Decreased venous return is neither sufficient nor necessary to elicit ultrasonic vocalizations of infant rat pups

It has been proposed that all ultrasonic vocalizations (USVs) in young rats are by-products of a cardiovascular response to decreased venous return, the abdominal compression reaction. To test the hypothesis, venous return was decreased in infant rats while USV and cardiovascular measures were monitored. Neither injection of the vasodilator sodium nitroprusside nor blood withdrawal from the superior vena cava or carotid artery elicited USV from pups in their home cage. Thus, decreased venous return by itself is not sufficient to elicit USV. To test whether venous return is a necessary mechanism for USV production, 5% dextrose in water or blood was infused intravenously into isolated pups that were producing USV. This artificial increase of venous return did not affect the rate of USV.     

Whose child is it anyway? Resolving parent-physician conflict in the NICU setting

Much has been written on parental involvement in decision making when dealing with critically ill children, but few articles have touched upon parental refusal of treatment in noncritically ill children. What steps should be taken when a parent refuses what is generally considered "standard of care" medicine for their hospitalized child? Does medical advice outweigh parental views or wishes, and what does one do when our role as physician turns from medical expert into one of medical negotiator? The following case and discussion deal with parental refusal of conventional medical care, and how one may find peaceful resolutions to challenging situations for the ultimate good of the child.     

Three-dimensional display modes for CT colonography: conventional 3D virtual colonoscopy versus unfolded cube projection

The authors compared a conventional two-directional three-dimensional (3D) display for computed tomography (CT) colonography with an alternative method they developed on the basis of time efficiency and surface visibility. With the conventional technique, 3D ante- and retrograde cine loops were obtained (hereafter, conventional 3D). With the alternative method, six projections were obtained at 90 degrees viewing angles (unfolded cube display). Mean evaluation time per patient with the conventional 3D display was significantly longer than that with the unfolded cube display. With the conventional 3D method, 93.8% of the colon surface came into view; with the unfolded cube method, 99.5% of the colon surface came into view. Sensitivity and specificity were not significantly different between the two methods. Agreements between observers were kappa = 0.605 for conventional 3D display and kappa = 0.692 for unfolded cube display. Consequently, the latter method enhances the 3D endoluminal display with improved time efficiency and higher surface visibility.     

Case reports: scrub typhus during pregnancy in India

Scrub typhus, caused by Orientia tsutsugamushi, is a rural zoonosis endemic in the Asian Pacific region. Doxycycline and chloramphenicol, the recommended drugs for treating this infection, may not be safe during pregnancy. We report on 5 patients with scrub typhus during pregnancy who were seen in India between October 2001 and February 2002. Four of the 5 women were treated initially with ciprofloxacin. Three women had stillbirths, 1 an abortion and 1 a low birthweight baby, which suggests that ciprofloxacin should not be used for treating pregnant women and that scrub typhus leads to severe adverse effects during pregnancy. Randomized controlled trials are urgently needed to ascertain the optimal drug choice, given that currently recommended drugs are contraindicated in pregnant women.     

The Botrychiopsis genus and its biostratigraphic implications in Southern Paraná Basin

Botrychiopsis has been considered an important floristic element of Westphalian/Artinskian associations of the Paraná Basin. The occurrence of Botrychiopsis in roof-shales of the Rio Bonito Formation in Southern Paraná Basin (Quitéria area), supported by the identification of Botrychiopsis valida, enlarges the genus biochron. Consequently, the stratigraphic hierarchy for Botrychiopsis plantiana and Botrychiopsis valida was defined for the Paraná Basin. Although it is climatically controlled and related to a deglaciation icehouse stage, stratigraphic distribution of the genus presents a substantial climate tolerance, from cold/cool to warm/temperate conditions. A new phytostratigraphic zonation is proposed for the southern portion of the basin that includes the Botrychiopsis Zone (Asselian/Kungurian), which is subdivided into the Botrychiopsis plantiana (Asselian/Artinskian) and Botrychiopsis valida (Late Artinskian/Kungurian) subzones.     

