Macromastia and gigantomastia: efficacy of the superomedial pedicle pattern for breast reduction surgery.
Reduction mammoplasty procedures in patients with macromastia and gigantomastia can prove a major challenge to the plastic surgeon. Although several techniques have been described to reduce very large breasts, they can often result in vascular compromise to the nipple-areola complex (NAC) and skin flaps, decrease in NAC sensation and inability to breast-feed. The superomedial pedicle (SMP) procedure is often used in patients with moderate to large breast reductions. For extremely large breast reductions, macromastia and gigantomastia breast amputation with a free nipple graft is often recommended. For large resections and long suprasternal notch-nipple (N-N) distances there is no consensus in terms of approach. To evaluate the efficacy and complication rate of the SMP reduction mammoplasty technique for extremely large, macromastia and gigantomastic breasts at two institutions in Johannesburg. Retrospective review of patient records with macromastia and gigantomastia who had undergone the SMP technique reduction mammoplasty between 2008 and 2012. Complications were assessed at 1 week, 3 weeks, 6 months and a mean of one year postoperatively. There was a total of 31 patients, 62 breasts, with macromastia and gigantomastia who had an SMP pattern of reduction. The mean age was 30.1 years, mean BMI was 28.1 and average resection weight from each breast was 1835 g. The mean N-N was 44.13 cm. The majority, 90% of patients had a good aesthetic outcome with less than 20% having any long-term complications, which were all relatively minor. The SMP reduction mammoplasty efficiently reduces extremely large breasts while preserving the vascular integrity and sensation of the NAC, while simultaneously providing a well-shaped, projecting breast in macromastia and gigantomastia patients.


Applying near-infrared photoimmunotherapy to B-cell lymphoma: comparative evaluation with radioimmunotherapy in tumor xenografts.
Radioimmunotherapy (RIT) has proven effective for patients with relapsed and refractory lymphoma. However, new types of therapy are strongly desired as B-cell lymphoma remains incurable for many patients. Photoimmunotherapy (PIT) is an emerging targeted cancer therapy that uses photosensitizer (IR700)-conjugated monoclonal antibodies (mAbs) to specifically kill cancer cells. To evaluate the usefulness and potential role of PIT for treating B-cell lymphoma in a comparison with RIT, we performed in vivo PIT and RIT studies with an IR700 or 90Y-conjugated anti-CD20 mAb, NuB2. IR700 or 90Y were conjugated to NuB2. Since cell aggressiveness greatly affects the therapeutic effect, we selected both an indolent (RPMI 1788) and an aggressive (Ramos) type of B-cell lymphoma cell line. The in vitro therapeutic effect of PIT and the biodistribution profiles of IR700-NuB2 were evaluated. In vivo PIT and RIT studies were performed with 100 or 500 μg of IR700-NuB2 and 150 μCi/20 μg of 90Y-NuB2, respectively, in two types of B-cell lymphoma-bearing mice. The in vitro studies revealed that Ramos was more sensitive than RPMI 1788 to PIT. The therapeutic effect of PIT with 500 µg IR700-NuB2 was superior to any other therapies against aggressive Ramos tumors, whereas RIT showed the highest therapeutic effect in indolent RPMI 1788 tumors. Since the uptake levels and intratumoral distribution of IR700-NuB2 were comparable in both tumors, a possible cause of this difference is the tumor growth rate. The PIT with 500 µg (IR700-NuB2) group showed a significantly greater therapeutic effect than the PIT with 100 µg group due to the higher and more homogeneous tumor distribution of IR700-NuB2. PIT was effective for both indolent and aggressive B-cell lymphoma, and the higher dose provided a better therapeutic effect. In aggressive tumors, PIT was more effective than RIT. Thus, PIT would be a promising strategy for the locoregional treatment or control of B-cell lymphoma. Since PIT and RIT have distinctive advantages over each other, they could play complementary rather than competitive roles in B-cell lymphoma treatment.


MRI features and clinical outcomes of unexpected uterine sarcomas in patients who underwent high-intensity focused ultrasound ablation for presumed uterine fibroids.
To investigate the MRI features and clinical outcomes of unexpected uterine sarcomas in patients after high-intensity focused ultrasound (HIFU) ablation for presumed uterine fibroids. 15,759 consecutive patients who came for HIFU treatment, from November 2008 to September 2019, for presumed uterine fibroids were retrospectively reviewed. All the patients had completed a pre-HIFU MRI. All MRI images were independently analyzed and interpreted by two radiologists in every center. According to the T2WI MRI features of hyperintensity, accompanied by irregular margins, necrosis or cystic degeneration, multi-lobulated lesion with internal septation, 46 patients were suspected to be uterine sarcomas before HIFU. Eleven patients were histologically diagnosed as uterine sarcomas after laparotomy. Among the 15713 patients who received HIFU treatment for presumed uterine fibroids, 8 patients were found to have occult recurrence during the follow-up period, and 6 were confirmed histologically as uterine sarcomas after laparotomy. The incidence rate of uterine sarcomas was 0.108% (17/15759). Among them, 12 cases were low-grade endometrial stromal sarcoma (LG-ESS) and 5 cases were uterine leiomyosarcoma (LMS). No histological dissemination of the sarcoma was detected in patients with unexpected uterine sarcomas. Although some MRI features of uterine sarcomas and uterine fibroids overlapped, MRI is valuable in distinguishing between uterine fibroids and uterine sarcomas. HIFU does not seem to cause histological dissemination of the sarcoma, but follow-up visits should be strictly adhered to in order to detect unexpected uterine sarcomas at an early stage and to treat them in a timely manner.


Relationship between residual feed intake and digestibility for lactating Holstein cows fed high and low starch diets.
We determined if differences in digestibility among cows explained variation in residual feed intake (RFI) in 4 crossover design experiments. Lactating Holstein cows (n=109; 120±30d in milk; mean ± SD) were fed diets high (HS) or low (LS) in starch. The HS diets were 30% (±1.8%) starch and 27% (±1.2%) neutral detergent fiber (NDF); LS diets were 14% (±2.2%) starch and 40% (±5.3%) NDF. Each experiment consisted of two 28-d treatment periods, with apparent total-tract digestibility measured using indigestible NDF as an internal marker during the last 5d of each period. Individual cow dry matter (DM) intake and milk yield were recorded daily, body weight was measured 3 to 5 times per week, and milk components were analyzed 2 d/wk. Individual DM intake was regressed on milk energy output, metabolic body weight, body energy gain, and fixed effects of parity, experiment, cohort (a group of cows that received treatments in the same sequence) nested within experiment, and diet nested within cohort and experiment, with the residual being RFI. High RFI cows ate more than expected and were deemed less efficient. Residual feed intake correlated negatively with digestibility of starch for both HS (r=-0.31) and LS (r=-0.23) diets, and with digestibilities of DM (r=-0.30) and NDF (r=-0.23) for LS diets but was not correlated with DM or NDF digestibility for HS diets. For each cohort within an experiment, cows were classified as high RFI (HRFI; >0.5 SD), medium RFI (MRFI; ±0.5 SD), and low RFI (LRFI; <-0.5 SD). Digestibility of DM was similar (~66%) among HRFI and LRFI for HS diets but greater for LRFI when fed LS diets (64 vs. 62%). For LS diets, digestibility of DM could account for up to 31% of the differences among HRFI and LRFI for apparent diet energy density, as determined from individual cow performance, indicating that digestibility explains some of the between-animal differences for the ability to convert gross energy into net energy. Some of the differences in digestibility between HRFI and LRFI were expected because cows with high RFI eat at a greater multiple of maintenance, and greater intake is associated with increased passage rate and digestibility depression. Based on these data, we conclude that a cow's digestive ability explains none of the variation in RFI for cows eating high starch diets but 9 to 31% of the variation in RFI when cows are fed low starch diets. Perhaps differences in other metabolic processes, such as tissue turnover, heat production, or others related to maintenance, can account for more variation in RFI than digestibility.


Improving low health literacy and patient engagement: A social ecological approach.
This article posits four principal objectives related to the overarching goal of broadening the conceptualization of health literacy. We propose a social ecological approach to health literacy and patient engagement by illustrating how this multilevel approach offers an array of strategic options for interventions. A social ecological approach supports a broader understanding of health literacy that aligns with increased patient engagement. The ecological model highlights the importance of context, demonstrates how health literacy and patient engagement are inextricably connected, and gives rise to strategies to enhance them both. We illustrate the five multilevel intervention strategies for addressing low health literacy and promoting patient engagement: accumulation, amplification, facilitation, cascade, and convergence strategies. In addition, we provide a theoretical foundation to facilitate the development of interventions to enhance health literacy and ultimately increase patient engagement. The practice implications of adopting a broader social ecological perspective to address low health literacy shifts the field from thinking about individual educational interventions to how individual interventions may be augmented or supported by interventions at additional levels of influence. The potential benefit of adopting a multilevel intervention approach is that combining interventions could produce synergies that are greater than interventions that only utilize one level of influence.


Interfacial properties of apolipoprotein B292-593 (B6.4-13) and B611-782 (B13-17). Insights into the structure of the lipovitellin homology region in apolipoprotein B.
The N-terminal sequence of apolipoprotein B (apoB) is critical in triacylglycerol-rich lipoprotein assembly. The first 17% of apoB (B17) is thought to consist of three domains: B5.9, a beta-barrel, B6.4-13, a series of 17 alpha-helices, and B13-17, a putative beta-sheet. B5.9 does not bind to lipid, while B6.4-13 and B13-17 contain hydrophobic interfaces that can interact with lipids. To understand how B6.4-13 and B13-17 might interact with triacylglycerol during lipoprotein assembly, the interfacial properties of both peptides were studied at the triolein/water interface. Both B6.4-13 and B13-17 are surface active. Once bound, the peptides can be neither exchanged nor pushed off the interface. Some residues of the peptides can be ejected from the interface upon compression but readsorb on expansion. B13-17 binds to the interface more strongly. The maximum pressure the peptide can withstand without being partially ejected (Pi(max)) is 19.2 mN/m for B13-17 compared to 16.7 mN/m for B6.4-13. B13-17 is purely elastic at the interface, while B6.4-13 forms a viscous-elastic film. When they are spread at an air/water interface, the limiting area and the collapse pressures are 16.6 A(2)/amino acid and 31 mN/m for B6.4-13 and 17.8 A(2)/amino acid and 35 mN/m for B13-17, respectively. The alpha-helical B6.4-13 contains some hydrophobic helices that stay bound and prevent the peptide from leaving the surface. The beta-sheets of B13-17 bind irreversibly to the surface. We suggest that during lipoprotein assembly, the N-terminal apoB starts recruiting lipid as early as B6.4, but additional sequences are essential for formation of a lipid pocket that can stabilize lipoprotein emulsion particles for secretion.


