Primary Health Care Nurses' Self-Perception of Theoretical Knowledges and Practical Skills in Life-Threatening Emergencies: A Cross-Sectional Study.
Within out-of-hospital emergencies, primary health care (PHC) nurses must face life-threatening emergencies (LTEs), which are defined as "a situation associated with an imminent life risk that entails the start-up of resources and special means to resolve the situation." The objectives of this study were to know the training received for out-of-hospital LTEs by PHC nurses of Asturias, Spain and the perception they have about their theoretical knowledge and practical skills in a series of emergency procedures or techniques used in LTE emergencies; as well as to analyze the differences according to the geographical area of their work. Cross-sectional, descriptive, and observational study was conducted in 2018 of a sample of PHC service nurses of Asturias, Spain. A total of 236 nurses from PHC service centers of Asturias, Spain, from among the total of 730 nurses who make up the staff of nurses of the PHC service of Asturias, between April and May 2018, were surveyed. The survey was designed ad hoc using the Doctrinal Body of Emergency Nursing (DBEN) proposed by the Spanish Society of Emergency Medicine (SEMES; Madrid, Spain), which indicates the theoretical and practical procedures that must be acquired by the PHC nurses. It is composed of 37 procedures or techniques employed in LTEs using an 11-point Likert scale rating to detect their self-perception about theoretical knowledge and practical skills from zero ("Minimum") to ten ("Maximum"). There were significant differences in the mean of theoretical knowledge and practical skills in many procedures or techniques studied, depending on the different areas of work. All PHC nurses must be perfectly trained to provide initial quality assistance to the LTE, with both theoretical and practical knowledge of the different techniques, so that it can continue to be attended by the corresponding Emergency Service.


Recent Developments of Nanodiamond Quantum Sensors for Biological Applications.
Measuring certain quantities at the nanoscale is often limited to strict conditions such as low temperature or vacuum. However, the recently developed nanodiamond (ND) quantum sensing technology shows great promise for ultrasensitive diagnosis and probing subcellular parameters at ambient conditions. Atom defects (i.e., N, Si) within the ND lattice provide stable emissions and sometimes spin-dependent photoluminescence. These unique properties endow ND quantum sensors with the capacity to detect local temperature, magnetic fields, electric fields, or strain. In this review, some of the recent, most exciting developments in the preparation and application of ND sensors to solve current challenges in biology and medicine including ultrasensitive detection of virions and local sensing of pH, radical species, magnetic fields, temperature, and rotational movements, are discussed.


Heteroborane analogs of silicon clusters: experimental and theoretical studies on Bi2Si5 and Bi2Si5(-).
We have investigated the electronic structure of anionic and neutral Bi(2)Si(5) by means of anion photoelectron spectroscopy and density functional calculations. Both the experiments and calculations reveal that the Bi(2)Si(5)(-) anion prefers to adopt a distorted trigonal-bipyramidal structure with Bi(2) bridges. Following the isolobal analogy between divalent Si and B-H group, we show that both neutral Bi(2)Si(5) and neutral Bi(2)B(5)H(5) adopt similar pentagonal-bipyrmidal geometries and have analogous orbital energy patterns.


Entrainment of neocortical neurons and gamma oscillations by the hippocampal theta rhythm.
Although it has been tacitly assumed that the hippocampus exerts an influence on neocortical networks, the mechanisms of this process are not well understood. We examined whether and how hippocampal theta oscillations affect neocortical assembly patterns by recording populations of single cells and transient gamma oscillations in multiple cortical regions, including the somatosensory area and prefrontal cortex in behaving rats and mice. Laminar analysis of neocortical gamma bursts revealed multiple gamma oscillators of varying frequency and location, which were spatially confined and synchronized local groups of neurons. A significant fraction of putative pyramidal cells and interneurons as well as localized gamma oscillations in all recorded neocortical areas were phase biased by the hippocampal theta rhythm. We hypothesize that temporal coordination of neocortical gamma oscillators by hippocampal theta is a mechanism by which information contained in spatially widespread neocortical assemblies can be synchronously transferred to the associative networks of the hippocampus.


Every Day's a New Day: A Captain's Reflection on a Losing Season.
Being captain of any team is a significant and prestigious position. In elite sport, the captain plays a vital role in both team and organisational leadership. To date there has been minimal research investigating captaincy, and none assessing the impact of regularly losing performances. A captain of a women's national basketball league team participated in an in-depth, semi-structured interview reflecting on her experience during a losing season. Following Schutz's (1967) framework, a social phenomenological analysis approach was taken, with seven higher-order themes emerging: being captain; relationship with coaching staff; relationship with teammates; team development; stressors; stress management; and self. Results suggest that while poor results affect all team members, there are increased levels of stress for the captain. The captain is expected to lead by example and avoid external expression of negativity. Further strains are placed on the captain, as they are the conduit between coaching and playing groups. As a result, the captain needs to have good support networks, from a variety of sources, to cope and minimise the impact on personal performance.


A study of pegylated liposomal Doxorubicin in platinum-refractory epithelial ovarian cancer.
The purposes of this study were to determine the efficacy of pegylated liposomal doxorubicin (PLD), using a dose of 40 mg/m2 given every 3 weeks, in the treatment of platinum-refractory epithelial ovarian cancer (EOC) and to evaluate the toxicities. Fourteen patients with platinum-resistant EOC were treated with intravenous PLD 40 mg/m2 every 3 weeks. Tumor responses were assessed every 2-3 cycles by CT scan. All 14 patients were evaluable for toxicity, but only 13 patients were evaluable for response because 1 patient who had grade 3 palmar-plantar erythrodysesthesia (PPE) refused to continue with the treatment. Three partial responses were observed in 13 patients. The overall response rate was 23% (95% confidence interval 10-38%). The median time to response was 2 months, and the median duration of response was 3 months. The median survival of the 13 patients was 14.5 months, and the median progression-free survival was 6 months. In this study, we had only 4 cases of grade 3 toxicity (2 cases of grade 3 leukopenia and 2 cases of grade 3 PPE). All toxicities that occurred were manageable. This is the first report of the use of a slightly modified dose schedule for PLD at a dose of 40 mg/m2 every 3 weeks, which is active in platinum-refractory EOC with manageable toxicities.


Traumatic rupture of the aorta: immediate or delayed repair?
To determine whether delay of the repair of the ruptured thoracic aorta in patients with other major injuries is safe and has a potential positive impact on survival. The accepted treatment for acute traumatic rupture of the thoracic aorta has been repair of the injury as soon as possible. This form of management, however, has been accompanied by a death rate of 0% to 54% mortality, often related to the presence of other injuries. The records of 30 consecutive patients with rupture of the thoracic aorta from blunt trauma treated from 1995 to 2001 were retrospectively reviewed. Two of them died shortly after admission and were excluded from further consideration. The remaining 28 patients were divided according to the time of the repair of the rupture into two groups. Group 1 patients underwent repair of the rupture immediately after the diagnosis was made. Group 2 patients, who had associated injuries that were likely to increase the risk of surgical death, had either repair more than 48 hours after injury (subgroup 2A) or had no repair (subgroup 2B). The patients in group 2 had their mean arterial pressure maintained at less than 70 mm Hg with medication to eliminate shear stress on the aortic tear while being observed. Twenty-eight patients (22 men, 6 women) with an average age of 36 years (range 19-76) were treated. Twenty-five had rupture of the descending thoracic aorta and three had rupture in the ascending thoracic aorta. Group 1 comprised 14 patients, 5 of whom died during surgery or in the early postoperative period. Group 2 comprised 14 patients, 9 in subgroup 2A and 5 in subgroup 2B. Two patients in subgroup 2A and three patients in subgroup 2B died of associated injuries or illnesses. Rupture of the traumatic pseudoaneurysm of the thoracic aorta did not occur in any of the patients in group 2. Delayed repair of acute traumatic aortic rupture is safe under appropriate treatment and should be considered in selected patients.


How to submit your revalidation application.
Rationale and key points This is the final in a series of eight articles providing information about the Nursing and Midwifery Council revalidation process. This article focuses on submitting a revalidation application to the NMC. » Nurses and midwives must demonstrate that they have: completed 450 hours of practice, or 900 hours if revalidating as both a nurse and midwife; undertaken 35 hours of continuing professional development, 20 hours of which must be participatory; recorded five examples of feedback on their practice; written five reflective accounts; had a reflective discussion with an NMC registrant; and sought confirmation that they have met these requirements. » Nurses and midwives who fail to submit their revalidation application by the stated date will put the renewal of their registration at risk. Reflective activity 'How to' revalidate articles can help to update your practice and provide information about the revalidation process, including how you can submit your revalidation application. Reflect on and write a short account of: 1. The professional accountability associated with declaring that you have met the revalidation requirements. 2. How you could use this article to educate your colleagues. Subscribers can upload their reflective accounts at: rcni.com/portfolio .


Pediatric inguinal hernia and hydrocele: an evidence-based review in the era of minimal access surgery.
Pediatric inguinal hernia and hydrocele share a common etiology as well as management. The era of minimal access surgery is challenging the conventional surgical management for pediatric inguinal hernia in particular. This review article aims to highlight the nature of diagnosis and treatment for both hernia and hydrocele and examines both the traditional and contemporary treatment strategies from an evidence-based perspective.


[A severe form of Chryseobacterium indologenes pneumonia in an immunocompetent patient].
We report a case of severe pneumonia due to Chryseobacterium indologenes in an immunocompetent patient. Chryseobacterium indologenes (formerly Flavobacterium indologenes) are saprophytic Gram-negative rods widely distributed in damp environment. Many sites of infection were described in the literature. These infections are always severe sometimes associated to multiple organ failure. The evolution is usually favorable with antibiotic treatment. Bacteria characteristically grow as yellow-pigmented colonies. They are naturally resistant to many antimicrobial agents. They are usually susceptible to piperacillin(DCI) alone or combined with tazobactam(DCI), ceftazidime(DCI), cefepime(DCI), fluoroquinolones(DCI), rifampin(DCI) and cotrimoxazole(DCI), but the in vitro susceptibility to these antibiotics should be systematically tested. Nevertheless, the optimum antibiotic treatment for Chryseobacterium-related infections remains to be established. In the case we report, the diagnosis was made according to the results of bronchial sample bacterial culture. This case report underlines the need for specific management of patients infected with this species.


