Zebrafish obesogenic test: a tool for screening molecules that target adiposity.
Dietary and xenobiotic compounds may alter endocrine signaling and lipid homeostasis, thus inducing obesity. We describe a short-term assay method, the zebrafish obesogenic (ZO) test, for examining the effects of diet, drugs, and environmental contaminants, singly or in combination, on white adipose tissue (WAT) dynamics in live larvae. The ZO test is an intermediate step in obesity research, between in vitro and rodent assays, and may be also used to study the effect of environmental toxicants on the adiposity of aquatic species. The procedure, using Nile Red (NR) fluorescent probe to reveal adipocyte lipid droplets, is suitable for pharmaceutical or toxicological screening. Larvae treated at an environmentally-relevant concentration of tributyltin chloride (TBT), an environmental obesogen, exhibited a remarkable increase in adiposity, irrespective of the lipid composition of the background diet. Exogenous compounds, e.g., rosiglitazone or TBT, known to increase adiposity in the fasting state, were classified as obesogenic. Anti-obesogenic compounds favored a decrease in adiposity in the fasting state. The ZO test, using adipocyte lipid droplet size and adiposity as its endpoints, is a whole-organism alternative testing assay for obesogenic and anti-obesogenic compounds and mixtures and provides relevant information for environmental and human risk assessments.


The G501C polymorphism of the oxidized low-density lipoprotein-receptor 1 gene is associated with acute coronary syndrome in the Han Chinese population.
Oxidized low-density lipoprotein-receptor 1 (OLR-1) might be involved in the risk of atherosclerosis and its complications. Several studies have been carried out to explore the role of OLR-1 gene polymorphisms in the risk of coronary artery disease. Our study investigated whether the G501C and the 3'UTR C188T polymorphisms of the OLR-1 gene were genetic risk factors of acute coronary syndrome (ACS) in the Han Chinese population. Significant differences were found in genotype frequencies of the OLR-1 G501C polymorphism between 198 ACS patients and 204 control individuals. The CC genotype frequency in the ACS group was significantly higher than that in the control group (5.6% and 1.5% in ACS patients and control subjects, respectively), and the p-value and odds ratio were 0.028 and 3.911, respectively. Using the CC genotype as a reference, we have shown a significant association between carriers of the G allele (GG + GC genotypes) and a decreased risk of ACS (p = 0.026, odds ratio = 0.254, 95% confidence interval = 0.070-0.924). The OLR-1 G501C polymorphism might be associated with ACS in the Han Chinese population.


Restless legs syndrome: a clinical update.
Restless legs syndrome (RLS) is a common and often disabling sensorimotor disorder. Epidemiologic studies suggest that RLS is an underrecognized and undertreated disorder affecting both children and adults. The diagnosis is based primarily on the following four essential criteria: (1) an urge to move, usually associated with paresthesias, (2) onset or exacerbation of symptoms at rest, (3) relief of symptoms with movement, and (4) symptoms manifesting in a circadian pattern. Supplemental workup including polysomnography, iron profile, and/or neuropathy screen can provide support for the diagnosis and aid in the treatment strategy. Behavioral techniques, dopaminergic agents, opiates, benzodiazepines, and antiepileptics all have potential value in treating this disorder. Dopaminergic agents continue to be the most effective RLS treatment. However, due to their potential long-term side effects, these agents should not be considered the sole treatment of choice. In the end, the therapeutic plan should be individualized to suit each patient's presentation and needs.


Caffeine, carnitine and choline supplementation of rats decreases body fat and serum leptin concentration as does exercise.
The effect of a combination of caffeine, carnitine and choline with or without exercise on changes in body weight, fat pad mass, serum leptin concentration and metabolic indices was determined in 20 male, 7-wk-old Sprague-Dawley rats. They were given free access to a nonpurified diet without or with caffeine, carnitine and choline at concentrations of 0.1, 5 and 11.5 g/kg diet, respectively. In a 2x2 factorial design, one-half of each dietary group was exercised, and the other half was sedentary. Body weight and food intake of all rats were measured every day for 28 d. Rats were killed and blood and tissue samples were collected and analyzed for biochemical markers. Food intake of the groups was not different, but the body weight was significantly reduced by exercise in both dietary groups. Fat pad weights and total lipids of epididymal, inguinal and perirenal regions were significantly reduced by the supplements as well as by exercise. Regardless of exercise, supplements significantly lowered triglycerides in serum but increased levels in skeletal muscle. Serum leptin concentrations were equally lowered by supplements and exercise. Serum leptin was correlated with body weight (r = 0.55, P< or =0.01), fat pad weight (r = 0.82, P< or =0.001) and serum glucose (r = 0.51, P< or =0.05). We conclude that the indices of body fat loss due to dietary supplements were similar to those due to mild exercise, and there were no interactive effects of the two variables.


Chronic urticaria associated with intra-articular methylprednisolone.
Reports of allergic reactions following treatment with systemic corticosteroids are rare, despite their widespread use. A 47-year-old man developed widespread urticaria, resistant to antihistamines, coinciding with injections of local anaesthetic and methylprednisolone for cervical spondylosis. He underwent immediate and delayed hypersensitivity tests. Intradermal tests showed immediate-type sensitivity to methylprednisolone and hydrocortisone. Patch tests were positive to 21 of 26 corticosteroids tested. A diagnosis of both an immediate and a delayed-type hypersensitivity to corticosteroids was made. With avoidance of all corticosteroids he has been free from urticarial rash for 9 months and has been able to stop all medication.


[An epidemiological survey of alcoholic liver disease in Zhejiang province].
To describe the brief survey of alcohol intake and the incidence of alcohol liver disease in Zhejiang province. 18,237 requested persons aged over 18 years were selected by multi-stage stratified cluster sampling in Zhejiang province. Questionnaire about alcohol consumption, hepatic ultrasonic scan and detection of hepatic enzymes and markers of HBV and HCV were carried out. Daily alcohol intake more than 40g (including equal to 40g/d) was essential for the diagnosis of alcoholic liver disease. Among the 18,237 persons (male 12,042, female 6195), the average daily alcohol intake was (17.7 +/- 27.2) g. The incidence of alcoholic liver disease in Zhejiang province was 4.34% (male 6.36%, female 0.36%) in the whole population. Four subtypes were separated as alcoholic cirrhosis, alcoholic fat liver, alcoholic hepatitis and mild alcoholic injury in liver with the corresponding incidence of 0.68%, 0.94%, 1.51% and 1.21% separately. Alcoholic liver disease is found to be a common disease in Zhejiang province, indicating an urgent need for the public education on alcohol abuse and the treatment on related health problems


Crystallization and preliminary crystallographic analysis of human serine dehydratase.
L-Serine dehydratase (SDH) catalyzes the pyridoxal phosphate (PLP) dependent deamination of L-serine to yield pyruvate. Recombinant human serine dehydratase was crystallized by the hanging-drop vapour-diffusion method. Crystals were grown at 291 K using (NH4)(2)SO4 as precipitant. Diffraction data were obtained to a resolution of 2.5 A from a single frozen crystal using Cu Kalpha radiation. The crystal belongs to space group I422, with unit-cell parameters a = 157.4, b = 157.4, c = 59.2 A, alpha = beta = gamma = 90 degrees. The asymmetric unit contains one molecule and has a solvent content of about 46%.


[Indirect, population effect of mass pneumococcal vaccinations (PCV7) on all-cause pneumonia incidence in Kielce, Poland].
In these article they made analysis of indirect, population effects of mass, free of charge, pneumococcal vaccinations (PCV7) on all-cause pneumonia incidence in Kielce, Poland. The strongest and significant fall (p=0.00079) in all-cause pneumonia incidence in the analyzed period 2005-2009 compared with remaining groups were observed in the group of children under 2 of years of life. He amounted to the 74% (around 25/1000 in 2005; 6/1000 in 2009). In the entire ancient group 0-29, embracing children under 2 yrs of life the fall of pneumonia incidence rate amounted to the 48% (from 2.8/1000 in 2005; 1.5/1000 in 2009). In the age 65+ group the fall in the incidence amounted to the 45% (19/1000 in 2005; <11/1000 in 2009 r.). At the moment they didn't observe, of such a fall in age groups 30-49 yrs and 50-64 yrs. Presented results are pointing population effectiveness of applied in Kielce mass vaccination in a 2+1 scheme. Analyzing only pneumonia requiring the hospitalization they tried at work to estimate, in the definitely simplified way, financial effects of mass pneumococcal vaccination in Kielce. Analysis showed at children up to 2 yrs frugalities of the row of the 174,420 zloty annually. In the group above 1 year of life analogous analysis showed frugalities of row 789,480 zloty. Results presented by us should, in our opinion, to induce decision-makers for free of charge mass pneumococcal vaccinations to entire Poland.


Path Planning for Mobile-Anchor Based Wireless Sensor Networks Localization: Obstacle-Presence Schemes.
In many Wireless Sensor Network (WSN) applications, the location of the nodes in the network is required. A logical method to find Unknown Nodes (UNNs) in the network is to use one or several mobile anchors (MAs) equipped with GPS units moving between UNNs and periodically broadcast their current location. The main challenge at this stage is to design an optimum path to estimate the locations of UNNs as accurately as possible, reach all nodes in the network, and complete the localization process as quickly as possible. This article proposes a new path planning approach for MA-based localization called Nested Hexagon Curves (NHexCurves). The proposed model's performance is compared with the performance of five existing static path planning models using Weighted Centroid Localization (WCL) and Accuracy Priority Trilateration (APT) localization techniques in the obstacle-presence scenario. With the obstacle-handling trajectories used for the models, the negative impact of the obstacle on the localization is reduced. The proposed model provides full coverage and high localization accuracy in the obstacle-presence scenario. The simulation results show the advantages of the proposed path planning model with the H-curve model over existing schemes.


