Impaired comprehension of nonliteral language in Tourette syndrome.

Objective: To investigate theory of mind and the understanding of nonliteral language in patients with Tourette syndrome (TS).

Background: In TS, striatal dysfunction could affect the functioning of the frontal cortex. Changes in frontal functioning could lead to impairments in theory of mind: the understanding of mental states, such as beliefs, emotions, and intentions.

Discovery of pyrrolopyrimidine inhibitors of Akt.

The discovery and optimization of a series of pyrrolopyrimidine based protein kinase B (Pkb/Akt) inhibitors discovered via HTS and structure based drug design is reported. The compounds demonstrate potent inhibition of all three Akt isoforms and knockdown of phospho-PRAS40 levels in LNCaP cells and tumor xenografts.

Altered Attribution of Intention in Tourette's Syndrome.

Core symptoms of Tourette's syndrome are assumed to result from inhibitory dysfunction, which could also impair theory of mind. Here the authors report evidence for theory of minddifficulties: patients exhibit deficits in recognizing faux pas and understanding intentionality.

The effect of respiratory syncytial virus on subsequent recurrent wheezing in atopic and nonatopic children.

Background: Although respiratory syncytial virus (RSV) lower respiratory tract infections (LRTIs) in early life are followed by later airway hyperreactivity, it is unclear whether there is a causal relationship between this and an atopic diathesis.

Objectives: To separate the effects of RSV LRTI and an atopic diathesis on subsequent recurrent wheezing, we examined the protective effect of previous palivizumab administration against subsequent recurrent wheeze in infants with and without a family history of atopy.

Methods: A prospective multicenter, matched, double cohort study was conducted in 27 centers in Europe and Canada.

Single-incision laparoscopic surgery: feasibility for pediatric appendectomies.

Introduction: Single-incision laparoscopic surgery (SILS) is a novel area of minimally invasive surgery using a single incision. The end result is a lone incision at the umbilicus for a perceived scarless abdomen. We report our early experience using the SILS technique for appendectomies in the pediatric population.

Tracheostomy in children: a population-based experience over 17 years.

Introduction: Tracheostomy is a lifesaving intervention with numerous complications.

Objectives: We describe the natural history of tracheostomy in children in a defined geographical area over a 17-year period. Our primary aim is to stress the need for a consensus on pediatric tracheostomy care.

A prospective controlled trial of the effect of a multi-faceted intervention on early recognition and intervention in deteriorating hospital patients.

Aim: To determine whether the introduction of a multi-faceted intervention (newly designed ward observation chart, a track and trigger system and an associated education program, COMPASS) to detect clinical deterioration in patients would decrease the rate of predefined adverse outcomes.

Methods: A prospective, controlled before-and-after intervention of trial was conducted in all consecutive adult patients admitted to four medical and surgical wards during a 4 month period, 1157 and 985, respectively. A sub-group of patients underwent vital sign and medical review analysis pre-intervention (427) and post-intervention (320).

Effect of vascular cadherin knockdown on zebrafish vasculature during development.

Background: Vascular endothelial cadherin (VE-cad) is essential for endothelial barrier integrity and vascular sprouting. However, the role of this important protein in cardiovascular development is only recently becoming apparent.

Methodology/principal Findings: To characterize the role of VE-cadherin in cardiovascular development, we analyzed cardiovascular development in a zebrafish VE-cad knockdown model.

Inhibition of tumor angiogenesis by the matrix metalloproteinase-activated anthrax lethal toxin in an orthotopic model of anaplastic thyroid carcinoma.

Patients with anaplastic thyroid carcinoma (ATC) typically succumb to their disease months after diagnosis despite aggressive therapy. A large percentage of ATCs have been shown to harbor the V600E B-Raf point mutation, leading to the constitutive activation of the mitogen-activated protein kinase pathway. ATC invasion, metastasis, and angiogenesis are in part dependent on the gelatinase class of matrix metalloproteinases (MMP).

Increased myoepithelial cells of bronchial submucosal glands in fatal asthma.

Background: Fatal asthma is characterised by enlargement of bronchial mucous glands and tenacious plugs of mucus in the airway lumen. Myoepithelial cells, located within the mucous glands, contain contractile proteins which provide structural support to mucous cells and actively facilitate glandular secretion.

Objectives: To determine if myoepithelial cells are increased in the bronchial submucosal glands of patients with fatal asthma.

A pilot study using nabilone for symptomatic treatment in Huntington's disease.