Biomass-Derived Provenance Dominates Glacial Surface Organic Carbon in the Western Himalaya.
The origin, transport pathway, and spatial variability of total organic carbon (OC) in the western Himalayan glaciers are poorly understood compared to those of black carbon (BC) and dust, but it is critically important to evaluate the climatic role of OC in the region. By applying the distribution of OC activation energy; 14C activity; and radiogenic isotopes of 208Pb/204Pb, 207Pb/204Pb, and 206Pb/204Pb in glacial debris and atmospheric particulate matter (PM10 size fraction), we demonstrate that 98.3 ± 1.6 and 1.7 ± 1.6% of OC in western Himalayan glaciers are derived from biomass and petrogenic sources, respectively. The δ13C and N/C composition indicates that the biomass is a complex mixture of C3 vegetation and autochthonous photoautotrophic input modified by heterotrophic microbial activity. The data set reveals that the studied western Himalayan glacier has negligible contributions from fossil-fuel-derived particles, which contrasts to the central and eastern Himalayan glaciers that have significant contributions from fossil fuel sources. We show that this spatial variability of OC sources relates to regional differences in air mass transport pathways and precipitation regimes over the Himalaya. Moreover, our observation suggests that biomass-derived carbon could be the only primary driver of carbon-induced glacier melting in the western Himalaya.


Retinoid signaling is required for the establishment of a ZPA and for the expression of Hoxb-8, a mediator of ZPA formation.
We show that retinoid receptor antagonists applied to the presumptive wing region block the formation of a zone of polarizing activity (ZPA). This suggests a direct relationship between retinoid signaling and the establishment of the ZPA. We provide evidence that the Hox gene, Hoxb-8, is a direct target of retinoid signaling since exogenously applied RA rapidly induces this gene in the absence of protein synthesis and, moreover, retinoid receptor antagonists down-regulate Hoxb-8 expression. In addition, we find that, in the lateral plate mesoderm, the domains of Hoxb-8 expression and of polarizing activity are coextensive. Taken together, these findings support the hypothesis that retinoids are required for the establishment of a ZPA, and that retinoids act, at least in part, through Hoxb-8, a gene associated with ZPA formation (Charité et al., 1994).


Small field motion detection in goldfish is red-green color blind and mediated by the M-cone type.
Large field motion detection in goldfish, measured in the optomotor response, is based on the L-cone type, and is therefore color-blind (Schaerer & Neumeyer, 1996). In experiments using a two-choice training procedure, we investigated now whether the same holds for the detection of a small moving object (size: 8 mm diameter; velocity: 7 cm/s). In initial experiments, we found that goldfish did not discriminate between a moving and a stationary stimulus, obviously not taking attention to the cue "moving." Therefore, random dot patterns were used in which the stimulus was visible only when moving. Using black and white random dot patterns with variable contrast between 0.2 and 1, we found that the fish could see motion only with high (0.8) contrast. In the decisive experiment, a red-green random dot pattern was used. By keeping the intensity of the red dots constant and reducing the intensity of the green dots, a narrow intensity range was found in which goldfish could no longer discriminate between the moving random dot stimulus in random dot surround and the stationary random dot pattern. The same was the case when a red moving disk was presented in green surround. This is the evidence that object motion is red-green color blind, i.e., color information cannot be used to detect the moving object. Calculations of the cone excitation values revealed that the M-cone type is decisive, as this cone type (and not the L-cone type) is not modulated by that particular red-green pattern in which the moving stimulus was invisible.


3D volume-selective turbo spin echo for carotid artery wall imaging with navigator detection of swallowing.
To improve 3D volume-selective turbo spin echo (TSE) carotid artery wall imaging by incorporating navigators to reduce artifacts caused by swallowing. Images were acquired on a Siemens Magnetom Sonata 1.5T scanner. 3D volume-selective TSE scans of the carotid arteries were acquired in six healthy volunteers. A cross-pair navigator placed on the back of the tongue was used to detect swallowing and movement. Two swallowing patterns were tested: 1) a single swallow approximately halfway through the scan time, at the center of k(z), and 2) repeated swallowing as often as possible throughout the scan period. Images were acquired with and without navigators for comparison. Signal intensity in the lumen was quantified for the quality of blood suppression, and the clarity of the vessel wall in the common carotid was ranked by four independent blinded observers. In general, lower signal intensity was recorded in the lumen, and decreased blurring and ghosting were observed on scans with navigator control. This reduction in lumen signal intensity signifies an improvement in the black-blood imaging technique. The differences likely reflect the improved double inversion/blood suppression efficiency due to cycles being rejected when the heart rate changed at the point of swallowing, or decreased motional blurring/ghosting of tissue when the navigator is used, or a combination of these two effects. A statistical analysis of image quality showed a significant difference between navigated and non-navigated scans as scored by four independent, blinded observers. For both swallowing patterns, the mean score for the navigator images was on average 0.6 greater than that of non-navigator images (on a scoring scale of 0-5, where 0 = no vessel visible, and 5 = good delineation and blood suppression) and P-values for all observers were less than 0.01. Overall, the central swallow scans were scored higher than the repeated swallow scans. One reason for this may be the fact that the heart rate increased on swallowing, and this often lasted for one or two cardiac cycles after the navigator returned to the normal acceptance position. The effect of the increased heart rate after swallowing is likely to have an effect on double inversion blood suppression efficiency. Therefore, the increased amount of heart rate changes with repeated swallowing may have a greater adverse effect, even if the navigator rejects data views during the swallowing motion. The clarity of vessel wall delineation and the apparent efficiency of blood suppression are reduced by swallowing during acquisition. Both motion blurring and quality of blood suppression are factors that can be improved with the use of a navigator accept/reject method.


Obstetric history and reproductive tract infections among married female (15-44 yrs.) in rural area of district Meerut, U.P.
The prevalence of RTIs in 600 married females (15-44 yrs.) representing 12 subcentre villages of Daurala block of Meerut was 35.3%. The reproductive tract infections were significantly associated with place of last delivery (P< 0.001), person conducted the last delivery (P< 0.001) and in women had history of abortions (P< .005).


Motion characterization scheme to minimize motion artifacts in intravital microscopy.
Respiratory- and cardiac-induced motion artifacts pose a major challenge for in vivo optical imaging, limiting the temporal and spatial imaging resolution in fluorescence laser scanning microscopy. Here, we present an imaging platform developed for in vivo characterization of physiologically induced axial motion. The motion characterization system can be straightforwardly implemented on any conventional laser scanning microscope and can be used to evaluate the effectiveness of different motion stabilization schemes. This method is particularly useful to improve the design of novel tissue stabilizers and to facilitate stabilizer positioning in real time, therefore facilitating optimal tissue immobilization and minimizing motion induced artifacts.


Superior sagittal sinus thrombosis. Still a killer.
Following treating a case of superior sagittal sinus thrombosis, we did an extensive search of the literature, eliciting 795 cases of the disorder. An analysis showed that even after the introduction of antibiotics, the preponderance of these cases have been diagnosed at autopsy. Our findings raise questions about the current methods of diagnosis and management of superior sagittal sinus thrombosis: Can the correct diagnosis be made earlier? Does a distinction between partial and complete thrombosis call for a different management?


The thermic vascular anastomosis (TVA). A new nonsuture method. I. History, instruments, and microsurgical technique.
In order to unite blood vessels in a split second during a total clamping time of less than three minutes a new microsurgical technique has been developed. Heat from a frequency electric current applied to calibrated metal loops unites the cuffs of the vessel ends instead of sutures. As a model for vascular anastomoses the new technique was used in an experiment with 320 rats. Two energy output adjustments of the power source combined with application of fibrin glue on the anastomosis are compared. The new instruments developed for this technique and the operation method are presented with reference to earlier vascular surgical procedures, and the results of patency controls of the anastomoses one day, 10 days, and 30 days postoperatively are listed. Preliminary findings of a long term study are added. This study shows that fully patent anastomoses can be obtained with this technique in much less time than with suturing.


Chemical properties investigation of commercial cigarettes by a "pseudo" targeted method using GC-MS-selected ions monitoring.
A "pseudo" targeted method using GC-MS-selected ions monitoring was applied to investigate the chemical characteristics of commercial cigarettes made in China and foreign countries. To identify the components and define the quantative ions for SIM acquisition, a quality control sample was analyzed using GC-MS full scan. Acquired data were treated with a homemade software. A peak table with 312 components and their related quantitation ions was achieved for SIM acquisition. Structure elucidation was performed using library searching, retention index, standard compounds, and fitted retention time. The fitted retention time was calculated by a linear correction curve obtained using measured and library retention time to verify compounds. A total of 90 compounds were elucidated. Chemical characteristics of different cigarette brands were investigated. The data acquisition was carried out in SIM mode. The principal component and the hierarchical clustering analyses showed that the Chinese domestic flue-cured cigarettes were significantly different from the domestic blended, the foreign flue-cured, and blended cigarettes. Sixty-seven differential compounds were defined using the nonparametric Mann-Whitney test and the group blending samples comparison. Chinese domestic flue-cured cigarettes have higher concentration of saccharides and lower concentration of organic acids and amino acids.


Planar IGRT dose reduction: A practical approach.
To retrospectively estimate the cumulative absorbed dose (at the skin) from kilovoltage planar x-rays received by 90 patients treated on a Varian iX and to determine if that dose could be reduced without sacrificing image quality. To estimate surface dose, measurements were obtained using the "in-air" method by varying the source-to-detector distance from 80 to 100 cm in steps of 5 cm. Energy was varied from 70 to 120 kVp. Using these data, a global equation was developed to estimate the cumulative skin dose by applying the imaging settings (kVp, mAs), patient-specific source-to-skin distance, and total number of images. To reduce the imaging dose, anterior and lateral images of RANDO phantoms were obtained using the same kVp; however, the mAs settings were systematically reduced. Contrast-to-noise ratios (CNRs) were calculated for both the standard phantom images and reduced mAs images. The mAs values were chosen to minimize skin dose while maintaining a similar CNR. Last, daily kV anterior and lateral images were obtained using these reduced mAs settings for 7 patients currently being treated with image guided radiation therapy. CNR was determined and compared with the values obtained on images taken 1 day before this change. Average cumulative kV imaging dose was as large as 162.2 cGy for pelvic cases with standard kVp, mAs. Other doses varied by site and technique. By lowering mAs, this dose could be reduced by 49% with only a 0.9% decrease in CNR. For the 7 patients currently being treated with image guided radiation therapy, CNR values were not statistically different (P = .79), whereas the skin dose was reduced by an average of approximately 50%. kV planar imaging dose reduction should be considered, given the large cumulative skin dose for certain disease sites. When mAs are reduced, planar dose reduction is clinically feasible without sacrificing image quality.


