Against a singular understanding of legal capacity: Criminal responsibility and the Convention on the Rights of Persons with Disabilities.
The United Nations Convention on the Rights of Persons with Disabilities (CRPD) is being used to argue for wider recognition of the legal capacity of people with mental disabilities. This raises a question about the implications of the Convention for attributions of criminal responsibility. The present paper works towards an answer by analysing the relationship between legal capacity in relation to personal decisions and criminal acts. Its central argument is that because moral and political considerations play an essential role in setting the relevant standards, legal capacity in the context of personal decisions and criminal acts should not be thought of as two sides of the same coin. The implications of particular moral or political norms are likely to be different in these two legal contexts, and this may justify asymmetries in the relevant standards for legal capacity. However, the analysis highlights a fundamental question about how much weight moral or political considerations should be given in setting these standards, and this is used to frame a challenge to those calling for significantly wider recognition of the legal capacity of people with mental disabilities on the basis of the Convention.


Body mass index and the risk of acute injury in adolescents.
To evaluate the relationship between body mass index (BMI) and acute injury in adolescents. An analysis of cross-sectional data from the Canadian Community Health Survey (CCHS) Cycle 3.1 collected by Statistics Canada in 2005 was conducted. The CCHS is a population-based survey that collects information pertaining to the Canadian population health status, health care use and health determinants. The CCHS Cycle 3.1 included 132,221 respondents, of whom 12,317 were 12 to 17 years of age. Multivariate logistic regression was used to estimate the odds of injury occurrence by BMI categories (obese, overweight and neither). The association between overweight and obese BMI levels and injury occurrence in the bivariate model was not significant after adjusting for sex, health status, activity levels and socioeconomic status (OR=1.10 [95% CI 0.97 to 1.24] for overweight and OR=1.12 [95% CI 0.92 to 1.37] for obesity). A subanalysis of those with an injury in the past 12 months found an elevated odds of experiencing multiple injuries in the overweight group, after adjusting for age, health status and physical activity level (OR=1.43 [95% CI 1.16 to 1.77]). An increased risk of acute injury in obese and overweight adolescents was not observed. However, the subgroup analysis suggested that multiple injuries are relatively frequent in the overweight BMI group.


Risk of incident and fatal melanoma in individuals with a family history of incident or fatal melanoma or any cancer.
A family history of melanoma is associated with an increased risk of melanoma and probably of other, discordant cancers. Limited data are available on familial mortality in melanoma. If fatal forms of melanoma were associated with fatal forms of melanoma or of some other cancers, only studies on familial mortality rather than on familial incidence might be able to detect them. Furthermore, estimates on familial aggregation based on mortality are free from bias of overdiagnosis. The aim of this study was the estimation of familial aggregation of concordant melanoma and of melanoma and any other cancers based both on incidence and on mortality. We used the nationwide Swedish Family-Cancer Database to calculate standardized incidence ratios (SIRs) for incident melanoma for relatives of any cancer patients and standardized mortality ratios (SMRs) for death from melanoma for relatives of individuals who died from any other cancer. Similar risks were determined for any common cancer when relatives were affected by melanoma. For concordant melanoma, familial incidence equalled familial mortality, SIR=SMR. Familial clustering (SIRs increased) of melanoma and oesophageal, colorectal, breast, prostate, kidney, nervous system and connective tissue cancers and myeloma and leukaemia was observed. The SMRs for pancreatic and nervous system cancers were increased in relatives whose parents had died from melanoma. These data should encourage a search for fatal subtypes of familial cancer, which may eventually have clinical implications.


The synaptic proteins neurexins and neuroligins are widely expressed in the vascular system and contribute to its functions.
Unlike other neuronal counterparts, primary synaptic proteins are not known to be involved in vascular physiology. Here, we demonstrate that neurexins and neuroligins, which constitute large and complex families of fundamental players in synaptic activity, are produced and processed by endothelial and vascular smooth muscle cells throughout the vasculature. Moreover, they are dynamically regulated during vessel remodeling and form endogenous complexes in large vessels as well as in the brain. We used the chicken chorioallantoic membrane as a system to pursue functional studies and demonstrate that a monoclonal recombinant antibody against beta-neurexin inhibits angiogenesis, whereas exogenous neuroligin has a role in promoting angiogenesis. Finally, as an insight into the mechanism of action of beta-neurexin, we show that the anti-beta-neurexin antibody influences vessel tone in isolated chicken arteries. Our finding strongly supports the idea that even the most complex and plastic events taking place in the nervous system (i.e., synaptic activity) share molecular cues with the vascular system.


[HCV infection from the viewpoint of medical law].
More than 200 million people worldwide and 0.7 percent of the population in Hungary are infected with hepatitis C virus (HCV). The consequent chronic viral hepatitis and its complications as well as the big population affected make HCV-infection an important medical issue. In addition to that the infection which is transmitted nowadays mainly by intravenous drug use and use of body jewelry, tattooing and sexual in some cases, and by blood transfusion in the past, raises several questions related to law as well. The authors give a short overview of the legal concerns of HCV infection highlighting some concrete juridical procedures in the present paper.


FunSpec: a web-based cluster interpreter for yeast.
For effective exposition of biological information, especially with regard to analysis of large-scale data types, researchers need immediate access to multiple categorical knowledge bases and need summary information presented to them on collections of genes, as opposed to the typical one gene at a time. We present here a web-based tool (FunSpec) for statistical evaluation of groups of genes and proteins (e.g. co-regulated genes, protein complexes, genetic interactors) with respect to existing annotations (e.g. functional roles, biochemical properties, localization). FunSpec is available online at http://funspec.med.utoronto.ca FunSpec is helpful for interpretation of any data type that generates groups of related genes and proteins, such as gene expression clustering and protein complexes, and is useful for predictive methods employing "guilt-by-association."


Follow-up after partial or total nephrectomy for renal cell carcinoma.
Salvage therapy is not readily available to patients with recurrent renal cell carcinoma. Selected solitary metastases may be resected, a tumor on the contralateral kidney may be excised, or the patient may be amenable to systemic biologic response modifier therapy. More commonly, only palliative therapy is available, and follow-up is tailored with the former considerations in mind. Early investigation of symptoms may minimize later morbidity from metastases to the brain or bone. A proposed follow-up schedule is presented.


[Systemic treatments of the vasospasm].
Cerebral vasospasm, a recognized complication of aneurysmal subarachnoid haemorrhage, can lead to delayed ischaemic neurological deficit, and death. The systematic administration of nimodipine confers a modest but real benefit against delayed ischaemic damage. When vasospasm occurs, triple-H therapy (hypervolaemia, hypertension, and haemodilution) has long been advocated in order to increase flow, but its usefulness remains unclear. Cardiac output optimization using inotropic drugs might also be considered in selected patients. In practice, only correction of volume depletion and induced hypertension (after aneurysm has been secured) can be recommended. In addition, according to phase II randomized trials, promising new treatments for vasospasm or its ischaemic complications include magnesium sulfate, the selective endothelin A-receptor antagonist clazosentan, and statins. The simple and safe profile of prophylactic use of statins appears particularly attractive. However, all these potential candidates need further validation through (on-going) clinical phase III trials.


Attitudes and Behaviors of Palliative Care Nurses on Euthanasia.
This review was planned to present an overview of the findings in the scientific literature on euthanasia, palliative care, and nurses' attitudes and behaviors. A literature search was done in "EBSCO," "PubMed" databases, and "Google Scholar" search engines. In the study, a search was made between January and March 2023 using the keywords "palliative care," "euthanasia," and "nurse attitudes." Articles published in English and accessible were included in the research. Palliative care practices differ according to the health system, socioeconomic status, cultural conditions, geographical location, and education levels of countries On the other hand, discussions on the integration of euthanasia into palliative care practices continue. While palliative care practices differentiate in countries where euthanasia has been legalized, scientific, legal, religious, and ethical discussions continue in countries where euthanasia is not legal. There are many different variables, such as age, gender, professional experience, and cultural and religious factors, that affect nurses' attitudes and behaviors on this issue. It can be suggested that the results of the research, which will evaluate the factors affecting the attitudes of nurses toward euthanasia, death and terminally ill patients, include social changes in order to provide a literature and database in this field.


FANCJ helicase controls the balance between short- and long-tract gene conversions between sister chromatids.
The FANCJ DNA helicase is linked to hereditary breast and ovarian cancers as well as bone marrow failure disorder Fanconi anemia (FA). Although FANCJ has been implicated in the repair of DNA double-strand breaks (DSBs) by homologous recombination (HR), the molecular mechanism underlying the tumor suppressor functions of FANCJ remains obscure. Here, we demonstrate that FANCJ deficient human and hamster cells exhibit reduction in the overall gene conversions in response to a site-specific chromosomal DSB induced by I-SceI endonuclease. Strikingly, the gene conversion events were biased in favour of long-tract gene conversions in FANCJ depleted cells. The fine regulation of short- (STGC) and long-tract gene conversions (LTGC) by FANCJ was dependent on its interaction with BRCA1 tumor suppressor. Notably, helicase activity of FANCJ was essential for controlling the overall HR and in terminating the extended repair synthesis during sister chromatid recombination (SCR). Moreover, cells expressing FANCJ pathological mutants exhibited defective SCR with an increased frequency of LTGC. These data unravel the novel function of FANCJ helicase in regulating SCR and SCR associated gene amplification/duplications and imply that these functions of FANCJ are crucial for the genome maintenance and tumor suppression.


Honokiol arrests cell cycle, induces apoptosis, and potentiates the cytotoxic effect of gemcitabine in human pancreatic cancer cells.
Survival rates for patients with pancreatic cancer are extremely poor due to its asymptomatic progression to advanced and metastatic stage for which current therapies remain largely ineffective. Therefore, novel therapeutic agents and treatment approaches are desired to improve the clinical outcome. In this study, we determined the effects of honokiol, a biologically active constituent of oriental medicinal herb Magnolia officinalis/grandiflora, on two pancreatic cancer cell lines, MiaPaCa and Panc1, alone and in combination with the standard chemotherapeutic drug, gemcitabine. Honokiol exerted growth inhibitory effects on both the pancreatic cancer cell lines by causing cell cycle arrest at G₁ phase and induction of apoptosis. At the molecular level, honokiol markedly decreased the expression of cyclins (D1 and E) and cyclin-dependent kinases (Cdk2 and Cdk4), and caused an increase in Cdk inhibitors, p21 and p27. Furthermore, honokiol treatment led to augmentation of Bax/Bcl-2 and Bax/Bcl-xL ratios to favor apoptosis in pancreatic cancer cells. These changes were accompanied by enhanced cytoplasmic accumulation of NF-κB with a concomitant decrease in nuclear fraction and reduced transcriptional activity of NF-κB responsive promoter. This was associated with decreased phosphorylation of inhibitor of kappa B alpha (IκB-α) causing its stabilization and thus increased cellular levels. Importantly, honokiol also potentiated the cytotoxic effects of gemcitabine, in part, by restricting the gemcitabine-induced nuclear accumulation of NF-κB in the treated pancreatic cancer cell lines. Altogether, these findings demonstrate, for the first time, the growth inhibitory effects of honokiol in pancreatic cancer and indicate its potential usefulness as a novel natural agent in prevention and therapy.


