Images from a jointly-arousing collective ritual reveal affective polarization.
Collective rituals are biologically ancient and culturally pervasive, yet few studies have quantified their effects on participants. We assessed two plausible models from qualitative anthropology: ritual empathy predicts affective convergence among all ritual participants irrespective of ritual role; rite-of-passage predicts emotional differences, specifically that ritual initiates will express relatively negative valence when compared with non-initiates. To evaluate model predictions, images of participants in a Spanish fire-walking ritual were extracted from video footage and assessed by nine Spanish raters for arousal and valence. Consistent with rite-of-passage predictions, we found that arousal jointly increased for all participants but that valence differed by ritual role: fire-walkers exhibited increasingly positive arousal and increasingly negative valence when compared with passengers. This result offers the first quantified evidence for rite of passage dynamics within a highly arousing collective ritual. Methodologically, we show that surprisingly simple and non-invasive data structures (rated video images) may be combined with methods from evolutionary ecology (Bayesian Generalized Linear Mixed Effects models) to clarify poorly understood dimensions of the human condition.


[Rhabdomyolisis associated with alcohol and cocaine intake].
We report a case of rhabdomyolisis in association with alcohol and cocaine intake. An 18 year-old boy consumed cocaine and alcohol and afterwards suffered from hyperthermia and rhabdomyolisis associated with decreased conscious level, severe renal insufficiency requiring hemodialysis, and persistent metabolic acidemia. Creatine phosphokinase raised up to 40.824 UI/l. He recovered two weeks later but a year of kinesiology treatment was required in order to recover strength and muscular mass. Rhabdomyolisis, a well documented complication of cocaine and other undue drugs, has been reported in 24% of cocaine users. The mechanism of cocaine-associated rhabdomyolisis is unclear but should be related with direct toxicity and/or ischemia due to vasoconstriction explained by the inhibition of the presinaptic reuptake of catecholamins. In unexplained cases of rhabdomyolisis, cocaine and other undue drugs consumption should be suspected.


Timing clorpirifos + cypermethrin and indoxacarb applications to control European corn borer damage and fumonisin contamination in maize kernels.
European corn borer (ECB) is the main maize pest in central and southern Europe and it promotes the infection of maize with Fusarium verticillioides, which is able to produce fumonisins. Field experiments were performed from 2006 to 2007 in northwestern Italy to determine the effects of the timing of insecticide applications on maize fungal ear rot and fumonisin contamination in natural infection conditions. Four application timings and two insecticides (clorpirifos + cypermethrin and indoxacarb) were compared each year. In both years, the treatments applied at the beginning of a consistent ECB flight activity and at the flight peak showed the best efficacy to control the insect damage on ears. Fungal ear rot and fumonisin contamination were clearly affected by ECB control. The efficacy of the best application timing to control fumonisin occurrence was 73% in 2006 and 84% in 2007. Earlier insecticide applications showed lower fumonisin contamination than treatments applied after the adult flight peak. The production of maize and maize-based foods with a low fumonisin content may be enhanced through correct insecticide application against the second ECB generation. The optimum timing of insecticides is between the beginning of a consistent adult flight activity and the flight peak.


In vitro multimerization of von Willebrand factor is triggered by low pH. Importance of the propolypeptide and free sulfhydryls.
Large von Willebrand factor (vWf) multimers are assembled by the formation of disulfide bonds between dimers in trans Golgi and post-Golgi compartments. We were able to reproduce this process in a cell-free system using purified vWf dimers. The multimers formed in vitro extended to 5 x 10(6) Da and were similar in size distribution to those secreted constitutively by endothelial cells in culture. Multimerization occurred only at acidic pH with an optimum at pH 5.8 and needed the continued presence of an acidic pH for it to proceed. Pro-vWf dimers multimerized, whereas mature dimers failed to assemble into large multimers. Multimerization required the propolypeptide to be a contiguous part of pro-vWf subunits since free propolypeptide did not promote multimerization of mature dimers. In addition, multimers formed in the presence of both pro-vWf and mature vWf dimers incorporated only pro-vWf dimers. Two out of six available monoclonal antibodies to the prosequence inhibited multimerization. Multimerization was also inhibited by chemical blocking of free sulfhydryl(s). The free sulfhydryl(s) were localized to the mature region of the pro-vWf by examination of the mature subunit and the propolypeptide derived by proteolytic cleavage of pro-vWf subunits.


Proteochemometrics modeling of the interaction of amine G-protein coupled receptors with a diverse set of ligands.
We have evaluated the proteochemometrics approach in the analysis of the interactions of a diverse set or organic ligands with subtypes of serotonin, dopamine, histamine, and adrenergic receptors. As used herein, proteochemometrics exploits affinity data for series of organic amines binding to wild-type amine G protein-coupled receptors, correlating it to descriptions and cross-description derived from the primary amino acid sequences of the receptors and the computed structures of the organic compounds. We show that after appropriate data preprocessing, statistically valid models that have good external predictive ability can be created. Evaluation of the models gave important quantitative insight into the mode of interactions of the amine G protein-coupled receptors with their ligands.


Relation of renin-angiotensin system activity to left ventricular hypertrophy and function in experimental and human hypertension.
This article examines available data concerning the hypothesis that the renin-angiotensin system directly stimulates cardiac hypertrophy and dysfunction in hypertension. Several experiments support a direct effect of angiotensin on myocardial protein synthesis and suggest that this may be independent of adrenergic influences. However, the role played by the renin system in the pathogenesis of hypertensive cardiac hypertrophy may be small, for left ventricular (LV) muscle mass is not systematically greater in high-renin as opposed to low-renin forms of experimental or human hypertension. In animal studies, regression of LV hypertrophy is more consistently observed in response to drugs that inhibit as opposed to those that stimulate renin-angiotensin system activity (i.e., converting enzyme inhibitors or beta-adrenoceptor blockers vs. diuretics or direct vasodilators), although the difference is more quantitative than absolute. Similarly, significant reductions in LV mass occurred in 13 of 16 human trials with converting enzyme inhibitors or beta blockers as opposed to 2 of 10 trials with diuretics or vasodilators (mean = 7.11; p less than 0.01). However, uncertainties regarding the degree of reduction in angiotensin II and adrenergic effects, possible interactions between these systems, and incomplete characterization of induced changes in hemodynamic load on the heart all limit the interpretation of available studies. Preliminary data suggest that an inverse relation exists between renin-angiotensin system activity and LV systolic performance in primary and secondary human hypertension, a possibility that merits further study.


Nickel-Catalyzed Enantioselective Synthesis of Pre-Differentiated Homoallylic syn- or anti-1,2-Diols from Aldehydes and Dienol Ethers.
Nickel catalysis allied with cyclodiphosphazane or VAPOL-derived phosphoramidite ligands provides selective access to monoprotected vicinal diols by reductive coupling of dienol ethers and aldehydes. The observed regioselectivity is unprecedented, in that the diene reacts at the least nucleophilic and most hindered C atom that is attached to the oxygen substituent rather than at the terminal position. Notably, both syn and anti diastereomers of the products can be accessed depending on the configuration of the diene partner with usually excellent diastereo- and enantioselectivity.


Chronic allograft nephropathy: pathogenesis and management of an important posttransplant complication.
Chronic allograft nephropathy is a devastating complication of kidney transplantation that is responsible for a significant proportion of graft loss. This complication is characterized by a progressive decline in kidney function, which is not attributable to a specific cause. Many risk factors exist for the development of chronic allograft nephropathy, including donor-, recipient-, and transplant-related factors (eg, use of calcineurin inhibitors and acute rejection episodes), as well as comorbid conditions such as hypertension and hyperlipidemia. There is no definitive treatment for this complication; management has focused on minimization or withdrawal of calcineurin inhibitors in conjunction with addition of sirolimus or mycophenolate mofetil. Alterations in the immunosuppressive regimen must be done cautiously, as precipitating acute rejection will cause further damage to the allograft. Optimal control of blood pressure, particularly with the use of agents such as angiotensin II receptor blockers, in conjunction with management of dyslipidemia may be effective concurrent therapies in patients with chronic allograft nephropathy.


The role of dissociation-related beliefs about memory in trauma-focused treatment.
Dysfunctional cognitions play a central role in the development of post-traumatic stress disorder (PTSD). However the role of specific dissociation-related beliefs about memory has not been previously investigated. This study aimed to investigate the role of dissociation-related beliefs about memory in trauma-focused treatment. It was hypothesized that patients with the dissociative subtype of PTSD would show higher levels of dissociation-related beliefs, dissociation-related beliefs about memory would decrease after trauma-focused treatment, and higher pre-treatment dissociation-related beliefs would be associated with fewer changes in PTSD symptoms. Post-traumatic symptoms, dissociative symptoms, and dissociation-related beliefs about memory were assessed in a sample of patients diagnosed with PTSD (n = 111) or the dissociative subtype of PTSD (n = 61). They underwent intensive trauma-focused treatment consisting of four or eight consecutive treatment days. On each treatment day, patients received 90 min of individual prolonged exposure (PE) in the morning and 90 min of individual eye movement desensitization and reprocessing (EMDR) therapy in the afternoon. The relationship between dissociation-related beliefs about memory and the effects of trauma-focused treatment was investigated. Dissociation-related beliefs about memory were significantly associated with PTSD and its dissociative symptoms. In addition, consistent with our hypothesis, patients with the dissociative subtype of PTSD scored significantly higher on dissociation-related beliefs about memory pre-treatment than those without the dissociative subtype. Additionally, the severity of these beliefs decreased significantly after trauma-related treatment. Contrary to our hypothesis, elevated dissociation-related beliefs did not negatively influence treatment outcome. The results of the current study suggest that dissociation-related beliefs do not influence the outcome of trauma-focused treatment, and that trauma-focused treatment does not need to be altered specifically for patients experiencing more dissociation-related beliefs about memory because these beliefs decrease in association with treatment.


