COVID-19, Social Policy and Care: A Complex Set of Processes and Outcomes.
This article looks at the 2020 period of COVID-19 and especially the first months through the lens of public policy support for care in Europe. It covers the policy responses to both care for young children and frail, ill or disabled adults and develops an understanding of care as welfare-related activity focused on practices and resources oriented to meeting care-related need. The article's over-arching research question centres around how European countries responded to the 2020 pandemic, especially in regard to the types of care need that were recognized, the resources committed, the actors/agency that were supported or taken for granted and the values underpinning the responses. What we find from the review is that, while care assumed a strong place in public rhetoric, this was not reflected in greater public resourcing of care for young children or long-term care. Instead, care for children was refamilialized and long-term care was under-resourced and relegated to a secondary position; both were in many ways rendered further dependent on the private agency of individuals. In sum, the pandemic spearheaded some reversion to old practices and the opportunity to invest in care as a human need, a basis of rights and entitlements and a valued activity was not availed of.


Responding to suspected smallpox cases in the Los Angeles County from 2002 to 2006: identifying areas for education.
Although smallpox has been eradicated, health care providers in emergency departments (EDs) need to remain vigilant to its recognition. Smallpox can be confused with chickenpox. We describe suspected smallpox cases reported in Los Angeles County from 2002 to 2006 and highlight areas for education. We retrospectively reviewed suspected smallpox reports from 2002 to 2006. Laboratory testing was performed. Photographs of rashes were taken. Five suspected smallpox cases were reported. Two presented first to an ED. Smallpox was suspected based on rash features. Previous history of chickenpox or varicella vaccination may have caused increased suspicion for smallpox. All 5 were determined to have a final diagnosis of chickenpox. Health care providers notified public health appropriately and responses were immediate. Public health investigated 5 suspected smallpox cases in the past 5 years. Two presented initially to EDs. Education differentiating smallpox from chickenpox and collaboration between public health, EDs, and health care providers remains important. The ability to respond rapidly to a potential bioterrorism emergency was tested.


Renal Effects and Underlying Molecular Mechanisms of Long-Term Salt Content Diets in Spontaneously Hypertensive Rats.
Several evidences have shown that salt excess is an important determinant of cardiovascular and renal derangement in hypertension. The present study aimed to investigate the renal effects of chronic high or low salt intake in the context of hypertension and to elucidate the molecular mechanisms underlying such effects. To this end, newly weaned male SHR were fed with diets only differing in NaCl content: normal salt (NS: 0.3%), low salt (LS: 0.03%), and high salt diet (HS: 3%) until 7 months of age. Analysis of renal function, morphology, and evaluation of the expression of the main molecular components involved in the renal handling of albumin, including podocyte slit-diaphragm proteins and proximal tubule endocytic receptors were performed. The relationship between diets and the balance of the renal angiotensin-converting enzyme (ACE) and ACE2 enzymes was also examined. HS produced glomerular hypertrophy and decreased ACE2 and nephrin expressions, loss of morphological integrity of the podocyte processes, and increased proteinuria, characterized by loss of albumin and high molecular weight proteins. Conversely, severe hypertension was attenuated and renal dysfunction was prevented by LS since proteinuria was much lower than in the NS SHRs. This was associated with a decrease in kidney ACE/ACE2 protein and activity ratio and increased cubilin renal expression. Taken together, these results suggest that LS attenuates hypertension progression in SHRs and preserves renal function. The mechanisms partially explaining these findings include modulation of the intrarenal ACE/ACE2 balance and the increased cubilin expression. Importantly, HS worsens hypertensive kidney injury and decreases the expression nephrin, a key component of the slit diaphragm.