Bleeding complications in patients with atrial fibrillation undergoing cardioversion randomized to transesophageal echocardiographically guided and conventional anticoagulation therapies

In a multicenter randomized trial, we studied a transesophageal echocardiography (TEE) guided strategy with short-term anticoagulation compared with a conventional strategy for patients with atrial fibrillation >2 days' duration and undergoing cardioversion. Composite major and minor bleeding was a predetermined secondary end point of the study. The objective of the study was to assess the incidence, location, and predictors of bleeding in the 2 treatment groups. A total of 1,222 patients were assigned to a TEE guided or conventional strategy and followed over 8 weeks. We present data on major and minor adjudicated bleeding complications for the 2 study groups during the 8-week study period. Composite major and minor bleeding complications occurred in 51 of 1,222 patients (4.2%) and were significantly lower in the TEE guided group compared with the conventional group (2.9 vs 5.5%, p = 0.025). The TEE group had fewer cancellations of cardioversion as a result of bleeding (0% vs 0.7%, p = 0.003). Major (n = 14) and minor (n = 38) bleeding complications were predominantly gastrointestinal (71.4% and 31.6%, respectively) and were associated with warfarin use. Predictors of bleeding included patient age, conventional group assignment, inpatient status, and functional status. Thus, composite major and minor bleeding complications occurred in 4.2% of the 1,222 patients and were significantly lower in the TEE guided group compared with the conventional group. Treatment variables affecting length of anticoagulant therapy in the conventional arm combined with advancing age and functional status are important concerns in patients who undergo cardioversion of atrial fibrillation.     

A biomechanical evaluation of the tibiofibular and tibiotalar ligaments of the ankle

The purpose of this ex vivo biomechanical study was to determine the strength and stiffness of the anterior and posterior syndesmotic tibiofibular ligaments and the posterior tibiotalar component of the deltoid ligament. Injuries to these ligaments are a prevalent clinical problem, yet little is known about their mechanical behavior. Ten fresh-frozen cadaver lower extremities (average age at death, 72 +/- 8 years) were harvested. The anterior and posterior tibiofibular ligaments and the posterior tibiotalar component of the deltoid were isolated and prepared as bone-ligament-bone complexes for tensile testing to determine strength, stiffness, and mode of failure. The posterior tibiofibular ligament exhibited greater strength, but not significantly so (p < .05), than the anterior tibiofibular ligament and the posterior tibiotalar component of the deltoid ligament. There were no significant differences in stiffness between the three ligaments tested. The dominant mode of failure for the anterior tibiofibular ligament was ligament substance rupture, primarily near its fibular insertion, whereas the failure modes of the posterior tibiofibular ligament were evenly split between substance ruptures and fibular avulsions. The posterior tibiotalar component of the deltoid ligament ruptured most often near the talar insertion. The tibiofibular ligaments showed greater strength than the lateral collateral and deltoid ligaments, as mentioned in literature. The greater strength of the tibiofibular ligaments relative to the lateral collateral and deltoid ligaments suggests that these ligaments play an important role in ankle constraint.     

Differential sensitivity of the three ASI factors in predicting panic disorder patients' subjective and behavioral response to hyperventilation challenge

The overall aim of the present investigation was to examine the association between the subscales of the ASI and emotional responding to voluntary hyperventilation challenge in a panic disorder population. Based on findings from [J. Abnorm. Psychol. 110 (2001) 372.], we predicted that the AS-Physical Concerns subscale would best predict the fear response to hyperventilation. We also examined the relative contribution of each of the three ASI subscales in predicting behavioral tolerance to hyperventilation. Participants (N = 192) meeting DSM-IV criteria for panic disorder with or without agoraphobia completed the Anxiety Sensitivity Index (ASI) and underwent a voluntary hyperventilation challenge. Consistent with prediction, the AS-Physical subscale significantly predicted subjective fear during the hyperventilation challenge (12% of variance accounted for); whereas only the AS-Social subscale accounted for significant variance (4%) in patients' behavioral tolerance to the hyperventilation challenge.