Algorithms for the treatment of femoral neck fractures.
Worldwide prevalence of femoral neck fractures is increasing, doubling for patients older than 50 years. Age of the patient, prefracture activity level, and associated comorbidities must be considered when determining treatment. It seems that hemiarthroplasty is best suited for an elderly patient who is a household ambulator with low demands on the prosthesis. Younger patients, and those with minimally displaced fractures, should be treated with internal fixation in an attempt to preserve the natural hip. Proximal femur fractures in the pediatric population are associated with high complication rates. Because of vascular vulnerability, avascular necrosis of the femoral head continues to be the most frequent and serious complication after hip trauma in children. Femoral neck fractures in children also differ from those in adults because a child can tolerate immobilization much more readily than can an adult. As healthcare resources become more limited and their use becomes scrutinized more closely, cost-effective treatment algorithms for femoral neck fractures will dictate orthopaedic treatment. For some fractures, closed treatment is evolving toward interventional approaches to minimize late sequelae. With the availability of viable treatment options, the potential risks and benefits of individual treatment modalities as related to each fracture pattern must be reviewed.


The role of radiofrequency ablation for pediatric supraventricular tachycardia.
Radiofrequency ablation has become frontline therapy for many pediatric patients with common supraventricular tachycardia (SVTs). Rather than long-term treatment with medications, radiofrequency ablation offers the possibility of "cure" for certain SVT substrates. The decision to perform radiofrequency ablation should be made after full disclosure with the patient and parents about radiofrequency ablation (RFA) benefits and risk, alternative therapies, and the natural history of the SVT. This paper presents a discussion about the current status of RFA and common pediatric SVTs, as well as, discussing evolving RFA issues and indications.


Effect of hydrophobically modified polymers on shear-induced multilamellar vesicles.
The effects of polymer concentration, polymer molecular weight, and hydrophobe substitution level of modified poly(acrylic acid) polymers on the formation, size, and viscoelastic properties of shear-induced multilamellar vesicles (onions) are studied by rheology and light diffraction. The onions are close-packed, space-filling vesicles formed by shearing aqueous lamellar phases of C12E5 surfactant to produce phases with sufficient order and size uniformity (O(1-3 microm)) to diffract light. The addition of hydrophobically modified polymers enhances the rate of formation, uniformity, and stability independent of hydrophobe substitution level. Onion size decreases with increasing shear rate as observed for pure surfactant onion systems, but the shear-rate dependence is changed by the polymer. The onion phase has a plateau modulus that increases with polymer concentration but is independent of hydrophobe substitution level or molecular weight. The model presented by Panizza et al. that relates the plateau modulus of the onion phase to membrane rigidity and the compression modulus is consistent with independent measurements of membrane properties from SANS.


The trickle-down effect of predictability: Secondary task performance benefits from predictability in the primary task.
Predictions optimize processing by reducing attentional resources allocation to expected or predictable sensory data. Our study demonstrates that these saved processing resources can be then used on concurrent stimuli, and in consequence improve their processing and encoding. We illustrate this "trickle-down" effect with a dual task, where the primary task varied in terms of predictability. The primary task involved detection of a pre-specified symbol that appeared at some point of a short video of a dot moving along a random, semi-predictable or predictable trajectory. The concurrent secondary task involved memorization of photographs representing either emotionally neutral or non-neutral (social or threatening) content. Performance in the secondary task was measured by a memory test. We found that participants allocated more attention to unpredictable (random and semi-predictable) stimuli than to predictable stimuli. Additionally, when the stimuli in the primary task were more predictable, participants performed better in the secondary task, as evidenced by higher sensitivity in the memory test. Finally, social or threatening stimuli were allocated more "looking time" and a larger number of saccades than neutral stimuli. This effect was stronger for the threatening stimuli than social stimuli. Thus, predictability of environmental input is used in optimizing the allocation of attentional resources, which trickles-down and benefits the processing of concurrent stimuli.


NAP: The Network Analysis Profiler, a web tool for easier topological analysis and comparison of medium-scale biological networks.
Nowadays, due to the technological advances of high-throughput techniques, Systems Biology has seen a tremendous growth of data generation. With network analysis, looking at biological systems at a higher level in order to better understand a system, its topology and the relationships between its components is of a great importance. Gene expression, signal transduction, protein/chemical interactions, biomedical literature co-occurrences, are few of the examples captured in biological network representations where nodes represent certain bioentities and edges represent the connections between them. Today, many tools for network visualization and analysis are available. Nevertheless, most of them are standalone applications that often (i) burden users with computing and calculation time depending on the network's size and (ii) focus on handling, editing and exploring a network interactively. While such functionality is of great importance, limited efforts have been made towards the comparison of the topological analysis of multiple networks. Network Analysis Provider (NAP) is a comprehensive web tool to automate network profiling and intra/inter-network topology comparison. It is designed to bridge the gap between network analysis, statistics, graph theory and partially visualization in a user-friendly way. It is freely available and aims to become a very appealing tool for the broader community. It hosts a great plethora of topological analysis methods such as node and edge rankings. Few of its powerful characteristics are: its ability to enable easy profile comparisons across multiple networks, find their intersection and provide users with simplified, high quality plots of any of the offered topological characteristics against any other within the same network. It is written in R and Shiny, it is based on the igraph library and it is able to handle medium-scale weighted/unweighted, directed/undirected and bipartite graphs. NAP is available at http://bioinformatics.med.uoc.gr/NAP .


Valvular heart disease as a possible predictor of trastuzumab-induced cardiotoxicity in patients with breast cancer.
Although the use of trastuzumab has been reported to improve overall survival in patients with HER2-positive breast cancer, there is increasing concern about the adverse effects of trastuzumab-induced cardiotoxicity (TIC). The aim of the present study was to investigate the predictor of TIC and to consider appropriate management for such patients. The present study breast cancer 119 patients with breast cancer who had been treated with trastuzumab. Patients were referred to our department for cardiac function screening. The patients' baseline characteristics, echocardiographic data, presence of trastuzumab-induced cardiotoxicity (TIC) and all-cause mortality were investigated. TIC was defined as a manifestation of overt heart failure or ≥10% reduction of left ventricular ejection fraction (LVEF) from baseline to an LVEF <55% in asymptomatic patients. During the follow-up period (mean, 1,410 days), symptomatic heart failure occurred in 2 out of 119 patients (1.6%), 11 patients (9.2%) had asymptomatic impairment of cardiac function that was ameliorated by discontinuing trastuzumab and 20 patients (16.8%) succumbed to cancer-associated fatality. In the logistic regression analysis, only the presence of valvular heart disease at the baseline was indicated to be a predictor of TIC. There was no other predictor for TIC, including baseline characteristics, other therapies and echocardiographic parameters. In addition, impairment of cardiac function was ameliorated by discontinuing trastuzumab. TIC occurred in ~10% of the patients treated with trastuzumab. Only the presence of valvular heart disease seems to be associated with occurrence of TIC, with no other specific predictor of TIC demonstrated in the present study. The present data suggests the importance of regular monitoring of cardiac function, and that presence of valvular heart disease may be a possible predictor of TIC.


Multimodality Imaging Assessment of Ocular Ischemic Syndrome.
To assess the underlying mechanisms of OIS and confirm the haemodynamic and retinal structure changes of early OIS. An observational cross-sectional study was conducted of 60 internal carotid artery (ICA) stenosis patients, and they were divided into OIS and control group. Colour doppler imaging, optical coherence tomography, and fundus fluorescein angiography were performed. The middle cerebral artery (MCA) stenosis differs significantly between the two groups. More OIS patients had new collateral patency of posterior communicating artery (PCoA) and retrograde flow via the ophthalmic artery (OA) (p < 0.001). The peak systolic velocity (PSV) in central retinal artery (CRA) and choroidal thickness (CT) was significantly reduced in OIS patients (p = 0.001 and p < 0.001). The arm-retina time (ART) and the retinal arteriovenous passage time (AVP) were prolonged in OIS patients (p < 0.001 and p = 0.001). CT, ART, and PSV of the CRA showed high sensitivity, while ART and ICA stenosis grade showed high specificity for the diagnosis of OIS according to ROC curve. Patients who suffered from severe ipsilateral ICA stenosis, new collateral patency of PCoAs, and MCA stenosis may be more susceptible to OIS. The most sensitive sign is PSV of CRA and CT, and the most specific sign is ART.


Proficiency testing in parasitology. An educational tool to improve laboratory performance.
In 1977, the Laboratory Proficiency Testing Program began testing laboratories that examine samples for gastrointestinal parasites and operated with little change in the subsequent 17 years. Four surveys, each containing four samples, are distributed each year to every currently licensed medical laboratory in Ontario. Participation is mandatory. Survey results indicate a remarkable improvement in laboratory performance during this period. Improvement is believed to result from a combination of the voluntary withdrawal from testing by laboratories with poor performance and the improved performance of the others. The extensive educational services devised and carried out by the Parasitology Committee is believed to have been a significant factor leading to this improvement.


Cardioprotection by cyclosporine A in experimental ischemia and reperfusion--evidence for a nitric oxide-dependent mechanism mediated by endothelin.
The acute effect of cyclosporine A (CSA) on myocardial function after ischemia and reperfusion and the mechanism of action was investigated in isolated working guinea-pig hearts. Myocardial function was experimentally infringed by imposing short-term global ischemia and reperfusion (15 min each). External heart work (EHW), determined before and after ischemia, served as the criterion for quantitation of recovery. Control hearts were perfused with modified Krebs-Henseleit buffer, other hearts received buffer supplemented with CsA +/- an endothelin receptor antagonist or exogenous endothelin +/- an inhibitor of nitric oxide (NO) synthesis. To assess the importance of endothelial production of mediators directly, NO release in coronary effluent (continuously measured with an amperometric sensor) and release of 6-keto-prostaglandin F1, (6-keto-PGFb), a stable metabolite of prostacyclin (PGI2), were determined in non-working. Langendorff hearts. Oxidative stress during reperfusion was assessed by measuring glutathione release in coronary venous effluent. Cyclosporine A (0.8 microM) improved post-ischemic function significantly (59% recovery of EHW nu 31% for controls). At 0.08 microM. CsA was without beneficial effect (30% recovery). The endothelin (ET)A- and ETB-receptor antagonist bosentan inhibited the protective action of 0.8 microM CsA (32% recovery). Exogenous ET-1 (80 pM) improved recovery to 53%, an effect which was blocked by the inhibitor of NO-synthase, NG-nitro-L-arginine (NOLAG. 1 microM. 31% recovery. In the control group, post-ischemic NO release in coronary effluent recovered from zero to about 100% of the pre-ischemic value by 10 min. but then decreased rapidly during the subsequent 15 min of reperfusion. In hearts treated with 0.8 microM CsA, NO release stayed at 100% of the pre-ischemic value throughout reperfusion, the difference between controls and CsA-treated hearts being significant after 20 min of reperfusion. On the other hand, coronary venous release of 6-keto-PGF1a was not different between the groups. Release of glutathione during early reperfusion first 5 min) was significantly lowered (P < 0.05) to about 50% in CsA (0.8 microMI- and ET-I-treated compared with controls (8.8 nmol/min). Cyclosporine A acts as a cardioprotective agent in our model of ischemia and reperfusion, presumably by elevating the level of endogenous nitric oxide and thereby reducing oxidative stress.


