Paget's disease of the breast in a man without underlying breast carcinoma

A case of histologically confirmed Paget's disease of the breast in a 72 year old man, without underlying breast carcinoma, is reported. This report raises questions about the pathogenesis of this condition and suggests that Paget's disease is an independent, intraepidermal carcinoma rather than a direct extension of intraductal carcinoma of the breast to the nipple and areola.     

Medical technology development: limiting regulation

The medical technology industry is one of the most innovative sectors of the US economy. The paper considers how the US federal government, in a variety of roles as promoter, protector and payer, is involved in every stage of the innovative process for medical technology. It discusses the influence of government policies on medical innovation     

Cognitive impenetrability of memory for orientation.

This research produced evidence that an aspect of visual long-term memory—memory for lateral orientation of pictures—is constrained by a viewer-centered or egocentric reference frame. Subjects in Experiment 1 verbally encoded and then verbally recalled the locations of objects within scenic pictures. Recall of locations in terms of left-right directions (using a viewer-centered frame) exceeded recall of locations in terms of relative proximities to features of the room (using an environmental frame), even if the relative proximities had been verbalized at input. Subjects in Experiment 2 viewed half of a list of pictures directly and the remainder, reflected in a mirror. They then took a test in which they classified old pictures—all viewed directly— as "same-orientation" or "reversed." Performance was much better with a viewer-centered definition of same orientation (Does the picture appear the same way around?) than with an environmental definition (Is the picture the same way around on the screen?), even with forewarning of an environmental orientation test. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Modern electronic and chemical thermometers used in the axilla are inaccurate

Rectal and axillary temperatures were measured simultaneously in 83 children using three different thermometer devices providing 166 pairs of results. In the first series consisting of 22 febrile children (44 measurements) and 20 afebrile children (40 measurements), the rectal mercury measurement was compared to an axillary mercury and axillary Tempa-DOT thermometer. The axillary mercury had sensitivity of 14/22 (64%) and specificity of 20/20 (100%) while the Tempa-DOT had sensitivity of 15/22 (68%) and specificity of 19/20 (95%). In the second series comprising 21 febrile children (42 measurements) and 20 afebrile children (40 measurements) the axillary mercury had sensitivity of 11/21 (52%) and specificity of 20/20 (100%) while the electronic thermometer had sensitivity of 10/21 (48%) and specificity of 20/20 (100%). Regardless of the thermometer used, the axilla is a poor alternative to rectal measurements in the diagnosis of fever. CONCLUSION: Mercury-free thermometers, when used in the axilla are as poor alternatives to rectal measurements as mercury-in-glass thermometers.     

Structure of very early protein folding intermediates: new insights through a variant of hydrogen exchange labelling

BACKGROUND: Hydrogen exchange labelling has been a key method in characterizing the structure of transient folding intermediates. In studies of several proteins, however, there has been clear spectroscopic evidence for partial folding of some kind at very early times, before any protection from exchange was measurable. These results, presumably a consequence of limited stability of specific backbone interactions, have made it difficult to assess the extent of native-like folding in the very early intermediates. We have used a variant of the labelling method to investigate marginally stable structures formed within the first few milliseconds of refolding of two such proteins, hen lysozyme and ubiquitin. RESULTS: In lysozyme, population of a subset of native-like secondary structures on this timescale is revealed, thus reconciling the exchange behaviour with circular dichroism measurements and confirming the significance of the rapidly formed embryonic structure as a foundation for the subsequent folding pathway. In the case of ubiquitin, by contrast, no significantly protective structure was detectable, suggesting that here secondary structural elements can be populated only marginally ahead of the major cooperative folding event; this was also supported by stopped-flow circular dichroism measurements. CONCLUSIONS: The hydrogen exchange approach can be extended to probe the formation of native-like structure formed in very early folding intermediates, even when the stability of specific interactions is marginal. In the case of lysozyme, this has provided a new window on an early stage of organization of the alpha-helical domain.     

Management of the patient with minor traumatic brain injury

Staff in the accident and emergency department and critical care unit are often confronted with patients who have sustained life-threatening injuries. In such situations the symptoms of a minor traumatic brain injury (MTBI) may be missed. It is important that, when the physical symptoms begin to subside, nurses are aware of the symptoms of MTBI and respond accordingly. A post-concussion syndrome may develop 2 weeks to 2 months after a MTBI. This syndrome can affect the patient's ability to perform the usual activities of living. This article defines MTBI, describes the symptoms encountered in patients with MTBI, and outlines the pathophysiology, clinical findings, treatment and nursing interventions.