Heterogeneity of glycoconjugates in the secretory cells of the chinchilla middle ear and eustachian tubal epithelia: a lectin-gold cytochemical study.
The present study was conducted to characterize and localize the glycoconjugates in the tubotympanum (auditory or eustachian tube and middle ear cavity) of chinchilla on an ultrastructural level, using lectin-gold complexes with six different lectins: BPA, ConA, RCA-1, WGA, LFA, and SNA. A comparison of the affinity of these lectins demonstrated the heterogeneity of secretory cells. The glandular serous cells and epithelial dark granulated cells produced "serum"-type glycoprotein. The glandular mucous cells and goblet cells produced dominantly "mucin"-type glycoprotein in the light granules, but "serum"-type glycoprotein in the dark cores. The labeling of LFA and SNA showed that sialic acids existed mainly in the mucinous granules of secretory cells and ciliated epithelium glycocalyx, and in the mucous blanket. The results also suggested that the dominant linkage of sialic acids of mucin is a Neu5Ac(alpha 2-6)Gal/GalNAc sequence. Furthermore, the data obtained from ConA and BPA suggested that initial O-glycosylation of mucin took place in the cis side of the Golgi apparatus and that initial N-glycosylation of the serum occurred in the rough endoplasmic reticulum.


Matrix stiffness controls lymphatic vessel formation through regulation of a GATA2-dependent transcriptional program.
Tissue and vessel wall stiffening alters endothelial cell properties and contributes to vascular dysfunction. However, whether extracellular matrix (ECM) stiffness impacts vascular development is not known. Here we show that matrix stiffness controls lymphatic vascular morphogenesis. Atomic force microscopy measurements in mouse embryos reveal that venous lymphatic endothelial cell (LEC) progenitors experience a decrease in substrate stiffness upon migration out of the cardinal vein, which induces a GATA2-dependent transcriptional program required to form the first lymphatic vessels. Transcriptome analysis shows that LECs grown on a soft matrix exhibit increased GATA2 expression and a GATA2-dependent upregulation of genes involved in cell migration and lymphangiogenesis, including VEGFR3. Analyses of mouse models demonstrate a cell-autonomous function of GATA2 in regulating LEC responsiveness to VEGF-C and in controlling LEC migration and sprouting in vivo. Our study thus uncovers a mechanism by which ECM stiffness dictates the migratory behavior of LECs during early lymphatic development.


In vitro pharmacodynamics of levofloxacin and other aerosolized antibiotics under multiple conditions relevant to chronic pulmonary infection in cystic fibrosis.
The inhalational administration of antibiotics can provide high concentrations locally in the lungs of cystic fibrosis patients and, thus, can be useful for the treatment of chronic bacterial infections. The present study evaluated the in vitro activities of levofloxacin, ciprofloxacin, tobramycin, amikacin, and aztreonam against clinical isolates of Pseudomonas aeruginosa, Burkholderia cepacia complex, Stenotrophomonas maltophilia, Alcaligenes xylosoxidans, and Staphylococcus aureus from cystic fibrosis patients. Levofloxacin was the most potent antibiotic against all cystic fibrosis isolates tested, with MIC(90)s ranging from 8 to 32 microg/ml. Levofloxacin was more potent than the aminoglycosides and aztreonam against P. aeruginosa biofilms. Time-kill assays with drug concentrations achievable in sputum following aerosol administration showed that levofloxacin had the most rapid rate of killing among mucoid and nonmucoid isolates of P. aeruginosa. In contrast to tobramycin, the bactericidal activity of levofloxacin was not affected by sputum from cystic fibrosis patients. The results of the study show that the high concentrations of levofloxacin readily achievable in the lung following aerosol delivery may be useful for the management of pulmonary infections in patients with cystic fibrosis.


Decreasing Food Stealing of Child with Prader-Willi Syndrome Through Function-Based Differential Reinforcement.
Challenging behaviors involving food are common for individuals with Prader-Willi syndrome (PWS) and often lead to obesity and other chronic health conditions. Efforts to decrease these behaviors, such as isolation during meals and strict monitoring of food consumption, can be stigmatizing. To decrease the food stealing of a 7 year-old girl with PWS, therapists conducted a latency-based functional analysis in a clinic setting before implementing a function-based intervention to facilitate her inclusion at the family dinner table. Intervention components entailed differential reinforcement procedures which incorporated a token board and schedule thinning. The intervention successfully generalized to the home setting and across food preferences and implementers.


The pragmatic use of apomorphine at the end of life.
Parkinson's Disease (PD) is an irreversible degenerative neurological disorder with no known cure. Apomorphine is a potent short-acting D1/D2 dopamine agonist administered sub-cutaneously that is used in the treatment of PD. Optimising PD medication is an important aspect of end of life care. There are no previously reported cases of apomorphine providing symptom relief in terminal care of PD patients. This case highlights its potential benefits for symptom control at the end of life.


Effects of Dopamine Receptor Antagonists and Radiation on Mouse Neural Stem/Progenitor Cells.
Dopamine receptor antagonists are psychotropic drugs that have been originally developed against psychiatric disorders. We recently identified dopamine receptor antagonists as potential anti-cancer agents and some have entered clinical trials against glioblastoma. Radiotherapy is known to cause cognitive impairment in patients receiving cranial irradiation through the elimination of neural stem/progenitor cells and subsequent loss of neurogenesis. Using transgenic mice that report the presence of neural stem/progenitor cells through Nestin promoter-driven expression of enhanced green fluorescent protein, the effects of dopamine receptor antagonists alone or in combination with radiation on murine neural stem/progenitor cells were assessed in sphere-formation assays, flow cytometry and immunofluorescence in vitro and in vivo . We report that several dopamine receptor antagonists show sex-dependent effects on neural stem/progenitor cells both in vitro and in vivo . Hydroxyzine, trifluoperazine, amisulpride, nemonapride or quetiapine alone or in combination with radiation significantly increased the number of neural stem/progenitor cells in female neurospheres but not in male mice. Dopamine receptor antagonists either protected neural stem/progenitor cells from radiation or expanded the stem cell pool, thus indicating that this combination therapy against glioblastoma will not increase radiation-induced cognitive decline through increasing elimination of neural stem/progenitor cells and subsequent loss of neurogenesis. We conclude that a therapeutic window for dopamine receptor antagonists in combination with radiation potentially exist, making it a novel combination therapy against glioblastoma. Normal tissue toxicity of this combination potentially differs depending on age and sex and should be taken into consideration when designing clinical trials. - Neural stem/progenitor cells show sex-dependent sensitivity to dopamine receptor antagonists- Dopamine receptor antagonists active against GBM increase Neural stem/progenitor cells counts. Combination therapy of dopamine receptor antagonists with radiation have entered clinical trials against glioblastoma but the normal tissue toxicity of this combination has not been fully explored yet. Here we present evidence that some dopamine receptor antagonists show sex-dependent effects on neural stem/progenitor cells either by protecting neural stem/progenitor cells from radiation or inducing an expansion of the stem cell pool, suggesting that this combination therapy against glioblastoma will not increase radiation-induced cognitive decline through increasing elimination of neural stem/progenitor cells and subsequent loss of neurogenesis. Normal tissue toxicity of this combination potentially differs depending on age and sex and should be further explored in clinical trials.


Ankle Swelling in Patients With Type 1 Neurofibromatosis: A Report of Two Cases With Rare Presentation of Common Genodermatosis.
Neurofibromatosis type 1 is characterized by multiple cutaneous neurofibromas of varying sizes along with skeletal, neurologic, and ophthalmic features. Solitary swellings in neurofibromatosis type 1 are not commonly encountered except in the form of plexiform neurofibromas. We report two cases with neurofibromatosis type 1 presenting with solitary swelling in the ankles which were proven to be the diffuse type of neurofibroma, radiologically and histopathologically. Diffuse type neurofibroma presenting as ankle swelling in type 1 neurofibromatosis has not been reported before.


A Phage Cocktail To Control Surface Colonization by Proteus mirabilis in Catheter-Associated Urinary Tract Infections.
Proteus mirabilis is a biofilm-forming bacterium and one of the most common causes of catheter-associated urinary tract infections (CAUTIs). The rapid spread of multidrug-resistant P. mirabilis represents a severe threat to management of nosocomial infections. This study aimed to isolate a potent phage cocktail and assess its potential to control urinary tract infections caused by biofilm-forming P. mirabilis. Two lytic phages, Isf-Pm1 and Isf-Pm2, were isolated and characterized by proteome analysis, transmission electron microscopy, and whole-genome sequencing. The host range and effect of the phage cocktail to reduce the biofilm formation were assessed by a cell adhesion assay in Vero cells and a phantom bladder model. The samples treated with the phage cocktail showed a significant reduction (65%) in the biofilm mass. Anti-quorum sensing and quantitative real-time PCR assays were also used to assess the amounts of transcription of genes involved in quorum sensing and biofilm formation. Furthermore, the phage-treated samples showed a downregulation of genes involved in the biofilm formation. In conclusion, these results highlight the efficacy of two isolated phages to control the biofilms produced by P. mirabilis CAUTIs. IMPORTANCE The rapid spread of multidrug-resistant (MDR) and extensively drug-resistant (XDR) bacterial strains and biofilm formation of bacteria have severely restricted the use of antibiotics and become a challenging issue in hospitals. Therefore, there is a necessity for alternative or complementary treatment measures, such as the use of virulent bacteriophages (phages), as effective therapeutic strategies.


Effect of sodium intake on gene expression and plasma levels of ANF in rats.
The effect of short- and long-term sodium loading and sodium restriction on the gene expression as well as on circulating plasma levels of atrial natriuretic factor (ANF) was evaluated in normotensive Wistar rats. These rats were fed either a low-, a regular-, or a high-sodium diet (regular diet and 1% saline as drinking fluid) and studied after 1 and 3 wk. The ANF mRNA was determined in pooled atria and ventricles of the different groups of rats, using the dot-blot technique. Plasma ANF levels were measured with a radioimmunoassay. After 1 wk on the high-sodium diet, ANF mRNA was increased in right atria and ventricles together with circulating ANF levels when compared with animals maintained for the same period on a low-sodium diet. After 3 wk on the various diets, the differences in cardiac ANF mRNA and in plasma ANF levels had disappeared. Gene expression of ANF was also looked for in different areas of the brain, lung, thyroid, adrenals, and the kidney; no hybridization was detected in any of these organs. These data suggest that in rats, the transcription of the ANF gene and peptide release in enhanced only during short-term adaptation to dietary sodium loading.