Geometrical properties of avalanches in self-organized critical models of solar flares.
We investigate the geometrical properties of avalanches in self-organized critical models of solar flares. Traditionally, such models differ from the classical sandpile model in their formulation of stability criteria in terms of the curvature of the nodal field, and belong to a distinct universality class. With a view toward comparing these properties to those inferred from spatially and temporally resolved flare observations, we consider the properties of avalanche peak snapshots, time-integrated avalanches in two and three dimensions, and the two-dimensional projections of the latter. The nature of the relationship between the avalanching volume and its projected area is an issue of particular interest in the solar flare context. Using our simulation results we investigate this relationship, and demonstrate that proper accounting of the fractal nature of avalanches can bring into agreement hitherto discrepant results of observational analyses based on simple, nonfractal geometries for the flaring volume.


Gastro-oesophageal reflux and dental erosion.
Relevant studies were sourced using Medline and the Cochrane Controlled Trials Register, along with reference lists from identified papers and reviews. Full papers were selected that assessed the prevalence of dental erosion in individuals who had gastro-oesophageal reflux (GERD), or vice versa, which were published in the English language. Data extractions was carried out by at least two authors using a standardised data extraction form. Because of a marked variation in outcome measures, qualitative synthesis was carried out. Seventeen studies met the selection criteria but they differed greatly in design, population, methods of diagnosing GERD, duration of followup and, consequently, in their findings. The median prevalence of dental erosion in GERD patients was 24%, with a large range (5-48%), and the median prevalence of GERD in dental erosion adults patients was 32.5% (range, 21-83%) and 17% in paediatric patients (range, 14-87%). This systematic review shows that there is a strong association between GERD and dental erosion. The severity of dental erosion seems to be correlated with the presence of GERD symptoms and also, at least in adults, with the severity of proximal oesophageal or oral exposure to an acidic pH. The inspection of the oral cavity in search for dental erosions should become a routine manoeuvre in patients who have GERD.


Association Between Waiting Time from Diagnosis to Treatment and Survival in Patients with Curable Gastric Cancer: A Population-Based Study in the Netherlands.
In the Netherlands, a maximum waiting time from diagnosis to treatment (WT) of 5 weeks is recommended for curative cancer treatment. This study aimed to evaluate the association between WT and overall survival (OS) in patients undergoing gastrectomy for cancer. This nationwide study included data from patients diagnosed with curable gastric adenocarcinoma between 2005 and 2014 from the Netherlands Cancer Registry. Patients were divided into two groups: patients who received neoadjuvant therapy followed by gastrectomy, or patients who underwent gastrectomy as primary surgery. WT was analyzed as a categorical (≤5 weeks [Reference], 5-8 weeks, >8 weeks) and as a discrete variable. Multivariable Cox regression analysis was used to assess the influence of WT on OS. Among 3778 patients, 1701 received neoadjuvant chemotherapy followed by gastrectomy, and 2077 underwent primary gastrectomy. In the neoadjuvant group, median WT to neoadjuvant treatment was 4.6 weeks (interquartile range [IQR] 3.4-6.0), and median OS was 32 months. In the surgery group, median WT to surgery was 6.0 weeks (IQR 4.3-8.4), and median OS was 25 months. For both groups, WT did not influence OS (neoadjuvant: 5-8 weeks, hazard ratio [HR] 0.82, p = 0.068; >8 weeks, HR 0.85, p = 0.354; each additional week WT, HR 0.96, p = 0.078; surgery: 5-8 weeks, HR 0.91, p = 0.175; >8 weeks, HR 0.92, p = 0.314; each additional week WT, HR 0.99, p = 0.264). Longer WT until the start of curative treatment for gastric cancer is not associated with worse OS. These results could help to put WT into perspective as indicator of quality of care and reassure patients with gastric cancer.


Brucella Infection in Asian Sea Otters (Enhydra lutris lutris) on Bering Island, Russia.
Infection with Brucella spp., long known as a cause of abortion, infertility, and reproductive loss in domestic livestock, has increasingly been documented in marine mammals over the past two decades. We report molecular evidence of Brucella infection in Asian sea otters (Enhydra lutris lutris). Brucella DNA was detected in 3 of 78 (4%) rectal swab samples collected between 2004 and 2006 on Bering Island, Russia. These 78 animals had previously been documented to have a Brucella seroprevalence of 28%, markedly higher than the prevalence documented in sea otters (Enhydra lutris) in North America. All of the DNA sequences amplified were identical to one or more previously isolated Brucella spp. including strains from both terrestrial and marine hosts. Phylogenetic analysis of this sequence suggested that one animal was shedding Brucella spp. DNA with a sequence matching a Brucella abortus strain, whereas two animals yielded a sequence matching a group of strains including isolates classified as Brucella pinnipedialis and Brucella melitensis. Our results highlight the diversity of Brucella spp. within a single sea otter population.


Dermatologic perivascular hemophagocytosis: a report of two cases.
Hemophagocytic syndrome includes fever, hepatosplenomegaly, cytopenias, coagulopathy, and abnormal liver function tests, with some patients developing lymphadenopathy and cutaneous eruptions. Herein we report two cases of dermal perivascular hemophagocytosis identified in skin biopsies of two patients with no additional symptoms attributable to hemophagocytic syndrome. Biopsies showed capillary ectasia with dermal perivascular infiltrates. The overlying epidermis and adjacent subcutaneous fat was unremarkable. The infiltrate consisted of perivascular neutrophils and benign histiocytes with predominately phagocytized erythrocytes and occasional engulfed karyorrhectic debris. Perivascular nuclear dust (leukocytoclasia) and extravasated erythrocytes were present, but other factors typically found in leukocytoclastic vasculitis were absent, namely fibrin deposition and endothelial hypertrophy and/or necrosis. This appears to be hemophagocytosis, possibly associated with late lesions of leukocytoclastic vasculitis. Both hemophagocytosis and leukocytoclastic vasculitis are associated with activated immunity with increased cytokines and/or immune complexes. It is important to consider this uncommon finding in the evaluation of indeterminate cutaneous eruptions.


Inflammation and caspase activation in long-term renal ischemia/reperfusion injury and immunosuppression in rats.
We have previously shown the long-term influence of renal ischemia/reperfusion (I/R) injury and immunosuppression on fibrotic genes and apoptosis in a rat model. For the first time, we have now investigated the effects of I/R and immunosuppression on inflammation and caspase activation. I/R injury was induced in the right kidney and the left was removed. Cyclosporin (CsA) (10 mg/kg), tacrolimus (0.2 mg/kg), rapamycin (1 mg/kg), or mycophenolate mofetil (MMF) (10 mg/kg) was then administered for 16 weeks. The effects of I/R and immunosuppressants on interstitial inflammation, interleukin (IL)-1beta expression, caspase-1 and caspase-3 activation, tubulointerstitial damage, and fibrosis were evaluated. ED-1+ (a specific rat monocyte/macrophage marker) cells were mainly localized in the tubulointerstitium and periglomerular areas and increased in I/R group compared to controls (P < 0.01). This was further increased by CsA, but decreased by tacrolimus, rapamycin, or MMF (P < 0.05). The 17 kD active IL-1beta remained unchanged, but 35 kD IL-1beta precursor was decreased by rapamycin in comparison with I/R group (P < 0.05). The 45 kD or 20 kD caspase-1 was increased by I/R or CsA, respectively, and decreased by rapamycin (P < 0.05). The 24 kD caspase-3, which proved to be an active caspase-3 subunit, was increased in I/R and CsA groups and deceased by tacrolimus, rapamycin, or MMF (P < 0.05), but not 32 kD precursor or 17 kD active caspase-3. The activity data of caspase-1 and caspase-3 exhibited the same trend as Western blotting data. The staining of active caspase-3 was scattered in kidneys, mainly in tubular and interstitial areas, which was consistent with that of ED-1+ cells. There was a strong positive correlation between interstitial inflammation and 24 kD caspase-3 expression or caspase-3 activity (r = 0.814 or 0.484), all of which were also closely related with urinary protein (r = 0.537, 0.529, or 0.517), serum creatinine (r = 0.463, 0.573, or 0.539), tubulointerstitial damage (r = 0.794, 0.618, or 0.712) and fibrosis (r = 0.651, 0.567, or 0.469), all P < 0.01. This study shows that the mechanisms of long-term I/R injury and immunosuppressants treatment include interstitial inflammation and caspase activation, most clearly demonstrated by the 24 kD active caspase-3.


