The purpose of this study was to develop a high-throughput method for the identification of pneumococcal capsular types. Multiplex PCR combined with fragment analysis and automated fluorescent capillary electrophoresis (FAF-mPCR) was utilized. FAF-mPCR was composed of only 3 PCRs for the specific detection of serotypes 1, 2, 3, 4, 5, 6A/6B, 6C, 7F/7A, 7C/(7B/40), 8, 9V/9A, 9N/9L, 10A, 10F/(10C/33C), 11A/11D/11F, 12F/(12A/44/46), 13, 14, 15A/15F, 15B/15C, 16F, 17F, 18/(18A/18B/18C/18F), 19A, 19F, 20, 21, 22F/22A, 23A, 23B, 23F, 24/(24A/24B/24F), 31, 33F/(33A/37), 34, 35A/(35C/42), 35B, 35F/47F, 38/25F, and 39. In order to evaluate the assay, all invasive pneumococcal isolates (n = 394) characterized at Hospital Sant Joan de Déu, Barcelona, Spain, from July 2010 to July 2011 were included in this study. The Wallace coefficient was used to evaluate the overall agreement between two typing methods (Quellung reaction versus FAF-mPCR). A high concordance with Quellung was found: 97.2% (383/394) of samples. The Wallace coefficient was 0.981 (range, 0.965 to 0.997). Only 11 results were discordant with the Quellung reaction. However, latex reaction and Quellung results of the second reference laboratory agreed with FAF-mPCR for 9 of these 11 strains (82%). Therefore, we considered that only 2 of 394 strains (0.5%) were not properly characterized by the new assay. The automation of the process allowed the typing of 30 isolates in a few hours with a lower cost than that of the Quellung reaction. These results indicate that FAF-mPCR is a good method to determine the capsular serotype of Streptococcus pneumoniae.
The Neotropical species of Asthenopodinae are revised in a formal phylogenetic context. The five known species of Asthenopus Eaton, 1871, together with other five new species were included in a cladistic analysis using morphological characters (continuous and discretes). Representatives of the Afro-Oriental group of the subfamily (Povilla Navás, 1912 and Languidipes Hubbard, 1984) were also included to test the monophyletic hypothesis traditionally accepted for the group. Additional taxa representing the other subfamilies of Polymitarcyidae were incorparated: Ephoron Williamson, 1802 (Polymitarcyinae) and Campsurus Eaton, 1868, Tortopus Needham & Murphy, 1924 and Tortopsis Molineri, 2010 (Campsurinae). A matrix of 17 taxa and 72 characters was analyzed under parsimony resulting in a single tree supporting the monophyly of the subfamily Asthenopodinae. Other results include the monophyly of the Afro-Oriental taxa (Povilla and Languidipes), the paraphyletic nature of Neotropical Asthenopodinae, and the recognition of four South American genera: Asthenopus (including Asthenopus
curtus (Hagen), 1861, Asthenopus
angelae de Souza & Molineri, 2012, Asthenopus
sp. n., Asthenopus
sp. n., Asthenopus
sp. n.), Asthenopodes Ulmer, 1924, stat. n. (including Asthenopus
picteti Hubbard, 1975, stat. n., Asthenopodes
sp. n., Asthenopodes
sp. n.), Priasthenopus
gen. n. (including Priasthenopus
gilliesi (Domínguez), 1988, comb. n.), and Hubbardipes
gen. n. (including Hubbardipes
crenulatus (Molineri et al.), 2011, comb. n.). Descriptions, diagnoses, illustrations and keys are presented for all Neotropical taxa of Asthenopodinae (adults of both sexes, eggs and nymphs). Additionally a key to the subfamilies and genera of Polymitarcyidae is included. A quantitative biogeographic analysis of vicariance is presented and discussed through the study of the “taxon history” of the group.
Ephemeroptera; Ephemeroidea; Fossoriae; vicariance; evolution; Neotropics; Campsurinae; Campsurus; Tortopus; Tortopsis; Povilla; Languidipes
We investigated the genetics and evolution of West Nile virus (WNV) since initial detection in the United States in 1999 on the basis of continual surveillance studies in the Houston, Texas, USA, metropolitan area (Harris County) as a surrogate model for WNV evolution on a national scale. Full-length genomic sequencing of 14 novel 2010–2012 WNV isolates collected from resident birds in Harris County demonstrates emergence of 4 independent genetic groups distinct from historical strains circulating in the greater Houston region since 2002. Phylogenetic and geospatial analyses of the 2012 WNV isolates indicate closer genetic relationship with 2003–2006 Harris County isolates than more recent 2007–2011 isolates. Inferred monophyletic relationships of these groups with several 2006–2009 northeastern US isolates supports potential introduction of a novel WNV strain in Texas since 2010. These results emphasize the need to maintain WNV surveillance activities to better understand WNV transmission dynamics in the United States.
