Over or under-detection? A comparison of exercise and eucapnic voluntary hyperpnoea challenges in the evaluation of exercise-induced bronchoconstriction

Background: The most appropriate objective bronchoprovocation challenge in the evaluation of exercise-induced bronchoconstriction (EIB) remains debated. Standardising minute ventilation and environmental conditions during an exercise challenge test (EX) is challenging, whereas it has recently been proposed that eucapnic voluntary hyperpnoea (EVH) may be overly sensitive. The primary aim of this study was therefore to compare the airway response to EX in a dry environment (25% RH) and EVH. An evaluation of current and revised diagnostic thresholds was undertaken to determine the impact of any proposed modification to EIB screening outcome. Methods: In randomised order, sixty-three recreational athletes (male: n = 47) (training 9 ± 4 hrs/week) attended the laboratory on two separate occasions to complete either an EX challenge (6-min high-intensity cycling exercise at >80% max heart rate) in an environmental chamber (16oC, 25% relative humidity), and a EVH challenge (6-min maximal ventilation of a dry compressed gas mixture: 21% O2, 5% CO2, N2 balanced). Spirometry was performed at baseline and 3, 5, 7, 10 and 15 minutes post challenge test in accordance with international guidelines. A positive diagnosis was defined by ≥10% fall in FEV1 at two consecutive time-points for both EX and EVH and ≥15% fall in FEV1 at one time-point for EVH. Results: The mean fall in lung function following EVH (-7.9 ± 6.9%) was greater in comparison to EX (-1.9 ± 7.1; P15% FEV1 fall following EVH, of which four were positive to EX. Conclusion: Our findings indicate that EVH consistently induces a greater fall in FEV1 in comparison to EX. Applying a 10% fall in FEV1 cut-off for EVH results in greater diagnostic sensitivity, whereas a 15% fall in FEV1 cut-off improves diagnostic specificity. Future population-based research evaluating the normative response to indirect bronchoprovocation in athletes remains a priority

Vaughan-Jackson-like syndrome as an unusual presentation of Kienböck's disease: a case report

<p>Abstract</p> <p>Introduction</p> <p>Kienböck's disease is a condition of osteonecrosis of the lunate bone in the hand, and most patients present with a painful and sometimes swollen wrist with a limited range of motion in the affected wrist. Vaughan-Jackson syndrome is characterized by the disruption of the digital extensor tendons, beginning on the ulnar side with the extensor digiti minimi and extensor digitorum communis tendon of the small finger. It is most commonly associated with rheumatoid arthritis. We describe a case of a patient with an unusual presentation of Kienböck's disease with symptoms similar to those of Vaughan-Jackson syndrome.</p> <p>Case presentation</p> <p>A 40-year-old man of Indian ethnic origin with no known history of trauma presented to our clinic with a ten-day history of an inability to extend his right little and ring fingers with associated pain in his right wrist. He was being treated with long-term steroids but had no other significant medical history. His examination revealed an inability to extend the metacarpal and phalangeal joints of the right ring and little fingers with localized tenderness over the lunate bone. Spontaneous disruption of the extensor tendons was diagnosed clinically and, after radiological investigation, was confirmed to be secondary to dorsal extrusion of the fragmented lunate bone. The patient underwent surgical repair of the tendons and had a full recovery afterward.</p> <p>Conclusion</p> <p>Kienböck's disease, though rare, is an important cause of spontaneous extensor tendon rupture. The original description of Vaughan-Jackson syndrome was of rupture of the extensor tendons of the little and ring fingers caused by attrition at an arthritic inferior radioulnar joint. We describe a case of a patient with Kienböck's disease that first appeared to be a Vaughan-Jackson-like syndrome.</p

Do Behavioral Foraging Responses of Prey to Predators Function Similarly in Restored and Pristine Foodwebs?

Efforts to restore top predators in human-altered systems raise the question of whether rebounds in predator populations are sufficient to restore pristine foodweb dynamics. Ocean ecosystems provide an ideal system to test this question. Removal of fishing in marine reserves often reverses declines in predator densities and size. However, whether this leads to restoration of key functional characteristics of foodwebs, especially prey foraging behavior, is unclear. The question of whether restored and pristine foodwebs function similarly is nonetheless critically important for management and restoration efforts. We explored this question in light of one important determinant of ecosystem function and structure – herbivorous prey foraging behavior. We compared these responses for two functionally distinct herbivorous prey fishes (the damselfish Plectroglyphidodon dickii and the parrotfish Chlorurus sordidus) within pairs of coral reefs in pristine and restored ecosystems in two regions of these species' biogeographic ranges, allowing us to quantify the magnitude and temporal scale of this key ecosystem variable's recovery. We demonstrate that restoration of top predator abundances also restored prey foraging excursion behaviors to a condition closely resembling those of a pristine ecosystem. Increased understanding of behavioral aspects of ecosystem change will greatly improve our ability to predict the cascading consequences of conservation tools aimed at ecological restoration, such as marine reserves

Quantitative real-time RT-PCR of CD24 mRNA in the detection of prostate cancer

BACKGROUND: Gene expression profiling has recently shown that the mRNA for CD24 is overexpressed in prostate carcinomas (Pca) compared to benign or normal prostate epithelial tissues. Immunohistochemical studies have reported the usefulness of anti-CD24 for detecting prostate cancer over the full range of prostate specimens encountered in surgical pathology, e.g. needle biopsies, transurethral resection of prostate chips, or prostatectomies. It is a small mucin-like cell surface protein and thus promises to become at least a standard adjunctive stain for atypical prostate biopsies. We tested the usefulness of real-time RT-PCR for specific and sensitive detection of CD24 transcripts as a supplementary measure for discriminating between malignant and benign lesions in prostatic tissues. METHODS: Total RNA was isolated from snap-frozen chips in 55 cases of benign prostatic hyperplasia (BPH) and from frozen sections in 59 prostatectomy cases. The latter contain at least 50% malignant epithelia. Relative quantification of CD24 transcripts was performed on the LightCycler instrument using hybridization probes for detection and porphobilinogen deaminase transcripts (PBGD) for normalization. RESULTS: Normalized CD24 transcript levels showed an average 2.69-fold increase in 59 Pca-cases (mean 0.21) when compared to 55 cases of BPH (mean 0.08). This difference was highly significant (p < 0.0001). The method has a moderate specificity (47.3%) but a high sensitivity (86.4%) if the cutoff is set at 0.0498. CD24 expression levels among Pca cases were not statistically associated with the tumor and lymph-node stage, the grading (WHO), the surgical margins, or the Gleason score. CONCLUSION: The present study demonstrates the feasibility of quantitative CD24 RNA transcript detection in prostatic tissues even without previous laser microdissection