A Single-Nucleotide Insertion in a Drug Transporter Gene Induces a Thermotolerance Phenotype in Gluconobacter frateurii by Increasing the NADPH/NADP+ Ratio via Metabolic Change.
Thermotolerant microorganisms are beneficial to the fermentation industry because they reduce the need for cooling and offer other operational advantages. Previously, we obtained a thermally adapted Gluconobacter frateurii strain by experimental evolution. In the present study, we found only a single G insertion in the adapted strain, which causes a frameshift in a gene encoding a putative drug transporter. A mutant derivative strain with the single G insertion in the transporter gene (Wild-G) was constructed from the wild-type strain and showed increased thermotolerance. We found that the thermotolerant strains accumulated substantial intracellular trehalose and manifested a defect in sorbose assimilation, suggesting that the transporter is partly involved in trehalose efflux and sorbose uptake and that the defect in the transporter can improve thermotolerance. The ΔotsAB strain, constructed by elimination of the trehalose synthesis gene in the wild type, showed no trehalose production but, unexpectedly, much better growth than the adapted strain at high temperatures. The ΔotsAB mutant produced more acetate as the final metabolite than the wild-type strain did. We hypothesized that trehalose does not contribute to thermotolerance directly; rather, a metabolic change including increased carbon flux to the pentose phosphate pathway may be the key factor. The NADPH/NADP+ ratio was higher in strain Wild-G, and much higher in the ΔotsAB strain, than in the wild-type strain. Levels of reactive oxygen species (ROS) were lower in the thermotolerant strains. We propose that the defect of the transporter causes the metabolic flux to generate more NADPH, which may enhance thermotolerance in G. frateuriiIMPORTANCE The biorefinery industry has to ensure that microorganisms are robust and retain their viability and function at high temperatures. Here we show that Gluconobacterfrateurii, an industrially important member of the acetic acid bacteria, exhibited enhanced thermotolerance through the reduction of trehalose excretion after thermal adaptation. Although intracellular trehalose may play a key role in thermotolerance, the molecular mechanisms of action of trehalose in thermotolerance are a matter of debate. Our mutated strain that was defective in trehalose synthase genes, producing no trehalose but a larger amount of acetic acid as the end metabolite instead, unexpectedly showed higher thermotolerance than the wild type. Our adapted and mutated thermotolerant strains showed increased NADPH/NADP+ ratios and reductions in ROS levels. We concluded that in G. frateurii, trehalose does not contribute to thermotolerance directly; rather, the metabolic change increases the NADPH/NADP+ ratio to enhance thermotolerance.


Burn epidemiology and cost of medication in paediatric burn patients.
Burns are common injuries that cause problems to societies throughout the world. In order to reduce the cost of burn treatment in children, it is extremely important to determine the burn epidemiology and the cost of medicines used in burn treatment. The present study used a retrospective design, with data collected from medical records of 140 paediatric patients admitted to a burn centre between 1 January 2009 and 31 December 2009. Medical records were examined to determine burn epidemiology, medication administered, dosage, and duration of use. Descriptive statistical analysis was completed for all variables; chi-square was used to examine the relationship between certain variables. It was found that 62.7% of paediatric burns occur in the kitchen, with 70.7% involving boiling water; 55.7% of cases resulted in third-degree burns, 19.3% required grafting, and mean duration of hospital stay was 27.5 ± 1.2 days. Medication costs varied between $1.38 US dollars (USD) and $14,159.09, total drug cost was $46,148.03 and average cost per patient was $329.63. In this study, the medication cost for burn patients was found to be relatively high, with antibiotics comprising the vast majority of medication expenditure. Most paediatric burns are preventable, so it is vital to educate families about potential household hazards that can be addressed to reduce the risk of a burn. Programmes are also recommended to reduce costs and the inappropriate prescribing of medication.


Comparison of a simulated 16.1-km time trial, VO2max and related factors in cyclists with different ventilatory thresholds.
Differences in cycling performance have been observed in cyclists with similar VO2max values yet different lactate thresholds. The purpose of the current study was to compare a simulated 16.1-km cycling time trial, VO2max and related factors in cyclists who significantly varied in ventilatory threshold. From an original group of 18 category III or IV cyclists, two groups of 6 cyclists were formed based on ventilatory threshold values as high (77 +/- 4% of VO2max-Group H) or low (68 +/- 2.8% - Group L). VO2max and a 16.1-km time trial were completed on a Velodyne trainer. No significant difference (p > or = 0.05) was noted between groups in VO2max (Group H 4.00 +/- 0.281.min-1, Group L 4.15 +/- 0.671.min-1), however significant differences (p < or = 0.05) were found in ventilatory threshold and time trial scores. Group H completed the time trial in 16.29 +/- 2.08 min while Group L averaged 20.93 +/- 3.03 min. Group H completed the time trial 28% more quickly by working at a significantly higher percentage of VO2max, a higher power output and a faster pedal rate than Group L. From a battery of physiologic and body composition parameters, the ventilatory threshold expressed as VO2 (l.min-1) was the best predictor (r = -0.76) of time trial performance in the 12 cyclists. The findings of this study indicate that the ventilatory threshold was superior to VO2max in discerning performance differences in a 16.1-km cycling time trial, and was the best predictor of the simulated time trial performance.


Adenosine reagent-free detection by co-immobilization of adenosine deaminase and phenol red on an optical biostrip.
Adenosine detection in human serum is important because this ribonucleoside has established clinical applications, modulating many physiological processes. Furthermore, a simple and cheap detection method is useful in adenosine production processes. Adenosine can be determined enzymatically using either S-adenosyl-homocysteine hydrolase and (3) [H]-adenosine, or adenosine kinase combined with GTP and luciferase, or an amperometric biosensor carrying adenosine deaminase (ADA), purine nucleoside phosphorylase, and xanthine oxidase. We developed a simple and cheap method relying on a transparent biostrip bearing ADA and the indicator phenol red (PR), co-immobilized to polyacrylamide, itself chemically adhered to a derivatized glass strip. The ADA-catalyzed conversion of adenosine to inosine and ammonia leads to a local pH alteration, changing the absorbance maximum of PR (from 425 to 567 nm), which is measured optically. The biostrip shows an analytical range 0.05-1.5 mM adenosine and is reusable when stored at 4 °C. When the biostrip was tested with serum, spiked with adenosine (70 and 100 μM), and filtered for protein and adenosine phosphates depletion, it showed good adenosine recovery. In summary, we show the proof-of-concept that adenosine can be determined reagent-free, at moderate sensitivity on an easy to construct, cheap, and reusable biostrip, based on commercially available molecular entities.


Current trends in the surgical treatment of solitary parathyroid adenoma. A questionnaire study from 53 surgical departments in 14 countries.
Current trends in the surgical treatment of primary hyperparathyroidism due to solitary parathyroid adenoma were evaluated in a questionnaire study. Response was obtained from 53 departments highly active in endocrine surgery in 14 countries (response rate 95%). Intraoperative histologic examination is widely (70%) regarded as necessary, but utilized more in North America and Scandinavia (87%) than elsewhere (45%). Intraoperative fat staining is used in one-third of the departments. Excisional biopsy including one whole gland is preferred by 32% to multiple incisional biopsies. Gross inspection of three normal parathyroid glands without histologic identification is favoured in 21% of the departments, while 31% prefer bilateral exploration and incisional biopsy. When an adenoma is found on the first side to be explored, 17% advocate bilateral exploration with incisional biopsy of all three normal glands, whereas unilateral exploration with excisional or incisional biopsy of the ipsilateral normal gland is preferred by a similar percentage.


Bringing Your Idea to the Market: A Primer for Plastic Surgeons.
The progress of biotechnology, medical instruments, and applied sciences contributes to a rapidly expanding space for the advancement of the medical field. Surgeons experience first-hand the limitations of current medical devices and thus have unique insight into problems that could be solved with new products. The process of turning an idea into a product capable of success in the marketplace, however, is often unfamiliar to surgeons. The authors seek to illuminate this process and provide an ordered list of tasks that can make bringing ideas to market more achievable for surgeons. The first step in this process is the generation and protection of a new idea. Next, the process of making an idea into a product is outlined. This phase involves team assembly, business planning, and product development. Market research and valuation are key to understanding how a product can be applied in the market, and meticulous research during this phase allows for informed decision-making that will help secure funding down the road. Finally, various options for financing are discussed and compared to help surgeon-entrepreneurs find an option that best fits their project, and steps to maximize leverage are described. The development of new products can be a complicated process for surgeons. Organized into four phases, with ordered instructional steps to advance through each phase, the process of bringing an idea to the market is clarified. Facilitating this process will possibly contribute to the continual improvement of medical and surgical abilities through the introduction of new devices and technologies.


Severe adverse events following benzathine penicillin G injection for rheumatic heart disease prophylaxis: cardiac compromise more likely than anaphylaxis.
Secondary prophylaxis through long-term antibiotic administration is essential to prevent the progression of acute rheumatic fever to rheumatic heart disease (RHD). Benzathine penicillin G (BPG) has been shown to be the most efficacious antibiotic for this purpose; however, adverse events associated with BPG administration have been anecdotally reported. This study therefore aimed to collate case reports of adverse events associated with BPG administration for RHD prophylaxis. A literature review was used to explore reported adverse reactions to BPG and inform development of a case report questionnaire. This questionnaire was circulated through professional networks to solicit retrospective reports of adverse events from treating physicians. Returned surveys were tabulated and thematically analysed. Reactions were assessed using the Brighton Collaboration case definition to identity potential anaphylaxis. We obtained 10 case reports from various locations, with patients ranging in age from early-teens to adults. All patients had clinical or echocardiogram-obtained evidence of valvular disease. The majority of patients (80%) had received BPG prior to the event with no previous adverse reaction. In eight cases, the reaction was fatal; in one case resuscitation was successful and in one case treatment was not required. Only three cases met Level 1 Brighton criteria consistent with anaphylaxis. These results indicate that anaphylaxis is not a major cause of adverse reactions to BPG. An alternative mechanism for sudden death following BPG administration in people with severe RHD is proposed.


Ravidasvir hydrochloride for genotype 1 hepatitis C treatment.
Effective oral combination regimens have been approved for treatment of hepatitis C virus (HCV) infection and demonstrated high cure rates in different HCV genotypes. These direct-acting agents target a variety of HCV proteins, including HCV-NS5A (nonstructural protein 5A). Ravidasvir hydrochloride, a potent pan-genotypic HCV-NS5A inhibitor approved in Egypt for treatment of HCV genotype 4 (G4), demonstrated impressive efficacy, safety profiles and a high barrier to resistance in multiple clinical trials when used as a key component in combination with other direct-acting agents in treating patients with HCV-G1.


Analysis of the temporal response of computed tomography fluoroscopy.
Computed tomography fluoroscopy (CTF) has found many applications in interventional procedures. The advantage of CTF is its ability to remove overlapping structures in the human anatomy and, thereby, provide accurate spatial information. Another advantage is its ability to reconstruct images in a short period of time so that "real-time" information can be provided. In this paper, we perform theoretical analysis and computer simulations to evaluate the temporal response of the CTF. We investigate the impact of various reconstruction algorithms on CTF and demonstrate the inherent limitations of the CTF in terms of the time lag and delay. The analysis provides a useful guidance to the CTF operators to avoid potential pitfalls.