West Nile virus; WNV; flavivirus; viruses; virus surveillance; viral epidemiology; virus evolution; phylogenetics; Texas
Despite the wide use of knee radiography in children and adolescent patients visiting the outpatient clinic, there has been no analysis about the prevalence and type of incidental findings yet. This study was performed to investigate the incidental findings on knee radiographs in children and adolescents according to age.
A total of 1,562 consecutive patients younger than 18 years of age were included. They who visited Seoul National University Bundang Hospital's outpatient clinic with a chief complaint of knee pain or malalignment between 2010 and 2011. We reviewed the knee radiographs and analyzed the prevalence and type of incidental findings, such as metaphyseal lucent area, epiphyseal cortical irregularity, osteochondroma and Harris growth arrest line.
The mean age of the patients was 10.2 years (range, 1 month to 18 years). We identified 355 incidental findings in 335 patients (21.4%) and 98 abnormal findings (6.3%). The most common incidental finding was metaphyseal lucent area (131, 8.4%), followed by epiphyseal cortical irregularity (105, 6.7%), Harris growth arrest line (75, 4.8%), and osteochondroma (44, 2.8%). An epiphyseal cortical irregularity tended to have a higher prevalence at younger age (p < 0.001) and the prevalences of metaphyseal lucent area and Harris growth arrest line were also higher at a younger age (p = 0.001 and p < 0.001, respectively). However, the osteochondroma tended to have a higher prevalence at an older age (p = 0.004).
This study describes the incidental findings on knee radiographs in children and adolescents and provides effective information from a viewpoint of an orthopedic doctor. The authors recommend considering those incidental findings if unfamiliar findings appear on a knee radiograph in the pediatric outpatient clinic.
Knee radiograph; Incidental finding; Children; Adolescent
The periacetabular area is one of the primary sites of metastatic tumors, which often present as osteolytic bone destruction. Bone destruction in the acetabulum caused by metastatic tumors will cause hip pain and joint dysfunction. It results in decreased quality of life for patients. The aim of our study was to explore the clinical effect of metastatic periacetabular tumors treated with percutaneous cementoplasty and interstitial implantation of 125I seeds.
A retrospective analysis was performed on 24 patients with metastatic periacetabular tumors who underwent combined therapy of percutaneous acetabuloplasty and interstitial implantation of 125I seeds between February 2003 and June 2011. There were 13 males and 11 females aged 19–80 years with a mean age of 57.3. The primary tumor site was the lung in eight cases, the breast in six, the prostate cancer in eight, and the liver in two. The amount of implanted 125I seeds was 12–20 seeds/person, with a mean of 16.5 seeds/person, and the matching peripheral dosage (MPD) was 80~100Gy. Routine postoperative chemotherapy and other combined treatments were applied to patients after the surgical operation. Changes in the Karnofsky Score(KPS), Harris Hip Score(Harris), and Visual Analog Scale(VAS) were observed during the follow-up period.
The 24 patients’ operations were all successful. No major complications occurred. Complete pain relief was achieved in 58% (14 of 24) of patients, and pain reduction was achieved in the 42% remaining (10) patients. The mean duration of pain relief was 8.3 months. Pain recurred in one patient 3 months after surgery. Six patients had died and 18 patients were alive at the time of the 1-year follow-up. Comparing the KPS, Harris and VAS scores pre- and postoperativelyat 1, 6, and 12 months, the combined therapy method was significantly effective in metastatic periacetabular tumor patients (P<0.05).
Percutaneous cementoplasty with interstitial implantation of 125I seeds is an effective treatment method for metastatic periacetabular tumor patients, providing tumor resistance, pain relief, increased bone stability, and improved quality of life for patients.
Periacetabular; Metastatic tumor; 125I seed implantation; Percutaneous acetabuloplasty; Bone cement
Theoretical and empirical observations generally support Darwin's view that sexual dimorphism evolves due to sexual selection on, and deviation in, exaggerated male traits. Wallace presented a radical alternative, which is largely untested, that sexual dimorphism results from naturally selected deviation in protective female coloration. This leads to the prediction that deviation in female rather than male phenotype causes sexual dimorphism. Here I test Wallace's model of sexual dimorphism by tracing the evolutionary history of Batesian mimicry—an example of naturally selected protective coloration—on a molecular phylogeny of Papilio butterflies. I show that sexual dimorphism in Papilio is significantly correlated with both female-limited Batesian mimicry, where females are mimetic and males are non-mimetic, and with the deviation of female wing colour patterns from the ancestral patterns conserved in males. Thus, Wallace's model largely explains sexual dimorphism in Papilio. This finding, along with indirect support from recent studies on birds and lizards, suggests that Wallace's model may be more widely useful in explaining sexual dimorphism. These results also highlight the contribution of naturally selected female traits in driving phenotypic divergence between species, instead of merely facilitating the divergence in male sexual traits as described by Darwin's model.
