The transcatheter aortic valve implementation (TAVI)--a qualitative approach to the implementation and diffusion of a minimally invasive surgical procedure.
The transcatheter aortic valve implantation (TAVI), a minimally invasive surgical procedure to treat patients with severe symptomatic aortic stenosis, showed a rapid diffusion in Germany compared to the international level. The aim of this study is to identify and analyze factors affecting the implementation and diffusion of the procedure in hospitals using a qualitative application of the diffusion of innovations theory. We conducted problem-centered interviews with cardiologists and cardiac surgeons working in German hospitals. The multi-level model "diffusion of innovations in health services organizations" developed by Greenhalgh et al. was used to guide the research. Data was analyzed using content and a thematic analysis. Among the ten participants who were interviewed, we found both barriers and facilitators related to the innovation itself, system readiness and antecedents, communication and influence, and the outer context. Key issues were the collaboration between cardiologists and cardiac surgeons, reimbursement policies, requirements needed to conduct the procedure, and medical advantages of the method. The findings show that there are multiple factors influencing the diffusion of TAVI that go beyond the reimbursement and cost issues. The diffusion of innovations model proved to be helpful in understanding the different aspects of the uptake of the procedure. A central theme that affected the implementation of TAVI was the collaboration and competition between involved medical departments: cardiology and cardiac surgery. Against this background, it seems especially important to moderate and coordinate the cooperation of the different medical disciplines.


The use of erythtropoietin in cerebral diseases.
Global and focal cerebral ischemia is followed by a secondary damage characterized by oxidative stress, excitotoxicity, inflammation and apoptosis. Erythropoietin (EPO) exerts antiapoptotic, anti-inflammatory, antioxidative, angiogenetic and neurotrophic properties. Its potential therapeutic role has been demonstrated in several animal models of cerebral ischemia and also in a clinical trial of ischemic stroke, so it could be considered an ideal compound for neuroprotection in ischemic stroke and in cardiac arrest. Intracerebral hemorrhage (ICH) is the least treatable form of stroke; the mechanisms involved in the secondary brain injury include hematoma mass effect, neuronal apoptosis and necrosis, inflammation. It has been demonstrated in an experimental ICH that EPO intervenes in the inflammatory process, reduces brain water content, hemorrhage volume and hemispheric atrophy, promotes cell survival, preserves cerebral blood flow, has antiapoptotic protective function against oxidative stress and excitotoxic damage. EPO can attenuate acute vasoconstriction and prevent brain ischemic damage in subarachnoid hemorrhage. The neuroprotective function of EPO has been studied also in traumatic brain injury: it reduces the inflammation and improves cognitive and motor deficits. The authors review some of the physiological actions of EPO in the physiopathology of ischemic and hemorrhagic stroke, subarachnoid hemorrhage and brain trauma, and its potential usefulness in the brain injured patient management.


Permeability of enamel following light-activated power bleaching.
This study sought to ascertain whether in-office photocured bleaching techniques would increase permeability to enamel. A 7.1 mm2 circular area located in the middle third of the coronal portion of 90 human canines was isolated by applying an acid-resistant varnish to the remaining surfaces of the tooth. According to a randomized complete block design (n = 15), specimens were treated using a 35% hydrogen peroxide bleaching product activated by an integrated LED/diode laser (LED/laser) source or a quartz tungsten halogen (QTH) light. Bleaching was accomplished by applying the 35% hydrogen peroxide agent to the enamel surface in three 10-minute sessions, conducted at one-week intervals over a period of three weeks. For the photocured bleached groups, a bleaching agent was applied to the specimen and irradiated with the LED/laser device or the QTH light for 30 seconds. Negative control groups were exposed to artificial saliva or irradiated by the LED/laser device or the QTH light. Specimens were subjected to a histochemical coloring method that employed copper sulfate and dithio-oxamide solutions. Three 300-microm thick sections taken from the exposed area were imaged in an optical microscope. Permeability was measured in the digitized images as the percentage of copper ions penetration over the total enamel thickness. Friedman's test (alpha = 0.05) showed significant difference among groups. Least significant difference test revealed that in comparison with the group treated with 35% hydrogen peroxide only, there was no significant increase in enamel permeability when bleaching was activated by either the LED/laser or QTH light devices but all bleached groups showed higher permeability than the unbleached/nonirradiated group.


Primer: Applying the new postpolypectomy surveillance guidelines in clinical practice.
Colonoscopy is being increasingly used for colorectal cancer screening, which has resulted in a growing cohort of patients who have polyps that require postpolypectomy surveillance. Risk stratification enables postpolypectomy surveillance to be tailored to individual patient needs, and this is one of the fundamental points emphasized by the unified US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society (USMSTF-ACS) guidelines. Most patients do not require intensive surveillance; those patients who have one or two small (<1 cm) adenomas can safely undergo repeat colonoscopy after 5-10 years. Consensus guidelines that merge the recommendations of all societies are more user-friendly than individual guidelines, decrease confusion, and eliminate conflicting recommendations that are a barrier to guideline uptake. Nonetheless, studies have shown that specialists and nonspecialists overutilize colonoscopy for postpolypectomy surveillance, which places a large burden on already strained resources. Barriers to guideline implementation include factors involving the patient, physician, and health-care system. Physician education and widespread implementation of continuous quality improvement programs are required to bridge the gap between the guidelines and their clinical application.


Discrimination of Kawasaki disease with concomitant adenoviral detection differentiating from isolated adenoviral infection.
Human adenovirus infection mimics Kawasaki disease (KD) but can be detected in KD patients. The aim of this study was to determine the clinical differences between KD with adenovirus infection and only adenoviral infection and to identify biomarkers for prediction of adenovirus-positive KD from isolated adenoviral infection. A total of 147 patients with isolated adenovirus were identified by quantitative polymerase chain reaction. In addition, 11 patients having KD with adenovirus, who were treated with intravenous immunoglobulin therapy during the acute phase of KD were also evaluated. Compared with the adenoviral infection group, the KD with adenovirus group was significantly associated with frequent lip and tongue changes, skin rash and changes in the extremities. In the laboratory parameters, higher C-reactive protein (CRP) level and presence of hypoalbuminemia and sterile pyuria were significantly associated with the KD group. In the multivariate analysis, lip and tongue changes (odds ratio [OR], 1.416; 95% confidence interval [CI], 1.151-1.741; P=0.001), high CRP level (OR, 1.039; 95% CI 1.743-1.454; P= 0.021) and sterile pyuria (OR 1.052; 95% CI 0.861-1.286; P=0.041) were the significant predictive factors of KD. In addition, the cutoff CRP level related to KD with adenoviral detection was 56 mg/L, with a sensitivity of 81.8% and a specificity of 75.9%. Lip and tongue changes, higher serum CRP level and sterile pyuria were significantly correlated with adenovirus-positive KD.


Regional perfusion monitoring in shock.
Despite restoration of adequate systemic blood flow in patients with shock, single organs may remain hypoperfused. In this review, we summarize the results of a literature research on methods to monitor single organ perfusion in shock. We focused on methods to measure heart, brain, kidney, and/or visceral organ perfusion. Furthermore, only methods that can be used in real-time and at the bedside were included. We identified studies on physical examination techniques, electrocardiography, echocardiography, contrast-enhanced ultrasound, near-infrared spectroscopy, and Doppler sonography to assess single organ perfusion. Physical examination techniques have a reasonable negative predictive value to exclude single organ hypoperfusion but are nonspecific to detect it. Technical methods to indirectly measure myocardial perfusion include ECG and echocardiography. Contrast-enhanced ultrasound can quantify myocardial perfusion but has so far only been used to detect regional myocardial hypoperfusion. Near-infrared spectroscopy and transcranial Doppler sonography can be used to assess cerebral perfusion and determine autoregulation thresholds of the brain. Both Doppler and contrast-enhanced ultrasound techniques are novel methods to evaluate renal and visceral organ perfusion. A key limitation of most techniques is the inability to determine adequacy of organ blood flow to meet the organs' metabolic demands.


In-vitro modelling of the bactericidal activity of teicoplanin versus flucloxacillin as used in surgical prophylaxis, against Staphylococcus aureus.
The bactericidal activities of teicoplanin and flucloxacillin in a 50:50 mixture of human serum and Iso-sensitest broth were compared in an in-vitro pharmacokinetic model, at serum concentrations present during surgical prophylaxis. The bactericidal activity of teicoplanin with and without serum was also compared. Six strains of Staphylococcus aureus were tested. The bactericidal rate of teicoplanin in serum was significantly lower than the rate in broth alone. However, there was no significant difference in the bactericidal rates in serum of teicoplanin compared with flucloxacillin, an antibiotic which is commonly used as prophylaxis for certain surgical procedures.


Subcellular localization and interactions among TGB proteins of cowpea mild mottle virus.
Cowpea mild mottle virus (CPMMV) is a flexuous filamentous virus that belongs to the genus Carlavirus (family Betaflexiviridae). The CPMMV genome contains six open reading frames (ORFs), among which the triple gene block (TGB), encoded by ORFs 2 to 4, has been reported to encode movement proteins for different viruses. The subcellular localization of the TGB proteins of CPMMV isolate CPMMV:BR:MG:09:2 was analysed by transient expression of each protein fused to a fluorophore. Overall, the accumulation pattern and interactions among CPMMV TGB proteins (TGBp) were similar to those of their counterparts from the potex-like group. Considering these similarities, we evaluated the potential interactions between the TGB proteins of CPMMV and of potato virus X, which could complement cell-to-cell movement. The TGBp2 and TGBp3 of PVX had an effect on CPMMV TGBp1, directing it to the plasmodesmata, but the reverse was not true.


Refined molecular hinge between allosteric and catalytic domain determines allosteric regulation and stability of fungal chorismate mutase.
The yeast chorismate mutase is regulated by tyrosine as feedback inhibitor and tryptophan as crosspathway activator. The monomer consists of a catalytic and a regulatory domain covalently linked by the loop L220s (212-226), which functions as a molecular hinge. Two monomers form the active dimeric enzyme stabilized by hydrophobic interactions in the vicinity of loop L220s. The role of loop L220s and its environment for enzyme regulation, dimerization, and stability was analyzed. Substitution of yeast loop L220s in place of the homologous loop from the corresponding and similarly regulated Aspergillus enzyme (and the reverse substitution) changed tyrosine inhibition to activation. Yeast loop L220s substituted into the Aspergillus enzyme resulted in a tryptophan-inhibitable enzyme. Monomeric yeast chorismate mutases could be generated by substituting two hydrophobic residues in and near the hinge region. The resulting Thr-212-->Asp-Phe-28-->Asp enzyme was as stable as wild type, but lost allosteric regulation and showed reduced catalytic activity. These results underline the crucial role of this molecular hinge for inhibition, activation, quaternary structure, and stability of yeast chorismate mutase.