A study of the vascular and acid-secretory responses of the rat gastric mucosa to histamine.
1. The effects of histamine on gastric mucosal blood flow in the presence and absence of gastric acid secretion were studied in the rat. 2. Histamine, in doses greater than those required to stimulate maximal acid secretion, caused a small increase in mucosal blood flow per unit acid output. 3. When acid secretion was inhibited by methyl analogues of prostaglandin E2, histamine reduced arterial blood pressure and gave a dose dependent rise in mucosal blood flow. 4. When acid secretion was inhibited by the histamine H2-receptor antagonists, burimamide and metiamide, histamine still increased mucosal blood flow. 5. The use of H1-receptor antagonists to inhibit the histamine-induced hyperaemia was made difficult by their vasodilator actions. 6. The selective histamine H2-receptor agonist, 4-methyl histamine, had no effect on arterial blood pressure in doses which stimulated acid secretion. The increase in mucosal blood flow which accompanied the stimulation of acid secretion was inhibited by the anti-secretory prostaglandins and H2-receptor antagonists. 7. The selective histamine H1-receptor agonist, 2-pyridyl ethylamine, had no effect on acid output but increased resting mucosal blood flow. 8. These results suggest that histamine H2-receptors, primarily concerned with acid secretion, and H1-receptors concerned with vasodilatation are both present in the rat gastric mucosa.


Identification of circulating miRNAs profiles that distinguish malignant pleural mesothelioma from lung adenocarcinoma.
Accurate diagnosis of malignant pleura mesothelioma (MPM) is challenging. Differential diagnosis of MPM versus lung adenocarcinoma (AD) is particularly difficult, yet clinically important since the two neoplasias call for different treatment approaches. Circulating miRNA-profiling to identify miRNAs that can be used to distinguish MPM from AD has not been reported. We conducted a wide screening study of miRNA profiles in serum pools of MPM patients (N = 11), AD patients (N = 36), and healthy subjects (N = 45) to identify non-invasive biomarkers for differential diagnosis of MPM and AD, using deep sequencing. Sequencing detected up to 300 known miRNAs and up to 25 novel miRNAs species in the serum samples. Among known miRNAs, 7 were upregulated in MPM and 12 were upregulated in AD compared to healthy controls. Of these, eight were distinctive for AD and three were unique for MPM. Direct comparison of the miRNA profiles for MPM and AD revealed differences in miRNA levels that could be useful for differential diagnosis. No differentially expressed novel miRNAs were found. Further bioinformatics analysis indicated that three upregulated miRNAs in MPM are associated with the p38 pathway. There are unique alterations in serum miRNAs in MPM and AD compared to healthy controls, as well as differences between MPM and AD profiles. Differing miRNA levels between MPM and AD may be useful for differential diagnosis. A potential association to p38 pathway of three upregulated miRNAs in MPM was revealed.


Validation of diffusion methods for macrolide susceptibility testing of Helicobacter pylori.
Helicobacter pylori resistance to macrolides is increasing, and the need for susceptibility testing has become crucial. The only standardized method is agar dilution, which is not adapted to clinical practice. The present work aimed: (1) to optimize the technical conditions and to assess the reproducibility of the E-test and disk diffusion method for macrolides susceptibility testing of H. pylori, and (2) to assess the performances of these two phenotypic methods in detecting strains harboring a resistance mechanism to macrolides. We used 191 isolates collected in nine centers of France and Belgium. Phenotypic tests were performed on Mueller-Hinton agar supplemented with 10% horse blood, inoculated with a 2-day-old H. pylori suspension (10(8) CFU/ml), and incubated for 72 hr at 37 degrees C under microaerophilic conditions. The reproducibility studied on two randomly selected strains was better for disk diffusion than for the E-test for both clarithromycin and erythromycin. For a subset of 10 strains, the MICs of erythromycin and clarithromycin did not differ from more than one two-fold dilution when determined by E-test or agar dilution method. The breakpoints were for MICs: 1 mg/L for both clarithromycin and erythromycin and for inhibition diameters, 22 mm for clarithromycin and 17 mm for erythromycin. There was a 100% concordance between susceptibility to erythromycin and clarithromycin. However, the susceptible and resistant populations were better separated by testing erythromycin. Of 34 resistant strains, two lacked the A2142G and A2143G point mutations in 23S rRNA by PCR-RFLP. None of 15 tested sensitive strains were positive for one of these two point mutations. For clinical practice, we recommend to assess macrolide susceptibility of H. pylori by using one of these two phenotypic methods under the described technical conditions.


Analysis of Ferroptosis-Related LncRNAs Signatures Associated with Tumor Immune Infiltration and Experimental Validation in Clear Cell Renal Cell Carcinoma.
Clear cell renal cell carcinoma (ccRCC) is the most aggressive subtype of renal cell carcinoma. Ferroptosis is an iron-dependent programmed cell death. Long non-coding RNAs (lncRNAs) emerge as a critical role in regulating cancer progression. This study aimed to identify molecular regulation of ferroptosis-related lncRNAs (FRLs) in ccRCC. The prognostic value of FRLs was investigated in ccRCC samples downloaded from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) dataset. The FRLs were screened out by Pearson correlation test. The 465 FRLs confirmed as potential prognostic factors through univariate Cox regression analysis were entered into Lasso and multivariate Cox regression to build a FRLs prognostic signature. A risk score based on the prognostic model divided ccRCC patients into low- and high-risk groups. A prognostic nomogram, derived from the prognostic signature and integrating clinical characteristics, was constructed. Gene set enrichment analysis (GSEA) revealed the immune- and tumor-associated pathways. Two distinct clusters were identified with different immune signatures through consensus clustering analysis. The prognostic value of some hub FRLs was externally validated via three GEO datasets (GSE46699, GSE53757 and GSE66272) and online databases. Finally, the three FRLs (LINC00460, LINC00941 and LINC02027) were verified through in vitro experiments. The FRLs prognostic signature, including 7 independent prognostic lncRNAs, exhibited good accuracy in predicting overall survival (OS) of ccRCC patients. This signature was correlated with immune infiltration and immune checkpoint blockade (ICB). We correlated two distinct clusters with immune infiltration signature of ccRCC. The worse prognosis of cluster 2 was probably mediated by immune evasion. We also found that the expression levels of LINC00460 and LINC00941 in ccRCC cell lines were higher than those in HK-2 cells, but LINC02027 showed the inverse trend. Collectively, our study demonstrated a FRLs prognostic signature which had great clinical value in prognosis assessment.


Treatment of children with stages II to IV anaplastic Wilms' tumor: a report from the National Wilms' Tumor Study Group.
To evaluate the effect of the combination of vincristine, dactinomycin, and doxorubicin with (regimen J) or without (regimen DD-RT) cyclophosphamide on the relapse-free survival of children with stages II to IV Wilms' tumor and focal or diffuse anaplasia. We reviewed the clinical courses of all randomized patients from National Wilms' Tumor Study (NWTS)-3 and NWTS-4 with stages II to IV anaplastic Wilms' tumor, and determined the 4-year relapse-free survival rate separately for those with focal or diffuse anaplasia. Anaplasia was evaluated using newly developed topographic definitions for focal and diffuse anaplasia. The 4-year relapse-free survival rate for five children with focal anaplasia who received regimen DD-RT was 80.0%, compared with 100.0% for eight children who received regimen J (P = .68). The 4-year relapse-free survival rate for 29 children with diffuse anaplasia treated with regimen DD-RT was 27.2%, compared with 54.8% for 30 children treated with regimen J (P = .02). We conclude that children with focal anaplasia have an excellent prognosis when treated with vincristine, doxorubicin, and dactinomycin. The addition of cyclophosphamide to the three-drug treatment regimen improved the 4-year relapse-free survival rate of children with stage II to IV diffuse anaplasia. This result suggests that further intensification of the treatment regimen for children with diffuse anaplasia may result in an additional improvement in prognosis.


Hepatoblastoma clinical research: lessons learned and future challenges.
The past four decades has brought significant improvement to the diagnosis, treatment, and outcomes of children diagnosed with hepatoblastoma. These improvements are the results of multidisciplinary and multi-institutional international cooperative trials, such as those conducted by the Children's Oncology Group (COG) or the International Childhood Liver Tumor Strategy Group (SIOPEL) and national studies such as those conducted in Germany and Japan. Due to the different treatment strategies used by the various groups, the information generated has been at times complementary but at other times contradictory. In this manuscript, we will provide a global picture of where "we stand and where we are going" in regards to clinical research of childhood hepatoblastoma. We will focus on lessons learned, especially in reference to the experiences of the COG and SIOPEL study groups, and discuss future challenges.


[Studies on defence effects of recombinant human granulocyte colony-stimulating factor (G-CSF) to infections. I. Induction of neutrophil polarization by G-CSF].
It is well known that recombinant human granulocyte increases dramatically the number of granulocytes in peripheral blood. It is interesting to see if G-CSF enhances the functions of neutrophil since the neutrophil is one of the most important factors of host defence mechanism against infections. In this study, we have demonstrated that G-CSF induced the polarization of neutrophil while it could not be chemoattractant for the cell. Polarization is considered to be the initial reaction of chemotaxis. Therefore, G-CSF might enhance the defence effect of the neutrophils+ to infections in this point.


A Review of Suicide Risk Assessment Tools and Their Measured Psychometric Properties in Korea.
While there has been a slew of review studies on suicide measurement tools until now, there were not any reviews focusing on suicide assessment tools available in Korea. This review aimed to examine the psychometric properties of tools developed in Korea or the translated versions from the original tools in their foreign language and to identify potential improvements and supplements for these tools. A literature search was done using the Korean academic information search service, Research Information Service System, to identify the suicide measures to be included in this review. Abstracts were screened to identify which measures were used to assess suicide-related factors. Based on the established inclusion and exclusion criteria, 18 tools remained and we assessed their psychometric properties. The current review indicated several major findings. First, many of the tools did not report predictive validity and even those with predictive validity were based on past suicide attempts. Second, some of the tools overlooked the interactive component for the cause of suicide. In addition, information to supplement the self-reported and clinician-administered reports by collecting reports from the subjects' families and acquaintances is needed. It is also important to develop a screening tool that examines other aspects of an individual's personal life, including unemployment, bereavement, divorce, and childhood trauma. Moreover, tools that have been studied in more diverse groups of the population are needed to increase external validity. Finally, the linguistic translation of the tools into Korean needs to consider other cultural, social, and psychological factors of the sample of interest.