Developing a Novel Terahertz Fabry-Perot Microcavity Biosensor by Incorporating Porous Film for Yeast Sensing.
We present a novel terahertz (THz) Fabry-Perot (FP) microcavity biosensor that uses a porous polytetrafluoroethylene (PTFE) supporting film to improve microorganism detection. The THz FP microcavity confines and enhances fields in the middle of the cavity, where the target microbial film is placed with the aid of a PTFE film having a dielectric constant close to unity in the THz range. The resonant frequency shift increased linearly with increasing amount of yeasts, without showing saturation behavior under our experimental conditions. These results agree well with finite-difference time-domain (FDTD) simulations. The sensor's sensitivity was 11.7 GHz/μm, close to the optimal condition of 12.5 GHz/μm, when yeast was placed at the cavity's center, but no frequency shift was observed when the yeast was coated on the mirror side. We derived an explicit relation for the frequency shift as a function of the index, amount, and location of the substances that is consistent with the electric field distribution across the cavity. We also produced THz transmission images of yeast-coated PTFE, mapping the frequency shift of the FP resonance and revealing the spatial distribution of yeast.


Major histocompatibility complex (MHC)-linked genes affecting development.
Genes affecting growth and development which are linked to the major histocompatibility complex have been found in the mouse (t-complex) and in the rat (growth and reproduction complex, grc), and there is some evidence that they also exist in humans. The genes of the t-complex have different effects depending upon the specific combinations involved: skeletal and fertility abnormalities, complete or partial embryonic mortality, high transmission ratios (segregation distortion) in males, high level of linkage disequilibrium with H-2, and suppression of recombination over the adjacent portion of the chromosome. The grc in the homozygous state causes small body size, sterility in the male and reduced fertility in the female, partial embryonic mortality, and a high level of linkage disequilibrium with RT1. It also interacts epistatically with the heterozygous Tal (tail anomaly lethal) gene to cause complete embryonic death. Mice carrying t-haplotypes and rats carrying the grc have an antigen in the male germ cells which cross-reacts very strongly (t-antigen). Suggestive evidence for such genes in humans comes from (1) studies on the relationship between skeletal defects and HLA haplotypes; (2) the association of specific HLA and complement haplotypes with a high transmission ratio in males, linkage disequilibrium among certain HLA and complement specificities and suppression of recombination in some MHC haplotypes; and (3) the lack of homozygotes in an isolated inbreeding population of desert nomads (Kel Kummer Tuaregs). In addition, immunogenetic studies on couples having chronic spontaneous abortions suggest that there is an unusually high incidence of homozygosity for the HLA-D/DR and HLA-A loci in these couples, and this finding is consistent with the presence of linked loci which behave like t or grc.


High-resolution patterning of solution-processable materials via externally engineered pinning of capillary bridges.
Electronics based on solution-processable materials are promising for applications in many fields which stimulated enormous research interest in liquid-drying and pattern formation. However, assembling of structure with submicrometre/nanometre resolution through liquid process is very challenging. We show a simple method to rapidly generate polymer structures with deep-submicrometre-sized features over large areas. In this method, a solution film is dried on a substrate under a suspended flexible template with groove/ridge surface topography. Upon solvent evaporation, the solution splits in the grooves and forms capillary bridges between the template and substrate, which are firmly pinned by the edges of the template grooves. This groove pinning stabilizes the contact lines, thereby allowing the formation of fine patterned structures with high aspect ratios which were used to fabricate various functional materials and electronic devices. We also produced secondary self-assembled nano-stripe patterns with resolutions of about 50 nm on the primary lines.


Optical, electrochemical and hydrophilic properties of Y2O3 doped TiO2 nanocomposite films.
The 5% Y2O3 doped TiO2 nanocomposite film (YTF) deposited on ITO glass substrate has been synthesized by the sol-gel dip-coating method. The as-synthesized samples were characterized using X-ray diffraction (XRD), atomic force microscopy (AFM), scanning electron microscope (SEM), X-ray photoelectron spectroscopy (XPS), voltage-current (V-I), electrochemical impedance spectroscopy (EIS) and ultraviolet-visible (UV-vis) analysis technologies. The crystalline structure, surface morphology and surface chemical composition of YTF sample have been primarily investigated. The results demonstrate that YTF is anatase crystalline phase with thickness of 480 nm and consists of spherical shape particles with a grain size of about 15.8 nm. The binding energy appears as a chemical shift, and relatively more Y and Ti species are present on the surface, indicating that active surfaces of the nanocomposite film have been enhanced with more oxygen vacancies Vö due to doping Y2O3 to TiO2. The absorption edge of YTF has a red shift, and the optical properties of YTF in visible light region have been obviously improved. The water contact angle is about 8 degrees after daylight lamp irradiation 60 min. An equivalent circuit model provided a reliable description for the electrochemical systems. Based on the Mott-Schottky equation, the donor concentration (ND) for YTF is 1.05 x 10(20) cm(-3), which enhances 1 order of magnitude than that for pure TiO2 film (TF), the flat-band potential (V(fb)) and the space charge layer (d(sc)) obviously decreased. With the incorporation of Y2O3 into TiO2, the optical, electrochemical and photoinduced hydrophilic properties of YTF in visible light region have obviously improved, indicating that YTF shows promising applications in solar energy conversion, self-cleaning and other potential fields.


High opacification of hilar pulmonary vessels with a small amount of nonionic contrast medium for general thoracic CT: a prospective study.
The main goal of this study was to determine whether in thoracic helical CT for general indications a high opacification of hilar pulmonary vessels could be obtained using a small amount of nonionic contrast medium. Two hundred consecutive patients referred for contrast-enhanced thoracic CT for malignancies or infections prospectively entered the study. They were randomly assigned to one of two simple bolus injection protocols (100 patients in each protocol): 60 mL of a nonionic contrast agent (250 mg I/mL) injected at a 3 mL/sec flow rate, or 80 mL of the same contrast agent injected at a 4 mL/sec flow rate. No saline flush or bolus triggering system was used. Hilar and mediastinal vessel enhancement was qualitatively (using a 4-point scale) and quantitatively (arterial attenuation values) assessed. Perivenous artifacts were also assessed. No extensive perivenous artifacts were noted. No significant difference was noted regarding pulmonary venous enhancement. Excellent opacification of the pulmonary veins was observed in 66% of patients injected at 3 mL/sec and in 56% of patients injected at 4 mL/sec (p > 0.192). A highly significant difference was noted for pulmonary artery enhancement. Excellent opacification of the pulmonary arteries was noted in 83% of patients injected with a 3mL/sec flow rate and in 61% of patients injected with a 4 mL/sec flow rate (p = 0.001). A high level of opacification of hilar pulmonary vessels, with no major perivenous artifacts, can be obtained with a small amount of nonionic contrast medium using a simple bolus injection.


Physical activity assessment: biomarkers and self-report of activity-related energy expenditure in the WHI.
We used a biomarker of activity-related energy expenditure (AREE) to assess measurement properties of self-reported physical activity and to determine the usefulness of AREE regression calibration equations in the Women's Health Initiative. Biomarker AREE, calculated as the total energy expenditure from doubly labeled water minus the resting energy expenditure from indirect calorimetry, was assessed in 450 Women's Health Initiative participants (2007-2009). Self-reported AREE was obtained from the Arizona Activity Frequency Questionnaire (AAFQ), the 7-Day Physical Activity Recall (PAR), and the Women's Health Initiative Personal Habits Questionnaire (PHQ). Eighty-eight participants repeated the protocol 6 months later. Reporting error, measured as log(self-report AREE) minus log(biomarker AREE), was regressed on participant characteristics for each instrument. Body mass index was associated with underreporting on the AAFQ and PHQ but overreporting on PAR. Blacks and Hispanics underreported physical activity levels on the AAFQ and PAR, respectively. Underreporting decreased with age for the PAR and PHQ. Regressing logbiomarker AREE on logself-reported AREE revealed that self-report alone explained minimal biomarker variance (R(2) = 7.6, 4.8, and 3.4 for AAFQ, PAR, and PHQ, respectively). R(2) increased to 25.2, 21.5, and 21.8, respectively, when participant characteristics were included. Six-month repeatability data adjusted for temporal biomarker variation, improving R(2) to 79.4, 67.8, and 68.7 for AAFQ, PAR, and PHQ, respectively. Calibration equations "recover" substantial variation in average AREE and valuably enhance AREE self-assessment.


Esthetic applications of restorative materials and techniques in the anterior dentition.
The esthetic expectations of our patients can be met by doing a thorough initial examination with emphasis on periodontal health, caries incidence, occlusion, possible orthodontic corrections, esthetic needs, and economic concerns. Through proper communication with the patient, a written treatment plan can be developed that uses the various techniques of bleaching, cosmetic recontouring, direct resin bonding, porcelain veneering, or crowning to meet the patient's restorative needs. The most conservative noninvasive techniques should be evaluated first. Often, bleaching and partial direct bonding are all that is needed. If the dentition is badly worn or discolored, then more extensive treatment is indicated. Patients frequently have concerns about longevity of restorations or require very high levels of esthetic correction, which can only be accomplished with more invasive techniques. When patients understand what can be accomplished and are involved in the treatment decision, then successful results are assured. Esthetic restorative dentistry is probably the most rewarding aspect of practice today, but it is also the most challenging. New materials appear and techniques change so rapidly that it is sometimes difficult to keep up. Practitioners should acquire a thorough knowledge of available methods and materials, learn the limitations of these materials and techniques, and master skills through continuing education (courses, journals, and newsletters) as well as chairside repetition as new procedures become available.


Adaptor protein Lnk associates with Tyr(568) in c-Kit.
The adaptor protein Lnk is expressed in haemopoietic cells and plays a critical role in haemopoiesis. Animal model studies demonstrated that Lnk acts as a broad inhibitor of signalling pathways in haemopoietic lineages. Lnk belongs to a family of proteins sharing several structural motifs, including an SH2 (Src homology 2) domain which binds phosphotyrosine residues in various signal-transducing proteins. The SH2 domain is essential for Lnk-mediated negative regulation of several cytokine receptors [e.g. Mpl, EpoR (erythropoietin receptor), c-Kit]. Therefore inhibition of the binding of Lnk to cytokine receptors might lead to enhanced downstream signalling of the receptor and thereby to improved haemopoiesis in response to exposure to cytokines (e.g. erythropoietin in anaemic patients). This hypothesis led us to define the exact binding site of Lnk to the stem cell factor receptor c-Kit. Pull-down experiments using GST (glutathione transferase)-fusion proteins of the different domains of c-Kit showed that Lnk almost exclusively binds to the phosphorylated juxtamembrane domain. Binding of Lnk to the juxtamembrane domain was abolished by point mutation of Tyr(568) and was competed by peptides with a phosphotyrosine residue at position 568. Co-immunoprecipitation with full-length wild-type or Y568F mutant c-Kit and Lnk confirmed these results, thus showing the importance of this phosphorylated tyrosine residue. Lnk bound directly to c-Kit without requiring other interacting partners. The identification of the binding site of Lnk to c-Kit will be useful to discover inhibitory molecules that prevent the binding of these two proteins, thus making haemopoietic cells more sensitive to growth factors.