The Role of Co-chaperones in Synaptic Proteostasis and Neurodegenerative Disease.
Synapses must be preserved throughout an organism's lifespan to allow for normal brain function and behavior. Synapse maintenance is challenging given the long distances between the termini and the cell body, reliance on axonal transport for delivery of newly synthesized presynaptic proteins, and high rates of synaptic vesicle exo- and endocytosis. Hence, synapses rely on efficient proteostasis mechanisms to preserve their structure and function. To this end, the synaptic compartment has specific chaperones to support its functions. Without proper synaptic chaperone activity, local proteostasis imbalances lead to neurotransmission deficits, dismantling of synapses, and neurodegeneration. In this review, we address the roles of four synaptic chaperones in the maintenance of the nerve terminal, as well as their genetic links to neurodegenerative disease. Three of these are Hsp40 co-chaperones (DNAJs): Cysteine String Protein alpha (CSPα; DNAJC5), auxilin (DNAJC6), and Receptor-Mediated Endocytosis 8 (RME-8; DNAJC13). These co-chaperones contain a conserved J domain through which they form a complex with heat shock cognate 70 (Hsc70), enhancing the chaperone's ATPase activity. CSPα is a synaptic vesicle protein known to chaperone the t-SNARE SNAP-25 and the endocytic GTPase dynamin-1, thereby regulating synaptic vesicle exocytosis and endocytosis. Auxilin binds assembled clathrin cages, and through its interactions with Hsc70 leads to the uncoating of clathrin-coated vesicles, a process necessary for the regeneration of synaptic vesicles. RME-8 is a co-chaperone on endosomes and may have a role in clathrin-coated vesicle endocytosis on this organelle. These three co-chaperones maintain client function by preserving folding and assembly to prevent client aggregation, but they do not break down aggregates that have already formed. The fourth synaptic chaperone we will discuss is Heat shock protein 110 (Hsp110), which interacts with Hsc70, DNAJAs, and DNAJBs to constitute a disaggregase. Hsp110-related disaggregase activity is present at the synapse and is known to protect against aggregation of proteins such as α-synuclein. Congruent with their importance in the nervous system, mutations of these co-chaperones lead to familial neurodegenerative disease. CSPα mutations cause adult neuronal ceroid lipofuscinosis, while auxilin mutations result in early-onset Parkinson's disease, demonstrating their significance in preservation of the nervous system.


Low levels of beta hexosaminidase A in healthy individuals with apparent deficiency of this enzyme.
Appreciable beta hexosaminidase A (hex A) activity has been detected in cultured skin fibroblasts and melanoma tissue from healthy individuals previously reported as having deficiency of hex A activity indistinguishable from that of patients with Tay-Sachs disease (TSD). Identification and quantitation of hex A, amounting to 3.5%-6.9% of total beta hexosaminidase activity, has been obtained by cellulose acetate gel electrophoresis, DEAE-cellulose ion-exchange chromatography, radial immunodiffusion, and radioimmunoassay. Previous family studies suggested that these individuals may be compound heterozygotes for the common mutant TSD gene and a rare (allelic) mutant gene. Thus, the postulated rate mutant gene appears to code for the expression of low amounts of hex A. Heterozygotes for the rare mutant may be indistinguishable from heterozygotes for the common TSD mutant. However, direct visualization and quantitation of hex A by the methods described may prevent false-positive prenatal diagnosis of TSD in fetuses having the incomplete hex A deficiency of the type described in the four healthy individuals.


A nomogram for predicting bowel obstruction in preoperative colorectal cancer patients with clinical characteristics.
Bowel obstruction (BO) is a complication that commonly affects patients with colorectal cancer (CRC). BO causes severe outcomes, and its treatment leads to a dilemma for many surgeons. Moreover, the factors correlated to BO in preoperative CRC patients remain unclear. The objectives of this study were to investigate the clinical characteristics of BO to identify risk predictors and to construct a BO prediction model with preoperative CRC patients. A large-scale, retrospective cohort, population-based study analyzed the data of 11,814 patients obtained from the Surveillance, Epidemiology, and End Results and Medicare claims-linked databases (SEER-M database). Patients aged ≥ 66 years and primarily diagnosed with CRC from 1992 to 2009 were divided into BO and non-BO groups. Cox proportional hazards regression models were used to determine predictors, and then, a nomogram was constructed by those predictors. A total of 11,814 patients (5293 men and 6251 women) were identified. In multivariate analysis, 14 factors were found to be associated with BO including age, race, marital status, residence location, T category, M category, primary tumor site, histologic type, histologic grade, tumor size, history of alcoholism, chemotherapy, radiotherapy, abdominal pain, and anemia. A nomogram predicting the 90- and 180-day rates of BO was built for the preoperative CRC patients with a C-index of 0.795. This study identified 14 BO-related factors, and a statistical model was constructed to predict the onset of BO in preoperative CRC patients. The obtained data may guide decision-making for the intervention of patients at risk for BO.


Routine Outcome Monitoring (ROM) and Feedback: Research Review and Recommendations.
To provide a research review of the components and outcomes of routine outcome monitoring (ROM) and recommendations for research and therapeutic practice. A narrative review of the three phases of ROM - data collection, feeding back data, and adapting therapy - and an overview of patient outcomes from 11 meta-analytic studies. Patients support ROM when its purpose is clear and integrated within therapy. Greater frequency of data collection is more important for shorter-term therapies, and use of graphs, greater specificity of feedback, and alerts are helpful. Overall effects on patient outcomes are statistically significant (g ≈ 0.15) and increase when clinical support tools (CSTs) are used for not-on-track cases (g ≈ 0.36-0.53). Effects are additive to standard effects of psychological therapies. Organizational, personnel, and resource issues remain the greatest obstacles to the successful adoption of ROM. ROM offers a low-cost method for enhancing patient outcomes, on average resulting in an ≈ 8% advantage (success rate difference; SRD) over standard care. CSTs are particularly effective for not-on-track patients (SRD between ≈ 20% and 29%), but ROM does not work for all patients and successful implementation is a major challenge, along with securing appropriate cultural adaptations.


[Analysis of TV food advertising in the context of recommendations by the Food Guide for the Brazilian Population].
This study aimed to analyze TV food advertising in Brazil based on the recommendations of the Food Guide for the Brazilian Population, 2014. Programming from the four most popular TV channels was recorded on two non-consecutive days in January 2014. The commercials were categorized in (i) foods and beverages, (ii) restaurants, and (iii) non-food services, goods, and products, with those in the first category subdivided according to recommendations in the food guide. The commercials' categories were described by means of their frequency (and 95% confidence interval), for all the records and according to the day of the week. Of the 2,732 commercials that were identified, food and beverage advertising was the third largest category, with 10.2% of the total. In this category, ultra-processed foods accounted for 60.7% of the commercials, while fresh or minimally processed foods at around 7%. The findings run counter to the guide's recommendations, reinforcing the importance of measures to regulate food advertising in Brazil.


Evolutionary game analysis for multi-level collaborative governance under public crisis in China: From a value perception perspective.
In a risk society, the survival and development of humans are facing threats of complex and severe public crisis events. Public participation in collaborative governance (CG) of public crisis events is increasingly recognized as an important direction for the reform of the current and future emergency management system. Previous studies of CG have mainly focused on the macro level and ignored to address micro-level discussions of the behavioral strategy evolution of stakeholders. From a fresh value perception perspective, this study constructs an evolutionary game model to clarify the evolution mechanism of multi-level emergency CG. First, the value perception model is built based on Prospect Theory and Mental Accounting to optimize the traditional game matrix. Second, the evolutionary stability is analyzed to solve the system evolution law. Finally, numerical simulation is conducted in the case of Heilongjiang province, a main region of food and energy supply in China. Results showed that (1) the CG game system has a complex evolutionary path; (2) the behavior of game players is affected by perceived incomes and perceived costs; (3) compared with the reference value and the risk aversion coefficient of income accounts, game players are more sensitive to that of cost accounts; (4) enhancing the perceived value of public psychological satisfaction and government reputation is helpful for the long-term construction of CG. Overall, this study aims to highlight the potential utility of value perception in promoting effective implementations of CG and to provide new insights for the development of CG in China and other countries.


A case of delayed postoperative bleeding after excision of endometrial polyp using resectoscope in an infertile woman with von Willebrand disease:a case report and literature review.
Von Willebrand disease (VWD) is a bleeding disorder caused by a congenital quantitative reduction, deficiency, or qualitative abnormality of the von Willebrand factor (VWF). Here, we report a case of delayed postoperative bleeding in an infertile woman with endometrial polyps complicated by VWD. The patient was a 39-year-old infertile woman with type 2A VWD. At 38 years of age, she was referred to our hospital for infertility and heavy menstrual bleeding. Hysteroscopy revealed a 15-mm polyp lesion in the uterus. The patient was scheduled for transcervical resection (TCR) of the endometrial polyp. Gonadotropin-releasing hormone agonists were preoperatively administered to prevent menstruation. The VWF-containing concentrate was administered for 3 days according to guidelines. The patient was discharged on postoperative day 3 after confirming the absence of uterine bleeding. Uterine bleeding began on postoperative day 6. The patient was readmitted on postoperative day 7 and treated with VWF-containing concentrate for 5 days, after which hemostasis was confirmed. TCR surgery for endometrial lesions is classified as a minor surgery, and guidelines recommend short-term VWF-containing concentrate replacement. However, it should be kept in mind that only short-term VWF-containing concentrate replacement may cause rebleeding postoperatively.


