Impact of clinical history on fracture detection with radiography

The effect of knowledge of localizing symptoms and signs in the detection of fractures was studied. Forty radiographs of the extremities were examined twice by seven radiologists; the sessions were separated by 4 months. In 26 cases, a subtle fracture was present; 14 cases were normal. In half of the cases at each session, the precise location of pain, tenderness, or swelling was provided. The observer was asked to determine if the case was normal or abnormal (provide the exact location of the fracture) and to indicate the degree of confidence in the diagnosis. Responses were converted to a numeric scale for analysis. Analysis of receiver operator characteristic parameters indicates that clues regarding location of trauma facilitate detection of fractures. The improvement is based largely on an increased true-positive rate without an increased false-positive rate, regardless of the decision criteria of the radiologist (overall willingness to "overread" or "underread"). This has direct clinical applicability and reinforces the plea of radiologists for precise clinical information.     

Lymph node infarction – a rare complication associated with disseminated intra vascular coagulation in a case of dengue fever

Background  

Lymph node infarction is known to occur in association with many non-neoplastic and neoplastic conditions however its occurrence in association with DIC is not reported hitherto in the literature.     

Breeding for 50-kHz Positive Affective Vocalization in Rats

Adolescent and adult rats exhibit at least two distinct ultrasonic vocalizations that reflect distinct emotional states. Rats exhibit 22-kHz calls during social defeat, drug withdrawal, as well as in anticipation of aversive events. In contrast, 50-kHz calls are exhibited in high rates during play behavior, mating, as well as in anticipation of rewarding events. The neurochemistry of 22-kHz and 50-kHz calls closely matches that of negative and positive emotional systems in humans, respectively. The aim of this study was to replicate and further evaluate selective breeding for 50-kHz vocalization, in preparation for the analysis of the genetic underpinnings of the 50-kHz ultrasonic vocalization (USV). Isolate housed adolescent rats (23–26 days old) received experimenter administered tactile stimulation (dubbed tickling), which mimicked the rat rough-and-tumble play behavior. This stimulation has previously been shown to elicit high levels of 50-kHz USVs and to be highly rewarding in isolate-housed animals. Each tickling session consisted of 4 cycles of 15 seconds stimulation followed by 15 seconds no stimulation for a total of 2 min, and was repeated once per day across 4 successive days. Rats were then selected for either High or Low levels of sonographically verified 50-kHz USVs in response to the stimulation, and a randomly selected line served as a control (Random group). Animals emitted both 22-kHz and 50-kHz types of calls. After 5 generations, animals in the High Line exhibited significantly more 50-kHz and fewer 22-kHz USVs than animals in the Low Line. Animals selected for low levels of 50-kHz calls showed marginally more 22-kHz USVs then randomly selected animals but did not differ in the rate of 50-kHz calls. These results extend our previous findings that laboratory rats could be bred for differential rates of sonographically verified 50-kHz USVs.     

High-frequency ultrasonic vocalizations index conditioned pharmacological reward in rats.

We have proposed that short (<0.5 s), high-frequency (approximately 50 kHz) ultrasonic vocalizations ("50-kHz USVs") index a positive affective state in adult rats, because they occur prior to rewarding social interactions (i.e., rough-and-tumble play, sex). To evaluate this hypothesis in the case of nonsocial stimuli, we examined whether rats would make increased 50-kHz USVs in places associated with the administration of rewarding pharmacological compounds [i.e., amphetamine (AMPH) and morphine (MORPH)]. In Experiment 1, rats made a greater percentage of 50-kHz USVs on the AMPH-paired side of a two-compartment chamber than on the vehicle-paired side, even after statistical correction for place preference. In Experiment 2, rats made a higher percentage of 50-kHz USVs on the MORPH-paired side than on the vehicle-paired side, despite nonsignificant place preference. These findings support the hypothesis that 50-kHz USVs mark a positive affective state in rats and introduce a novel and rapid marker of pharmacological reward.     

Mucinous syringometaplasia with prominent epithelial hyperplasia and deep dermal involvement

This report describes two patients with mucinous syringometaplasia whose findings expand the microscopic and clinical spectrum of the entity. The first patient had an eroded nodule that exhibited multiple epidermal invaginations that penetrated deeply into the dermis. In addition to mucinous metaplasia, there was also exuberant papillary epithelial hyperplasia. Expanded eccrine ducts with similar changes appeared as lobules isolated in the dermis but were shown to connect with the invaginations. In the second patient, a clinical "cyst" drained serous fluid. Multiple papillary-cystic epithelial lobules similar to those seen in the first case were located in the dermis. A few approached the epidermis, but epidermal connections were not identified. The epithelium in these lesions was identical to that previously described in mucinous syringometaplasia. The tumors differed from prior cases by virtue of the number of eccrine apparatus involved, the extent and depth of involvement, and the presence of prominent papillary epithelial hyperplasia.     

Clinical and genetic features of variegate porphyria in a Chinese patient

Acute porphyria is rare in orientals. We describe a Chinese woman with recurrent generalised tonic-clonic seizures and abdominal pain. Genomic DNA studies identified a heterozygous base substitution from guanine to adenine at nucleotide position 503, resulting in substitution of arginine by histidine at position 168 of the protein (R168H). This genetic abnormality is similar to the mutation reported in Caucasians with variegate porphyria. To the best of our knowledge, this is the first report in the English literature a Chinese patient with variegate porphyria with an identifiable mutation. A brief review of porphyria is presented.     

Acute coronary syndromes

The first 150 words of the full text of this article appear below. Key points Coronary artery disease accounts for >30% ofdeaths in Western society. The diagnosis of myocardial infarctionshould be qualified by size, causation and time from occurrence. Mortalityis reduced by immediate or ‘primary’ percutaneouscoronary intervention or thrombolysis within the first 24 hof onset of ST-segment elevation myocardial infarction. Strategiesto reduce platelet activation (glycoprotein IIb/IIIa receptorantagonists, or clopidogrel) are now recommended in the treatmentof high-risk non-ST-segment myocardial infarction/unstable angina. Elevatedserum troponins may be the result of non-ischaemic myocardialdamage, especially in critical illness.