Inability to assess breath sounds during air medical transport by helicopter

This study assessed the capabilities of a traditional and an amplified stethoscope used by flight nurses to assess breath sound during air medical transport in an MBB BO-105 helicopter. We developed a normal breath sound model using a prerecorded tape of breath sounds interspersed with segments without breath sounds; the recorder had been placed in the chest wall of a resuscitation training manikin. Flight nurses completed control listening sessions in a quiet environment and experimental sessions during flight using a traditional stethoscope for half of the sessions and an amplified stethoscope for the remaining half. In the quiet environment, flight nurses accurately reported the presence or absence of breath sounds in 110 (92%) of 120 trials. During helicopter flight, none of the flight nurses heard breath sounds during any of the recorded segments with either the traditional stethoscope or the amplified stethoscope. We conclude that flight nurses are unable to hear normal breath sounds using a traditional or amplified stethoscope during flight in a medically configured MBB BO-105 helicopter. Improved stethoscopes, innovative methods of listening, and reduction of aircraft noise are potential solutions to the problems of breath sound assessment during air medical transport.     

A gene from the locus of enterocyte effacement that is required for enteropathogenic Escherichia coli to increase tight-junction permeability encodes a chaperone for EspF

Disruption of the barrier properties of the enterocyte tight junction is believed to be important in the pathogenesis of diarrhea caused by enteropathogenic Escherichia coli (EPEC). This phenotype can be measured in vitro as the ability of EPEC to reduce transepithelial resistance (TER) across enterocyte monolayers and requires the products of the locus of enterocyte effacement (LEE) and, in particular, the type III secreted effector protein EspF. We report a second LEE-encoded gene that is also necessary for EPEC to fully reduce TER. rorf10 is not necessary for EPEC adherence, EspADB secretion, or formation of attaching and effacing lesions. However, rorf10 mutants have a diminished TER phenotype, reduced intracellular levels of EspF, and a reduced ability to translocate EspF into epithelial cells. The product of rorf10 is a 14-kDa intracellular protein rich in alpha-helices that specifically interacts with EspF but not with Tir or other EPEC secreted proteins. These properties are consistent with the hypothesis that rorf10 encodes a type III secretion chaperone for EspF, and we rename this protein CesF, the chaperone for EPEC secreted protein F.     

An extracellular matrix infrastructure provides support for murine secondary palatal shelf remodelling

A cricial part of secondary palate morphogenesis is the movement of the palatal shelves from an initial vertical position on either side of the tongue to a final horizontal one above it to achieve palate closure. The immunocytochemical localization of extracellular matrix (ECM) molecules in the palatal shelf during this remodelling and reorientation revealed the existence of an ECM infrastructure within the mesenchyme. The major components of this infrastructure were collagen III, fibronectin, and hyaluronate (HA). With remodelling, HA's domain within the mesenchyme was expanded, whereas those of fibronectin and collagen III became more circumscribed. The expansion of an HA-rich matrix within the mesenchyme is thought to be crucial for palatal reorientation. The results of this study suggest that, as this expansion occurs, it is modulated by collagen and fibronectin components of the ECM infrastructure. Prior to shelf remodelling, this infrastructure may be anchored by a specialized region of the midoral epithelial-mesenchymal interface and the subjacent mesenchyme which is characterized by the unique distribution of collagen III, fibronectin, and tenascin. The midoral palatal epithelium also may play a role in directing shelf expansion. This epithelial region undergoes changes in cell packing and epithelial cell layering that correlate with shelf remodelling. These changes occur concomitantly with changes in the expression of collagen III, collagen IV, and laminin within the underlying basement membrane. The localization and patterning of tenascin within the developing palate suggests that it not only contributes to the postulated anchoring structure of the midoral epithelial-mesenchymal region, but also plays a role in the determining the fate of the medial edge epithelial cells during the final stage of palate closure.© Willey-Liss, Inc.     