[Health, work and environment at the Brazilian rural].
This manuscript discusses the implications of the productive paradigm changes in health and environment of rural area of Brazil. It analyzes production, economy and demography data, facing social and structural determinants with health and environmental reflexes, revealing a serious panorama that includes: a) environmental impacts associated to large productive chains, such as corn, soy-bean, cotton and sugar cane; b) chemical contamination of diverse environment compartments due to pesticides and fertilizers used in agriculture; c) the use of natural land in the expansion of agriculture and cattle farming activities; and d) the reflexes of these actions on individuals, workers or not, that are more and more forced to deal with extreme vulnerability situations because of the risk of rural work processes. Thus, the present article points that macro-determinants (or driven-forces) tends to configure the health status of Rural Brazil inhabitants which, day after day, face a series of challenges in order to guarantee dignity in their work and quality of life.


Sacral nerve neuromodulation in the treatment of refractory motor urge incontinence.
Sacral nerve neuromodulation may be an effective treatment option in patients with motor urge incontinence when conservative therapy fails. The effect of treatment is durable in the majority of patients, but there is also a high failure rate. The cause of failure remains unclear in most cases as it is still unknown exactly how neuromodulation works. The present review summarizes the results of patient treatment and research into the working mechanism of neuromodulation, as well as the technical developments described in the past year.


Stimulation and sensitization of the isolated Venus heart by cerebrospinal fluid.
5-Hydroxytryptamine was not detected in animal cerebrospinal fluid after amine oxidase inhibitors, reserpine, or both. Both human and animal cerebrospinal fluid can produce a stimulating effect on the clam heart which is not due to 5-hydroxytryptamine. Cerebrospinal fluid also has the property of increasing the sensitivity of the clam heart to 5-hydroxytryptamine.


Not feeling ready to go home: a qualitative analysis of chronically ill patients' perceptions on care transitions.
Unplanned hospital readmissions frequently occur and have profound implications for patients. This study explores chronically ill patients' experiences and perceptions of being discharged to home and then acutely readmitted to the hospital to identify the potential impact on future care transition interventions. Twenty-three semistructured interviews were conducted with chronically ill patients who had an unplanned 30-day hospital readmission at a university teaching hospital in the Netherlands. A constructive grounded theory approach was used for data analysis. The core category identified was 'readiness for hospital discharge,' and the categories related to the core category are 'experiencing acute care settings' and 'outlook on the recovery period after hospital discharge.' Patients' readiness for hospital discharge was influenced by the organization of hospital care, patients' involvement in decision-making and preparation for discharge. The experienced difficulties during care transitions might have influenced patients' ability to cope with challenges of recovery and dependency on others. The results demonstrated the importance of assessing patients' readiness for hospital discharge. Health care professionals are recommended to recognize patients and guide them through transitions of care. In addition, employing specifically designated strategies that encourage patient-centered communication and shared decision-making can be vital in improving care transitions and reduce hospital readmissions. We suggest that health care professionals pay attention to the role and capacity of informal caregivers during care transitions and the recovery period after hospital discharge to prevent possible postdischarge problems.


Metritis in dairy herds: an epidemiological approach with special reference to ovarian cyclicity.
A four year retrospective study of metritis cases was performed in two dairy herds of 95 to 140 cows (herd A) and 60 cows (herd B). Systematic clinical examination and plasma progesterone analysis for ovarian status assessment were performed at 30 days after parturition. Calving conditions had been recorded earlier. These two herds were characterized by a high incidence of metritis (20 to 40% of the calving cows according to year or herd). Higher incidences were found (1) in Spring and (2) in females with difficult calvings. The major findings were that: (1) there was a 50% risk (approximately) that non-cycling females, at 30-37 days post-partum would be suffering from metritis, as opposed to a 34% risk in cycling animals (P less than 0.05); (2) there was no individual susceptibility to this infection. It has been suggested that for better monitoring and more effective treatment, this cyclicity factor should be given careful consideration.


Epigenetics and Pregnancy: Conditional Snapshot or Rolling Event.
Epigenetics modification such as DNA methylation can affect maternal health during the gestation period. Furthermore, pregnancy can drive a range of physiological and molecular changes that have the potential to contribute to pathological conditions. Pregnancy-related risk factors include multiple environmental, behavioral, and hereditary factors that can impact maternal DNA methylation with long-lasting consequences. Identification of the epigenetic patterns linked to poor pregnancy outcomes is crucial since changes in DNA methylation patterns can have long-term effects. In this review, we provide an overview of the epigenetic changes that influence pregnancy-related molecular programming such as gestational diabetes, immune response, and pre-eclampsia, in an effort to close the gap in current understanding regarding interactions between the environment, the genetics of the fetus, and the pregnant woman.


Open release and a hinged external fixator for the treatment of elbow stiffness in young patients.
Elbow stiffness is a well-recognized complication following elbow trauma, but little information is available regarding the surgical treatment of elbow stiffness in children and adolescents. This article presents the results of open arthrolysis with twin incisions and a hinged external fixator to treat severe elbow contracture in children and adolescents. Twenty-one patients (mean age, 14.9 years; range, 7-19 years) were evaluated. All patients underwent surgery using a hinged external fixator and a combined mediolateral approach to address the elbow contracture. Mayo elbow score and range of motion (ROM) were measured preoperatively and at 3, 12, and 24 months postoperatively. All but 1 patient achieved a functional ROM of 100°. Preoperatively, mean flexion was 70.2° (range, 30°-100°), extension was 42.6° (range, 0°-80°), and total ROM was 28.5° (range, 0° to 80°); postoperatively, mean flexion improved to 122.8° (range, 90°-140°), extension to 10° (range, 0°-30°), and total ROM to 114.5° (range, 60°-140°). The Mayo elbow score improved from a mean of 48 points (range, 35-65 points) to 90 points (range, 75-100 points), and 9 patients had excellent results, 7 had good results, 4 had fair results, and 1 had a poor result. No significant differences existed between postoperative measurements at 3, 12, and 24 months. No pin-tract infections or deep infections occurred, and no vascular or neurological complications were noted. Surgical treatment of elbow stiffness using a hinged external fixator and open arthrolysis is an effective procedure in children and adolescents.


Dipo: a miniaturized hopping robot via lightweight and compact actuator design for power amplification.
Kangaroo rats are well known as representative hoppers in small-scale animals. Especially kangaroo rats show rapid movement when a predator approaches. If this amazing motion can be applied to small-scale robots, they will be able to traverse lands at high speed while overcoming size limitations. To take advantage of hopping locomotion, in this paper, we present a lightweight and small-scale clutch-based hopping robot called Dipo. To make this possible, a compact power amplifying actuation system has been developed using a power spring and an active clutch. The power spring is possible to take out and use the accumulated energy little by little whenever the robot starts to hop. Moreover, the power spring needs low torque to charge the elastic energy, and a only tiny space is required to install. The active clutch controls the motion of hopping legs by adjusting the timing of energy release and storage. Thanks to these design strategies, the robot weighs 45.07 g, has the height of 5 cm in the stance phase, and achieves the maximum hopping height of 54.9 cm.


Characterization of novel polyomaviruses from Bornean and Sumatran orang-utans.
Serological screening of sera from orang-utans demonstrated a high percentage of sera that cross-reacted with antigens of the polyomavirus (PyV) simian virus 40. Analysis of archival DNA samples from 71 Bornean and eight Sumatran orang-utans with a broad-spectrum PCR assay resulted in the detection of PyV infections in 11 animals from both species. Sequence analysis of the amplicons revealed considerable differences between the PyVs from Bornean and Sumatran orang-utans. The genome from two PyVs, one from each species, was therefore amplified and sequenced. Both viral genomes revealed a characteristic PyV architecture, but lacked an obvious agnogene. Neighbour-joining analysis positioned the viruses in a large cluster together with viruses from bats, bovines, rodents and several primate PyVs from chimpanzees, African green monkeys, squirrel monkeys and the human Merkel cell PyV.


Instrumentation and methods for rapid estimation of selected viscoelastic parameters in foods.
A new method to estimate the selected viscoelastic parameters of foods using damped vibration analysis is presented for the evaluation of fruits and baked products. A flat disk is attached to the flat sample surface using a laser rangefinder that measures the sample thickness in advance, and it is locked by a trigger. Next, the trigger is released to allow the probe to press the sample through the force of gravity. The damped vibration of the probe caused by the deformation of the food is measured by monitoring the displacement of the probe via a linear encoder. The bulk modulus and viscosity are estimated using the fractional Zener model and mass. Young's modulus (E) is estimated independently by determining the maximum velocity of the probe using Hooke's law. Poisson's ratio (ν), and the shear modulus and viscosity are calculated by employing the estimated E and bulk modulus. The bulk modulus, bulk viscosity, shear modulus, shear viscosity, and E of apples were found to be higher than those of bananas. The bulk modulus, bulk viscosity, E, and shear modulus for white bread were lower than those for pound cake, but the ν values were higher, whereas those of sponge cake were intermediate. After drying the baked products for 1 day, most of the parameters of the samples increased, but the value of ν for white bread decreased. The proposed free-falling device estimated the four viscoelastic coefficients, Poisson's ratio, and Young's modulus of the food sample in less than 1 s.


Addressing Health Equity and Racism Through a Hispanic Psychiatry Fellowship.
The scarcity of bilingual psychiatrists, as well as appropriate mental health services for populations with limited English proficiency, has led to inequitable health outcomes. A fellowship program was developed, which draws from a clinical model staffed by bilingual (Spanish-English) professionals from racial-ethnic minority groups, to address access to care and the structural determinants of health. This new Hispanic Psychiatry Fellowship focuses on health inequality and racism in policy and leadership, clinical care for Spanish-speaking patients, cultural psychiatry, recovery, forensics, substance use, and education. This column describes the program's development, first 2 years of implementation, and feasibility indicators for use in creating similar programs.


Opioid Use Disorder and Pregnancy.
Over-prescription of opioid pain medications and increases in heroin use have contributed to the sharp rise in opioid-related hospitalizations and overdose deaths among young adults in the United States, including pregnant women. This has imposed substantial direct and indirect costs to our nation's health care system. Effective treatment with methadone and buprenorphine is available, but significant barriers to care may restrict access for many. Improved screening tools and expanded access to treatments for substance use disorders are keys to addressing the epidemic of opioid use disorder.