[The health care structure law as a political public health reform in ambulatory and day surgery].
The statutory opening of hospitals for ambulatory surgery can't without more ado be derived from the health-care reform which came into force on the 1st of January 1993. From the genesis of this reform it can be understood that the field of ambulatory surgery has been integrated just shortly before its legislation into the outlines of the health-care reform. As a consequence the hospitals are obliged to follow the principle "ambulatory before stationary" even in the stationary field. In this way the strict separation between the two fields (ambulatory and stationary) will be overcome to a great extent. Taking into consideration the further changes brought by the health-care reform in the stationary field new ranges of action for hospitals, with their chances but also their risks, have to be expected.


Adjuvant therapy for orbital non-rhabdomyosarcoma soft tissue sarcoma: comparison of long-term outcome between radiotherapy and chemotherapy.
To illustrate clinicopathological features of orbital non-rhabdomyosarcoma soft tissue sarcoma (NRSTS), and to compare the treatment outcome between postoperative radiotherapy (RT) and chemotherapy in a retrospective analysis nearly 20y. A retrospective cohort study of 56 patients with orbital NRSTS were reviewed, 34 of whom received postoperative RT, and 22 received postoperative chemotherapy. The clinicopathological features, local recurrence, metastases, and survival data were recorded. Survival analysis was performed using the Kaplan-Meier method. During follow-up (111.8mo, ranged 8-233mo) for 56 patients, 19 patients of them developed local recurrence, and 7 patients developed distant metastases. Fifteen patients died during follow-up period. Overall survival rates considering the whole study group was 78.57% at 5y, and 72.16% at 10y after the initial diagnosis. Compared with chemotherapy, RT was associated with lower risk of local recurrence [hazard ratio for RT vs chemotherapy, 0.263, 95% confidence interval (CI), 0.095-0.728, P=0.0015]; with lower risk of distant metastasis (hazard ratio for RT vs chemotherapy, 0.073, 95%CI, 0.015-0.364, P=0.0014); and with lower risk of death from disease (hazard ratio for RT vs chemotherapy, 0.066, 95%CI, 0.022-0.200, P<0.0001). The 5-year survival rate in RT group was 97.06% compared to 50% in chemotherapy group. In patients with orbital NRSTS, postoperative RT provides better control of local recurrence, distant metastasis, and death from disease than chemotherapy. RT is the more preferrable adjuvant therapy compared to chemotherapy possibly.


Aphasia in vascular lesions of the basal ganglia: A comprehensive review.
Between 1970 and 1990, the study of aphasia secondary to subcortical lesions (including the basal ganglia - BG) was largely driven by the advent of modern neuroimaging techniques such as MRI and PET. However, attempts to characterize a pattern of language abnormalities in patients with basal ganglia lesions proved unfruitful. We conducted a comprehensive review of language disturbances after vascular lesions in the BG. Literature search in Medline and LILACS (1966-2016) and PsychINFO (last 25years) was conducted, and returned 145 articles, with 57 eligible for the review yielding data on 303 patients. We report the clinical and neuroimaging features of these cases. Results showed that aphasias caused by BG lesions are heterogeneous with weak clinicoanatomical correlations. Data derived from follow-up and flow/metabolism studies suggest that subcortical aphasia caused by BG lesions involves hypoperfusion in the cortical territories of the middle cerebral/internal carotid arteries (MCA/ICA) and their branches.


The influence of packing on free radical yields in crystalline nucleic acids: the pyrimidine bases.
The total free radical yield has been measured for crystals of five pyrimidine derivatives: thymine (T), 1-methylthymine (1MeT), 1-methyluracil (1MeU), 1-methylcytosine (1MeC) and cytosine monohydrate (C:HOH). Q-band EPR measurements were made on samples X-irradiated between 4 and 12 K. The G values in units of 10(-7) mol/J are 1MeC < 0.01, T < 0.04, 1MeU = 0.15, 1MeT = 0.25, and C:HOH = 0.8. The types of free radicals formed in these crystals are known through previous EPR investigations. A model is presented that attempts to identify the salient variables behind the large range in G values and, simultaneously, explain the variation in radical types. It is concluded that packing is a critical variable. Hydrogen-bonding networks promote the trapping of radicals through reversible proton transfer. In the absence of such a network less probable radical types are observed, such as radicals formed by irreversible protonation/deprotonation, higher-order reactions and homolytic bond cleavage. Crystals with low G values trap radicals formed predominantly by irreversible protonation/deprotonation at carbon positions and by excitation-spawned homolytic bond cleavage. In contrast, crystals with high G values trap radicals formed predominantly by reversible protonation/deprotonation at heteroatom positions. This model is extended to polynucleotides irradiated at low temperatures, where G values are typically 2-6. The high trapping efficiency seen in polynucleotides reflects highly efficient proton transfer. Consistent with this is the predominance of radicals formed by reversible protonation/deprotonation compared to those formed by irreversible protonation/deprotonation.


Second Hematopoietic Stem Cell Transplantation for Post-Transplantation Relapsed Acute Leukemia in Children: A Retrospective EBMT-PDWP Study.
Outcome data were collected from the European Society for Blood and Marrow Transplantation registry on 373 children from 120 centers with relapsed leukemia (214 with acute lymphoblastic leukemia [ALL] and 159 with acute myelogenous leukemia [AML]) who underwent second allogeneic hematopoietic stem cell transplantation (HSCT) between 2004 and 2013. Overall survival (OS) was 38% at 2 years and 29% at 5 years, and leukemia-free survival (LFS) was 30% at 2 years and 25% at 5 years. Median follow-up after second HSCT was 36.4 months in the ALL group and 50.2 months in the AML group. In the ALL group, OS was 43% at 2 years and 33% at 5 years, and LFS was 34% at 2 years and 31% at 5 years. In the AML group, OS was 32% at 2 years and 24% at 5 years, and LFS was 24% at 2 years and 17% at 5 years. The 2-year nonrelapse mortality (NRM) rate was 22% in the ALL group and 18% in the AML group. Favorable prognostic factors (P < .05) for OS and LFS included >12 months between transplantations and chronic graft-versus-host disease after the first HSCT (in both groups), complete response before the second HSCT (ALL group only), and age >12 years (AML group only). Findings were more consistent over time in the ALL group, with no significant differences between 2-year and 5-year rates of relapse, NRM, and LFS. Children with relapsed acute leukemias have a substantial likelihood of long-term survival following second HSCT. Given the many novel targeted and immunomodulation therapies currently under development, it is important to identify specific patient subpopulations that may benefit from a second HSCT compared with those better suited to new approaches.


Imaging of pleural infections.
Imaging plays a major role in both the detection and management of pleural space infections. This review will summarize the techniques that are useful in the detection and localization of pleural abnormalities due to infection, including the interventional procedures that can be used to aspirate and drain complicated parapneumonic effusions. While the pleural changes induced by most infectious agents are non-specific, some radiographic patterns may narrow the diagnostic possibilities. The "diagnostic" radiographic findings that are useful, in conjunction with the clinical presentation, in suggesting a specific causative agent will be reviewed.


Approach to analytically minimize the LCD moiré by image-based particle swarm optimization.
In this paper, we proposed a methodology to optimize the parametric window of a liquid crystal display (LCD) system, whose visual performance was deteriorated by the pixel moiré arising in between multiple periodic structures. Conventional analysis and minimization of moiré patterns are limited by few parameters. With the proposed image-based particle swarm optimization (PSO), we enable a multivariable optimization at the same time. A series of experiments was conducted to validate the methodology. Due to its versatility, the proposed technique will certainly have a promising impact on the fast optimization in LCD design with more complex configuration.


[The importance of mammography in the early diagnosis of breast cancer (author's transl)].
Mammography has been performed routinely preoperatively over the last 5 years on 278 patients with breast tumors. In 85 per cent the radiographic findings showed an exact correlation to histologic results. In 12 per cent there was only a partial correlation, in only 3 per cent the mammograpic findings could not be verified by the pathologist. The purpose of this paper is to emphasize that mammography should be considered as the prime diagnostic procedure in the diagnosis of breast disease. The examination of the breast should therefore always be followed by mammography, especially in women at risk and elderly patients. In this connection we would also like to stress the vital cooperation between the radiologist and surgeon both pre- and intraoperatively. and intraoperatively. In summary we would like to emphasize the importance of possibility to achieve a better survial rate in these patients.


D-optimal experimental designs to test for departure from additivity in a fixed-ratio mixture ray.
Traditional factorial designs for evaluating interactions among chemicals in a mixture may be prohibitive when the number of chemicals is large. Using a mixture of chemicals with a fixed ratio (mixture ray) results in an economical design that allows estimation of additivity or nonadditive interaction for a mixture of interest. This methodology is extended easily to a mixture with a large number of chemicals. Optimal experimental conditions can be chosen that result in increased power to detect departures from additivity. Although these designs are used widely for linear models, optimal designs for nonlinear threshold models are less well known. In the present work, the use of D-optimal designs is demonstrated for nonlinear threshold models applied to a fixed-ratio mixture ray. For a fixed sample size, this design criterion selects the experimental doses and number of subjects per dose level that result in minimum variance of the model parameters and thus increased power to detect departures from additivity. An optimal design is illustrated for a 2:1 ratio (chlorpyrifos:carbaryl) mixture experiment. For this example, and in general, the optimal designs for the nonlinear threshold model depend on prior specification of the slope and dose threshold parameters. Use of a D-optimal criterion produces experimental designs with increased power, whereas standard nonoptimal designs with equally spaced dose groups may result in low power if the active range or threshold is missed.