Autophagy inhibitor facilitates gefitinib sensitivity in vitro and in vivo by activating mitochondrial apoptosis in triple negative breast cancer.
Epidermal growth factor receptor (EGFR) is over-expressed in about 50% of Triple negative breast cancers (TNBCs), but EGFR inhibitors have not been effective in treating TNBC patients. Increasing evidence supports that autophagy was related to drug resistance at present. However, the role and the mechanism of autophagy to the treatment of TNBC remain unknown. In the current study, we investigated the effect of autophagy inhibitor to gefitinib (Ge) in TNBC cells in vitro and in nude mice vivo. Our study demonstrated that inhibition of autophagy by 3-Methyladenine or bafilomycin A1 improved Ge's sensitivity to MDA-MB-231 and MDA-MB-468 cells, as evidence from stronger inhibition of cell vitality and colony formation, higher level of G0/G1 arrest and DNA damage, and these effects were verified in nude mice vivo. Our data showed that the mitochondrial-dependent apoptosis pathway was activated in favor of promoting apoptosis in the therapy of Ge combined autophagy inhibitor, as the elevation of BAX/Bcl-2, Cytochrome C, and CASP3. These results demonstrated that targeting autophagy should be considered as an effective therapeutic strategy to enhance the sensitivity of EGFR inhibitors on TNBC.


CARMIL2 is a novel molecular connection between vimentin and actin essential for cell migration and invadopodia formation.
Cancer cell migration requires the regulation of actin networks at protrusions associated with invadopodia and other leading edges. Carcinomas become invasive after undergoing an epithelial-mesenchymal transition characterized by the appearance of vimentin filaments. While vimentin expression correlates with cell migration, the molecular connections between vimentin- and actin-based membrane protrusions are not understood. We report here that CARMIL2 (capping protein, Arp2/3, myosin-I linker 2) provides such a molecular link. CARMIL2 localizes to vimentin, regulates actin capping protein (CP), and binds to membranes. CARMIL2 is necessary for invadopodia formation, as well as cell polarity, lamellipodial assembly, membrane ruffling, macropinocytosis, and collective cell migration. Using point mutants and chimeras with defined biochemical and cellular properties, we discovered that localization to vimentin and CP binding are both essential for the function of CARMIL2 in cells. On the basis of these results, we propose a model in which dynamic vimentin filaments target CARMIL2 to critical membrane-associated locations, where CARMIL2 regulates CP, and thus actin assembly, to create cell protrusions.


Combined hydraulic and biological modelling and full-scale validation of SBR process.
The biological reactions during the settling and decant periods of Sequencing Batch Reactors (SBRs) are generally ignored as they are not easily measured or described by modelling approaches. However, important processes are taking place, and in particular when the influent is fed into the bottom of the reactor at the same time (one of the main features of the UniFed process), the inclusion of these stages is crucial for accurate process predictions. Due to the vertical stratification of both liquid and solid components, a one-dimensional hydraulic model is combined with a modified ASM 2d biological model to allow the prediction of settling velocity, sludge concentration, soluble components and biological processes during the non-mixed periods of the SBR. The model is calibrated on a full-scale UniFed SBR system with tracer breakthrough tests, depth profiles of particulate and soluble compounds and measurements of the key components during the mixed aerobic period. This model is then validated against results from an independent experimental period with considerably different operating parameters. In both cases, the model is able to accurately predict the stratification and most of the biological reactions occurring in the sludge blanket and the supernatant during the non-mixed periods. Together with a correct description of the mixed aerobic period, a good prediction of the overall SBR performance can be achieved.


Variation in health beliefs across different types of cervical screening non-participants.
Understanding factors associated with different types of cancer screening non-participation will help with the development of more targeted approaches for improving informed uptake. This study explored patterns of general health beliefs and behaviour, and cancer-specific beliefs across different types of cervical screening non-participants using the Precaution Adoption Process Model (PAPM). A population-representative sample of women in Britain completed a home-based survey in 2016. Women classified as non-participants (n = 839) completed additional questions about health beliefs. Some general health beliefs and behaviours, as well as cancer-specific beliefs, were associated with particular types of non-participation. For example, those who scored higher on fatalism were more likely to be unaware of screening (OR = 1.74, 95%CI: 1.45-2.08) or unengaged with screening (OR = 1.57, CI: 1.11-2.21). Women with greater deliberative risk perceptions were less likely to be unengaged with screening (OR = 0.74 CI: 02.55-0.99) and less likely to have decided against screening (OR = 0.71, CI: 0.59-0.86). Women who had seen a general practitioner in the last 12 months were less likely to be unaware (OR = 0.49, CI: 0.35-0.69), and those reporting cancer information avoidance were more likely to be unengaged with screening (OR = 2.25, CI: 1.15-4.39). Not wanting to know whether one has cancer was the only factor associated with all types of non-participation. Interventions to raise awareness of screening should include messages that address fatalistic and negative beliefs about cancer. Interventions for women who have decided not to be screened could usefully include messages to ensure the risk of cervical cancer and the relevance and benefits of screening are well communicated.