HIV infection in 567 active pulmonary tuberculosis patients in Brazil.
We studied 567 patients with active pulmonary tuberculosis (APT) in Rio de Janeiro, Brazil, by using a standardized questionnaire and by testing blood for HIV antibodies. The rate of HIV infection was 3.9% in 1987, 4.8% in 1988, and 5.2% in 1989, and did not differ by sex. It was highest (7.4%) in the 15- to 39-year age group. There was no difference between patients infected and not infected by HIV with regard to education, income, housing, or employment. Among all patients with definite HIV risk behavior, the HIV infection rate was 23.3%, rising to 31.2% among homo/bisexual men and 36.4% among intravenous drug users, and the rate was 6.5% for blood-transfusion recipients. Among patients who denied risk behavior, the rate was 1.2%. Generalized lymphadenopathy and oral candidiasis occurred with greater frequency among HIV-infected patients (p < 0.0001). Applying the World Health Organization 1985 clinical criteria and revised case definition for AIDS, we found, respectively, sensitivities of 34% and 76.9% and specificities of 31% and 26.3%; in the Rio de Janeiro environment, these clinical criteria without HIV serology should not be adopted for tuberculosis patients. For chest radiographs, a significant association was found between HIV infection and the occurrence of atypical images (p = 0.0001), and hilar and/or mediastinal adenopathy (p = 0.0002) and absence of cavities (p = 0.0003). A PPD (purified protein derivative) skin test induration of < 5 mm was identified in 53% of the HIV-positive cases and in 31.3% of the HIV-negative cases. Only 11.5% of HIV-infected APT patients met the Centers for Disease Control 1987 AIDS criteria.


Verrucous carcinoma of the oral cavity.
The clinical course and morphologic (light and ultrastructural) characteristics of a case of verrucous carcinoma of the lower gingival mucosa are presented. Clinical course of the patient was unfavorable following surgery (supposedly incomplete) and radiotherapy (6,000 R) of the tumor. The therapeutic factors that may influence an unfavourable prognosis are commented upon, especially in regard to a slow-growing neoplasm with a generally good course.


Variable Features of Juvenile Polyposis Syndrome With Gastric Involvement Among Patients With a Large Genomic Deletion of BMPR1A.
Loss-of-function mutations of BMPR1A cause juvenile polyposis syndrome (JPS), but large genomic deletions in BMPR1A are rare, reported in few families only, and data regarding the associated phenotype are limited. We investigated clinical features and genomic data of 7 extended seemingly unrelated families with a genomic deletion of the entire coding region of BMPR1A. We defined mutation size, mutation prevalence, and tumor pathogenesis using whole-genome sequencing, targeted genotyping, and haplotype analysis. Patients with JPS from 7 families of Bukharin Jewish ancestry carried a deletion of 429 kb, encompassing the BMPR1A coding sequence and 8 downstream genes. Haplotype analysis and testing controls identified this as a common founder mutation occurring in 1/124 individuals of Bukharin origin. Tumor testing did not demonstrate loss of heterozygosity. Among carriers, JPS was almost fully penetrant, but clinical features varied widely, ranging from mild to very severe, including pan-enteric polyps, gastritis, and colorectal, esophageal, and testicular cancer, and carriers with phenotypes, which would not have raised suspicion of JPS. The phenotype in this large cohort was extremely variable, although all carriers shared the same variant and the same genetic background. New observations include a preponderance of adenomatous rather than juvenile polyps, possible association with testicular cancer, and unexpected upper gastrointestinal involvement.


The Critical Role of Potassium Efflux and Nek7 in Pasteurella multocida-Induced NLRP3 Inflammasome Activation.
Pasteurella multocida is a zoonotic pathogen causing respiratory infection in different animal species such as cattle, sheep, pigs, chickens and humans. Inflammasome is a complex assembled by multiple proteins in the cytoplasm and plays an important role in the host defense against microbial infection. Bovine Pasteurella multocida type A (PmCQ2) infection induces NLRP3 inflammasome activation and IL-1β secretion, but the mechanism of PmCQ2-induced activation of NLRP3 inflammasome is still unknown. Therefore, the underlying mechanism was investigated in this study. The results showed that potassium efflux mediated PmCQ2-induced IL-1β secretion and blocking potassium efflux attenuated PmCQ2-induced caspase-1 activation and ASC oligomerization. Furthermore, NIMA-related kinase 7 (Nek7) was also involved in PmCQ2-induced caspase-1 activation and IL-1β secretion. In addition, PmCQ2 infection promoted Nek7-NLRP3 interaction, which is dependent on potassium efflux. In conclusion, our results indicate the critical role of potassium efflux and Nek7 in Pasteurella multocida-induced NLRP3 inflammasome activation, which provides useful information about Pasteurella multocida-induced host immune response.


Knowledge and Prevention Practices among U.S. Pregnant Immigrants from Zika Virus Outbreak Areas.
We administered an anonymous survey to assess knowledge, attitudes, and prevention practices related to the Zika virus among pregnant women residing in Texas. Multivariate logistic regression models controlling for age, race/ethnicity, education, and number of years in the United States assessed differences between women born in outbreak areas (N = 390) versus those born in the United States (N = 249). Results demonstrated that most women wanted more information on the Zika virus and desired to obtain it from their physician. The majority did not know that the Zika virus could be spread through sex with an asymptomatic partner or how often those infected were symptomatic. Few women took precautions to avoid mosquito bites. Only 40% reported frequently using repellent; 21% stated that cost was problematic and almost half were concerned about use during pregnancy. Three-fourths stated they would agree to vaccination, if available. Compared with U.S.-born women, those born in outbreak areas were more likely to have already discussed the Zika virus with their doctor (adjusted odds ratio [aOR] = 1.86, 95% confidence interval [CI] = 1.27, 2.71) and identify microcephaly as the most common birth defect (aOR = 2.59, 95% CI = 1.78, 3.76). Moreover, women born in outbreak areas were less likely to desire to keep it a secret if they became infected (aOR = 0.47, 95% CI = 0.31, 0.71). This study found that, regardless of birthplace, pregnant women need more education on the Zika virus disease and assurance regarding the safety of using repellent during pregnancy. They also need financial assistance for repellent, especially if living in states where transmission by mosquitos has been reported.


A randomized trial to consider the effect of Romanian deadlift exercise on the development of lumbar extension strength.
To consider the efficacy of 10 weeks of Romanian deadlift (DL) training in increasing lumbar extension strength compared to isolated lumbar extension (LUMX) training. Comparison of pre- and post-test data for Romanian deadlift 1RM, and lumbar extension torque between and within groups. Male trained subjects (n = 36; (x¯±SD) 24.9 ± 6.5 years; 178.5 ± 5.2 cm; 81.6 ± 10.0 kg). Pre- and post-testing included a Romanian deadlift 1RM and isometric strength tests every 12° through full range of motion on the MedX lumbar extension machine (MedX, Ocala, FL). Repeated measures analysis of variance (ANOVA) with Bonferroni adjustments revealed that 1RM Romanian deadlift significantly increased from pre- to post-test in the DL group (p < 0.008; 143.3 ± 23.4 kg to 166.3 ± 21.9 kg) and the LUMX group (p < 0.008; 135.8 ± 23.1 kg to 146.0 ± 25.5 kg). In contrast, tested functional torque (TFT) significantly increased at 6 out of 7 joint angles (p < 0.008) for the LUMX group only. The control group showed no significant differences pre- to post-test. These data suggest that the Romanian deadlift does not enhance lumbar extension torque. However, performing specific isolated lumbar extension training appears to improve both lumbar extension torque and Romanian deadlift 1RM.


Breast MR Imaging before Surgery: Outcomes in Patients with Invasive Lobular Carcinoma by Using Propensity Score Matching.
Purpose To investigate the association between preoperative breast magnetic resonance (MR) imaging and surgical outcomes in patients with invasive lobular carcinoma (ILC) by using propensity score matching to decide whether MR examination is beneficial in the ILC subtype of breast cancer. Materials and Methods The authors identified 603 patients with ILC who underwent surgery between January 2005 and December 2016. Of the 603 patients, 369 (61.2%) underwent MR imaging. The authors calculated the MR detection rate of additional lesions that were occult at mammography and ultrasonography and analyzed any alterations in surgical management. After propensity score matching, 196 pairs of patients were allocated to the groups, and the 17 possible confounding variables regarding patient and tumor characteristics and various clinical features were well balanced between the patients who underwent MR imaging and those who did not. Surgical outcomes were compared. Results Of the 369 patients who underwent MR imaging, additional lesions were detected in 145 (39.3%); 95 of the 145 patients (65.5%) had malignant lesions. A change in surgical management occurred because of MR findings in 94 of the 369 patients (25.5%). According to pathologic findings, this change was appropriate for 84 of the 94 patients (89.4%). In the propensity score-matched analysis, breast MR imaging was associated with lower odds of repeat surgery (odds ratio, 0.140; P < .001) and similar likelihood of initial mastectomy (odds ratio, 0.876; P = .528) and final mastectomy (odds ratio, 0.744; P = .151) compared with patients without breast MR imaging. Conclusion Preoperative MR imaging is useful for detecting additional synchronous malignancy and significantly reducing the likelihood of repeat surgery without increasing the rate of mastectomy in patients with ILC. © RSNA, 2018.


Beam splitting at the output of photonic crystal waveguides with discrete surface point defects.
With the method of adding two point defects on modulated surface, novel photonic crystal (PC) waveguide-based beam splitters were presented. The modulated surface layer supports surface states, and introduced discrete point defects can serve as discrete light emitters. The finite-difference time-domain (FDTD) simulations show that the number of beams is sensitive to the distance of two point defects. By adjusting the positions of the point defects, 1-to-N beam splitters can be realized. These simple, easy-to-fabricate and controllable structures have important potential applications in integrated optical circuits.