Chemical characterization and biological activities of Simmondsia chinensis (Link) C. K. Schneid seeds oil.
The chemical composition, main physicochemical properties, and biological activities of Simmondsia chinensis (S. chinensis) seeds oil were studied. The results revealed that the physiochemical characteristics of S. chinensis seeds oil were as follows: acid values 1.15 mg KOH/g, peroxide values 8.00 meq O2 Kg-1, iodine values 80.00 g/100 g of oil and saponification values 92.00 mg KOH/g, phenolic content 50.91 mg gallic acid equivalents/g extract. Gas chromatography analysis indicated that eicosenoic (55.50 %), erucic (20.43 %) and oleic (19.01 %) acids were the most abundant, saturated and unsaturated, fatty acids in the oil. Moreover, the evaluation of their antioxidant (DPPH, TAC), antibacterial, antidiabetic and acetylcholinesterase evinced interesting results. Seeds of S. chinensis constitute a substitute source for stable vegetable oil and protein with regard to nutritional and industrial applications.


Process and Outcome of Community Engagement Event on Substance Use and Addiction Risks Facing Their Immigrant Communities in Regina, Saskatchewan.
Canada is a significant destination for immigrants who are drawn from different ethnic and cultural backgrounds some of whom have a hidden risk for substance use disorders due to acculturation stress and are not screened for risks of substance use or addiction when considering medical admissibility. Not surprisingly, healthcare providers in Regina are reporting a noticeable increase in substance use among immigrants. These immigrants experience barriers in seeking substance use prevention and treatment services due to diverse challenges: stigma, shame, and lack of knowledge of existing services. Considering the discussed challenges and risks of substance use disorders in immigrant communities, creating a safe space for discussing these topics is urgent. To understand and address these challenges, a connection grant from the Saskatchewan Health Research Foundation (SHRF) to mobilize immigrant communities in Regina to explore substance use issues and their impact on the community was sought and received. Subsequently, a Zoom knowledge-sharing event brought settlement agency stakeholders together to deliberate issues on substance use and addiction faced by immigrants in Regina, Saskatchewan. The Zoom session included presentations on immigrants and substance use from the clinical, community, and lived experience perspectives of immigrants. Because of the challenges and risks, this community consultation process revealed that acculturation stress and the ease of obtaining socially acceptable substances fuel substance use and addiction among immigrants in Regina; this is further exacerbated by the lack of programming available to prevent and reduce the risks of substance use in this population. A team of knowledge keepers with lived experiences, service providers, and researchers was assembled to explore substance use and addiction among immigrants. This manuscript reports the process of community engagement to identify solutions to this budding issue. The strengths, challenges, and lessons learned are identified.


Unresolved orthology and peculiar coding sequence properties of lamprey genes: the KCNA gene family as test case.
In understanding the evolutionary process of vertebrates, cyclostomes (hagfishes and lamprey) occupy crucial positions. Resolving molecular phylogenetic relationships of cyclostome genes with gnathostomes (jawed vertebrates) genes is indispensable in deciphering both the species tree and gene trees. However, molecular phylogenetic analyses, especially those including lamprey genes, have produced highly discordant results between gene families. To efficiently scrutinize this problem using partial genome assemblies of early vertebrates, we focused on the potassium voltage-gated channel, shaker-related (KCNA) family, whose members are mostly single-exon. Seven sea lamprey KCNA genes as well as six elephant shark genes were identified, and their orthologies to bony vertebrate subgroups were assessed. In contrast to robustly supported orthology of the elephant shark genes to gnathostome subgroups, clear orthology of any sea lamprey gene could not be established. Notably, sea lamprey KCNA sequences displayed unique codon usage pattern and amino acid composition, probably associated with exceptionally high GC-content in their coding regions. This lamprey-specific property of coding sequences was also observed generally for genes outside this gene family. Our results suggest that secondary modifications of sequence properties unique to the lamprey lineage may be one of the factors preventing robust orthology assessments of lamprey genes, which deserves further genome-wide validation. The lamprey lineage-specific alteration of protein-coding sequence properties needs to be taken into consideration in tackling the key questions about early vertebrate evolution.


[Dermatosis and depressive symptoms].
Dermatological diseases modify and impair patients' self-image and can result in considerable psychological suffering. The purpose of this study was to determine the prevalence of depressive symptoms in patients consulting for dermatological diseases. A prospective study was carried out on 5 successive days at the dermatology department of the Saint-Louis Hospital in Paris. A questionnaire designed to assess depressive symptoms, the CES-D, was given to all patients consulting throughout the study period. This self-assessment scale for depression was devised by the National Institute of Mental Health and has been validated over more than 20 years by means of hundreds of large-scale epidemiological studies in both general and selected patient populations. On completion of the 5-day study, 879 questionnaires had been collected. The sex-ratio was 53.4% women to 46.6% men. The prevalence of depressive symptoms as evaluated by the questionnaire was 23.6% for a total of 774 evaluable dossiers. Patients consulting without an appointment (n = 172) represented 22% of study subjects versus 78% attending a scheduled visit (n = 602). Depressive symptoms were found in 31.4% of patients consulting without an appointment versus 21.4% of patients with an appointment (p<0.01). Male patients consulting without an appointment constituted the most fragile group, with depressive symptoms being seen in 38.8% of this population. The prevalence of depressive symptoms among patients seen at a hospital dermatology department was 23.6% in this study. This figure was significantly higher among patients consulting without an appointment, and among men in particular. It was equal to or higher than that seen among patients considered as having more incapacitating or painful conditions as assessed using the same questionnaire. The incidence of concomitant depression should prompt dermatologists to investigate for its existence and to take appropriate therapeutic measures in order to reduce the mental suffering of their patients.


Social support, social problem-solving abilities, and adjustment of family caregivers of stroke survivors.
To determine contributions of social support and social problem-solving abilities in prediction of adjustment of family caregivers of stroke survivors. Descriptive. Two rehabilitation facilities (1 private, 1 state) in the southeastern United States. Fifty-two family caregivers (46 women, 6 men) of stroke survivors (28 women, 24 men). Not applicable. Predictor variables were social support and social problem-solving abilities. Outcome measures of caregiver adjustment were depressive symptomatology, well-being, and general health. Participants completed these measures 1 to 2 days before discharge from inpatient rehabilitation and at 5, 9, and 13 weeks postdischarge in the home. Trajectory analysis indicated higher levels of social support were associated with lower levels of caregiver depressive symptomatology and higher levels of well-being and general health, independent of social problem solving. A greater negative problem orientation was associated with higher levels of depressive symptomatology and lower levels of well-being. A more positive problem orientation was associated with greater increases in general health. The strength or slope of this positive relation lessened over time. Social support and the emotion-focused component of social problem solving, problem orientation, independently contribute to caregiver adjustment. Interventions that provide social support and assist caregivers to develop more adaptive abilities toward problem solving may be beneficial.


Synthesis of the Tricyclic Ring Structure of Daphnanes via Intramolecular [4 + 3] Cycloaddition/SmI2-Pinacol Coupling.
A synthetic approach toward the tricyclic 5,7,6-membered ring structure of daphnane-family natural products is described. An intramolecular [4 + 3] cycloaddition reaction of furan with an oxypentadienyl cation constructed the oxa-bridged bicyclic structure in a stereoselective fashion. Structural analysis revealed that the desired exo isomer was predominantly acquired through epimerization. Finally, formation of the five-membered ring was achieved through SmI2-mediated pinacol coupling.


A calcification-related calmodulin-like protein in the oyster Crassostrea gigas mediates the enhanced calcium deposition induced by CO2 exposure.
Calcium transportation and homeostasis are essential for marine bivalves to maintain basic metabolism and build their shells. Calmodulin-like proteins (CaLPs) are important calcium sensors and buffers and can respond to ocean acidification (OA) in marine calcifiers. However, no further study of their physiological function in calcium metabolism under elevated CO2 has been performed. Here, we identified a novel CaLP (designated CgCaLP) in the Pacific oyster Crassostrea gigas and demonstrated its participation in the calcification process: the mRNA expression level of CgCaLP peaked at the trochophore larval stage and remained high at stages when shells were shaped; the mRNA and protein of CgCaLP were more highly expressed in mantle tissue than in other tissues. Under elevated CO2 levels, the protein expression level of CgCaLP in hemocytes increased, while in contrast, significantly decreased protein levels were detected in gill and mantle tissues. Shell dissolution caused the imbalance of calcium in hemocytes and decreased calcium absorption and transportation demand in gill and mantle tissues, inducing the molecular function allocation of CgCaLP under CO2 exposure. Despite the decreased protein level in mantle tissue, CgCaLP was found to translocate to outer mantle epithelium (OME) cells where condensed calcium-rich deposits (CRDs) were detected. We further demonstrated that CgCaLP mRNA and protein expression levels could respond to seawater Ca2+ availability, suggesting that the calcium deposition capacity of oysters might be enhanced to fight against shell dissolution problems and that CgCaLP might serve as an essential participator of the process. In summary, CgCaLP might enhance calcium deposition under CO2 exposure and thus play a significant and flexible molecular function involved in a compensation strategy of oysters to fight against the acidified ocean.


Testing a biopsychosocial model of the basic birth beliefs.
Women perceive what birth is even before they are pregnant for the first time. Part of this conceptualization is the basic belief about birth as a medical and natural process. These two separate beliefs are pivotal in the decision-making process about labor and birth. Adapting Engel's biopsychosocial framework, we explored the importance of a wide range of factors which may contribute to these beliefs among first-time mothers. This observational study included 413 primiparae ≥24 weeks' gestation, recruited in medical centers and in natural birth communities in Israel. The women completed a questionnaire which included the Birth Beliefs Scale and a variety of biopsychosocial characteristics such as obstetric history, birth environment, optimism, health-related anxiety, and maternal expectations. Psychological dispositions were more related to the birth beliefs than the social or biomedical factors. Sociodemographic characteristics and birth environment were only marginally related to the birth beliefs. The basic belief that birth is a natural process was positively related to optimism and to conceiving spontaneously. Beliefs that birth is a medical process were related to pessimism, health-related anxiety, and to expectations that an infant's behavior reflects mothering. Expectations about motherhood as being naturally fulfilling were positively related to both beliefs. Psychological factors seem to be most influential in the conceptualization of the beliefs. It is important to recognize how women interpret the messages they receive about birth which, together with their obstetric experience, shape their beliefs. Future studies are recommended to understand the evolution of these beliefs, especially within diverse cultures.