[Emergency room risk stratification of patients with chest pain without ST segment elevation].
To investigate the prognostic factors in patients who come to the emergency room with chest pain but without ST segment elevation. 743 consecutive patients were evaluated by recording clinical history, electrocardiogram and troponin I determination, and early (<24 h) exercise testing was done for the low-risk subgroup of patients (n=203). All patients were followed during 3 months for major events (acute myocardial infarction or death). Major events occurred in 71 patients (9.6%). Multivariate analysis (C statistic=0.79; 95% CI 0.73-0.84; p=0.0001) identified the following predictors: age > or =72 years (OR=1.7; 95% CI, 1.0-2.9; p=0.05), insulin-dependent diabetes mellitus (OR=2.9; 95% CI, 1.5-5.4; p=0.001), previous ischemic heart disease (OR=1.9; 95% CI, 1.1-3.2; p=0.02), ST depression (OR=2.1; 95% CI, 1.2-3.8; p=0.01) and troponin I elevation (OR=2.9; 95% CI, 1.5-5.3; p=0.001). These five predictors were used to construct a risk score based on their odds ratios, which allowed event rate stratification by quartiles of the score: 0-2 points (1.6% events), 3-4 points (8.1% events), 5-7 points (11.9% events) and > or =8 points (26.2% events); p=0.0001. No patient with negative findings in the early exercise testing had major events. In patients with chest pain, the combination of clinical, electrocardiographic and biochemical data available on admission to the emergency service allows rapid prognostic stratification. Early exercise testing is advisable for the final stratification of low risk patients.


Multiple hormone requirement for the synthesis of alpha 2u-globulin by monolayers of rat hepatocytes in long term primary culture.
Primary cultures of adult rat hepatocytes were prepared by releasing liver cells through fractional trypsinization and by a novel nonenzymatic procedure involving the imprinting of liver explants on the surface of the culture flask (explant imprinting). The comparative properties of these two primary cultures and their abilities to synthesize alpha 2u-globulin under multihormonal stimulation were investigated. The hepatocytes isolated from male rats by fractional trypsinization were found to divide rapidly and form a confluent monolayer within 5-7 days of culture. However, these cells failed to synthesize alpha 2u-globulin even after treatment with 5 alpha-dihydrotestosterone, GH, T3, and dexamethasone, hormones with known stimulatory effects on the synthesis of alpha 2u-globulin in vivo. On the contrary, hepatocytes prepared from male rats by the nonenzymatic procedure of explant imprinting were found to synthesize alpha 2u-globulin for more than 2 weeks and responded to GH, T3, and dexamethasone with enhanced production of this protein. Fortification of the culture medium with all of the above three hormones caused an approximately 9-fold enhancement of alpha 2u production within 4 days of culture compared to production in control culture without these hormones. The above results substantiate earlier findings concerning the multiple hormonal requirement for hepatic synthesis of alpha 2u-globulin in vivo and show that isolation and culture of hepatocytes by nonenzymatic explant imprinting may serve as a useful procedure for studying endocrine regulation of gene activity in vitro.


Measurement of 18 perfluorinated organic acids and amides in human serum using on-line solid-phase extraction.
We have developed an on-line solid-phase extraction (SPE) method coupled to high-performance liquid chromatography (HPLC)-tandem mass spectrometry (MS/MS) for measuring trace levels of 18 perfluorinated chemicals (3 perfluorosulfonates, 8 perfluorocarboxylates, 7 perfluorosulfonamides) in serum. Without protein precipitation, only dilution with 0.1 M formic acid, one aliquot of 100 microL of serum was injected into a commercial column switching system that allowed for concurrent SPE and HPLC-MS/MS acquisition. First, the analytes were concentrated on a C18 SPE column. Then, this column was placed automatically in front of a C8 analytic HPLC column for chromatographic separation of the analytes. Detection and quantification were done using negative-ion TurboIonSpray ionization, a variant of electrospray ionization, MS/MS. Excellent recovery was achieved for all analytes including the volatile sulfonamide derivatives that could not be determined before using traditional off-line SPE methods. The high throughput and low limits of detection (0.05-0.8 ng/mL) using a small sample volume (100 microL of serum) and isotope dilution quantification make this method suitable for large-scale epidemiologic studies.


