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Human immunodeficiency virus (HIV)-associated nephropathy (HIVAN) is the most common finding on renal biopsy in HIV-infected black patients and is also the commonest cause of end-stage renal disease in these patients. Early detection of HIVAN may be beneficial in evaluating early treatment. This study examined the pattern of renal diseases in HIV-infected South Africans and also attempted to diagnose HIVAN at an early stage. In this single-center cross-sectional study, 615 HIV-infected patients were screened for proteinuria. Thirty patients with varying degrees of proteinuria underwent renal biopsy. Patients with diabetes mellitus, uncontrolled hypertension, known causes of chronic kidney disease, and serum creatinine above 250 μmol/l were excluded. Patients in this study were not on antiretroviral therapy. HIVAN was found in 25 (83%) patients. Six of them (24%) had microalbuminuria. Altogether, seven patients with persistent microalbuminuria were biopsied and six (86%) showed HIVAN. Other biopsy findings included membranoproliferative nephropathy in two (7%) and interstitial nephritis in three (10%). Four patients with HIVAN had associated membranous nephropathy. HIVAN is the commonest biopsy finding among our study patients with HIV infection who present with varying degrees of proteinuria. Microalbuminuria is a manifestation of HIVAN in our study patients. Therefore, microalbuminuria may be an early marker of HIVAN, and screening for its presence may be beneficial. Renal biopsy may be considered in seropositive patients who present with persistent microalbuminuria, especially with low CD4 counts irrespective of good renal function. This will allow diagnosis and treatment of HIVAN at an early stage and may prevent further disease progression.

Gamma-hydroxybutyrate overdose can cause drowsiness, respiratory depression, or coma.1Gamma-hydroxybutyrate and its pro-drug gamma-butyrolactone are dangerous drugs within the meaning of the Dangerous Drugs Ordinance.2 1,4-Butanediol, an industrial solvent, is converted to GHB by hepatic alcohol dehydrogenase and aldehyde dehydrogenase.3 Generally, its onset of action is 5 to 20 minutes after ingestion with effects lasting for 2 to 3 hours.4 Nonetheless there is inter-individual variability in its metabolism to GHB, mainly due to differences in alcohol dehydrogenase activity.3 Importantly, concurrent ethanol intake inhibits conversion of 1,4-butanediol to GHB.5With a delayed onset of GHB-related desirable effects, inadvertent overdose may occur in those whose intention was to ingest GHB rather than 1,4-butanediol.3 6 At the time or writing, 1,4-butanediol is not listed as a dangerous drug. Gamma-hydroxybutyrate (GHB), 1,4-butanediol (1,4BD), and gamma-butyrolactone (GBL) intoxication: a state-of-the-art review. Drug & Chemical Evaluation Section, Diversion Control Division, Drug Enforcement Administration, US Department of Justice. 1,4-Butanediol.

To the Editor—Ketamine analogues are new psychoactive substances that share the arylcyclohexylamine backbone of ketamine and produce dissociative effects through antagonistic activity at the N-methyl-D-aspartate receptor.1Ketamine and its analogues have plagued Hong Kong over the last two decades. Analysis or interpretation of data: TM Han 1,2; Magdalene HY Tang 1,2; HF Tong 1,2; YT Cheung 1,2; Jeremiah SB Tseung 1,2; MK Yip 1,2; CK Ching 1,2; YK Chong 1,2 1 Hospital Authority Toxicology Reference Laboratory, Hong Kong SAR, China 2 Chemical Pathology Laboratory, Department of Pathology, Princess Margaret Hospital, Hong Kong SAR, China

Hundreds of specimens of spirally coiled, megascopic, carbonaceous fossils resembling Grypania spiralis (Walcott), have been found in the 2.1-billion-year-old Negaunee Iron-Formation at the Empire Mine, near Marquette, Michigan. This occurrence of Grypania is 700 million to 1000 million years older than fossils from previously known sites in Montana, China, and India. As Grypania appears to have been a photosynthetic alga, this discovery places the origin of organelle-bearing eukaryotic cells prior to 2.1 billion years ago.

Artemisia rupestris L. is the perennial herb of rupestris belonging to Artemisia (Compositae), which is wildly distributed in Xinjiang (China), middle Asia, and Europe. It is known to have anti-inflammatory, hepatoprotective, immune function regulation, and gastrointestinal function regulation effects. AR is used to treat digestive diseases, but the effects of AR on antifunctional dyspepsia (FD) activity have not yet been reported. In this study, we aimed to investigate the therapeutic effects of Artemisia rupestris L. extract (ARE) on gastrointestinal hormones and brain-gut peptide in functional dyspepsia (FD) rats. Sixty Sprague-Dawley rats were randomly divided into 6 groups. An FD rat model was established by irregular tail clamp stimulation for 14 days except the blank group. After FD rat models, the blank group and model group were given menstruum, and the medicated rats were given corresponding medicine for 14 days. The general observations, bodyweight, and food intake were observed, and the content of serum gastrin (GAS), plasma motilin (MTL), plasma vasoactive intestinal peptide (VIP), and plasma somatostatin (SS) by the enzyme-linked immunosorbent assay was observed. The content of plasma VIP and plasma SS in the ARE group was significantly lower than in the model group, and the content of serum GAS and plasma MTL was increased in the ARE group; the GAS expression of antrum and hypothalamus was increased in the ARE group, and SS expression of antrum and hypothalamus was decreased in the ARE group by immunohistochemical detection; the results of semiquantitative reverse transcription polymerase chain reaction (RT-PCR) indicate that ARE inhibits the mRNA expression of VIP. Our results suggest that ARE can recover gastrointestinal hormone levels and regulation of the peripheral and central nervous system and alter gut peptide levels, which confirm the therapeutic effect of ARE on functional dyspepsia.