TAK-242 Protects Against Apoptosis in Coronary Microembolization-Induced Myocardial Injury in Rats by Suppressing TLR4/NF-κB Signaling Pathway.
Myocardial apoptosis is heavily implicated in the myocardial injury caused by coronary microembolization (CME), and toll-like receptor 4 (TLR4) is considered to be involved in this apoptotic cascade. Therefore, the present study was designed to investigate the role of TLR4/NF-κB signaling pathway regulated by TAK-242, a selective TLR4 signal transduction inhibitor, in the myocardial apoptosis after CME in rats. Forty-five rats were randomized (random number) into three groups: sham, CME and CME + TAK-242 (n = 15 per group).CME was induced by injecting polyethylene microspheres (42µm) into the left ventricular except the sham group. CME + TAK-242 group was treated with TAK-242 (2mg/kg) via the tail vein 30 minutes before CME modeling. Cardiac function was evaluated 6 hours after operation. Tissue biopsy was stained with HBFP to measure the size of micro-infarction area. TUNEL staining was used to detect myocardial apoptosis. Western blot and qPCR were used to evaluate the expression of TLR4, MyD88, NF-κB p65, p-IκBα and Cleaved caspase-3. Cardiac function in the CME group and CME + TAK-242 group were significantly decreased compared with the sham group (P < 0.05) and the micro-infarction area, the apoptotic index, the expression of TLR4, NF-κB p65, p-IκBα and Cleaved caspase-3 were increased significantly (P < 0.05). Cardiac function in the CME + TAK-242 group was significantly improved compared with the CME group (P < 0.05) and the micro-infarction area, the apoptotic index, the expression of TLR4, MyD88, NF-κB p65, p-IκBα and Cleaved caspase-3 were decreased significantly (P < 0.05). TAK-242 can effectively improve CME-induced cardiac dysfunction by regulating TLR4/NF-κB signaling pathway and then reducing the myocardial apoptosis.


Correspondence regarding 'Assefa Y, et al., BMC Health Services Research. 2011; 11 (1):81 and 2014; 14(1):45': The Positive-Deviance approach for translating evidence into practice to improve patient retention in HIV care.
The purpose of this correspondence is to describe how the positive-deviance approach can be used to translate evidence into practice, based on successive studies conducted in Ethiopia. In earlier studies, it was identified that retention in antiretroviral treatment care was variable across health facilities; and, seeking compliance across facilities, a framework was developed based on the practices of those positive-deviant health facilities, where performance was noted to be markedly better. It was found that the positive deviance approach was effective in facilitating the transfer of innovative practices (using different mechanisms) from positive-deviant health facilities to negative-deviant health facilities. As a result, the variability in retention in care across health facilities narrowed over time, increasing from 83 to 96% in 2007/8 to 95-97% in 2013/14. In conclusion, the positive-deviance approach is a valuable tool to translate evidence into practice, spread good practices, and help achieving universal health coverage.


Study on the relevance between beany flavor and main bioactive components in Radix Astragali.
Beany flavor is a traditional sensory indicator for evaluating the quality of Radix Astragali (RA or "Huangqi" in Chinese). A RA root with a strong beany flavor is considered to be good quality in Chinese medicine. However, there is neither a study reporting volatile compounds contributing to RA beany flavor nor the relevance between beany flavor and the quality of RA. In this study, we assessed the quantification of beany flavor substance and main bioactive metabolites. The results showed that hexanal was a major volatile component contributing to the beany flavor in RA. The value of hexanal was significantly related to the origin and growth age of RA, indicating that the component could be used as a volatile indicator for the distinction of RA. Statistical analysis further demonstrated that hexanal, astragaloside IV, and total polysaccharides were primary indicators and total isoflavonoids, astragalosides, calycosin, and formononetin were the secondary indicators for quality control of RA. Correlation analysis showed that the level of hexanal was positively associated with the concentration of astragaloside IV and total polysaccharides. Our study demonstrated that aroma is one of the most important quality attributes of RA and will help to understand the role of aroma in quality assessment of traditional Chinese medicines.


[Drug treatment of cardiac insufficiency with systolic dysfunction].
Improvement of symptoms, increase in exercise capacity and prevention of disease progression are the aims of drug therapy in patients with congestive heart failure. At present only the ACE inhibitors are able to achieve all therapeutic targets and should therefore be regarded as drugs of first choice in systolic dysfunction. Diuretics are also necessary in most patients since they rapidly reduce pulmonary congestion and peripheral oedema, but have no documented beneficial long term effects on the course of CHF. Digoxin remains a useful drug to treat symptomatic patients who do not respond adequately to the combination of ACE inhibitors and diuretics, as well as in patients with atrial fibrillation. However, a reduction of mortality by digitalis glycosides cannot be expected. A new trend in the treatment of CHF is the utilisation of beta blockers. These drugs showed positive effects in chronic CHF in several studies, particularly in patients with dilated cardiomyopathy. Newer drugs such as carvedilol, seem to improve the symptoms and reduce complications even in CHF due to coronary artery disease. The role of beta blockers in the routine management of patients with heart failure requires further evaluation.


A rare form of limb girdle muscular dystrophy (type 2E) seen in an Iranian family detected by autozygosity mapping.
Sarcoglycanopathies (SGPs) constitute a subgroup of autosomal recessive limb girdle muscular dystrophies (LGMDs) which are caused by mutations in sarcoglycan (SGs) genes. SG proteins form a core complex consisting of α, β, γ and δ sarcoglycans which are encoded by SGCA, SGCB, SGCG and SGCD genes, respectively. Genetic defect, in any of these SG proteins, results in instability of the whole complex. This effect can be helpful in interpreting muscle biopsy results. Autozygosity mapping is a gene mapping approach which can be applied in large consanguineous families for tracking the defective gene in most autosomal recessive disorders. In the present study, we used autozygosity mapping, to find the gene responsible for muscular dystrophy. Proband was a 10-year-old boy referred to our center for ruling out DMD (Duchenne muscular dystrophy). According to the pedigree and clinical reports, we assessed him for SGPs. Haplotyping, using the four short tandem repeat (STR) markers for each of the SG genes, showed that the phenotype may segregate with SGCB gene; and observing two crossing overs which occurred within the gene suggested that the mutation might be in the first two exons of SGCB gene. Mutation analysis showed a 26 bp duplication (10 bp before the initiation codon till 13 bp after the ATG start codon). This will cause a frameshift in protein synthesis.


Evidence that hatching enzyme of the sea urchin Strongylocentrotus purpuratus is a chymotrypsin-like protease.
The sea urchin blastula secretes a hatching enzyme (HE) that dissolves the fertilization envelope. HE was collected from the supernatant seawater of cultures of hatched Strongylocentrotus purpuratus blastulae, and concentrated 20 times by ultrafiltration. The proteolytic activity of HE using casein as substrate was inhibited by the chymotrypsin inhibitors, chymostatin and N-tosyl-L-phenylalanine chloromethyl ketone. The activity was not inhibited by inhibitors (antipain, elastatinal, pepstatin, phosphoramidon, soybean trypsin inhibitor, and N alpha-p-tosyl-L-lysine chloromethyl ketone) of other types of proteases. HE did not hydrolyze the synthetic trypsin substrate, alpha-N-benzoyl-L-arginine ethyl ester, but did hydrolyze the synthetic substrate of chymotrypsin, N-benzoyl-L-tyrosine ethyl ester (BTEE). The BTEEase activity of HE was completely inhibited by the chymotrypsin inhibitors chymostatin and 2-nitro-4-carboxyphenyl N,N-diphenylcarbamate (NCDC). Chymostatin inhibited the natural hatching of sea urchin blastulae. Application of HE to freshly fertilized sea urchin eggs, 2 h after insemination, caused premature dispersal of the hardened fertilization envelope. Chymostatin and NCDC inhibited HE-induced lysis of the fertilization envelope, while inhibitors of other types of proteases were ineffective. These data suggest that sea urchin HE is a chymotrypsin-like protease we call "chymotrypsin."


Experimental design and RSM on the recovery of Ni (II) ions by ELM using TX-100 as a biodegradable surfactant.
The present work deals with the extraction and pre-concentration of nickel (II) ions using emulsified liquid membrane (ELM) in the presence of di- (2-ethylhexyl) phosphoric acid (D2EHPA) as an extractant. The emulsion stability was achieved by the biodegradable surfactants Triton X-100 addition diluted in kerosene. Influence of operating conditions that affect ELM performance were investigated. A comparative study between the optimization parameters of this process was carried out both experimentally and with the Response Surface Methodology (RSM), in accordance with the Box-Behnken matrix. The following parameters were investegated: D2EHPA / Triton X-100 ratio between 0.5 and 3.5, initial concentration of the feed phase between 200 and 500 ppm and pH of the feed phase from 2.5-10. The transport of Ni (II) ions was evaluated according to the extraction yield as an analytical response and the optimal conditions were determined. It was found that the calculated values being in good agreement with experimental data that under the optimized conditions ([Ni] = 350 ppm, Vagitation = 200 rpm, t = 20 min and pH = 6.6), Ni (II) ions extraction was recorded more than 94% of efficiency.


New species-group taxa of Glossoscolex (Clitellata: Glossoscolecidae) from Rio Grande do Sul, Brazil.
Five new species-group taxa of Clitellata of the genus Glossoscolex from Rio Grande do Sul State, Brazil are described in this paper: Glossoscolex (Glossoscolex) riograndensis n. sp. has three subspecies, G. (G.) riograndensis riograndensis, G. (G.) riograndensis pollulus n. ssp., G. (G.) riograndensis nativus n. ssp. The two other new species are named G. (G.) pastivus n. sp., and G. (G.) pampas n. sp. All new species are part of the truncatus species group within the subgenus, characterized by the presence of male pores in segment xvii. A single unnamed specimen, also described here, is deemed to belong to a sixth new species-group taxon of the truncatus group. A tabular character comparison of the new taxa and known and morphologically similar species is given. Information on the habitat, such as vegetation cover and soil characteristics, is given as well. G. (G.) r. riograndensis and G. (G.) r. pollulus had an unusual storage of sperm in the nephridia. Histological sections were performed to verify it.


Referent cognitions theory: the role of closeness of reference points in the psychology of voice.
The most generally accepted and best documented manipulation in procedural justice experiments is varying whether or not participants are allowed an opportunity to voice their opinion about a decision. To better understand the psychology of voice, the authors focus on Referent Cognitions Theory (RCT). It is argued that thus far RCT has not been used to explain the psychology of voice and that previous RCT research suffers from methodological problems and has been more outcome oriented than necessary. Two experiments resolve these problems and show that people react more strongly to procedures (especially no-voice procedures) when reference points are close as opposed to distant. These findings suggest that closeness of reference points plays an important role in the psychology of voice. The findings expand RCT in significant ways and indicate that insight into the role of reference points is essential for understanding the psychology of justice.