Rat hypothalamus contains an antimitogenic factor acting via benzodiazepine receptors.
The effect of crude rat hypothalamic extracts on the lymphocyte proliferation in vitro was investigated. It was found that hypothalamic extracts (HE) significantly inhibited the 3H-thymidine incorporation by the mouse spleen lymphocytes cultured in vitro. The factor (or factors) responsible for the antimitogenic effect is thermostabile and partially destroyable by trypsin digestion. The latter observation suggests that it is probably a peptide. Diazepam had been found to exert a similar antimitogenic effect on mouse spleen lymphocytes as HE. The putative endogenous benzodiazepine (BZD) receptor ligand is also assumed to be a peptide. The working hypothesis that the antimitogenic effect of HE depends on endogenous substance acting via BZD receptor was proposed. To test such a possibility, the interaction of HE and specific BZD receptor ligands Ro-15-1788 and Ro-5-4864 was investigated. It was found that Ro-5-4864 alone suppressed the lymphocyte proliferation, and the joint antiproliferative effect of HE and Ro-5-4864 was not additive. Ro-15-1788 alone did not influence the lymphocyte proliferation but abolished the antiproliferative effect of HE. These data suggest that antimitogenic factor present in HE acts via BZD receptors.


Aberrant expression of genes and proteins in pterygium and their implications in the pathogenesis.
Pterygium is a common ocular surface disease induced by a variety of factors. The exact pathogenesis of pterygium remains unclear. Numbers of genes and proteins are discovered in pterygium and they function differently in the occurrence and development of this disease. We searched the Web of Science and PubMed throughout history for literatures about the subject. The keywords we used contain pterygium, gene, protein, angiogenesis, fibrosis, proliferation, inflammation, pathogenesis and therapy. In this review, we summarize the aberrant expression of a range of genes and proteins in pterygium compared with normal conjunctiva or cornea, including growth factors, matrix metalloproteinases and tissue inhibitors of metalloproteinases, interleukins, tumor suppressor genes, proliferation related proteins, apoptosis related proteins, cell adhesion molecules, extracellular matrix proteins, heat shock proteins and tight junction proteins. We illustrate their possible mechanisms in the pathogenesis of pterygium as well as the related intervention based on them for pterygium therapy.


Diagnosis and Detection.
The aim of the chapter is to provide a practical but exhaustive guide in detecting macular edema and to describe its features according to the retinal condition that causes it. The most useful imaging techniques (biomicroscopy, retinography, optical coherence tomography, and fluorescein/indocyanine-green angiography will be analyzed in order to identify the best diagnostic algorithm in each pathology. There is a table at the end of the chapter which summarizes the important points of the chapter.


Transformation of expression intensities across generations of Affymetrix microarrays using sequence matching and regression modeling.
The utility of previously generated microarray data is severely limited owing to small study size, leading to under-powered analysis, and failure of replication. Multiplicity of platforms and various sources of systematic noise limit the ability to compile existing data from similar studies. We present a model for transformation of data across different generations of Affymetrix arrays, developed using previously published datasets describing technical replicates performed with two generations of arrays. The transformation is based upon a probe set-specific regression model, generated from replicate measurements across platforms, performed using correlation coefficients. The model, when applied to the expression intensities of 5069 shared, sequence-matched probe sets in three different generations of Affymetrix Human oligonucleotide arrays, showed significant improvement in inter generation correlations between sample-wide means and individual probe set pairs. The approach was further validated by an observed reduction in Euclidean distance between signal intensities across generations for the predicted values. Finally, application of the model to independent, but related datasets resulted in improved clustering of samples based upon their biological, as opposed to technical, attributes. Our results suggest that this transformation method is a valuable tool for integrating microarray datasets from different generations of arrays.


Whole blood ristocetin-activated platelet impedance aggregometry (Multiplate) for the rapid detection of Von Willebrand disease.
Von Willebrand disease (VWD) is the most common bleeding disorder, but no bedside tests specific for Von Willebrand factor are available. The objective of this study was to evaluate the diagnostic accuracy of whole blood ristocetin-induced platelet aggregometry (WB-RIPA) in VWD. WB-RIPA was performed in VWD patients (n=100) and healthy controls (n=17) using the Multiplate® platelet impedance aggregometry platform. The diagnostic properties of the test were described as sensitivity/specificity, positive and negative predictive value, and ROC area under the curve (AUC). Patients with VWD had impaired platelet aggregation by WB-RIPA. At a cut-off of 98 U, the test sensitivity and specificity of WB-RIPA for VWD was 0.95 and 0.53. A cut-off of 60 U provided a specificity of 1.00 with reduced sensitivity of 0.76. All patients with type 3 VWD and >90 % of patients with type 2 VWD were accurately distinguished from the controls. Incorrect classifications were attributable to patients with type 1 VWD, showing partly overlapping WB-RIPA results with healthy controls. Remarkably, these patients had lower bleeding scores and higher VWF activity than other type 1 VWD patients. Overall, WB-RIPA discriminated VWD patients from healthy controls accurately with a ROC AUC of 0.94. These results show that WB-RIPA is a promising diagnostic test for VWD, especially when timely results are required. Depending on the chosen test threshold, WB-RIPA could be clinically used as a rule out test, or to suggest patients in whom further testing for VWD is warranted.


Polymorphism of angiotensin converting enzyme is associated with severe circulatory compromise in febrile neutropenic children with cancer.
Angiotensin converting enzyme (ACE) gene insertion(I)/deletion(D) polymorphism influences the outcome of a number of cardiovascular diseases. ACE I/D polymorphism was investigated by PCR in 207 pediatric cancer patients and 144 controls. ACE I/D distribution of patients and controls was similar. The frequency of the D allele and the prevalence of the deletion (DD) genotype were significantly (P < 0.05) higher among patients with severe circulatory compromise requiring treatment in the intensive care unit (ICU) than among the other patients and controls. Patients with the DD and ID genotypes spent significantly (P < 0.05) longer time in the ICU than patients with the II genotype.


Kinetic isotope effects on dehalogenations at an aromatic carbon.
In order to interpret the observed isotopic fractionation it is necessaryto understand its relationship with the isotope effect(s) on steps that occur during the conversion of the initial reactant to the final product. We examine this relationship from the biochemical point of view and elaborate on the consequences of the assumptions that it is based on. We illustrate the discrepancies between theoretical and experimental interpretation of kinetic isotope effects on examples of dehalogenation reactions that occur at an aromatic carbon atom. The examples include 4-chlorobenzoyl-CoA dehalogenase-catalyzed conversion of 4-chlorobenzoyl-CoA to 4-hydroxybenzoyl-CoA, dehaloperoxidase-catalyzed conversion of 2,4,6-trichlorophenol to 2,6-dichloroquinone, and spontaneous hydrolysis of atrazine at pH 12. For this latter reaction we have measured the chlorine kinetic isotope effect and estimated its value theoretically at the DFT level of theory. Results of chlorine kinetic isotope effects suggest that the studied dechlorination reactions proceed in a single step with significant weakening of the carbon-chlorine bond in the transition state.


The GA 20-Oxidase Encoding Gene MSD1 Controls the Main Stem Elongation in Medicago truncatula.
Plant height is an important agronomic trait that is closely related to biomass yield and crop production. Despite legumes comprise one of the largest monophyletic families that are second only to grasses in terms of economic and nutritional values, due to an ancient genome duplication event, most legume plants have complex genomes, thus the molecular mechanisms that determine plant height are less known in legumes. Here, we report the identification and characterization of MAIN STEM DWARF1 (MSD1), which is required for the plant height in the model legume Medicago truncatula. Loss of function of MSD1 leads to severely reduced main stem height but normal lateral branch elongation in M. truncatula. Histological analysis revealed that the msd1-1 main stem has shorter internodes with reduced cell size and number compared with the wild type, indicating that MSD1 affects cell elongation and cell proliferation. MSD1 encodes a putative GA 20-oxidase that is expressed at significantly higher levels in the main shoot apex than in the lateral shoot apices, suggesting that MSD1 expression is associated with its effect on the main stem elongation. UPLC-MS/MS analysis showed that GA9 and GA4, two identified products of the GA 20-oxidase, were severely reduced in msd1-1, and the dwarf phenotype of msd1-1 could be rescued by supplementation with gibberellic acid GA3, confirming that MSD1 functions as a biologically active GA 20-oxidase. Moreover, we found that disruption of either MtGA20ox7 or MtGA20ox8, homologs of MSD1, has little effects on the elongation of the main stem, while the msd1-1 mtga20ox7-1 mtga20ox8 triple mutants exhibits a severe short main shoot and lateral branches, as well as reduced leaf size, suggesting that MSD1 and its homologs MtGA20ox7 and MtGA20ox8, redundantly regulate M. truncatula shoot elongation and leaf development. Taken together, our findings demonstrate the molecular mechanism of MSD1-mediated regulation of main stem elongation in M. truncatula and provide insights into understanding the functional diversity of GA 20-oxidases in optimizing plant architecture in legumes.


The impact of the coronavirus pandemic on patients hospitalized due to acute coronary syndrome.
The coronavirus disease 2019 (COVID-19) pandemic significantly increased mortality worldwide. However, only part of the excess mortality is related directly to the infection. Local healthcare accessibility, time to reach medical care and patients' reluctance to seek medical aid strongly affected the treatment results in many fields. The current report aims to analyze mortality and morbidity in patients who suffered from acute coronary syndrome (ACS) during the COVID-19 pandemic, as well as to investigate the factors that may have a significant impact on their baseline characteristics and outcome. Multiple reports were evaluated. Most of them point to reluctance and longer time to reach medical care, longer pre-hospital delay, lower overall number of ACS admissions, greater percentage of ST-elevation myocardial infarction patients and complications. Younger and less ill patients were more likely to suffer from ACS than in the pre-pandemic period. They presented with more prominent biomarker elevation. Further, the number of invasive procedures dropped significantly, which was most prominent in the field of surgical revascularization. Consequently, a higher number of adverse events and greater mortality during the COVID-19 pandemic were noted, which was valid for both patients with and without coronavirus infection. In summary, the pandemic had a great impact on overall populational mortality and morbidity, which was greatly pronounced in patients with cardiovascular disease, particularly in ACS cases. They differed in baseline characteristics, underwent different treatment and their outcome was worse as compared with the period prior to the pandemic.


Bilateral poly implant prothèse implant rupture: an uncommon presentation.
A woman in her 50s underwent delayed bilateral Poly Implant Prothèse implant reconstruction following mastectomy for breast cancer. Symptoms of implant rupture developed 43 months after surgery with an erythematous rash on her trunk. The rash then spread to her reconstructed breast mounds. Initial ultrasound scan and magnetic resonance imaging were normal; however, subsequent magnetic resonance imaging demonstrated left implant rupture only. In theater, following removal of both implants, both were found to be ruptured. The rash on her trunk resolved within 3 weeks in the postoperative period. Chemical analyses of silicone in both implants confirmed a nonauthorized silicone source; in addition, the chemical structure was significantly different between the left and right implant, perhaps explaining the variation in presentation.


