An unusual case of gout in the wrist: the importance of monitoring medication dosage and interaction. A case report

<p>Abstract</p> <p>Background</p> <p>Gouty arthritis of the wrist is uncommon although gout itself is the most common inflammatory arthritis in older patients. Some known risk factors for the development of gout include trauma, alcohol use, obesity, hyperuricaemia, hypertension and diabetes mellitus. As well, certain medications have been shown to promote the development of gout. These include thiazide diuretics, low dose salicylates and cyclosporine. We present a case of gouty wrist pain possibly precipitated by a medication dosage increase as well as medication interactions.</p> <p>Case presentation</p> <p>A 77 year old male presented with right wrist pain. Redness and swelling was present at the dorsal aspect of his wrist and range of motion was full with pain at end range upon examination. One week prior, his anti-hypertensive medication dosage had been increased. The patient's situation continued to worsen. Radiographic examination revealed changes consistent with gouty arthritis.</p> <p>Conclusion</p> <p>It is important for clinicians treating joint conditions to be aware of patients' comorbidities, medication usage and changes in dosages. Education of patients with gout is of prime importance. Clinicians should educate patients that gout may occur at any joint in the body not only the lower limb. Patients should be aware of the signs and symptoms of an acute gouty attack and be made aware that changes in certain medication dosages may precipitate an attack. Awareness of radiographic changes associated with gout is still of importance although these changes are not seen as frequently as they have been in the past due to better control of the disease.</p

Postcopulatory sexual selection

The female reproductive tract is where competition between the sperm of different males takes place, aided and abetted by the female herself. Intense postcopulatory sexual selection fosters inter-sexual conflict and drives rapid evolutionary change to generate a startling diversity of morphological, behavioural and physiological adaptations. We identify three main issues that should be resolved to advance our understanding of postcopulatory sexual selection. We need to determine the genetic basis of different male fertility traits and female traits that mediate sperm selection; identify the genes or genomic regions that control these traits; and establish the coevolutionary trajectory of sexes

Sperm death and dumping in Drosophila

Mating with more than one male is the norm for females of many species. In addition to generating competition between the ejaculates of different males, multiple mating may allow females to bias sperm use. In Drosophila melanogaster, the last male to inseminate a female sires approximately 80% of subsequent progeny. Both sperm displacement, where resident sperm are removed from storage by the incoming ejaculate of the copulating male, and sperm incapacitation, where incoming seminal fluids supposedly interfere with resident sperm, have been implicated in this pattern of sperm use. But the idea of incapacitation is problematic because there are no known mechanisms by which an individual could damage rival sperm and not their own. Females also influence the process of sperm use, but exactly how is unclear. Here we show that seminal fluids do not kill rival sperm and that any 'incapacitation' is probably due to sperm ageing during sperm storage. We also show that females release stored sperm from the reproductive tract (sperm dumping) after copulation with a second male and that this requires neither incoming sperm nor seminal fluids. Instead, males may cause stored sperm to be dumped or females may differentially eject sperm from the previous mating

G11.92-0.61 MM1: A Keplerian disc around a massive young proto-O star

The formation process of massive stars is not well understood, and advancement in our understanding benefits from high resolution observations and modelling of the gas and dust surrounding individual high-mass (proto)stars. Here we report sub-arcsecond (<1550 au) resolution observations of the young massive star G11.92-0.61 MM1 with the SMA and VLA. Our 1.3 mm SMA observations reveal consistent velocity gradients in compact molecular line emission from species such as CH$_3$CN, CH$_3$OH, OCS, HNCO, H$_2$CO, DCN and CH$_3$CH$_2$CN, oriented perpendicular to the previously reported bipolar molecular outflow from MM1. Modelling of the compact gas kinematics suggests a structure undergoing rotation around the peak of the dust continuum emission. The rotational profile can be well fit by a model of a Keplerian disc, including infall, surrounding an enclosed mass of 30-60M$_{\odot}$, of which 2-3M$_{\odot}$ is attributed to the disc. From modelling the CH$_3$CN emission, we determine that two temperature components, of 150 K and 230 K, are required to adequately reproduce the spectra. Our 0.9 and 3.0cm VLA continuum data exhibit an excess above the level expected from dust emission; the full centimetre-submillimetre wavelength spectral energy distribution of MM1 is well reproduced by a model including dust emission, an unresolved hypercompact H{\i}{\i} region, and a compact ionised jet. In combination, our results suggest that MM1 is an example of a massive proto-O star forming via disc accretion, in a similar way to that of lower mass stars.European Research Council (ERC-2013-ADG DISCSIM project (Grant ID: 341137), ERC-2011-ADG ECOGAL project (Grant ID: 291227)), Science and Technology Facilities Council (Grant ID: ST/M001296/1), Royal Astronomical Society (Undergraduate Research Bursary)This is the final version of the article. It first appeared from Oxford University Press via http://dx.doi.org/10.1093/mnras/stw191