[Benefit of ultrasound in the early management of patients in shock].
Shock is a hemodynamic situation that aggravates the vital prognostic of every patient regardless of the underlying pathology. It has been well documented that the speed at which hemodynamics is restored to standard values significantly decreases the mortality and morbidity in these patients. Initially described in traumatology, then in every type of shock, the contribution of ultrasonography performed at the bedside by the physician in charge allows for a significant shortening of the diagnostic procedure and thus an earlier start for a goal-directed treatment.


Oxidative Stress in Intracerebral Hemorrhage: Sources, Mechanisms, and Therapeutic Targets.
Intracerebral hemorrhage (ICH) is associated with the highest mortality and morbidity despite only constituting approximately 10-15% of all strokes. Complex underlying mechanisms consisting of cytotoxic, excitotoxic, and inflammatory effects of intraparenchymal blood are responsible for its highly damaging effects. Oxidative stress (OS) also plays an important role in brain injury after ICH but attracts less attention than other factors. Increasing evidence has demonstrated that the metabolite axis of hemoglobin-heme-iron is the key contributor to oxidative brain damage after ICH, although other factors, such as neuroinflammation and prooxidases, are involved. This review will discuss the sources, possible molecular mechanisms, and potential therapeutic targets of OS in ICH.


Development of a Novel Hygiene Monitoring System Based on the Detection of Total Adenylate (ATP+ADP+AMP).
ATP is the universal energy molecule found in animals, plants, and microorganisms. ATP rapid hygiene monitoring tests have been employed in the food industry to ensure that adequate cleanliness is being maintained. However, because ATP is hydrolyzed to ADP and AMP by metabolic processes, by heat treatment, or under acidic or alkaline conditions, total adenylate (ATP+ADP+AMP [A3]) could be a more reliable sanitation indicator of food residues that may cause biofilm formation and allergen contamination. Therefore, a novel hygiene monitoring system to measure A3 was developed based on the luciferin-luciferase assay with the combination of two enzymes, pyruvate kinase and pyruvate phosphate dikinase, that can convert ADP into ATP and recycle AMP into ATP, respectively. The newly developed A3 assay system afforded stable bioluminescence signals and equivalent linear calibration curves between relative light units (RLU) and the amounts of ATP, ADP, and AMP, respectively. To verify the significance of the A3 method, the ratios of ATP, ADP, and AMP in various food samples were determined; large amounts of ADP and AMP were found in a variety of foods, such as meat, seafood, dairy, nuts, fruits, vegetables, and fermented foods. Sanitation monitoring of stainless steel exposed to raw meat was also examined, and the A3 method achieved a 200-RLU level, the typical benchmark value, after complete washing with detergent and rinsing. In contrast, a conventional ATP method showed less than 200 RLU after only a light cold and hot water rinse. In conclusion, the A3 assay appeared to be suitable for detection of adenylates from food residues that are not detected by the conventional ATP assay.


[Mucocele of the maxillary sinus. Apropos of 60 cases from the stomatology department of the Cardiology Hospital in Lyon].
60 cases of maxillary sinus mucosal cyst diagnosed in patients with cardio-vascular pathology, are reported. Symptoms, histology and treatment are recalled. Surgical excision (or sinusoscopy) seems to be necessary in "high risk" patients (8.4% of asymptomatic infection).


Identification of distinct populations of prostasomes that differentially express prostate stem cell antigen, annexin A1, and GLIPR2 in humans.
In addition to sperm cells, seminal fluid contains various small membranous vesicles. These include prostasomes, membrane vesicles secreted by prostate epithelial cells. Prostasomes have been proposed to perform a variety of functions, including modulation of (immune) cell activity within the female reproductive tract and stimulation of sperm motility and capacitation. How prostasomes mediate such diverse functions, however, remains unclear. In many studies, vesicles from the seminal plasma have been categorized collectively as a single population of prostasomes; in fact, they more likely represent a heterogeneous mixture of vesicles produced by different reproductive glands and secretory mechanisms. We here characterized membranous vesicles from seminal fluid obtained from vasectomized men, thereby excluding material from the testes or epididymides. Two distinct populations of vesicles with characteristic sizes (56 ± 13 nm vs. 105 ± 25 nm) but similar equilibrium buoyant density (∼1.15 g/ml) could be separated by using the distinct rates with which they floated into sucrose gradients. Both types of vesicle resembled exosomes in terms of their buoyant density, size, and the presence of the ubiquitous exosome marker CD9. The protein GLIPR2 was found to be specifically enriched in the lumen of the smaller vesicles, while annexin A1 was uniquely associated with the surface of the larger vesicles. Prostate stem-cell antigen (PSCA), a prostate-specific protein, was present on both populations, thereby confirming their origin. PSCA was, however, absent from membrane vesicles in the seminal fluid of some donors, indicating heterogeneity of prostasome characteristics between individuals.


Prevalence of ethanol and other potentially harmful excipients in pediatric oral medicines: survey of community pharmacies in a Nigerian City.
Excipients are needed in the formulation of oral liquid medicines intended for children; they have however been reported to trigger safety issues. This study evaluated the concentrations and prevalence of ethanol and other potentially harmful excipients in pediatric formulations marketed in South Eastern Nigeria in line with international labeling guidelines and allowable daily limits (ADL). The study sampled oral pediatric formulations offered for sale in registered pharmacies. Those with accessible information leaflets were assessed for the presence and quantity of previously flagged excipients with potential to harm the pediatric population. Of the 380 oral pediatric medicines, 140 provided access to list/quantity of ingredients. 47.9% (67) of the formulations contain at least one of the flagged excipients while the remaining only listed the active ingredients. Ethanol had the highest occurrence (62.7%) and was more in cough/cold medicines. A homeopathic cough and cold remedy had concentration of 90% v/v. Ethanol and sucrose in some formulations exhibited concentrations with a potential of crossing their approved daily intake (ADI) (1-90% v/v and 1.7 g-3.7 g/5 ml respectively). Ethanol use in studied pediatric formulations was quite high, with ethanol-containing formulations being prescribed for children 0-6 years and older. Only 26 (38.8%) completely satisfied the labelling requirements for ethanol containing formulations.


A comprehensive and quantitative exploration of thousands of viral genomes.
The complete assembly of viral genomes from metagenomic datasets (short genomic sequences gathered from environmental samples) has proven to be challenging, so there are significant blind spots when we view viral genomes through the lens of metagenomics. One approach to overcoming this problem is to leverage the thousands of complete viral genomes that are publicly available. Here we describe our efforts to assemble a comprehensive resource that provides a quantitative snapshot of viral genomic trends - such as gene density, noncoding percentage, and abundances of functional gene categories - across thousands of viral genomes. We have also developed a coarse-grained method for visualizing viral genome organization for hundreds of genomes at once, and have explored the extent of the overlap between bacterial and bacteriophage gene pools. Existing viral classification systems were developed prior to the sequencing era, so we present our analysis in a way that allows us to assess the utility of the different classification systems for capturing genomic trends.


[Elderly patient with non specific multiple ulcer of the small intestine associated with nutritional edema and anemia].
An 83-year-old woman had felt malaise. Blood examination showed renal failure, anemia, and hypoproteinemia. On the 7th day, she suddenly had tarry stool. But, gastroscopy and colonfiberscopy disclosed no remarkable abnormality on the mucosal surface of the stomach, the duodenum and the large intestine. On the 10th day, her symptom became aggravated, and emergency laparotomy and endoscopy in the small intestine was scheduled. After the jejunotomy, she underwent endoscopy of the small intestine. The endoscopic examination showed multiple ulcer of the jejunum, and she underwent jejunectomy. Pathologic examination diagnosed her as having non specific multiple ulcer of the small intestine with jejunal lesion.


A phenomenological exploration of loneliness in the older adult.
Loneliness is an important phenomenon of concern for psychiatric mental health nursing. Research findings have related loneliness in older adults to mental health problems especially depression. However, little is known about loneliness from the perspective of older adults living in the community. A phenomenological inquiry using Giorgi's research methodology was undertaken to explore and describe the meaning of loneliness for older adults. Twenty participants, most who are over the age of 75, were interviewed and 1385 naïve meaning units were extrapolated from tape-recorded verbatim transcripts. These units were clustered into five major themes describing the loneliness experience. The findings are described and discussed relative to the literature on loneliness. Implications for mental health nursing are presented.


Precision medicine and personalising therapy in pulmonary hypertension: seeing the light from the dawn of a new era.
Pulmonary hypertension (PH) and pulmonary arterial hypertension (PAH) include different cardiopulmonary disorders in which the interaction of multiple genes with environmental and behavioural factors modulates the onset and the progression of these severe conditions. Although the development of therapeutic agents that modulate abnormalities in three major pathobiological pathways for PAH has revolutionised our approach to the treatment of PAH, the long-term survival rate remains unsatisfactory. Accumulating evidence has underlined that clinical outcomes and responses to therapy in PAH are modified by multiple factors, including genetic variations, which will be different for each individual. Since precision medicine, also known as stratified medicine or personalised medicine, aims to better target intervention to the individual while maximising benefit and minimising harm, it has significant potential advantages. This article aims to assemble and discuss the different initiatives that are currently underway in the PH/PAH fields together with the opportunities and prospects for their use in the near future.