Since 1972, 17 patients have been surgically treated for double aortic arch at our institution. The procedure became necessary before 12 months of age in 11 patients and before 24 months in 16 patients. The major symptoms were respiratory distress, noisy breathing, and respiratory infections; four patients also had dysphagia. A high degree of clinical suspicion should warrant further investigation. Barium swallow and bronchoscopy were diagnostic and revealed extrinsic compression of the esophagus and trachea, respectively. Division of the anterior arch was performed in 16 patients; the right (posterior) arch was divided in the remaining patient. Kommerell's diverticulum was found in four patients and was resected in order to avoid recurrence of dysphagia by compression. A vascular suspension procedure was necessary in 13 patients to further release the trachea and eosphagus. There was no mortality in this series, and symptomatic improvement was achieved in all patients. A degree of tracheomalacia may be responsible for some residual symptoms in four patients.

PurposeOne out of every eight women is diagnosed with breast cancer, making it the most prevalent type of cancer in women. A significant portion of women choose to undergo mastectomy; the subsequent deformities lead to the desire for breast reconstruction. The options for breast reconstruction include prosthetic implant, autologous tissue, or a combination of both. The transverse rectus abdominis musculocutaneous flap (TRAM) is a well-known technique that has been established as one of the mainstays of autogenous breast reconstruction. Evaluation of the TRAM flap viability is a highly desired criterion, but one that is clinically difficult to assess intraoperatively. A new technique which employs the novel device the ODISseyTM Tissue Oximeter (Optical Imaging and Diffusion Spectroscopy), which measures tissue oxygenation saturation at the capillary level, allows real-time evaluation of blood perfusion and therefore provides a tangible measurement of perfusion to each zone.MethodsThree patients who had previously undergone a unilateral mastectomy desired reconstruction using autologous tissue and were felt to be good candidates for a TRAM flap reconstruction. Measurements for tissue oxygenation were taken with the ODISsey Tissue Oximeter prior to elevation of the flap and after ligation of the inferior epigastric artery in each of the four zones.ResultsThe pre-ligation numbers were similar in all four zones as would be expected. However, the tissue oxygen saturation was consistently higher in zone III than in zone II.ConclusionIn our studies the use of the ODISsey Tissue Oximeter was shown to be a quick and safe technique to reliably evaluate blood perfusion to a particular area of tissue. Our analysis shows that although Zone II has traditionally been thought to have better perfusion than zone III, we found that, in fact, Zone III had better perfusion after ligation of the inferior epigastric artery. This allowed us to preserve more tissue for breast reconstruction. Further studies are currently under way to re-define the perfusion zones.

The effect of different biofilter media on the environment and growth performance of whiteleg shrimp cultured in a recirculating aquaculture system (RAS) was evaluated. Three different biofilter media applied in this study included type 1 biofilter media with a specific surface area (SSA) of 750 m2(m3)-1 (control), type 2 biofilter media with an SSA of 1,000 m2(m3)-1, and type 3 biofilter media with an SSA of 600 m2(m3)-1 which were set to get the surface area of 22 m2 across all treatments. After 56 days of rearing, all used biofilter media showed benefits in water quality maintenance, and the total count of Vibrio spp. was limited and varied around 103 CFU mL-1. Regarding feed efficiency, the type 1 biofilter helped to reduce the FCR (feed conversion ratio) significantly compared with other biofilter media. Other growth parameters were not significantly different across the treatments. Generally, the study reviewed that the total surface area of biofilter media is the key factor in RAS application in shrimp farming, rather than the amount of those media.

The effect of stocking density on growth performance, stress responses and hematological changes of large-sized hybrid grouper (Epinephelus fuscoguttatus ♀ × Epinephelus lanceolatus ♂) was investigated in the present study. Hybrid grouper (initial weight ~ 205 g) were reared for 60 days in recirculating aquaculture systems (RAS) (tank volume of 2 m3). The experiment was conducted with three replicates across three stocking densities including 15 fish m-3 (~3.10 kg m-3, D1), 25 fish m-3 (~5.17 kg m-3, D2) and 35 fish m-3 (~7.15 kg m-3, D3). Growth characteristics were significantly affected at high stocking densities. Plasma cortisol and glucose concentrations were significantly higher at the high density than at the two lower stocking densities. Hematological indices (red blood cell, hemoglobin and hematocrit) decreased with increasing stocking density and were significant lower in the D3 treatment compared to those in the D1 treatment. Coefficient of variation in fish weight was positively associated with stocking density. However, stocking density had no significant effect on fish survival. Moreover, final biomass significantly increased with stocking density. Overall, while hybrid grouper of the studied size can tolerate high stocking densities (no mortality), lower stocking densities result in significantly greater and more uniform growth performance. Nevertheless, stocking density represents a trade-offbetween growth performance, biomass yield and economic efficiency where reduced growth may be acceptable to enhance overall production output.