Anatomically corrected malposition of the great arteries, inflow ventricular septal defect, and subaortic stenosis: diagnostic and operative implications.
Intracardiac correction of the combination of rare congenital heart lesion of anatomically corrected malposition of the great arteries, severe muscular as well as fibrous subaortic stenosis, and ventricular septal defects in the inflow and the trabecular septum in a 2 1/2 years old boy is reported. There was an additional large secundum atrial septal defect. The operation consisted of resection of the subaortic stenosis by a combined transatrial and transaortic approach, thereby regaining a wide outflow tract of the systemic ventricle. Both the ventricular and atrial septal defects were closed with Dacron patches. Reinvestigation 10 days after the operation revealed a residual pressure gradient across the outflow of the systemic ventricle of less than 10 mmHg. A secondary ventricular septal defect was detected in the anterior muscular septum at the same time and closed with a patch in a reintervention. At discharge from the hospital two weeks later the child was in excellent condition and had a stable sinus rhythm. The preoperative differential diagnosis of a double outlet right ventricle with L-malposition of the aorta as well as possible surgical approaches are discussed.


Endovascular treatment of AVM-associated aneurysm of anterior inferior cerebellar artery through persistent primitive hypoglossal artery.
We present a patient with the combination of persistent primitive hypoglossal artery and the origin of left common carotid artery from the brachiocephalic trunk, who had subarachnoid haemorrhage caused by a ruptured aneurysm. The aneurysm was on distal anterior inferior cerebellar artery which was a feeder to cerebellar arterio-venous malformation.


Antibiofilm Platform based on the Combination of Antimicrobial Polymers and Essential Oils.
The development of potent strategies to counter microbial biofilm is an urgent priority in healthcare. The majority of bacterial infections in humans are biofilm related, however, effective treatments are still lacking especially for combating multidrug-resistant (MDR) strains. Herein, we report an effective antibiofilm platform based on the use of synthetic antimicrobial polymers in combination with essential oils, where the antimicrobial polymers play a secondary role as delivery vehicle for essential oils. Two ternary antimicrobial polymers consisting of cationic primary amines, low-fouling oligo(ethylene glycol) and hydrophobic ethylhexyl groups were synthesized in the form of random and block copolymers, and mixed with either carvacrol or eugenol. Coadministration of these compounds improved the efficacy against Pseudomonas aeruginosa biofilms compared to the individual compounds. We observed about a 60-75% and 70-85% biofilm inhibition effect for all tested combinations against wild-type P. aeruginosa PAO1 and MDR strain PA37, respectively, upon 6.5 h of incubation time. While both random and block copolymers demonstrated similar biofilm inhibition potencies in combination with essential oils, only the block copolymer acted synergistically with essential oils in killing biofilm. Treatment of PAO1 biofilm for 20 min with the block copolymer-oil combinations resulted in the killing of >99.99% of biofilm bacteria. This synergistic bactericidal activity is attributed to the targeted delivery of essential oils to the biofilm, driven by the electrostatic interaction between positively charged delivery vehicles, in the form of polymeric micelles, and negatively charged bacteria. This study thus highlights the advantage of combining essential oils and antimicrobial polymers as an effective avenue for antibacterial applications.


Production of African breadfruit (Treculia africana) and soybean (Glycine max) seed based food formulations, 2: Effects of germination and fermentation on microbiological and physical properties.
The effects of germination (G) and naturally fermented (F) on the bacterial flora, viscosities and moisture sorption isotherms of soybean (S) and African breadfruit (B) seed based food products were investigated. Bacillus, Enterobacter, Enterobacteriaceae, Proteus, Serratia and Staphylococcus species dominated in the nonfermented products. Lactobacillus, Leuconostoc, Pediococcus and yeast species dominated in the fermented products whose gruels also inhibited growth of coagulase positive Staphylococcus aureus in challenge tests. Germination and fermentation resulted in significant (p < 0.05) decreases in cooked paste viscosities which is advantageous in increasing nutrient density. The monolayer moisture contents (g H2O/g solid) and surface areas for monolayer adsorption (m2/g solid) derived from BET model were 0.0422 and 148.1 (GFSB); 0.0428 and 150.4 (NGFSB); 0.0436 and 153.3 (NGNFSB); 0.0531 and 186.6 (GNFSB), respectively.


High-Throughput Tertiary Amine Deoxygenated Photopolymerizations for Synthesizing Polymer Libraries.
The huge chemical space potential of synthetic polymers means that in many studies only a small parameter range can be realistically synthesized in a short time and hence the "best" formulations may not be optimum. Throughput is traditionally limited by the need for deoxygenation in radical polymerizations, but advances in photopolymerization now provide opportunities for "in-air" polymerizations. Here, we have developed a protocol using liquid handling robots (or multichannel pipettes) with blue light photolysis of reversible addition fragmentation chain transfer agents and tertiary amine deoxygenation to enable the synthesis of polymer libraries in industry-standard 96-well plates with no specialized infrastructure and no degassing step. The roles of solvents and amine deoxygenators are explored to optimize the polymerization, particularly to look at alternatives to dimethyl sulfoxide (DMSO) for hydrophobic monomer (co)polymerization. DMSO is shown to aid the degassing process but is not easy to remove and hence prevents isolation of pure polymers. In contrast, using dioxane in-plate evaporation or precipitation of the tertiary amine allowed isolation of polymers in-plate. This removed all reaction components yielding pure polymers, which is not easily achieved with systems using metal catalysts and secondary reductants, such as ascorbic acid. As an example of the throughput, in just under 40 h, 392 polymers were synthesized and subsequently analyzed direct from plates by a 96-well plate sampling size exclusion chromatography system to demonstrate reproducibility. Due to less efficient degassing in dioxane (compared to DMSO), the molecular weight and dispersity control were limited in some cases (with acrylates giving the lowest dispersities), but the key aim of this system is to access hundreds of polymers quickly and in a format needed to enable testing. This method enables easy exploration of chemical space and development of screening libraries to identify hits for further study using precision polymerization methods.


Communicating tubular duplication of upper esophagus-a rare occurrence.
Duplications of esophagus are commonly classified into two types, tubular and cystic. Tubular duplication of esophagus is a rare occurrence and is much less common than cystic duplication of foregut. Most esophageal duplications are located in the lower third of the esophagus. A cervical esophageal duplication is extremely rare. Esophageal duplications have been reported twice as commonly on the right as on the left. We report a case of incidental finding identified on computed tomography of communicating tubular esophageal duplication involving the left side of the upper esophagus in a tuberculosis patient that was subsequently confirmed on barium swallow test.


Analysis of In Vitro Activity of Cefiderocol Against Carbapenem-Resistant Gram-Negative Bacilli by Broth Microdilution and Disk Diffusion Method: A Single-Center Study in Odisha, India.
Cefiderocol (CFDC), a novel semi-synthetic siderophore cephalosporin has been developed to combat the menace of infections caused by carbapenem-resistant Gram-negative bacilli (CR-GNB) including Carbapenem-resistant Enterobacterales (CRE) and Carbapenem-resistant Nonfermenting Gram-negative bacilli (CR-NFGNB). We determined the in vitro activity of CFDC against a contemporary collection of 503 CR-GNB isolates by the reference broth microdilution method (BMD) using Iron depleted cation adjusted Mueller-Hinton broth (ID-CAMHB). Performance of CFDC disk diffusion (DD) was evaluated against the reference BMD, as an alternative convenient testing method. Molecular characterization of carbapenemase in CR-GNB was performed by PCR targeting bla NDM-1, bla OXA-48like alleles, bla KPC, bla IMP, and, bla VIM. Minimum inhibitory concentration (MIC) distribution of CFDC in CR-GNB harbouring different carbapenemase enzymes was also analyzed. In our study, 81.7% (411/503) of CR-GNB isolates [81.3%, (278/342) CRE and 82.6% (133/161) CR-NFGNB] were susceptible to CFDC (p>0.05). Categorical agreement (CA) of DD ranged from 79.8% to 87.5%, Minor error (mE) ranged from 0 to 14%, Major error (ME) ranged from 0 to 3.5%, and Very Major error (VME) ranged from 0 to 12.5% with variations by species tested. Overall CFDC MIC50 and MIC90 values of CR-GNB isolates without any carbapenemase genes were higher as compared to those with the presence of carbapenemase genes (4 µg/mL and 128 µg/mL versus 2 µg/mL and 16 µg/mL respectively). CFDC is not yet available for clinical use in India. Hence, multicentric studies are the need of the hour in India for standardization of CFDC susceptibility using disks and CAMHB from different manufacturers as well as understanding mechanisms of high MIC values.


Walking Speed Influences the Effects of Implicit Visual Feedback Distortion on Modulation of Gait Symmetry.
The use of visual feedback in gait rehabilitation has been suggested to promote recovery of locomotor function by incorporating interactive visual components. Our prior work demonstrated that visual feedback distortion of changes in step length symmetry entails an implicit or unconscious adaptive process in the subjects' spatial gait patterns. We investigated whether the effect of the implicit visual feedback distortion would persist at three different walking speeds (slow, self-preferred and fast speeds) and how different walking speeds would affect the amount of adaption. In the visual feedback distortion paradigm, visual vertical bars portraying subjects' step lengths were distorted so that subjects perceived their step lengths to be asymmetric during testing. Measuring the adjustments in step length during the experiment showed that healthy subjects made spontaneous modulations away from actual symmetry in response to the implicit visual distortion, no matter the walking speed. In all walking scenarios, the effects of implicit distortion became more significant at higher distortion levels. In addition, the amount of adaptation induced by the visual distortion was significantly greater during walking at preferred or slow speed than at the fast speed. These findings indicate that although a link exists between supraspinal function through visual system and human locomotion, sensory feedback control for locomotion is speed-dependent. Ultimately, our results support the concept that implicit visual feedback can act as a dominant form of feedback in gait modulation, regardless of speed.