Repeated gestational exposure to diesel engine exhaust affects the fetal olfactory system and alters olfactory-based behavior in rabbit offspring.
Airborne pollution, especially from diesel exhaust (DE), is known to have a negative effect on the central nervous system in exposed human populations. However, the consequences of gestational exposure to DE on the fetal brain remain poorly explored, with various effects depending on the conditions of exposure, as well as little information on early developmental stages. We investigated the short-term effects of indirect DE exposure throughout gestation on the developing brain using a rabbit model. We analyzed fetal olfactory tissues at the end of gestation and tested behaviors relevant to pups' survival at birth. Pregnant dams were exposed by nose-only inhalation to either clean air or DE with a content of particles (DEP) adjusted to 1 mg/m3 by diluting engine exhaust, for 2 h/day, 5 days/week, from gestational day 3 (GD3) to day 27 (GD27). At GD28, fetal olfactory mucosa, olfactory bulbs and whole brains were collected for anatomical and neurochemical measurements. At postnatal day 2 (PND2), pups born from another group of exposed or control female were examined for their odor-guided behavior in response to the presentation of the rabbit mammary pheromone 2-methyl-3-butyn-2-ol (2MB2). At GD28, nano-sized particles were observed in cilia and cytoplasm of the olfactory sensory neurons in the olfactory mucosa and in the cytoplasm of periglomerular cells in the olfactory bulbs of exposed fetuses. Moreover, cellular and axonal hypertrophies were observed throughout olfactory tissues. Concomitantly, fetal serotoninergic and dopaminergic systems were affected in the olfactory bulbs. Moreover, the neuromodulatory homeostasis was disturbed in a sex-dependent manner in olfactory tissues. At birth, the olfactory sensitivity to 2MB2 was reduced in exposed PND2 pups. Gestational exposure to DE alters olfactory tissues and affects monoaminergic neurotransmission in fetuses' olfactory bulbs, resulting in an alteration of olfactory-based behaviors at birth. Considering the anatomical and functional continuum between the olfactory system and other brain structures, and due to the importance of monoamine neurotransmission in the plasticity of neural circuits, such alterations could participate to disturbances in higher integrative structures, with possible long-term neurobehavioral consequences.


[Laparoscopic excision of infected urachal remnant: a case report].
A 18-year-old man presented with fever and periumbilical nodule. Computed tomography (CT) showed complicated abscess of urachal remnant and laparoscopic surgery was performed transperitoneally via 3 ports. Laparoscopic excision of urachal remnant was first demonstrated in 1992 by Neufung et al, and in Japan first case was reported in 1998 by Ohmori et al. Some cases of laparoscopic surgery for urachal remnant were reported, but the surgical techniques, including port configuration, have not been standardized. In this case, we performed laparoscopic surgery with camera port in the umbilicus and two working ports in the bilateral positions. Our port configuration may be promising in ensuring good viewing during surgery and excising urachal remnant completely including umbilicus.


[Host-guest molecule interaction mechanism of hemostatics with liposomes and red blood cells studied with fluorescence polarimetric method].
The supermolecule compounds of adrenobazone, p-aminomethylbenzoic acid, vitamin K1, 6-amino caproic acid with liposomes and red blood cells were studied by fluorescence polarimetric method. The mechanisms of formation of the supermolecule compounds were examined by fluorescence probe of the link of 1,6-dipheny-1,3,5-hexatriene (DPH) with liposomes which were taken as a model of blood cells. The interaction mechanism of hemostatics with red blood cells was described according the quantitative relationship between polarization value (P) and the microviscosity [formula: see text]. The result showed that the acting force between hemostatics and liposomes or that between hemostatics and red blood cells were mainly supermolecular acting force. The acting force between vitamin K1 and cytomembrane is hydrophobic force and those between adrenobazone, p-aminomethylbenzoic acid, or 6-amino caproic acid and cytomembrane are hydrogen bond or electrostatic force. Under the same drug concentration, all of the four haemostatics can reduce the fluidity of the cell membrane, which benefits blood coagulation. The binding ways of hemostatics with red blood cells was also discussed.


IgG subclasses in pemphigus in Indian and UK populations.
The autoimmune blistering disease pemphigus is more common in the Indian subcontinent than in the UK. This study of 19 patients from Oxford, UK and 39 patients from New Delhi, India demonstrates that the incidence of the disease subtypes is different in the two countries. In the UK the commonest subtypes are pemphigus vulgaris and foliaceus with equal prevalence (both eight of 19), but in India pemphigus vulgaris is the most frequent (31 of 39), while pemphigus foliaceus is uncommon (three of 39) and with equal prevalence to the other subtypes. These populations also differ with a younger age at onset in the Indian patients (36.9 India; 52.7 UK) though the sex distribution is the same. Study of the immunopathology shows that the antibodies produced by patients in the two countries do not differ significantly, and are predominantly of the IgG4 subclass. The antibody produced does not vary with the subtype of pemphigus or the age or sex of the patient. Although there are considerable differences between the two groups of patients this difference is not reflected by the subclass of auto-antibody response.


Acellular bovine pericardia with distinct porous structures fixed with genipin as an extracellular matrix.
A cell extraction process was employed to remove the cellular components from bovine pericardia. Various porous structures of the acellular tissues were then created, using acetic acid and collagenase, and subsequently fixed with genipin. The biological response and tissue regeneration pattern for each studied group were evaluated in a growing rat model. One month postoperatively, fibroblasts, neoconnective tissue fibrils, and neocapillaries were observed in the acellular, acetic acid-treated, and collagenase-treated tissues to fill the pores within the implanted samples, indicating that these tissue samples were being regenerated. The neoconnective tissue fibrils were identified to be neocollagen fibrils and neoglycosaminoglycans. On the other hand, no tissue regeneration was observed in the cellular tissue throughout the entire course of the study; tissue regeneration was limited to the outer most layer of the acellular tissue. In contrast, the areas of tissue regeneration in the acetic acid-treated and collagenase-treated tissues were expanded with increasing duration of implantation. However, 1 year postoperatively there were still numerous inflammatory cells observed in the acetic acid-treated tissue, whereas inflammatory cells in the collagenase-treated tissue had almost disappeared. These results indicated that tissue regeneration patterns within acellular tissues were significantly affected by their porous structures.


[Cardiotoxic complications in Wilms' tumour survivors after treatment with anthracyclines].
The aim of the study was an evaluation of circulatory system functions in patients with Wilms' tumour who underwent the multidrug chemotherapy with anthracyclines. The investigation was carried out on 43 patients after chemotherapy between 1994-1997, from 4 centres of paediatric oncology (in Gdansk, Poznan, Lublin and Bydgoszcz). All patients were divided into two groups. The children from the first group received anthracyclines without Cardioxan protection. The patients from the second group had been treated with both anthracyclines and Cardioxan. The cardiotoxicity was estimated in relation to the total dose of anthracyclines. Comparing the side effects of chemotherapy in both groups there were no essential differences in bone marrow suppression and in hepatotoxic symptoms.


Suboptimal response to ferrous sulfate in iron-deficient patients taking omeprazole.
Iron deficiency anemia is commonly encountered in outpatient practice. Gastric acid is one of the important factors for optimum absorption of iron. Proton pump inhibitors are very commonly prescribed medications. One of the debated effects of proton pump inhibitors is on oral iron absorption. Their effect on absorption of oral iron supplementation in iron-deficient patients has not been studied. At the Cooper Hematology Outpatient office, we reviewed charts of iron-deficient anemic patients who were on omeprazole for the last 4 years. Fifty patients having no apparent ongoing blood loss, having other causes of anemia especially that of chronic diseases ruled out, and on omeprazole while starting ferrous sulfate therapy for iron deficiency were selected for chart review. The iron-study results at the start of oral ferrous sulfate therapy and at 3 months follow-up were compared to evaluate the response of ferrous sulfate. The mean hemoglobin change was 0.8 ± 1.2 g/L. The mean change in ferrtin values was 10.2 ± 7.8 μg/L. Only 16% of the patients had a normal response to hemoglobin levels (rise of >2 g/dL), and only 40% had a normal response to ferritin levels (rise of >20 μg/dL). The average age of patients having a suboptimal response to both hemoglobin and ferritin was significantly higher compared with that of the patients with an optimal response. Omeprazole and possibly all proton pump inhibitors decrease the absorption of oral iron supplementation. Iron-deficient patients taking proton pump inhibitors may have to be treated with high dose iron therapy for a longer duration or with intravenous iron therapy.


Lung cancer histologic type in the surveillance, epidemiology, and end results registry versus independent review.
Because few studies have assessed the accuracy of lung cancer histologic diagnoses reported by state cancer registries, we examined whether the Iowa Surveillance, Epidemiology, and End Results Cancer Registry (i.e., the Iowa Cancer Registry)-reported lung cancer histologic diagnoses were reliable. We investigated agreement between lung cancer histologic types reported for 413 patients with lung cancer by the Iowa Cancer Registry and those obtained through an independent review of diagnostic slides. Among lung cancer histologic types, small-cell carcinoma had the highest sensitivity (94.1%, 95% confidence interval [CI] = 85.6% to 98.4%), positive predictive value (94.1%, 95% CI = 85.6% to 98.4%), negative predictive value (98.8%, 95% CI = 96.9% to 99.7%), and highest percent exact agreement (98.0%, 95% CI = 96.6% to 99.4%). The lowest sensitivity (21.9%, 95% CI = 9.3% to 40.0%) and positive predictive value (23.3%, 95% CI = 9.9% to 42.3%) were noted for large-cell carcinoma, probably because other more specific features of adenocarcinoma or squamous carcinoma were absent. Adenocarcinoma had the lowest specificity (84.4%, 95% CI = 79.0% to 88.9%), negative predictive value (85.2%, 95% CI = 79.9% to 89.6%), and percent exact agreement (82.9%, 95% CI = 79.2% to 86.6%). Samples collected by cytologic examination (odds ratio [OR] = 2.4, 95% CI = 1.1 to 5.2) or biopsy examination (OR = 2.2, 95% CI = 1.1 to 4.2) were more likely to be misclassified than samples obtained via resection. Thus, the histologic type obtained by the Iowa Cancer Registry is reasonably reliable, but independent slide review is needed for precise histologic typing of lung cancer.