Perceived social support in adults with autism spectrum disorder and attention-deficit/hyperactivity disorder.
Perceived social support (PSS) has been related to physical and mental well-being in typically developing individuals, but systematic characterizations of PSS in autism spectrum disorder (ASD) are limited. We compared self-report ratings of the multidimensional scale of PSS (MSPSS) among age- and IQ-matched groups of adults (18-58 years) with cognitively high-functioning ASD (N = 41), or attention-deficit/hyperactivity disorder (ADHD; N = 69), and neurotypical controls (NC; N = 69). Accompanying group comparisons, we used machine learning random forest (RF) analyses to explore predictors among a range of psychopathological and socio-emotional variables. Relative to both ADHD and NC, adults with ASD showed lower MSPSS ratings, specifically for the friends subscale (MSPSS-f). Across ASD and ADHD, interindividual differences in autism severity, affective empathy, symptoms of anxiety related to social interactions, hyperactivity/impulsivity, and somatization best predicted MSPSS-f. These relationships did not differ between clinical groups. While group comparisons demonstrated greater impairment in individuals with ASD, analyzing individuals' characteristics revealed cross-diagnoses similarities in regard to their MSPSS-f relationships. This is consistent with the Research Domain Criteria framework, supporting a trans-diagnostic approach as on the path toward "precision medicine." Autism Res 2017, 10: 866-877. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.


Antiobesity drugs in the management of type 2 diabetes: A shift in thinking?
Antiobesity medications can improve metabolic control for patients with type 2 diabetes mellitus (DM) and obesity, but are underutilized. In this review, we describe the role of antiobesity drugs in the context of medically supervised and comprehensive weight-loss interventions and propose a pragmatic therapeutic algorithm for patients with type 2 DM and obesity that incorporates the use of antiobesity drugs early in the course of management.


"It Feels Good to Know That Someone Cares".
Diabetes is the leading cause of death in Hispanic communities. Self-management is an important part of diabetes care, and diabetes self-management education (DSME) aims to teach the skills necessary for preventing and delaying complication. However, DSME is underutilized. The purpose of this study was to explore Hispanic adults' motivations for attending a DSME class to identify effective strategies for promoting class participation and retention. Nineteen adults participated in seven focus groups conducted in Spanish. Discussions were audio-recorded, transcribed, and translated. Transcripts were content coded by two coders to create a thematic coding scheme. Five main themes emerged as motivations for attendance: (1) frustration with physiological changes, (2) desire to "do better" because of family experience with death/complications from diabetes, (3) free access to information that is unattainable elsewhere, (3) a way to take control, and (4) group setting offered valued emotional and informational support as well as peer support for those who were uncomfortable discussing diabetes with family or lived with family who do not support lifestyle changes. Gaining diabetes self-management knowledge only partly explains the perceived value of classes. Culturally relevant content and appealing to the social supportive aspects of groups may encourage participation.


Antibiotics Use among Geriatric Patients Admitted in the Department of Medicine in a Tertiary Care Centre: A Descriptive Cross-sectional Study.
Ageing predisposes to increased risk of infections which make these population vulnerable to high risk of various chronic co-morbidities, organ dysfunction and mortality. Increased frequency of infections has led to an increasing proportion of geriatric patient admission to hospitals, and antibiotics therapy has long been recognized as a cornerstone in the treatment of infections. The aim of this study was to find out the prevalence of antibiotic use among geriatric patients admitted to the Department of Medicine in a tertiary care centre. A descriptive cross-sectional study was conducted among geriatric patients admitted to Department of Medicine in a tertiary care centre from 1 May 2022 to 31 August 2022. Ethical approval was obtained from the Institutional Review Committee (Reference number: 17/22). Patients with the age of ≥60 years, admitted to the Department of Medicine who stayed for at least 24 hours was included as the study population. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Among 520 geriatric patients, antibiotics was used in 252 (48.46%) (44.16-52.76, 95% Confidence Interval) patients. Ceftriaxone was the most common antibiotic used in 165 (65.48%) patients, followed by oral azithromycin in 72 (28.57%). The mean antibiotics used per patient was 1.59±0.73. The prevalence of antibiotic use in the geriatric population was found to be lower than in the other studies done in similar settings. aged; antibiotics; drug utilization.


The effect of increasing the pore size of nanofibrous scaffolds on the osteogenic cell culture using a combination of sacrificial agent electrospinning and ultrasonication.
One of the major problems associated with the electrospun scaffolds is their small pore size, which limits the cellular infiltration for bone tissue engineering. In this study, the effect of increasing the pore size on cellular infiltration was studied in poly/nanohydroxyapatite electrospun scaffolds, which were modified using ultrasonication, co-electrospinning with poly (ethylene oxide), and a combination of both. Ultrasonic process was optimized by central composite design. The ultrasonic output power and time of the process were considered as the effective parameters. The pore size of the scaffolds was evaluated by scanning electron microscope. The optimum conditions, according to the pore area and mechanical properties of the scaffolds were selected, and finally the groups that had the highest pore size and mechanical strength were selected for the combined method. Increasing the pore size enhanced the cellular proliferation, extension and infiltration, as well as the osteodifferentiation of stem cells. At the optimum condition, the average cellular infiltration was 36.51 µm compared to the control group with no cellular infiltration. In addition, alkaline phosphatase activity and the expression of osteocalcin and collagen I (COL I) were, respectively, 1.86, 2.54, and 2.16 fold compared to the control group on day 14. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 1887-1899, 2017.


Antimicrobial Effect of Ocimum gratissimum L. Essential Oil on Shewanella putrefaciens: Insights Based on the Cell Membrane and External Structure.
The main objective of this study was to assess the in vitro antibacterial effectiveness of Ocimum gratissimum L. essential oil (OGEO) against Shewanella putrefaciens. The minimum inhibitory concentration and minimum bactericidal concentration of OGEO acting on S. putrefaciens were both 0.1% and OGEO could inhibit the growth of S. putrefaciens in a dose-dependent manner. The restraint of the biofilm growth of S. putrefaciens was found in the crystal violet attachment assay and confocal laser scanning microscopy. The disruption of cell membranes and exudation of contents in S. putrefaciens with OGEO treatment were observed by scanning electron microscopy, hemolysis and ATPase activity. The results demonstrated that OGEO had a positive inhibitory effect on the growth of S. putrefaciens, which primarily developed its antibacterial function against S. putrefaciens by disrupting the formation of biofilms and cell membranes. This study could provide a new method of inhibiting the spoilage of food in which the dominant spoilage bacteria are S. putrefaciens.


[EXPERIMENTAL RESEARCH OF DIFFERENTIATION OF HUMAN AMNIOTIC MESENCHYMAL STEM CELLS INTO LIGAMENT CELLS IN VITRO].
To discuss whether human amniotic mesenchymal stem cells (hAMSCs) possesses the characteristic of mesenchymal stem cells, and could differentiate into ligament cells in vitro after induction. The hAMSCs were separated through enzyme digestion, and the phenotypic characteristics of hAMSCs were tested through flow cytometry. The cells at passage 3 were cultured with L-DMEM/F12 medium containing transforming growth factor beta1 (TGF-beta1) + basic fibroblast growth factor (bFGF) (group A), containing hyaluronic acid (HA) (group B), containing TGF-beta1+bFGF+HA (group C), and simple L-DMEM/F12 medium (group D) as control group. The morphology changes of cells in each group were observed by inverted phase contrast microscope at 21 days after induction; the cellular activities and proliferation were examined by sulforhodamine (SRB) colorimetric method; and specific mRNA and protein expressions of ligament including collagen type I, collagen type III, and tenascin C (TNC) were measured by real-time fluorescence quantitative PCR and immunohistochemical staining. The flow cytometry result indicated that hAMSCs expressed mesenchymal stem cell phenotype. After 21 days of induction, the cells in groups A, B, and C grew like spindle-shaped fibroblasts under inverted phase contrast microscope, and cells showed single shape, obvious directivity, and compact arrangement in group C. The SRB result indicated that the cells in each group reached the peak of growth curve at 6 days; the cellular activities of groups A, B, and C were significantly higher than that of group D at 6 days after induction. Also, the immunohistochemical staining results showed that no expressions of TNC were detected in 4 groups at 7 days; expressions of collagen type I in groups A, B, and C were significantly higher than that in group D at 7, 14, and 21 days (P<0.001); the expressions of collagen type III in groups A, B, and C were significantly higher than that in group D at 14 and 21 days (P<0.001). There was an increasing tendency with time in collagen type I of group B, in collagen type III and TNC of groups A and C, showing significant difference among different time points (P<0.001). The real-time fluorescence quantitative PCR results revealed that the mRNA expressions of collagen type I and TNC in group C were significantly higher than those in groups A and B (P<0.05), and the mRNA expression of collagen type III in group B were significantly higher than that in groups A and C at 21 days (P<0.05). The mRNA expressions of collagen type I and TNC in groups A and C and mRNA expression of collagen type III in group C had an increasing tendency with time, showing significant difference among different time points (P<0.001). The hAMSCs possesses the characteristics of mesenchymal stem cells and excellent proliferation capacity. After in vitro induction, the expressions of ligament specific genes can be up-regulated and the synthesis of ligament specific proteins can be also strengthened. As a result, it can be used as one of ligament tissue engineering seed cell sources.


Systemic versus local adipokine expression differs in a combined obesity and osteoarthritis mouse model.
Osteoarthritis (OA) is a degenerative joint disease characterized by cartilage loss and reduced joint function. OA risk factors are age and obesity. Many adipokines are altered by obesity but also OA although systemic adipokine regulation in OA is not always clear. Therefore, metabolic effects of diet-induced obesity on OA development as well as the influence of obesity and OA progression on systemic vs. local adipokine expression in joints were compared. C57Bl/6-mice fed with HFD (high fat diet) or normal diet prior to destabilization of the medial meniscus (DMM) were sacrificed 4/6/8 weeks after surgery. Sera were evaluated for adiponectin, leptin, visfatin, cytokines. Liver grading and staging for non-alcoholic steatohepatitis (NASH) was performed and crown-like structures (CLS) in adipose tissue measured. OA progression was scored histologically. Adipokine-expressing cells and types were evaluated by immunohistochemistry. Time-dependent changes in DMM-progression were reflected by increased systemic adiponectin levels in DMM especially combined with HFD. While HFD increased serum leptin, DMM reduced systemic leptin significantly. OA scores correlated with bodyweight, leptin and hepatic scoring. Locally, increased numbers of adiponectin- and leptin-producing fibroblasts were observed in damaged menisci but visfatin was not changed. Local adipokine expression was independent from systemic levels, suggesting different mechanisms of action.