Case report. Disseminated cutaneous cryptococcosis in an immunocompetent host.
A 50-year-old Indian housewife presented with multiple cutaneous lesions over the upper back, thigh and both the extremities, which first appeared 5 months previously. The diagnosis of disseminated cutaneous cryptococcosis was made on the basis of the demonstration and isolation of Cryptococcus neoformans from the aspirated pus and skin biopsy. A serological test for HIV antibodies was negative. The patient responded to itraconazole treatment.


Therapeutic activity of sunitinib for Her2/neu induced mammary cancer in FVB mice.
Mouse mammary tumor virus-Neu (MMTV/neu) transgenic mice on an FVB-background (FVB-neuN) have increased numbers of myeloid derived suppressor cells (MDSCs) and regulatory T-cells (T-regs) in the spleen during mammary tumor induction and progression. Using this transgenic tumor model, we assessed the therapeutic activity of sunitinib, a multi-targeted, tyrosine kinase (TK) inhibitor and its effects on immune-regulatory cells. Our preliminary results show that sunitinib at 40mg/kg/day, p.o. (per os), delayed the time to tumor induction and reduced the incidence and growth of tumors in FVB-neuN mice. In association with its therapeutic activity, sunitinib reduced the absolute number of splenic T-reg cells (CD4(+)CD25(+)CD62L(+)) and MDSCs (CD11b(+)Gr1(+)) that were increased during tumor progression with less activity in mice with gross tumors. A significant decrease in the absolute number of splenic T-regs, dendritic cells (DCs), MDSCs and hematopoietic progenitors (Lin(-)Sca1(+)CD90(dull)) was observed following sunitinib treatment. The frequency of splenic T-regs and hematopoietic progenitors, but not MDSCs was also reduced by sunitinib treatment. Additionally immune-regulatory cytokines and enzymes were down regulated by sunitinib treatment, including TGFbeta and NOS2 in the spleen cells of sunitinib treated mice as compared to untreated tumor bearing (TB) mice. We conclude that sunitinib has therapeutic activity, in association with the down regulation of MDSCs and T-regs and has a trend towards the normalization of the inflammatory cytokine levels induced by tumor progression and growth. Based on these results, we suggest that sunitinib reduction of immune suppressive cells is a critical part of its adjuvant immune therapeutic activity.


Transplants of fibroblasts genetically modified to express BDNF promote axonal regeneration from supraspinal neurons following chronic spinal cord injury.
Transplants of fibroblasts genetically modified to express BDNF (Fb/BDNF) have been shown to promote regeneration of rubrospinal axons and recovery of forelimb function when placed acutely into the injured cervical spinal cord of adult rats. Here we investigated whether Fb/BDNF cells could stimulate supraspinal axon regeneration and recovery after chronic (4 week) injury. Adult female Sprague-Dawley rats received a complete unilateral hemisection injury at the third cervical spinal cord segment (C3). Four-five weeks later the injury site was exposed and rats received transplants of unmodified fibroblasts (Fb/UM) or Fb/BDNF. Four-five weeks after transplantation, locomotor recovery was examined on a test of forelimb usage and regeneration of supraspinal axons was studied following injection of the anterograde tracer biotin dextran amine (BDA). Rubrospinal tract (RST), reticulospinal tract (ReST), and vestibulospinal tract (VST) axons regenerated into transplants of either Fb/UM or Fb/BDNF but the length of axonal growth was significantly different in the two groups. The absolute distance of ReST growth was 1.8-fold greater in Fb/BDNF than in Fb/UM and the absolute distance of growth of RST and VST axons showed a statistically significant 4-fold increase. All three types of regenerated axons occupied a greater proportional length of Fb/BDNF transplants than of Fb/UM transplants. Only VST axons extended into the host spinal cord caudal to the Fb/BDNF grafts, but these axons were sparse. Rats receiving Fb/BDNF used both forelimbs together to explore walls of a cylinder more often than rats receiving Fb/UM, indicating partial recovery of forelimb usage. These results demonstrate that fibroblasts genetically modified to express BDNF promote axon regeneration from supraspinal neurons in the chronically injured spinal cord with accompanying partial recovery of locomotor performance.


Cytologic findings in signet-ring adenocarcinoma of the large bowel. A case report.
Signet-ring adenocarcinoma of the large bowel is an uncommon tumor with distinctive gross anatomic, radiologic and histologic features. A case in a 34-year-old man is presented. Because of the unusual appearance of the bowel at colonoscopy, diagnostic cytologic smears were taken. The patient subsequently underwent resection of this tumor but died within 20 months of metastatic disease. The histologic and cytologic features are described; the cytologic findings do not appear to have been previously reported.


Risk factors for hip fractures occurring in the hospital.
Risk factors for in-hospital hip fractures among patients aged > or = 65 years were evaluated in a population-based case-control study conducted in the Canadian province of Saskatchewan from 1983 through 1985. There were 129 cases with confirmed in-hospital hip fractures and 234 controls, who were those controls from a previous study in this setting hospitalized on their assigned index date. Study variables were abstracted from the hospital chart. Six factors were independently associated with a significantly increased risk of in-hospital hip fracture: impaired vision (odds ratio = 1.97, 95% confidence interval (CI) 1.18-3.30), assisted ambulation (odds ratio = 2.12, 95% CI 1.25-3.59), confusion (odds ratio = 2.48, 95% CI 1.37-4.48), psychotropic drug use (odds ratio = 2.02, 95% CI 1.22-3.33), lowest weight tertile (odds ratio = 2.86, 95% CI 1.38-5.92), and prior in-hospital fall (odds ratio = 2.71, 95% CI 1.52-4.82). The risk increased substantially with the number of factors present, from an odds ratio of 4.08 (95% CI 1.56-10.67) for one factor (reference group, no factors) to 82.84 (95% CI 18.6-368.7) for four or more factors (p < 0.001, test for trend). These data underscore the multifactorial etiology of in-hospital hip fracture and suggest that prevention programs need to target multiple risk factors.


Influence of fabrication techniques and artificial aging on the fracture resistance of different cantilever zirconia fixed dental prostheses.
To evaluate the influence of dynamic fatigue on fracture load and failure mode of different types of adhesive zirconia restorations. Eighty adhesive cantilever fixed dental prostheses (CFDP) were fabricated and assigned to four equal groups (n = 20) using the following materials and techniques. Group 1: machine copy-milling zirconia (Cercon), group 2: manual copy-milling technique (ZirkonZahn), group 3: slip casting technique (Vita In-ceram Zirconia), group 4: metal-ceramic CFDP. Specimens in groups 1and 2 received selective infiltration-etching surface treatment, specimens in group 3 were acid etched with hydrofluoric acid and silanated, while those of group 4 were airborne particle abraded. All specimens were bonded with resin cement (Panavia F2.0) and thermocycled (5000 cycles/ 5 to 55°C). Then, half the number of the specimens of each group (n = 10) underwent dynamic loading (one million cycles at alternating loads between 10 and 40 N in a water bath at 37°C). All specimens were subjected to one-cycle loading to failure to evaluate fracture resistance. One-way and two-way ANOVA and Bonferroni post-hoc tests were used to analyze the data (α = 0.05). The intaglio surfaces of fractured specimens were examined using stereomicroscopy and scanning electron microscope (SEM). Statistical analysis revealed that the failure load of metal (413 ± 26 N) and machine copy-milled zirconia (368 ± 24 N) restorations was significantly higher (F = 129, p < 0.001) than manually copy-milled (316 ± 18) and In-ceram zirconia (210 ± 17) restorations. Dynamic fatigue significantly (p < 0.03) reduced failure load of the manually copy-milled and In-ceram zirconia restorations, while metal and machine copy-milling zirconia restorations were not influenced by fatigue. The fatigue strength of adhesive zirconia restorations is influenced by cyclic loading and the technique used to manufacture these restorations.


Inducible ablation of adipocytes in adult transgenic mice expressing the E. coli nitroreductase gene.
We describe the use of an enzyme prodrug system based on E. coli nitroreductase (NTR) to achieve the specific ablation of adipose tissue. Transgenic mice expressing the NTR gene specifically in the adipose tissue were generated using the adipocyte specific promoter aP2. After treatment with the prodrug CB1954 these mice showed extensive cell depletion in all fat depots; this was directly correlated to both the dose of prodrug and the levels of NTR expression. Higher doses of CB1954 resulted in complete disappearance of visible adipose stores in some transgenic mice. These mice exhibited an impaired ability to thermoregulate body temperature. Lower doses of CB1954 resulted in a partial reduction of the adipose tissue leaving non-expressing cells that escape ablation. These animals show normal levels of blood glucose and triglycerides but have reduced leptin levels. After 30 days they were able to regenerate the fat depots and leptin levels returned to normal but, interestingly, no NTR-expressing cells were detectable. The present model provides a new approach to manipulate the number of adipocytes at different stages of mouse development and provides a new system for the study of fat metabolism especially in abnormal conditions such as obesity and its modulation through manipulation of the target cell population.


Synchronous Defect and Interface Engineering of NiMoO4 Nanowire Arrays for High-Performance Supercapacitors.
Developing high-performance electrode materials is in high demand for the development of supercapacitors. Herein, defect and interface engineering has been simultaneously realized in NiMoO4 nanowire arrays (NWAs) using a simple sucrose coating followed by an annealing process. The resultant hierarchical oxygen-deficient NiMoO4@C NWAs (denoted as "NiMoO4-x@C") are grown directly on conductive ferronickel foam substrates. This composite affords direct electrical contact with the substrates and directional electron transport, as well as short ionic diffusion pathways. Furthermore, the coating of the amorphous carbon shell and the introduction of oxygen vacancies effectively enhance the electrical conductivity of NiMoO4. In addition, the coated carbon layer improves the structural stability of the NiMoO4 in the whole charging and discharging process, significantly enhancing the cycling stability of the electrode. Consequently, the NiMoO4-x@C electrode delivers a high areal capacitance of 2.24 F cm-2 (1720 F g-1) at a current density of 1 mA cm-2 and superior cycling stability of 84.5% retention after 6000 cycles at 20 mA cm-2. Furthermore, an asymmetric super-capacitor device (ASC) has been constructed with NiMoO4-x@C as the positive electrode and activated carbon (AC) as the negative electrode. The as-assembled ASC device shows excellent electrochemical performance with a high energy density of 51.6 W h kg-1 at a power density of 203.95 W kg-1. Moreover, the NiMoO4//AC ASC device manifests remarkable cyclability with 84.5% of capacitance retention over 6000 cycles. The results demonstrate that the NiMoO4-x@C composite is a promising material for electrochemical energy storage. This work can give new insights on the design and development of novel functional electrode materials via defect and interface engineering through simple yet effective chemical routes.