Relationship between physical properties of casein micelles and rheology of skim milk concentrate.
The properties of casein micelles in milk concentrates are of interest for the use of ultrafiltered (UF) skim milk concentrates in dairy products, and for the general understanding of colloidal stability and behavior of the casein micelle. The rheological behavior of UF skim milk concentrate with a casein concentration of 19.5% (wt/wt) was investigated at different pH and NaCl concentrations by analyzing flow viscometry and small amplitude oscillatory shear measurements. Viscometric flow curves were fitted to the Carreau-Yasuda model with the aim of determining values for the viscosity at infinite high shear rates and thereby estimate the voluminosity of the casein micelles (nu(casein)) in the UF concentrate. The voluminosity of the casein micelles increased with addition of NaCl and decreased when pH was decreased from 6.5 to 5.5. At pH 5.2, nu(casein) increased because of acid-induced aggregation of the casein micelles. The changes in nu(casein) could be interpreted from transmission electron microscopy of freeze-fractured samples of the UF concentrate and partly from dynamic light scattering measurements. Altered interactions between casein micelles due to different pH and NaCl concentrations are proposed to occur due to collapse of the kappa-casein layer, changed ionic strength, and altered distance between casein micelles.


Substrate-specific inactivation of staphylococcal penicillinase.
1. The rate of hydrolysis of methicillin, cloxacillin and quinacillin by staphylococcal extracellular penicillinase decreases progressively with time. 2. The inactivation is prevented but not reversed by benzylpenicillin. 3. The rate of inactivation produced by quinacillin is minimal when the rate of hydrolysis is at a maximum. 4. Under certain conditions, partially inactivated enzyme can be reactivated. 5. Combination of the enzyme with antiserum, while permitting hydrolysis, prevents inactivation. 6. No evidence for a stable enzyme-substrate complex has been found.


Role of peptide YY in the endocrine control of digestion.
Peptide YY is released into the circulation after ingestion of a meal, a response that is markedly enhanced in patients with malabsorption. The enhanced release of peptide YY slows gastric emptying and transit of meals through the small intestine. The net effect is increased efficiency of digestion and absorption of nutrients. Once the efficiency of nutrient utilization is optimized and the delivery of unabsorbed nutrients to the distal gut decreased, peptide YY release is inhibited. As peptide YY slows colonic transit, it could also improve salvage of unabsorbed nutrients by enhancing bacterial production of volatile fatty acids and their subsequent absorption by the colonic mucosa.


Tyrosine hydroxylase and dopamine beta-hydroxylase inductions evoked by reserpine in the superior cervical ganglion of developing eu- and hypothyroid rats.
This study was designed to determine the effect of neonatally-produced hypothyroidism on reserpine-elicited tyrosine hydroxylase (TH) and dopamine beta-hydroxylase (D beta H) induction in the superior cervical ganglion (SCG) in rats. Some rats were rendered hypothyroid from birth by daily treatment with propylthiouracil (PTU). Some hypothyroid rats received replacement therapy with triiodothyronine (T3). Some rats received PTU for 20 days, beginning at 90 days of age. Some rats were not treated and served as controls. TH and D beta H activities were assayed at 30, 50 and 110 days of age. Basal TH activity in the SCG for rats made hypothyroid as neonates was significantly lower than for controls at all ages tested; basal D beta H activity for these rats was lower than for controls at 30 and 50 days of age, but by 110 days was not different from that for controls. Basal TH activity for rats made hypothyroid as adults was intermediate between that for controls and rats made hypothyroid from infancy. Injecting control rats with reserpine produces a robust TH induction in the SCG at each age tested, and a strong D beta H induction at 50 and 110 days of age. Reserpine-evoked TH and D beta H inductions in rats made hypothyroid as adults were not different from those seen in controls. In contrast, rats made hypothyroid from infancy showed virtually no evidence of a reserpine-provoked TH or D beta H induction at any age tested. TH and D beta H inductions for hypothyroid rats given T3 replacement were completely normal.(ABSTRACT TRUNCATED AT 250 WORDS)


Chronic rupture of tendo Achillis. Long-term results of operative management using polyester tape.
We report the long-term results of the surgical treatment of chronic rupture of tendo Achillis using polyester tape. This requires minimal postoperative splintage and allows early mobilisation and a prompt return to work and sport. We reviewed 16 patients (10 women and 6 men) at a mean period of three years after surgery. The median time from injury to operation was 16.8 months (3.9 months to 13 years), and the median age of the patients was 52 years (27 to 78). The median time to full weight-bearing was 40 days and the median time for return to sport was 18 weeks (5.4 to 32). One patient required further surgery and one had numbness along the distribution of the sural nerve. After surgery only two patients had increased dorsiflexion of the ankle compared with the uninjured side. There were no cases of rerupture. We recommend this technique for the treatment of chronic rupture of tendo Achillis.


Survey of utilization of medetomidine and atipamezole in private veterinary practice in Quebec in 2002.
This survey evaluates early perceptions about the use of medetomidine and atipamezole among veterinary practitioners in Quebec in 2002. Response rate was 23.5%; 71.1% of the practitioners did not use these products because of lack of information (69.3%), unavailability of the drugs in the practice (23.3%), or other reasons (7.3%), including concerns about the safety of alpha-2 agonists. Most veterinarians who used these products (70.4%) used them only rarely. Sedation by medetomidine was qualified as good (44.2%) or excellent (36%), and analgesia as good (46.5%) or average (32.7%). Waking up after atipamezole was qualified as good (47.5%) or excellent (40.9%). These perceptions indicate an opportunity for wider use of the products in veterinary practice. With more education and experience, practitioners could find medetomidine hydrochloride alone or in combination with an opioid useful for sedation, analgesia, and premedication for healthy animals. Reversal with atipamezole hydrochloride is considered effective, when residual sedation is undesirable.


Wildfire reveals transient changes to individual traits and population responses of a native bumble bee Bombus vosnesenskii.
Fire-induced changes in the abundance and distribution of organisms, especially plants, can alter resource landscapes for mobile consumers driving bottom-up effects on their population sizes, morphologies and reproductive potential. We expect these impacts to be most striking for obligate visitors of plants, like bees and other pollinators, but these impacts can be difficult to interpret due to the limited information provided by forager counts in the absence of survival or fitness proxies. Increased bumble bee worker abundance is often coincident with the pulses of flowers that follow recent fire. However, it is unknown if observed postfire activity is due to underlying population growth or a stable pool of colonies recruiting more foragers to abundant resource patches. This distinction is necessary for determining the net impact of disturbance on bumble bees: are there population-wide responses or do just a few colonies reap the rewards? We estimated colony abundance before and after fire in burned and unburned areas using a genetic mark-recapture framework. We paired colony abundance estimates with measures of body size, counts of queens, and estimates of foraging and dispersal to assess changes in worker size, reproductive output, and landscape-scale movements. Higher floral abundance following fire not only increased forager abundance but also the number of colonies from which those foragers came. Importantly, despite a larger population size, we also observed increased mean worker size. Two years following fire, queen abundance was higher in both burned and unburned sites, potentially due to the dispersal of queens from burned into unburned areas. The effects of fire were transient; within two growing seasons, worker abundance was substantially reduced across the entire sampling area and body sizes were similar between burned and unburned sites. Our results reveal how disturbance can temporarily release populations from resource limitation, boosting the genetic diversity, body size, and reproductive output of populations. Given that the effects of fire on bumble bees acted indirectly through pulsed resource availability, it is likely our results are generalizable to other situations, such as habitat restorations, where resource density is enhanced within the landscape.


[On the necessity of the development of modern algorithms for the evaluation of the injuries inflicted with scissors].
At present, a steady growth in the frequency of wounds inflicted by sharp injurious objects (e.g. scissors) is being observed. It necessitates an enhanced attention to the investigation of the causes underlying such events and the circumstances accompanying them. This article presents an example of one of the injuries inflicted with scissors that required the most careful and comprehensive criminalistic study despite the seemingly self-evident circumstances of the event. This case illustrates the necessity of development of the modern algorithms for the evaluation of the injuries inflicted with the scissors.


A comparison of quantitative echocardiographic methods for delineating infarct-induced abnormal wall motion.
Current echocardiographic methods for quantitating abnormal regional left ventricular wall motion rely primarily on changes in endocardial excusion from end-diastole to end-systole. Recent studies demonstrating important spatial and temporal heterogeneity in wall motion within ischemic regions, however, raise questions about the validity of this approach. To determine the optimal method for defining abnormal left ventricular wall motion, we used a canine preparation of acute experimental infarction to examine four quantitative methods of wall motion analysis. The circumferential extent of abnormal wall motion assessed by each method was compared with the circumferential extent of infarction (defined by triphenyltetrazolium chloride staining) and the circumferential extent of reduced transmural blood flow (determined by radiolabeled microsphere techniques) 6 hr after acute coronary occlusion. The following methods of quantitating abnormal wall motion were examined: (1) determination of end-diastolic to end-systolic endocardial excursion (less than 0.20 end-diastolic radius), (2) determination of the extent of maximal dyskinesis (systolic bulging), and (3) and (4) two derived correlation methods that consider the entire course of systolic radial motion by correlating the observed echocardiographic field-by-field (every 16.7 msec) motion of each of 36 evenly spaced endocardial targets with the course of normal motion established from pooled normal data. Results obtained with the correlation methods showed a better correlation with the triphenyltetrazolium chloride-defined circumferential extent of infarction (r = .87 and r = .78) than did determinations of reduced end-diastolic to end-systolic endocardial excursion (r = .35) or the extent of maximal dyskinesis (r = .37). Similarly, the best correlation with the extent of reduced flow was obtained with one of the correlation methods (r = .80). We conclude that correlation methods that "integrate" endocardial motion over the entire systolic contraction sequence provide better definition of ischemic left ventricular dysfunction than do methods that consider motion at only single points in time.


Approach an appropriate decision on fetus with endocardial fibroelastosis in collaboration with cardiovascular profile score: A case report.
Fetal endocardial fibroelastosis (EFE) is a kind of rare fetal cardiac malformation characterized by the diffuse thickening of the ventricular endocardium. The diagnosis of fetal EFE depends on the echocardiographic features which are still confused that how to make an appropriate pregnant decision due to the conflict between high prenatal mortality and acceptable prognosis once after birth. Here, we seriously built a 4-gradation recommendation system based on cardiovascular profile score (CVPS) to supply a prediction of clarified pregnant outcomes with EFE and provide a practical way to offer optimal medical consultation. A suspected case of fetal EFE has been aware at 24th gestational week by fetal echocardiography. The CVPS of this affected fetus dropped to 6 out of 10 points, which indicated a severe heart condition along with the fetus and predicted an adverse fetal prognosis according to our recommendation system. After fully informed consent, the prospective parents determined to terminate pregnancy. Following the induced abortion, postmortem pathological findings confirmed the echocardiographic suspicion of EFE. According to our experience and previous researches, we could reach a relative clear prediction of the outcomes of the EFE fetuses based on the CVPS of such suspected fetuses, which should lead to approach an appropriate pregnant decision for such fetuses.