Myeloperoxidase-positive cell infiltration of normal colorectal mucosa is related to body fatness and is predictive of adenoma occurrence.
Body fatness is a risk factor for colorectal cancer, and promotes an inflammatory environment. Indeed, inflammation in normal colorectal mucosa may be a factor linking body fatness to colorectal carcinogenesis. In this study, we evaluated myeloperoxidase (MPO)-positive cells infiltration of normal colorectal mucosa as a marker of cancer-promoting inflammation in overweight and obese subjects. One hundred and three subjects with normal colonoscopy entered the study. Waist circumference (WC) and body mass index (BMI) were measured, and MPO-positive cells on histological sections of biopsies of normal colorectal mucosa were counted under a light microscope. The occurrence of adenomas was then evaluated on follow-up colonoscopies. Mean MPO-positive cell count (±s.e.m.) was higher in subject with a WC equal or above the obesity cutoff values according to gender (2.63±0.20 vs 2.06±0.18, P=0.03), and in subjects with BMI equal or above 25 kg m-2 (2.54±0.18 vs 1.97±0.20, P=0.03). A Cox proportional hazard model showed that mean MPO-positive cell count in normal colorectal mucosa was the only factor independently related to occurrence of adenomas in follow-up colonoscopies. Though preliminary, these results show that MPO-positive cell infiltration in normal colorectal mucosa is related with body fatness, as evaluated by WC and BMI, and it may be considered a useful and simple marker to estimate adenoma occurrence risk.


Telomere Length Analysis: A Tool for Dissecting Aging Mechanisms in Developmental Programming.
Accelerated cellular aging is known to play an important role in the etiology of phenotypes associated with developmental programming, such as cardiovascular disease and type 2 diabetes. Telomere length analysis is a powerful tool to quantify cellular aging. Here we describe a telomere length methodology, refined to quantify discrete telomere length fragments. We have shown this method to be more sensitive in detecting small changes in telomere length than the traditional average telomere length comparisons.


Genes and proteins governing the cellular sensitivity to HSP90 inhibitors: a mechanistic perspective.
HSP90 inhibitors such as 17AAG have the major therapeutic advantage that they exert downstream inhibitory effects on multiple oncogenic client proteins. They therefore block several mission critical cancer-causing pathways and have the potential to modulate all of the hallmark biological features of malignancy. Consistent with this combinatorial anti-oncogenic profile, 17AAG exhibits broad-spectrum antitumour activity against cultured cancer cell lines and in vivo animal models. However, there are clear differences in sensitivity between various cancer cell lines and it is quite possible that some tumour types or individual patients will be more responsive in the clinic than others. We describe the methods used to investigate the genes and proteins involved in the mechanism of action of HSP90 inhibitors and discuss the significance of these for cellular sensitivity. Methods used involve the conventional cell and molecular biology techniques, together with the more recent application of high throughput global technologies such as gene expression microarrays and proteomics. Selected examples that seem to play a role in sensitivity to HSP90 inhibitors are highlighted and the potential relevance to the response of cancer patients is discussed. Important determinants of response include: 1) Dependence upon key HSP90 client proteins such as ERBB2, steroid hormone receptors and AKT/PKB; 2) Levels of HSP90 family members and co-chaperones, such as HSP70 and AHA1; and 3) expression of various cell cycle and apoptotic regulators. In the case of 17AAG, metabolic enzymes such as NQO1 and membrane efflux pumps are also important for sensitivity.


Medical professionalism in the new millennium: a physicians' charter*.
The practice of medicine in the modern era is beset with unprecedented challenges in virtually all cultures and societies. These challenges centre on increasing disparities between the legitimate needs of patients, the available resources to meet those needs, the increasing dependence on market forces to transform healthcare systems, and the temptation for physicians to forsake their traditional commitment to the primacy of patients' interests. To maintain the fidelity of medicine's social contract during this turbulent time, we believe that physicians must reaffirm their active dedication to the principles of professionalism, which entails not only their personal commitment to the welfare of their patients but also collective efforts to improve the healthcare system for the welfare of society. This Charter on Medical Professionalism is intended to encourage such dedication and to promote an action agenda for the profession of medicine that is universal in scope and purpose.


Support of parenting in undergraduate medical training in New Zealand.
This research assessed support for parents studying undergraduate medicine at a New Zealand medical school and identified requirements for additional support. Support documentation was sourced from Student Affairs and university and medical school websites. The Medical Deans of Australia and New Zealand Medical Students Outcome and Longitudinal tracking Project was retrospectively examined for data specific to medical student parents. Student parents and medical school staff were also surveyed for their knowledge and perceptions around organisation and effectiveness of available support, and suggestions for additional support. Parents and expectant parents formed a consistent, likely growing sub-group studying medicine from 2008 to 2020, yet no formal student parent support policy existed until 2019. Prior to this, 67% of student parents and 47% of staff lacked knowledge of available support. Since 2020, calls for greater visibility of parenting policies and flexibility in the curriculum have been operationalised by the medical school. Formalising policies and procedures, maximising access to parenting support resources and introducing flexibility in medical curricula can help students balancing families and medical training. This is relevant for sustainability of medicine as a career option for medical students wanting children, especially considering over half of all medical students are female.


Evaluation of Magnesium-Phosphate Particle Incorporation into Co-Electrospun Chitosan-Elastin Membranes for Skin Wound Healing.
Major challenges facing clinicians treating burn wounds are the lack of integration of treatment to wound, inadequate mechanical properties of treatments, and high infection rates which ultimately lead to poor wound resolution. Electrospun chitosan membranes (ESCM) are gaining popularity for use in tissue engineering applications due to their drug loading ability, biocompatibility, biomimetic fibrous structure, and antimicrobial characteristics. This work aims to modify ESCMs for improved performance in burn wound applications by incorporating elastin and magnesium-phosphate particles (MgP) to improve mechanical and bioactive properties. The following ESCMs were made to evaluate the individual components' effects; (C: chitosan, CE: chitosan-elastin, CMg: chitosan-MgP, and CEMg: chitosan-elastin-MgP). Membrane properties analyzed were fiber size and structure, hydrophilic properties, elastin incorporation, MgP incorporation and in vitro release, mechanical properties, degradation profiles, and in vitro cytocompatibility with NIH3T3 fibroblasts. The addition of both elastin and MgP increased the average fiber diameter of CE (~400 nm), CMg (~360 nm), and CEMg (565 nm) compared to C (255 nm). Water contact angle analysis showed elastin incorporated membranes (CE and CEMg) had increased hydrophilicity (~50°) compared to the other groups (C and CMg, ~110°). The results from the degradation study showed mass retention of ~50% for C and CMg groups, compared to ~ 30% seen in CE and CEMg after 4 weeks in a lysozyme/PBS solution. CMg and CEMg exhibited burst-release behavior of ~6 µg/ml or 0.25 mM magnesium within 72 h. In vitro analysis with NIH3T3 fibroblasts showed CE and CEMg groups had superior cytocompatibility compared to C and CMg. This work has demonstrated the successful incorporation of elastin and MgP into ESCMs and allows for future studies on burn wound applications.


[The use of computers in the exercise of electrocardiography (author's transl)].
The use of computers in the exercise of electrocardiography is considered. The problems related to this use concern the choice of leads, the filtration of the signal, the recognition of characteristic segments of ECG, the calculation of various indexes and their statistical evaluation for diagnostic purposes. The authors use a bipolar derivation filtered by averaging and digital filters. The characteristic points of ECG are recognized by the analysis of the curvature. The Tchebycheff coefficients of the S-T tract are evaluated; they appeared to be a very good means for judging positive and negative cases.


Of pacemakers and statistics: the actuarial method extended.
Pacemakers cease functioning because of either natural battery exhaustion (nbe) or component failure (cf). A study of four series of pacemakers shows that a simple extension of the actuarial method, so as to incorporate Normal statistics, makes possible a quantitative differentiation between the two modes of failure. This involves the separation of the overall failure probability density function PDF(t) into constituent parts pdfnbe(t) and pdfcf(t). The approach should allow a meaningful comparison of the characteristics of different pacemaker types.


Molecular cloning, expression and chromosomal localization of a novel human REG family gene, REG III.
Regenerating gene (Reg), first isolated from a regenerating islet cDNA library, encodes a secretory protein with a growth stimulating effect on pancreatic beta cells that ameliorates the diabetes of 90% depancreatized rats and non-obese diabetic mice. Reg and Reg-related genes have been revealed to constitute a multigene family, the Reg family, which consists of four subtypes (types I, II, III, IV) based on the primary structures of the encoded proteins of the genes [Diabetes 51(Suppl. 3) (2002) S462]. Plural type III Reg genes were found in mouse and rat. On the other hand, only one type III REG gene, HIP/PAP (gene expressed in hepatocellular carcinoma-intestine-pancreas/gene encoding pancreatitis-associated protein), was found in human. In the present study, we found a novel human type III REG gene, REG III. This gene is divided into six exons spanning about 3 kilobase pairs (kb), and encodes a 175 amino acid (aa) protein with 85% homology with HIP/PAP. REG III was expressed predominantly in pancreas and testis, but not in small intestine, whereas HIP/PAP was expressed strongly in pancreas and small intestine. IL-6 responsive elements existed in the 5'-upstream region of the human REG III gene indicating that the human REG III gene might be induced during acute pancreatitis. All the human REG family genes identified so far (REG Ialpha, REG Ibeta, HIP/PAP, REG III and REG IV) have a common gene structure with 6 exons and 5 introns, and encode homologous 158-175-aa secretory proteins. By database searching and PCR analysis using a yeast artificial chromosome clone, the human REG family genes on chromosome 2, except for REG IV on chromosome 1, were mapped to a contiguous 140 kb region of the human chromosome 2p12. The gene order from centromere to telomere was 5' HIP/PAP 3'-5' RS 3'-3' REG Ialpha 5'-5' REG Ibeta 3'-3' REG III 5'. These results suggest that the human REG gene family is constituted from an ancestor gene by gene duplication and forms a gene cluster on the region.