Adsorption of fluoxetine HCl by activated charcoal.
We studied the adsorption of fluoxetine HCl (Prozac) by Norit USP XXIII activated charcoal in vitro, in simulated gastric fluid (USP; pH 1.2), and in simulated intestinal fluid (USP; pH 7.5). The data were fitted to both Langmuir and Freundlich equations. The Langmuir Qm values (maximal adsorption capacities) for pH 1.2 and 7.5 were 0.258 and 0.330 g drug/g charcoal, respectively. These excellent capacities suggest that oral charcoal therapy would be effective for fluoxetine overdose.


Matrix Stiffness Differentially Regulates Cellular Uptake Behavior of Nanoparticles in Two Breast Cancer Cell Lines.
Matrix stiffness regulates cell behavior in various biological contexts. In breast tumors, the deposition of extracellular matrix correlates with increasing matrix stiffness and poor survival. Nanoparticulate carriers represent a promising therapeutic vehicle for disease diagnosis and efficient anticancer drug delivery. However, how matrix stiffness influences cellular uptake of nanoparticles remains largely unexplored. Here, we selected photopolymerized polyacrylamide gels with varying stiffnesses as model substrates and studied the impact of matrix stiffness on cell morphology and nanoparticle uptake efficiency in two representative breast cancer cell lines with varying invasiveness, that is, MCF-7 with low invasiveness and MDA-MB-231 with high invasiveness. In our study, both cell lines showed similar morphological changes with changing stiffness. MCF-7 cells adhered on compliant substrates (1 kPa) showed a roundlike morphology with the lowest cell uptake efficiency among four stiffnesses under investigation at each given time point, whereas for MDA-MB-231 cells, the uptake efficiency showed no significant differences across varying stiffnesses. The percentages of MCF-7 cell proliferation on a 1 kPa substrate were significantly decreased at 48 and 72 h as compared to those on stiff substrates and coverslips. When treated with pluronic/d-α-tocopheryl polyethylene glycol 1000 succinate mixed micelle-loaded paclitaxel, cells on stiff substrates of 7, 20, and 25 kPa showed higher cell apoptosis rates as compared to those of cells on 1 kPa substrates. To sum up, our work presents an example of how physical cues impact specific cellular behavior and function, which may further contribute to engineering nanoparticulate delivery systems for more efficient delivery in vivo.


The therapeutic effects of Cserkeszölö thermal water in osteoarthritis of the knee: a double blind, controlled, follow-up study.
The effects of thermal water from Cserkeszölö in Hungary were appraised in a randomised, double blind study conducted on 58 patients with osteoarthritis of the knee. Balneotherapy was delivered as a 15-day course of 30-min daily sessions performed with thermal water (active treatment) or tap water of similar colour and odour (placebo treatment). The musculoskeletal status of participants was evaluated at baseline, at the end of the balneotherapy course, and 3 months later. Study endpoints (initial pain, range of motion, tenderness on palpation, stair climbing, physicians' opinion and subjective rating by patients, and ambulation) were assessed using visual analogue scales and symptom scores. Both groups improved; however, the magnitude of improvement was significantly greater in patients treated with thermal water from Cserkeszölö.


Evaluation of Surface Roughness and Bacterial Adhesion on Tooth Enamel Irradiated With High Intensity Lasers.
The aim was to evaluate the surface roughness and bacterial adhesion on enamel irradiated with high intensity lasers, associated or not to a fluoride varnish. Eighty fragments of bovine enamel were equally divided in 8 groups (n=10). Group 1 was not treated and Group 2 received only a 5% fluoride varnish application. The other groups were irradiated with an Er:Cr:YSGG (8.92 J/cm2), an Nd:YAG (84.9 J/cm2) and a diode laser (199.04 J/cm2), associated or not to a 5% fluoride varnish. The surface roughness was measured before and after treatments. Afterward, all samples were incubated in a suspension of S. mutans at 37 °C for 24 h. The colony-forming units (CFU) were counted by a stereoscope and the results were expressed in CFU/mm2. One-way ANOVA and the Tukey´s test compared the roughness data and the Student´s test compared the results obtained in the bacterial adhesion test (a=5%). The results showed that the irradiated samples without varnish presented the same roughness and the same bacterial adhesion that the non-irradiated samples. However, samples irradiated in the presence of fluoride varnish showed higher surface roughness and higher bacterial adhesion than the non-irradiated samples and those irradiated without varnish. Presence of pigments in the varnish increased the lasers' action on the enamel surface, which produced ablation in this hard tissue and significantly increased its surface roughness. For this reason, the enamel's susceptibility to bacterial adhesion was higher when the irradiation of the samples was made in presence of fluoride varnish.