Diblock copolymers based on dihydroxyacetone and ethylene glycol: synthesis, characterization, and nanoparticle formulation.
Polymeric biomaterials have played an integral role in tissue engineering, biomedical devices, and targeted drug delivery. Block copolymers are especially important because their physical and chemical properties can be controlled by adjusting the ratio, size, and type of constituting blocks. Herein, the synthesis and characterization of diblock copolymers composed of poly(ethylene glycol) and a polycarbonate based on the metabolic intermediate, dihydroxyacetone, are reported. The length of the dihydroxyacetone-based block was controlled by adjusting the reactant feed ratios and initiator injection conditions. Intermediates and final products were characterized via (1)H NMR, GPC, DSC, TGA, and diffusion-ordered NMR spectroscopy. The dihydroxyacetone-based hompolymer is insoluble in water and most organic solvents, but is hydrophilic in nature. This, coupled with poly(ethylene glycol)'s solubility characteristics, allows the block copolymer to form nanoparticles in aqueous and organic anti-solvents. Dynamic light scattering and TEM results indicated the formation of spherical nanoparticles.


Cerebrospinal fluid β-amyloid and tau are not associated with risk of delirium: a prospective cohort study in older adults with hip fracture.
To examine the association between cerebrospinal fluid (CSF) β-amyloid (Aβ1-42), tau, and hyperphosphorylated tau (Ptau) and risk of delirium in older adults with hip fracture. Prospective cohort study. University-affiliated general hospital in Alkmaar, the Netherlands. Seventy-six participants aged 75 and older admitted for surgical repair of acute hip fracture. Presurgical baseline screening and assessment included the Informant Questionnaire on Cognitive Decline-short form (IQCODE-N), Mini-Mental State Examination, standardized Snellen test for visual impairment, Geriatric Depression Scale, Barthel Index (BI), and Lawton Instrumental Activity of Daily Living (IADL) scale. The number of medical comorbidities and medications at home, American Society of Anesthesiologists score, and Acute Physiology and Chronic Health Evaluation II score were determined according to chart review. Delirium was diagnosed using the Confusion Assessment Method. CSF was collected at the onset of spinal anesthesia. Postoperative delirium occurred in 30 (39.5%) participants. Participants with delirium were older, showed more signs of cognitive decline, were more dependent at home in activity of daily living and IADL functioning, and used more medications before admission. Preoperative CSF Aβ1-42, tau, and Ptau levels were not significantly different in participants who did and did not develop delirium during subsequent hospitalization. In contrast, prefracture cognitive decline (IQCODE-N) was significantly related to delirium (odds ratio=9.43, 95% confidence interval=2.45-36.31). Cognitive impairment predisposes to delirium, but in this study, postoperative delirium was not associated with baseline CSF Aβ1-42, tau, and Ptau levels. These findings suggest that CSF markers for plaque and tangle formation are not strongly associated with delirium risk in older adults with hip fracture.


Inhalant abuse: A cause for concern.
Inhalant abuse is of growing concern in adolescent and young adult population in the underdeveloped regions of the world. In the absence of availability of definitive tests in routine clinical settings, diagnosis is often difficult. Equally difficult is management and ensuring adherence to therapy. We report two successive cases of inhalant abuse seen at the outpatient department of the Department of Psychiatry, Mental Health Institute, SCB Medical College, Cuttack, Orissa, India. We report here two cases of inhalant abuse: one with an unusual mode of abuse and another with atypical clinical presentation.


Biodegradation of ochratoxin a for food and feed decontamination.
Ochratoxin A (OTA) is one of the most important mycotoxins that is found in food and feed products. It has proven toxic properties, being primarily known for its nephrotoxicity and carcinogenicity to certain animal species. OTA is produced by several species of Aspergillus and Penicillium that can be found in a wide variety of agricultural products, which makes the presence of OTA in these products common. Many countries have statutory limits for OTA, and concentrations need to be reduced to as low as technologically possible in food and feed. The most important measures to be taken to control OTA are preventive in order to avoid fungal growth and OTA production. However, these measures are difficult to implement in all cases with the consequence of OTA remaining in agricultural commodities. Remediation processes are often used to eliminate, reduce or avoid the toxic effects of OTA. Biological methods have been considered increasingly as an alternative to physical and chemical treatments. However, examples of practical applications are infrequent. This review will focus on the (i) known microorganisms and enzymes that are able to biodegrade OTA; (ii) mode of action of biodegradation and (iii) current applications. A critical discussion about the technical applicability of these strategies is presented.


Molecular evidence for a founder effect in invasive house finch (Carpodacus mexicanus) populations experiencing an emergent disease epidemic.
The impact of founder events on levels of genetic variation in natural populations remains a topic of significant interest. Well-documented introductions provide a valuable opportunity to examine how founder events influence genetic diversity in invasive species. House finches (Carpodacus mexicanus) are passerine birds native to western North America, with the large eastern North American population derived from a small number of captive individuals released in the 1940s. Previous comparisons using amplified fragment length polymorphism (AFLP) markers found equivalent levels of diversity in eastern and western populations, suggesting that any genetic effects of the founder event were ameliorated by the rapid growth of the newly established population. We used an alternative marker system, 10 highly polymorphic microsatellites, to compare levels of genetic diversity between four native and five introduced house finch populations. In contrast to the AFLP comparisons, we found significantly lower allelic richness and heterozygosity in introduced populations across all loci. Three out of five introduced populations showed significant reductions in the ratio of the number of alleles to the allele size range, a within-population characteristic of recent bottlenecks. Finally, native and introduced populations showed significant pairwise differences in allele frequencies in every case, with stronger isolation by distance within the introduced than native range. Overall, our results provide compelling molecular evidence for a founder effect during the introduction of eastern house finches that reduced diversity levels at polymorphic microsatellite loci and may have contributed to the emergence of the Mycoplasma epidemic which recently swept the eastern range of this species.


In vivo shoulder function after surgical repair of a torn rotator cuff: glenohumeral joint mechanics, shoulder strength, clinical outcomes, and their interaction.
Surgical repair of a torn rotator cuff is based on the belief that repairing the tear is necessary to restore normal glenohumeral joint (GHJ) mechanics and achieve a satisfactory clinical outcome. Dynamic joint function is not completely restored by rotator cuff repair, thus compromising shoulder function and potentially leading to long-term disability. Controlled laboratory study and Case series; Level of evidence, 4. Twenty-one rotator cuff patients and 35 control participants enrolled in the study. Biplane radiographic images were acquired bilaterally from each patient during coronal-plane abduction. Rotator cuff patients were tested at 3, 12, and 24 months after repair of a supraspinatus tendon tear. Control participants were tested once. Glenohumeral joint kinematics and joint contact patterns were accurately determined from the biplane radiographic images. Isometric shoulder strength and patient-reported outcomes were measured at each time point. Ultrasound imaging assessed rotator cuff integrity at 24 months after surgery. Twenty of 21 rotator cuff repairs appeared intact at 24 months after surgery. The humerus of the patients' repaired shoulder was positioned more superiorly on the glenoid than both the patients' contralateral shoulder and the dominant shoulder of control participants. Patient-reported outcomes improved significantly over time. Shoulder strength also increased over time, although strength deficits persisted at 24 months for most patients. Changes over time in GHJ mechanics were not detected for either the rotator cuff patients' repaired or contralateral shoulders. Clinical outcome was associated with shoulder strength but not GHJ mechanics. Surgical repair of an isolated supraspinatus tear may be sufficient to keep the torn rotator cuff intact and achieve satisfactory patient-reported outcomes, but GHJ mechanics and shoulder strength are not fully restored with current repair techniques. The study suggests that current surgical repair techniques may be effective for reducing pain but have not yet been optimized for restoring long-term shoulder function.


Characterization of reversible myocardial dysfunction by magnetic resonance imaging.
Some recent cardiovascular applications of nuclear magnetic resonance imaging (MRI) are discussed, on the basis of both literature and personal data. Management of coronary patients has become directed to strategies aiming at salvaging the ischemic myocardium, and MRI can play an important role in providing the necessary data leading to an appropriate assessment. Due to its capability in showing morphofunctional information on wall thickness and thickening, cine-MRI technique can be used to detect myocardial ischemia and infarction, since it allows the acquisition of 16 or more frames of the cardiac cycle which can be displayed in a cine loop format. In an Italian Cooperative Study the role of MRI in discriminating stunned from necrotic areas has been investigated. Comparison of fractional area change by echo versus cine-MR turned out to be almost completely overlapping, but cine-MRI allowed a more accurate measurement of systolic wall thickening due to better visualization of endo- and epicardial borders (more sensitive marker of kinetic damage than wall motion). Other studies have also been performed in order to determine the capability of contrast agents of allowing differentiation between reperfused reversible and irreversible myocardial injury and allowing distinction between reperfused and occlusive myocardial infarction. In a recent study we investigated the MRI possibility of identifying viable myocardium in severely chronic systolic dysfunctioning areas by comparing, in corresponding left ventricular segments, regional perfusion and metabolism at IPPA scintigraphy and regional signal intensity at MR images obtained before and after paramagnetic contrast media administration. The potential role of MRI was shown in the identification of viable myocardium with the use of contrast medium, that is of crucial importance in this respect.


[Diagnosis and therapy of fibromyalgia syndrome].
The meaningfulness of the term fibromyalgia syndrome (FMS), possible diagnostic criteria, and the therapeutic procedure, were for a long time points of contention between different professional associations. In an interdisciplinary S3 guideline on the definition, pathophysiology, diagnosis and therapy of FMS, it has now been possible to work out a consensus that is accepted by all involved professional associations and patient representatives on the basis of the available evidence. The most important results for clinical practice are presented and discussed here using case examples. The number of FMS patients in Germany is estimated to lie at 1.6 million (2% of the population), and 80-90% of those affected are women. FMS is classified under the functional somatic syndromes of the diseases of the musculoskeletal system and of the connective tissue (ICD 10 M 79.7). Comorbidities with other functional somatic syndromes and mental disorders are frequent. The clinical diagnosis of an FMS can ensue both by examining the tender points and also based on symptoms. Basic therapy includes elucidation and psychoeducation, aerobic endurance training adapted to the individual performance capability, operant behavioural therapy, and as a drug-based therapy option, amitriptyline 25-50mg/d (all level of evidence 1a). A graded therapeutic procedure which includes the patients in the decision-making is recommended.