X-ray diffraction study of Anodisc filters.
X-ray diffraction from Anodisc membrane filters is measured and analyzed. The patterns are consistent with pores of constant diameter and a Gaussian distribution of pore-pore spacing. The mean distance between pores, measured using x rays is 0.37 microm compared to 0.32 microm calculated from the nominal density of pores/cm(2). The results may be modeled both in terms of the convolution of a structure factor of the pores with the resolution function, and by modeling the source as a collection of incoherent sources with an ideal monochromator crystal. The incoherent source analysis provides an explanation for the common observation that the resolution function in many x-ray spectrometers is better fit to a sum of Lorentzians, rather than a single Lorentzian.


Intraoperative monitoring of danaparoid sodium anticoagulation during cardiovascular operations.
Patients with cardiovascular disorders frequently need anticoagulation for diagnostic studies, surgical procedures, and therapy. Heparin-induced thrombocytopenia is a relatively common complication of heparin therapy that can result in thrombosis and subsequent limb loss or death, necessitating use of alternative anticoagulants. Two patients who needed cardiac surgery had thrombocytopenia induced by exposure to heparin and heparin-coated tubing. Several assays were examined for their ability to monitor intraoperative anticoagulation of a factor Xa inhibitor, danaparoid sodium. In vitro, celite and kaolin activated dotting times and activated partial thromboplastin time were prolonged linearly in the presence of increasing concentrations of danaparoid sodium. Aprotinin did not alter the linearity of the response but did alter its slope. In vivo, activated clotting times and activated partial thromboplastin time were insensitive to clinically significant changes in danaparoid sodium plasma levels during cardiopulmonary bypass. Correction in activated partial thromboplastin time lagged 2 hours behind clinically important changes in anti-factor Xa levels. Only anti-factor Xa levels were adequate to monitor intraoperative danaparoid sodium levels. Anticoagulation for cardiopulmonary bypass can be successfully performed with danaparoid sodium and intraoperative anti-factor Xa monitoring.


Device-associated infection rates, mortality, length of stay and bacterial resistance in intensive care units in Ecuador: International Nosocomial Infection Control Consortium's findings.
To report the results of the International Nosocomial Infection Control Consortium (INICC) study conducted in Quito, Ecuador. A device-associated healthcare-acquired infection (DA-HAI) prospective surveillance study conducted from October 2013 to January 2015 in 2 adult intensive care units (ICUs) from 2 hospitals using the United States Centers for Disease Control/National Healthcare Safety Network (CDC/NHSN) definitions and INICC methods. We followed 776 ICU patients for 4818 bed-days. The central line-associated bloodstream infection (CLABSI) rate was 6.5 per 1000 central line (CL)-days, the ventilator-associated pneumonia (VAP) rate was 44.3 per 1000 mechanical ventilator (MV)-days, and the catheter-associated urinary tract infection (CAUTI) rate was 5.7 per 1000 urinary catheter (UC)-days. CLABSI and CAUTI rates in our ICUs were similar to INICC rates [4.9 (CLABSI) and 5.3 (CAUTI)] and higher than NHSN rates [0.8 (CLABSI) and 1.3 (CAUTI)] - although device use ratios for CL and UC were higher than INICC and CDC/NSHN's ratios. By contrast, despite the VAP rate was higher than INICC (16.5) and NHSN's rates (1.1), MV DUR was lower in our ICUs. Resistance of A. baumannii to imipenem and meropenem was 75.0%, and of Pseudomonas aeruginosa to ciprofloxacin and piperacillin-tazobactam was higher than 72.7%, all them higher than CDC/NHSN rates. Excess length of stay was 7.4 d for patients with CLABSI, 4.8 for patients with VAP and 9.2 for patients CAUTI. Excess crude mortality in ICUs was 30.9% for CLABSI, 14.5% for VAP and 17.6% for CAUTI. DA-HAI rates in our ICUs from Ecuador are higher than United States CDC/NSHN rates and similar to INICC international rates.


The role of Siglec-1 in HIV-1/macrophage interaction.
Although CD4 T-cells are a major target for HIV, recent work has demonstrated the ability of macrophages despite expressing relatively low levels of CD4, to be a target of the virus. Our recent study has found that the presence of growth factors not only play a role in the phenotype of these monocyte-derived-macrophages, but also are an important aspect of the permissiveness of these cells to infection. The work utilized cellular and biophysical methods to examine Siglec-1 on macrophages as a primary receptor in HIV-1 infection. These findings support the notion that Siglec-1 and macrophages and their interactions with the HIV-1 envelope should be considered in HIV-1 vaccine development.


Radio-iodine therapy in differentiated thyroid cancer: indications and procedures.
Post-surgical ablative iodine-131 therapy is recommended for all differentiated thyroid cancer primary tumors>1 cm in diameter. Regarding smaller primary tumors, 131I ablation may be helpful in special cases: tumor close to the thyroid capsule, previous percutaneous radiation to the neck, familial occurrence of thyroid cancer, tumor diameter 5-10 mm, and unfavorable histological variants. In this context, the patient's preferences for safety should be considered. In most centers, standard fixed activities of 1-3 GBq are used for 131I ablation. Preparation for the procedure with such activities requires a low-iodine diet for 2-3 weeks and stimulation of thyroid stimulating hormone (TSH) by withholding of thyroid hormone for 3 weeks following thyroidectomy or by use of recombinant human TSH. The advantages of recombinant TSH are avoidance of hypothyroid morbidity and consequently a better quality of life, as well as a lower radiation dose to extra-thyroidal compartments. To treat metastastic differentiated thyroid cancer, higher activities of radio-iodine (in the range 4-11 GBq) are necessary; if possible, individual dosimetry is recommended. The standard approach to preparation for 131I therapy in patients with metastases is endogenous hypothyroidism after thyroid hormone withdrawal.


Cruciform DNA binding protein in HeLa cell extracts.
We have analyzed by band-shift assays HeLa cell protein-DNA interactions on a stable cruciform DNA molecule. The stable cruciform was formed by heteroduplexing the HindIII-SphI fragment of SV40 virus DNA that contains the origin of replication with a derivative mutant containing a heterologous substitution at the central inverted repeat. We have identified a novel binding activity in HeLa cell extracts with specificity for the cruciform-containing DNA and no apparent sequence specificity. The activity is protein-dependent, void of detectable nuclease activity, and distinct from that reported for HMG1. A cruciform binding protein (CBP) with an apparent molecular weight of 66 kDa was enriched from HeLa cell extracts. In addition to the CBP, we have detected sequence-specific binding activities to sites proximal to the cruciform. Binding to one such site is increased in the cruciform-containing heteroduplex DNA by comparison to its linear homoduplex counterpart, suggesting transmission of structural effects by the stem-loops to their local environment.


Cultural adaptation and Turkish version of Physical Activity Scale for Individuals with Physical Disabilities in individuals with spinal cord injury: a reliability and validity study.
To translate the "Physical Activity Scale for Individuals with Physical Disabilities (PASIPD)" into Turkish, to make a cultural adaptation, and to examine the psychometric properties including validity and reliability. During the translation period cross-cultural adaptation design proposed by guideline was used. Patients completed the Turkish version of the PASIPD and it was applied again a week later. To determine the reliability and internal consistency, Cronbach's alpha coefficient was calculated. Test-retest reliability was determined by using intraclass correlation coefficient (ICC) and Pearson's correlation analysis. Construct validity was examined with factor analysis. Convergent validity was examined by comparing PASIPD with Functional Independent Measurement (FIM), Nottingham Health Profile (NHP), and Craig Handicap Assessment and Reporting Technique Short (CHART-SF), and criterion validity was examined by comparing PASIPD with Manual wheelchair propulsion tests scores. Cronbach's alpha coefficient was 0.725. The ICC coefficient for the test-retest reliability was 0.851. PASIPD was explained by three factors. The ratio of explaining the total variance of these 3 factors was determined as 51.66%. FIM (r = 0.307, p = 0.040) and CHART-SF were moderately positively correlated with PASIPD total score. The correlation between the total score of PASIPD and NHP was r = -0.443 (p = 0.002). 20 Meters Propulsion (r = -0.404, p = 0.005) and Slalom Tests (r = -0.305, p = 0.037) were highly negative and 6 min Push Propulsion (r = 0.456, p = 0.001) were moderately positive with PASIPD total score. The Turkish version of the PASIPD is a valid and reliable scale in patients with spinal cord injury. IMPLICATIONS FOR REHABILITATIONThe Turkish and cross-culturally adapted version of PASIPD is a useful physical activity scale to evaluate the physical activity level of SCI.The Turkish version of the PASIPD is a valid and reliable scale and can be used in Turkish patients with SCI.PASIPD can be used to compare physical activity levels between disability types and groups with and without disabilities.PASIPD can be used to evaluate the effectiveness of attempts to increase physical activity in patients with SCI.


Catalytic Activity and Proton Translocation of Reconstituted Respiratory Complex I Monitored by Surface-Enhanced Infrared Absorption Spectroscopy.
Respiratory complex I (CpI) is a key player in the way organisms obtain energy, being an energy transducer, which couples nicotinamide adenine dinucleotide (NADH)/quinone oxidoreduction with proton translocation by a mechanism that remains elusive so far. In this work, we monitored the function of CpI in a biomimetic, supported lipid membrane system assembled on a 4-aminothiophenol (4-ATP) self-assembled monolayer by surface-enhanced infrared absorption spectroscopy. 4-ATP serves not only as a linker molecule to a nanostructured gold surface but also as pH sensor, as indicated by concomitant density functional theory calculations. In this way, we were able to monitor NADH/quinone oxidoreduction-induced transmembrane proton translocation via the protonation state of 4-ATP, depending on the net orientation of CpI molecules induced by two complementary approaches. An associated change of the amide I/amide II band intensity ratio indicates conformational modifications upon catalysis which may involve movements of transmembrane helices or other secondary structural elements, as suggested in the literature [ Di Luca , Proc. Natl. Acad. Sci. U.S.A. , 2017 , 114 , E6314 - E6321 ].