Novel Amidine Protein Cross-Links Formed by the Reaction of Glyoxal with Lysine.
One crucial aspect of the Maillard reaction is the formation of reactive α-dicarbonyl structures like glyoxal, which are prone toward further reactions with proteins, e.g., the N6-amino group of lysine. The initially formed labile glyoxal-imine was previously established as a key intermediate in the formation of the advanced glycation end products N6-carboxymethyl lysine (CML), glyoxal lysine amide (GOLA), glyoxal lysine dimer (GOLD), and N6-glycolyl lysine (GALA). Here, we introduce a novel amidine cross-link structure N1,N2-bis-(5-amino-5-carboxypentyl)-2-hydroxy-acetamidine (glyoxal lysine amidine, GLA), which is formed exclusively from glyoxal through the same isomerization cascade. After independent synthesis of the authentic reference standard, we were able to quantitate this cross-link in incubations of 40 mM N2-t-Boc-lysine with glyoxal and various sugars (40-100 mM) under mild conditions (pH 7.4, 37 °C) using an HPLC-MS/MS method. Furthermore, incubations of proteins (6 mg/mL) with 50 mM glyoxal confirmed the cross-linking by GLA, which was additionally identified in acidic hydrolyzed proteins of butter biscuits after HPLC enrichment.


Sonoporation-enhanced chemotherapy significantly reduces primary tumour burden in an orthotopic pancreatic cancer xenograft.
Adenocarcinoma of the pancreas remains one of the most lethal human cancers. The high mortality rates associated with this form of cancer are subsequent to late-stage clinical presentation and diagnosis, when surgery is rarely possible and of modest chemotherapeutic impact. Survival rates following diagnosis with advanced pancreatic cancer are very low; typical mortality rates of 50% are expected within 3 months of diagnosis. However, adjuvant chemotherapy improves the prognosis of patients even after palliative surgery, and successful newer neoadjuvant chemotherapeutical modalities have recently been reported. For patients whose tumours appear unresectable, chemotherapy remains the only option. During the past two decades, the nucleoside analogue gemcitabine has become the first-line chemotherapy for pancreatic adenocarcinoma. In this study, we aim to increase the delivery of gemcitabine to pancreatic tumours by exploring the effect of sonoporation for localised drug delivery of gemcitabine in an orthotopic xenograft mouse model of pancreatic cancer. An orthotopic xenograft mouse model of luciferase expressing MIA PaCa-2 cells was developed, exhibiting disease development similar to human pancreatic adenocarcinoma. Subsequently, two groups of mice were treated with gemcitabine alone and gemcitabine combined with sonoporation; saline-treated mice were used as a control group. A custom-made focused ultrasound transducer using clinically safe acoustic conditions in combination with SonoVue® ultrasound contrast agent was used to induce sonoporation in the localised region of the primary tumour only. Whole-body disease development was measured using bioluminescence imaging, and primary tumour development was measured using 3D ultrasound. Following just two treatments combining sonoporation and gemcitabine, primary tumour volumes were significantly lower than control groups. Additional therapy dramatically inhibited primary tumour growth throughout the course of the disease, with median survival increases of up to 10% demonstrated in comparison to the control groups. Combined sonoporation and gemcitabine therapy significantly impedes primary tumour development in an orthotopic xenograft model of human pancreatic cancer, suggesting additional clinical benefits for patients treated with gemcitabine in combination with sonoporation.


A novel surface modification technique for forming porous polymer monoliths in poly(dimethylsiloxane).
A new method of surface modification is described for enabling the in situ formation of homogenous porous polymer monoliths (PPMs) within poly(dimethylsiloxane) (PDMS) microfluidic channels that uses 365 nm UV illumination for polymerization. Porous polymer monolith formation in PDMS can be challenging because PDMS readily absorbs the monomers and solvents, changing the final monolith morphology, and because PDMS absorbs oxygen, which inhibits free-radical polymerization. The new approach is based on sequentially absorbing a non-hydrogen-abstracting photoinitiator and the monomers methyl methacrylate and ethylene diacrylate within the walls of the microchannel, and then polymerizing the surface treatment polymer within the PDMS, entangled with it but not covalently bound. Four different monolith compositions were tested, all of which yielded monoliths that were securely anchored and could withstand pressures exceeding the bonding strength of PDMS (40 psi) without dislodging. One was a recipe that was optimized to give a larger average pore size, required for low back pressure. This monolith was used to concentrate and subsequently mechanical lyse B lymphocytes.


Search for new phenomena in events with at least three photons collected in pp collisions at [Formula: see text] = 8 TeV with the ATLAS detector.
Results of a search for new phenomena in events with at least three photons are reported. Data from proton-proton collisions at a centre-of-mass energy of 8 TeV, corresponding to an integrated luminosity of 20.3 fb[Formula: see text], were collected with the ATLAS detector at the LHC. The observed data are well described by the Standard Model. Limits at the 95 % confidence level on new phenomena are presented based on the rate of events in an inclusive signal region and a restricted signal region targeting the rare decay [Formula: see text], as well as di-photon and tri-photon resonance searches. For a Standard Model Higgs boson decaying to four photons via a pair of intermediate pseudoscalar particles (a), limits are found to be [Formula: see text] for 10 GeV [Formula: see text] 62 GeV. Limits are also presented for Higgs boson-like scalars (H) for [Formula: see text] 125 GeV, and for a [Formula: see text] decaying to three photons via [Formula: see text]. Additionally, the observed limit on the branching ratio of the Z boson decay to three photons is found to be BR[Formula: see text], a result five times stronger than the previous result from LEP.


Knowledge, attitudes, and practices of health sciences students regarding epilepsy at the end of their curriculum in Benin.
The main objective of this study was to evaluate the knowledge, attitudes, and practices (KAP) of health sciences students regarding epilepsy at the end of their curriculum in Benin. We conducted a cross-sectional survey among medical, pharmacy, nursing, and midwife students in their last year of health sciences training in the University of Abomey-Calavi in Benin. Students completed a self-administered questionnaire, containing items addressing demographics, epilepsy treatment, diagnosis, clinical practice, and social tolerance regarding a person with epilepsy (PWE). The response rate to our survey was 87.7% (n = 164). The sample consisted of 64 medical students, 22 pharmacy students, 43 nursing students, and 35 midwife students. They were divided into 95 female subjects and 69 males; sex ratio was 0.7. The mean age of participants was 23.6 ± 1.8 years. The mean scores for epilepsy knowledge, practices, and attitudes were respectively 7.6 ± 1.7 out of a maximum score of 11, 3.9 ± 1.8 out of 8, and 9.6 ± 0.8 out of 10. The KAP overall score was 21.1 ± 3.4 out of a maximum score of 29.0. The variables associated with the overall KAP score were training school, gender, having heard about epilepsy before health sciences studies (p = 0.017), and having a relative with epilepsy (p = 0.001). Male students and medical school students had significantly better overall KAP score than female students or the other training schools respectively (p < 0.001). These findings support the need to improve the health sciences students' knowledge of epilepsy, in particular, during their training.


Molecular simulations for adsorption and separation of natural gas in IRMOF-1 and Cu-BTC metal-organic frameworks.
We use Monte Carlo simulations to study the adsorption and separation of the natural gas components in IRMOF-1 and Cu-BTC metal-organic frameworks. We computed the adsorption isotherms of pure components, binary, and five-component mixtures analyzing the siting of the molecules in the structure for the different loadings. The bulk compositions studied for the mixtures were 50 : 50 and 90 : 10 for CH4-CO2, 90 : 10 for N2-CO2, and 95 : 2.0 : 1.5 : 1.0 : 0.5 for the CH4-C2H6-N2-CO2-C3H8 mixture. We choose this composition because it is similar to an average sample of natural gas. Our simulations show that CO2 is preferentially adsorbed over propane, ethane, methane and N2 in the complete pressure range under study. Longer alkanes are favored over shorter alkanes and the lowest adsorption corresponds to N2. Though IRMOF-1 has a significantly higher adsorption capacity than Cu-BTC, the adsorption selectivity of CO2 over CH4 and N2 is found to be higher in the latter, proving that the separation efficiency is largely affected by the shape, the atomic composition and the type of linkers of the structure.


Symptomatic and asymptomatic benign prostatic hyperplasia: molecular differentiation by using microarrays.
Benign prostatic hyperplasia (BPH) is a disease of unknown etiology that significantly affects the quality of life in aging men. Histologic BPH may present itself either as symptomatic or asymptomatic in nature. To elucidate the molecular differences underlying BPH, gene expression profiles from the prostate transition zone tissue have been analyzed by using microarrays. A set of 511 differentially expressed genes distinguished symptomatic and asymptomatic BPH. This genetic signature separates BPH from normal tissue but does not seem to change with age. These data could provide novel approaches for alleviating symptoms and hyperplasia in BPH.


[Artificial intelligence-based fluorescence method versus traditional flow cytometry in detection of sperm DNA fragmentation index].
To compare the result of the artificial intelligence (AI) recognition-based fluorescence method and that of traditional flow cytometry in the examination of the sperm DNA fragmentation index (DFI) and assess the reliability of the AI-based fluorescence detection. Using flow cytometry and the AI-based fluorescence method, we examined the sperm DFI in the semen samples collected from 338 outpatients. We analyzed the correlation between the results and compared the positive rates detected by the two methods. We repeated the AI-based fluorescence method twice for each semen sample to observe its technical stability in the detection of sperm DFI. The result of flow cytometry was well correlated with that of the AI-based fluorescence method in the detection of sperm DFI (R2 = 0.7131), but poorly correlated for low-concentration, sticky semen and some other extreme samples (R2 = 0.2065). No statistically significant difference was found between the two methods in the positive rate of detection. The AI-based fluorescence method exhibited an excellent technical stability (R2 = 0.9671). The AI-based fluorescence method has an excellent technical stability in the detection of sperm DFI and the result is not significantly different from that of traditional flow cytometry.