Community Capacity Building for Physical Activity Promotion among Older Adults-A Literature Review.
Community-based interventions to promote physical activity (PA) among older adults are of high interest in health promotion since they promise to be effective strategies to reach this population group. Community capacity building, that is, the local promotion of knowledge, skills, commitment, structures, and leadership, is among the recommended core strategies. However, little guidance is provided on how to achieve a high degree of community capacity. This study aims to identify practical strategies to enhance community capacities for PA promotion among older adults (50 years or older) and to evaluate their success. A literature review was conducted using scientific databases (PsycInfo and Web of Sciences) and grey literature (national and international project databases), and 14 studies (16 articles) were identified. Five groups of capacity building strategies emerged from the literature: (1) building community coalitions and networks, (2) training of professionals, (3) training of laypersons, (4) strengthening competence and awareness in the target population, and (5) allocation of financial resources. All studies used more than one strategy. Coalition building and strengthening competence and awareness were most frequently used. Feasibility and acceptability of the capacity building strategies were demonstrated. However, intervention effects on PA behavior and other relevant outcomes were inconsistent. The one study that systematically compared different capacity building approaches did not find any evidence for beneficial effects of intensified capacity building. More rigorous research evaluating the efficacy of specific strategies to enhance community capacities for PA promotion is needed.


Assessing Preference in a Paired-Stimulus Arrangement with Captive Vultures (Aegypius Monachus).
Vultures play an important role in our ecosystem by filtering out bacteria and viruses harmful to humans (e.g., rabies, botulism). However, many vultures remain in human care due to skill deficits and behavioral excesses, which can be treated using behavior-management practices that rely on effective (often edible) reinforcers. The current study replicated the forced-choice or paired-stimulus preference assessment with five birds of prey. Across all vultures, participants displayed a preference for animal (e.g., meat) over nonanimal stimuli (e.g., fruit), and mice meat was the most preferred edible for 4 of the 5 vultures. The application of this methodology to birds of prey might allow rehabilitators, conservationists, and other caretakers to make greater gains in training vultures to both acquire new skills and decrease problem behavior using highly preferred edible items.


Identification, management and care of refugee patients at a metropolitan public health service: a healthcare worker perspective.
Objective To describe the perceptions of healthcare workers employed at a metropolitan public health service, with respect to how they identify, manage and care for refugee patients. Methods This study surveyed healthcare workers using a cross-sectional, mixed methods descriptive design, which partially replicates a previous Australian study. A total of 215 responses to a brief online survey were received (n=48 medical, n=100 nursing and midwifery, n=50 allied health, n=4 other). Results Nurses and allied health respondents were more likely to record working with refugees rarely or never (P=0.00). Most respondents (70.3%) identified no negative effects from working with refugees, and perceived this patient group enhanced (71.3%) their work. Insufficient identification, interpreter availability, education, healthcare worker capacity and providing culturally specific treatment were all identified as potential service barriers. Allied health respondents were more likely to report low confidence about working with refugees in general (P=0.04). Respondents with more than 10 years' experience with refugees (P=0.02), and those with good self-perceived awareness of community services (P=0.01), were more confident in their ability to manage social issues. Conclusions This study suggests that contextual factors influence the perceptions of healthcare workers who provide care to refugee patients; however, communication, health literacy and healthcare worker capacity were consistently raised as key issues when working with refugees. What is known about the topic? Refugee and asylum seeker patients may present with complex health needs to any part of the Australian health system. The majority of previous research has occurred in primary care settings. What does this paper add? This study adds an acute and subacute perspective to the evidence base, and also includes medical respondents for the first time. Compared to previous research, respondents of this study saw refugee patients more frequently in their practice, and also reported fewer negative effects from working with them. Most demographic characteristics had no significant effect on worker-reported confidence in this study; however, greater experience of working with refugees and good self-perceived awareness of community services were both identified as positive influences. What are the implications for practitioners? Practitioners should prioritise remedying barriers that are consistently identified as affecting the service provided to refugee patients (communication, health literacy and healthcare worker capacity) as part of their quality and service improvement efforts.


Monoallelic gene expression and mammalian evolution.
Monoallelic gene expression has played a significant role in the evolution of mammals enabling the expansion of a vast repertoire of olfactory receptor types and providing increased sensitivity and diversity. Monoallelic expression of immune receptor genes has also increased diversity for antigen recognition, while the same mechanism that marks a single allele for preferential rearrangement also provides a distinguishing feature for directing hypermutations. Random monoallelic expression of the X chromosome is necessary to balance gene dosage across sexes. In marsupials only the maternal X chromosome is expressed, while in eutherian mammals the paternal X genes are silenced in the developing placenta and early blastocyst. These examples of epigenetic gene regulation commonly employ asynchrony of replication, the binding of polycomb proteins and antisense RNA, and histone modifications to chromatin structure. The same is true for genomic imprinting which among vertebrates is unique to mammals and represents a special kind of epigenetic modification that is heritable according to parent of origin. Genomic imprinting pervades many aspects of mammalian growth and evolution but in particular has played a significant role in the co-adaptive evolution of the mother and foetus.


Impact of the Geriatric Nutritional Risk Index on the Long-Term Outcomes of Patients Undergoing Open Bypass for Intermittent Claudication.
Nutritional status has been reported to be a predictor of the outcomes of critical limb ischemia. However, there have been no reports of the association between nutritional status and the prognosis of patients with intermittent claudication (IC). The aim of this study was to examine whether or not the geriatric nutritional risk index (GNRI) is independently associated with the long-term outcomes of elderly patients following open bypass for IC.Methods and Results:The preoperative nutritional status of patients aged ≥65 years undergoing infrainguinal bypass for IC between 1991 and 2017 was retrospectively evaluated using the GNRI. Patients were divided into 3 groups based on the GNRI: Group I (normal nutritional risk), GNRI >98; Group II (low nutritional risk), GNRI 92 to ≤98; Group III (moderate to high nutritional risk), GNRI <92. The amputation-free survival (AFS), overall survival, and freedom from cardiovascular death up to 5 years were calculated by Kaplan-Meier method and a multivariate analysis was performed to detect independent predictors of each outcome. Group I showed superior outcomes to Group III for each of the 3 outcomes and the multivariate analysis showed that GNRI was an independent predictor of AFS. The GNRI was independently associated with the AFS of elderly patients who underwent open bypass for IC.


Postbiopsy arteriovenous fistula in renal allograft: An ultrasound case study.
Arteriovenous fistula is a well-known but rarely diagnosed complication of percutaneous renal biopsy. On Doppler sonography, these fistulae are characterized by a region of high velocity shifts and random color assignment due to vibrating interfaces in the perivascular tissue. Most of them resolve spontaneously, while larger symptomatic ones need intervention.


Nitric oxide activation by progesterone suppresses ATP-induced ciliary activity in oviductal ciliated cells.
Ciliary beat frequency (CBF) regulates the oviductal transport of oocytes and embryos, which are important components of the reproductive process. Local release of ATP transiently increases CBF by increasing [Ca2+]i. Ovarian hormones also regulate ciliary activity and oviductal transport. Progesterone (P4) induces nitric oxide (NO) production and high P4 concentrations induce ciliary dysfunction. However, the mechanism by which P4 affects CBF has not been elucidated. To evaluate the role of P4 in NO production and its effect on ATP-induced increases in CBF, we measured CBF, NO concentrations and [Ca2+]i in cultures of oviductal ciliated cells treated with P4 or NO signalling-related molecules. ATP induced a [Ca2+]i peak, followed by an increase in NO concentrations that were temporally correlated with the decreased phase of the transiently increased CBF. Furthermore, P4 increased the expression of nitric oxide synthases (iNOS and nNOS) and reduced the ATP-induced increase in CBF via a mechanism that involves the NO signalling pathway. These results have improved our knowledge about intracellular messengers controlling CBF and showed that NO attenuates oviduct cell functions. Furthermore, we showed that P4 regulates neurotransmitter (ATP) actions on CBF via the NO pathway, which could explain pathologies where oviductal transport is altered and fertility decreased.


[Giant orthotopic ureterocele. Diagnosis by ureteral jet detection with doppler color ultrasonography].
To present an additional case of orthotopic ureterocele in a patient that consulted for hematuria and outlet obstruction, with special reference to the utility of non-invasive color doppler ultrasound in the diagnosis of this condition. This condition was suspected on detecting a ureteral jet inside a cystic lesion of the bladder. The diagnosis was confirmed by IVP and cytoscopy. Treatment was by transurethral resection with good functional results. Color doppler ultrasound is useful for the diagnosis of ureteroceles, particularly in patients in whom contrast or ionizing radiation must be avoided.


Dental anomalies of the permanent lateral incisors and prevalence of hypodontia outside the cleft area in complete unilateral cleft lip and palate.
To determine in complete unilateral cleft lip and palate (UCLP) subjects the characteristics (location, shape) of the cleft-side lateral incisor. The presence of a supernumerary tooth at the cleft side and the prevalence of hypodontia outside the cleft area were evaluated. A comparison was made of the shape of the cleft side lateral incisor to its contralateral incisor. Hospital for Rehabilitation of Craniofacial Anomalies (HRCA), Sao Paulo, Brazil. Orthopantomograms of 203 subjects with UCLP and without syndromes were chronologically selected from the HRCA data bank, within an age range of 5 to 10 years. Orthopantomograms were analyzed by the same observer according to established criteria. There were no statistically significant differences between sexes for any of the criteria studied. The cleft-side lateral incisor was present in 50.2%, and it was more commonly located at the distal side (76.5%). The congenital absence of the cleft-side lateral incisor was observed in 49.8% of the sample, and its antimere was congenitally missing in 10.9%, this difference being statistically significant. The most commonly missing tooth outside the cleft area was the maxillary second premolar. The high prevalence of hypodontia of the permanent lateral incisor in the cleft side showed that the cleft could play an important role in this absence. There were different patterns for the presence of the cleft-side lateral incisor.


Note on the value of Frenzel's glasses for the recognition and qualitative evaluation of spontaneous nystagmus.
Spontaneous nystagmus encountered in neuro-otological practice is nearly always a physical sign of high diagnostic importance. Its localizing value is largely determined by certain of its qualitative characteristics and these are best studied and evaluated by means of the electronystagmograph, but for reasons discussed this is not suitable for use in smaller clinics. For the recognition and qualitative analysis of spontaneous nystagmus the use of Frenzel's glasses used in complete darkness, as recommended by Frenzel himself, has been found to give very satisfactory results.