CO(1-0) in z gtrsim 4 Quasar Host Galaxies: No Evidence for Extended Molecular Gas Reservoirs

We present 12CO(J = 1 → 0) observations of the high-redshift quasi-stellar objects (QSOs) BR 1202-0725 (z = 4.69), PSS J2322+1944 (z = 4.12), and APM 08279+5255 (z = 3.91) using the NRAO Green Bank Telescope (GBT) and the MPIfR Effelsberg 100 m telescope. We detect, for the first time, the CO ground-level transition in BR 1202-0725. For PSS J2322+1944 and APM 08279+5255, our observations result in line fluxes that are consistent with previous NRAO Very Large Array (VLA) observations, but they reveal the full line profiles. We report a typical lensing-corrected velocity-integrated intrinsic 12CO(J = 1 → 0) line luminosity of L = 5 × 1010 K km s-1 pc2 and a typical total H2 mass of M(H2) = 4 × 1010 M for the sources in our sample. The CO/FIR luminosity ratios of these high-z sources follow the same trend as seen for low-z galaxies, leading to a combined solution of log LFIR = (1.39 ± 0.05) log LCO - 1.76. It has previously been suggested that the molecular gas reservoirs in some quasar host galaxies may exhibit luminous, extended 12 CO(J = 1 → 0) components that are not observed in the higher J CO transitions. Using the line profiles and the total intensities of our observations and large velocity gradient (LVG) models based on previous results for higher J CO transitions, we derive that emission from all CO transitions is described well by a single gas component in which all molecular gas is concentrated in a compact nuclear region. Thus, our observations and models show no indication of a luminous extended, low surface brightness molecular gas component in any of the high-redshift QSOs in our sample. If such extended components exist, their contribution to the overall luminosity is limited to at most 30%

Evaluating Effects of Divided Hemispheric Processing on Word Recognition in Foveal and Extrafoveal Displays: The Evidence from Arabic

Background: Previous studies have claimed that a precise split at the vertical midline of each fovea causes all words to the left and right of fixation to project to the opposite, contralateral hemisphere, and this division in hemispheric processing has considerable consequences for foveal word recognition. However, research in this area is dominated by the use of stimuli from Latinate languages, which may induce specific effects on performance. Consequently, we report two experiments using stimuli from a fundamentally different, non-Latinate language (Arabic) that offers an alternative way of revealing effects of split-foveal processing, if they exist. Methods and Findings: Words (and pseudowords) were presented to the left or right of fixation, either close to fixation and entirely within foveal vision, or further from fixation and entirely within extrafoveal vision. Fixation location and stimulus presentations were carefully controlled using an eye-tracker linked to a fixation-contingent display. To assess word recognition, Experiment 1 used the Reicher-Wheeler task and Experiment 2 used the lexical decision task. Results: Performance in both experiments indicated a functional division in hemispheric processing for words in extrafoveal locations (in recognition accuracy in Experiment 1 and in reaction times and error rates in Experiment 2) but no such division for words in foveal locations. Conclusions: These findings from a non-Latinate language provide new evidence that although a functional division i

An ERP Assessment of Hemispheric Projections in Foveal and Extrafoveal Word Recognition

The existence and function of unilateral hemispheric projections within foveal vision may substantially affect foveal word recognition. The purpose of this research was to reveal these projections and determine their functionality.Single words (and pseudowords) were presented to the left or right of fixation, entirely within either foveal or extrafoveal vision. To maximize the likelihood of unilateral projections for foveal displays, stimuli in foveal vision were presented away from the midline. The processing of stimuli in each location was assessed by combining behavioural measures (reaction times, accuracy) with on-line monitoring of hemispheric activity using event-related potentials recorded over each hemisphere, and carefully-controlled presentation procedures using an eye-tracker linked to a fixation-contingent display.Event-related potentials 100–150 ms and 150–200 ms after stimulus onset indicated that stimuli in extrafoveal and foveal locations were projected unilaterally to the hemisphere contralateral to the presentation hemifield with no concurrent projection to the ipsilateral hemisphere. These effects were similar for words and pseudowords, suggesting this early division occurred before word recognition. Indeed, event-related potentials revealed differences between words and pseudowords 300–350 ms after stimulus onset, for foveal and extrafoveal locations, indicating that word recognition had now occurred. However, these later event-related potentials also revealed that the hemispheric division observed previously was no longer present for foveal locations but remained for extrafoveal locations. These findings closely matched the behavioural finding that foveal locations produced similar performance each side of fixation but extrafoveal locations produced left-right asymmetries.These findings indicate that an initial division in unilateral hemispheric projections occurs in foveal vision away from the midline but is not apparent, or functional, when foveal word recognition actually occurs. In contrast, the division in unilateral hemispheric projections that occurs in extrafoveal locations is still apparent, and is functional, when extrafoveal word recognition takes place