Stimulating effect of a newly synthesized sulfonamido-based gallate on articular chondrocytes in vitro.
The phenotype of chondrocyte is easy to be lost when expanded in vitro by a process defined "dedifferentiation". Traditional growth factors such as transforming growth factor (TGF-β1) are effective in preventing of dedifferentiation, but high costs and loss of activity limited their use. It is of significance to find substitutes which can reduce dedifferentiation and preserve chondrocytes phenotype to ensure sufficient differentiated cells for further study. We synthesized new type of sulfonamido-based gallates named ZXHA-C and investigated its effect on primary articular chondrocytes of rats. After preliminary screening by cytotoxicity test, ZXHA-C of 1.06 × 10-8, 1.06 × 10-7 and 1.06 × 10-6M were chosen for further studies. Cell proliferation, morphology, viability, GAG synthesis and cartilage specific gene expression were detected. Also the effects of ZXHA-C on Wnt/β-catenin signaling pathway were investigated. ZXHA-C could significantly promote chondrocytes growth. And it could enhance ECM synthesis by up-regulating expression levels of cartilage specific markers like aggrecan, collagen II and Sox9. Expression of collagen I which marked chondrocytes dedifferentiation was also significantly down-regulated after treated by ZXHA-C. Further exploration of the molecular mechanism indicated that ZXHA-C activated the Wnt/β-catenin signal pathway in chondrocytes, as evidenced by up-regulated gene expression of β-catenin, Wnt-4, cyclin D1 and Frizzled-2 and decreased glycogen synthase kinase 3β (GSK-3β). Among the various concentrations, ZXHA-C of 1.06 × 10-7 M showed the best performance, which was close to positive control (group with TGF-β1). ZXHA-C might be potential a novel agent for the maintenances of chondrocytes phenotype.


Assessment of Patient Radiation Dose during Conventional Diagnostic X-ray Examinations in Three Public Hospitals in Northern Jordan using TLDs.
This study aims to measure entrance surface doses during routine chest and abdomen x-ray examinations of adult and child patients. Radiation dose measurements were performed using thermoluminescent dosimeters TLD-100s in three major public hospitals in northern Jordan on a total of 100 patients. Wide variations in entrance surface doses were observed within and between hospitals, which might be attributed to significant variations of the selected exposure parameters. For adult patients, the results have shown that the majority of entrance surface dose values from both chest and abdomen examinations were within recommended values of diagnostic reference levels. For child patients, the mean entrance surface dose from chest examinations in three age groups were 0.131 mGy (0-1 y), 0.136 mGy (1-5 y), and 0.191 mGy (5-10 y). These values were considered relatively high compared to the European reference levels and published results in the literature. However, for abdomen examinations, entrance surface dose values were relatively lower than European reference levels. Patient effective doses were estimated using a PCXMC 2.0 Monte Carlo program. The results for both adults and children were found to be relatively lower than the values reported by international publications. Due to the wide variations of entrance surface dose and the higher radiation doses delivered to child patients, this study recommends implementing a quality assurance program in such hospitals to achieve optimization between good image quality and minimum dose according to the as low as reasonably achievable principle. Moreover, the results of this work will provide a useful base for establishing local diagnostic reference levels for chest and abdomen examinations in Jordan.


CT scan studies of aphasia.
CT scan studies of lesion localization in aphasic patients have in general confirmed the traditional locus of damage within the left hemisphere for the major syndromes. Some interesting exceptions have come to light, such as the possible occurrence of global aphasia with a partial lesion (anterior or posterior) of the language zone. The study of correlations in vivo has underlined the importance of considering time since onset in the evaluation of the clinical picture. Description of atypical aphasias associated with subcortical lesions and correlation of lesion site with specific, partial aspects of linguistic impairment are two areas where CT scan studies are increasing our understanding of the language machinery in the brain.


Severe Tuberculosis Requiring Intensive Care: A Descriptive Analysis.
Background. This study aims to describe the characteristics of tuberculosis (TB) patients requiring intensive care and to determine the in-hospital mortality and the associated predictive factors. Methods. Retrospective cohort study of all TB patients admitted to the ICU of the Infectious Diseases Department of Centro Hospitalar de São João (Porto, Portugal) between January 2007 and July 2014. Comorbid diagnoses, clinical features, radiological and laboratory investigations, and outcomes were reviewed. Univariate analysis was performed to identify risk factors for death. Results. We included 39 patients: median age was 52.0 years and 74.4% were male. Twenty-one patients (53.8%) died during hospital stay (15 in the ICU). The diagnosis of isolated pulmonary TB, a positive smear for acid-fast-bacilli and a positive PCR for Mycobacterium tuberculosis in patients of pulmonary disease, severe sepsis/septic shock, acute renal failure and Multiple Organ Dysfunction Syndrome on admission, the need for mechanical ventilation or vasopressor support, hospital acquired infection, use of adjunctive corticotherapy, smoking, and alcohol abuse were significantly associated with mortality (p < 0.05). Conclusion. This cohort of TB patients requiring intensive care presented a high mortality rate. Most risk factors for mortality were related to organ failure, but others could be attributed to delay in the diagnostic and therapeutic approach, important targets for intervention.


Early detection of isolated memory deficits in the elderly: the need for more sensitive neuropsychological tests.
Early detection of cognitive decline in the elderly is important because this may precede progression to Alzheimer's disease. The aim of this study was to see whether sensitive neuropsychological tests could identify pre-clinical cognitive deficits and to characterize the cognitive profile of a subgroup with poor memory. A neuropsychological test battery was administered to a community-dwelling sample of 155 elderly volunteers who were screened with CAMCOG at enrolment (mean age 74.7 years). The battery included tests of episodic memory. semantic and working memory, language and processing speed. Episodic memory test z scores below 1 S.D. from the cohort mean identified 25 subjects with non-robust' memory performance. This group was compared to the remaining 'robust memory' group with a General Linear Model controlling for age, IQ, education and gender. Test performance was significantly different in all tests for episodic and semantic memory, but not in tests for working memory, processing speed and language. CANTAB paired associates learning and spatial recognition tests identified the highest percentages of those in the 'non-robust memory group. Processing speed partialled out the age effect on memory performance for the whole cohort, but the 'non-robust memory' group's performance was not associated with age or processing speed. Sensitive neuropsychological tests can detect performance below the norm in elderly people whose performance on MMSE and CAMCOG tests is well within the normal range. Age-related decline in memory performance in a cohort of the elderly may be largely due to inclusion within the cohort of individuals with undetected pre-clinical Alzheimer's disease or isolated memory impairment.


Molecular genetic linkage maps of mouse chromosomes 4 and 6.
We have generated a moderate resolution genetic map of mouse chromosomes 4 and 6 utilizing a (C57BL/6J x Mus spretus) F1 x Mus spretus backcross with RFLPs for 31 probes. The map for chromosome 4 covers 77 cM and details a large region of homology to human chromosome 1p. The map establishes the breakpoints in the mouse 4-human 1p region of homology to a 2-cM interval between Ifa and Jun in mouse and to the interval between JUN and ACADM in human. The map for mouse chromosome 6 spans a 65-cM region and contains a large region of homology to human 7q. These maps also provide chromosomal assignment and order for a number of previously unmapped probes. The maps should allow the rapid regional assignment of new markers to mouse chromosomes 4 and 6. In addition, knowledge of the gene order in mouse may prove useful in determining the gene order of the homologous regions in human.


A Rare Case of Phosphaturic Tumor/Oncogenic Osteomalacia - Diagnostic Challenges and Management Algorithm.
Oncogenic osteomalacia is a rare paraneoplastic syndrome of acquired hypophosphatemic osteomalacia, resulting from a deficit in renal tubular phosphate reabsorption, in which fibroblast growth factor 23 seems to be implicated. A 42-year-old male presented with complaints of low back pain for the past 4 years and inability to walk for the past 3 years. Blood investigations showed hypophosphatemia and elevated serum alkaline phosphatase. Radiographs and magnetic resonance imaging revealed features of osteomalacia. DOTONAC PET-computed tomography (CT) showed a lesion in the greater trochanter suggestive of a phosphaturic mesenchymal tumor. CT-guided biopsy of the lesion was done which confirmed the diagnosis. The tumor was resected by intralesional methods (burring and cementation) with correction of hypophosphatemia by oral phosphorus supplementation. Patient clinically improved and was able to walk with support at the time of discharge. Phosphaturic tumor was localized to be in the posterior aspect of the right greater trochanter. To find the tumor was a major diagnostic challenge involving various diagnostic modalities. The occurrence of such a condition is rare and it may take even years to correctly diagnose the disease.


Marine macromolecules cross-linked hydrogel scaffolds as physiochemically and biologically favorable entities for tissue engineering applications.
Marine biopolymer composite materials provide a technological platform for launching biomedical applications. Biomaterials demand good biocompatibility without the possibility of inflammation or foreign body reactions. In this study, we prepared two biocomposite hydrogels namely; HAC (hydroxyapatite, alginate & chitosan) and HACF (hydroxyapatite, alginate, chitosan & fucoidan) followed by calcium chloride cross linking. The prepared scaffolds were characterized by Fourier transform infrared spectroscopy and scanning electron microscopy. Porosity measurement, swelling, biodegradation, hemolysis, RBC aggregation, plasma protein adsorption and cytotoxicity studies were also done. The hydrogel scaffold HACF possessed a well-defined porous architecture, sufficient water holding capacity, better hemocompatibility and biodegradability. The biocompatibility was confirmed through in vitro cytotoxicity studies such as MTT assay, Neutral red uptake, DAPI staining, Trypan blue dye exclusion test and direct contact assay in L929 mouse fibroblast cells. In addition, immunomodulatory and anti-inflammatory properties of both of these scaffolds were revealed by the mRNA expressions of major inflammatory marker genes in cytotoxic condition such as TNF-α, IL-6 and NF-κB. The physiochemical characterization and biological responses of HACF hydrogel signifies its suitability for various tissue engineering applications.