[Alkaline phosphatase during the puerperium in ewes and its relation to thyroid hormones and ovarian steroids].
Triacylglycerols as the sources of cholesterol, the primary precursor of steroid synthesis, are one of the factors that limit the speed of steroidogenesis. Synthesis and resynthesis of triacylglycerols depend, in addition to other factors, on phosphatid hydrolysis that is controlled during pregnancy by placentary ALP (Sumikawa et al., 1987) and the FFA pool in the systemic blood stream. Enzymes participating in FFA release from the fat tissue are affected by thyroid hormones and TSH (Mayes, 1977). In view of the above facts, this work was aimed at the observation of changes in alkaline phosphatase (ALP), thyroxine (T4), triiodothyronine (T3), 17 beta-oestradiol (E2) and progesterone (P4) levels and their mutual correlations in the systemic blood stream of sheep from the first day after parturition to day 51 p.p. Our attention was paid to the possible delayed effects of placentary ALP and thyroid hormones on the synthesis of ovarian steroids in puerperal ewes. Nine merino sheep were included in the experiment; they lambed in the first decade of February and were kept together with their lambs in a classical sheep-cot on deep litter. The animals were fed according to the Czechoslovak State Standard CSN 46 7070. Blood samples were taken from the v. jugularis from 8 to 9 o'clock a.m. 24 hs (day -1) prior to parturition (a.p.), 36 hs and on days 4, 7, 14, 17, 21, 25, 34, 42 and 51 after parturition (p.p.). As compared with day -1 (2.6 +/- 1.08 mu kat/l), ALP concentrations showed a decrease with minimum values occurring on day 17 (1.34 +/- 0.97 mu kat/l, P < 0.05). T4 concentrations also decreased from day -1 (59.4 +/- 9.69 nmol/l) to day 21 (54.89 +/- 11.06 nmol/l, P < 0.05). A similar decrease (from 1.82 +/- 0.33 nmol/l on day 1 to 0.85 +/- 0.32 nmol/l on day 21) could also be observed in T3 levels. As early as 36 hs p.p., the concentrations of both steroid hormones, E2 and P4, significantly decreased [from 2.45 +/- 0.65 and 9.46 +/- 0.34 nmol/l on day -1 to 0.30 +/- 0.24 and 0.05 +/- 0.08 nmol/l, respectively (P < 0.001)]. Throughout the period of investigation, apart from an unsubstantial increase in E2 values on days 17 and 42 and an episodic increase in P4 levels on day 34, the concentrations of both steroids had the values that were significantly lower than those observed on day -1.(ABSTRACT TRUNCATED AT 400 WORDS)


Method to geometrically personalize a detailed finite-element model of the spine.
To date, developing geometrically personalized and detailed solid finite-element models (FEMs) of the spine remains a challenge, notably due to multiple articulations and complex geometries. To answer this problem, a methodology based on a free-form deformation technique (kriging) was developed to deform a detailed reference finite-element mesh of the spine (including discs and ligaments) to the patient-specific geometry of 10- and 82-year-old asymptomatic spines. Different kriging configurations were tested: with or without smoothing, and control points on or surrounding the entire mesh. Based on the results, it is recommended to use surrounding control points and smoothing. The mean node to surface distance between the deformed and target geometries was 0.3±1.1 mm. Most elements met the mesh quality criteria (95%) after deformation, without interference at the articular facets. The method's novelty lies in the deformation of the entire spine at once, as opposed to deforming each vertebra separately, with surrounding control points and smoothing. This enables the transformation of reference vertebrae and soft tissues to obtain complete and personalized FEMs of the spine with minimal postprocessing to optimize the mesh.


Development of a semi-quantitative Food Frequency Questionnaire (FFQ) to assess dietary intake of multiethnic populations.
The Food Frequency Questionnaire (FFQ) is one of the most commonly used methods in epidemiological studies to assess long-term nutritional exposure. The purpose of this study is to develop a general FFQ for the Israeli population and present the procedures undertaken to select foods to be included in a questionnaire for a multiethnic population. Random population cluster sampling was done using voter registration lists of the Negev Jewish population, aged 35 years and over, which were divided into three groups based on where they were born, namely: Israel, Asia Africa and Europe-America. Participants were interviewed for their dietary intake using 24 hour recalls. Foods eaten by our subjects were aggregated into conceptually similar food groups and entered in stepwise regression models to predict variation in nutrient intake. Separate models were created for each origin group. It was found that the dietary intake was significantly lower for energy and vitamin E among European-American born subjects and significantly lower for calcium intake among Asian-African born subjects. Differences between ethnic groups were seen in the list of foods, which explained the between-person variability for energy and zinc. For most nutrients, fewer items were needed to explain the between-person variation in the group of people born in Israel. The final list of foods included 126 items and explained over 90% of the between-person variability in selected nutrients for all three groups. The newly developed FFQ for the Negev population includes 126 items that are sufficient to rank the nutritional exposure of people over 35 years old from the three origin groups in Israel.


Potential self-selection bias in a nested case-control study on indoor environmental factors and their association with asthma and allergic symptoms among pre-school children.
Selection bias means a systematic difference between the characteristics of selected and non-selected individuals in epidemiological studies. Such bias may be introduced if participants select themselves for a study. The present study aims at identifying differences in family characteristics, including health, building characteristics of the home, and socioeconomic factors between participating and non-participating families in a nested case-control study on asthma and allergy among children. Information was collected in a baseline questionnaire to the parents of 14,077 children aged 1-6 years in a first step. In a second step 2,156 of the children were invited to participate in a case-control study. Of these, 198 cases and 202 controls were finally selected. For identifying potential selection bias, information concerning all invited families in the case-control study was obtained from the baseline questionnaire. Results show that there are several possible biases due to self-selection involved in an extensive study on the impact of the home environment on asthma and allergy among children. Factors associated with participating were high socioeconomic status of the family, more health problems in the case families, and health-related lifestyle factors, such as non-smoking parents. The overall conclusion of this study is that there are selection biases involved in studies that need close cooperation with the families involved. One solution to this problem is stratification, i.e. investigating associations between exposures and health in the same socioeconomic strata.


Percutaneous image-guided radiofrequency ablation for adrenal tumours: a systematic review.
To undertaken a systematic review of the technical success and technique efficacy rates of percutaneous image-guided radiofrequency ablation (RFA) for adrenal tumours. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the electronic databases MEDLINE, EMBASE, and PubMed were searched for relevant studies from inception to the third week of January 2020. Only studies reporting effectiveness rates of percutaneous RFA for adrenal tumours were included. Data regarding sample size, tumours, effectiveness rates, outcomes, and complications were extracted in duplicate and recorded. A total of 15 studies evaluating 292 individuals with 305 tumours were included. Patient selection criteria included age ≥18 years, contraindication to surgical intervention, and no uncorrected coagulopathy. Cumulative technical success, primary technique efficacy, and secondary technique efficacy rates were 99%, 95.1% and 100%, respectively, indicating optimal immediate control of adrenal tumours. Technical success and technique efficacy rates of primary adrenal tumours were higher than adrenal metastases; however, formal statistical analyses were precluded due to lack of comparative studies. Local tumour progression rates for adrenal metastases were 20.3% at 3 months, 26.3% at 6 months, and 29.3% at 12 months. Overall survival rates for adrenal metastases were 81.8% at 6 months, 59.6% at 12 months, and 62.9% at 18 months. The intraprocedural complication rate was 30.2%, with the most frequency reported complication being procedural hypertensive crisis. The findings of this study suggest percutaneous image-guided RFA is a safe and efficacious procedure. Further studies are warranted to define patient selection criteria and long-term outcomes.


Preventive therapy with isoniazid. Cost-effectiveness of different durations of therapy.
Daily administration of isoniazid for one year to persons infected with Mycobacterium tuberculosis is effective in considerably reducing the risk of disease. From a practical viewpoint, this approach to prevention is less than ideal because it results in considerable costs as health care providers monitor for possible hepatotoxic effects and because it is difficult to maintain compliance for 12 months. The efficacy and toxicity of isoniazid preventive therapy regimens of 12, 24, and 52 weeks' duration were recently assessed in a study conducted in Eastern Europe. We used data from this study to conduct a cost-effectiveness analysis of the three alternative regimens. The results indicate that over a wide range of assumptions, a regimen of 24 weeks' duration is more cost-effective than either the 12- or 52-week regimen. Using base case estimates, the cost per case prevented for the 24-week regimen was $7,112, compared with $16,024 for the 52-week regimen. Among a cohort of 1,000 persons treated, each additional case prevented by the 52-week regimen would cost $80,807. Thus, a shorter course of isoniazid preventive therapy is relatively cost-effective compared with current policy.


How to Grow Xenopus laevis Tadpole Stages to Adult.
In Xenopus laevis, the tadpole stage is characterized by three forms-those occurring before the initiation of limb development, those covering limb development, and those encompassing metamorphosis. Maximal tadpole growth, especially during the second form, is critically dependent on good husbandry practices. Here we describe a protocol for raising Xenopus laevis tadpoles through to adulthood. Each step may need to be modified depending on the aquaria used and local conditions.


[Periprosthetic Infection of the Knee Megaprosthesis following a Resection of Malignant Tumours around the Knee].
PURPOSE OF THE STUDY The study presents the monocentric retrospective study of a group of patients with malignant tumours around the knee, treated by a wide resection and a reconstruction with megaprosthesis due to infectious complications. Provided is a detailed analysis of each operative treatment due to the manifestation and process of periprostethic infection of the knee megaprosthesis and the use of external fixator during a two-stage revision. MATERIAL AND METHODS Between 01/1993 and 12/2013, a total of 67 cemented megaprostheses were assessed, with a detailed analysis of 12 patients with periprosthetic infection. The Kaplan-Meier method and MSTS for lower extremity clinical assessment were used and a range of motion was evaluated. RESULTS The endoprosthesis failed due to all kinds of complications (mechanical, biological, infection) in 27 (40.3%) patients. The estimated one-year survival rate from the surgery was 94%, the five-year survival rate was 72%, and the ten-year survival rate was 46%. Based on the statistical analysis of the implant survival due to infection, the one-year survival rate was 94%, the five-year survival rate was 75%, and the ten-year survival rate was 57%. Three patients were treated with radical surgical debridement. Five patients were treated with a two-stage revision with a cement spacer and external fixator, and three patients underwent nail fixation. Clinical values before and two years after the revision surgery for periprosthetic infection using MSTS were assessed. The mean of the difference of clinical values was 1.91 and the p value of paired t-test was 0.24, therefore there was no prove of the clinical result difference using MSTS before and after the revision surgery. DISCUSSION The acute radical debridement and lavage is preferred, if the surgery can be done up to three weeks after the first clinical signs of infection under the condition of good retention of the implant. In case of extensive infectious damage, when abscess, fistula and loosening of the implant are present and when the patient has a good oncological prognosis, we prefer a twostage revision with a cement spacer stabilized by an external fixator. In patients with mitigated infection or uncertain oncological prognosis we prefer a two-stage revision with the combination of a cement spacer and intramedullary nail fixation. CONCLUSIONS The study presents the results of operative treatment of periprosthetic infection of megaprosthesis and the modification of the two-stage replantation of infected MP with the use of external fixation for stabilisation of a non-articulated cement spacer allowing the patient to remain active during the time before the second stage. Key words: periprosthetic infection, megaprosthesis, bone tumour, external fixator, two-stage revision.


