Rattlesnake venoms can cause a wide range of adverse human health effects. However, with the availability of modern antivenin, toxicity can generally be minimized and controlled. We present a rare case of rattlesnake envenomation resulting in severe systemic effects and syndrome relapse. Management considerations and patient course are described in the context of the current literature.

When conducting optical imaging experiments, in vivo, the signal to noise ratio and effective spatial and temporal resolution is fundamentally limited by physiological motion of the tissue. A three-dimensional (3D) motion tracking scheme, using a multiphoton excitation microscope with a resonant galvanometer,(512 × 512 pixels at 33 frames s(-1)) is described to overcome physiological motion, in vivo. The use of commercially available graphical processing units permitted the rapid 3D cross-correlation of sequential volumes to detect displacements and adjust tissue position to track motions in near real-time. Motion phantom tests maintained micron resolution with displacement velocities of up to 200 μm min(-1), well within the drift observed in many biological tissues under physiologically relevant conditions. In vivo experiments on mouse skeletal muscle using the capillary vasculature with luminal dye as a displacement reference revealed an effective and robust method of tracking tissue motion to enable (1) signal averaging over time without compromising resolution, and (2) tracking of cellular regions during a physiological perturbation.

Numerous candidate gene association studies of bipolar disorder (BP) have been carried out, but the results have been inconsistent. Individual studies are typically underpowered to detect associations with genes of small effect sizes. We conducted a meta-analysis of published candidate gene studies to evaluate the cumulative evidence. We systematically searched for all published candidate gene association studies of BP. We then carried out a random-effects meta-analysis on all polymorphisms that were reported on by three or more case-control studies. The results from meta-analyses of these genes were compared with the findings from a recent mega-analysis of eleven genome-wide association studies (GWAS) in BP performed by the Psychiatric GWAS Consortium (PGC). A total of 487 articles were included in our review. Among these, 33 polymorphisms in 18 genes were reported on by three or more case-control studies and included in the random-effects meta-analysis. Polymorphisms in BDNF, DRD4, DAOA, and TPH1, were found to be nominally significant with a P-value < 0.05. However, none of the findings were significant after correction for multiple testing. Moreover, none of these polymorphisms were nominally significant in the PGC-BP GWAS. A number of plausible candidate genes have been previously associated with BP. However, the lack of robust findings in our review of these candidate genes highlights the need for more atheoretical approaches to study the genetics of BP afforded by GWAS. The results of this meta-analysis and from other on-going genomic experiments in BP are available online at Metamoodics (http://metamoodics.igm.jhmi.edu). © 2012 Wiley Periodicals, Inc.

Calculation of the biological age of an individual has application in many fields of dentistry. It can be used to determine the appropriate timing of interventionist treatment for example in orthodontics; to analyse the developmental stage of an individual relative to the general population in the management of genetic or congenital conditions which disturb growth; and to estimate the age of a living or deceased person for forensic purposes. Many of the techniques used to estimate age can be quite time consuming to complete. This time component is a major disadvantage in a forensic context when age estimations in mass disasters are required as part of the post-mortem examination process. Consequently, forensic practitioners have tended to use the simpler but less reliable atlas style techniques of Schour and Massler and Ubelaker in these situations. For mass disaster situations, such as the recent Victorian Bushfires, it would be advantageous to have access to Australian specific data in the convenient Schour and Massler format. This project reinterpreted the Australian data previously collected by Blenkin and other relevant studies and applied it to a schematic similar to that of Ubelaker to develop a reliable, convenient and contemporary reference for use in age estimation.

We report inelastic neutron scattering measurements on Na_{2}IrO_{3}, a candidate for the Kitaev spin model on the honeycomb lattice. We observe spin-wave excitations below 5 meV with a dispersion that can be accounted for by including substantial further-neighbor exchanges that stabilize zigzag magnetic order. The onset of long-range magnetic order below T_{N}=15.3  K is confirmed via the observation of oscillations in zero-field muon-spin rotation experiments. Combining single-crystal diffraction and density functional calculations we propose a revised crystal structure model with significant departures from the ideal 90° Ir-O-Ir bonds required for dominant Kitaev exchange.