Primary oral malignant melanoma.
Malignant melanoma of the oral cavity is a rare neoplasm. It is well known for his poor prognosis and the need for an evidence-based treatment. Therapy is commonly based on surgical excision of the primary tumour, supplemented by adjuvant therapy. In this paper two new cases of primary oral melanoma are reported with a review of the literature.


Optimization of Nitrogen Rate and Planting Density for Improving Yield, Nitrogen Use Efficiency, and Lodging Resistance in Oilseed Rape.
Yield and lodging related traits are essential for improving rapeseed production. The objective of the present study was to investigate the influence of plant density (D) and nitrogen (N) rates on morphological and physiological traits related to yield and lodging in rapeseed. We evaluated Huayouza 9 for two consecutive growing seasons (2014-2016) under three plant densities (LD, 10 plants m-2; MD, 30 plants m-2; HD, 60 plants m-2) and four N rates (0, 60, 120, and 180 kg ha-1). Experiment was laid out in split plot design using density as a main factor and N as sub-plot factor with three replications each. Seed yield was increased by increasing density and N rate, reaching a peak at HD with 180 kg N ha-1. The effect of N rate was consistently positive in increasing the plant height, pod area index, 1,000 seed weight, shoot and root dry weights, and root neck diameter, reaching a peak at 180 kg N ha-1. Plant height was decreased by increasing D, whereas the maximum radiation interception (~80%) and net photosynthetic rate were recorded at MD at highest N. Lodging resistance and nitrogen use efficiency significantly increased with increasing D from 10 to 30 plants m-2, and N rate up to 120 kg ha-1, further increase of D and N decreased lodging resistance and NUE. Hence, our study implies that planting density 30 plants m-2 can improve yield, nitrogen use efficiency, and enhance lodging resistance by improving crop canopy.


Efficient allocation of resources to prevent HIV infection among injection drug users: the Prevention Point Philadelphia (PPP) needle exchange program.
The objective of this study is to determine the allocation of resources within a multi-site needle exchange program (NEP) that achieves the largest possible reduction in new HIV infections at minimum cost. We present a model that relates the number of injection drug user (IDU) clients and the number of syringes exchanged per client to both the costs of the NEP and the expected reduction in HIV infections per unit time. We show that cost-effective allocation within a multi-site NEP requires that sites be located where the density of IDUs is highest, and that the number of syringes exchanged per client be equal across sites. We apply these optimal allocation rules to a specific multi-site needle exchange program, Prevention Point Philadelphia (PPP). This NEP, we find, needs to add 2 or 3 new sites in neighborhoods with the highest density of IDU AIDS cases, and to increase its total IDU client base by about 28%, from approximately 6400 to 8200 IDU clients. The case-study NEP also needs to increase its hours of operation at two existing sites, where the number of needles distributed per client is currently sub-optimal, by 50%. At the optimal allocation, the estimated cost per case of HIV averted would be dollar 2800 (range dollar 2300-dollar 4200). Such a favorable cost-effectiveness ratio derives primarily from PPP's low marginal costs per distributed needle.


Effects of exercise frequency on the gut microbiota in elderly individuals.
Growing evidence has shown that exercise can affect the gut microbiota. The effects of exercise frequency on the gut microbiota in elderly individuals are still largely unknown. In the present study, samples from 897 elderly and 1,589 adult individuals (18-60 years old) from the American Gut Project were screened. Microbial diversity and composition were analyzed by QIIME2, and microbial function was predicted by PICRUSt2. The outcomes were further analyzed by STAMP. The analysis showed that the α-diversity of gut microbiota increased with increasing age, and regular exercise reshaped the alterations in microbial composition and function induced by aging. Moreover, the α-diversity of gut microbiota was higher in overweight elderly individuals than in normoweight elderly individuals, and regular exercise significantly affected the microbial composition and function in overweight elderly individuals. In conclusion, we revealed that regular exercise benefits elderly individuals, especially overweight elderly individuals, by modulating the gut microbiota.


Surgical Treatment for Bisphosphonate-related Atypical Femoral Fracture: A Systematic Review.
Atypical femoral fractures are the femoral fractures located anywhere between the lesser trochanter and the supracondylar flare of the femur. Long-term bisphosphonates, as the most common preventive and treatment medications for osteoporosis, are thought to have an important role in these fractures. Most of the fractures should be treated surgically, and the complications are considerable. We searched Medline, CENTRAL, Embase, and DART on February 26, 2020. One author reviewed and retrieved citations from these four databases for irrelevant and duplicate studies, and two other authors independently extracted data from the studies and rated their quality.Patients with surgical treatment of bisphosphonate-related atypical femoral fracture, according to the American Society for Bone and Mineral Research definition, were included. Animal studies, case reports, studies with high-energy trauma, pathological fracture, or malignancy-related fractures were excluded. In total, 316 patients (348 fractures) were included in this study. Mean age of patients was 70.47 years, and 97.5% of them were female. Duration of using bisphosphonates was 4.04 to 8.8 years, and Alendronate was the most common type. Moreover, 65.27% and 34.72% of the reported fractures were in diaphyseal and subtrochanteric, respectively. Moreover, the most common fixation type was intramedullary. Rate of complication was 17.52%, and the most frequent one was non-union, followed by implant failure. The main limitation of this research was that most of the studies did not have a high level of evidence. An increase in the rate of atypical femoral fracture with its challenging management makes it an important issue to be noted by orthopedic surgeons. Based on the results of this study, subtrochanteric fractures might have more complications post-operatively and are suggested to be operated on by more experienced surgeons. It was also found that extra-medullary fixation increases the risk of complications. Future studies on union time, outcomes of different surgical methods, and teriparatide therapy may help shed more light on the surgical management of these fractures.


Use of skin-lightening products among outpatient attendees in a North Indian Hospital.
In India, fair skin is a highly valued physical attribute. Skin lightener products comprise 60% of the dermatological market. This cross-sectional study was conducted in the general medical outpatient clinics of Champa Christian Hospital to elucidate the perceptions of fair skin and determinants/pattern of skin lighter use. Demographics, pattern of skin lightener use and incidence of side effects, perceptions of lighter skin tones were the main outcomes and measures studied. The use of skin lighteners was highly prevalent in our study population. Believing that lighter skin is beneficial for self-esteem is a predictor for skin lightener use. Higher education was associated with lower perceived benefits of fairer skin and therefore reduced skin lightener use. Further education and increased community awareness are important to address the issues surrounding potential over-use of skin-lightening products.


Nobiletin Inhibits Hepatic Lipogenesis via Activation of AMP-Activated Protein Kinase.
We aimed to investigate the effects of nobiletin on hepatic lipogenesis in high glucose-induced lipid accumulation in HepG2 cells. Nobiletin, a citrus polymethoxyflavonoid with six methoxy groups, is present abundantly in the peels of citrus fruits. HepG2 cells were incubated in Dulbecco's modified Eagle's medium containing high glucose (25 mM) and subsequently treated with nobiletin at different concentrations (5, 25, and 50 μM). Results showed that nobiletin markedly inhibited high glucose-induced hepatic lipid accumulation in HepG2 cells. In addition, it reduced the protein expression of lipogenic factors, including sterol regulatory element-binding protein 1c (SREBP-1c) and fatty acid synthase (FAS). Nobiletin significantly increased the phosphorylation of AMP-activated protein kinase (AMPK) and acetyl-CoA carboxylase. Pretreatment with compound C, an AMPK inhibitor, abolished the inhibitory effects of nobiletin on SREBP-1c and FAS expression. These results suggested that nobiletin might attenuate high glucose-induced lipid accumulation in HepG2 hepatocytes via modulation of AMPK signaling pathway. Therefore, nobiletin might be useful for the prevention and treatment of nonalcoholic fatty liver diseases.


M5 segment aneurysm presenting as "pure acute SDH".
Spontaneous "pure acute subdural hematoma (SDH)" is arguably a rare condition. We report on a pregnant female patient presenting as spontaneous acute SDH without subarachnoid hemorrhage (SAH) due to rupture of distal (M5 segment) middle cerebral artery aneurysm. We hereby discuss the diagnostic dilemma of this rare condition, along with the need for watchful evaluation of acute SDH without preceding head injury presenting in emergency outpatient departments, especially when it is first encountered by a trainee resident.


Management of infertility in HIV infected couples: a review.
The HIV epidemic has continued to grow and remains a major challenge to mankind. In the past, ethical considerations about the resulting child and risks of sexual, vertical and nosocomial transmission of HIV prevented practitioners from offering fertility services to people living with HIV. In recent times however, the use of highly active antiretroviral therapy (HAART), has not only improved the life expectancy and quality of life of those infected but also reduced the risk of HIV transmission. The need for fertility services in the HIV-positive population has thus increased and may be employed for management of infertility and protection from transmission or acquisition of HIV infection. As such, preconception counseling, sexual health and fertility screening have become routine in the management of HIV-positive couples. The option of care include adoption, self insemination with husband sperm, embryo donation from couples who have been verified to be HIV negative, insemination with donor sperm, timed unprotected intercourse (TUI) and sperm washing combined with intrauterine insemination (IUI) and assisted reproductive technology (ART) including in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Access to these fertility services by HIV-positive clients should be facilitated as part of efforts to promote their reproductive health and rights.


Bacterial infection and acrylic cement in the rat.
In thirty-one rat tibiae, plugs of plain acrylic cement were inoculated with Staphylococcus aureus; these all remained contaminated at the end of two weeks when the animals were killed. Inoculation with known strains of Pseudomonas, Proteus and Gp. G Streptococcus resulted in 70 to 93 per cent persisting contamination. Gentamicin, to which the organisms were fully sensitive, was efficacious in controlling the infection (90 per cent plugs proving sterile after two weeks). Fucidin was less successful against Staphylococcus aureus although effective in vitro. Intravenous inoculation with a suspension of Staphylococcus aureus succeeded in contaminanting 70 per cent of sixty plain cement plugs when injected into the tail vein half an hour after closure of the leg wounds. Only 11 per cent of sixty-four plugs were so contaminanted when the injection was delayed for two weeks. This animal model is submitted as a possible future means of testing different antibiotic-cement combinations against infection.