Pilot study of nabilone in Huntington's disease (HD). Double-blind, placebo-controlled, cross-over study of nabilone versus placebo. Primary outcome, Unified Huntington's Disease Rating Scale (UHDRS) total motor score.

Critical care services and 2009 H1N1 influenza in Australia and New Zealand.

Background: Planning for the treatment of infection with the 2009 pandemic influenza A (H1N1) virus through health care systems in developed countries during winter in the Northern Hemisphere is hampered by a lack of information from similar health care systems.

Methods: We conducted an inception-cohort study in all Australian and New Zealand intensive care units (ICUs) during the winter of 2009 in the Southern Hemisphere. We calculated, per million inhabitants, the numbers of ICU admissions, bed-days, and days of mechanical ventilation due to infection with the 2009 H1N1 virus.

Treatment of RSV bronchiolitis: drugs, antibiotics.

RSV bronchiolitis is one of the most common reasons for hospital admission and for visits to emergency departments for children, and at least half of affected infants will have subsequent episodes of respiratory illness. Despite this, there are wide variations in management. Initial assessment of respiratory status should include a measure of oxygenation and oxygen should be given when there is clinical evidence of respiratory distress even before full assessment is completed.

Delayed transhiatal herniation of the small bowel after Ivor Lewis esophagectomy.

Transhiatal intrathoracic herniation of the intestine after an Ivor Lewis esophagectomy is an unusual occurrence. This complication may present after any form of esophagectomy at varying intervals following primary surgery. Diagnosis is established on the basis of presenting symptoms and radiological features on computed tomography (CT scan).

Alcohol and drug screening of newborns: would women consent?

Objectives: To examine the conditions under which mothers would consent to alcohol and drug screening of their infants, and to identify predictors of screening consent.

Methods: A cross-sectional survey was administered in person by trained research assistants on the postpartum units of three hospitals in a large Canadian urban centre over four months. The survey was administered to 1509 mothers (78.

Propionibacterium acnes endocarditis of a prosthetic aortic valve.

In the few reported cases of Propionibacterium infective endocarditis involving prosthetic aortic valves, abscess is common and frequently requires surgery. We report a case of P. acnes infective endocarditis identified on prolonged blood cultures with aortic root abscess involving a Starr-Edwards valve.

The effect of fenoldopam and dopexamine on hepatic blood flow and hepatic function following coronary artery bypass grafting with hypothermic cardiopulmonary bypass.

Background: Hypothermic cardiopulmonary bypass is associated with low perfusion state causing a mismatch between demand and supply to various organs such as gut, kidneys and brain. The consequences are thought to be responsible for postoperative complications like systemic inflammatory response, renal failure, neurological injury, etc. Pharmacological agents like dopamine, dopexamine and dobutamine have been used in an attempt to reduce hypoperfusion and hence complications.

Can medical students achieve skills proficiency through simulation training?

Background: The purpose of this study was to determine whether third-year medical students can become proficient in open technical skills through simulation laboratory training.

Methods: A total of 204 students participated in a structured curriculum including bladder catheterization, breast examination, and knot-tying. Proficiency was documented using global rating scales and validated, objective, model-based metrics.

Ileal MALT lymphoma causing massive gastrointestinal haemorrhage revealed on computed tomography angiography.

Primary MALT lymphomas affecting the ileum are rare, and their presentation with massive haemorrhage exceptional. This report describes such a case. The patient presented with melaena and haemodynamic instability, but normal upper gastrointestinal endoscopy.

Intensive versus conventional glucose control in critically ill patients.

Background: The optimal target range for blood glucose in critically ill patients remains unclear.

Methods: Within 24 hours after admission to an intensive care unit (ICU), adults who were expected to require treatment in the ICU on 3 or more consecutive days were randomly assigned to undergo either intensive glucose control, with a target blood glucose range of 81 to 108 mg per deciliter (4.5 to 6.

Routine underwater seal drains are not required after transthoracic oesophagectomy: a pilot study.

Objective: Underwater seal drainage of the pleural cavity has been standard practice after transthoracic oesophagectomy. However these chest tubes cause pain and hamper mobility, thereby causing significant morbidity and delaying recovery. We postulated that if complete lung expansion and optimum pulmonary function could be achieved and maintained following a transthoracic oesophagectomy using simple gravity aided transabdominal tube drainage of the pleural cavity, then these may be a simpler alternative to the conventional underwater seal chest drains.