Impact of genetic variations and transcriptional alterations of HLA class I genes on cervical cancer pathogenesis.
In a novel attempt to understand the variations in DNA sequences underlying HLA class I alleles associated with HPV16-related CaCx, we determined the alleles by reconstructing SNP-based haplotypes from resequencing of the most polymorphic exons 2 and 3 of HLA-A, HLA-B and HLA-C. We also determined the impact of SNPs and transcriptional alterations of the genes on CaCx. A high density of SNPs was identified from resequencing. HLA expression was determined by real-time PCR. We identified that even a single associated HLA allele had many underlying SNP-based haplotypes. Out of the most frequent (≥5%) HLA class I alleles, HLA-B*40:06 and HLA-B*15:02 respectively imparted significant risk towards and protection from CaCx as well as HPV16 infection. Employing median-joining networks to detect clusters of sequence-variations for specific HLA alleles, we found the protective SNP-based signature, GAATTTA, in all SNP-based haplotypes of HLA-B*15:02 allele. The signature was derived from seven SNPs within HLA-B which were newly associated with the disease. Contrarily, similarly derived risk-signature, TTGCGCC, mapped only to 52% of SNP-based haplotypes of HLA-B*40:06 allele. This indicated that all SNP-based haplotypes underlying a particular associated HLA allele might or might not have a single signature of risk/protection. HLA-A, HLA-B and HLA-C expressions were downregulated among CaCx cases compared to asymptomatic infections and HPV-negative controls. HLA-A and HLA-B were repressed in both cases harbouring episomal and integrated HPV16, whereas HLA-C in only the latter. Novel genetic variations and differential downregulation-patterns of HLA class I have a significant bearing on HPV16-related CaCx pathogenesis.


Treatment of x-ray ulcers by omental transposition.
A case is reported of closure of a very deeply penetrating X-ray ulcer of the axilla. Omental tissue was used as a pedicle flap and the advantages of this procedure to cover and salvage ischaemic tissue are pointed out.


Immunosuppressive therapy: a potential alternative to bone marrow transplantation as initial therapy for acquired severe aplastic anemia in childhood?
Currently bone marrow transplantation (BMT) with an HLA-identical sibling donor is recommended as optimal therapy for children with acquired severe aplastic anemia (SAA). Immunosuppressive therapy (IST) has become a very successful initial therapy for SAA in children lacking a related bone marrow donor. We wished to evaluate whether current IST regimens may be as efficacious as BMT. A retrospective review identified children treated for SAA over a 12-year period. Children with a related donor received a BMT. Children lacking a donor were treated with IST followed by a "rescue" BMT if IST was ineffective. IST consisted of anti-thymocyte globulin and steroid +/- cyclosporine A. Transfusion independence and survival rates were compared between the two groups. Twenty-seven children were identified. Nine received a related BMT; seven of these survive and are transfusion independent (median follow-up 54 months). Sixteen of 18 patients who received IST are transfusion-independent survivors, including three of four patients who received a rescue BMT (median follow-up 33.5 months). Actuarial survival is 75% (95% CI = 45%, 105%) and 92% (95% CI = 78%, 107%) for the BMT and IST groups, respectively (p = 0.15). Severe toxicity was not experienced by any patient as a result of IST. Equivalent rates of transfusion independence and survival were experienced by patients receiving BMT and IST. We propose that a prospective trial be undertaken to evaluate IST as initial therapy in all children with SAA, to be followed by BMT if there is inadequate response.


Cystic duct leaks after laparoendoscopic single-site cholecystectomy.
Leakage from the clipped cystic duct stump (cystic duct stump leak [CDSL]) as a cause of biliary peritonitis has not been emphasized enough. It deserves special mention because it is not an uncommon cause and it is easier to treat. With the advent of laparoendoscopic single-site (LESS) cholecystectomy, its occurrence in relation to other causes of biliary peritonitis needs reexamination. Details of 756 patients undergoing LESS cholecystectomy were analyzed, and patients presenting with biliary peritonitis were identified. The investigative profile included an ultrasound, contrast-enhanced computed tomography scan, and endoscopic retrograde cholangiopancreatography (ERCP) to identify the site of leak. The management in addition to stenting included abdominal tube drainage. There were 5 (0.66%) patients, all female, with biliary peritonitis, and 4 of them (0.53%) had cystic stump leakage as identified by ERCP. The usual time of presentation was in the first week after surgery, with acute abdominal pain and vomiting. Common bile duct stenting was carried out, after choledocholithotomy where required, at the same ERCP session. Tube abdominal drain was required in 2 patients, and 1 patient had to undergo exploratory laparotomy for an associated acute intestinal obstruction. All the patients recovered completely. The stent was removed between 4 and 6 weeks after ERCP. Effective CDSL management requires early recognition and management. ERCP is the cornerstone for correct identification, and common bile duct stenting was curative in all patients.


Femtosecond Raman-Induced Kerr Effect Study of Temperature-Dependent Intermolecular Dynamics in Pyrrolidinium-Based Ionic Liquids: Effects of Anion Species.
We investigated the temperature dependence of the intermolecular vibrational dynamics of pyrrolidinium-based ionic liquids (ILs) with 10 different anion species using femtosecond Raman-induced Kerr effect spectroscopy. The features of the temperature-dependent vibrational spectra vary with the different anions. In the case of the ILs with spherical top anions, such as tetrafluoroborate and hexafluorophosphate, and trifluoromethanesulfonate, the spectral intensity in the low-frequency region below 50 cm-1 increases with rising temperature, while that in the high-frequency region above 50 cm-1 remains almost unchanged. Similar temperature-dependent features were also found in the bis(fluorosulfonyl)amide and bis(perfluoroalkylsulfonyl)amide salts. However, the difference spectra at respective temperature relative to 293 K indicate that the spectra of the bis(fluorosulfonyl)amide and bis(perfluoroalkylsulfonyl)amide salts are more temperature-sensitive in the low-frequency region below 50 cm-1 compared to those of the tetrafluoroborate, hexafluorophosphate, and trifluoromethanesulfonate salts. The spectra of 1-butyl-1-methylpyrrolidinium-based ILs with dicyanamide and tricyanomethide anions show a characteristic temperature dependence; in addition to an increase of the spectral intensity in the low-frequency region below 50 cm-1, a red shift of the spectra in the high-frequency side above 50 cm-1 was observed with increasing temperature. This implies that the librational motions of planar dicyanamide and tricyanomethide anions contribute substantially to the low-frequency spectra. We also compared the temperature-dependent low-frequency spectra of 1-butyl-1-methylpyrrolidinium- and 1-(2-methoxyethyl)-1-methylpyrrolidinium-based ILs with some anions. Although the spectral shapes are slightly different in the range of 70-150 cm-1, which can be attributed to the intramolecular vibrational modes of the cations, the temperature dependence of the spectral shapes is quite similar, indicating that the ether substitution in the cation side groups has little effects on the temperature dependence of the low-frequency spectra. The fragilities of the ILs were also estimated from the temperature-dependent viscosities and the glass-transition temperatures. The fragility parameter seems to be correlated with the temperature dependence of the first moment of the low-frequency spectral bands mainly arising from the intermolecular vibrations of the ILs.


Micro-tensile bond strength of different adhesive systems on sound dentin and resin-based composite: An in-vitro study.
To analyze the difference in the micro-tensile bond strength of specimens made with two different adhesive systems and compare them with two homogenous substrates. Sixty permanent mandibular molars were mounted in acrylic blocks and sectioned with exposed dentin surfaces. Samples were then divided into four groups. To Group-I Adper Single Bond 2 and to Group-II Adper Self-Etch plus bonding agents were applied. For Group-I and Group-II beams consisted of resin composite in the upper half and dentin in the lower half. In Group-III beams were made of only dentin. In Group-IV beams were made of only composite. Fifteen specimens of each group were taken for the micro-tensile bond strength test. The results are analyzed using one-way analysis of variance and Critical Difference test. The interface bonded with the two adhesive systems had lower micro-tensile bond strength than those of dentin and resin composite and the self-etching adhesive Adper Self-Etch plus had comparable bond strength with total-etch adhesive Adper Single Bond 2. The bond strength values for current adhesive systems cannot be compared to the micro-tensile bond strength of dentin and resin composite, and self-etching adhesives have comparable bond strength with total-etch adhesives.


[Screening of AGGF1 interacting with inhibitor of differentiation-1].
To screen the proteins interacting with inhibitor of differentiation 1(Id1) using yeast two-hybrid analysis in adult human lung cDNA libraries. The coding sequence of Id1 was amplified by PCR and cloned into the bait plasmid. The recombinant bait vector pHybLex/Zeo-Id1 was verified by restriction endonuclease digestion before transformation into the yeast strain EGY48/pSH18-34, which was tested subsequently for reporter genes Leu2 and LacZ activation. The pHybLex/Zeo-Id1 plasmid and the cDNA library plasmid were sequentially transformed into the yeast strains and screened to obtain Leu2(+) and Leu2(+)LacZ(+) clones, with the false positive clones excluded using positive and negative controls, and the plasmid of the true positive clone was sequenced and blasted for homological analysis. Successful construction of pHybLex/Zeo-Id1 was confirmed by enzyme digestion. After transformation of pHybLex/Zeo-Id1 into EGY48/pSH18-34, no specific reporter genes Leu2 and LacZ activation was found. The pHybLex/Zeo-Id1 plasmid and the cDNA library plasmid were sequentially transformed into yeast strain, and 198 Leu(+) clones and 19 Leu(+)LacZ(+) double positive clones were obtained. After elimination of the false positive clones, one true positive clone was obtained, whose plasmid analysis by sequencing and blasting indicated high homology (99.5%, 556/559) to AGGF1 (an angiogenic factor with G-patch and FHA domains 1). AGGF1 expression was confirmed in the true positive yeast cells by Western blotting. AGGF1 is confirmed to interact with Id1 by yeast two-hybrid analysis for screening adult human lung cDNA libraries.