Clinically node-positive micropapillary bladder cancer in a young female desiring to spare functional bladder and fertility.
A 38-year-old female developing pelvic lymph node recurrence (cN2) of bladder cancer was referred to our hospital. Eighteen months earlier, she had received complete transurethral resection of bladder tumor and pathological diagnosis of muscle-invasive urothelial carcinoma with micropapillary variant had been made. She had declined radical cystectomy or chemoradiation because of a strong desire to spare the bladder and fertility. She received induction gemcitabine/cisplatin therapy. After three cycles, she achieved a clinically complete response. Then, she underwent transumbilical gasless retroperitoneoscopic super-extended pelvic lymph node dissection up to the inferior mesenteric artery trunk using the three-dimensional head-mounted display system. Pathologically, one of 42 resected lymph nodes was positive for metastasis. She is alive with no evidence of disease 5 years after lymph node dissection, retaining functional bladder and normal ovarian functions.


Dynamic evolution of ceftazidime-avibactam resistance due to interchanges between blaKPC-2 and blaKPC-145 during treatment of Klebsiella pneumoniae infection.
The emergence of ceftazidime-avibactam (CZA) resistance among carbapenem-resistant Klebsiella pneumoniae (CRKP) is of major concern due to limited therapeutic options. In this study, 10 CRKP strains were isolated from different samples of a patient with CRKP infection receiving CZA treatment. Whole-genome sequencing (WGS) and conjugation experiments were performed to determine the transferability of the carbapenem resistance gene. This infection began with a KPC-2-producing K. pneumoniae (CZA MIC = 2 μg/mL, imipenem MIC ≥ 16 μg/mL). After 20 days of CZA treatment, the strains switched to the amino acid substitution of T263A caused by a novel KPC-producing gene, blaKPC-145, which restored carbapenem susceptibility but showed CZA resistance (CZA MIC ≥ 256 μg/mL, imipenem MIC = 1 μg/mL). The blaKPC-145 gene was located on a 148,185-bp untransformable IncFII-type plasmid. The subsequent use of carbapenem against KPC-145-producing K. pneumoniae infection led to a reversion of KPC-2 production (CZA MIC = 2 μg/mL, imipenem MIC ≥ 16 μg/mL). WGS analysis showed that all isolates belonged to ST11-KL47, and the number of SNPs was 14. This implied that these blaKPC-positive K. pneumoniae isolates might originate from a single clone and have been colonized for a long time during the 120-day treatment period. This is the first report of CZA resistance caused by blaKPC-145, which emerged during the treatment with CZA against blaKPC-2-positive K. pneumoniae-associated infection in China. These findings indicated that routine testing for antibiotic susceptibility and carbapenemase genotype is essential during CZA treatment.


Cutaneous non-epitheliotropic T-cell lymphoma associated with a fracture site in a cat.
A 7-year-old male neutered domestic shorthair cat presented for investigation of a swelling over the right forelimb. Radiographs of the right forelimb revealed significant lysis and soft tissue swelling surrounding a previously implanted surgical plate, used to repair a fracture of the distal radius 5 years prior. The implant was removed, and a biopsy was collected. Histopathological analysis and immunohistochemistry diagnosed a non-epitheliotropic T-cell cutaneous lymphoma. Staging confirmed multiple regional lymph node involvement. The cat was started on a CHOP-based protocol (vincristine, doxorubicin, cyclophosphamide and prednisolone). At week 4, the disease progressed both locally and within the regional lymph nodes. The primary lesion became severely ulcerated and the cat was euthanased, 42 days post-diagnosis. This is the first report of a cutaneous non-epitheliotropic lymphoma developing at the site of a previous traumatic fracture and metal implant. The cat's response to chemotherapy was poor and euthanasia was performed owing to progressive disease. More investigation is required to understand the role that malignant transformation could have at sites of chronic inflammation, bone fractures and surgical implants.


LILRB4 deficiency aggravates the development of atherosclerosis and plaque instability by increasing the macrophage inflammatory response via NF-κB signaling.
Atherosclerosis is a chronic inflammatory disease. LILRB4 is associated with the pathological processes of various inflammatory diseases. However, the potential function and underlying mechanisms of LILRB4 in atherogenesis remain to be investigated. In this study, LILRB4 expression was examined in both human and mouse atherosclerotic plaques. The effects and possible mechanisms of LILRB4 in atherogenesis and plaque instability were evaluated in LILRB4-/-ApoE-/- and ApoE-/- mice fed a high-fat diet. We found that LILRB4 was located primarily in macrophages, and its expression was up-regulated in atherosclerotic lesions from human coronary arteries and mouse aortic roots. LILRB4 deficiency significantly accelerated the development of atherosclerotic lesions and increased the instability of plaques, as evidenced by the increased infiltration of lipids, decreased amount of collagen components and smooth muscle cells. Moreover, LILRB4 deficiency in bone marrow-derived cells promoted the development of atherosclerosis. In vivo and in vitro analyses revealed that the pro-inflammatory effects of LILRB4 deficiency were mediated by the increased activation of NF-κB signaling due to decreased Shp1 phosphorylation. In conclusion, the present study indicates that LILRB4 deficiency promotes atherogenesis, at least partly, through reduced Shp1 phosphorylation, which subsequently enhances the NF-κB-mediated inflammatory response. Thus, targeting the "LILRB4-Shp1" axis may be a novel therapeutic approach for atherosclerosis.


Caring: from philosophical concerns to practice.
I read Hilde L. Nelson's article with great interest. To be "against caring" is tantamount to being against apple pie and motherhood. Caring as philosophy, theory, behavior, and ontology is pervasive in the literature of almost all socially interactive professions. Nelson's article raises common concerns about caring.... My difficulties with Nelson's argument against caring center around three issues: misunderstanding of caring in nursing practice, discomfort with ambiguity, and heroism as a replacement for the ethics of care....


Characterization of the p90 ribosomal S6 kinase 2 carboxyl-terminal domain as a protein kinase.
The carboxyl-terminal domain (CTD) of the p90 ribosomal S6 kinases (RSKs) is an important regulatory domain in RSK and a model for kinase regulation of FXXFXF(Y) motifs in AGC kinases. Its properties had not been studied. We reconstituted activation of the CTD in Escherichia coli by co-expression with active ERK2 mitogen-activated protein kinase (MAPK). GST-RSK2-(aa373-740) was phosphorylated in the P-loop (Thr(577)) by MAPK, accompanied by increased phosphorylation on the hydrophobic motif site, Ser(386). Activated GST-RSK2-(aa373-740) phosphorylates synthetic peptides based on Ser(386). The peptide RRQLFRGFSFVAK, which was termed CTDtide, was phosphorylated with K(m) and V(max) values of approximately 140 microm and approximately 1 micromol/min/mg, respectively. Residues Leu at p -5 and Arg at p -3 are important for substrate recognition, but a hydrophobic residue at p +4 is not. RSK2 CTD is a much more selective peptide kinase than MAPK-activated protein kinase 2. CTDtide was used to probe regulation of hemagglutinin-tagged RSK proteins immunopurified from epidermal growth factor-stimulated BHK-21 cells. K100A but not K451A RSK2 phosphorylates CTDtide, indicating a requirement for the CTD. RSK2-(aa1-389) phosphorylates the S6 peptide, and this activity is inactivated by S386A mutation, but RSK2-(aa1-389) does not phosphorylate CTDtide. In contrast, RSK2-(aa373-740) containing only the CTD phosphorylates CTDtide robustly. Thus, CTDtide is phosphorylated by the CTD but not the NH(2)-terminal domain (NTD). Epidermal growth factor activates the CTD and NTD in parallel. Activity of the CTD for peptide phosphorylation correlates with Thr(577) phosphorylation. CTDtide activity is constrained in full-length RSK2. Interestingly, mutation of the conserved lysine in the ATP-binding site of the NTD completely eliminates S6 kinase activity, but a similar mutation of the CTD does not completely ablate kinase activity for intramolecular phosphorylation of Ser(386), even though it greatly reduces CTDtide activity. The standard lysine mutation used routinely to study kinase functions in vivo may be unsatisfactory when the substrate is intramolecular or in a tight complex.


A grazing-incidence reflectometer for BL-39XU at SPring-8.
A new grazing-incidence reflectometer has been designed for the X-ray undulator beamline BL-39XU at SPring-8. It will be used for analytical applications, especially ultra-trace-level determination by total reflection X-ray fluorescence (TXRF), nanometer-scale surface topography by specular/non-specular X-ray reflection, and thin-film interface studies by combined measurements of X-ray fluorescence and X-ray reflection. The requirements for the instrument and the solutions in the present design are discussed. A prototype has been developed to test the feasibility of the design. It has been confirmed that the measurements planned at the beamline are achievable with this reflectometer.


Modeling Agrobacterium-Mediated Gene Transformation of Tobacco (Nicotiana tabacum)-A Model Plant for Gene Transformation Studies.
The multilayer perceptron (MLP) topology of an artificial neural network (ANN) was applied to create two predictor models in Agrobacterium-mediated gene transformation of tobacco. Agrobacterium-mediated transformation parameters, including Agrobacterium strain, Agrobacterium cell density, acetosyringone concentration, and inoculation duration, were assigned as inputs for ANN-MLP, and their effects on the percentage of putative and PCR-verified transgenic plants were investigated. The best ANN models for predicting the percentage of putative and PCR-verified transgenic plants were selected based on basic network quality statistics. Ex-post error calculations of the relative approximation error (RAE), the mean absolute error (MAE), the root mean square error (RMS), and the mean absolute percentage error (MAPE) demonstrated the prediction quality of the developed models when compared to stepwise multiple regression. Moreover, significant correlations between the ANN-predicted and the actual values of the percentage of putative transgenes (R 2 = 0.956) and the percentage of PCR-verified transgenic plants (R 2 = 0.671) indicate the superiority of the established ANN models over the classical stepwise multiple regression in predicting the percentage of putative (R 2 = 0.313) and PCR-verified (R 2= 0.213) transgenic plants. The best combination of the multiple inputs analyzed in this investigation, to achieve maximum actual and predicted transgenic plants, was at OD 600 = 0.8 for the LB4404 strain of Agrobacterium × 300 μmol/L acetosyringone × 20 min immersion time. According to the sensitivity analysis of ANN models, the Agrobacterium strain was the most important influential parameter in Agrobacterium-mediated transformation of tobacco. The prediction efficiency of the developed model was confirmed by the data series of Agrobacterium-mediated transformation of an important medicinal plant with low transformation efficiency. The results of this study are pivotal to model and predict the transformation of other important Agrobacterium-recalcitrant plant genotypes and to increase the transformation efficiency by identifying critical parameters. This approach can substantially reduce the time and cost required to optimize multi-factorial Agrobacterium-mediated transformation strategies.