Batesian mimicry; polymorphism; female-limited mimicry; directional selection; stabilizing sexual selection; convergence
Historical analysis can play a major role in public health policy.
Alfred Russel Wallace, eminent naturalist and codiscoverer of the principle of natural selection, was a major participant in the antivaccination campaigns in late 19th-century England. Wallace combined social reformism and quantitative arguments to undermine the claims of provaccinationists and had a major impact on the debate. A brief account of Wallace’s background, his role in the campaign, and a summary of his quantitative arguments leads to the conclusion that it is unwarranted to portray Victorian antivaccination campaigners in general as irrational and antiscience. Public health policy can benefit from history, but the proper context of the evidence used should always be kept in mind.
Vaccination; Alfred Russel Wallace; vaccines; England; historical review
Nipah virus (NiV) (Genus Henipavirus) is a recently emerged zoonotic virus that causes severe disease in humans and has been found in bats of the genus Pteropus. Whilst NiV has not been detected in Australia, evidence for NiV-infection has been found in pteropid bats in some of Australia’s closest neighbours. The aim of this study was to determine the occurrence of henipaviruses in fruit bat (Family Pteropodidae) populations to the north of Australia. In particular we tested the hypothesis that Nipah virus is restricted to west of Wallace’s Line. Fruit bats from Australia, Papua New Guinea, East Timor and Indonesia were tested for the presence of antibodies to Hendra virus (HeV) and Nipah virus, and tested for the presence of HeV, NiV or henipavirus RNA by PCR. Evidence was found for the presence of Nipah virus in both Pteropus vampyrus and Rousettus amplexicaudatus populations from East Timor. Serology and PCR also suggested the presence of a henipavirus that was neither HeV nor NiV in Pteropus alecto and Acerodon celebensis. The results demonstrate the presence of NiV in the fruit bat populations on the eastern side of Wallace’s Line and within 500 km of Australia. They indicate the presence of non-NiV, non-HeV henipaviruses in fruit bat populations of Sulawesi and Sumba and possibly in Papua New Guinea. It appears that NiV is present where P. vampyrus occurs, such as in the fruit bat populations of Timor, but where this bat species is absent other henipaviruses may be present, as on Sulawesi and Sumba. Evidence was obtained for the presence henipaviruses in the non-Pteropid species R. amplexicaudatus and in A. celebensis. The findings of this work fill some gaps in knowledge in geographical and species distribution of henipaviruses in Australasia which will contribute to planning of risk management and surveillance activities.
MicroRNAs are small noncoding RNAs and microRNA-214 (miR-214) has been associated with the inhibition of cancer cell growth, migration, and invasion. The aim of this study was to investigate whether cell-free miR-214 isolated from urine could be used as a biomarker for non-muscle-invasive bladder cancer (NMIBC).
Materials and Methods
A total of 138 patients with primary NMIBC and 144 healthy normal controls were enrolled in this study. By use of quantitative polymerase chain reaction (PCR), the urinary levels of cell-free miR-214 were measured and the clinicopathological parameters of patients with NMIBC were compared with those of the controls.
The urinary levels of cell-free miR-214 were significantly higher in the NMIBC patients than in the controls (20.08±3.21 vs. 18.96±2.68, p=0.002). However, the urinary levels of cell-free miR-214 were neither graded nor staged for the NMIBC patients (p>0.05, each). When we compared the urinary levels of cell-free miR-214 according to clinical outcomes, patients with recurrence had lower levels of miR-214 than did those with no recurrence (19.24±2.67 vs. 20.41±3.41, p=0.023). By contrast, there were no significant differences in the urinary level of cell-free miR-214 between the NMIBC patients showing progression and those showing no progression (p=0.919). Multivariate Cox regression analysis revealed that urinary levels of cell-free miR-214 were an independent predictor of NMIBC recurrence (hazard ratio, 2.011; 95% confidence interval, 1.027 to 3.937; p=0.041).
Urinary levels of cell-free miR-214 could be an independent prognostic parameter for NMIBC recurrence. Thus, urinary cell-free microRNA-214 might be a useful prognostic marker for NMI BC.
MicroRNAs; Neoplasms; Recurrence; Urinary bladder
Dual antiplatelet therapy (DAPT) – aspirin and clopidogrel – is recommended after transcatheter aortic valve implantation (TAVI) without an evidence base. The main aim of the study was to estimate the impact of antithrombotic therapy on early and late bleeding. Moreover, we assessed the impact of patients’ characteristics on early bleeding and the influence of bleeding on prognosis.
Material and methods
Between 2009 and 2011, 83 consecutive TAVI patients, age 81.1 ±7.2 years, were included. Bleeding complications were defined by the Valve Academic Research Consortium (VARC) scale. The median follow-up was 12 ±15.5 months (range: 1 to 23) and included 68 (81.9%) patients.