Long-term effect of anticoagulation following left atrial appendage occlusion with the LARIAT device in patients with nonvalvular atrial fibrillation: impact on thromboembolism, bleeding and mortality. Real life data.
Indications for left atrial appendage occlusion (LAAO) are varied and patients require individual management strategies. However, currently no guidelines exist for postprocedure oral anticoagulation (OAC) after an LAAO procedure. To evaluate the effect of OAC on thromboembolism, bleeding and mortality following the LAAO procedure for patients with AF. One hundred and thirty-nine consecutive patients with nonvalvular atrial fibrillation (NVAF) who underwent LAAO with the LARIAT device were followed for at least 40 months. Decisions about OAC and its modifications were individualized based on clinical presentation, patient and physician preferences. Following LAAO, 52 (41%) patients did not receive OAC (No-OAC group) and 75 (59%) patients received OAC (OAC group), without any intergroup differences in CHADS2, CHA2DS2-VASc score or other thromboembolic risk factors. The median HAS-BLED score was higher in the OAC-group (median 3 (3-4) vs. 3 (2-4), p = 0.014). During a median follow-up time of 51 (43-57) vs. 55 (48-59) months in the No-OAC group and in the OAC group (p = 0.19) there were no significant differences between groups in ischemic stroke/TIA, 0 (0%) vs. 2 (2.7%), other thromboembolic events, 0 (0%) vs. 1 (1.3%), life-threatening, disabling or major events, 2 (3.7%) vs. 2 (2.7%), or annual mortality rate, 1.9% vs. 0.9%, respectively. There is no need for OAC after the LAAO procedure. Omitting OAC after an LAAO procedure in AF patients: (1) has similar stroke prevention rates as patients on OAC, (2) has similar bleeding prevention rates as patients on OAC, (3) has similar safety endpoints and long-term efficacy as patients on OAC.


Microbiota and the human nature: know thyself.
Biology has been driven by the human desire for self-knowledge. The discovery of our intimate symbiosis with microbes raises the question about our identity. A central issue is whether the microbiome associated with humans changes our phenotype in an observable way. As we deal with a great multitude of colonizing microbes and as even monozygotic twins differ substantially for their microbiome, we might deal with a dynamic system that is highly sensitive to initial conditions for which long-term prediction are impossible according to chaos theory. The overall colonization of the human alimentary tract can be teleological rationalized by a strong antimicrobial activity in the proximal and a mutualistic but controlled relationship with the microbiome in the distal gut segments. Yet the association of a specific microbiome with physiological traits turned out to be complicated and became frequently only clear after microbiota transfer experiments into gnotobiotic mice as a reductionist approach. As pathogenic bacteria create human phenotypes by their presence, mutualistic bacteria create symptoms (phenotypes) by their absence as exemplified by lactobacilli in bacterial vaginosis.


[Thrombocytopenic purpura after isolated or combined vaccination against measles, mumps and rubella].
A retrospective epidemiological survey was conducted to evaluate the incidence and characteristics of thrombocytopenic purpura (TP) reported in France following measles, mumps or rubella vaccination with monovalent or multivalent vaccines. Sixty cases of TP were reported i.e an incidence/100,000 doses of 0.23 and 0.17 for measles or rubella vaccines respectively given alone, to 0.87 for combined measles-rubella vaccine and 0.95 for MMR vaccine. The mean age was 21 +/- 12 months and the delay of diagnosis was 16 +/- 6 days after vaccination. Thrombopenia was severe (mean platelet count: 8000 +/- 6000/mm3) and always associated with purpura. The immediate outcome was favourable in 89.5 per cent of cases. Vaccine-associated TP appears to be similar to acute childhood idiopathic thrombocytopenic purpura but the clear temporal relationship between MMR vaccination and the occurrence of TP make a causal relationship highly plausible. Acute TP seems a rare complication of measles-rubella and MMR vaccination but clinicians had to be informed of the possibility of their occurrence. Acute TP following vaccination should be reported by physicians to their Regional Drug Surveillance Centre.


Punishment-modulated attentional capture is context specific.
Attention prioritizes stimuli previously associated with punishment. Despite the importance of this process for survival and adaptation, the potential generalization of punishment-related attentional biases has been largely ignored in the literature. This study aimed to determine whether stimulus-punishment associations learned in a specific context bias attention in another context (in which the stimulus was never paired with punishment). We examined this issue using an antisaccade task in which participants had to shift their gaze in the opposite direction of a colored square during stimulus-outcome learning. Two contexts and three colors were employed. One color was associated with punishment (i.e., electrical shock) in one context and never paired with punishment in the other context. For a second color, the punishment-context relationship was reversed. A third color never paired with shock in either context (neutral) was included in Experiment 1 but absent in Experiment 2. Participants then performed search for a shape-defined target in an extinction phase (in which no shock was delivered) in which attentional bias for the colors was assessed. Context was manipulated via the background image upon which the stimuli were presented. In each of the two experiments, a bias to selectively orient toward the color that had been associated with punishment in the current context was observed, suggesting that punishment-modulated attentional priority is context specific.


Why in 2016 are patients with hypertension not 100% controlled? A call to action.
The objective is to consider the problem of high blood pressure (BP), a leading global risk factor, associated with substantial morbidity and mortality. Despite the availability of treatment guidelines and a wide range of therapies, BP control is suboptimal in many countries. Recent data indicate that only around 40% of patients manage to achieve an adequate level of BP control. A group of international experts in the field of hypertension met in 2008 to consider this problem. The resulting white paper delivered an urgent call to action and identified six key issues for improving BP control. In 2015, a working group of investigators spontaneously undertook an action with the primary aim of considering the current hypertension management situation in Europe, to discuss whether the situation had changed since 2008 and to determine what can be learnt from the projects in other continents, such as the Canadian Hypertension Education Program, which has shown that higher levels of BP control can be achieved across a general population. The working group identified the main challenges affecting the improvement of BP control today and suggests five key actions: identify the BP treatment target of less than 140/90 mmHg for the majority of patients, simplify treatment strategies and encourage pill reduction, decrease therapeutic inertia, improve patient empowerment, and involve healthcare systems and reduce the prevailing focus on drug costs in many healthcare systems. Implementing key actions identified by the working group may help to improve achievement of better BP control across Europe.


Effects of lotus seedpod oligomeric procyanidins on the inhibition of AGEs formation and sensory quality of tough biscuits.
The advanced glycation end products (AGEs) are formed in baked products through the Maillard reaction (MR), which are thought to be a contributing factor to chronic diseases such as heart diseases and diabetes. Lotus seedpod oligomeric procyanidins (LSOPC) are natural antioxidants that have been added to tough biscuit to create functional foods that may lower the risk of chronic diseases. The effect of LSOPC on AGEs formation and the sensory quality of tough biscuit were examined in this study. With the addition of LSOPC, the AGEs scavenging rate and antioxidant capacity of LSOPC-added tough biscuits were dramatically improved. The chromatic aberration (ΔE) value of tough biscuits containing LSOPC increased significantly. Higher addition of LSOPC, on the other hand, could effectively substantially reduced the moisture content, water activity, and pH of LSOPC toughen biscuits. These findings imply that using LSOPC as additive not only lowers the generation of AGEs, but also improves sensory quality of tough biscuit.


Long-term clinical evaluation of tapered multi-threaded implants: results and influences of potential risk factors.
This prospective study evaluated the long-term performance of tapered screw implants placed in patients with a variety of potentially compromising clinical variables. Sixty patients were treated with 218 implants; each case included one or more potential risk factors associated with increased rates of implant failure, peri-implant bone loss or clinical complications in the dental literature: short implants (23%), comorbid conditions (25%), maxillary implants (61%), immediate loading (88.5%), placement into extraction sockets (91%), and partial edentulism (97%). The implants were restored with a variety of prostheses. Marginal bone changes were calculated utilizing periapical radiographs taken at placement and at all subsequent appointments utilizing a standardized paralleling device and a 1-mm measurement grid. Mean clinical follow-up was 67.5 (range: 1-94) months for implants and 60 (range: 15-74) months for prostheses. Four implants failed to integrate and were immediately replaced by wide-diameter implants. Eight prostheses sustained porcelain fracture (n = 7) or cement failure (n = 1) and were replaced. No peri-implant marginal bone loss was observed for 98% of the implants; the remaining 2% exhibited 1 mm of bone loss. Cumulative survival rates were 98.2% for implants and 96.3% for prostheses after 5 years of clinical loading. Concerns that tapered implant designs may be more prone to crestal bone loss than cylinder designs are unsupported by the results of this study. Tapered implants maintained integration and marginal bone levels despite the presence of one or more potentially compromising variables.


Sex differences in adolescent exposure to alcohol advertising in magazines.
To measure girls' and boys' exposure to alcohol advertising in magazines and to compare this exposure with that of legal-age persons. Alcohol advertisements (N = 6239) in 103 national magazines for which placement, audience, and cost data for 2001 and 2002 were available, categorized by year, beverage type, and brand. Placement and readership (age and sex) data generated estimates of media exposure for the age groups 12 to 20, 21 to 34, and 21 years and older. Gross rating points, an advertising industry standard measure of the level of media exposure of a given population, and gross rating point ratios comparing exposure of different demographic groups. Alcohol companies spent 590.4 million US dollars to place 471 beer and ale advertisements (8%), 4748 distilled spir-its advertisements (76%), 116 low-alcohol refresher advertisements (2%), and 904 advertisements for wine (14%) in magazines in 2001 and 2002. In 2002, underage youth saw 45% more beer and ale advertising, 12% more distilled spirits advertising, 65% more low-alcohol refresher advertising, and 69% less advertising for wine than persons 21 years and older. Girls aged 12 to 20 years were more likely to be exposed to beer, ale, and low-alcohol refresher advertising than women in the group aged 21 to 34 or women in the group aged 21 years and older. Girls' exposure to low-alcohol refresher advertising increased by 216% from 2001 to 2002, while boys' exposure increased 46%. Exposure of underage girls to alcohol advertising is substantial and increasing, pointing to the failure of industry self-regulation and the need for further action.