Elevated pregnancy-associated plasma protein A predicts myocardial dysfunction and death in severe sepsis.
Pregnancy-associated plasma protein A (PAPPA) is an emerging biomarker used in various medical fields but has yet to be evaluated in critical care medicine. This study evaluates the value of PAPPA as a biomarker in predicting myocardial dysfunction and 28-day mortality in patients with severe sepsis. Serum concentrations of PAPPA and traditional cardiac biomarkers including cardiac troponin I (cTnI) and B-type natriuretic peptide (BNP) were measured on admission in 118 severely septic patients. The value of PAPPA for the diagnosis of sepsis-related myocardial dysfunction (SRMD) and for the prediction of 28-day mortality was subsequently evaluated using statistical methods. PAPPA was elevated (≥4.5 ng/mL) in 76 (64.4%) patients; patients with elevated PAPPA were more likely to have SRMD (76.3% vs. 38.1%, P < 0.001). By comparison of the area under the curve (AUC) in receiver operating characteristics analysis, PAPPA had comparable value (AUC 0.661, P = 0.003) to conventional biomarkers (BNP: AUC 0.699, P < 0.001; cTnI: AUC 0.647, P = 0.007) in the diagnosis of SRMD and offered superior value (AUC 0.771, P < 0.001) over them (all AUC<0.7, P > 0.05) in the prediction of 28-day death. Increased PAPPA (≥5.4 ng/mL) was associated with lower 28-day survival (χ(2) = 19.78, P < 0.001) and independently predicted 28-day mortality in septic patients. Serum PAPPA concentration frequently increases in patients with severe sepsis and appears to be associated with SRMD. PAPPA can be used as a novel biomarker for the diagnosis of SRMD and the prediction of outcomes in critically ill patients.


Combination chemotherapy of adult acute lymphoblastic leukemia with randomized central nervous system prophylaxis.
Although major progress has been made in the treatment of childhood leukemia, the optimal chemotherapy of acute lymphoblastic leukemia (ALL) in adults has been unclear. In addition, the value of central nervous system prophylaxis (CNS-P) in adults has been assumed, but not established in a systematic fashion. The Southeastern Cancer Study Group has completed a prospective study in which the use of vincristine plus low-dose methotrexate and high-dose prednisone in adult acute lymphoblastic leukemia has produced an 80% (79/99) complete remission rate in patients age 15 yr and over. Younger patients had a significantly higher remission rate but no increase in remission duration. This induction regimen was associated with minimal toxicity. Random assignment to CNS-P or to no prophylaxis, after a multidrug consolidation regimen, has demonstrated a significant prolongation of CNS relapse-free interval (p=0.008) in favor of CNS-P. CNS-P did not improve hematologic remission duration or survival. All complete remitters were maintained on mercaptopurine, methotrexate, and cyclophosphamide with pulses of prednisone and vincristine; the median time from remission to either hematologic or CNS relapse was 19.3 mo after CNS-P, and survival for these patients was 26.1 mo. We conclude that our current induction regimen is highly effective in adult ALL and that CNS-P prophylaxis is indicated in such patients.


DNA genetic artificial fish swarm constant modulus blind equalization algorithm and its application in medical image processing.
This study proposes use of the DNA genetic artificial fish swarm constant modulus blind equalization algorithm (DNA-G-AFS-CMBEA) to overcome the local convergence of the CMBEA. In this proposed algorithm, after the fusion of the fast convergence of the AFS algorithm and the global search capability of the DNA-G algorithm to drastically optimize the position vector of the artificial fish, the global optimal position vector is obtained and used as the initial optimal weight vector of the CMBEA. The result of application of this improved method in medical image processing demonstrates that the proposed algorithm outperforms the CMBEA and the AFS-CMBEA in removing the noise in a medical image and improving the peak signal to noise ratio.


Surface Molecules Released by Trypanosoma cruzi Metacyclic Forms Downregulate Host Cell Invasion.
The question whether metacylic trypomastigote (MT) forms of different T. cruzi strains differentially release surface molecules, and how they affect host cell invasion, remains to be fully clarified. We addressed that question using T. cruzi strains that differ widely in the ability to invade cells. Metacyclic forms were incubated at 37°C for 1 h in complete D10 medium or in nutrient-deprived PBS containing Ca2+ and Mg2+ (PBS++). The conditioned medium (CM), collected after parasite centrifugation, was used for cell invasion assays and Western blot analysis, using monoclonal antibodies directed to gp82 and gp90, the MT surface molecules that promote and negatively regulate invasion, respectively. CM of poorly invasive G strain (G-CM) contained high amounts of gp90 and gp82, either in vesicles or as soluble molecules. CM of highly invasive CL strain (CL-CM) contained gp90 and gp82 at very low levels. HeLa cells were incubated for 1 h with CL strain MT in D10, in absence or in the presence of G-CM or CL-CM. Parasite invasion was significantly inhibited by G-CM, but not by CL-CM. As G strain MT invasion rate in D10 is very low, assays with this strain were performed in PBS++, which induces invasion-promoting lysosome-spreading. G-CM, but not CL-CM, significantly inhibited G strain internalization, effect that was counteracted by preincubating G-CM with an anti-gp90 monoclonal antibody or anti-gp82 polyclonal antibody that do not recognize live MT. G strain CM generated in PBS++ contained much lower amounts of gp90 and gp82 as compared to CM produced in D10, and exhibited lower inhibitory effect on host cell invasion. Our data suggest that the surface molecules spontaneously released by MT impair parasite-host cell interaction, gp82 presumably competing with the molecule expressed on MT surface for the host cell receptor, and gp90 further contributing to down modulate invasion.


General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicentre, randomised controlled trial.
The effect of carotid endarterectomy in lowering the risk of stroke ipsilateral to severe atherosclerotic carotid-artery stenosis is offset by complications during or soon after surgery. We compared surgery under general anaesthesia with that under local anaesthesia because prediction and avoidance of perioperative strokes might be easier under local anaesthesia than under general anaesthesia. We undertook a parallel group, multicentre, randomised controlled trial of 3526 patients with symptomatic or asymptomatic carotid stenosis from 95 centres in 24 countries. Participants were randomly assigned to surgery under general (n=1753) or local (n=1773) anaesthesia between June, 1999 and October, 2007. The primary outcome was the proportion of patients with stroke (including retinal infarction), myocardial infarction, or death between randomisation and 30 days after surgery. Analysis was by intention to treat. The trial is registered with Current Control Trials number ISRCTN00525237. A primary outcome occurred in 84 (4.8%) patients assigned to surgery under general anaesthesia and 80 (4.5%) of those assigned to surgery under local anaesthesia; three events per 1000 treated were prevented with local anaesthesia (95% CI -11 to 17; risk ratio [RR] 0.94 [95% CI 0.70 to 1.27]). The two groups did not significantly differ for quality of life, length of hospital stay, or the primary outcome in the prespecified subgroups of age, contralateral carotid occlusion, and baseline surgical risk. We have not shown a definite difference in outcomes between general and local anaesthesia for carotid surgery. The anaesthetist and surgeon, in consultation with the patient, should decide which anaesthetic technique to use on an individual basis. The Health Foundation (UK) and European Society of Vascular Surgery.


Animal model of Mycoplasma pneumoniae infection using germfree mice.
We have attempted to establish a gnotobiotic mouse model monoassociated with Mycoplasma pneumoniae following single or repeated infection to examine the mechanism of pathogenesis following M. pneumoniae infection. M. pneumoniae inoculated into germfree mice colonized equally well at 10(5) CFU/lung in both single infection and repeated infection. In histopathological observation, repeatedly infected mice showed pneumonia with mild infiltration of mononuclear cells and macrophages. Antibody titers against M. pneumoniae rose in the repeatedly infected mice but not in the singly infected mice. The percentage of CD4-positive, CD8-positive, and CD25-positive lymphocytes infiltrated in the lung was increased in the repeatedly infected mice. In contrast, the lymphocyte subset in the spleen was not significantly different among mock-, singly, and repeatedly infected mice. In the study of cytokine productivity of spleen cells, production of interleukin (IL)-4 and IL-10 was significantly increased and that of gamma interferon was remarkably increased in the mice following repeated infection. These results indicate that a gnotobiotic mouse model monoassociated with M. pneumoniae was established and that immune mechanisms might be involved in the pathogenesis in pneumonia following M. pneumoniae infection.


Differences in femoral notch anatomy between men and women: a magnetic resonance imaging study.
Research has shown that variations in femoral intercondylar notch morphometry may be a predisposing factor for noncontact anterior cruciate ligament injury. There are anatomic differences in the anterior cruciate ligament and femoral notch between men and women. Descriptive anatomic study. Using magnetic resonance imaging, we performed a three-dimensional analysis of the femoral intercondylar notch morphometry to look for differences in femoral notch and anterior cruciate ligament volumes between men and women. Axial plane magnetic resonance imaging scans were performed on 96 knees in 48 asymptomatic subjects. Digital measurements were taken of femoral notch area, anterior cruciate ligament area, notch width, and bicondylar width, within defined parameters of the femoral notch. The notch and anterior cruciate ligament volumes were then calculated. Analysis of variance was performed using sex, height, and weight as covariates. The volume of the femoral notch was found to be statistically smaller in women compared with men; this difference was primarily related to height. A similar relationship was found for anterior cruciate ligament volume. A statistically significant correlation was found between femoral notch volume and anterior cruciate ligament volume; patients with smaller notches also had smaller anterior cruciate ligaments. Our results suggest that there is a difference in femoral notch and anterior cruciate ligament volume between men and women, which, in turn, is related to differences in height and weight.


Sanguinaria-related leukoplakia: epidemiologic and clinicopathologic features of a recently described entity.
An association between the use of Viadent toothpaste and/or mouthwash and the development of leukoplakia oral mucosal lesions has been described recently. Discontinuing the Viadent products may result in resolution of the leukoplakia, although frequently this is not the case. In order to corroborate the earlier study and to provide further insight regarding the clinical features of this process, a case-control study was conducted. A significant association was seen between the use of Viadent products and the development of oral leukoplakia. Furthermore, leukoplakias affecting sites other than the buccal vestibule also were associated with the use of these products.