Early bleeding occurred in 51 (61.4%) patients. Vitamin K antagonists (VKA) pre-TAVI (p = 0.001) and VKA + clopidogrel early post-TAVI (p = 0.04) were the safest therapies; in comparison to the safest one, peri-procedural DAPT (p = 0.002; p = 0.05) or triple anticoagulant therapy (TAT) (p = 0.003, p = 0.05) increased the risk for early bleeding. Predictors for early bleeding were: clopidogrel pre-TAVI (OR: 4.43, 95% CI: 1.02–19.24, p = 0.04), preceding percutaneous coronary intervention (PCI) (10.08, OR: 95% CI: 1.12–90.56, p = 0.04), anemia (OR: 4.00, 95% CI: 1.32–12.15, p = 0.01), age > 85 years (OR: 5.96, 95% CI: 1.47–24.13, p = 0.01), body mass index (BMI) (OR: 0.86, 95% CI: 0.74–0.99, p = 0.04). Late bleeding occurred in 35 patients (51.4%) on combined therapy, and none on VKA or clopidogrel monotherapy (p = 0.04). Bleeding complications did not worsen the survival.
This study seems to suggest that advanced age, BMI, and a history of anemia increased the risk for early bleeding after TAVI. Clopidogrel pre-TAVI should be avoided; therefore, time of preceding PCI should take into account discontinuation of clopidogrel in the pre-TAVI period. Vitamin K antagonists with clopidogrel seems to be the safest therapy in the early post-TAVI period, similarly as VKA/clopidogrel monotherapy in long-term prophylaxis.
transcatheter aortic valve implantation; antithrombotic prophylaxis; bleeding complications; aortic stenosis
The recent dry phase experienced by the St Lucia estuarine system has led to unprecedented desiccation and hypersaline conditions through most of its surface area. This has changed only recently, at the end of 2011, with the onset of a new wet phase that has already caused a major shift to oligo- and mesohaline conditions. The estuary mouth, however, remains closed to the ocean, making the weak connection recently established between the St Lucia and the Mfolozi estuaries the only conveyance for marine recruitment. As a result, only 10 indigenous and two alien aquatic gastropod species are currently found living in the St Lucia estuarine lake. This is out of a total of 37 species recorded within the system since the earliest survey undertaken in 1924, half of which have not been reported in the literature before. The tick shell, Nassarius kraussianus, which was consistently found in large abundance prior to the recent dry phase, appears to have temporarily disappeared from the system, probably as a result of the extinction of Zostera marine grasses inside the lake. Population explosions of the bubble shell Haminoea natalensis, with its distinct egg masses, were recorded seasonally until 2009, but the species has subsequently not been observed again. A molecular DNA analysis of the various populations previously reported as belonging to the same assimineid species, variably referred to as Assiminea capensis, A. ovata, or A. bifasciata, has revealed that the St Lucia assemblage actually comprises two very distinct taxa, A. cf. capensis and a species provisionally referred to here as “A.” aff. capensis or simply Assimineidae sp. In the mangroves, the climbing whelk Cerithidea decollata is still found in numbers, while ellobiids such as Cassidula labrella, Melampus semiaratus and M. parvulus are present in low abundances and all previously recorded littorinids have disappeared. A number of alien freshwater species have colonized areas of the system that have remained under low salinity. These include the invasive thiarid Tarebia granifera, which can be found in concentrations exceeding 5000 ind.m-2, the lymnaeid Pseudosuccinea columella and the physid Aplexa marmorata.
Mollusca; Gastropoda; biodiversity census; hypersalinity; iSimangaliso Wetland Park; illustrated checklist
To examine the potential utility of conventional MRI signs in differentiating pseudoprogression (PsP) from early progression (EP).
This retrospective study reviewed initial postradiotherapy MRI scans of 321 patients with glioblastoma undergoing chemotherapy and radiotherapy. A total of 93 patients were found to have new or increased enhancing mass lesions, raising the possibility of PsP. Final diagnosis of PsP or EP was established upon review of surgical specimens from a second resection or by clinical and radiologic follow-up. A total of 11 MRI signs potentially helpful in the differentiation between PsP and EP were examined on the initial post-RT MRI and were correlated with the final diagnosis through χ2 or Fisher exact test.
Sixty-three (67.7%) of the 93 patients had EP, of which 22 (34.9%) were diagnosed by pathology. Thirty patients (32.3%) had PsP; 6 (16.7% of the 30) were diagnosed by pathology. Subependymal enhancement was predictive for EP (p = 0.001) with 38.1% sensitivity, 93.3% specificity, and 41.8% negative predictive value. The other 10 signs had no predictive value (p = 0.06–1.0).