Mutant Analysis Reveals Allosteric Regulation of ClpB Disaggregase.
The members of the hexameric AAA+ disaggregase of E. coli and S. cerevisiae, ClpB, and Hsp104, cooperate with the Hsp70 chaperone system in the solubilization of aggregated proteins. Aggregate solubilization relies on a substrate threading activity of ClpB/Hsp104 fueled by ATP hydrolysis in both ATPase rings (AAA-1, AAA-2). ClpB/Hsp104 ATPase activity is controlled by the M-domains, which associate to the AAA-1 ring to downregulate ATP hydrolysis. Keeping M-domains displaced from the AAA-1 ring by association with Hsp70 increases ATPase activity due to enhanced communication between protomers. This communication involves conserved arginine fingers. The control of ClpB/Hsp104 activity is crucial, as hyperactive mutants with permanently dissociated M-domains exhibit cellular toxicity. Here, we analyzed AAA-1 inter-ring communication in relation to the M-domain mediated ATPase regulation, by subjecting a conserved residue of the AAA-1 domain subunit interface of ClpB (A328) to mutational analysis. While all A328X mutants have reduced disaggregation activities, their ATPase activities strongly differed. ClpB-A328I/L mutants have reduced ATPase activity and when combined with the hyperactive ClpB-K476C M-domain mutation, suppress cellular toxicity. This underlines that ClpB ATPase activation by M-domain dissociation relies on increased subunit communication. The ClpB-A328V mutant in contrast has very high ATPase activity and exhibits cellular toxicity on its own, qualifying it as novel hyperactive ClpB mutant. ClpB-A328V hyperactivity is however, different from that of M-domain mutants as M-domains stay associated with the AAA-1 ring. The high ATPase activity of ClpB-A328V primarily relies on the AAA-2 ring and correlates with distinct conformational changes in the AAA-2 catalytic site. These findings characterize the subunit interface residue A328 as crucial regulatory element to control ATP hydrolysis in both AAA rings.


Experimental infection with avian infectious bronchitis virus (Kagoshima-34 strain) in chicks at different ages.
Chicks at 2, 4 or 6 weeks of age were experimentally infected individually with a nephrosis/nephritis-causing avian infectious bronchitis virus (IBV) strain Kagoshima-34. The susceptibility of chicks in each group to the infection was compared, based on the clinical signs, excretion of virus in the faeces and antibody titres in the serum. The results showed that although all chicks appeared to be susceptible to IBV infection, the most severe clinical response was observed following infection at 2-week-old. Likewise, whilst the virus was also recovered from the faeces of all the chicks infected, the duration of viral excretion was longest in the 2-week-old chicks. A high antibody titre was detected at 4 weeks post infection (PI) and was maintained for at least another 16 weeks in the 4- and 6-week-old chicks. In contrast, a low antibody titre was detected only between 8 to 12 weeks PI in the 2-week-old chicks. Thereafter, no antibody was detected despite the presence of clinical signs.


Haploinsufficiency of utrophin gene worsens skeletal muscle inflammation and fibrosis in mdx mice.
To address whether mdx mice with haploinsufficiency of utrophin (mdx/utrn+/-) develop more severe skeletal muscle inflammation and fibrosis than mdx mice, to represent a better model for Duchenne muscular dystrophy (DMD), we performed qualitative and quantitative analysis of skeletal muscle inflammation and fibrosis in mdx and mdx/utrn+/- littermates. Inflammation was significantly worse in mdx/utrn+/- quadriceps at age 3 and 6 months and in mdx/utrn+/- diaphragm at age 3 but not 6 months. Fibrosis was more severe in mdx/utrn+/- diaphragm at 6 months, and at this age, mild fibrosis was noted in quadriceps of mdx/utrn+/- but not mdx mice. The findings indicate that utrophin compensates, although insufficiently, for the effects of dystrophin loss with regard to inflammation and fibrosis of both quadriceps and diaphragm muscles in mdx mice. With more severe muscle dystrophy than mdx mice and a longer life span than utrophin-dystrophin-deficient (dko) mice, mdx/utrn+/- mice provide a better mouse model for testing potential therapies for muscle inflammation and fibrosis associated with DMD.


Application of mesenchymal stem cell-derived exosomes from different sources in intervertebral disc degeneration.
Intervertebral disc degeneration (IVDD) is a main cause of lower back pain, leading to psychological and economic burdens to patients. Physical therapy only delays pain in patients but cannot eliminate the cause of IVDD. Surgery is required when the patient cannot tolerate pain or has severe neurological symptoms. Although surgical resection of IVD or decompression of the laminae eliminates the diseased segment, it damages adjacent normal IVD. There is also a risk of re-protrusion after IVD removal. Cell therapy has played a crucial role in the development of regenerative medicine. Cell transplantation promotes regeneration of degenerative tissue. However, owing to the lack of vascular structure in IVD, sufficient nutrients cannot be provided for transplanted mesenchymal stem cells (MSCs). In addition, dead cells release harmful substances that aggravate IVDD. Extracellular vesicles (EVs) have been extensively studied as an emerging therapeutic approach. EVs generated by paracrine MSCs retain the potential of MSCs and serve as carriers to deliver their contents to target cells to regulate target cell activity. Owing to their double-layered membrane structure, EVs have a low immunogenicity and no immune rejection. Therefore, EVs are considered an emerging therapeutic modality in IVDD. However, they are limited by mass production and low loading rates. In this review, the structure of IVD and advantages of EVs are introduced, and the application of MSC-EVs in IVDD is discussed. The current limitations of EVs and future applications are described.


Thymus-independent crypt hyperplasia and villous atrophy in the small intestine of mice infected with the trematode Echinostoma revolutum.
Conventional mice and congenitally athymic, nude mice were infected with 20 metacercariae of the intestinal trematode Echinostoma revolutum. The sequential events in the pathological changes in the intestine were studied at different intervals post-infection. By day 11 onwards the conventional mice displayed dilatation of the region of the intestine which harboured the parasites. The mucosa in the dilated region showed marked crypt hyperplasia, villous atrophy and subepithelial fibrosis as the most conspicuous features which, together with a hypertrophy of the muscular layers, made the wall of the gut in the dilated region thicker than normal. The changes were thymus-independent as they were found to be as severe in the athymic, nude mice as in the conventional mice. The main histological features observed in the mice are discussed in relation to other conditions with similar changes, such as coeliac disease, nippostrongyliasis and trichinellosis. It is concluded that the present results support the view that there may be more than one effector mechanism of the change.


Methyl alpha-D-mannopyranoside-responsive release of microencapsulated glucoamylase.
Microcapsules are made of porous membranes through which enzymes or proteins can readily permeate. Glucoamylase was encapsulated into microcapsules in the presence of concanavalin A. Microencapsulated glucoamylase was released from the microcapsules into the bulk phase in the presence of methyl alpha-D-mannopyranoside, while it was not released in the absence of methyl alpha-D-mannopyranoside. The initiation and cessation of glucoamylase release from the microcapsules accurately corresponded to the addition and removal of methyl alpha-D-mannopyranoside, respectively. Methyl alpha-D-mannopyranoside served as a controller for the release of glucoamylase.


Predictive Value of PRISMA-7, qSOFA, ESI, and CFS for 28-Day Mortality in Elderly Patients in the Emergency Department.
To explore the predictive value of the Programme on Research for Integrating Services for the Maintenance of Autonomy 7 (PRISMA-7), quick Sequential Organ Failure Assessment (qSOFA) score, Emergency Severity Index (ESI), and Clinical Frailty Scale (CFS) on the 28-day mortality risk in emergency elderly patients. A multicenter prospective observational study was conducted to select elderly patients (≥65 years old) admitted to the emergency department of three Grade-A hospitals in different regions of China from January 2020 to March 2022. Primary data were collected at the time of admission. All patients were followed up for 28 days. The primary outcome was 28-day mortality. The predictive value of four scoring systems for 28-day mortality in elderly emergency patients was assessed by receiver operating characteristic (ROC) and logistic regression analysis. A total of 687 elderly emergency patients were enrolled, of whom 66 (9.61%) died within 28 days. Age, ICU admission rate, PRISMA-7, qSOFA, and CFS were significantly higher in the death group than in the survival group (P < 0.05), and ESI was lower than in the survival group (P < 0.001). The AUC for CFS was the largest of the four scoring systems at 0.80. According to the Youden index, the optimal cutoff values for PRISMA-7, qSOFA, ESI, and CFS were >3.5, >0.5, <2.5, and >4.5, respectively. Logistic regression revealed that qSOFA and CFS were the primary risk factors for increased 28-day mortality in elderly emergency patients (P < 0.001). The combined predictor L (L=X1+0.50X2, X1 and X2 are qSOFA and CFS values, respectively) had an AUC of 0.86 and a cutoff value >2.75. PRISMA-7, qSOFA, ESI, CFS, and the combined qSOFA+CFS predictor were all effective predictors of 28-day mortality risk in elderly emergency patients, with the combined qSOFA+CFS predictor having the best predictive power.


Changes in human pluripotent stem cell gene expression after genotoxic stress exposures.
Human pluripotent stem cells (hPSCs) represent heterogeneous populations, including induced pluripotent stem cells (iPSCs), endogenous plastic somatic cells, and embryonic stem cells (ESCs). Human ESCs are derived from the inner cell mass of the blastocyst, and they are characterized by the abilities to self-renew indefinitely, and to give rise to all cell types of embryonic lineage (pluripotency) under the guidance of the appropriate chemical, mechanical and environmental cues. The combination of these critical features is unique to hESCs, and set them apart from other human cells. The expectations are high to utilize hESCs for treating injuries and degenerative diseases; for modeling of complex illnesses and development; for screening and testing of pharmacological products; and for examining toxicity, mutagenicity, teratogenicity, and potential carcinogenic effects of a variety of environmental factors, including ionizing radiation (IR). Exposures to genotoxic stresses, such as background IR, are unavoidable; moreover, IR is widely used in diagnostic and therapeutic procedures in medicine on a routine basis. One of the key outcomes of cell exposures to IR is the change in gene expression, which may underlie the ultimate hESCs fate after such a stress. However, gaps in our knowledge about basic biology of hESCs impose a serious limitation to fully realize the potential of hESCs in practice. The purpose of this review is to examine the available evidence of alterations in gene expression in human pluripotent stem cells after genotoxic stress, and to discuss strategies for future research in this important area.


Application of Deep Learning in Civil Engineering Management.
Construction safety issues are of great significance in civil engineering management. In this paper, the entry point is the recognition of workers wearing helmets during the construction process, and the recognition performance is improved by combining deep learning and traditional classifiers to achieve intelligent recognition of construction safety clothing. In the specific process, the deep residual networks (ResNet) and sparse representation-based classification (SRC) are used as basic classifiers to classify samples with unknown categories. The results of the two decisions are fused and the reliability of the fused decision is determined. Afterwards, the reliable test samples are added to the original training samples to update the classifier, so as to obtain more reliable recognition results. The proposed method is tested and verified with actual measured data. The experimental results show the effectiveness and robustness of the proposed method.