Specific directional exercises for patients with low back pain: a case series.
To determine whether outcomes could be changed after poor response to non-specific exercise therapy when the prescription was changed to specific, directional-preference exercises (McKenzie method). Patients who participated in a randomized clinical trial (RCT) and the alternative care phase immediately following formed the cohort for this case series. In an earlier RCT, patients with directional preference were randomized to exercises/advice matched to their individual directional preference or to one of two unmatched protocols. The primary inclusion criterion for our case series was patient reports of being unchanged or worse following 2 weeks' treatment in the RCT. The secondary inclusion criterion was patient requests for "a change to one of the other stretching protocols to see if I can achieve better pain control." Patients meeting either of these criteria were offered matched exercises/advice if they had not previously received this intervention. Two-way repeated-measures ANOVA and McNemar tests compared outcomes during two consecutive time intervals: baseline to 2 weeks and 2 weeks to discharge. Dropouts were included in the intention-to-treat analysis. Four patients from the matched group met the primary inclusion criterion of "unchanged" (none reported being worse); 10 additional patients requested alternative treatment for better pain control (secondary criterion). Eighty-five patients from the two unmatched treatment groups met all the inclusion criteria, and an additional 22 patients met only the secondary criterion. These patients were offered matched treatment, and 96 consented. Those reporting improvement or resolution of symptoms were 22 % in the first two weeks of unmatched care (during the RCT) compared to 84 % with matched care. Statistically significant and clinically meaningful changes occurred in all outcomes (p < 0.001) after receiving matched care, compared to clinically unimportant changes with previous unmatched care during the RCT. Poor outcomes from non-specific/unmatched exercise protocols appeared to reverse when patients with directional preference were given sub-group-matched, direction-specific exercises. Because of the limitations of our study design, replication with a control group and longer-term follow-up are required to validate the findings.


Device Malfunctions and Complications Associated with Benign Prostatic Hyperplasia Surgery: Review of the Manufacturer and User Facility Device Experience Database.
Introduction and Objectives: Multiple surgical therapies for benign prostatic hyperplasia (BPH) have been developed to decrease complications and increase provider efficiency. We investigated contemporary BPH treatment device-related adverse events by searching a publicly available database. Materials and Methods: The Manufacturer and User Facility Device Experience (MAUDE) database was queried for contemporary BPH treatments. All devices were evaluated for malfunction, patient complications, and manufacturer review. The MAUDE adverse event classification system was used to standardize complications. Univariate analysis was performed to identify associations between BPH devices and adverse events. Results: A total of 2567 reports were identified: transurethral resection of the prostate (TURP) 197 (7.67%), holmium laser enucleation of the prostate (HoLEP) 39 (1.52%), GreenLight™ 2315 (90.2%), and UroLift® 16 (0.62%). The most common deviations for each modality included cutting loop detachment during TURP 116 (58.9%), morcellator dysfunction for HoLEP 23 (58.9%), tip fracture/detachment for GreenLight (68.8%), and failure to deploy during UroLift 10 (62.5%). Only 18 (0.7%) patients required medical/surgical management (MAUDE II-IV) due to a device complication. No significant relationship was seen between each modality and complications; however, morcellator use (27.8%) was observed in higher grade complications. Manufacturer review occurred in 61.7% of cases, with 41.3% of reviewed cases finding the operator the cause of the malfunction. Conclusion: Each BPH modality investigated had minimal patient harm with over 99% of patients experiencing no complication after device malfunction. Of note, great care should be taken with morcellator use during HoLEP as it had the greatest number of MAUDE II to IV complications among all devices. Manufacturer review revealed that over 40% of cases were due to misuse by the user. Therefore, urologists should select the modalities they are most familiar with to decrease patient harm and prevent device malfunctions.


The niche, limits to species' distributions, and spatiotemporal variation in demography across the elevation ranges of two monkeyflowers.
Understanding the processes that create and maintain species' geographic range limits has implications for many questions in ecology, evolution, and conservation biology. Many expectations for the ecological and evolutionary dynamics of populations at the range margin rest on the concordance of geographic limits and the limits of a species' ecological niche. If range limits are coincident with niche limits, then marginal populations should have lower and/or more variable vital rates and population growth rates than central populations. Using data from 8 annual censuses of marked individuals, I investigated the demography of Mimulus cardinalis and Mimulus lewisii across the species' elevation ranges. Central and marginal populations exhibited striking demographic differences, but only for one species were differences in expected directions. Marginal populations from the M. lewisii lower elevation range limit had lower and more variable survival than central populations and appeared to be demographic sinks. In contrast, marginal populations from the M. cardinalis upper elevation limit had higher fecundity and higher population growth rates than central populations. Although the species differed with respect to central-marginal patterns, they were concordant with respect to elevation; that is, both species had higher fitness in higher reaches of their examined ranges. Potential explanations for these patterns include source-sink dynamics, with asymmetrical gene flow mediated by river currents, and climate change, with recent warming shifting the species' climatic envelopes to higher elevations. Hence, assessment of spatiotemporal variation in both demography and dispersal is necessary to fully understand the relationship between the niche and species' distributions.


Use of whole-exome sequencing to identify novel monogenic gene mutations and genotype-phenotype correlations in Chinese Han children with urolithiasis.
The incidence of urolithiasis (UL) in children has been increasing. Although the pathogenesis of pediatric UL is controversial and remains unclear, multiple monogenic causes of UL have been identified. We aim to investigate the prevalence of inherited UL causes and explore the genotype-phenotype correlation in a Chinese pediatric group. In this study, we analyzed the DNA of 82 pediatric UL patients using exome sequencing (ES). The data of metabolic evaluation and genomic sequencing were subsequently analyzed together. We detected 54 genetic mutations in 12 of 30 UL-related genes. A total of 15 detected variants were described as pathogenic mutations, and 12 mutations were considered likely pathogenic. Molecular diagnoses were made in 21 patients with pathogenic or likely pathogenic variants. Six novel mutations that were not previously reported were identified in this cohort. Calcium oxalate stones were detected in 88.9% cases (8/9) with hyperoxaluria-related mutations, while 80% of individuals (4/5) with cystinuria-causing defects were diagnosed with cystine stones. Our study highlights the significant genetic abnormalities in pediatric UL and demonstrates the diagnostic power of ES for screening patients with UL.


Electroconvulsive therapy in a cochlear implant patient.
To report the first use of electroconvulsive therapy (ECT) in a patient with a cochlear implant (CI). Clinical Capsule Report. University hospital. : A 17-year-old boy who underwent Nucleus 22 cochlear implantation in 1995 presented with delirious mania in 2009. Aggressive pharmacologic management was ineffective, and ECT was recommended due to the potentially lethal nature of his psychiatric illness. After careful consideration by a multidisciplinary team, unilateral ECT on the side opposite the CI without removal of the device was recommended. Electroconvulsive therapy was performed on hospital Days 20 and 21. Integrity testing of the CI was performed on hospital Day 38. Subjective and objective assessment of cochlear implant functioning and response to ECT. Electroconvulsive therapy was well tolerated and contributed to alleviation of presenting symptoms. The patient used his CI without subjective degradation of performance. Integrity testing of the CI after ECT confirmed proper functioning of the device. This is the first report of ECT in a patient with CI. Unilateral ECT was performed contralateral to the CI without subjective or objective decline in performance. This Clinical Report motivates further study regarding the use of ECT in CI patients.


[Effects of physical training in patients with type 2 diabetes mellitus: a systematic review].
Physical training is recommended in several studies and guidelines for the control of type 2 diabetes mellitus (DM2) and its complications. We performed a systematic review about the effects of aerobic training (AT), resistance (RT) or the combination of both (AT/ RT), on glycated hemoglobin (HbA1c) in patients with DM2. Therefore, we included 15 clinical trials with at least 12 weeks duration about training program or recommendations of physical exercise, that evaluated the reduction in HbA1c levels in patients with DM2. Information was obtained on training modality (AT, RT or AT / RT), training parameters, duration and weekly training frequency. The results showed increases in peak or maximal oxygen uptake, exercise tolerance time and muscle strength, depending on the type of training, and a reduction in HbA1c levels. We conclude that exercise training is associated with reductions of HbA1c in patients with DM2. Thus, it can be a complementary tool in the management of these patients.


Prognostic value of coronary computed tomography (CT) angiography.
Coronary computed tomography angiography (CTA) allows increasingly reliable visualization of the coronary arteries. Over the past two years, several relevant scientific studies on the clinical utility and prognostic value of CT angiography have been published, and this review will provide a summary of the currently available data.


[Pilot-scale comparison research of different constructed wetland types to treat eutrophic lake water].
Comparison research of different constructed wetland types to treat lake Wulihu water was carried out. Under the condition of the loading rates 0.8 m3/(m2 x d), the removal efficiencies of the vertical flow wetland (VFW), subsurface flow wetland (SFW) and free surface wetland(FSW) had the following results: To ammonia nitrogen (NH4(+)-N) the average removal rates were 33.2%, 27.4% and 14.1%, respectively; To total nitrogen (TN) the average removal rates were 52.3% , 50.1% and 19.2%, respectively; To total phosphorus (TP) the average removal rates were 58.8%, 57.9% and 26.3%, respectively; To permanganate index the average removal rates were 37.2%, 38.3% and 14.8%, respectively; To chlorophyll a (Chl-a) the average removal rates were 86.9%, 96.1% and 55.3%, respectively. Obviously, VFW and SFW are more effective than FSW at treating eutrophicated water such as Lake Wulihu which with characters of low organically pollution and with high nitrogen and phosphorus pollution, and the VFW is the most effective on the removal of NH4(+)-N, TN and TP. SFW is the most effective on the removal of permanganate index and Chl-a. The effluent stability of VFW is better than SFW, and the SFW is better than FSW.