EVOLUTION OF UNISEXUALITY IN THE HAWAIIAN FLORA: A TEST OF MICROEVOLUTIONARY THEORY.
The evolution of separate sexes as a means of avoiding self-fertilization requires the controversial coexistence of large inbreeding depression and high selfing rate in the ancestral hermaphrodite population. Fitness components of adult females and hermaphrodites in nature, of their open-pollinated progeny, and of experimental selfs and outcrosses onto hermaphrodites were compared in endemic Hawaiian Bidens sandvicensis, all of whose known populations are gynodioecious, consisting of a mixture of females and hermaphrodites. Multilocus selfing rates of hermaphrodites were also estimated, and sex morph ratio monitored over four seasons in three populations of B. sandvicensis and one population of gynodioecious B. cervicata. Total mean inbreeding depression in seed set (in the glasshouse), germination rate (in an open-air nursery on Kauai), and first year survivorship and fecundity in the field were estimated as 0.94 (SE 0.04), and occurred primarily in drought months. Lower survivorship and fecundity of selfs were partially explained by their consistently smaller size. Open-pollinated seed of females had significantly lower germination rate, proportion flowering, and fecundity than outcrossed progeny of hermaphrodites, suggesting moderate biparental inbreeding in females and a lack of any non-outcrossing advantage to progeny of females. In all fitness components, open-pollinated progeny of hermaphrodites were inferior to those of females and to outcrosses, and in most components were superior to selfs. Total performance of open-pollinated progeny of females relative to those of hermaphrodites was calculated as 2.3 (SE = 0.4), but since inflorescences of females also set 20% to 50% more seed than those of hermaphrodites, their total relative ovule success was estimated as 3.2 (SE = 0.5). If inheritance of male sterility is nuclear, this superiority is sufficient to maintain females in frequencies over 20% in populations, whose actual frequencies ranged from 14% to 33%. In four populations, selfing rates of hermaphrodites, assayed in seedlings, were 0.50, 0.45, 0.25, and 0.30, but since substantial inbreeding depression occurred prior to germination, the mean selfing rate of hermaphrodite ovules exceeded 0.57. Female frequencies were significantly higher in the two populations with higher hermaphrodite selfing rate. These results suggest that inbreeding depression can exert a profound influence on the mating system of self-compatible plants on Hawaii and perhaps other oceanic islands, and can be sufficiently strong to electively favor the elimination of the male function.


Vitamin A content in mature breast milk and its adequacy to the nutritional recommendations for infants.
To determine vitamin A content in breast milk and evaluate whether it satisfies the recommendations for infants. Observational, prospective, cross sectional study. Milk samples were obtained between 30 and 90 days postpartum from mothers seen in public hospitals, and analyzed. Vitamin A concentration was determined by chromatography and its adequacy to the recommended dietary intake. The correlation between outcome measures was analyzed using Spearman's correlation coefficient. A total of 79 mothers participated. Vitamin A concentration in milk samples was 1.80 umol/L (1.36-2.30) and the mean breastfeeding time was 57 days. No significant correlation between breastfeeding days and vitamin A content was observed. In 50% of the samples, vitamin A content did not satisfy the recommendations for infants. Vitamin A content was not enough to satisfy the recommendations in half of the cases.