1H nuclear magnetic resonance of modified bases of valine transfer ribonucleic acid (Escherichia coli). A direct monitor of sequential thermal unfolding.
Proton magnetic resonances at 220 MHz from three nucleotide residues of valine I tRNA (Escherichia coli) serve as intrinsic probes of local molecular structure. Resonances from the methyl group of ribothymidine, the methyl group of N6-methyladenosine, and the C-5 methylene of dihydrouridine monitor separate conformational transitions in the TpsiC, anticodon, and dihydrouridine loops, respectively. As the temperature is raised in a solution containing 0.23 M Na+ and no Mg2+, the dihydrouridine region melts with a Tm of 55 degrees, the anticodon region at 58 degrees, and the TpsiC region at 67 degrees. The dihydrouridine nuclear magnetic resonance (NMR) transition correlates with the major change in absorbance monitored in the uv at 330 nm which is ascribed to structural pertubations near the 4-thiouracil moiety. On the NMR time scale slow exchange is seen throughout the temperature range for dihydrouridine and below the apparent Tm for the ribothymidine methyl group. Chemical shift and line width differences between folded and unfolded forms of the polynucleotide indicate that, in the native structure, ribothymidine is in a highly structured region and N6-methyladenosine is in a somewhat less restricted environment. Narrow line widths for the C-5 methylene triplet are found over the whole temperature range indicating that this base is undergoing rapid internal reorientation relative to the overall macromolecule.


Impairment in Pain Perception in Adult Rats Lesioned as Neonates with 5.7-Dihydroxytryptamine.
Whereas some studies have demonstrated the essential role of 5-hydroxytryptamine (5-HT) in tramadol and acetaminophen analgesia, other research has presented conflicting results. To dispel doubts, some aspects of the involvement of 5-HT in the antinociceptive properties of these drugs remain to be clarified. The aim of this study was to determine whether the serotoninergic system dysfunction produced by neonatal 5-HT lesion in rats may affect the antinociceptive effects of tramadol and acetaminophen administered in adulthood. Three days after birth, the control rats were pretreated with desipramine HCl (20 mg/kg i.p.) 30 min before intraventricular saline--vehicle injection. A separate group received 5.7-DHT; 2×35 µg in each lateral ventricle. At the age of 8 weeks, 5-HT and 5-hydroxyidoleaceticacid (5-HIAA) concentrations were determined in the thalamus and spinal cord by an HPLC/ED method. The antinociceptive effects of tramadol (20 mg/kg i.p.) or acetaminophen (100 mg/kg i.p.) were evaluated by a battery of tests. 5.7-DHT lesioning was associated with a reduction in 5-HT and 5-HIAA content of the thalamus (>85% and >90%) and spinal cord (>58% and 70%). Neonatal 5.7-DHT treatment produced a significant reduction in the antinociceptive effect of tramadol in the hot plate, tail-immersion, paw withdrawal and writhing tests. In the formalin hind paw test, the results were ambiguous. 5-HT lesion was also associated with a decrease in the analgesic effect of acetaminophen in the hot plate and writhing tests. A similar relationship wasn't found in the other assessments conducted with the use of acetaminophen. The present study provides evidence that (1) an intact serotoninergic system is required for the adequate antinociceptive action of tramadol, and (2) the serotoninergic system exerts a negligible influence on acetaminophen-induced analgesia in rats. We hypothesize that similar abnormalities in nociception may occur in patients with 5-HT dysfunction (e.g. depression), so these results should be complied in analgesic dosage adjustment.


Epigenetic cancer therapies: DNA methyltransferase inhibitors.
Human cancers frequently show altered patterns of DNA methylation, particularly at CpG islands. These CpG islands are sequences of DNA rich in CpG dinucleotides and are often found close to gene promoters. Methylation within islands has been shown to be associated with transcriptional repression of the linked gene. Genes involved in all facets of tumour development and progression can become methylated and epigenetically silenced. Re-expression of such silenced genes can lead to suppression of tumour growth or sensitisation to anticancer therapies. Agents that can reverse DNA methylation include nucleoside and non-nucleoside inhibitors of DNA methyltransferase. Such agents are now undergoing preclinical evaluation and clinical trials in cancer patients.


Reciprocal modulation of C/EBP-α and C/EBP-β by IL-13 in activated microglia prevents neuronal death.
In response to aggravation by activated microglia, IL-13 can significantly enhance ER stress induction, apoptosis, and death via reciprocal signaling through CCAAT/enhancer-binding protein alpha (C/EBP-α) and C/EBP-beta (C/EBP-β). This reciprocal signaling promotes neuronal survival. Since the induction of cyclooxygenase-2 (COX-2) and peroxisome proliferator-activated receptor gamma/heme oxygenase 1 (PPAR-γ/HO-1) by IL-13 plays a crucial role in the promotion of and protection from activated microglia, respectively; here, we investigated the role of IL-13 in regulating C/EBPs in activated microglia and determined its correlation with neuronal function. The results revealed that IL-13 significantly enhanced C/EBP-α/COX-2 expression and PGE2 production in LPS-treated microglial cells. Paradoxically, IL-13 abolished C/EBP-β/PPAR-γ/HO-1 expression. IL-13 also enhanced ER stress-evoked calpain activation by promoting the association of C/EBP-β and PPAR-γ. SiRNA-C/EBP-α effectively reversed the combined LPS-activated caspase-12 activation and IL-13-induced apoptosis. In contrast, siRNA-C/EBP-β partially increased microglial cell apoptosis. By NeuN immunochemistry and CD11b staining, there was improvement in the loss of CA3 neuronal cells after intrahippocampal injection of IL-13. This suggests that IL-13-enhanced PLA2 activity regulates COX-2/PGE2 expression through C/EBP-α activation. In parallel, ER stress-related calpain downregulates the PPAR-γ/HO-1 pathway via C/EBP-β and leads to aggravated death of activated microglia via IL-13, thereby preventing cerebral inflammation and neuronal injury.


Consequences of receipt of a psychiatric diagnosis for completion of college.
The purpose of this study was to evaluate the independent associations between DSM-IV psychiatric disorders and the failure to complete college among college entrants. Data were from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). The sample included 15,800 adults, aged 22 years and older, who at least entered college. Diagnoses were made with the NESARC survey instrument, the Alcohol Use Disorder and Associated Disability Interview Schedule-DSM-IV Version. The large sample permitted analysis of multiple psychiatric disorders in the same multivariable logistic regression models. Given the frequent comorbidity of these disorders, this approach is an important step toward disentangling the independent roles of disorders in postsecondary educational outcomes. Evaluation of the independent associations between specific psychiatric disorders and postsecondary educational attainment showed that five diagnoses were positively and significantly associated with the failure to graduate from college. Four were axis I diagnoses: bipolar I disorder, marijuana use disorder, amphetamine use disorder, and cocaine use disorder. One was an axis II diagnosis: antisocial personality disorder. This study provides new data on DSM-IV diagnoses associated with the failure to complete postsecondary education. The findings suggest that psychiatric factors play a significant role in college academic performance, and the benefits of prevention, detection, and treatment of psychiatric illness may therefore include higher college graduation rates.


X-linked genes and the neural basis of social cognition.
The neural basis of social cognition is subject to intensive research in both humans and non-human primates. Autism is the archetypal disorder of social cognitive skills, and increasing interest is being paid to the role played by efferent and afferent connectivity between the amygdala and neocortical brain regions, in predisposing to this condition. Such circuits are now known to be critical for the processing of social information. Recent research suggests a sub-cortical neural pathway, routed through the amygdala, may turn out to be a key player in the mystery of why humans are so prone to disorders of social adjustment. This pathway responds to certain simple classes of potential threat, including direct eye contact and, in humans, arousal evoked by this exquisitely social stimulus is modulated and controlled by a variety of specific (largely frontal) neocortical regions. Dysfunction of these modulating circuits can occur in the context of developmental disorders that are associated with haploinsufficiency of one or more classes of X-linked genes, lacking Y-homologues, which may be sexually dimorphic in expression.


Evaluation of Hypocaloric Diet With Protein Supplementation in Middle-Aged Sarcopenic Obese Women: A Pilot Study.
The aim of this study was to evaluate the efficacy of a nutritional program, which is characterized by a different modulation of proteins, in adult patients with sarcopenic obesity. We studied 18 obese women aged 41-74 years. Obesity was diagnosed as fat mass > 34.8% and sarcopenia was defined when lean body mass was <90% of the subject's ideal fat free mass. All subjects were randomly assigned to different nutritional interventions: Hypocaloric diet plus placebo (A) and hypocaloric high-protein diet (1.2-1.4 g / kg body weight reference / day) (B). Anthropometric measurements, body composition, resting energy expenditure, handgrip test, Short Physical Performance Battery (SPPB), and SF-36 questionnaire were evaluated at baseline and after 4 months. Weight significantly decreased in both groups. Women with high-protein diet preserved lean body mass compared to low-calorie diet and improved significantly muscle strength; SPPB score did not change in both groups. SF-36 test showed a significant change for general health after 4 months in group B. In our study, sarcopenic obese patients with high-protein diet showed an improvement in muscle strength. Furthermore, dietary protein enrichment may represent a protection from the risk of sarcopenia following a hypocaloric diet.


Sertoli-Leydig cell tumor of the ovary: analysis of a single institution database.
To evaluate the clinicopathological features, management, survival and prognostic factors of patients with Sertoli-Leydig cell tumors of the ovary (SLCT) managed at a single institution. The clinical records of patients with Sertoli-Leydig cell tumors of the ovary managed at the KK Women's and Children's Hospital, Singapore, between October 1998 and December 2008 were reviewed. Data of pathological features, treatment given and progress on follow-up was studied. Sertoli-Leydig cell tumor of the ovary accounted for 1.3% of malignant ovarian neoplasms. The median age of the patient was 30 years. The most common mode of presentation was with hormonal-related symptoms (80%) in the form of secondary amenorrhea, irregular menses and features of virilization. Thirteen of the 15 patients underwent surgical staging and all were found to have stage-I disease at the time of diagnosis. Ten patients with intermediate and poorly differentiated tumors received adjuvant bleomycin, etoposide and cisplatin (BEP) chemotherapy. Recurrent disease was detected in two patients (13.3%) during a median follow-up of 63 months, both of whom had poorly differentiated type of tumor. Both these patients underwent optimal debulking surgery followed by postoperative chemotherapy (BEP regimen). There were no disease -elated deaths and all patients were under complete remission at the last follow-up. As most Sertoli-Leydig cell tumors of the ovary are seen in young women and detected while still in the early stages, a favorable outcome can be achieved by conservative surgery. Patients with moderate and poorly differentiated types of tumors benefit from adjuvant chemotherapy. Recurrences tend to occur early and are commonly seen in patients with poorly differentiated tumors.