Conventional MRI signs have limited utility in diagnosing PsP in patients with recently treated glioblastomas and worsening enhancing lesions. We did not find a sign with a high negative predictive value for PsP that would have been the most useful for the clinical physician. When present, subependymal spread of the enhancing lesion is a useful MRI marker in identifying EP rather than PsP. Neurology® 2011;76:1918–1924
History and current status of human taeniasis in the Republic of Korea, due to Taenia solium, Taenia asiatica, and Taenia saginata, are briefly reviewed. Until the 1980s, human taeniasis had been quite common in various localities of Korea. A study from 1924 reported 12.0% egg prevalence in fecal examinations. Thereafter, the prevalence of Taenia spp. ranged from 3% to 14% depending on the time and locality. Jeju-do, where pigs were reared in a conventional way, was the highest endemic area of taeniasis. An analysis of internal transcribed spacer 2 and mitochondrial cytochrome c oxidase 1 genes of 68 taeniasis cases reported from 1935 to 2005 in Korea by a research group revealed the relative occurrence of the 3 Taenia spp. as follows: T. solium (4.4%), T. asiatica (75.0%), and T. saginata (20.6%). However, national surveys on intestinal helminths conducted every 5 years on randomly selected people revealed that the Taenia egg prevalence dropped from 1.9% in 1971 to 0.02% in 1997 and finally to 0.0% in 2004. With the exception of 3 egg-positive cases reported in 2008 and 2 worm-proven cases in 2011, no more cases have been officially recorded. Based on these surveys and also on other literature, it can be concluded that taeniasis has virtually disappeared from Korea, although a few sporadic cases may remain hidden. Human cysticercosis is also expected to disappear within a couple of decades in Korea.
Taenia asiatica; Taenia solium; Taenia saginata; taeniasis; prevalence
Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. Epidemiologic and etiologic studies help in the prevention of disease and improve surveillance of affected patients. The aim of this study was to study the etiology and epidemiology of HCC in West Azarbaijan of Iran.
Materials and Methods:
In this cross-sectional, retrospective study, medical records of 60 patients with HCC who were diagnosed between 2006 and 2011 in West Azarbaijan of Iran were analyzed for age, sex, location, presence of liver cirrhosis and/or well-known risk factors of HCC. Data were analyzed by SPSS 17 software.
From 60 patients with HCC, 75% were male and 25% were female. Mean age of the patients was 63.47 years. 51.66% were from rural areas and 48.33% were from urban areas. 43.33% of HCC patients were cirrhotic while 56.66% patients were non-cirrhotic. Of the 26 cirrhotic patients, 57.69% were seropositive for hepatitis B surface antigen (HBsAg), 15.38% not only had history of excess alcohol intake but were also HBsAg positive, 3.84% had history of alcoholism, 3.84% had history of Wilson disease and the rest (19.24%) had cryptogenic cirrhosis. Of the 34 non-cirrhotic patients, 35.29% were positive for HBsAg. None of the 60 patients with HCC had positive serology for hepatitis C virus (HCV) or history of hepatitis C infection.
In our study, most of the patients (>50%) with HCC did not have underlying liver cirrhosis. In the cirrhotic patients, hepatitis B infection was the most common predisposing factor, followed by hepatitis B infection concomitant with alcoholism, alcoholism alone and Wilson disease. In the remaining cirrhotic patients, we could not find any predisposing factor for cirrhosis. Infection with HCV was not found in our studied group. We concluded that etiology of HCC in our province is different from that in the western countries.
Etiology; epidemiology; hepatocellular carcinoma; risk factor
TB and HIV co-epidemic is a major public health problem in many parts of the world. But the prevalence of TB/HIV co-infection was diversified among countries. Exploring the reasons of the diversity of TB/HIV co-infection is important for public policy, planning and development of collaborative TB/HIV activities. We aimed to summarize the prevalence of TB and HIV co-infection worldwide, using meta-analysis based on systematic review of published articles.
We searched PubMed, Embase, and Web of Science for studies of the prevalence of TB/HIV co-infection. We also searched bibliographic indices, scanned reference lists, and corresponded with authors. We summarized the estimates using meta-analysis and explored potential sources of heterogeneity in the estimates by metaregression analysis.
We identified 47 eligible studies with a total population of 272,466. Estimates of TB/HIV co-infection prevalence ranged from 2.93% to 72.34%; the random effects pooled prevalence of TB/HIV co-infection was 23.51% (95% CI 20.91–26.11). We noted substantial heterogeneity (Cochran’s χ2 = 10945.31, p<0.0001; I2 = 99.58%, 95% CI 99.55–99.61). Prevalence of TB/HIV co-infection was 31.25%(95%CI 19.30–43.17) in African countries, 17.21%(95%CI 9.97–24.46) in Asian countries, 20.11%(95%CI 13.82–26.39) in European countries, 25.06%(95%CI 19.28–30.84) in Latin America countries and 14.84%(95%CI 10.44–19.24) in the USA. Prevalence of TB/HIV co-infection was higher in studies in which TB diagnosed by chest radiography and HIV diagnosis based on blood analyses than in those which used other diagnostic methods, and in countries with higher prevalence HIV in the general population than in countries with lower general prevalence.