Effects of a 30-week combined training program in normoxia and in hypoxia on exercise performance and health-related parameters in obese adolescents: a pilot study.
A light but regular combined training program is sufficient to improve health in obese adolescents. Hypoxia is known to potentiate the effects of a high intensity period of combined training on exercise performance and glucose metabolism in this population. Here, we tested the effects of a less intensive hypoxic combined training program on exercise performance and health-related markers in obese adolescents. Fourteen adolescents volunteered to participate to a 30-week combined training protocol whether in normoxia (FiO2 21%, NE, N.=7) or in hypoxia (FiO2 15%, HE, N.=7). Once a week, adolescents exercised for 50-60min including 12min on a cycloergometer and strength training of the abdominal, quadriceps and biceps muscles. Combined training reduced body mass (NE: -12%; HE: -8%), mainly due to a loss in fat mass (NE: -26%; HE: -15%), similarly in both the hypoxic and normoxic groups. After training, maximal O2 consumption (VO2max) (NE: +30%; HE: +25%,), maximal aerobic power (MAP) (NE: +20%; HE: +36%), work capacity and one-repetition maximum (1RM) for the quadriceps (NE: +26%; HE: +12%), abdominal (NE: +48%; HE: +36%) and biceps muscles (NE: +26%; HE: +16%) were increased similarly in both groups but insulin sensitivity markers were not modified. Except for insulin sensitivity, 1h a week of combined training for 30 weeks improved morphological and health-related markers as well as exercise performance in obese adolescents in both normoxic and hypoxic conditions. This is of particular importance for motivating those adolescents, who often are reluctant to exercise. Even a low dose of exercise per week can induce positive health outcomes.


Dermoid Cyst with Intracranial Extension Presenting With Headache.
Dermoid cysts (DC) are benign cutaneous developmental anomalies comprising of hair follicles, sweat glands and sebaceous glands, and lined by stratified squamous epithelium. They are most commonly found on the face, lower back, and ovaries. We present a case of DC with intracranial extension in a 9 year old boy who presented with headache and a fluctuant scalp swelling. Magnetic resonance imaging revealed a midline scalp mass with intracranial extension. The lesion was excised with superior sagittal sinus preservation; and confirmed as DC by histopathological examination. The boy made good recovery.


Rapid thrombelastography thresholds for goal-directed resuscitation of patients at risk for massive transfusion.
Uncontrolled hemorrhage is a leading cause of mortality after trauma accounting for up to 40% of deaths. Massive transfusion protocols offer a proven benefit in resuscitation of these patients. Recently, the superiority of thrombelastography (TEG)-guided resuscitation over strategies guided by conventional clotting assays has been established. We seek to determine optimal thresholds for rapid (r)-TEG driven resuscitation. The r-TEG data were reviewed for 190 patients presenting to our level 1 trauma center from 2010 to 2015. Criteria for inclusion were highest level trauma activation in patients 18 years or older with hypotension presumed due to acute blood loss. Exclusion criteria included isolated gunshot wound to the head, pregnancy, and chronic liver disease. Receiver operating characteristic (ROC) analysis was performed to test the predictive performance of r-TEG for massive transfusion requirement defined by need for (1) >10 units of RBCs total or death in the first 6 hours or (2) >4 units of RBCs in any hour within the first 6 hours. Cutpoint analysis was then performed to determine optimal thresholds for TEG-based resuscitation. The ROC analysis of r-TEG yielded areas under the curve (AUC) greater than 70% for all outputs with respect to both transfusion thresholds considered, with exception of activated clotting time and lysis at 30 minutes for greater than 4 U RBC in any hour in the first 6 hours. Optimal cutpoint analysis of the resultant ROC curves was performed and for each value, the most sensitive cutpoint was identified, respectively activated clotting time of 128 seconds or longer, angle (α) of 65 degrees or less, maximum amplitude of 55 mm or less, and lysis at 30 minutes of 5% or greater. Through ROC analysis of prospective TEG data, we have identified optimal thresholds to guide hemostatic resuscitation. These thresholds should be validated in a prospective multicenter trial. Therapeutic study, level V.


An Enhanced Differential Evolution with Elite Chaotic Local Search.
Differential evolution (DE) is a simple yet efficient evolutionary algorithm for real-world engineering problems. However, its search ability should be further enhanced to obtain better solutions when DE is applied to solve complex optimization problems. This paper presents an enhanced differential evolution with elite chaotic local search (DEECL). In DEECL, it utilizes a chaotic search strategy based on the heuristic information from the elite individuals to promote the exploitation power. Moreover, DEECL employs a simple and effective parameter adaptation mechanism to enhance the robustness. Experiments are conducted on a set of classical test functions. The experimental results show that DEECL is very competitive on the majority of the test functions.


Plasma levels of adenosine 3',5'-monophosphate in the fetoplacental unit and maternal circulation at delivery.
Adenosine 3',5'-monophosphate (cAMP) was measured in matched samples of maternal plasma (MV) and umbilical artery (UA) and vein (UV) of 14 normal infants born following an uncomplicated vaginal delivery. There was good correlation between UA and UV cAMP levels, which seems to indicate that the fetoplacental unit maintains a constant equilibrium of the nucleotide concentration in the umbilical circulation. There was a markedly increased UA cAMP concentration at term relative to that of MV, as well as an arteriovenous gradient of plasma cAMP level (UA greater than UV) in the fetoplacental circulation, which strongly suggest that the high cAMP levels in the cord blood originate mainly from the fetus.


The Effect of Spatial Uncertainty on Visual Search in Older School-Aged Children with and without ADHD.
Numerous studies support that simple visual search tests may not be sufficient to differentiate children with and without attention-deficit/hyperactivity disorder (ADHD), especially for older school-aged children. This study aimed to explore whether the high spatial uncertainty visual search tasks can effectively discriminate older school-aged children with ADHD from their typically developing (TD) peers. In a randomized, two-period crossover design, 122 school-aged children (61 ADHD and 61 TD subjects), aged 10-12 years old, were measured using comparable visual search tasks with structured and unstructured layouts. First, the discriminant effectiveness of unstructured visual search tasks, which are associated with high-level spatial uncertainty, is superior to structured ones. Second, combining accuracy and speed into a Q score is a more sensitive measure than accuracy or time calculated alone in visual search tasks. A more in-depth ROC analysis showed that all variables could accurately identify ADHD from their TD peers under unstructured visual search tasks, with the index of the Q score performing best (AUR = 0.956). Third, the development of detectability, which represents the ability to distinguish between target and non-target, is approaching maturity in 10-12-year-old children with ADHD. However, these children showed severe deficits in dealing with disorganized distractors when performing visual search tasks with high-level spatial uncertainty. The findings of this study support that older school-aged children with ADHD demonstrate less efficient search performance than their TD peers in complex/difficult visual search tasks, especially under higher spatial uncertainty.


Arsenic contamination in sesame and possible mitigation through organic interventions in the lower Gangetic Plain of West Bengal, India.
The widespread geogenic arsenic contamination of groundwater in the Gangetic Delta of West Bengal, leading to toxicities through the food chain-principally through irrigated rice-drew due attention from researchers. Oilseeds such as sesame might be a remunerative alternative to rice and can be grown with small quantities of contaminated groundwater. The present study was conducted to explore the efficiency of organic matter in reducing arsenic accumulation in sesame. Accumulation of total arsenic in sesame seed and available arsenic in post-harvest soils varied from 0.08 to 0.58 mg kg(-1) and from 3.87 to 8.89 kg ha(-1) , respectively. The organic manures added as soil amendment significantly reduced the accumulation (concentration) of arsenic in sesame seed to a maximum extent of 65.5% (vermicompost), 50% (phosphocompost), 42% (mustard cake) and 40% (farmyard manure (FYM)) compared with the control counterpart. The risk associated with dietary exposure to arsenic-contaminated sesame oil reached a value of 15.55% of provisional tolerable weekly intake for arsenic at the maximum accumulation of arsenic in sesame oil. Substantial accumulation of arsenic in the soil-plant system was found. Risks of exposure to arsenic-contaminated oil remained considerably high. Irrigation through surface water and organic amendments both significantly reduced arsenic accumulation in sesame.


A mathematical modelling for the cheliped regeneration with handedness in fiddler crab.
An enormously developed giant cheliped with the other small one characterizes the adult male fiddler crab. Some experiments with artificial severances of cheliped indicate that such a handedness in the cheliped size is maintained even after the regeneration of severed cheliped. Other experimental researches give some results about an unknown physiological system which controls the emergence and the regeneration of the handedness in the cheliped size. In this paper, with two hypothesized factors relevant to the regeneration of a severed cheliped, we propose a simple mathematical model to describe the experimental result about the cheliped regeneration with a handedness after the cheliped severance for the fiddler crab. Our model gives a suggestion about an underlying system for the cheliped regeneration in the fiddler crab or some other crustacean species.


Effect of Er:YAG Laser and Sandblasting in Recycling of Ceramic Brackets.
Introduction: This study was performed to determine the shear bond strength of rebonded mechanically retentive ceramic brackets after recycling with Erbium-Doped Yttrium Aluminum Garnet (Er:YAG) laser or sandblasting. Methods: Twenty-eight debonded ceramic brackets plus 14 intact new ceramic brackets were used in this study. Debonded brackets were randomly divided into 2 groups of 14. One group was treated by Er:YAG laser and the other with sandblasting. All the specimens were randomly bonded to 42 intact human upper premolars. The shear bond strength of all specimens was determined with a universal testing machine at a crosshead speed of 0.5 mm/min until bond failure occurred. The recycled bracket base surfaces were observed under a scanning electron microscope (SEM). Analysis of variance (ANOVA) and Tukey tests were used to compare the shear bond strength of the 3 groups. Fisher exact test was used to evaluate the differences in adhesive remnant index (ARI) scores. Results: The highest bond strength belonged to brackets recycled by Sandblasting (16.83 MPa). There was no significant difference between the shear bond strength of laser and control groups. SEM photographs showed differences in 2 recycling methods. The laser recycled bracket appeared to have as well-cleaned base as the new bracket. Although the sandblasted bracket photographs showed no remnant adhesives, remarkable micro-roughening of the base of the bracket was apparent. Conclusion: According to the results of this study, both Er:YAG laser and sandblasting were efficient to mechanically recondition retentive ceramic brackets. Also, Er:YAG laser did not change the design of bracket base while removing the remnant adhesives which might encourage its application in clinical practice.