Purity assessment of ginsenoside Rg1 using quantitative 1H nuclear magnetic resonance.
Ginseng herbs comprise a group of the most popular herbs, including Panax ginseng, P. notoginseng and P. quinquefolius (Family Araliaceae), which are used as traditional Chinese medicine (TCM) and are some of the best-selling natural products in the world. The accurate quantification of ginsenoside Rg1 is one of the major aspects of its quality control. However, the purity of the commercial Rg1 chemical reference substance (CRS) is often measured with high-performance chromatography coupled with an ultraviolet detector (HPLC-UV), which is a selective detector with unequal responses to different compounds; thus, this detector introduces probable error to purity assessments. In the present study, quantitative nuclear magnetic resonance (qNMR), due to its absolute quantification ability, was applied to accurately assess the purity of Rg1 CRS. Phenylmethyl phthalate was used as the internal standard (IS) to calibrate the purity of Rg1 CRS. The proton signal of Rg1 CRS in methanol-d4 at 4.37ppm was selected to avoid interfering signals, enabling accurate quantitative analysis. The relaxation delay, number of scans, and NMR windowing were optimized for data acquisition. For post-processing, the Lorentz/Gauss deconvolution method was employed to increase the signal accuracy by separating the impurities and noise in the integrated region of the quantitative proton. The method validation showed that the developed method has acceptable sensitivity, linearity, precision, and accuracy. The purity of the commercial Rg1 CRS examined with the method developed in this research was 90.34±0.21%, which was obviously lower than that reported by the manufacturer (>98.0%, HPLC-UV). The cross-method validation shows that the commonly used HPLC-UV, HPLC-ELSD (evaporative light scattering detector) and even LC-MS (mass spectrometry) methods provide significantly higher purity values of Rg1 CRS compared with the qNMR method, and the accuracy of these LC-based methods largely depend on the amount of the sample that was loaded and the properties of the impurities.


Computed tomography in suppurative ear disease: a correlation of surgical and radiographic findings.
Forty-two patients with chronic otitis media underwent preoperative CT scanning followed by surgical exploration of the middle ear and mastoid. The CT finding of abnormal soft tissue density associated with bone erosion was highly correlated with the surgical finding of cholesteatoma. By contrast, the total absence of abnormal soft tissue on CT essentially excluded cholesteatoma. However, 50% of all patients had abnormal soft tissue on CT scan not accompanied by bone erosion. In this largest group of patients it was not possible to diagnose or exclude cholesteatoma on the basis of CT findings alone. Also, CT occasionally gave the erroneous impression of lateral semicircular canal fistulization, tegmen tympani erosion, and facial nerve involvement due to volume averaging of these structures with adjacent soft tissues. CT scan has a role in the evaluation of selected patients with chronic otitis media, but must be interpreted cautiously in view of its limitations and numerous pitfalls.


Structured modulation multi-height microscopy for high-resolution imaging.
Conventional multi-height microscopy techniques introduce different object-to-detector distances to obtain multiple measurements for phase retrieval. However, surpassing the diffraction limit imposed by the numerical aperture (NA) of the objective lens remains a challenging task. Here, we report a novel structured modulation multi-height microscopy technique for quantitative high-resolution imaging. In our platform, a thin diffuser is placed in between the sample and the objective lens. By translating the diffuser to different axial positions, a sequence of modulated intensity images is captured for reconstruction. The otherwise inaccessible high-resolution object information can thus be encoded into the optical system for detection. In the construction process, we report a ptychographic phase retrieval algorithm to recover the existing wavefront of the complex object. We validate our approach using a resolution target, a phase target, and various biological samples. We demonstrate a ∼4-fold resolution gain over the diffraction limit. We also demonstrate our approach to achieve a 6.5 mm by 4.3 mm field of view and a half-pitch resolution of 1.2 µm. The reported methodology provides a portable, turnkey solution for quantitative high-resolution imaging with potential applications in disease diagnosis, sample screening, and other fields.


Cryptosporidium parvum in children with diarrhea in Zulia State, Venezuela.
The prevalence and importance of Cryptosporidium parvum as a causal agent of acute diarrhea among pediatric patients from Zulia State, Venezuela was assessed. Single stool specimens were collected from 310 children 0-60 months of age with acute diarrheal disease who were admitted to three public hospitals and from 150 comparable control children without gastrointestinal symptoms who were seen as outpatients. Cryptosporidium parvum oocysts were identified in 35 (11.2%) of 310 children with diarrhea and the coccidium was the single detectable pathogen in only 12 (34.2%). Other potential pathogenic parasites were present in most of the patients shedding oocysts (23 of 35, 65%). In nondiarrheal control children, oocysts were identified in nine (6%) of 150. The data suggest that C. parvum is relatively highly endemic in children 0-60 months of age in Zulia State and that although C. parvum may be an important pathogen associated with diarrhea, it may be a cause of only a small proportion of diarrheal episodes.


Educating for advocacy: exploring the source and substance of community-responsive physicians.
Physicians are called to be community responsive. But with few existing operational definitions, how can it be taught? The nature, inclination, and impact of community-responsive physicians were studied to address this educational fissure. Case studies on eight community-responsive physicians were conducted. Data were qualitatively analyzed using NVivo software. One way physicians were community responsive was through advocacy. Three themes arose: (1) having knowledge of difference, social determinants of health, and the power and privilege of physicians; (2) being influenced by role models and exposure to marginalized groups; and (3) motivation to do the right thing, give back, make a difference, and be intellectually challenged. Educational strategies to advance the teaching of physicians to be community-responsive advocates are highlighted.


Differential forces within the proximal patellar tendon as an explanation for the characteristic lesion of patellar tendinopathy: an in vivo descriptive experimental study.
Patellar tendinopathy is a common condition affecting the posterior region of the proximal patellar tendon, but the reason for this typical location remains unclear. The posterior region of the proximal patellar tendon is subjected to greater tendinous forces than is the corresponding anterior region. Descriptive laboratory study. An optic fiber technique was used to detect forces in both the anterior and the posterior regions of the proximal patellar tendon in 7 healthy persons. The optic fiber force sensor works on the principle of the amplitude modulation of transmitted light when the optic fiber is geometrically altered owing to the forces acting on it. Longitudinal strain in the tendon or ligament produces a negative transverse strain, thus causing a force that effectively squeezes the optic fiber. Measurements were recorded during the following exercises: closed kinetic chain quadriceps contraction (eccentric and concentric), open kinetic chain quadriceps contraction (eccentric and concentric), a step exercise, and a jump exercise. During all the exercises, the peak differential signal output in the posterior location of the proximal patellar tendon was greater than in the corresponding anterior location. The greatest differential signal output was found in the jump and squat exercises. The posterior region of the proximal patellar tendon is subjected to greater tendinous forces than is the corresponding anterior region. This finding supports the tensile-overload theory of patellar tendinopathy. Jump activities and deep squat exercises expose the patellar tendon to very large tendinous forces.


Acute onset polymyositis after prolactinoma extirpation.
Hyperprolactinemia has been related to autoimmune diseases. Herein, we describe a case of a female with a prolactin producer pituitary macroadenoma who developed severe polymyositis one month after its removal. The patient had very high levels of CPK and muscle biopsy showed remarkable inflammatory infiltration. Steroid therapy was followed with total recovery. To the best of our knowledge, this is the first case reported of acute polymyositis after pituitary macroadenoma exeresis.


Blood flow in rats during hemorrhagic shock: differences between surviving and dying animals.
Cardiac output distribution was measured during hemorrhage and hemorrhagic shock in unanaesthetized rats. In comparison to control animals, a varying degree of decreased blood flow was found in the skin, kidneys, splanchnic bed, and carcass. Bronchial and hepatic arterial blood flows were within normal limits for the entire experiment. Whereas the coronary blood flow fluctuated between values higher and lower than normal, the cerebral blood flow values were normal or decreased. When survivors were compared to dying rats, differences were foun in the early and late stages of shock. Initially, the carcass flow in survivors was higher, while the splanchnic flow was lower, than in dying rats. This redistribution of cardiac output may be responsible for an increased venous return and improved chances for survival. At the late stages of shock, survivors had significantly higher bronchial and hepatic arterial blood flow.


In vitro Evaluation and in vivo Digestibility of Physically, Chemically and Biologically Treated Jatropha Meal.
Protein considered the second main nutrient in diet formulation for all types of animals after energy. Present study aimed to evaluate the effect of different treatments on the nutritive value of Jatropha meal (JM) by in vitro and in vivo trials as protein source in sheep diet. Chemical composition, in vitro digestibility, gas production and phorbol esters (PE) were recorded for physically, chemically and biologically treated Jatropha meal. In vivo digestibility was measured by using 24 Barki rams randomly assigned into 4 nutritional groups (6 animals/treatment) as follow: 1) control ration and in 2, 3 and 4 groups cotton seed meal replaced with 30, 45 and 60% heated Jatropha meal (HJM). The various treatments raised DM (Dry matter), CP (Crude protein), NFE (Nitrogen free extract) and ash, whereas reduced OM (Organic matter), CF (Crude fiber) and EE (Ether extract) content in JM, the results of in vitro dry matter disappearance (IVDMD) have a significant height (p<0.01) for physical followed by the chemical and biological treatments. Otherwise high significant results (p<0.01) for gas production for different treatments was observed. The different treatments decreased the concentration of PE in JM than untreated. It can be concluded that all treatments especially heat enhanced chemical composition, IVDMD of JM and gas production. Feeding values were better with the ratio 30 and 45%.


Elevated atmospheric CO2 concentration ameliorates effects of NaCl salinity on photosynthesis and leaf structure of Aster tripolium L.
This study investigated the interaction of NaCl-salinity and elevated atmospheric CO(2) concentration on gas exchange, leaf pigment composition, and leaf ultrastructure of the potential cash crop halophyte Aster tripolium. The plants were irrigated with five different salinity levels (0, 25, 50, 75, 100% seawater salinity) under ambient and elevated (520 ppm) CO(2). Under saline conditions (ambient CO(2)) stomatal and mesophyll resistance increased, leading to a significant decrease in photosynthesis and water use efficiency (WUE) and to an increase in oxidative stress. The latter was indicated by dilations of the thylakoid membranes and an increase in superoxide dismutase (SOD) activity. Oxidative stress could be counteracted by thicker epidermal cell walls of the leaves, a thicker cuticle, a reduced chlorophyll content, an increase in the chlorophyll a/b ratio and a transient decline of the photosynthetic efficiency. Elevated CO(2) led to a significant increase in photosynthesis and WUE. The improved water and energy supply was used to increase the investment in mechanisms reducing water loss and oxidative stress (thicker cell walls and cuticles, a higher chlorophyll and carotenoid content, higher SOD activity), resulting in more intact thylakoids. As these mechanisms can improve survival under salinity, A. tripolium seems to be a promising cash crop halophyte which can help in desalinizing and reclaiming degraded land.


