Combined Discography and Metrizamide Myelography in Evaluation of Confusing Low Back Pain

44 discs (in 35 patients) were diagnosed as being ruptured by combined discography and metrizamide myelography. The patients had initially presented with confusing low back pain. All the discs were subsequently shown to be ruptured at surgery. Combined discography and metrizamide myelography is suggested as a method of evaluation of selected difficult cases of confusing low back pain.     

TRICHO-RHINO-PHALANGEAL SYNDROME

The major characteristics of tricho-rhino-phalangeal syndrome (TRPS) include shortened and deviated digits, a typical facies with a pear-shaped nose, a long philtrum and slow-growing, fine, sparse hair. Cone-shaped digital epiphyses are seen on x-ray. A few patients with TRPS are mentally retarded. Associated endocrine abnormalities have been reported. Autosomal dominant and recessive patterns of inheritance have been described with most cases showing a dominant mode of inheritance.     

Control of peptide disulfide regioisomer formation by mixed cysteine–penicillamine bridges

While incorporation of penicillamine residues (Pen; β,β-dimethyl cysteine) into a peptide can cause dramatic changes in biological activity, the tendency of Pen to form mixed disulfides should also allow the exploitation of the steric bulk of the β-methyls as a synthetic device to control the production of disulfide isomers. That is, oxidation of a peptide containing an equal number of Cys and Pen residues should predominantly form products which contain mixed Cys–Pen disulfides. Endothelin (ET) is a 21 amino acid peptide which contains Cys at positions 1, 3, 11 and 15. While oxidation of ET tetrathiol has been reported to produce a 3:1 ratio of the natural 1–15, 3–11 to the unnatural 1–11, 3–15 isomers, we show that oxidation of ET analogs containing two cysteines and two penicillamines predominantly formed products containing Cys–Pen disulfides. Random oxidation (air, aqueous NH₄OH) of the tetrathiols of [Pen^1,11, Nle⁷]-ET-1 or [Pen^3,15, Nle⁷]-ET-1 produced the correct 1–15, 3–11 isomer in > 12:1 and > 22:1 ratios, respectively. Oxidation of the tetrathiol of [Pen^1,15, Nle⁷]-ET-1 favored the unnatural 1–11, 3–15 isomer by a 4:1 ratio, indicating that a normally contrathermodynamic disulfide isomer can become the favored product as a result of the driving force for penicillamine mixed disulfide formation. Disulfide isomers were identified using ion-spray mass spectrometry in conjunction with enzymatic and acid hydrolysis. [Pen^1,11, Nle⁷]-ET-1 was a partial agonist at the ETA receptor (EC₅₀= 7.5 nM in rabbit carotid artery rings; K_d= 4.5 nM in rat A10 cell membranes) while [Pen^3,15, Nle⁷]-ET-1 (EC₅₀= 0.9 nM; K_d= 0.7 nM) was a full agonist with similar potency to ET-1.     

Duration of inter-facility neonatal transport and neonatal mortality: Systematic review and cohort study

BACKGROUND: Regionalization of perinatal health services has been actively discussed, although important determinants such as effect of duration of neonatal transport on neonatal outcomes have not been investigated well as yet. Therefore the purpose of the present paper was to investigate the association between duration of inter-facility transport and perinatal mortality. METHODS: For the systematic review, six major databases were searched. Any comparative studies investigating associations between duration of inter-facility neonatal transport and their outcomes, published in the English language were selected. The studies were screened and reviewed by two independent researchers. For the cohort study, study subjects included every neonate transported to neonatal wards in Osaka, Japan between 1980 and 2000 in an existing surveillance called Neonatal Mutual Cooperative System. They are followed up until 28 days of age, or discharge if earlier. Other variables were also considered as effect modifiers or confounders, including calendar year, birthweight (BW), gestational age (GA), sex, maternal/paternal age, Apgar scores at 1 and 5 min, place of birth and personnel accompanying the neonate during transport (transport personnel), body temperature before transport and on admission, severity of illness, and intraventricular hemorrhage (IVH) grade. Cox regression analyses were performed to obtain principal results, and sensitivity analysis to support them. RESULTS: Systematic review: only one cross-sectional study conducted in an urban area in India was identified. That study showed that neonates with a long duration of transport had 79% higher odds of death than those transported for a short duration after adjusting for the confounding effects. For the cohort study, among 16 429 subjects, full data were available for 4966 neonates. There was strong evidence that those transported for >90 min had more than twice the rate of neonatal death (rate ratio [RR] 2.26, 95% confidence interval [CI]: 1.26-4.04), and some evidence that those transported for between 60 and 89 min had an 80% higher rate of neonatal death (RR 1.81, 95%CI: 1.07-3.06), both compared with those transported for between 30 and 59 min, after adjusting for the confounding effects. A sensitivity analysis on missing values also supported the results. CONCLUSION: There is evidence of an association between duration of transport and increased neonatal mortality, which can be applied to organization of perinatal health services. A prospective cohort study is needed for further investigation.     

Innovative model for clinical education in dietetics

Aim:  Professional practice placement programs in dietetics face a number of challenges in respect of quantity, quality and sustainability. The aim of the present study is to report on the development of an innovative placement model based on a variety of training and supervision approaches to address these aforementioned challenges.
Methods:  The model was developed following an investigation of existing practice and the literature with approaches that were identified as important to the requirements and constraints of dietetics clinical training incorporated into the model.
Results:  Although one-on-one supervision is the predominant approach in Australian dietetic education, the educational literature and the authors' experience showed that a variety of approaches are represented in some form. The model developed involves the pairing of two students with one supervisor with students changing peer partners and supervisors every three weeks during the nine-week placement to diversify exposure to working and learning styles. The model integrates four customised approaches: incremental exposure to tasks; use of a clinical reasoning framework to help structure student understanding of the methods and judgements involved in patient care; structured enquiry in group discussions; and peer observation and feedback.
Conclusions:  The model has potential to achieve efficiencies in supervisors' involvement by coordinating the skill development activities of students as a group and promoting peer-assisted learning.     

Rh sensitization in a primipara caused by intramuscular injection of human serum resulting in fatal erythroblastosis

It is now generally recognized that transfusions, or even intramuscular injections of Rh-positive blood are far more potent in sensitizing Rh-negative individuals than is pregnancy with Rh-positive fetuses. Thus, while only one of about 25 Rh-negative women bearing Rh-positive babies becomes sensitized to the Rh factor, fully one-half of such individuals can be sensitized by injections of Rh-positive blood.¹ This difference is readily explained by the difference in quantity of antigen injected. On the other hand, it has been generally believed up to now that such sensitization could not result from the injection of serum or plasma, which is presumably free of red cells.The purpose of this report is to present possibly the first case which demonstrates that such sensitization can occur after intramuscular injection of serum, causing fatal erythroblastosis even in a firstborn infant.