Our analyses suggest that it is necessary to attach importance to HIV/TB co-infection, especially screening of TB/HIV co-infection using methods with high sensitivity, specificity and predictive values in the countries with high HIV/AIDS prevalence in the general population.
Health departments often have little knowledge of HIV testing and linkage activities outside of those they directly fund. Many health departments also have limited access to outside academic expertise.
We conducted a survey of health organizations in the Houston/Harris County region to determine the number of HIV tests completed in 2011, activities that organizations conducted to promote linkage to care for persons newly diagnosed with HIV, and barriers to linkage to care. We also convened a Scientific Advisory Council to advise the local health department on HIV prevention activities.
In 2012, 55 of 84 organizations (65.5%) completed the survey, and 43 of those 55 organizations reported conducting HIV testing, so were included in this analysis. Organizations reported conducting 210,565 HIV tests in 2011, 50.9% under health department contract. The median number of tests per organization was 1045 (IQR 159 and 3520). Over 90% of the organizations used active linkage to care methods, but only 46.5% had written linkage to care protocols. Barriers to linkage to care most often reported were client refusal, followed by staff capacity and funding limitations. The Scientific Advisory Council provided valuable informal expertise to the local health department.
Half of the HIV testing in the Houston/Harris County region is conducted without local health department funding, and half the organizations conducting HIV testing have linkage to care protocols. The findings of the study and Scientific Advisory Council advice have helped the health department with policy, procedures, evaluation tools, and technical assistance offerings.
HIV/AIDS; Linkage to Care; Barriers to Care; HIV/AIDS Testing
The Agrilus occipitalis species–group is redefined and diagnosed. Two species from this group, Agrilus auriventris Saunders, 1873 and Agrilus occipitalis (Eschscholtz, 1822), are known as the serious pests of cultivated Citrus trees. Overall twenty-three taxa are included in the Agrilus occipitalis species–group. A complete list of references, type material, species examined and distribution is given for each taxon. The host plants, adult occurrence and altitude range is cited for most taxa. Habitus of all taxa and aedeagi of available males are pictured. Images of primary type specimens are provided. A character state matrix table for diagnostic characters is given for all taxa to facilitate their determination.
The following new taxonomic and nomenclatural acts are proposed. New species:eight new species are described: Agrilus mucidus
sp. n., Agrilus nebulosus
sp. n., Agrilus picturatus
sp. n., Agrilus pluvius
sp. n., Agrilus pseudoambiguus
sp. n., Agrilus tesselatus
sp. n., Agrilus trepanatus
sp. n. and Agrilus umrongso
synonyms: eight synonyms are proposed: celebicola Obenberger, 1924, syn. n. (synonym of occipitalis Eschscholtz, 1822); connexus Kerremans, 1900, syn. n. (synonym of occipitalis Eschscholtz, 1822); cupricauda Saunders, 1867 syn. n. (synonym of occipitalis Eschscholtz, 1822); evinadus Gory & Laporte, 1839, syn. n. (synonym of occipitalis Eschscholtz, 1822); nirius Obenberger, 1924 syn. reconfirmed (synonym of occipitalis Eschscholtz, 1822); oblatus Kerremans, 1900, syn. n. (synonym of occipitalis Eschscholtz, 1822); samoensis Blair, 1928, syn. n. (synonym of auriventris Saunders, 1873); tebinganus Obenberger, 1924, syn. n. (synonym of occipitalis Eschscholtz, 1822). New lectotype designations: six lectotypes are designated: Agrilus celebicola Obenberger, 1924; Agrilus cupricauda Saunders, 1867; Agrilus korenskyi Obenberger, 1923; Agrilus kurandae Obenberger, 1923; Agrilus nirius Obenberger, 1924; Agrilus nitidus Kerremans, 1898.
Buprestidae; Agrilini; Agrilus; new species; synonymy; lectotype designation; Citrus; pest
AO/OTA 31-A3 intertrochanteric femoral fractures have completely different fracture line directions and biomechanical characteristics compared with other types of intertrochanteric fractures. The choice of the fixation method has been a focus of dispute among orthopedic trauma surgeons. The purpose of this study was to review the outcomes of these fractures treated with a percutaneous compression plate at our institute.
Seventeen patients with AO/OTA 31-A3 intertrochanteric femoral fractures were treated with a percutaneous compression plate at our institute from January 2010 to December 2011. The clinical data and imaging results were retrospectively analyzed.