Xiphidiocercariae from naturally infected Lymnaea columella (Mollusca, Gastropoda) in urban area: morphology and ultrastructure of the larvae and histological changes in the mollusc host.
Urban agriculture is very common in the cities, as Rio de Janeiro and adjacencies, being important as economic activity. However, this practice can create appropriate conditions for establishment and maintenance of life cycle of many parasites. Lymneid snails can act as intermediate hosts of many trematodes species, including those that infect humans and wild and domestic. In the present study, the snail Lymnaea columella was collected from an urban watercress plantations and the morphology of cercariae released by them was analyzed by light and scanning electron microscopy. The specimens were identified as xiphidiocercariae, belonging to the Cercariae Ornatae group, of the order Plagiorchiiformes. Histological examination of the digestive gland of the infected snails revealed the presence of developing sporocysts, with hemocitary infiltration and metaplasia in the epithelial tissue.


Establishment of a Human Neuronal Network Assessment System by Using a Human Neuron/Astrocyte Co-Culture Derived from Fetal Neural Stem/Progenitor Cells.
Using human cell models mimicking the central nervous system (CNS) provides a better understanding of the human CNS, and it is a key strategy to improve success rates in CNS drug development. In the CNS, neurons function as networks in which astrocytes play important roles. Thus, an assessment system of neuronal network functions in a co-culture of human neurons and astrocytes has potential to accelerate CNS drug development. We previously demonstrated that human hippocampus-derived neural stem/progenitor cells (HIP-009 cells) were a novel tool to obtain human neurons and astrocytes in the same culture. In this study, we applied HIP-009 cells to a multielectrode array (MEA) system to detect neuronal signals as neuronal network functions. We observed spontaneous firings of HIP-009 neurons, and validated functional formation of neuronal networks pharmacologically. By using this assay system, we investigated effects of several reference compounds, including agonists and antagonists of glutamate and γ-aminobutyric acid receptors, and sodium, potassium, and calcium channels, on neuronal network functions using firing and burst numbers, and synchrony as readouts. These results indicate that the HIP-009/MEA assay system is applicable to the pharmacological assessment of drug candidates affecting synaptic functions for CNS drug development.


Electromagnetic characteristics of antisymmetric toroidal dipole array of plasmonic metasurfaces.
An antisymmetric toroidal dipole array of plasmonic metasurfaces, whose unit cell consisted of a pair of physically connected asymmetric split-ring resonators, is presented in this study. Moreover, a new paradigm was established to control toroidal electric dipole properties. Toroidal electric dipoles and electric and magnetic hybrid pseudo-anapole states are excited owing to imperfect and perfect destructive interference, respectively, which leads to the spatial separation of the electric and magnetic fields and a distinct asymmetric Fano line shape in the transmission spectrum. The imperfect destructive interference was further modified by adjusting the relative position between the even and odd layers of the metasurfaces. The scattered power of the toroidal electric dipole is tuned continuously and linearly, which enables the tailoring of the electromagnetic response. The displacement sensitivity is approximately 0.13 GHz/mm over the range 0-8 mm. The modulation depth of the scattered power of the toroidal electric dipole can reach 740%, realising a toroidal electric-dipole-to-electric-dipole transition. The proposed plasmonic metasurfaces provide a platform to efficiently control near-field enhancement, far-field radiation, and electric-magnetic separation and find potential applications in frequency-selective surfaces, sensors, filters, spectroscopic tests, and many other areas.


Ehlers-Danlos syndrome.
Ehlers-Danlos syndrome (EDS) is a generalized disorder of one element of connective tissue manifesting clinically by fragility and hyperelasticity of the skin and joint laxity. It is a hereditary disorder, the inheritance being usually autosomal dominant with low penetrance. Autosomal recessive and X-linked recessive varieties are also known. First described by Hippocrates in 4(th) century B.C., the various clinical types with variable penetrance have been described lately. The number of cases EDS reported in the literature is very meagre. With the available information only about six publications of classic EDS in siblings had been reported in Indian literature.


Genetically modified CD34+ cells do not contribute to the mesenchymal compartment after autologous transplantation in the baboon.
There is ongoing controversy about the transdifferentiation of hematopoietic stem cells (HSC) into different tissues such as mesenchymal cells. This transdifferentiation or 'plasticity' would be an appealing concept for many therapeutic strategies. While studies in the murine model show encouraging results, reports from clinical allogeneic stem cell transplantations do not support the concept of HSC plasticity. Our aim was to determine whether transplantation of transduced autologous marrow CD34+ cells leads to long-term engraftment of gene-marked cells with mesenchymal characteristics in the baboon. We analyzed marrow of two baboons that had received green fluorescence protein (GFP)-marked CD34+ autologous marrow cells after myeloablative conditioning. Marrow was obtained 1 and 2.5 years after transplantation and adherent CD11a- (pan-leukocyte Ab) cells were cultured for 3 weeks. Cultures were then analyzed by flow cytometry and fluorescence microscopy for the presence of GFP+ cells. For further analysis fresh and cultured cells were also labeled with multiple Ab and functional analysis was performed. Both animals showed persistent and stable GFP marking by flow cytometry in peripheral blood leukocytes as well as in CD34+ marrow cells at 1 and 2.5 years after transplantation. There was no evidence of GFP+ mesenchymal cells by either flow cytometry or fluorescence microscopy, while functional and phenotypical analysis identified mesenchymal stem cells in these cultures. We conclude that genetically modified CD34+ cells do not contribute to the adherent marrow-derived mesenchymal cell population after autologous transplantation.


Qualitative and quantitative reversed-phase liquid chromatography of a new bisisoxazolylnaphthoquinone.
The main objective of this study was to develop and test the applicability of a sensitive, accurate, and precise liquid chromatographic (LC) method for evaluating the stability characteristics of a new bisisoxazolylnaphthoquinone, 2-(3,5-dimethyl-4-isoxazolylamino)-N-(3,5-dimethyl-4-isoxazolyl)-1,4-naphthoquinone-4-imine compound 1. The method was shown to be selective and stability-indicating. Isocratic elution with a mobile phase of methanol-water (75 + 25, v/v) on a reversed-phase column with UV detection at ambient temperature completely resolved compound 1 from its degradation products. The LC system was calibrated by plotting peak responses versus known concentrations of a reference standard by using an internal standardization procedure. Complete elution occurred after 12 min with a peak symmetry factor of 0.95 for the drug peak. The kinetic degradation of compound 1 was studied over a pH range of 0.88-14.00 to determine the kinetic parameters involved in its decomposition path in aqueous solution.


Formulation, evaluation and comparison of gels containing different COX-2 inhibitors.
PG synthesis plays major role in inflammation. The enzymes responsible for PG synthesis are cox-1 and cox-2. Cox-1 regulates physiological functions in gut and kidney while cox-2 induces inflammation. Selective cox-2 inhibitors have little effect on cox-1 and thus showed better GI tolerability. The efficacy of new drugs is not greater than that of NSAID's by oral route of administration. In the present study new selective cox-2 inhibitors also showed less efficacy than NSAID'S by topical route of administration. However if current studies confirm the reduced GI toxicity this can be the only advantage of these drugs because these drugs showed less efficacy than NSAID'S by oral and topical routes of administration.


Real-life efficacy of pregabalin for the treatment of peripheral neuropathic pain in daily clinical practice in Denmark: the NEP-TUNE study.
The aim of this study was to provide evidence regarding the real-life efficacy of pregabalin in the treatment of peripheral neuropathic pain (NeP) in Denmark. In this prospective, observational, noninterventional study, pregabalin (Lyrica(®)) was prescribed following usual clinical practice. Compared with baseline, the primary study end points after 3 months of observation were changes in 1) the average level of pain during the past week, 2) the worst level of pain during the past week, and 3) the least level of pain during the past week. The Wilcoxon signed-rank test was used to perform paired analyses, and a multivariate regression analysis investigated factors driving change in pain. A total of 86 of the 128 patients included were regarded as efficacy evaluable (those completing 3 months of pregabalin treatment). Patients (59 years) were long-time sufferers of peripheral NeP, and 38% of them had comorbidities. The majority had previously been treated with tricyclic antidepressants or gabapentin. The average dose of pregabalin was 81.5 mg/d at baseline and 240 mg/d after 3 months. A clinically and statistically significant improvement of 2.2 points in the average level of pain intensity was found after 3 months. The higher the pain intensity at baseline, the higher was the reduction of the pain score. Positive results were also found for pain-related sleep interference, patients' global impression of change, quality of life, and work and productivity impairment. Twenty-one patients reported 28 adverse events. This real-life study indicates that for some patients (two-thirds), addition of pregabalin for peripheral NeP helps to reduce their pain intensity significantly.


Treatment patterns with etanercept and adalimumab for psoriatic diseases in a real-world setting.
This study examined real-world etanercept and adalimumab treatment patterns in patients with psoriasis, psoriatic arthritis, or both. This retrospective analysis utilized data from patients with psoriasis, psoriatic arthritis, or both from a large, US claims database. Outcome measures included persistence on index therapy; pauses (7-59 days) and gaps (≥60 days) in therapy; and rates of discontinuing, switching and restarting index therapy in nonpersistent patients. Of 4,453 patients, 2,534 initiated etanercept and 1,919 initiated adalimumab. In psoriasis patients (n = 2,775), 46.4% and 56.8% on etanercept and adalimumab, respectively, were persistent for ≥12 months, 49.0% and 56.3% discontinued, 23.8% and 22.4% restarted and 14.9% and 11.3% switched index therapy within 12 months. In psoriatic arthritis patients (n = 1,197), 60.7% and 63.3% on etanercept and adalimumab, respectively, were persistent for ≥12 months, 48.3% and 51.6% discontinued, 25.8% and 20.0% restarted and 16.5% and 17.9% switched index therapy. In patients with both (n = 481), 58.1% and 59.6% on etanercept and adalimumab, respectively, were persistent for ≥12 months, 42.7% and 63.2% discontinued, 24.3% and 12.6% restarted and 21.4% and 15.8% switched index therapy. Treatment modifications were common in patients with psoriasis, psoriatic arthritis, or both within 12 months of initiating etanercept or adalimumab.