Relationship between resident workload and self-perceived learning on inpatient medicine wards: a longitudinal study

BACKGROUND: Despite recent residency workload and hour limitations, little research on the relationship between workload and learning has been done. We sought to define residents' perceptions of the optimal patient workload for learning, and to determine how certain variables contribute to those perceptions. Our hypothesis was that the relationship between perceived workload and learning has a maximum point (forming a parabolic curve): that either too many or too few patients results in sub-optimal learning. METHODS: Residents on inpatient services at two academic teaching hospitals reported their team and individual patient censuses, and rated their perception of their learning; the patient acuity; case variety; and how challenged they felt. To estimate maximum learning scores, linear regression models with quadratic terms were fit on learning score. RESULTS: Resident self-perceived learning correlated with higher acuity and greater heterogeneity of case variety. The equation of census versus learning score, adjusted for perception of acuity and case mix scores, showed a parabolic curve in some cases but not in others. CONCLUSION: These data suggest that perceived resident workload is complex, and impacted by additional variables including patient acuity and heterogeneity of case variety. Parabolic curves exist for interns with regard to overall census and for senior residents with regard to new admissions on long call days

ALMA observations of the Extended Green Object G19.01−0.03 – I. A Keplerian disc in a massive protostellar system

Using the Atacama Large Millimetre/submillimeter Array (ALMA) and the Karl G. Jansky Very Large Array (VLA), we observed the Extended Green Object (EGO) G19.01-0.03 with sub-arcsec resolution from 1.05 mm to 5.01 cm wavelengths. Our 0.4 arcsec 1600 au angular resolution ALMA observations reveal a velocity gradient across the millimetre core MM1, oriented perpendicular to the previously known bipolar molecular outflow, which is consistently traced by 20 lines of 8 molecular species with a range of excitation temperatures, including complex organic molecules (COMs). Kinematic modelling shows the data are well described by models that include a disc in Keplerian rotation and infall, with an enclosed mass of 40-70 M (within a 2000 au outer radius) for a disc inclination angle of i = 40, of which 5.4-7.2 M is attributed to the disc. Our new VLA observations show that the 6.7 GHz Class II methanol masers associated with MM1 fo a partial ellipse, consistent with an inclined ring, with a velocity gradient consistent with that of the theal gas. The disc-to-star mass ratio suggests the disc is likely to be unstable and may be fragmenting into as-yet-undetected low-mass stellar companions. Modelling the centimetre-millimetre spectral energy distribution of MM1 shows the ALMA 1.05 mm continuum emission is dominated by dust, whilst a free-free component, interpreted as a hypercompact H ii region, is required to explain the VLA 5 cm emission. The high enclosed mass derived for a source with a moderate bolometric luminosity (104L) suggests that the MM1 disc may feed an unresolved high-mass binary system

Postcopulatory Sexual Selection Is Associated with Reduced Variation in Sperm Morphology

The evolutionary role of postcopulatory sexual selection in shaping male reproductive traits, including sperm morphology, is well documented in several taxa. However, previous studies have focused almost exclusively on the influence of sperm competition on variation among species. In this study we tested the hypothesis that intraspecific variation in sperm morphology is driven by the level of postcopulatory sexual selection in passerine birds.Using two proxy measures of sperm competition level, (i) relative testes size and (ii) extrapair paternity level, we found strong evidence that intermale variation in sperm morphology is negatively associated with the degree of postcopulatory sexual selection, independently of phylogeny.Our results show that the role of postcopulatory sexual selection in the evolution of sperm morphology extends to an intraspecific level, reducing the variation towards what might be a species-specific 'optimum' sperm phenotype. This finding suggests that while postcopulatory selection is generally directional (e.g., favouring longer sperm) across avian species, it also acts as a stabilising evolutionary force within species under intense selection, resulting in reduced variation in sperm morphology traits. We discuss some potential evolutionary mechanisms for this pattern