Development of a New Multiple Stimuli-Responsive Fluorescent Material Using the Minus Strategy Based on the Structure of Tetraphenyl-1,3-butadiene.
In this study, we designed and synthesized a new class of aggregation-induced emission luminogens, which was inspired and developed from the structure of tetraphenyl-1,3-butadienes derivative (TPB-1) through the minus strategy by removing one of the phenyl groups. Among them, L1 and L4 exhibited an aggregation-induced emission effect and multistimuli-responsive chromic behavior. Moreover, two types of single crystals of L1 were obtained, and their different emission behaviors were elucidated clearly by analyzing the single-crystal data.


Management of gingival inflammation in orthodontic patients with ozonated water irrigation--a pilot study.
Ozonated water irrigation has recently been tried for its antimicrobial and anti-inflammatory effects in treatment of periodontitis. During orthodontic treatment, gingival inflammation occurs along with increased lactate dehydrogenase (LDH) enzyme levels in gingival crevicular fluid (GCF). Thus, the aim of this pilot study was to evaluate the clinical effects of a single subgingival irrigation with ozonated water on gingival inflammation in orthodontic patients and also to correlate the clinical effects with LDH enzyme activity in GCF. Fifteen systemically healthy orthodontic patients (seven men and eight women, mean age 17.3 years) with full-mouth brackets were included in this prospective, cross-sectional, clinical and laboratory investigation. Clinical parameters, LDH enzyme activity and GCF volume were measured at baseline (0 day) followed by subgingival irrigation with 0.01 mg l(-1) ozonated water. These parameters were again assessed on 14th and 28th day. There was significant (P < 0.05) reduction in values of clinical parameters, GCF LDH activity and GCF volume after subgingival irrigation with ozonated water. Also, a significant correlation (r = 0.50, P = 0.01) was observed only between the post-treatment changes of plaque index and LDH values, among the clinical parameters assessed. A single subgingival irrigation of 0.01 mg l(-1) ozonated water can effectively reduce the gingival inflammation in orthodontic patients, which is also reflected in the reduction of LDH enzyme levels. However, further randomized controlled trials are required to validate the use of ozone irrigation in orthodontic patients for plaque control measures.


Olanzapine prolongs cardiac repolarization by blocking the rapid component of the delayed rectifier potassium current.
Prolongation of the QT interval has been observed during treatment with olanzapine, a thienobenzodiazepine antipsychotic agent. Our objectives were 1) to characterize the effects of olanzapine on cardiac repolarization and 2) to evaluate effects of olanzapine on the major time-dependent outward potassium current involved in cardiac repolarization, namely I(Kr) (I(Kr): rapid component of the delayed rectifier potassium current).Isolated, buffer-perfused guinea pig hearts (n = 40) were stimulated at different pacing cycle lengths (150-250 msec) and exposed to olanzapine at concentrations ranging from 1 to 100 microM. Olanzapine increased monophasic action potential duration measured at 90% repolarization (MAPD90) in a concentration-dependent manner by 6.7 +/- 0.7 msec at 3 microM but by 26.0 +/- 4.3 msec at 100 microM (250 msec cycle length). Increase in MAPD(90) was also reverse frequency dependent; 30 microM olanzapine increased MAPD90 by 28.0 +/- 6.2 msec at a pacing cycle length of 250 msec but by only 18.9 +/- 2.2 msec at a pacing cycle length of 150 msec. Experiments in HERG-transfected (HERG: human ether-a-gogo-related gene) HEK293 cells (n = 36) demonstrated concentration-dependent block of the rapid component (I(Kr)) of the delayed rectifier potassium current: tail current was decreased 50% at olanzapine 3.8 microM. Olanzapine possesses direct cardiac electrophysiological effects similar to those of class III anti-arrhythmic drugs. These effects were observed at concentrations that can be measured in patients under conditions of impaired drug elimination such as renal or hepatic insufficiency, during co-administration of other CYP1A2 substrates/inhibitors or after drug overdose. These results offer a new potential explanation for QT prolonging effects observed during olanzapine treatment in patients.


Transcatheter treatment of angina after coronary surgery due to concomitant internal mammary steal and right coronary artery stenosis: a need for staging.
Unligated side branches of the internal mammary artery used as a conduit in bypass surgery can be responsible for a flow steal phenomenon, causing recurrent angina. In this report we describe such a case, which was treated with a transcatheter embolization technique using coils as an alternative to surgery. However, heparin administration for simultaneous balloon dilatation of another lesion delayed successful embolization. Whenever balloon dilatation and embolization have to be performed on the same patient, both procedures should be staged to avoid heparin administration during and after the embolization procedure.


Baboon bearing resemblance in pigmentation pattern to Siamese cat carries a missense mutation in the tyrosinase gene.
An infant hamadryas baboon exhibiting an albino phenotype-white body hair and red eyes-was born to parents with wild-type body color. Pigmentation on some parts of its body surfaced during childhood and progressed with age. This baboon in adulthood has gray hair on parts of its body, such as the tail, distal portion of the legs, and face, with the remainder being white. This pigmentation pattern resembles that of the Siamese cat and the Himalayan variants of the mouse and the mink. The distinguishing phenotypes in these animals are known to be caused by a temperature-sensitive activity of tyrosinase, an enzyme essential for biosynthesis of melanin. We sequenced all the five exons of the tyrosinase (TYR) gene of this albino baboon, which were amplified by PCR, and found a base substitution leading to alteration of the 365th amino acid from Ala to Thr. Tyrosinase requires copper as a cofactor for its enzyme function. It has two copper-binding sites, the second of which contains His residues in positions 363 and 367 that are critical to its function. Thus, p.(Ala365Thr) due to a mutation in the TYR gene is a likely candidate for the cause of the albino phenotype in this baboon.


Bolt-Loosening Detection Using 1D and 2D Input Data Based on Two-Stream Convolutional Neural Networks.
At present, the detection accuracy of bolt-loosening diagnoses is still not high. In order to improve the detection accuracy, this paper proposes a fault diagnosis model based on the TSCNN model, which can simultaneously extract fault features from vibration signals and time-frequency images and can precisely detect the bolt-loosening states. In this paper, the LeNet-5 network is improved by adjusting the size and number of the convolution kernels, introducing the dropout operation, and building a two-dimensional convolutional neural network (2DCNN) model. Combining the advantages of a one-dimensional convolutional neural network (1DCNN) with wide first-layer kernels to suppress high-frequency noise, a two-stream convolutional neural network (TSCNN) is proposed based on 1D and 2D input data. The proposed model uses raw vibration signals and time-frequency images as input and automatically extracts sensitive features and representative information. Finally, the effectiveness and superiority of the proposed approach are verified by practical experiments that are carried out on a machine tool guideway. The experimental results show that the proposed approach can effectively achieve end-to-end bolt-loosening fault diagnoses, with an average recognition accuracy of 99.58%. In addition, the method can easily achieve over 93% accuracy when the SNR is over 0 dB without any denoising preprocessing. The results show that the proposed approach not only achieves high classification accuracy but also has good noise immunity.


Asymmetric synthesis of both enantiomers of point-difluorinated-eldanolide, analogues of insect sex pheromone.
Substitution of two fluorine atoms on organic molecules is expected to alter both chemical reactivity and biological activity due to the strong electron-withdrawing nature of fluorine. The synthesis of partly gem-difluorinated compounds remains a significant challenge to synthetic organic chemists. We report that [2,3]-Wittig rearrangement of 1,1,2-trifluoroallylic ether gave a new type of partly gem-difluorinated allylic alcohol: 6-methyl-4,4,5-trifluorohept-1,5-dien-3-ol, 3, in a highly stereoselective fashion, and optical resolution of alcohol 3 was accomplished via lipase PS(PCL)-catalyzed reaction. Using this alcohol as the starting material, the first asymmetric synthesis of both enantiomers of point-fluorinated-eldanolides, 2,2,5,5,6-pentafluoroeldanolide 1 and 5,5,6-trifluoroeldanolide 2, analogues of the sex pheromone of the male African sugarcane borer, has been demonstrated.


Low-profile 1-piece bifrontal craniotomy for anterior skull base approach and reconstruction.
The anterior skull base is a location of many pathologic lesions. These pathologic lesions are treated by bifrontal craniotomy and anterior skull base approach, either primarily or combined with facial osteotomies. To obtain wide exposure, low-profile craniotomies are preferred. In this article, we attempt to describe our own technique of frontal craniotomy for anterior skull base approach. In this technique, the frontal bone, frontal sinus, and the superior supraorbital bar are elevated in en bloc fashion. Bicoronal skin incision is followed by dissection and retraction of the skin flap in the epigaleal plan. The pericranial galeal flap is dissected separately in subperiosteal fashion until the superior orbital rim. After dissection and retraction of the tip of the temporal muscles, bilateral pterional key burr holes and 1 or 2 parasagittal burr holes are opened. The sagittal burr hole(s) is placed in the point where the upper horizontal surface of the frontal bone slopes vertically downward the forehead. With the craniotome rotating tip (Midas F2/8TA23, Medtronic Inc, Ft Worth, TX), bone cut is made between the pterional key burr holes, passing through the superior orbital bar and the anterior wall of the frontal sinus. To minimize the brain retraction, the operating microscope is placed beside the head, and exposure from the lateral view angle is obtained. Reconstruction of the defect is performed by using pericranial galeal flap and/or Cortoss (Orthovita, Malvern, PA). With this approach, wide exposure of the anterior skull base pathologic lesions was achieved with minimal brain retraction. In the postoperative period, patients tolerated this approach well with favorable functional and cosmetic outcomes. No infections or adverse effects related to this technique or Cortoss were observed. Anterior skull base pathologic lesions can be widely exposed by low-profile bicoronal craniotomy and anterior skull base approach with minimal brain retraction. This wide exposure allows us to gain more control of the pathologic lesion with better resection and reconstruction, reflected on the prognosis of the patients.


[Problems in the management of testicular cancer].
Within the last decade, progress in the management of testicular cancer has been remarkable. It has become a well-known fact that chemotherapy with or without excision of residual tumors can cure far-advanced disease. There are, as yet, unsolved problems such as the management of stage I disease, role of surgery in the treatment of stage III non-seminomatous testicular cancer and testicular damages by chemotherapy and so on. These problems will be discussed in this paper.