The medical complication of popliteal vein thrombosis occurred in one patient. Sixteen patients were followed up for 12 to 21 months. Two patients had malunion and mild pain. Fracture collapse occurred in two patients, with one having head penetration. These two patients had moderate pain. There were no occurrences of nonunion or reoperation. The mean Harris hip score obtained during the last follow-up was 84.1 (61-97). Patients with a poor quality of reduction were more likely to have pain results (p = 0.001). A trend existed toward the presence of a poor quality of reduction (p = 0.05) in patients with a collapse of fracture. Patients with poor preoperative mobility were more likely to have a lower Harris hip score (p = 0.000).
The percutaneous compression plate is an alternative device for the treatment of AO/OTA 31-A3 intertrochanteric femoral fractures. Good fracture reduction and an ideal placement position of the neck screw are important in the success of the device.
AO/OTA 31-A3 Intertrochanteric Femoral Fractures; Percutaneous Compression Plate; Sliding Hip Screw; Intramedullary Nail
The aim of this study is to evaluate the clinical outcome of various surgery methods in children suffering pathological dislocation of the hip joint due to coxotuberculosis.
Patients and methods
From January 2006 to January 2011, 29 children with coxotuberculosis hip dislocation were treated with open reduction (4 children) and acetabular reconstruction (25 children). According to degree of dislocation and age, acetabular reconstructions included Salter osteotomy (nine children), Pemberton operation (six children), Dega operation (seven children), the hip shelf arthroplasty (two children), and Chiari operation (one child). During acetabular reconstruction, 16 children underwent upper femoral rotational shortening osteotomies simultaneously, 6 children underwent the femoral head and neck reconstruction simultaneously, and 3 children were underwent corrective osteotomy. After operation, children were immobilized with plaster external fixation for 1–3 months and treated with routine anti-infective therapy for 3 days. During follow-up study (12–18 months), the hip stability was examined via X-ray. The recovery was evaluated via acetabular index (AI) and Harris hip score.
Postoperative X-ray films of 29 children showed concentric reduction of all hips. Total 25 children healed I incision surgery, while 4 children with skin antrum of incision were further treated leading to 1–3 months delay of healing. Total 24 children were followed up for 2–5 years. X-ray examination revealed no redislocation after 2 years postoperative. The postoperative AI was normal (15°–20°) in 22 children and increased to 25°– 30° in 2 children. After 2 years postoperative, 8 children had normal function of hip joint, 13 children had mild limitation of flexion and rotation, and 3 children had fibrous ankylosis. The average of Harris hip score was 83 (ranged, 62–90).
In our study, pathological hip dislocations of children attributed to coxotuberculosis were treated via open reduction and acetabular reconstruction and the outcomes were both excellent. Individual characteristic should be taken into consideration during treatment, and proper surgery approach should be adopted according to pathological changes of the hip.
Pathological hip dislocation; Coxotuberculosis; Open reduction; Acetabular reconstruction
This prospective case-series, without control group, study presents our early experience in the
treatment of both stable and unstable peri-trochanteric fractures with a new cephalocondylic implant; the Veronail system.
Materials & Methods:
Enrolment in our study was from January 2008 through September 2009, with follow-up until
October 2011 (at least 1 year). During this period 65 consecutively patients with a fracture in the trochanteric region of the
femur (31.A1, A2 and A3 according to AO classification) were surgically managed and prospectively followed up for at
least one year. Average age was 78 years old (range 42 to 93) with 40 female and 25 male patients. All patients were
surgically treated using the Veronail system. Demographic and nursery data such as pre-existing illness, previous
ambulatory status, type of anaesthesia, duration of surgery, volume of blood loss, transfusions, length of hospital stay,
time to union and overall complications were systematically recorded and analysed.
Mean follow up was 17 months (range, 12 to 23 months). Radiological evaluation was performed at 1, 3, 6 and
12 months postoperatively, as well as at the last follow up visit. Clinical outcome was assessed using the parameters of
Harris Hip score. Solid union was achieved in 57/60 patients (95%) at a mean time of 12.5 weeks. Two fractures did not
progress to union. There were 3 superficial infections and 1 deep infection; all were successfully managed with
appropriate antibiotic treatment. The Harris hip score at the last follow up visit was excellent or good in 46 (77%) of the
In the face of the good clinical and radiological results we consider the Veronail system to be of particular
interest and perfectly adapted in primary surgery for both elderly and young patients.
Cephalo-medullary systems; pertrochanteric fractures; veronail implant.