A lactate-related LncRNA model for predicting prognosis, immune landscape and therapeutic response in breast cancer.
Breast cancer (BC) has the highest incidence rate of all cancers globally, with high heterogeneity. Increasing evidence shows that lactate and long non-coding RNA (lncRNA) play a critical role in tumor occurrence, maintenance, therapeutic response, and immune microenvironment. We aimed to construct a lactate-related lncRNAs prognostic signature (LRLPS) for BC patients to predict prognosis, tumor microenvironment, and treatment responses. The BC data download from the Cancer Genome Atlas (TCGA) database was the entire cohort, and it was randomly assigned to the training and test cohorts at a 1:1 ratio. Difference analysis and Pearson correlation analysis identified 196 differentially expressed lactate-related lncRNAs (LRLs). The univariate Cox regression analysis, least absolute shrinkage and selection operator (LASSO), and multivariate Cox regression analysis were used to construct the LRLPS, which consisted of 7 LRLs. Patients could be assigned into high-risk and low-risk groups based on the medium-risk sore in the training cohort. Then, we performed the Kaplan-Meier survival analysis, time-dependent receiver operating characteristic (ROC) curves, and univariate and multivariate analyses. The results indicated that the prognosis prediction ability of the LRLPS was excellent, robust, and independent. Furthermore, a nomogram was constructed based on the LRLPS risk score and clinical factors to predict the 3-, 5-, and 10-year survival probability. The GO/KEGG and GSEA indicated that immune-related pathways differed between the two-risk group. CIBERSORT, ESTIMATE, Tumor Immune Dysfunction and Exclusion (TIDE), and Immunophenoscore (IPS) showed that low-risk patients had higher levels of immune infiltration and better immunotherapeutic response. The pRRophetic and CellMiner databases indicated that many common chemotherapeutic drugs were more effective for low-risk patients. In conclusion, we developed a novel LRLPS for BC that could predict the prognosis, immune landscape, and treatment response.


A geospatial study of the potential of two exotic species of mosquitoes to impact the epidemiology of West Nile virus in Maryland.
We used geospatial techniques to study the potential impact of 2 exotic mosquitoes, Aedes albopictus and Ochlerotatus japonicus japonicus, on the epidemiology of West Nile virus in Maryland. These 2 species have established populations in Maryland over the past 15 years. Larvae of both mosquito species are found in natural and artificial water-holding cavities and containers, particularly water in tires. Therefore, we used locations of licensed tire dealers and of tire dumps scheduled for clean up as an index for potential sources of mosquito vectors. This index was expected to underestimate the actual population of source habitats. West Nile virus activity in Maryland during 1999, 2000, and 2001 was indicated by the presence of dead, infected birds, particularly American crows and other corvids; infected pools of mosquitoes; and human and horse infections. Adult females of both mosquito species are aggressive, opportunistic feeders that have been observed to take blood meals from avian and mammalian hosts. Susceptible vertebrate hosts, particularly birds, are ubiquitously distributed throughout the developed areas of the state. This analysis demonstrated a spatial convergence of the virus, the exotic mosquito vectors, and susceptible hosts. This conjunction indicated that these 2 mosquito species have a high potential to serve as bridge vectors and thus, impact the epidemiology of West Nile virus under favorable environmental and climatic conditions. Positive mosquito pools were collected from only the Baltimore-Washington metropolitan corridor, suggesting a newly created enzootic focus for this virus. Land-cover analysis of the sites where virus activity had been detected showed predominantly developed land uses. Analyses of the environmental justice aspects (social, economic, and housing characteristics) of block groups with human West Nile fever cases or with positive mosquito pools were equivocal. Human cases seemed to occur in developed block groups with lower income levels.


Dynamical assessment of fluorescent probes mobility in poplar cell walls reveals nanopores govern saccharification.
Improving lignocellulolytic enzymes' diffusion and accessibility to their substrate in the plant cell walls is recognised as a critical issue for optimising saccharification. Although many chemical features are considered as detrimental to saccharification, enzymes' dynamics within the cell walls remains poorly explored and understood. To address this issue, poplar fragments were submitted to hot water and ionic liquid pretreatments selected for their contrasted effects on both the structure and composition of lignocellulose. In addition to chemical composition and porosity analyses, the diffusion of polyethylene glycol probes of different sizes was measured at three different time points during the saccharification. Probes' diffusion was mainly affected by probes size and pretreatments but only slightly by saccharification time. This means that, despite the removal of polysaccharides during saccharification, diffusion of probes was not improved since they became hindered by changes in lignin conformation, whose relative amount increased over time. Porosity measurements showed that probes' diffusion was highly correlated with the amount of pores having a diameter at least five times the size of the probes. Testing the relationship with saccharification demonstrated that accessibility of 1.3-1.7-nm radius probes measured by FRAP on non-hydrolysed samples was highly correlated with poplar digestibility together with the measurement of initial porosity on the range 5-20 nm. Mobility measurements performed before hydrolysis can serve to explain and even predict saccharification with accuracy. The discrepancy observed between probes' size and pores' diameters to explain accessibility is likely due to biomass features such as lignin content and composition that prevent probes' diffusion through non-specific interactions probably leading to pores' entanglements.