Development of an Extended-Reality (XR)-Based Intervention to Treat Adolescent Obesity.
Public health policies aimed at obesity reduction are more often directed toward adults than children. This is alarming given that rates of childhood obesity have been steadily increasing, and, if not treated early, adolescents with obesity may develop comorbidities into adulthood. Lifestyle-based interventions are the cornerstone of childhood obesity treatment. Recently, extended-reality (XR)-based interventions have been incorporated into the treatment of obesity, and parents and adolescents perceive virtual reality (VR) interventions as a promising approach to increasing physical activity levels and improving eating habits. VR is a tool that fits perfectly with contemporary adolescent culture, which is radically different from that of just two generations ago. It is plausible that an XR-based intervention for treating adolescents with obesity could have a profound influence on obesity management over the long-term. An understanding of adolescents' preferences, wants, and needs must be considered in the development of new interventions. We suggest that VR interventions can provide a new approach to weight management for children and adolescents and provide recommendations to assess adolescents', caregivers', and primary care providers' needs. These needs could then be used for the development of an XR-based intervention aimed at inducing sustained lifestyle changes in adolescents with obesity.


Selection, management, and outcome of vitamin K antagonist-treated patients with atrial fibrillation not switched to novel oral anticoagulants. Results from the Dresden NOAC registry.
Atrial fibrillation (AF) patients treated with well-controlled vitamin K antagonists (VKAs) may benefit less from non-vitamin K antagonist oral anticoagulants (NOACs) because they are supposed to be at low risk of thromboembolic and bleeding complications. However, little is known about the selection, management, and outcome of such "stable" VKA patients in current practice. We assessed characteristics, VKA persistence and 12 months' outcome of AF patients selected for VKA continuation. On March 1, 2013, the Dresden NOAC registry opened recruitment of patients continuing on VKA for sites that had been actively recruiting AF patients treated with NOACs in the prior 18 months. Patient characteristics were compared with those of NOAC patients from the same sites. Four hundred twenty-seven VKA patients had a significantly lower bleeding risk profile compared with 706 patients selected for NOAC treatment. For VKA, international normalised ratio time-in-therapeutic range before enrolment was 71 % and increased to 75 % during a mean follow-up of 15 months. Rates of stroke/transient ischaemic attack/systemic embolism were 1.3/100 patient-years (intention-to-treat) and 0.94/100 patient-years (as-treated). On-treatment rate of ISTH major bleeding was 4.15/100 patient-years (95 % CI 2.60-6.29) with a case-fatality rate of 16.3 % (all-cause mortality at day 90 after major bleeding). In conclusion, in daily care, AF patients selected for VKA therapy are healthier than those treated with NOAC, demonstrate a high quality of anticoagulant control and very low stroke rates. However, despite adequate patient selection and INR control, the risk of major VKA bleeding is unacceptably high and bleeding outcome is poor.


Determination of mineral contents of wild Boletus edulis mushroom and its edible safety assessment.
This study aimed to determine the contents of main mineral elements of wild Boletus edulis and to assess its edible safety, which may provide scientific evidence for the utilization of this species. Fourteen mineral contents (Ba, Ca, Cd, Co, Cr, Cu, Fe, Mg, Mn, Na, Ni, Sr, V and Zn) in the caps and stipes of B. edulis as well as the corresponding surface soils collected from nine different geographic regions in Yunnan Province, southwest China were determined. The analyses were performed using inductively coupled plasma atomic emission spectrometer (ICP-AES) after microwave digestion. Measurement data were analyzed using variance and Pearson correlation analysis. Edible safety was evaluated according to the provisionally tolerable weekly intake (PTWI) of heavy metals recommended by United Nations Food and Agriculture Organization and World Health Organization (FAO/WHO). Mineral contents were significantly different with the variance of collection areas. B. edulis showed relative abundant contents of Ca, Fe, Mg and Na, followed by Ba, Cr, Cu, Mn and Zn, and the elements with the lower content less were Cd, Co, Ni, Sr and V. The elements accumulation differed significantly in caps and stipes. Among them, Cd and Zn were bioconcentrated (BCF > 1) while others were bioexcluded (BCF < 1). The mineral contents in B. edulis and its surface soil were positively related, indicating that the elements accumulation level was related to soil background. In addition, from the perspective of food safety, if an adult (60 kg) eats 300 g fresh B. edulis per week, the intake of Cd in most of tested mushrooms were lower than PTWI value whereas the Cd intakes in some other samples were higher than this standard. The results indicated that the main mineral contents in B. edulis were significantly different with respect to geographical distribution, and the Cd intake in a few of regions was higher than the acceptable intakes with a potential risk.


Protection of atherogenesis in thromboxane A2 receptor-deficient mice is not associated with thromboxane A2 receptor in bone marrow-derived cells.
In the previous study, we generated mice lacking thromboxane A2 receptor (TP) and apolipoprotein E, apoE(-/-)TP(-/-) mice, and reported that the double knockout mice developed markedly smaller atherosclerotic lesions than those in apoE(-/-) mice. To investigate the mechanism responsible for reduced atherosclerosis in apoE(-/-)TP(-/-) mice, we examined the role of TP in bone marrow (BM)-derived cells in the development of the atherosclerotic lesions. When we compared the function of macrophages in apoE(-/-) and in apoE(-/-)TP(-/-) mouse in vitro, there was no difference in the expression levels of cytokines and chemokines after stimulation with lipopolysaccharide. We then transplanted the BM from either apoE(-/-) or apoE(-/-)TP(-/-) mice to either apoE(-/-) or apoE(-/-)TP(-/-) mice after sublethal irradiation. After 12 weeks with high fat diet, we analyzed the atherosclerotic lesion of aortic sinus. When the BM from apoE(-/-) or apoE(-/-)TP(-/-) mice was transplanted to apoE(-/-) mice, the lesion size was almost the same as that of apoE(-/-) mice without BM transplantation. In contrast, when the BM from apoE(-/-) or apoE(-/-)TP(-/-) mice was transplanted to apoE(-/-)TP(-/-) mice, the lesion size was markedly reduced. These results indicate that the protection of atherogenesis in TP(-/-) mice is not associated with TP in BM-derived cells.


Molecular cloning, spatial and temporal expression analysis of CatSper genes in the Chinese Meishan pigs.
Sperm ion channel proteins (CatSpers) are essential for sperm hyperactivated motility, and then penetration through the zona pellucida. The CatSper class of proteins have well been characterized in the mouse and human. However, such data for pigs are not available. In the present study, we cloned the porcine CatSper 1-4 genes, analysed their spatial expression in various organs and temporal expression in the testes from birth until sexual maturity in Meishan boars. Rapid amplification of cDNA ends (RACE) was performed to clone the full length cDNAs of porcine CatSper genes and bioinformatics analysis of inferred CatSper proteins was also determined. Various organs were collected from 150 day-old pigs to characterize the spatial expression of CatSper genes by qualitative reverse transcriptase polymerase chain reaction (RT-PCR), and testes from birth to 150 day-old boars were sampled to detect the temporal expression of CatSper genes by quantitative real-time RT-PCR. The mRNA sequences of CatSper1 (2452 bp), CatSper2 (2038 bp), CatSper3 (1408 bp), and CatSper4 (1799 bp), including full length of cDNAs, 5' and 3' flanks, were obtained. The bioinformatics analysis indicated that coding regions spanning the ion transport domains were conserved for different species analyzed. Among the four CatSpers, CatSper2, 3, and 4 were more conserved across species, compared with CatSper1. In addition, six conservative trans-membrane domains, a pore forming motif, and a coiled-coil motif were also identified. The spatial analysis from different organs showed that CatSper1 was detected in both testes and hypothalamus, CatSper2 was restricted in testes only, CatSper4 was expressed in testes and rete testes; whereas CatSper3 was more ubiquitously. CatSper3 and CatSper4 transcripts were also detected in ejaculated sperm. At Days 1 and 30 of age, CatSper mRNAs exhibited only sparse expression in the testes. However, these transcripts highly expressed at Day 60 and onward till sexual maturity (Day 150 of age). The spatial and temporal expression profiles of CatSper genes were reported herein for the first time in pigs. CatSper1, CatSper2 and CatSper4 were primarily expressed in testes, while CatSper3 transcript was prevalent in a variety of organs. CatSper3 and CatSper4 mRNAs were present in mature sperm cells. Substantial upregulation of CatSper genes was initiated at Day 60 and maintained this marked production until sexual maturity.


Structural, microstructural and magnetic characterization of the β-CoTe nanophase synthesized by a novel mechanochemical method.
This work reports an unprecedented mechanochemistry synthesis of β-CoTe and its systematic characterization through X-ray powder diffraction (XRPD), transmission electron microscopy (TEM), and magnetometry techniques. The mechanical alloying produced the desired material within 6 h along with minor impurities, showing good stabilization for higher milling times (15 h) and long-term storage. XRPD characterization employed the Rietveld profile fitting analysis with fundamental parameters analysis in a direct convolution approach, giving the material's structure and microstructure information. For the spherical shape, the diameter mass average of the crystallites furnished values around 13 nm with 1.1% of microstrain. The double-Voigt procedure also modeled a triaxial ellipsoid shape for the crystallite size and obtained a surface-weighted average value for its volume around 150 nm3. TEM images confirmed the nanometric size visually and showed the crystallites to aggregate in large particles hundreds of nanometers in size. Measuring hundreds of supposed crystallite sizes, we could achieve a numerical distribution of their sizes with an average of 16 nm. The magnetization analysis performed both experimentally and via numerical simulations showed that β-CoTe is predominantly superparamagnetic with a magnetic domain size compatible with the double-Voigt one.


Determining Whether Low Protein Intake (<1.0 g/kg) Is a Risk Factor for Malnutrition in Patients with Cirrhosis.
The prevalence of malnutrition in patients with cirrhosis is considerably high. Body mass index (BMI) is a well-known risk factor for malnutrition, but the other risk factors are unknown. We investigated the prevalence of malnutrition and its risk factors in patients with cirrhosis. In total, 361 patients with cirrhosis were enrolled. Muscle quality and quantity were retrospectively assessed using the grip strength test and bioelectrical impedance analysis. Subjective global assessment (SGA) of malnutrition and dietary intake assessments were performed by a clinical dietician. The prevalence rates of sarcopenia, malnutrition assessed by SGA, and inadequate energy intake were 22.7%, 13.6%, and 27.5%, respectively. The prevalence of malnutrition evaluated using any of the assessment methods was 46.3%, and no significant difference was observed according to liver disease etiology. The prevalence of malnutrition increased with the increasing disease severity (p = 0.034) and decreasing BMI (p = 0.007). The prevalence of malnutrition was 64.4% in patients with protein intake <1.0 g/kg. Low protein intake, Child-Pugh C grade, older age, and low BMI were independent risk factors for malnutrition in multivariate analysis. Low protein intake (<1.0 g/kg) is an independent risk factor for malnutrition in patients with cirrhosis.


