath. Eight subjects received tones after each minute of sleep and 8 received tones after each 4 min of sleep. Control subjects (N=8) HI did not receive (ones. The subjects were tested for daytime sleepiness using the Multiple Steep latency Test. It was found that: 1) subjects responded reliably lo tones presented during sleep; 2) behavioral control was accompanied by brief electro-physiological indices of arousal on almost all trials, and occasionally led to fall awakenings; 3) sleep was markedly altered in the 1-min condition; 4) a relatively small effect on sleep (reduced stage 4 sleep) was produced by the 4-min condition, and 5) daytime sleepiness was increased by the 1-min condition but not the 4-min condition. It was concluded that the most parsimonious explanation of these results is (he Continuity of Sleep hypothesis.     

Thymidine kinase activation of ganciclovir in recurrent malignant gliomas: a gene-marking and neuropathological study

OBJECT: The gene therapy paradigm of intratumoral activation of ganciclovir (GCV) following transduction of tumor cells by retroviral vectors bearing the thymidine kinase (tk) gene has produced dramatic remissions of malignant gliomas in animal models. In human trials, although the technique has been deemed safe, little antitumor effect has been demonstrated. To evaluate the basis of this inefficacy in human gliomas, the authors conducted a gene-marking trial involving neuropathological and biochemical studies of treated tumor specimens. METHODS: Five patients with malignant recurrent gliomas underwent stereotactic biopsy sampling and intratumoral implantation procedures with three aliquots of 10(6) vector-producing cells (VPCs) in columns. After 5 days, the tumor was resected and the tumor bed reimplanted with VPCs, and a course of GCV was given. Patients received clinical and radiological follow up for 6 months. Tumor specimens were analyzed neuropathologically and for tk gene expression by anti-TK immunohistochemistry and TK enzymatic activity. Four patients tolerated the treatment well but experienced tumor progression. The other developed an abscess after the second operation and died. Increased TK enzymatic activity was demonstrated in the one tumor specimen analyzed. Immunohistochemical evidence of tk gene expression was limited to VPCs. Transduction of tumor cells was not seen. Viable tumor cells were seen near VPCs containing TK. The lymphocytic immune response was mild. CONCLUSIONS: Except for the risk of infection inherent in reoperation, this tk-GCV paradigm was both feasible and safe. Pathological studies indicated that limited dissemination of VPCs and vector from the infusion site and failure to transduce tumor cells with the tk gene are major barriers to efficacy.     

Utility of skull radiographs in infants undergoing 3D head CT during evaluation for physical abuse

BackgroundClinical practice guidelines recommend performing head CT and skull radiographs (SR) when evaluating infants for physical abuse. We compared the accuracy of 3-dimensional CT (3DCT) and SR for detecting skull fractures.MethodsWe reviewed children <12 months evaluated for physical abuse undergoing 3DCT and SR between January 2017 and December 2018. 3DCT and SR images were blindly read by 2 radiologists. Interrater reliability (IRR) was calculated. Diagnostic accuracy was compared using McNemar's test.Results158 infants with a mean age of 5.0 months underwent 3DCT and SR. Consensus reading identified 46 fractures (29.1%) on 3DCT and 40 fractures (25.3%) on SR. IRR was higher for 3DCT (κ = 0.95) than for SR (=0.65). 11 fractures were identified on 3DCT but not SR. 5 fractures were identified on SR but not 3DCT. There was no difference in the diagnostic accuracy of 3DCT and SR (χ² = 1.56, p = 0.211).ConclusionsWe found no difference in the accuracy of 3DCT and SR for detecting skull fractures in infants. Because 3DCT has better IRR and evaluates for both bony and intracranial injuries it is superior to SR. Omitting SRs may be acceptable if a 3DCT is performed, and would reduce radiation exposure without compromising diagnostic accuracy.     

Schwannoma of the sino-nasal tract: a rare clinico-pathological entity revisited

Schwannomas are benign neoplasms arising from Schwann cells of the peripheral, cranial and autonomic nerves. We report a case of schwannoma in the sino-nasal tract, a very rare site of tumour origin with unusual pseudoangiomatous histopathological changes, which we came across in a 22 years male with progressive nasal obstruction.     

Therapeutic Potential of Growth Factors in Pulmonary Emphysematous Condition

Pulmonary emphysema is a major manifestation of chronic obstructive pulmonary disease (COPD), which is characterized by progressive destruction of alveolar parenchyma with persistent inflammation of the small airways. Such destruction in the distal respiratory tract is irreversible and irreparable. All-trans-retinoic acid was suggested as a novel therapy for regeneration of lost alveoli in emphysema. However, profound discrepancies were evident between studies. At present, no effective therapeutic options are available that allow for the regeneration of lost alveoli in emphysematous human lungs. Recently, some reports on rodent’s models have suggested the beneficial effects of various growth factors toward alveolar maintenance and repair processes.     

The incidence,aetiology and outcome of acute seizures in children admitted to a rural Kenyan district hospital

Background  

Acute seizures are a common cause of paediatric admissions to hospitals in resource poor countries and a risk factor for neurological and cognitive impairment and epilepsy. We determined the incidence, aetiological factors and the immediate outcome of seizures in a rural malaria endemic area in coastal Kenya.     

Role of postnatal penicillin prophylaxis in prevention of neonatal group B streptococcus infection

This prospective study was designed to identify the role of postnatal penicillin prophylaxis in the prevention of neonatal group B streptococcus (GBS) infection. We studied 10 998 infants. Of these, 5389 were in the penicillin prophylaxis group (PP) and 5609 infants did not receive penicillin prophylaxis (NPP). Infants were allocated to treatment by month of birth, alternating 3-mo blocks or 2-mo blocks to the two groups after the first block was randomly assigned. The use of PP reduced the incidence of clinical sepsis (1.7% PP versus 2.5% NPP, p < 0.01), GBS infection (0.4% PP versus 0.9% NPP, p < 0.001) and deaths from sepsis (0.1% PP versus 0.3% NPP, p < 0.05). We conclude that the routine use of postnatal penicillin prophylaxis appears to be effective in reducing the incidence of clinical sepsis and death from sepsis in neonates.