Kidney transplantation in the time of COVID-19: Dilemmas, experiences, and perspectives.
Hospital do Rim is a high-volume kidney transplant (KT) center located in São Paulo, a city with 12.2 million inhabitants. Over the last 18 years, we performed 11 436 KT, 70% of which from deceased donors. To mitigate the effects of reduction in the number of transplants on the waiting list, sequential measures were implemented when COVID-19 was declared pandemic. The first step was to provide SARS-COV-2 RT-PCR testing for all symptomatic employees and patients and the compulsory use of personal protective equipment in the hospital facilities. Living donor KT were postponed, and all deceased donors and recipients were tested before the transplantation. The immunosuppressive protocols were maintained, and telehealth strategies were developed. Among the 1013 employees, there were 214 cases of COVID-19, nine required ward hospitalization, and no deaths occurred. In 26%, the probable source of contamination was occupational. From the first patient diagnosed with COVID-19 in 03/20/2020 till 10/21/2020, 523 deceased KT were performed, a 21% increase compared with 2019, with no confirmed donor-derived SARS-CoV-2 infection. Four patients were transplanted with a positive pretransplant SARS-CoV-2 test, but none of them developed the disease. Overall, of 11 875 KT followed in our center, 674 developed COVID-19. Among the hospitalized, 53% required mechanical ventilation, and 45% required hemodialysis. Their overall mortality rate was 27.5%. This experience shows the challenges that transplant centers faced as the pandemic unfolded and illustrates the effectiveness of the sequential measures implemented to provide a safe environment for transplantation.


Pre-meiotic 21-nucleotide reproductive phasiRNAs emerged in seed plants and diversified in flowering plants.
Plant small RNAs are important regulatory elements that fine-tune gene expression and maintain genome integrity by silencing transposons. Reproductive organs of monocots produce abundant phased, small interfering RNAs (phasiRNAs). The 21-nt reproductive phasiRNAs triggered by miR2118 are highly enriched in pre-meiotic anthers, and have been found in multiple eudicot species, in contrast with prior reports of monocot specificity. The 24-nt reproductive phasiRNAs are triggered by miR2275, and are highly enriched during meiosis in many angiosperms. Here, we report the widespread presence of the 21-nt reproductive phasiRNA pathway in eudicots including canonical and non-canonical microRNA (miRNA) triggers of this pathway. In eudicots, these 21-nt phasiRNAs are enriched in pre-meiotic stages, a spatiotemporal distribution consistent with that of monocots and suggesting a role in anther development. Although this pathway is apparently absent in well-studied eudicot families including the Brassicaceae, Solanaceae and Fabaceae, our work in eudicots supports an earlier singular finding in spruce, a gymnosperm, indicating that the pathway of 21-nt reproductive phasiRNAs emerged in seed plants and was lost in some lineages.


Epidemiological characteristics and clinical analyses of chronic cutaneous wounds of inpatients in China: Prevention and control.
The increased incidence of chronic cutaneous wounds is likely to lead to increased mortality, and therefore, deserves greater attention. More insight is needed into the magnitude of the problem of chronic cutaneous wounds and methods for their prevention and treatment in China. A retrospective analysis of data retrieved from an electronic health-records database on 3300 patients with chronic skin wounds was conducted from 1 January 2018 to 31 December 2018. The patients had been admitted to the medical and surgical wards of 17 third-grade class-A hospitals in China. The study's aim was to compare the characteristics (eg, demographic and clinical) associated with different causes and distributions of patients' chronic wounds. Among the 3300 patients, 66.03% were males and 33.97% were females. The mean age was 57 years and the increasing prevalence of chronic skin wounds with aging was quite high. The primary causes of chronic wounds were diabetes or infection, followed by pressure ulcers, trauma, and iatrogenic wounds. The distribution of skin wounds was mainly in the lower extremities (56.1%), followed by the trunk (18.6%). The mean duration of hospital stay was 29 days and the mean recurrence was 3 months. Chronic skin wounds were related to occupation, educational level, lifestyle habits, and income. The main cause of chronic skin wounds has shifted from trauma to chronic disease. Normalization checks, bacterial cultures, and antibiotic use in China need to be standardized and the training of wound specialists should be further strengthened. The association of aging and wound infection was significant. Preventive management and efficient treatment should correspond to the needs of the different regions of China. These results may serve as a reference for other developing countries in their transitional development.


Day-to-day Consistency in Positive Parent-Child Interactions and Youth Well-Being.
The frequency of positive parent-child interactions is associated with youth adjustment. Yet, little is known about daily parent-child interactions and how day-to-day consistency in positive parent-child interactions may be linked to youth well-being. Using a daily diary approach, this study added to this literature to investigate whether and how day-to-day consistency in positive parent-child interactions was linked to youth depressive symptoms, risky behavior, and physical health. Participants were youth whose parents were employed in the IT division of a Fortune 500 company (N = 129, youth's mean age = 13.39, 55 % female), who participated in an 8 day daily diary study. Analyses revealed that, controlling for cross-day mean levels of positive parent-child interactions, older (but not younger) adolescents who experienced more consistency in positive interactions with parents had fewer depressive and physical health symptoms (e.g., colds, flu). The discussion focuses on the utility of daily diary methods for assessing the correlates of consistency in parenting, possible processes underlying these associations, and intervention implications.


Hepatitis C virus induces a prediabetic state by directly impairing hepatic glucose metabolism in mice.
Virus-related type 2 diabetes is commonly observed in individuals infected with the hepatitis C virus (HCV); however, the underlying molecular mechanisms remain unknown. Our aim was to unravel these mechanisms using FL-N/35 transgenic mice expressing the full HCV ORF. We observed that these mice displayed glucose intolerance and insulin resistance. We also found that Glut-2 membrane expression was reduced in FL-N/35 mice and that hepatocyte glucose uptake was perturbed, partly accounting for the HCV-induced glucose intolerance in these mice. Early steps of the hepatic insulin signaling pathway, from IRS2 to PDK1 phosphorylation, were constitutively impaired in FL-N/35 primary hepatocytes via deregulation of TNFα/SOCS3. Higher hepatic glucose production was observed in the HCV mice, despite higher fasting insulinemia, concomitant with decreased expression of hepatic gluconeogenic genes. Akt kinase activity was higher in HCV mice than in WT mice, but Akt-dependent phosphorylation of the forkhead transcription factor FoxO1 at serine 256, which triggers its nuclear exclusion, was lower in HCV mouse livers. These findings indicate an uncoupling of the canonical Akt/FoxO1 pathway in HCV protein-expressing hepatocytes. Thus, the expression of HCV proteins in the liver is sufficient to induce insulin resistance by impairing insulin signaling and glucose uptake. In conclusion, we observed a complete set of events leading to a prediabetic state in HCV-transgenic mice, providing a valuable mechanistic explanation for HCV-induced diabetes in humans.


Virologic and Immunologic Features of Simian Immunodeficiency Virus Control Post-ART Interruption in Rhesus Macaques.
Antiretroviral therapy (ART) cannot eradicate human immunodeficiency virus (HIV) and a rapid rebound of virus replication follows analytical treatment interruption (ATI) in the vast majority of HIV-infected individuals. Sustained control of HIV replication without ART has been documented in a subset of individuals, defined as posttreatment controllers (PTCs). The key determinants of post-ART viral control remain largely unclear. Here, we identified 7 SIVmac239-infected rhesus macaques (RMs), defined as PTCs, who started ART 8 weeks postinfection, continued ART for >7 months, and controlled plasma viremia at <104 copies/ml for up to 8 months after ATI and <200 copies/ml at the latest time point. We characterized immunologic and virologic features associated with post-ART SIV control in blood, lymph node (LN), and colorectal (RB) biopsy samples compared to 15 noncontroller (NC) RMs. Before ART initiation, PTCs had higher CD4 T cell counts, lower plasma viremia, and SIV-DNA content in blood and LN compared to NCs, but had similar CD8 T cell function. While levels of intestinal CD4 T cells were similar, PTCs had higher frequencies of Th17 cells. On ART, PTCs had significantly lower levels of residual plasma viremia and SIV-DNA content in blood and tissues. After ATI, SIV-DNA content rapidly increased in NCs, while it remained stable or even decreased in PTCs. Finally, PTCs showed immunologic benefits of viral control after ATI, including higher CD4 T cell levels and reduced immune activation. Overall, lower plasma viremia, reduced cell-associated SIV-DNA, and preserved Th17 homeostasis, including at pre-ART, are the main features associated with sustained viral control after ATI in SIV-infected RMs.IMPORTANCE While effective, antiretroviral therapy is not a cure for HIV infection. Therefore, there is great interest in achieving viral remission in the absence of antiretroviral therapy. Posttreatment controllers represent a small subset of individuals who are able to control HIV after cessation of antiretroviral therapy, but characteristics associated with these individuals have been largely limited to peripheral blood analysis. Here, we identified 7 SIV-infected rhesus macaques that mirrored the human posttreatment controller phenotype and performed immunologic and virologic analysis of blood, lymph node, and colorectal biopsy samples to further understand the characteristics that distinguish them from noncontrollers. Lower viral burden and preservation of immune homeostasis, including intestinal Th17 cells, both before and after ART, were shown to be two major factors associated with the ability to achieve posttreatment control. Overall, these results move the field further toward understanding of important characteristics of viral control in the absence of antiretroviral therapy.


Examining the use of message tailoring to promote physical activity among medically underserved adults.
The purpose of this study was to examine if messages tailored to an individual's regulatory focus (i.e. their tendency to focus on prevention or promotion) increased exercise intentions and behavior in a medically underserved sample. Adult English as a Second Language students (N = 58) were presented with tailored exercise messages. There was a significant main effect for message type; participants who received promotion messages reported greater exercise intentions than those who received prevention messages. Intentions and behavior were not higher among those who received messages matching their regulatory focus. Implications for message tailoring frameworks are discussed.