Long-term results of polyglactin mesh for the prevention of incisional hernias in obese patients.
The aim of this study was to compare prospectively the incidence of incisional hernia in two groups of patients operated on for morbid obesity, with or without intraperitoneal polyglactin mesh. From October 1990 to September 1993, a total of 288 patients were randomly assigned to the two groups. There were 144 patients in the mesh group and 144 in the no-mesh group. Altogether 240 patients (83%) were reviewed personally, 45 (16%) were interviewed by phone (n = 39) or mail (n = 6), and 3 (1%) were inaccessible for follow-up since discharge from the hospital. The mean follow-up period was 29.8 months (range 0-67 months). A total of 33 incisional hernias were observed in the mesh group and 41 in the no-mesh group. There was no significant difference in the distribution of herniation time between the two groups (p = 0.43). The two main predictive factors of herniation were age and weight. In conclusion, the use of an intraperitoneal polyglactin mesh does not prevent postoperative incisional hernias in obese patients.


Randomized controlled trials of mental health nurse-delivered interventions: A systematic review.
WHAT IS KNOWN ON THE SUBJECT?: Well conducted randomized controlled trials provide the highest level of evidence of effectiveness of healthcare interventions, including those delivered by mental health nurses. Trials have been conducted over the years but there has not been a comprehensive review since 2005, and never one including studies conducted outside the UK. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper provides a comprehensive overview of results from randomized controlled trials of mental health nurse-delivered interventions conducted in the UK, Ireland, US, Australia, New Zealand, or Canada and reported 2005 to 2020. It highlights that the trial evidence is limited and offers only partial evidence for interventions that are central to mental health nursing practice. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Much mental health nursing practice is not supported by the highest level trial evidence. Mental health nurses need to carefully select evidence on which to base their practice both from the mental health nursing literature and beyond. Mental health nurses and other stakeholders should demand greater investment in trials to strengthen the evidence base. INTRODUCTION: Nurses are the largest professional disciplinary group working in mental health services and have been involved in numerous trials of nursing-specific and multidisciplinary interventions. Systematic appraisal of relevant research findings is rare. To review trials from the core Anglosphere (UK, US, Canada, Ireland, Australia, New Zealand) published from 2005 to 2020. A systematic review reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Comprehensive electronic database searches were conducted. Eligible studies were randomized controlled trials of mental health nurse-delivered interventions conducted in relevant countries. The risk of bias was independently assessed. Synthesis involved integration of descriptive statistics of standardized metrics and study bias. Outcomes from 348 between-group comparisons were extracted from K = 51 studies (N = 11,266 participants), Standardized effect sizes for 68 (39 very small/small, 29 moderate/large) statistically significant outcomes from 30 studies were calculable. All moderate/large effect sizes were at risk of bias. Trial evidence of effective mental health nurse-delivered interventions is limited. Many studies produced few or no measurable benefits; none demonstrated improvements related to personal recovery. Mental health nurses should look beyond gold standard RCT evidence, and to evidence-based interventions that have not been trialled with mental health nurse delivery.