Detection of A/B toxin and isolation of Clostridium difficile and Clostridium perfringens from foals.
Toxin detection and screening could contribute to knowledge of the transmission patterns, risk factors and epidemiology of Clostridium difficile and Clostridium perfringens. To isolate C. difficile and C. perfringens and to detect A/B toxins in faecal samples from diarrhoeic and nondiarrhoeic foals. Cross-sectional observational study. A total of 153 samples from foals were collected: 139 samples from farms and 14 samples from diarrhoeic foals admitted to a veterinary hospital. The A/B toxins were detected by cytotoxicity assay. All suspected colonies of C. perfringens were subjected to polymerase chain reaction for detection of the major toxin genes (α, β, ε and ι) and for detection of β2-, NetB- and enterotoxin-encoding genes. Furthermore, C. difficile and C. perfringens isolates were evaluated for in vitro antimicrobial susceptibility. Seven of 153 (4.6%) samples, all from diarrhoeic foals, were positive for C. difficile A/B toxin. Of these, 5 of 14 (35.7%) were from hospitalised foals, and only 2 of 63 (3.2%) diarrhoeic foal samples were from farms (P = 0.002). Clostridium perfringens was isolated from 31 (20.3%) foals, of which 21 of 76 (27.6%) were diarrhoeic and 10 of 76 (13.2%) were nondiarrhoeic, demonstrating a difference between these 2 groups (P = 0.045). Only 4 strains were positive for the β2-encoding gene (cpb2). All C. difficile and C. perfringens isolates were susceptible to metronidazole and vancomycin. The present report highlights the need for laboratory diagnostics to differentiate C. difficile-associated infection in foals from other causes of diarrhoea to facilitate adequate antimicrobial therapy. More studies are needed to clarify the role of C. perfringens as a primary agent of diarrhoea in foals.


Periodic phase synchronization in coupled chaotic oscillators.
We investigate the characteristics of temporal phase locking states observed in the route to phase synchronization. It is found that before phase synchronization there is a periodic phase synchronization state characterized by periodic appearance of temporal phase-locking state and that the state leads to local negativeness in one of the vanishing Lyapunov exponents. By taking a statistical measure, we present the evidences of the phenomenon in unidirectionally and mutually coupled chaotic oscillators, respectively. And it is qualitatively discussed that the phenomenon is described by a nonuniform oscillator model in the presence of noise.


A Comprehensive Review of Polysaccharide-Based Hydrogels as Promising Biomaterials.
Polysaccharides have emerged as a promising material for hydrogel preparation due to their biocompatibility, biodegradability, and low cost. This review focuses on polysaccharide-based hydrogels' synthesis, characterization, and applications. The various synthetic methods used to prepare polysaccharide-based hydrogels are discussed. The characterization techniques are also highlighted to evaluate the physical and chemical properties of polysaccharide-based hydrogels. Finally, the applications of SAPs in various fields are discussed, along with their potential benefits and limitations. Due to environmental concerns, this review shows a growing interest in developing bio-sourced hydrogels made from natural materials such as polysaccharides. SAPs have many beneficial properties, including good mechanical and morphological properties, thermal stability, biocompatibility, biodegradability, non-toxicity, abundance, economic viability, and good swelling ability. However, some challenges remain to be overcome, such as limiting the formulation complexity of some SAPs and establishing a general protocol for calculating their water absorption and retention capacity. Furthermore, the development of SAPs requires a multidisciplinary approach and research should focus on improving their synthesis, modification, and characterization as well as exploring their potential applications. Biocompatibility, biodegradation, and the regulatory approval pathway of SAPs should be carefully evaluated to ensure their safety and efficacy.


Outcome of one-stage surgical treatment of developmental dysplasia of the hip in children from 1.5 to 6 years old. A retrospective study.
This study aimed to evaluate the outcome of one-stage treatment for developmental dysplasia of the hip (DDH) in patients after walking age. A Total of 58 children (67 hips) were retrospectively investigated to assess the efficacy and safety of one-stage treatment of developmental dysplasia of the hip (DDH) in children from 1.5 to 6 years of age with a mean follow-up of 4.00±0.43 (range 3-6.8) years. Eleven (19%) were male, forty-seven (81%) were female. Our method consisted of open reduction, Salter innominate osteotomy, femoral shortening and derotation. The patients were distributed into three groups according to the age at which they were operated: 12 (20.7%) patients with 12 hips (17.9%) were operated between 1.5 and 2 years of age (Group I), 35 (60.3%) patients with 44 hips (65.7%) were operated between 2 and 4 years (Group II), 11 (19%) patients with 11 hips (16.4%) were operated between 4 and 6 years (Group III). Clinical and radiological assessment at final follow-up showed that the outcome was not significantly different between group I and group II. But clinically, there was significant difference between group I and group III, and also between group II and group III. Although in the outcome of radiological assessment there was no significant difference between group I and group II compared with group III. The rate of avascular nerosis in group I was lower than in group II or in group III. Children with DDH between 1.5 and 6 years of age were treated successfully with one-stage treatment, but in our hands the best age at surgery is before 4 years of age.


Detection of ebaf, a novel human gene of the transforming growth factor beta superfamily association of gene expression with endometrial bleeding.
Human endometrium is unique since it is the only tissue in the body that bleeds at regular intervals. In addition, abnormal endometrial bleeding is one of the most common manifestations of gynecological diseases, and is a prime indication for hysterectomy. Here, we report on a novel human gene, endometrial bleeding associated factor (ebaf), whose strong expression in endometrium was associated with abnormal endometrial bleeding. In normal human endometrium, this gene was transiently expressed before and during menstrual bleeding. In situ hybridization showed that the mRNA of ebaf was expressed in the stroma without any significant mRNA expression in the endometrial glands or endothelial cells. The predicted protein sequence of ebaf showed homology with and structural features of the members of TGF-beta superfamily. Fluorescence in situ hybridization showed that the ebaf gene is located on human chromosome 1 at band q42.1. Thus, ebaf is a novel member of the TGF-beta superfamily and an endometrial tissue factor whose expression is associated with normal menstrual and abnormal endometrial bleeding.


Distribution and abundance of freshwater decapods in an Atlantic rainforest catchment with a dammed future.
Variations in physical characteristics along the course of a river influence habitat availability which reflects in species distribution. Knowledge of ecology and diversity of lotic species is important for evaluating how river ecosystems will respond to environmental impacts. Freshwater decapods are a group of high ecological and economic importance, but the knowledge about factors influencing their distribution is scarce in Brazil. We performed a survey of decapods to describe their abundance and distribution as well as to study their relationships with stream physical variables and especially their association with different substrates types. We studied 23 sites located in 15 tributaries of Guapiaçú River, RJ, where we collected decapods in different substrates types and measured a set of physical variables. We found five decapods species, including amphidromous and non-amphidromous shrimps and crabs. Decapods were strongly associated with leaf-litter substrates and their abundance was related to a multivariate axis describing longitudinal changes in stream characteristics. We concluded that decapods occurring in the Guapiaçú catchment inhabit mainly small streams with preserved riparian forests where they find shelter and potential prey of invertebrates. The ongoing project to build a dam on the Guapiaçú River will have negative consequences to migrating shrimps and we strongly recommend that mitigating actions, such the construction of structures to allow the passage of migrating fauna, should be taken.


Effect of flow disturbance on ultrasonic backscatter from blood.
Due to the better resolution and performance provided by the new generation of real-time high resolution ultrasonic scanners, blood now becomes a tissue which can also be visualized ultrasonically. There is strong experimental evidence indicating that the echogenicity of blood is increased as a result of erythrocyte aggregation. In this paper, we will show that flow disturbance may also play a significant role in influencing blood ultrasonic backscatter or echogenicity. Our results indicate that the introduction of turbulent flow can cause ultrasonic backscatter from erythrocyte suspensions to increase appreciably for hematocrits greater than 10%. We will also show that this increase may be correlated to the turbulent intensity. Moreover, the scattering peak is observed to shift to lower hematocrits when turbulence is eliminated. Experimental results obtained for uniform flow are in excellent agreement with theoretical models for small spherical scatterers which predict a scattering maximum at a hematocrit of 13%.


PNPLA3 rs1010023 Predisposes Chronic Hepatitis B to Hepatic Steatosis but Improves Insulin Resistance and Glucose Metabolism.
PNPLA3 polymorphisms serve as the genetic basis of hepatic steatosis in normal population and lead to dysregulated glucose metabolism. Whether it underlies the hepatic steatosis and glucose homeostasis in chronic hepatitis B patients remains uncertain. Here, we investigated the PNPLA3 polymorphisms in biopsy-proven chronic hepatitis B patients with (CHB+HS group, n = 52) or without hepatic steatosis (CHB group, n = 47) and non-CHB subjects with (HS group, n = 37) or without hepatic steatosis (normal group, n = 45). When compared to the TT genotype, C-allele at PNPLA3 rs1010023 (CC and TC genotypes) conferred higher risk to hepatic steatosis in chronic hepatitis B patients (odds ratio (OR) = 1.768, 95% confidence interval (CI): 1.027-3.105; P = 0.045) independent of age, gender, and body mass index. In contrast to their role in hepatic steatosis, CC and TC genotypes of PNPLA3 rs1010023 were correlated to significant improvement of homeostasis model assessment index (HOMA-IR) as compared to TT genotype in the CHB+HS group. Downregulated fasting blood glucose also characterized the CHB+HS patients with C-allele at PNPLA3 rs1010023 (CC/TC versus TT: 4.81 ± 0.92 mmol/L versus 5.86 ± 2.11 mmol/L, P = 0.02). These findings suggest that PNPLA3 rs1010023 may predispose chronic hepatitis B patients to hepatic steatosis but protects them from glucose dysregulation by attenuating insulin resistance.


[Combined action of nitrofuran preparations and bile acids on staphylococci].
The effect of cholic, glycocholic and deoxycholic bile acids on the antimicrobial activity of furacin, furadonin, furagin and furoxone was studied with the use of collection strains and fresh isolates of staphylococci. The method of dilutions in liquid media was used. Cholic and glycocholic acids lowered the MIC of furacin, furadonin, furoxone and furagin with respect to the collection strains by 4-16, 5, 4-6 and 22-37 times, respectively. The potentiating effect of deoxycholic acid on the nitrofuran drugs was even more pronounced. Thus, when the nitrofurans were used in combination with deoxycholic acid, their MIC dropped by 16-114 times. A significant increase in the antimicrobial activity of the nitrofurans under the effect of the bile acids was also observed with respect to the fresh isolates of Staphylococcus, while it was somewhat lower. The subbacteriostatic doses of cholic, glycocholic and deoxycholic bile acids also increased the bactericidal effect of the nitrofuran drugs. The minimum bactericidal concentrations (MBC) of furacin, furoxone, furadonin and furagin decreased from 12.5, 2.08, 25.0 and 1.82 to 0.78, 0.26, 2.34 and 0.032 micrograms/ml, respectively. The most pronounced decrease in the MBC was observed under the effect of deoxycholic acid. Therefore, the bile acids potentiated the nitrofuran antistaphylococcal activity. The combinations of deoxycholic acid with furagin or furoxone were the most effective.