Objective: The purpose was to examine the inter-rater reliability of the Nottingham Neurological Driving Assessment.Participants: Six drivers with dementia (mean age 78 years, 5 men).Interventions: Participants were assessed for their safety to drive on a set route while being observed by two driving assessors, who were experienced in assessing safety to drive in people with dementia.Main measures: Performance was rated in terms of overall safety to drive and 25 items were recorded as correct, minor error (not compromising safety) and major error (compromising safety).Results: Four drivers were found to be probably safe to drive and two definitely unsafe to drive. There was perfect agreement in the overall decisions about safety to drive. There were significant discrepancies between correct or minor error and major error on six of the 25 items of the road test involving three participants.Conclusions: Two experienced driving assessors agreed on the overall safety to drive of six participants with dementia. There were discrepancies about safety on six out of 150 observations (4%).

AimThe aim of this study was to explore the relationships between plasma concentrations of N-terminal pro brain natriuretic peptide (NT-proBNP) and characteristics and prognosis of patients with heart failure and preserved (HFPEF) left ventricular ejection fraction (LVEF). No substantial trial has shown that treatment alters prognosis in patients with HFPEF due, in part, to much lower than anticipated event rates. The lack of a simple, objective test to identify patients with HFPEF at increased risk of cardiovascular events would be valuable. METHODS AND RESULTS: The Perindopril in Elderly People with Chronic Heart Failure Trial (PEP-CHF) was a randomized, controlled trial comparing perindopril and placebo in patients with symptoms and signs of heart failure who had an LVEF >40% and evidence of LV diastolic dysfunction. The primary endpoint was all-cause mortality or heart failure-related hospitalization. NT-proBNP was measured in 375 patients. Quartile thresholds were 176, 409, and 1035 pg/mL. Patients in the highest quartile of NT-proBNP were older, had lower body mass, more often had atrial fibrillation, had greater atrial and ventricular dimensions and a lower LVEF, and were more likely to receive loop diuretic therapy. Compared with the first quartile of NT-proBNP, the hazard ratios for the primary endpoint in the second {1.38 [95% confidence interval (CI) 0.64-2.99]}, third [2.84 (95% CI 1.42-5.72)], and fourth [4.47 (95% CI 2.30-8.72)] quartiles were increased. In a multivariable model, NT-proBNP, but not echocardiographic measures, was associated with outcome. CONCLUSIONS: NT-proBNP is a powerful prognostic marker in patients with HFPEF.

Salmonella serotype Heidelberg is the fifth most common serotype that causes human disease in the United States and appears to be more invasive than other nontyphoidal serotypes (3, 6).…

The 2009 H1N1 influenza pandemic showed the speed with which a novel respiratory virus can spread and the ability of a generally mild infection to induce severe morbidity and mortality in a subset of the population. Recent in vitro studies show that the interferon-inducible transmembrane (IFITM) protein family members potently restrict the replication of multiple pathogenic viruses. Both the magnitude and breadth of the IFITM proteins' in vitro effects suggest that they are critical for intrinsic resistance to such viruses, including influenza viruses. Using a knockout mouse model, we now test this hypothesis directly and find that IFITM3 is essential for defending the host against influenza A virus in vivo. Mice lacking Ifitm3 display fulminant viral pneumonia when challenged with a normally low-pathogenicity influenza virus, mirroring the destruction inflicted by the highly pathogenic 1918 'Spanish' influenza. Similar increased viral replication is seen in vitro, with protection rescued by the re-introduction of Ifitm3. To test the role of IFITM3 in human influenza virus infection, we assessed the IFITM3 alleles of individuals hospitalized with seasonal or pandemic influenza H1N1/09 viruses. We find that a statistically significant number of hospitalized subjects show enrichment for a minor IFITM3 allele (SNP rs12252-C) that alters a splice acceptor site, and functional assays show the minor CC genotype IFITM3 has reduced influenza virus restriction in vitro. Together these data reveal that the action of a single intrinsic immune effector, IFITM3, profoundly alters the course of influenza virus infection in mouse and humans.