Hip joint instability can be secondary to congenital hip pathologies like developmental dysplasia (DDH) or acquired such as sequel of infective or neoplastic process. An unstable hip is usually associated with loss of bone from the proximal femur, proximal migration of the femur, lower-extremity length discrepancy, abnormal gait, and pain. In this case series of 37 patients coming to our institution between May 2005 and December 2011, we report our results in treatment of unstable hip joint by hip reconstruction osteotomy using the Ilizarov method and apparatus. This includes an acute valgus and extension osteotomy of the proximal femur combined with gradual varus and distraction (if required) for realignment and lengthening at a second, more distal, femoral osteotomy. 18 males and 19 females participated in the study. There were 17 patients with DDH, 12 with sequelae of septic arthritis, 2 with tuberculous arthritis, 4 with posttraumatic arthritis, and 2 with focal proximal femoral deficiency. Outcomes were evaluated by using Harris Hip Scoring system. At the mean follow-up of 37 months, Harris Hip Score had significantly improved in all patients. To conclude, illizarov hip reconstruction can successfully improve Trendelenburg's gait. It supports the pelvis and simultaneously restores knee alignment and corrects lower-extremity length discrepancy (LLD).
The studies that correlate the results obtained by different typing methodologies rely solely on qualitative comparisons of the groups defined by each methodology. We propose a framework of measures for the quantitative assessment of correspondences between different typing methods as a first step to the global mapping of type equivalences. A collection of 325 macrolide-resistant Streptococcus pyogenes isolates associated with pharyngitis cases in Portugal was used to benchmark the proposed measures. All isolates were characterized by macrolide resistance phenotyping, T serotyping, emm sequence typing, and pulsed-field gel electrophoresis (PFGE), using SmaI or Cfr9I and SfiI. A subset of 41 isolates, representing each PFGE cluster, was also characterized by multilocus sequence typing (MLST). The application of Adjusted Rand and Wallace indices allowed the evaluation of the strength and the directionality of the correspondences between the various typing methods and showed that if PFGE or MLST data are available one can confidently predict the emm type (Wallace coefficients of 0.952 for both methods). In contrast, emm typing was a poor predictor of PFGE cluster or MLST sequence type (Wallace coefficients of 0.803 and 0.655, respectively). This was confirmed by the analysis of the larger data set available from http://spyogenes.mlst.net and underscores the necessity of performing PFGE or MLST to unambiguously define clones in S. pyogenes.
To discuss the care of a patient with congenital torticollis who was treated with chiropractic diversified technique and a chiropractic technique proposed by Frogley and Wallace in a previously published article.
A 6-year-old female suffered from congenital torticollis with a left head-tilt subsequent to a difficult birth that culminated in a Caesarian section. Computerized tomography of the brain revealed plagiocephaly. Left facial asymmetry was demonstrated on visual observation.
Intervention and Outcome
The patient was treated with a chiropractic adjusting protocol as suggested by Frogley and Wallace and by diversified chiropractic technique. She tolerated the care well and experienced substantial changes in clinical presentation including a distinct improvement in head-tilt. The improvement in head-tilt has been maintained for a period of 1 year.
The conservative chiropractic methodology postulated by Frogley and Wallace in the care of headache patients should be investigated further in its use for congenial torticollis. The positive results observed with this patient lead the authors to recommend that additional studies be undertaken to assess whether these clinical observations can be replicated in other cases of congenital torticollis.
Wallace's Line, separating the terrestrial faunas of South East Asia from the Australia-New Guinea region, is the most prominent and well-studied biogeographical division in the world. Phylogenetically distinct subgroups of major animal and plant groups have been documented on either side of Wallace's Line since it was first proposed in 1859. Despite its importance, the temporal history of fragmentation across this line is virtually unknown and the geological foundation has rarely been discussed. Using molecular phylogenetics and dating techniques, we show that the split between taxa in the South East Asian and the Australian-New Guinean geological regions occurred during the Late Jurassic to Early Cretaceous in two independent lizard clades. This estimate is compatible with the hypothesis of rifting Gondwanan continental fragments during the Mesozoic and strongly rejects the hypothetical origin of various members of the Australian-New Guinean herpetofauna as relatively recent invasions from South East Asia. Our finding suggests an ancient fragmentation of lizard taxa on either side of Wallace's Line and provides further evidence that the composition of modern global communities has been significantly affected by rifting and accretion of Gondwanan continental plates during the Middle to Late Mesozoic.
Purpose: To determine if a soft insemination catheter increases pregnancy rates.
Methods: Seven hundred forty-seven consecutive intrauterine insemination (IUI) cycles in 364 women in a reproductive endocrinology office between October 1998 and March 2000. Patients with even birth years were inseminated with the Tomcat catheter, and those with odd birth year with the Wallace IUI catheter. Clinical pregnancy rates were compared.
Results: The Wallace catheter group included 180 women for 372 cycles and an overall pregnancy rate of 16.4%. The Tomcat catheter group included 184 women for 375 cycles and an overall pregnancy rate of 18.1%. This difference is not statistically significant (P = 0.61). Potential confounders were accounted for.
Conclusions: When comparing the softer Wallace catheter to the less pliable Tomcat catheter during IUI cycles, there was no significant difference in pregnancy rate when using a standard gentle technique that includes not touching the top of the fundus with the catheter.
Intrauterine insemination (IUI); catheter; Wallace; Tomcat; endometrium