Water-Sintered Transient Nanocomposites Used as Electrical Interconnects for Dissolvable Consumer Electronics.
Rapid development of electronic technology shortens the development time for new products and accelerates the obsolescence of consumer electronics, resulting in the explosive growth of electronic waste that is difficult to recycle and hazardous to the environment and human health. Transient electronics that can dissolve in water may potentially be adopted to tackle the issues of electronic waste; however, promising approaches to yield large-scale and high-performance transient consumer electronics have not yet been developed. Here, the joint effect of galvanic corrosion and redeposition has been utilized to develop bimetallic transient nanocomposites, which can be printed and water-sintered to yield high-performance transient PCB circuits with excellent electrical conductivity and mechanical robustness. The entire sintering process requires no external energy and strict environmental conditions. The achieved PCB circuits offer a conductivity of 307,664.4 S/m that is among the highest in comparison with other printed transient circuits. The supreme performance of the transient circuits eventually leads to the first dissolvable smartwatch that offers the same functions and similar performance as conventional smartwatches and dissolves in water within 40 h. The joint effect of galvanic corrosion and redeposition between two metals with distinct activities leads to novel nanocomposites and processing techniques of transient electronics. The resulting high-performance transient devices may reshape the appearance of consumer electronics and reform the electronics recycling industry by reducing recycling costs and minimizing environmental pollution and health hazard.


Clinical and biochemical abnormalities in endurance horses eliminated from competition for medical complications and requiring emergency medical treatment: 30 cases (2005-2006).
To describe the clinical and clinicopathologic abnormalities in endurance horses eliminated from competition and requiring emergency medical treatment. Retrospective study over a 2-year period (2005-2006). Ten horses that successfully completed the ride in 2006 were included for comparison. Temporary equine emergency field hospital. All horses (n=30) that were removed from endurance competition and treated for a metabolic abnormality were studied. Horses were treated with IV fluids and analgesics. Monitoring included lab work (PCV, total protein, and electrolytes) and serial physical examinations. Statistical analysis included descriptive statistics and parametric and nonparametric comparisons (ANOVA, Friedman's test, and Kruskal-Wallis) where appropriate. The clinical diagnoses identified included colic, esophageal obstruction, poor cardiovascular recovery, myopathy, and synchronous diaphragmatic flutter. As a group, these sick horses had lower plasma chloride and potassium and higher total plasma protein concentrations as compared with 10 healthy horses that successfully completed the ride (P<0.05, <0.01, and <0.05 for chloride, potassium, and total protein, respectively). Horses with colic had a lower PCV as compared with horses with poor recovery and those with synchronous diaphragmatic flutter (P<0.05). All horses, including colics, were treated medically and discharged to owners. Based on the results of this study, the prognosis for horses requiring emergency veterinary treatment after being removed from endurance competition (for metabolic reasons) appears to be good if horses are withdrawn from competition under the same criteria outlined in this study. Biochemical abnormalities tend to be mild and do not necessarily aid in delineating sick horses from successfully completing horses. None of the horses with gastrointestinal disease required abdominal surgery.


Implications for clients when nurses view weight as main cause of Type 2 diabetes in primary care.
Type 2 diabetes (T2D) is often seen as primarily caused by weight, and its amelioration associated with individual behaviour change, which has the potential for negative consequences for people living with the disease. The aims of this study were to explore how weight was framed by diabetes resource nurses and to determine the implications of that framing for nurse practice in a primary care setting in Australia. The research was a qualitative empirical case study using semistructured interviews with nurses focusing on meanings and interpretations. The findings were interpreted using a constructivist epistemology of both inductive and deductive inference. The study found that nurses viewed overweight and obesity as unhealthy and the primary causes of T2D, and that weight was frequently discussed in the health care encounter. Nurses emphasised individual responsibility through behaviour change to manage T2D, downplaying other known causes such as age and family history and important social inequalities. Studies show that nurses have negative attitudes towards overweight and obese patients. The implications of this research are that the nurses' views could potentially negatively affect clients' management of T2D, which has the potential for poor health outcomes.


Performance consistency of normal observers in forced-choice tachistoscopic visual line bisection.
Pseudoneglect (PN) refers to the leftward error exhibited by normal observers on line bisection tasks (Bowers and Heilman, Neuropsychologia, 18, (1980) 491-8). Although a thorough review of the literature has shown PN to be relatively robust (Jewell and McCourt, Neuropsychologia, 38, (2000) 93-110), controversy remains concerning the reliability of the phenomenon, with some studies reporting a relatively high incidence of normal subjects with rightward bisection errors. The present experiment assesses the consistency of bisection performance in normal young observers. Right-handed subjects (N=22) participated in a tachistoscopic forced-choice line bisection task. Each subject participated in 7-16 experimental sessions separated by at least 24 h (total bisection measurements=317). Individual bisection performance could thus be evaluated with respect to within-subject variability measures. An eyetracker recorded gaze position during the task in one session. A highly significant mean group bisection error of -0.26 degrees (P<0.001) was obtained (left negative), and individual subject means ranged from -0.55 degrees to +0.03 degrees. Of the 317 total bisection measurements, 9% (28) deviated rightward. Significant (P<0.05) mean leftward errors occurred in 91% (20/22) of subjects. Mean bisection error in two subjects was not significantly different from zero. No subject possessed a significant rightward error. Mean gaze deviation from screen (and line) center ranged from +/-0.9 degrees, and was positively correlated (P<0.05) with bisection error. It is concluded that forced-choice tachistoscopic line bisection measures are highly reliable; a mean correlation of +0.87 exists between mean error based on 15 trials and means estimated from a random sample of only two trials. The incidence of true rightward bisection error in the population of normal right-handed subjects is thus estimated to be less than 5%.


Distribution of Solitary and Multiple Enchondromas of the Hand.
Although some patients with enchondroma have multiple lesions, no study has investigated the distribution of lesions in patients with multiple enchondromas. This retrospective study included 118 patients with enchondroma of the hand. The incidence and characteristic feature of multiple enchondromas of the hand were investigated. Four patients (3.4%) had multiple enchondromas. In all the patients with multiple enchondromas, the lesions occurred in the middle phalanx, proximal phalanx, and metacarpal bone in the same digital ray. The development of the hand rapidly progresses from intrauterine day 33 to day 54. The digital rays are evident on intrauterine day 41, and separation of the distal phalanx, middle phalanx, proximal phalanx, and metacarpal bone is completed until intrauterine day 54. The successive occurrence of multiple enchondroma lesions in the same digital ray in all four cases suggests that the occurrence of lesions preceded the separation of the hand bones and the lesions were divided during the development of these bones.


Alpinumisoflavone Impairs Mitochondrial Respiration via Oxidative Stress and MAPK/PI3K Regulation in Hepatocellular Carcinoma Cells.
Alpinumisoflavone is a natural prenylated isoflavonoid extracted from the raw fruit of Cudrania tricuspidata. Several studies have reported the beneficial characteristics of alpinumisoflavone, such as its antioxidant, anti-inflammation, anti-bacterial, osteoprotective, and neuroprotective effects. Alpinumisoflavone also has anti-cancer effects on thyroid, renal, and ovarian cancers, but its therapeutic effects on hepatocellular carcinoma (HCC) have not yet been demonstrated. We investigated the anti-cancer effects of alpinumisoflavone on HCC using human liver cancer cell lines, Hep3B and Huh7. Our results confirmed that alpinumisoflavone inhibited viability and regulated the MAPK/PI3K pathway in Hep3B and Huh7 cells. We also verified that alpinumisoflavone can depolarize the mitochondrial membrane potential and suppress the mitochondrial respiration in HCC cells. Moreover, we confirmed the dysregulation of the mitochondrial complexes I, III, and V involving mitochondrial oxidative phosphorylation at the mRNA level and the accumulation of calcium ions in the mitochondrial matrix. Lastly, we demonstrated that alpinumisoflavone induced mitochondria-mediated apoptosis via regulation of the Bcl-xL and BAK proteins. This study elucidates the anti-cancer effects of alpinumisoflavone on HCC.


Clinical and histologic results related to a low-modulus composite total hip replacement stem.
Osteolysis secondary to stress shielding in patients with a total hip arthroplasty has been attributed to greater stiffness of the prosthetic femoral stem compared with the stiffness of the femur. This concern led to the development of a composite femoral stem implant with a structural stiffness similar to that of the native femur. The stem consists of a cobalt-chromium-alloy core surrounded by polyaryletherketone and titanium mesh for bone ingrowth. The purpose of this study was to determine the intermediate-term clinical, radiographic, and histologic results of the use of this stem. Twenty-eight patients (nineteen men and nine women) with an average age of 51.3 years underwent primary total hip arthroplasty with the Epoch stem and were followed for an average of 6.2 years. Harris hip scores were determined and radiographic studies were performed preoperatively, postoperatively, and at two-year intervals thereafter. In addition, dual x-ray absorptiometry scans were made up to two years postoperatively to evaluate osseous resorption. Two femora obtained at autopsy thirteen and forty-eight months after surgery were analyzed for bone ingrowth and ongrowth. The Harris hip scores averaged 56 points preoperatively and improved to 97 points at the time of the last follow-up. Dual x-ray absorptiometry scans demonstrated the greatest decrease in mean bone density (27.5%) in Gruen zone 7 at two years. Radiographs demonstrated no instances of migration, and only one hip had osteolysis. All stems had stable osseous fixation. Histologic evaluation of the two femora that had been retrieved at autopsy at thirteen and forty-eight months showed the mean bone ingrowth (and standard deviation) along the entire length of the stem to be 49.62% +/- 13.04% and 73.57% +/- 8.48%, respectively, and the mean bone ongrowth to be 54.18% +/- 7.68% and 80.92% +/- 6.06%, respectively. Intermediate-term follow-up of hips treated with the Epoch stem indicated excellent clinical success, radiographic evidence of osseous integration, and histologic findings of osseous ingrowth and ongrowth. Although the implant has been associated with excellent results in both the short and the intermediate term, longer follow-up will be necessary to assess the long-term function of the implant.