Anaerobic-aerobic sewage treatment using the combination UASB-SBR activated sludge.
The performance of a pilot scale sewage treatment system composed of an upflow anaerobic sludge blanket (UASB) digester and a sequencing batch activated sludge reactor (SBR) is described. The system constitutes a simple, economic, and compact treatment option and is able to produce consistently a final effluent quality that is equal or better than that of a conventional activated sludge plant. The entire treatment system had a retention time of only 9h and an average operational temperature of 25 degrees C. Due to the efficient anaerobic pre treatment the aerobic sludge production was low and could easily be accommodated for stabilisation in the UASB reactor. The system exhibited excellent operational stability with full nitrification for aerobic sludge ages longer than 9 days. At shorter sludge ages there was excessive wash out of sludge particles and the sludge mass could not be maintained in the SBR reactor. Sludge settleability was good throughout the experimental investigation period of one year. The reduction of the reactor volume and oxygen consumption was more than 50% compared to conventional activated sludge. The anaerobic excess sludge had a high concentration and good stability so that its dewatering and final disposal was a relatively minor problem.


Betaine delays the onset of neurological impairment in nitrous oxide-induced vitamin B-12 deficiency in fruit bats.
The mechanism whereby vitamin B-12 deficiency leads to neurological changes in humans is still uncertain. Nitrous oxide (N2O), which inactivates vitamin B-12 in vivo, results in neurological impairment leading to ataxia and death in the fruit bat Rousettus . These changes were prevented by the injection of the vitamin. The effect of dietary betaine (a catalytic product of choline) or methionine supplementation was studied in bats exposed to N2O. Supplementation with betaine resulted in less weight loss and delayed onset of neurological impairment when compared with unsupplemented animals. Supplementation with methionine at similar concentrations (600 mg/kg fruit and 2 g/kg fruit) was more effective in preventing weight loss and delaying the onset of neurological impairment than the corresponding levels of betaine. These results suggest that dietary betaine was effective in increasing that part of methionine synthesis that is not dependent on vitamin B-12 in N2O-exposed bats with impairment of the vitamin B-12-dependent methionine synthase reaction.


Some inquiries in neuroanesthesia and neurological supportive care.
Complications of performing neurosurgery in the sitting position have been well defined, and include cardiac and respiratory effects, air embolism, and pneumocephalus. Prophylactic measures and early diagnosis allow prompt therapy with minimal residual sequelae. All anesthetic agents and techniques alter the intracranial dynamics. A clear understanding of drug effects and the pathology involved allow a rational choice of anesthetic management to maximize the potential for a good outcome. Patients with cerebrovascular disorders frequently have multisystem disease, and careful preanesthetic assessment and preparation ensure a more stable intraoperative and postoperative course. Many chemical and mechanical reactions follow an ischemic hypoxic insult, but appropriate therapeutic intervention and early establishment of cardiorespiratory support measures have shown promise in improving the neurological outcome in these patients.


[Hereditary spastic paraplegia: up to date].
Hereditary spastic paraplegia (HSP) is a clinically and genetically heterogeneous group of neurodegenerative disorders that are clinically characterized by progressive spasticity and weakness of the lower limbs. HSP genetic loci are designated SPG1-72 in order of their discovery. In 206 Japanese families with autosomal dominant HSP, SPG4 was the most common form, accounting for 38%, followed by SPG3A (5%), SPG31 (5%), SPG10 (2%), and SPG8 (1%). We have identified novel mutations in the C12orf65 gene and the LYST gene in several Japanese families with autosomal recessive HSP. JASPAC will facilitate gene discovery and mechanistic understanding of HSP. The future challenge will be the establishment of treatment of HSP.


Non-reward neural mechanisms in the orbitofrontal cortex.
Single neurons in the primate orbitofrontal cortex respond when an expected reward is not obtained, and behaviour must change. The human lateral orbitofrontal cortex is activated when non-reward, or loss occurs. The neuronal computation of this negative reward prediction error is fundamental for the emotional changes associated with non-reward, and with changing behaviour. Little is known about the neuronal mechanism. Here we propose a mechanism, which we formalize into a neuronal network model, which is simulated to enable the operation of the mechanism to be investigated. A single attractor network has a reward population (or pool) of neurons that is activated by expected reward, and maintain their firing until, after a time, synaptic depression reduces the firing rate in this neuronal population. If a reward outcome is not received, the decreasing firing in the reward neurons releases the inhibition implemented by inhibitory neurons, and this results in a second population of non-reward neurons to start and continue firing encouraged by the spiking-related noise in the network. If a reward outcome is received, this keeps the reward attractor active, and this through the inhibitory neurons prevents the non-reward attractor neurons from being activated. If an expected reward has been signalled, and the reward attractor neurons are active, their firing can be directly inhibited by a non-reward outcome, and the non-reward neurons become activated because the inhibition on them is released. The neuronal mechanisms in the orbitofrontal cortex for computing negative reward prediction error are important, for this system may be over-reactive in depression, under-reactive in impulsive behaviour, and may influence the dopaminergic 'prediction error' neurons.


Involvement of the GABA/benzodiazepine receptor in the axiolytic-like effect of nociceptin/orphanin FQ.
We investigated the mechanism underlying the anxiolytic actions of the neuropeptide nociceptin/orphanin FQ (N/OFQ) with an elevated plus-maze test. In mice, intracerebroventricular (i.c.v.) infusions of N/OFQ (0.1 and 0.32 nmol) led to an increase in time spent in the open arms (anxiolytic-like effects). A non-peptidyl N/OFQ receptor (NOP) antagonist, J-113397(1-{(3R,4R)-1-cyclooctylmethyl-3-hydroxymethyl-4-piperidyl}-3-ethyl-1,3-dihydro-2H-benzimidazol-2-one), (1.0 and 3.2 mg/kg, s.c.) blocked the increase induced by N/OFQ. On the other hand, a benzodiazepine receptor antagonist, flumazenil, (10 mg/kg, i.p.) and a GABAA receptor antagonist, (+)-bicuculline, (5.6 mg/kg, i.p.) also inhibited the increase induced by N/OFQ. In rats, microinfusions of N/OFQ (10 and 32 pmol) into the amygdala led to an increase in time spent in the open arms. However, intracranial infusions of N/OFQ (10-100 pmol) into the dorsal hippocampus did not affect the time spent in the open arms. These findings suggest that the anxiolytic-like effects of N/OFQ may be related to the GABA/benzodiazepine system in the amygdala.


Impact of a nutritional supplement (Impryl) on male fertility: study protocol of a multicentre, randomised, double-blind, placebo-controlled clinical trial (SUppleMent Male fERtility, SUMMER trial).
Infertility is a worldwide problem and about 10%-15% of all couples will be affected by the inability to have children. In approximately 50% of infertile couples, a male factor is involved. Most of the male infertile cases are characterised as 'idiopathic', except for a small percentage of cases which are causative by a genetic aetiology. In the past decade, the role of oxidative stress related to sperm quality has been researched thoroughly and estimated to be the problem in 25%-87% of male infertility cases. Impryl is a nutritional supplement which works on the metabolic system and the regulation of oxidative stress by activating the 1-carbon cycle and therefore recycling of homocysteine. We hypothesise that the nutritional supplement Impryl in men of infertile couples might improve the ongoing pregnancy rate. We designed a multicentre, randomised, double-blind, placebo-controlled clinical trial. We aimed to include 1200 male adults aged 18-50 years, part of a couple that is diagnosed with infertility. The couple will either start or has already been started with fertility treatment, that is, expectative management (duration of 6 months), intrauterine insemination (IUI) with or without mild ovarian stimulation or ovulation induction, either in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) treatment. Male participants will be randomised in either the Impryl or the placebo group, with identical appearance of the tablets to be distributed (doses: one tablet each day), for a total duration of maximal 6 months. Patients can start directly with fertility treatment and/or natural conception. The primary outcome is the number of ongoing pregnancies confirmed by ultrasound at ≥10 to 12 weeks, and conceived in the time window between randomisation up to and including month 6 of intervention use. Secondary outcomes are change in semen parameters between baseline and after 3 months of intervention in the IUI/IVF/ICSI group, based on (prewash) total motile sperm count. Furthermore the number of pregnancies conceived in the optimal intervention time window (after full spermatogenesis of 72 days), overall number of pregnancies, time to pregnancy, embryo fertilisation rate in IVF/ICSI, embryo-utilisation rate in IVF/ICSI, number of miscarriages, live birth rate and adverse events are documented within the study period of 15 months. The protocol is approved by the local medical ethical review committee at the Radboud University Medical Centre and by the national Central Committee on Research Involving Human Subjects. Findings will be shared with the academic and medical community, funding and patient organisations in order to contribute to optimisation of medical care and quality of life for patients with infertility. NCT03337360 and NTR6551.


[Immune hemolytic anemia induced by drugs].
Drugs may induce immune destruction of red blood cells through either autoantibody formation or antibody formation against the drug or its metabolites. In the former scheme the drug is believed to induce autoimmunization by causing some central dysregulation of the immune system the mechanism of which is still unclear. In the latter, data have been accumulating during the last decade pertaining to clinical manifestations, incriminated drugs, and immunohematologic diagnosis. The sharp specificity and individual variations of drug specific antibodies as well as the recognition of the receptor role of red cell blood group antigens explaining the involvement of red cells in drug-antidrug complexes are among the recent achievements in the knowledge of these anemias.


AGL-Score: Algebraic Graph Learning Score for Protein-Ligand Binding Scoring, Ranking, Docking, and Screening.
Although algebraic graph theory-based models have been widely applied in physical modeling and molecular studies, they are typically incompetent in the analysis and prediction of biomolecular properties, confirming the common belief that "one cannot hear the shape of a drum". A new development in the century-old question about the spectrum-geometry relationship is provided. Novel algebraic graph learning score (AGL-Score) models are proposed to encode high-dimensional physical and biological information into intrinsically low-dimensional representations. The proposed AGL-Score models employ multiscale weighted colored subgraphs to describe crucial molecular and biomolecular interactions in terms of graph invariants derived from graph Laplacian, its pseudo-inverse, and adjacency matrices. Additionally, AGL-Score models are integrated with an advanced machine learning algorithm to predict biomolecular macroscopic properties from the low-dimensional graph representation of biomolecular structures. The proposed AGL-Score models are extensively validated for their scoring power, ranking power, docking power, and screening power via a number of benchmark datasets, namely CASF-2007, CASF-2013, and CASF-2016. Numerical results indicate that the proposed AGL-Score models are able to outperform other state-of-the-art scoring functions in protein-ligand binding scoring, ranking, docking, and screening. This study indicates that machine learning methods are powerful tools for molecular docking and virtual screening. It also indicates that spectral geometry or spectral graph theory has the ability to infer geometric properties.