The curability of breast cancer

A long-term follow-up study was performed of 704 women who were treated for breast cancer during 1947–50 at Addenbrooke's Hospital, Cambridge, England. After 21 years the observed survival curve for the treated patients and the expected survival curve for the normal population became parallel, suggesting a cure rate of about 18% for all cases of breast cancer and about 30% for cancers in stages I and II combined. At least 6 patients died of breast cancer after 20 years. Eighty-one patients survived for 20 or more years, and at least 21 of these originally had metastases in axillary lymph nodes. It would be very worthwhile if this curable group could be identified at the time of diagnosis so that they would be spared systemic adjuvant treatments.

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Résumé Cette étude porte sur 704 femmes traitées pour cancer du sein de 1947 à 1950 au Addenbrooke's Hospital de Cambridge, Angleterre. Après 21 ans, la courbe de survie de ces patientes devient parallèle à celle de la population normale, suggérant qu'il y a 18% de guérisons pour tous les cas de néoplasie mammaire, et environ 30% pour l'ensemble des cancers aux stades I et II. Six patientes au moins sont mortes de cancer du sein après 20 ans. Quatre-vingt une patientes ont survécu 20 ans ou plus et, parmi celles-ci, 21 au moins avaient des métastases ganglionnaires axillaires. Il serait très intéressant de pouvoir identifier ce groupe curable au moment du diagnostic, afin d'éviter à ces malades les traitements systémiques adjuvants.

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Supported by a grant from the Cancer Research Campaign.     

Congenital toxoplasmosis presenting as isolated acute chorioretinitis in the neonate

We describe a neonate with congenital ocular toxoplasmosis that presented as isolated, acute bilateral retinochoroiditis. Although toxoplasmic retinochoroiditis is not rare, it is quite unusual to diagnose congenital toxoplasmosis based on isolated bilateral retinochoroiditis in an otherwise healthy neonate. Bilateral retinochoroiditis can be caused by syphilis, herpes virus, cytomegalovirus, and toxoplasmosis. Because specific treatments now exist for these conditions, it is important to establish proper diagnosis so that treatment can be initiated promptly. The differential diagnosis, work-up, and management of retinochoroiditis in the newborn is presented and discussed.     

WIRM: An Open Source Toolkit for Building Biomedical Web Applications

This article describes an innovative software toolkit that allows the creation of web applications that facilitate the acquisition, integration, and dissemination of multimedia biomedical data over the web, thereby reducing the cost of knowledge sharing. There is a lack of high-level web application development tools suitable for use by researchers, clinicians, and educators who are not skilled programmers. Our Web Interfacing Repository Manager (WIRM) is a software toolkit that reduces the complexity of building custom biomedical web applications. WIRM’s visual modeling tools enable domain experts to describe the structure of their knowledge, from which WIRM automatically generates full-featured, customizable content management systems.Biomedical research efforts are becoming increasingly reliant on the interoperability of autonomous heterogeneous software applications, involving widespread collaboration by teams of scientists and clinicians across multiple disciplines and institutions. Consequently, there is a need for a new generation of biomedical information systems that facilitate remote collaboration, data sharing, workflow management, and integration of heterogeneous knowledge sources. The diverse nature of experimental data and protocols dictates that each information system be custom-tailored through a domain-specific set of object classes, templates, interfaces, and workflow facilities. This suggests a need for template-based, adaptable frameworks that enable scientists, clinicians, and educators to create their own custom information systems. Such frameworks should provide high-level interfaces that empower domain experts to model the structure of their content and workflow requirements, according to their own domain knowledge.This article identifies the informatics requirements for such a framework and describes the architecture and implementation of a prototype open source toolkit that begins to meet those requirements: the Web Interfacing Repository Manager (WIRM). WIRM consists of a visual development environment and a high-level programming interface that allows health professionals to rapidly design and implement their own custom web-based interfaces to biomedical content.¹ WIRM enables a nonprogrammer to model domain knowledge as object-oriented schemas, using a menu-driven interface. Once schemas are defined, WIRM automatically generates a drill-down web information system for acquiring, querying, navigating, annotating, and editing instances of those schemas.WIRM has been released as an open source toolkit and has been used to build a wide range of applications for clinicians, researchers, and educators. As estimated by the developers, WIRM reduced implementation time for the applications by 50–75% over more traditional approaches. Planned improvements should increase the usability to point that a growing number of medical professionals will be able to create custom applications that improve the efficiency of their research efforts and expand their capacity to share knowledge.