Neurogenic bladder dysfunction due to myelomeningocele: neonatal versus childhood treatment.
We sought to determine whether the neonatal institution of treatment of neurogenic bladder dysfunction in myelomeningocele patients at high risk for urinary tract deterioration improves renal and bladder outcome. We reviewed the records of patients with bladder dysfunction believed to be at high risk for renal deterioration based on urodynamic studies. All patients were treated with clean intermittent catheterization. We compared rates of urinary infection, hydronephrosis, reflux, continence and surgical intervention in 46 patients in whom treatment was started in year 1 of life and 52 treated after age 4 years. Renal outcome was similar in both groups with persistent hydronephrosis in 6 of 46 patients (13%) and 7 of 52 (14%), respectively. However, significantly fewer bladder augmentation procedures were required in patients started on treatment during year 1 of life (5 of 46, 11% versus 14 of 52, 27%, p < 0.05). In addition to any psychological benefit, early intervention with clean intermittent catheterization in children with neurogenic bladder dysfunction may help to prevent irreversible bladder dysfunction and limit the need for bladder augmentation.


Anterolateral upper cervical approach for ventral C1-C2 meningioma.
The surgical management of ventral upper cervical meningiomas poses significant challenges due to their deep location and limited accessibility. These tumors have the potential to compress or involve nearby neurovascular structures, leading to various neurological complications including inferior cranial nerve palsy, motor deficits, and sensory disturbances such as hypoesthesia, paresthesia, and impaired coordination. To address this issue, surgical intervention through an anterolateral or far lateral approach has been recognized as the optimal treatment strategy. In this video, the authors present a detailed demonstration of the operative technique using an anterolateral upper cervical approach to safely resect a ventrally located C1-2 meningioma.


Predictive value of persistent versus transient antiphospholipid antibody subtypes for the risk of thrombotic events in pediatric patients with systemic lupus erythematosus.
Study objectives were to determine, in children with systemic lupus erythematosus (SLE), (1) the association of antiphosholipid antibody (APLA) subtypes with thrombotic events (TEs) and (2) the predictive value of persistent versus transient antibodies for TEs. This is a cohort study of 58 SLE children in whom lupus anticoagulants (LAs), anticardiolipin antibodies (ACLAs), anti-beta2-glycoprotein-I (anti-beta2-GPI), and antiprothrombin (anti-PT) were assessed on at least 2 occasions (more than 3 months apart). Antibodies were classified as persistent (positive on at least 2 occasions) or transient (positive once). Outcomes were symptomatic TEs confirmed by objective radiographic tests identified retrospectively and prospectively. Seven of the 58 patients (12%) had 10 TEs; 5 patients had TEs during prospective follow-up. Persistent LAs showed the strongest association with TEs (P < .001). Persistent ACLAs (P = .003) and anti-beta2-GPI (P = .002) were significantly associated with TEs; anti-PT (P = .063) showed a trend. Persistent or transient LAs and anti-beta2-GPI showed similar strength of association, while ACLAs and anti-PT were no longer associated with TEs. Positivity for multiple APLA subtypes showed stronger associations with TEs than for individual APLA subtypes because of improved specificity. Lupus anticoagulant is the strongest predictor of the risk of TEs; other APLA subtypes provide no additional diagnostic value. Anticardiolipin antibodies and anti-PT require serial testing because only persistent antibodies are associated with TEs.


Angiogenesis inhibitors target the endothelial cell cytoskeleton through altered regulation of heat shock protein 27 and cofilin.
Inhibition of angiogenesis has emerged as a key focus for the treatment of cancer, necessitating a better understanding of the downstream molecular targets of angiogenesis inhibitors. Endostatin, thrombospondin-1, fumagillin, and its synthetic derivative, TNP-470, are potent inhibitors of endothelial cell proliferation and migration in culture and of angiogenesis in vivo. To identify targets that mediate the effects of these inhibitors, we compared two-dimensional gel electrophoresis patterns from lysates of treated and untreated human endothelial cells. Among the proteins identified were cofilin and hsp27, two proteins involved in actin dynamics. Western blotting and immunofluorescence experiments confirmed that the phosphorylation states and subcellular localization of these two proteins were affected by all of the inhibitors tested and that treated cells had a more extensive network of actin stress fibers and more numerous focal adhesion plaques compared with untreated cells. Endothelial monocyte activating polypeptide II, another angiogenesis inhibitor, elicited the same response in the actin cytoskeleton and focal adhesions of endothelial cells. This more adherent phenotype may explain the shared ability of these inhibitors to block endothelial migratory signals. Starting with a proteomics approach, we have identified common effector molecules used by a panel of angiogenesis inhibitors that perturb the cytoskeleton to prevent endothelial migration.


Stabilin-1 expression defines a subset of macrophages that mediate tissue homeostasis and prevent fibrosis in chronic liver injury.
Macrophages are key regulators of fibrosis development and resolution. Elucidating the mechanisms by which they mediate this process is crucial for establishing their therapeutic potential. Here, we use experimental models of liver fibrosis to show that deficiency of the scavenger receptor, stabilin-1, exacerbates fibrosis and delays resolution during the recovery phase. We detected a subset of stabilin-1(+) macrophages that were induced at sites of cellular injury close to the hepatic scar in mouse models of liver fibrosis and in human liver disease. Stabilin-1 deficiency abrogated malondialdehyde-LDL (MDA-LDL) uptake by hepatic macrophages and was associated with excess collagen III deposition. Mechanistically, the lack of stabilin-1 led to elevated intrahepatic levels of the profibrogenic chemokine CCL3 and an increase in GFAP(+) fibrogenic cells. Stabilin-1(-/-) macrophages demonstrated a proinflammatory phenotype during liver injury and the normal induction of Ly6C(lo) monocytes during resolution was absent in stabilin-1 knockouts leading to persistence of fibrosis. Human stabilin-1(+) monocytes efficiently internalized MDA-LDL and this suppressed their ability to secrete CCL3, suggesting that loss of stabilin-1 removes a brake to CCL3 secretion. Experiments with cell-lineage-specific knockouts revealed that stabilin-1 expression in myeloid cells is required for the induction of this subset of macrophages and that increased fibrosis occurs in their absence. This study demonstrates a previously unidentified regulatory pathway in fibrogenesis in which a macrophage scavenger receptor protects against organ fibrosis by removing fibrogenic products of lipid peroxidation. Thus, stabilin-1(+) macrophages shape the tissue microenvironment during liver injury and healing.


Cortical echogenicity in the hemolytic uremic syndrome: clinical correlation.
The initial renal sonograms of 15 patients, aged 8 months to 5 years, with hemolytic uremic syndrome (HUS) were reviewed. Ultrasound studies were graded according to cortical echogenicity relative to the liver, they were compared to the severity of the clinical syndrome at admission and to the ultimate outcome of the disease. The degree of cortical echogenicity correlated with the clinical outcome of HUS in 12 of the patients, whereas clinical assessment alone predicted outcome in 13 patients. Sonography overestimated severity in three patients with mild disease correctly assessed clinically, whereas clinical assessment overestimated severity in two patients with moderate disease in whom the sonographic assessment proved correct. The sonographic changes are most likely multifactorial. They appear to reflect a combination of platelet-thrombus deposition in the renal cortex, as well as the general fluid status of the patient. Ultrasound is useful in ruling out other causes of acute renal failure such as obstruction or congenital diseases. It cannot replace laboratory tests and clinical judgement, but nevertheless provides another index of severity in patients with HUS.


Differential inhibition of DNA/protein interactions by aromatic amidines with 2, 3 and 4 benzamidine residues.
We have recently reported that aromatic polyamidines are powerful inhibitors of in vitro proliferation of tumour cell lines and in vivo tumorigenicity of melanoma cells xenografted into nude mice. Interestingly, we have found that tetrabenzamidines are able to bind DNA, and to inhibit the interaction between transacting factors and specific target DNA sequences. In order to obtain more detailed information on structure-activity relationships, we have analysed the effects of different aromatic polyamidines on the binding of a recombinant protein, the Epstein-Barr virus (EBV) nuclear antigen 1 (EBNA-1), to the target sequence of EBV DNA, containing the 12 bp palindromic consensus TAGCATATGCTA. The results obtained suggest that aromatic polyamidines inhibit the interactions between DNA-binding proteins and target DNA sequences with different efficiency, depending (i) on the number of amidine residues and (ii) on the presence of halogen substitutions (Cl, Br or I) on the benzene rings of tetra-benzamidine molecules.


Serum levels of the myokine irisin in relation to metabolic and renal function.
Irisin has recently been introduced as a novel myokine which reverses visceral obesity and improves glucose metabolism in mice. However, regulation of irisin in humans in relation to renal and metabolic disease has not been comprehensively studied. Serum irisin levels were quantified by ELISA and correlated with anthropometric and biochemical parameters of renal function, glucose and lipid metabolism, as well as inflammation, in 532 patients with stages 1-5 of chronic kidney disease (CKD). Median serum irisin levels adjusted for age, gender, and BMI significantly decreased with increasing CKD stage and lowest concentrations were seen in patients with CKD stage 5. Furthermore, irisin concentrations were associated with facets of the metabolic syndrome including diastolic blood pressure, markers of impaired glucose tolerance, and dyslipidemia in univariate analysis. Moreover, markers of renal function, e.g. glomerular filtration rate, and insulin resistance, e.g. homeostasis model assessment of insulin resistance, remained independently associated with circulating irisin levels in robust multivariate analysis. We show that irisin serum concentrations decrease with increasing CKD stage and are independently and positively predicted by renal function and insulin resistance. The physiological relevance of our findings, as well as the factors contributing to irisin regulation in humans, needs to be further defined in future experiments.


Transfer of Listeria monocytogenes during slicing of turkey breast, bologna, and salami with simulated kitchen knives.
In response to continued concerns regarding Listeria cross-contamination during the slicing of deli meats, a series of specially prepared grade 304 and 316 stainless steel kitchen knife blades was inoculated with a six-strain Listeria monocytogenes cocktail (10(8), 10(5), and 10(3) CFU per blade) composed of two weak, two medium, and two strong biofilm-forming strains. The blades were then attached to an Instron 5565 electromechanical compression analyzer and used to slice whole chubs of delicatessen turkey breast, bologna, and salami to entirety (30 slices) at a cutting speed of 8.3 mm/s. Homogenates of the slices in University of Vermont Medium were surface or pour plated with modified Oxford agar and then enriched. Listeria transfer from knife blades inoculated at 10(8) CFU per blade was logarithmic, with a 2-log decrease seen after 8 to 12 slices and direct counts obtained thereafter out to 30 slices. However, blades containing 10(5) and 10(3) CFU per blade typically yielded direct counts out to only 20 and 5 slices, respectively. Normalizing data on a log scale for the first 10 slices resulted in significantly greater Listeria transfer and "tailing" from grade 304 as opposed to grade 316 stainless (P < 0.05) for all three products. After 1 year of use, surface roughness values as determined by surface profilometry were significantly greater (P < 0.001) for grade 304 than for grade 316 stainless blades. Cutting force and blade sharpness were not significantly different (P > 0.05) within stainless steel grade (P < 0.05) for each product. However, significant differences in cutting force were seen between salami and turkey (P < 0.05) for grades 304 and 316 stainless, respectively. In addition to compositional differences in the deli meats and knife blades, wear and scoring on the blade likely affected Listeria transfer during slicing.