An Update on Medical School Accreditation in the United States: Implications for the Single Graduate Medical Education (GME) Era.
In the United States, medical schools are accredited by either the Liaison on Committee Medical Education (LCME) or the Commission on Osteopathic College Accreditation (COCA), which assesses the quality and standards of Doctor of Medicine (MD)-granting and Doctor of Osteopathic Medicine (DO)-granting institutions, respectively. Thereafter, new MD and DO physicians complete graduate medical education (GME) training. Historically, the two physician licensure pathways have been predominantly separate, but in 2020, the Accreditation Council for Graduate Medical Education and American Osteopathic Association finalized a single accreditation GME system. Now, other elements of MD and DO physician training that have traditionally remained separate, such as undergraduate medical education (UME), are increasingly being scrutinized. Since 2010, when the accreditation of UME was last qualitatively criticized, the standards and competencies set forth by LCME and COCA have converged. COCA, in particular, has updated its requirements to emphasize scholarly activity, improve inpatient clinical rotation requirements, engage medical students, and enhance clinical faculty qualifications. Such convergence brings to question the continuing need for two independent accreditation pathways and barriers that may prevent a single accreditation. We argue that although MD and DO physicians are unique, the natural confluence of UME accreditation represents an opportunity to simplify and improve physician training in the United States. Our analysis suggests the major barriers to implementing a single accreditation system surround the requirement of Osteopathic Manipulative Medicine (OMM)-focused faculty by COCA and the two separate licensing exams (USMLE (United States Medical Licensing Examination) and COMLEX (Comprehensive Osteopathic Medical Licensing Examination)). However, with a continuing decline in osteopathic physicians practicing OMM and growing debate over a new single licensing exam, a single accreditation UME system may be practically achieved.


The periodontally-involved root surface.
Recent years have seen much research on the periodontally-involved root surface. Many of these studies have produced results which suggest that plaque contaminants of the root surface are only superficially placed, and capable of being removed by gentle means. Further research has attested to the difficulties in rendering periodontally-involved root surfaces free of calculus deposits by instrumentation, yet clinical studies show that periodontal disease can be managed by root planing. It is concluded that root surface debridement is best assessed on the basis of the healing response and that it should aim to disrupt plaque on and remove plaque from the periodontally-involved root surface rather than to remove part of the root surface itself.


The essential role of H-F substitution in the electron-phonon interactions and electron transfer in the negatively charged acenes.
The single charge transfer through acenes, partially H-F substituted acenes, and fluoroacenes is discussed. The reorganization energies between the neutral molecules and the corresponding monoanions for partially H-F substituted acenes lie between those for acenes and fluoroacenes. The delocalization of the lowest unoccupied molecular orbitals (LUMO) by substituting hydrogen atoms by fluorine atoms with the highest electronegativity in every element is the main reason why the reorganization energy between the neutral molecule and the monoanion for partially H-F substituted acenes lies between those for acenes and fluoroacenes. This result implies that the negatively charged partially H-F substituted acenes would be better conductors with rapid electron transfer than the negatively charged fluoroacenes if we assume that the overlap of the LUMO between partially H-F substituted acenes is not significantly different from that between two neighboring fluoroacenes. The structures of the monoanions of acenes, fluoroacenes, and partially H-F substituted acenes are optimized under D2h geometry, and the Jahn-Teller effects in the monoanions of benzene and fluorobenzene are discussed. The vibration effect onto the charge transfer problem is also discussed. The C-C stretching modes around 1500 cm(-1) are the main modes converting the neutral molecules to the monoanions in acenes, fluoroacenes, and partially H-F substituted acenes. It can be confirmed from the calculational results that the C-C stretching modes around 1500 cm(-1) the most strongly couple to the LUMO in these molecules. The main reason why the total electron-phonon coupling constants (lLUMO) for the monoanions of acenes in which four outer hydrogen atoms are substituted by fluorine atoms are larger than those for the monoanions of acenes in which several inner hydrogen atoms are substituted by fluorine atoms is suggested. The relationships between the electron transfer and the electron-phonon interactions are discussed. The plot of the reorganization energies against the lLUMO values is found to be nearly linear. In view of these results, the relationships between the normal and superconducting states are briefly discussed.


Implementing a ventilator care bundle in an adult intensive care unit.
Ventilator-associated pneumonia (VAP), in addition to causing distress to patients, is associated with increased length of stay in intensive care, higher rates of morbidity and mortality and pressure on critical care capacity and costs. A care bundle approach for the management of ventilated patients can reduce the risk of VAP. This paper aims to appraise the implementation of a series of high impact intervention care bundle components directed at preventing the development of VAP, within an adult intensive care unit of a district general hospital. Subsequent to the implementation of care bundle components, evidence from audit data revealed that compliance fell below standard. To address this, Department of Health staff who were visiting the hospital recommended that the frequency of audit activity should be increased to facilitate the rapid identification of areas of poor compliance, which could then be rectified. Daily care bundle audits showed a positive impact on compliance. However, without a robust method to collect data on prevalence of VAP, the impact of the care bundles on improving outcomes for this aspect of care is unknown.


Psychiatric research and science policy in Germany: the history of the Deutsche Forschungsanstalt fur Psychiatrie (German Institute for Psychiatric Research) in Munich from 1917 to 1945).
The Deutsche Forschungsanstalt fur Psychiatrie (DFA) in Munich, one of the most important research institutes in the field of theoretical and clinical psychiatry, was founded in 1917 by Emil Kraepelin. Its financial existence between the world wars was assured by generous donations from the Jewish American scholar and philanthropist James Loeb. The scientific work done by Walther Spielmeyer (neuropathology), Felix Plaut (serology), Kurt Schneider (clinical psychiatry) and Ernst Rudin (psychiatric genetics) earned the DFA a reputation as an international center for psychiatry and neurology. During the 'Third Reich' Ernst Rudin cooperated with the National Socialist health system. His genetic concepts provided support for eugenic programmes such as forced sterilization of individuals with psychoses. These complex interactions underscore the importance of the DFA in understanding the recent history of medicine in Germany.


Malignant glomus tumor: a case report and review of literature, focusing on its clinicopathologic features and immunohistochemical profile.
Malignant glomus tumor (MGT) is a rare, recently described neoplasm that recapitulates the appearance of the modified smooth cells of the normal glomus body. We report a case of MGT of the hand of a 48-year-old woman. Magnetic resonance imaging (MRI) showed a 2.8-cm, well circumscribed, enhancing mass on the volar aspect of the thenar region of the right hand in immediate continuity with the ulnar artery and nerve. Computed tomography scan (CT-Scan) of the chest was normal. Histologic evaluation revealed a multilobular lesion with prominent branching capillary vasculature and perivascular arrangement of sheets of tumor cells. The tumor cells were round, relatively uniform in size with distinct cell borders and perinuclear cytoplasmic clearing. They were of intermediate to high nuclear grade and showed significant mitotic activity. A wide local excision with negative margins was performed. Multiple lung metastases were evident at 8-month follow-up. To date, forty-five cases of MGT of skin and soft issue have been reported in the literature. Twelve of the forty-five cases developed metastasis. In this report, we emphasize the differential diagnosis of MGT in the skin and deep soft tissue.


Effectiveness of the maze procedure using cooled-tip radiofrequency ablation in patients with permanent atrial fibrillation and rheumatic mitral valve disease.
Although the Cox-Maze III procedure is effective for treating permanent atrial fibrillation (AF), its high complexity limits its use. The Saline-Irrigated Cooled-tip Radiofrequency Ablation (SICTRA) System is an alternative source of energy used to ablate AF. The aim of this study was to evaluate the effectiveness of the SICTRA for the treatment of permanent AF in patients with rheumatic mitral valve (MV) disease. Between February 2002 and April 2003, 70 patients with permanent AF and rheumatic MV disease were randomly assigned to undergo a modified Maze III procedure using SICTRA associated with MV surgery (group A) or MV surgery alone (group B). Groups A and B were similar in terms of baseline characteristics. The in-hospital mortality rate was 2.3% (1 death) in group A versus 0% (no deaths) in group B (P>0.99). The additional time required for the left-sided radiofrequency ablation in group A was 14.2+/-5.1 minutes and for right-sided ablation was 12.3+/-4.2 minutes. The mean postoperative follow-up periods were 13.8+/-3.4 and 11.5+/-7.3 months, respectively, in groups A and B. The overall mid-term survival rate was 95.1% in group A and 92.8% in group B (P>0.99). The cumulative rates of sinus rhythm were 79.4% in group A and 26.9% in group B (P=0.001). Doppler echocardiography documented biatrial transport function in 90.3% of group A patients in sinus rhythm. The SICTRA is effective for treating permanent AF associated with rheumatic MV disease.


A Novel Penicillium sp. Causes Rot in Stored Sugar Beet Roots in Idaho.
Penicillium vulpinum along with a number of other fungi can lead to rot of stored sugar beet roots. However, Penicillium isolates associated with necrotic lesions on roots from a recent sugar beet storage study were determined to be different from P. vulpinum and other recognized Penicillium species. Phylogenies based on sequencing of the internal transcribed spacer (ITS)-5.8S, β-tubulin (BenA), and RNA polymerase II second largest subunit (RPB2) DNA regions indicate that these isolates are novel, but most closely related to the following Penicillium spp. in the section Fasiculata: P. aurantiogriseum, P. camemberti, and P. freii. Macro- and micromorphological data also support designating these isolates as a new species for which we propose the name, Penicillium cellarum sp. nov. Inoculation studies with the P. cellarum isolates on roots of the commercial sugar beet cultivar B-7 led to the formation of necrotic lesions 23 to 25 mm in diameter after 86 days in storage. These lesions were similar to those observed on sugar beet roots in commercial storage piles. These data indicate that P. cellarum is a pathogen which can cause root rot in stored sugar beet roots.