Pentapeptide IIAEK ameliorates cholesterol metabolism via the suppression of intestinal cholesterol absorption in mice.
Dietary protein-derived peptides are effective in improving dyslipidemia and hypercholesterolemia. We previously identified a novel cholesterol-lowering pentapeptide IIAEK from milk beta-lactoglobulin. However, it remains unclear whether IIAEK affects the micellar solubility of cholesterol and the bile acid-binding ability to lower cholesterol. Moreover, there is no direct evidence that IIAEK inhibits intestinal cholesterol absorption and affects hepatic cholesterol and fecal steroid excretion in vivo. Herein, we showed that IIAEK did not affect the micellar solubility of cholesterol and the bile acid-binding ability. However, we found that IIAEK decreased serum and liver cholesterol levels and increased fecal steroid excretion in mice. Interestingly, IIAEK markedly suppressed the intestinal absorption of [3H]-cholesterol in mice. In conclusion, we found that IIAEK ameliorated cholesterol metabolism by suppressing intestinal cholesterol absorption without affecting in vitro micellar solubility of cholesterol and the bile acid-binding ability in mice.


Monocyte in vitro function in systemic lupus erythematosus (SLE). III. Bactericidal activity in presence of SLE-sera.
The bactericidal activity of normal monocytes in the presence of serum from 14 patients with SLE was studied with a modification of the Maaloe technique. The bactericidal activity was impaired in the presence of sera from 8/14 patients. The group with abnormal bacterial killing showed higher clinical activity than did the group with normal killing capacity. Corticosteroid therapy was also more common among patients with reduced killing. A further difference between patients with abnormal and normal killing was that the former had more episodes of infection during a 2-year follow-up period.


Epidural injections for the treatment of symptomatic lumbar herniated discs.
Epidural steroid injections are widely used as part of the conservative care for symptomatic herniated lumbar discs. There are studies showing their effectiveness, and some studies demonstrating no clinical benefits. The purpose of this study was to evaluate the effectiveness of epidural steroid injections for patients with symptomatic lumbar disc herniations who were surgical candidates. Sixty-nine patients were diagnosed with a herniated disc in the lumbar spine and remained symptomatic despite conservative care, and were treated with an epidural injection in an attempt to avoid surgical discectomy. Of the total group of 69 patients (average age = 44.8 years, range 19-77 years, average follow-up = 1.5 years), 53 (77%) had successful resolution or significant decrease of their symptoms and were able to avoid surgery. Only 16 (23%) patients failed to have significant relief of their symptoms and required surgical treatment of their herniated disc. Epidural steroid injections have a reasonable success rate for the alleviation of radicular symptoms from lumbar herniated discs for up to twelve to twenty-seven months. Patients treated with injections may be able to avoid surgical treatment up to this period and perhaps even longer.


Which will Trump: human rights and professional ethics, or torture redux?
Recent political developments in the United States raise concerns about the potential return of aggressive interrogation strategies, particularly in the event of another large-scale terror attack on the U.S. mainland. This essay reviews various legal, ethical and policy responses to revelations of torture during the Bush administration. It asks whether they improve the prospect that, in future, human rights will trump torture, not vice versa. The essay argues that physicians could help prevent further abuses - especially given their access, social status and expertise - but that insufficient steps have been taken to empower them to do so.


Encystment Induces Down-Regulation of an Acetyltransferase-Like Gene in Acanthamoeba castellanii.
Acanthamoeba castellanii is a ubiquitous free-living amoeba. Pathogenic strains are causative agents of Acanthamoeba keratitis and granulomatous amoebic encephalitis. In response to adverse conditions, A. castellanii differentiate into cysts, which are metabolically inactive and resistant cells. This process, also named encystment, involves biochemical and genetic modifications that remain largely unknown. This study characterizes the role of the ACA1_384820 Acanthamoeba gene during encystment. This gene encodes a putative N-acetyltransferase, belonging to the Gcn5-related N-acetyltransferase (GNAT) family. We showed that expression of the ACA1_384820 gene was down-regulated as early as two hours after induction of encystment in A. castellanii. Interestingly, overexpression of the ACA1_384820 gene affects formation of cysts. Unexpectedly, the search of homologs of ACA1_384820 in the Eukaryota gene datasets failed, except for some species in the Acanthamoeba genus. Bioinformatics analysis suggested a possible lateral acquisition of this gene from prokaryotic cells. This study enabled us to describe a new Acanthamoeba gene that is down-regulated during encystment.


Contributions to the anatomy of the cervical spine. Functional and pathogenetic significance of certain structures of the cervical vertebrae.
Following the investigations carried out on about 350 macerated vertebrae by the dissection of 120 human cadavers, a number of structural pecularities of the cervical vertebrae are described, with special emphasis on their functional and pathogenetic significance. The most specific structures of the cervical vertebrae -- the transverse, unciform, and articular processes, and the vertebral pedicle -- embody from the ontogenetic, the morphofunctional and the pathogenetic point of view, a unity named the uncotransversoarticular complex. The components of this complex delimit the spinal nerve groove, the intervertebral canal and participate in the cervical locking mechanism, in this way contributing to the protection of the vasculonervous formations passing through the cervical spine. The osteovasculonervous relationships at the level of the intervertebral canal, the anatomical variants of the intervertebral canal as well as certain possibilities of the occurrence of a cervical locking deficiency are described.


[Radiation-induced changes in critical organs in rats irradiated in the state of parabiosis].
A study was made of the influence of parabiosis on the critical organ status in rats exposed to supralethal doses. The presence of a nonirradiated partner was shown to accelerate the recovery processes both in the intestine and the haemopoietic organs. The X-ray dose leading to a 50% decrease in the number of crypts was 11.9 Gy for parabionts, and 6.6 Gy for single animals.


Getting Along in Assisted Living: Quality of Relationships Between Family Members and Staff.
Assisted living facilities (ALFs) have quickly expanded as an alternative to nursing homes. Research on nursing homes has revealed problems in relationships between family members and staff. However, little is known about these relationships within ALFs. The purpose of the current study was to examine the prevalence of conflict and positive and negative interactions from the perspective of both family members and staff and to examine the effects of positive and negative aspects of the relationship on salient staff and family outcomes in ALFs. Data were collected from 252 family members and 472 staff members across 20 ALFs who participated in the Partners in Care in Assisted Living study. Participants completed measures including interpersonal conflict, depressive symptoms, perception of treatment, and stress related to caregiving. Conflict among family and staff members was found to be relatively low. For staff, interpersonal conflict and treatment by family members significantly predicted burnout and depressive symptoms. For families, only female gender significantly predicted burden. Subgroup analyses, however, indicated that the effect of interpersonal conflict was significantly associated with perceived caregiver burden among family members whose relative had dementia. Despite the relatively harmonious relationships among family-staff in ALFs, sources of conflict and negative interactions were identified, revealing the importance of collaborative relationships and the influence these relationships have on both family and staff outcomes. These findings can inform intervention efforts to improve family-staff interactions within ALFs.


Subcutaneous estradiol pellet implantation in management of advanced prostatic carcinoma.
Thirty patients with previously untreated Stage C and D carcinoma of the prostate were treated with subcutaneously implanted estradiol pellets in an effort to determine the efficacy of this mode of therapy in the control of advanced prostatic carcinoma. Serum levels of gonadotropins, testosterone, and estradiol were obtained prior to institution of therapy and at monthly intervals thereafter. Twenty-eight patients were followed for at least one year. Sixteen patients were hormonally castrate at six months following 1-pellet implantation. In these 16 patients the means serum testosterone level was 43.6 ng./dl. with a serum luteinizing hormone (LH) of 13.3 mlU/ml. and a serum estradiol of 19.2 ng./dl. Twenty-two patients were hormonally castrate at twelve months following 1 or more pellet implantations. In this group the mean serum testosterone level was 51.5 ng./dl. with a serum LH of 16.2 mlU/ml. and a serum estradiol of 22 ng./dl. Fifteen patients who were taking narcotics for pain relief either became pain free or had a marked decrease in need for analgesics. Increased weight improvement in over-all well-being was noted in 86 per cent of patients. pellet implantation intervals ranged from four to ten months, with a mean interval of 5.85 months between implantations. Complications attributable to this mode of therapy were no more apparent than with oral estrogens. In addition to better compliance, subcutaneously implanted estrogen pellets appear to provide a safe, reliable, and effective method of tumor control and palliation in advanced carcinoma of the prostate.


Enhancement of immune responses to hepatitis B vaccine in immunodepressed mice by CpG oligodeoxynucleotide.
To investigate enhancement of immune response to hepatitis B vaccine in immunosuppressed mice by CpG oligodeoxynucleotide (ODN). Immunodepressed C57BL/6 mice caused by cytoxan were given an injection of either hepatitis B vaccine alone or hepatitis B vaccine and CpG ODN into the left tibialis anterior muscle, then the mice were given another shot after 2 weeks using the same formulation. Blood was collected at 5 weeks after immunization and anti-hepatitis B surface antigen IgG and IL-12 levels were measured by ELISA. Spleens of immunized mice were observed under microscope. There was a two-fold increase in anti-hepatitis B surface antigen IgG level when hepatitis B vaccine was mixed with CpG ODN to immunize immunodepressed mice. There was a significant increase in IL-12 level when hepatitis B vaccine was mixed with CpG ODN. Under optical microscope, there were fewer lymphocytes in immunodepressed mice than in normal control group. The proliferation level of spleen lymphocytes in CpG ODN group was elevated compared with that of normal control group and nuclei of lymphocytes became larger. CpG ODN can enhance the immune response to hepatitis B vaccine in immunodepressed mice.


Mechanisms underlying the health benefits of intermittent hypoxia conditioning.
Intermittent hypoxia (IH) is commonly associated with pathological conditions, particularly obstructive sleep apnoea. However, IH is also increasingly used to enhance health and performance and is emerging as a potent non-pharmacological intervention against numerous diseases. Whether IH is detrimental or beneficial for health is largely determined by the intensity, duration, number and frequency of the hypoxic exposures and by the specific responses they engender. Adaptive responses to hypoxia protect from future hypoxic or ischaemic insults, improve cellular resilience and functions, and boost mental and physical performance. The cellular and systemic mechanisms producing these benefits are highly complex, and the failure of different components can shift long-term adaptation to maladaptation and the development of pathologies. Rather than discussing in detail the well-characterized individual responses and adaptations to IH, we here aim to summarize and integrate hypoxia-activated mechanisms into a holistic picture of the body's adaptive responses to hypoxia and specifically IH, and demonstrate how these mechanisms might be mobilized for their health benefits while minimizing the risks of hypoxia exposure.