Best method for analysis of brain oscillations in healthy subjects and neuropsychiatric diseases.
The research related to brain oscillations and their connectivity is in a new take-off trend including the applications in neuropsychiatric diseases. What is the best strategy to learn about functional correlation of oscillations? In this report, we emphasize combined application of several analytical methods as power spectra, adaptive filtering of Event Related Potentials, inter-trial coherence and spatial coherence. These combined analysis procedure gives the most profound approach to understanding of EEG responses. Examples from healthy subjects, Alzheimer's Diseases, schizophrenia, and Bipolar Disorder are described.


Laparoscopic appendicectomy at the Aga Khan Hospital, Nairobi.
To evaluate our experience of laparoscopic appendicectomy at the Aga Khan Hospital, Nairobi over a six year period from the inception of the technique and to assess its advantages and disadvantages. Case series study. The Aga Khan Hospital, Nairobi. One hundred and six cases operated on from May 1996 to June 2002. Clinical presentation, age and sex demographics, average hospital stay, operating time, intra-operative and post-operative complications and outcome. There was a female preponderance with a female to male ratio of 2:3:1. Mean age was 30.6 years. There was a slightly more number of patients with recurrent appendicitis as opposed to the acute form. Totally laparoscopic procedure was in 39.6% of the cases, laparoscopic assisted in 45.3%. The conversion rate to an open procedure was 15.1%. Post operative port-site infection was 8.5%. No mortality was reported in these series. However there was one case which required re-operation following significant port site haemorrhage. Mean post-operative hospital stay was 2.2 days. Laparoscopic appendicectomy is a safe procedure in well trained hands. The major advantages are less morbidity and excellent cosmesis. Discovery of other intraabdominal pathologies is possible through laparoscopy as opposed to classical appendicectomy.


Channel separation of crosstalk cancellation systems with mismatched and misaligned sound sources.
Loudspeakers in virtual sound imaging systems are usually modeled as omnidirectional monopole sources. These models are, however, only an approximation for the low frequency range. This paper presents an analytical model of crosstalk cancellation systems in a free field which takes into account the scattering and spatial characteristics of the sound sources. Based on the proposed model, the effects caused by the spatial characteristics of the sound source and its misalignments on the performance of the crosstalk cancellation system are studied numerically. It is found that although the factors such as the directivity of the sound sources and the distance between the sound sources and receiver affect the performance of the system to a certain extent, the channel separation of the crosstalk cancellation system, however, is most sensitive to the misalignment of the subtended angle of the sound sources. Therefore, if highly accurate binaural cues are required in practical applications, the type and characteristics of the playback sound sources, their locations, and orientations all should be considered carefully.


An analysis of violations of Osha's (1987) occupational exposure to benzene standard.
The Occupational Safety and Health Administration (OSHA), which was formed by the Occupational Safety and Health Act of 1970 (OSH Act), establishes enforceable health and safety standards in the workplace and issues violations and penalties for non-compliance with these standards. The purpose of the current study was to evaluate the number and type of violations of the OSHA (1987) Occupational Exposure to Benzene Standard. Violations of the OSHA Hazard Communication Standard (HCS), particularly those that may pertain to specific provisions of the benzene standard, were also assessed. All analyses were based on OSHA inspection data that have been collected since the early 1970s and that are publicly available from the U.S. Department of Labor enforcement website. Analysis of these data shows that fewer than a thousand OSHA violations of the benzene standard have been issued over the last 25+ years. The results for benzene are in contrast to those for some other toxic and hazardous substances that are regulated by OSHA, such as blood-borne pathogens, lead, and asbestos, for which there have been issued tens of thousands of OSHA violations. The number of benzene standard violations also varies by time period, standard provision, industry sector, and other factors. In particular, the greatest number of benzene standard violations occurred during the late 1980s to early/mid 1990s, soon after the 1987 final benzene rule was promulgated. The majority of benzene standard violations also pertain to noncompliance with specific provisions and subprovisions of the standard dealing with initial exposure monitoring requirements, the communication of hazards to employees, and medical surveillance programs. Only a small fraction of HCS violations are attributed, at least in part, to potential benzene hazards in the workplace. In addition, most benzene standard violations are associated with specific industries within the manufacturing sector where benzene or benzene-containing products may be used or produced during production processes, such as petroleum refineries, metal industries, and chemical companies. Not surprisingly, the greatest number of benzene standard violations have been issued to private facility owners (rather than government entities), given that the OSH Act primarily covers private sector employers. More violations have also been issued during inspections where union representation was present and from complaint-driven (vs. planned or other) inspections, which is consistent with OSHA inspection priorities. Violations of the benzene standard have typically involved a single instance per facility and 10 or fewer exposed employees. Because the OSH Act prescribes penalty caps for citations, initial penalties issued for noncompliance with the benzene standard have generally been less than $5,000 per violation. Despite some potential limitations, the OSHA inspection database contains the best available data for assessing historical and current violations of the benzene standard. These data, which have not been previously analyzed or published for benzene, may be of interest to professionals and practitioners involved in benzene risk assessment, risk management, and/or public policy issues.


Outcomes of delayed abdominal-based autologous reconstruction versus latissimus dorsi flap plus implant reconstruction in previously irradiated patients.
Local recurrence after breast conservation therapy is usually managed with salvage mastectomy. Multiple methods of reconstruction are possible, although delayed autologous reconstruction provides the most reliable results. We compared complications in delayed abdominal-based [transverse rectus abdominis muscle (TRAM)/deep inferior epigastric perforator (DIEP)] reconstruction with delayed latissimus dorsi plus implant-based reconstruction in previously irradiated breasts. The authors reviewed 133 consecutive cases of delayed breast reconstructions performed in patients who had postmastectomy radiation therapy and reconstruction with abdominal-based methods (single-pedicle TRAM, supercharged pedicle TRAM, muscle-sparing TRAM free flap, DIEP flap, and superficial inferior epigastric artery flap) or a pedicled latissimus dorsi flap plus implant. Complications for donor and recipient sites were recorded including infection, seroma, hematoma, and partial flap loss. Seventy-five patients were reconstructed with abdominal-based flaps (37 muscle-sparing TRAMs, 19 pedicled TRAMs, 12 DIEPs, 6 supercharged pedicled TRAMs, and 1 superficial inferior epigastric artery). Their median age was 50 years and mean follow-up was 22.7 months. Three (4.0%) patients required reoperation during the same hospital visit for vascular compromise that resulted in 2 (2.7%) flap failures. Three (4.0%) patients had partial flap loss that ultimately required debridement and primary closure. Seventeen (22.7%) patients had minor complications including seroma, small hematoma, cellulitis, and abdominal bulge. Fifty-six patients were reconstructed with latissimus dorsi flaps plus implants. Their median age was 47 years and mean follow-up was 32 months. Three (5.4%) patients developed infections resulting in implant loss. Four (7.1%) patients had partial flap loss that required debridement and primary closure. Thirteen (23.2%) patients had minor complications including seroma (12 patients) and hematoma (1 patient) that required drainage. Fisher exact test was used to determine statistical significance of complication and failure rates between the 2 types of reconstruction. In patients who had postmastectomy radiation therapy, those with abdominal-based reconstructions had fewer complications compared with latissimus dorsi flap plus implant reconstructions (28.0% vs 30.4%, P=0.846). Also, fewer reconstructions failed in patients with abdominal-based reconstruction (2.7% vs 5.4%, P=0.650). Abdominal-based autologous reconstruction had fewer complications and fewer reconstruction failures than latissimus dorsi flap plus implant reconstructions in patients with postmastectomy radiation therapy in our series; however, these rates were not statistically significant.


[Primary small cell carcinoma of the kidney: report of a case].
Primary small cell carcinoma (SCC) of the kidney is an extremely rare neoplasm. The morphological, immunohistological and ultrastructural features are closely akin to primary SCC of the lung. The case of a 38-year-old married male, nonsmoker, with primary small cell carcinoma of the kidney and associated multiple bony metastases is reported. Roentgenographic studies exhibited a tumor mass 3 cm in diameter over the middle portion of the left kidney. A CT scan of the cervical and thoracic spines, and a whole body bone scan displayed multiple osteolytic lesions suggesting multiple bony metastatic lesions. A chest X ray and CT scan of the nasopharynx demonstrated no significant lesions. A complete workup was performed followed by a left nephrectomy. Histologically, the tumor revealed SCC of the kidney. Immunohistochemically, the tumor cells demonstrated immunoreactivity to cytokeratin (CK), neuron-specific enolase (NSE) and produced negative stains to argentaffin, argyrophil, S-100 and chromogranin A. Ultrastructurally, these neoplastic small cells revealed a few cytoplasmic dense-core neuroendocrine-type differentiated secretory granules, measuring 110 to 115 nm in size. Thus, adjuvant therapy, supplemented with chemotherapy and radiotherapy, was employed. The patient was alive and well 6 months after surgery. To the best of our knowledge, there are four documented cases of primary SCC of the kidney. In this article, the light microscopic, immunohistochemical and ultrastructural studies of renal SCC are presented and suggest a renal pelvic epithelial origin of renal SCC. Cognitively renal SCC appears to be an aggressive tumor, regardless of the degree of neuroendocrine differentiation.


Inverted impaction of primary incisors: a case report.
Dental and radiological findings of a 5-year-old female patient show inverted impaction of the maxillary primary incisors. Family and personal histories of the patient were unremarkable. There were no abnormalities in general growth and development nor was there any history of trauma.


Recent advances in pristine tri-metallic metal-organic frameworks toward the oxygen evolution reaction.
Pristine metal-organic frameworks (MOFs) have received much attention in recent years due to their high specific surface areas, large porosity, excellent pore size distributions, flexible structure, and remarkable catalytic properties. The design of functional MOFs that can function as efficient HER and OER catalysts is significant in solving the energy crisis but remains a big challenge. Tri-metallic metal-organic frameworks show a good application prospect in water oxidation. In this review, we are going to focus on the latest progress and future trends in the development of pristine trimetallic MOFs with respect to the OER. The synergistic effect between multi-metal active sites is effective at improving the intrinsic activity of MOFs toward the OER. By summarizing the synthesis method of tri-metallic MOFs and observing their performance toward the oxygen evolution reaction, we hope that this review will trigger new developments in coordination chemistry, electrochemistry, nanomaterials and energy materials.