A standardized patient program in a mandatory geriatrics clerkship for medical students.
This article describes the development and implementation of a new standardized patient program in a required geriatrics clinical clerkship for fourth-year medical students. A student survey was also conducted to provide evaluations of the program and to determine the frequency with which students' clinical skills are directly evaluated by faculty. Thirty-six percent reported never having been observed while obtaining a history and 24% having been observed only once; 26% had never been observed while completing a physical examination and 39% had been observed only once. The implementation of a standardized patient program provided students with direct feedback on their clinical skills and was rated positively, (good, very good, or outstanding) by 76% of the students.


Ultrafast Carrier Drift Transport Dynamics in CsPbI3 Perovskite Nanocrystalline Thin Films.
We study the early time carrier drift dynamics in CsPbI3 nanocrystal thin films with a sub 25 ps time resolution. Prior to trapping, carriers exhibit band-like transport characteristics, which is similar to those of traditional semiconductor solar absorbers including Si and GaAs due to optical phonon and carrier scattering at high temperatures. In contrast to the popular polaron scattering mechanism, the CsPbI3 nanocrystal thin film demonstrates the strongest optical phonon scattering mechanism among other inorganic-organic hybrid perovskites, Si, and GaAs. This ultrafast dynamics study establishes a foundation for understanding the fundamental carrier drift properties that drive perovskite nanocrystal optoelectronics.


Fluorescent Chemosensor for Selective Detection of Phosgene in Solutions and in Gas Phase.
The detection of highly toxic chemicals in a convenient, fast, and reliable manner is essential for coping with serious threats to humankind and public security caused by unexpected terrorist attacks and industrial accidents. In this paper, a highly selective fluorescent probe has been constructed through o-phenylenediamine covalently linking to coumarin (o-Pac), which can respond to phosgene in turn-on fluorescence mode. The response time is less than 0.5 min and the detection limit is as low as 3 nM in solutions. More importantly, the sensor exhibits good selectivity to phosgene over triphosgene and various acyl chlorides. Furthermore, a portable test paper has been fabricated with polystyrene membrane containing o-Pac for real-time selective monitoring of phosgene in gas phase.


Oral cavity eumycetoma.
Mycetoma is a pathological process in which eumycotic (fungal) or actinomycotic causative agents from exogenous source produce grains. It is a localized chronic and deforming infectious disease of subcutaneous tissue, skin and bones. We report the first case of eumycetoma of the oral cavity in world literature. A 43-year-old male patient, complaining of swelling and fistula in the hard palate. On examination, swelling of the anterior and middle hard palate, with fistula draining a dark liquid was observed. The panoramic radiograph showed extensive radiolucent area involving the region of teeth 21-26 and the computerized tomography showed communication with the nasal cavity, suggesting the diagnosis of periapical cyst. Surgery was performed to remove the lesion. Histopathological examination revealed purulent material with characteristic grain. Gram staining for bacteria was negative and Grocott-Gomori staining for the detection of fungi was positive, concluding the diagnosis of eumycetoma. The patient was treated with ketoconazole for nine months, and was considered cured at the end of treatment. Histopathological examination, using histochemical staining, and direct microscopic grains examination can provide the distinction between eumycetoma and actinomycetoma accurately.


Relationship between size of denture foundation area and resorption of alveolar ridge in the edentulous mandible.
The relationship between the size of the denture foundation area and the resorption of the alveolar ridge was investigated in 55 edentulous subjects. The denture foundation area was recorded using a modelling compound impression technique with border moulding. Both sides of each edentulous mandible were examined separately, making a total of 110 experimental sides in the study. On a stone cast made from each impression, the size of of the superficial denture foundation area and of the projected denture foundation area on the tentative plane of occlusion of each anatomical zone were measured. The vertical height of the alveolar ridge at the lateral incisor and first molar region was also evaluated. The size of the superficial denture foundation area in the antero-lingual and postero-lingual zones showed no significant correlation with the degree of alveolar ridge resorption. The size of the projected denture foundation area on the tentative plane of occlusion in the anterior section showed negative significant correlation with the degree of alveolar ridge resorption. The size of the projected denture foundation area on the tentative plane of occlusion in the posterior section showed no significant correlation with the degree of alveolar ridge resorption.


Tips and Traps for Trainees Traversing Social Media.
The spread of coronavirus disease (COVID-19) infection across the world accelerated the adoption of social media as the platform of choice for real-time dissemination of medical information. Though this allowed useful clinical anecdotes and links to the latest articles related to COVID-19 to quickly circulate, the broad use of social media also highlighted the power of platforms such as Twitter to spread misinformation. Trainees in medicine have important perspectives to share on social media but may be reluctant to do so for a variety of reasons. There is a need to provide guidance on how to safely engage with social media as well as move the conversation forward in a meaningful way. In this manuscript, we suggest a stepwise approach for trainee social media engagement that integrates the modified Bloom's Taxonomy for social media with Aristotle's principles of rhetoric. This provides trainees with guidance on making ethical, logical, and persuasive cases on social media when creating, consuming, promoting, and discussing content produced by themselves or others.


Materials and Schemes of Multimodal Reconfigurable Micro/Nanomachines and Robots: Review and Perspective.
Mechanically programmable, reconfigurable micro/nanoscale materials that can dynamically change their mechanical properties or behaviors, or morph into distinct assemblies or swarms in response to stimuli have greatly piqued the interest of the science community due to their unprecedented potentials in both fundamental research and technological applications. To date, a variety of designs of hard and soft materials, as well as actuation schemes based on mechanisms including chemical reactions and magnetic, acoustic, optical, and electric stimuli, have been reported. Herein, state-of-the-art micro/nanostructures and operation schemes for multimodal reconfigurable micro/nanomachines and swarms, as well as potential new materials and working principles, challenges, and future perspectives are discussed.


[Multiplicity of the molecular forms of acetylcholinesterase and thermal acclimatization in Carassius auratus].
Multiple forms of acetylcholinesterase have been studied in Goldfish adapted to 15 degrees C and 25 degrees C. Three forms of enzyme (sedimenting at 18S, 12S and 5S) could be distinguished by sucrose gradient centrifugation. Their molecular and enzymatic properties did not vary with environmental temperature. It was noted that the relative proportion of the three forms differed between brain and muscle extracts, the 18S forms predominating in muscle (about 75 per cent) the 12S forms being more abundant in the brain, suggesting a physiological differentiation between these forms. The latter form varied from 48 per cent to 70 per cent in Goldfish adapted to 15 degrees and 25 degrees C respectively. The relative efficiency of saline buffer solubilization for each form also depended on the tissue used and in all cases decreased with rising environmental temperature. These two facts are taken to reflect interactions between acetylcholinesterase and membrane that depend on the nature of the membrane and probably involve the aliphatic chains of its phospholipids. The greater case of solubilization found in the low temperature adapted fish may be a function of the increased fluidity of the cellular membranes formed at lower temperatures.


Bile salt metabolism. II. Bile salts and disease.
Alterations of bile salt metabolism have been shown in numerous diseases. Liver damage results in elevated serum bile salt concentrations which may be useful as a sensitive index of hepatocellular disease. Changes in the relative proportions of the individual bile salts in serum occur with cholestasis. Urinary excretion of bile salts, largely in the form of sulphates, increases as a compensatory mechanism. Ileal disease or resection causes bile salt melabsorption. The increase in colonic bile salts produces a watery diarrhoea while the decrease in duodenal levels may cause steatorrhoea. Cholelithiasis may result from alteration in the relative proportions of cholesterol, lecithin and bile salts in bile. The mechanism apparently differs in various conditions predisposing to gallstone formation. A primary alteration of bile salt metabolism has been postulated in several other conditions. Considerable interest centres on the importance of metabolites of bile salts in the pathogenesis of colonic carcinoma. Chenodeoxycholic acid is a successful though costly treatment for selected patients with cholesterol gallstones. Bile salt binding agents, such as cholestyramine, are extremely useful especially in the control of pruritus in patients with cholestasis.


Capsaicin pretreatment modifies hydrogen sulphide-induced pulmonary injury in rats.
One of the major target organs of hydrogen sulphide gas is the lung. Exfoliation of upper respiratory epithelia and pulmonary edema are prominent effects. Various neuropeptides contained in afferent C-fibres are intimately associated with the epithelia of the conducting airways and are liberated upon exposure to noxious gases. We sought to determine their role in the pathogenesis of hydrogen-sulphide-induced pulmonary injury by pretreating rats with the neurotoxin, capsaicin, which is known to ablate a subpopulation of vagal afferent C-fibres. Groups of capsaicin and saline (control) pretreated Fischer 344 rats were exposed to an edemogenic concentration of hydrogen sulphide (525-559 mg/m3) for 4 hr. Mortality was significantly greater (p less than 0.01) in the capsaicin treated rats (12/12) compared to the control animals (2/12). Pulmonary injury was also more severe in the capsaicin pretreated animals as assessed by lung water content, histological grade of pulmonary edema and protein in the broncho-alveolar fluid. Animals depleted of substance P exhibited a significantly greater (p less than 0.01) degree of bronchial epithelial cell exfoliation and ulceration following exposure to hydrogen sulphide. These experiments indicate that capsaicin sensitive sensory nerves may play a major role in pulmonary defense against the effects of inhaled toxic gases such as hydrogen sulphide.


Plant trait effects on soil organisms and functions.
Global change alters the composition and functioning of ecosystems by creating novel environmental conditions and thereby selecting for specific traits of organisms. Thus, trait-based approaches are promising tools to more mechanistically understand compositional and functional shifts in ecological communities as well as the dependency of response and effect traits upon global change. Such approaches have been particularly successful for the study of plant communities in terrestrial ecosystems. However, given the intimate linkages between aboveground and belowground compartments as well as the significance of plants as integrating organisms across those compartments, the role of plant traits in affecting soils communities has been understudied. This special issue contains empirical studies and reviews of plant trait effects on soil organisms and functions. Based on those contributions, we discuss here plasticity in trait expression, the context-dependency of plant trait effects, time lags in soil biotic responses to trait expression, and limitations of measured plant traits. We conclude that plant trait-based approaches are an important tool to advance soil ecological research, but also identify critical limitations and next steps.