Evaluation of the antibacterial substantivity of several intra-canal agents.
The aim of this in vitro study was to compare the antimicrobial substantivity of 2% chlorhexidine gluconate (CHX), 100 mg ml(-1) doxycycline and 2.6% sodium hypochlorite (NaOCl) in bovine root dentine. Eighty dentine tubes prepared from bovine incisors were infected in vitro for 14 days with Enterococcus faecalis. The specimens were divided into five groups as follows: doxycycline HCl; CHX; NaOCl; infected dentine tubes (positive control); and sterile dentine tubes (negative control). Dentine chips were collected with round burs into tryptic soy broth. After culturing, the number of colony-forming units (CFU) was counted. In all experimental groups, the number of CFU was minimum in the first cultures, and the results obtained were significantly different from each other at any time period (P < 0.05). In the first culture, the NaOCl group and doxycycline HCl group showed the lowest and highest number of CFU, respectively. In each group, the number of CFU increased significantly by time-lapse (P < 0.05). In conclusion, the substantivity of CHX was significantly greater than NaOCl and doxycycline.


Invasive Mediastinal Staging Guideline Concordance.
Despite guidelines for preoperative invasive mediastinal staging (IMS) for non-small cell lung cancer (NSCLC), concordance with guidelines and whether the use of these guidelines results in expected frequency of lymph node metastases has not been evaluated. Our objectives were to determine guideline concordance, reasons for nonconcordance, and, in patients who did not receive IMS, to determine the use of operative nodal sampling and final pathologic staging. Patients who had a resection for NSCLC between 2010 and 2012 were identified from the Institutional Cancer Registry. A chart audit was performed to determine adherence to Cancer Care Ontario (CCO) IMS guideline criteria, and pathologic reports were reviewed to determine postresection staging. Of 242 resections performed in the study period 102 (42%) did not receive IMS. 66 patients (65%) did not require IMS based on CCO guidelines and thus were concordant with guidelines, whereas 36 (36%) were guideline nonconcordant. Of 102 patients who did not have preoperative IMS, only 72 had intraoperative lymph node assessment and only 35 (34%) had sampling of three or more ipsilateral (N2) nodal stations. In the guideline concordant group, 2 of 66 patients (5%) had positive N2 nodes, whereas in the nonconcordant group 3 of 36 patients (11%) were N2 positive. Although overall IMS was used in only 140 patients (58%), concordance with guidelines was high at 85% (206 of 242 patients). However, rates of intraoperative nodal sampling for non-IMS cases (both concordant and nonconcordant) was lower than expected, resulting in potentially understaged patients.


[Experimental data on avian influenza virus detection using magnetic immunosorbents].
To increase the sensitivity and specificity of detecting high-pathogenic avian influenza variant (HSN1), laboratory studies were conducted at low virus concentrations in water samples, by using magnetic immunosorbent (MIS) test systems and selective avian influenza virus concentrating units. MIS-based selective virus concentrating, followed by rapid assays (ELIZA and RT-PCR), detect the low concentrations (as low as 10 nm in 5,000 ml of water) of avian influenza A/H5N1 antigen and RNA. The method developed opens new avenues for indication of an avian influenza pathogen in different environmental objects, including the water of surface water reservoirs of unlimited volume, with varying pollutions and low virus concentrations.


[A case of MIDCAB to the left circumflex via the left posterolateral thoracotomy].
There have been many reports of MIDCAB to left anterior descending artery via a small dissection utilizing the left anterolateral thoracotomy. We report here a case of CABG reoperation to the circumflex artery by MIDCAB via the left posterolateral thoracotomy. A 66-year-old male patient had received a 3 branch bypass graft on the LITA-LAD and the SVG-OM-4 PD at another institution. Postoperative angiography revealed a SVG occlusion. Since repeated intervention was unsuccessful, reoperation was necessary. To preserve the patency of the LITA, the 4th left intercostal posterolateral thoracotomy was selected. We utilized a commercially available rib retractor for MIDCAB, as well as a stabilizer and a CO2 blower to obtain a nearly perfect bloodless stabilized view. A new SVG was used to connect the left circumflex artery. The operation was successful without any postoperative complications or need for transfusion. After a two week hospital stay, the graft patency was confirmed and the patient was discharged.


Architecture of the RNA polymerase II-Paf1C-TFIIS transcription elongation complex.
The conserved polymerase-associated factor 1 complex (Paf1C) plays multiple roles in chromatin transcription and genomic regulation. Paf1C comprises the five subunits Paf1, Leo1, Ctr9, Cdc73 and Rtf1, and binds to the RNA polymerase II (Pol II) transcription elongation complex (EC). Here we report the reconstitution of Paf1C from Saccharomyces cerevisiae, and a structural analysis of Paf1C bound to a Pol II EC containing the elongation factor TFIIS. Cryo-electron microscopy and crosslinking data reveal that Paf1C is highly mobile and extends over the outer Pol II surface from the Rpb2 to the Rpb3 subunit. The Paf1-Leo1 heterodimer and Cdc73 form opposite ends of Paf1C, whereas Ctr9 bridges between them. Consistent with the structural observations, the initiation factor TFIIF impairs Paf1C binding to Pol II, whereas the elongation factor TFIIS enhances it. We further show that Paf1C is globally required for normal mRNA transcription in yeast. These results provide a three-dimensional framework for further analysis of Paf1C function in transcription through chromatin.


Preoperative Localization of Adenomas in Primary Hyperparathyroidism: The Value of 11C-Choline PET/CT in Patients with Negative or Discordant Findings on Ultrasonography and 99mTc-Sestamibi SPECT/CT.
We aimed to assess the value of 11C-choline PET in patients with primary hyperparathyroidism and negative or discordant results on 99mTc-sestamibi imaging and neck ultrasound. Methods: Eighty-seven such patients were assessed and subsequently underwent parathyroidectomy. PET/CT image data were analyzed semiquantitatively using SUVmax and SUV ratios (target to contralateral thyroid gland and carotid artery). A positive PET/CT result was defined as focal uptake significantly higher than regular thyroid tissue. Ectopic foci were also considered positive. Inconclusive PET/CT cases were defined as a lesion with uptake equal to normal thyroid tissue. If no prominent or ectopic uptake was detectable, the PET/CT result was considered negative. Results: When dichotomizing the 11C-choline PET/CT imaging results by defining lesions with both positive and inconclusive uptake as positive, we found 84 of 92 lesions (91.3%) to have true-positive uptake whereas 8 lesions (8.7%) had false-positive uptake. One lesion showed false-negative uptake; the sensitivity was 98.8%. The corresponding positive predictive value for lesions was 91.3%. The mean SUVmax was 6.15 ± 4.92 in 72 lesions with positive uptake (70 patients) and 2.96 ± 2.32 in 20 lesions with inconclusive uptake (18 patients). Conclusion: These results in a large group of patients indicate that 11C-choline PET/CT is a promising tool for parathyroid adenoma localization when ultrasound and 99mTc-sestamibi imaging yield negative or discordant results.


Topographic relationship; sinusitis and paranasal sinus computed tomography.
Topographic relationship; sinusitis and paranasal sinus computed tomography. The association between the symptoms of chronic rhinosinusitis (CRS) and computed tomography (CT) findings is controversial, especially the topography of the symptoms and CT findings. To determine the relationship between topographic and overall paranasal CT findings with topographic and overall symptoms. This was a two-center study comprising 166 patients diagnosed with chronic sinusitis. All patients underwent CT scans and completed a questionnaire. The symptom scores and CT findings were compared. A correlation between anterior ethmoid sinusitis and hyposmia was found. Blockage of the osteomeatal complex and posterior ethmoid sinusitis was associated with halitosis. There were also correlations between maxillary and sphenoid sinusitis and tooth pain. The total visual scale score was not associated with any of the symptoms. No association was seen between facial pain or facial pressure and paranasal sinus CT scores. No correlation was found between the topographic correlation of sinus pain and topographic paranasal sinus CT findings. No relationship exists between symptoms and paranasal sinus CT findings in patients with chronic rhinosinusitis.


[Efficacy and safety of different beta-blockers in patients with isolated systolic hypertension associated with diabetes mellitus and obstructive pulmonary diseases].
To compare efficacy and safety of atenolol, methoprolol and bisoprolol, as the most usable beta-blockers, in patients with isolated systolic arterial hypertension (ISAH) and concomitant diabetes mellitus (DM) and/or chronic obstructive pulmonary disease (COPD). Forty tow patients with ISAH and coronary heart disease, 30 patients with these diseases associated with DM and 32 patients with associated COPD were randomized into three groups. Group 1 received atenolol in a dose 25 mg twice a day, group 2--metoprolol tartrate in a dose 25-50 mg twice a day, group 3--bisoprolol in a single dose 5-10 mg/day. All the patients were examined before the treatment and in 8 weeks. Arterial pressure was assessed at 24-h monitoring (ABPM-04 unit, Mediteck, Hungary) and quality of life (QL) was estimated by DISS Disability Scale. In addition, blood glucose was measured in patients with concomitant DM, external respiration function (ERF) was studied before and after the treatment in patients with concomitant COPD. In all ISAH patients there was a significant fall of systolic arterial pressure and heart rate. 2 hours after intake of atenolol and methoprolol blood glucose lowered significantly in diabetics as well as peak volume expiration velocity in patients with COPD. In the bisoprolol group ERF and blood glucose in DM and COPD patients remained unchanged. Atenolol deteriorated QL by the "job" and "social life" scales, methoprolol--by the scale "job" while bisoprolol improved the above parameters. The results of bisoprolol treatment are better than those of methoprolol and atenolol treatment of hypertensive patients with concomitant DM and COPD.