Ultra high performance liquid chromatography coupled with triple quadrupole mass spectrometry and chemometric analysis of licorice based on the simultaneous determination of saponins and flavonoids.
Licorice is among the most popular herbal medicines and frequently used in traditional medicine, food products, and cosmetics. In China, only Glycyrrhiza uralensis Fisch., Glycyrrhiza inflata Bat. and Glycyrrhiza glabra L. are officially used and are usually processed with honey prior to use. To maintain the quality of commercially available herbal products, a simple, rapid, and reliable ultra high performance liquid chromatography with triple quadrupole mass spectrometry was developed to investigate the major active constituents of commercially available licorice products. Nineteen components were accurately determined, including eight triterpenoid saponins, one triterpene, and ten flavonoids. Subsequently, multivariate statistical analysis methods were employed to further explore and interpret the experimental data. The results indicated that liquiritin apioside may be considered as a candidate index for the quality control of licorice as well as 18β-glycyrrhizic acid and liquiritin. In addition, both 18β-glycyrrhizic acid and licorice-saponin G2 can be used for discrimination between crude and honey-processed licorice. Furthermore, using 18β-glycyrrhizic acid and liquiritin as markers, this work revealed that the quality of licorice products may have declined in recent years. This highlights the need for additional effort focused on good agricultural practice during the processing of licorice. In summary, this study provides a valuable reference for the quality assessment of licorice.


Orbital wall fractures. Conventional views and CT.
In order to evaluate the benefit derived by conventional views in the initial diagnosis of fractures of the orbital walls, a clinical study was designed to compare the results of evaluations by plain films and coronal CT scans. The conventional Caldwell's and Waters' views will provide a fairly reliable result as to the presence of orbital fractures: orbital floor (anterior in 78%, posterior in 73%), medial orbital wall (anterior in 71%, posterior in 72%), and ethmoid-maxillary plate in 64%. False-negative diagnosis was seen at the anterior portion of the floor in 13%, at the anterior portion of the medial orbital wall in 7%, and at the ethmoid-maxillary plate in 11%. False-negative diagnosis was seen at the orbital floor (anterior in 9%, posterior in 10%), at the medial orbital wall (anterior in 21%, posterior in 29%), and at the ethmoid-maxillary plate in 21%. Our results agree well with those of the past reports.


Current status of achieving blood pressure target and its clinical correlates in Japanese type 2 diabetes.
To investigate the current status of achieved blood pressure levels in association with the number of antihypertensive drug classes as of 2013, and to explore the clinical correlates with achievement of target blood pressure in a large-scale cohort of Japanese subjects with type 2 diabetes. A nationwide survey was conducted including 12,811 subjects with type 2 diabetes. Subjects were divided by achieved blood pressure, <130/80 or 140/90 mmHg, and the number of drug classes taken. The percentages achieving a blood pressure of <130/80 or 140/90 mmHg were 52.0% and 86.1%, respectively. The prevalence of hypertension, if defined as ≥130/80 mmHg or treated, became 67.9%. Among subjects taking antihypertensive drugs, a blood pressure of <130/80 or <140/90 mmHg was 46.7% and 83.2%, respectively. The percentages of <130/80 mmHg were 55.9% without drugs, 47.1% on 1, 42.5% on 2, 47.2% on 3, and 56.8% on ≥4 drugs, respectively. The most prescribed drugs were renin-angiotensin system inhibitors, followed by calcium channel blockers, diuretics, and β-blockers. The multiple logistic regression analysis indicated that a blood pressure <130/80 mmHg was associated with lower values in age, body mass index, albuminuria, and glomerular filtration rate, higher proportions on targets for HbA1C and lipids, and less retinopathy. In type 2 diabetes, hypertension is common and only 52% achieved <130/80 mmHg, indicating a difficulty in blood pressure lowering. This was correlated with difficulties in glycemic and lipid management, obesity, and vascular complications, implying these clustering to be a serious problem. This article is protected by copyright. All rights reserved.


Sphenoethmoidal Meningocele: Endoscopic Approach.
The sphenoethmoidal meningocele is a herniation of the meninges through a communication of the skull base with an aeric cavity. It means the presence of an osteomeningeal breach, which is manifested by cerebrospinal rhinorrhea and nasal obstruction. iIs diagnosis is based on a very specific radiological assessment and biology allows the dosage of certain substances to confirm the nature of the cerebrospinal fluid, such as beta-2-transferrin, Once the breach has been found, the endoscopic route exclusively allows the pathology to be treated and the defect to be reconstructed using different materials before the occurrence of serious complications such as meningitis.


Surface chemistry study of the interactions of pharmaceutical ingredients with human meibum films.
To perform a surface chemistry study of the interactions between the benzalkonium chloride (BAC)-preserved eyedrops Travatan, the SofZia-preserved TravatanZ, and the Polyquad-preserved DuoTrav, and tear film (TF) constituents. The interactions of TF compounds with the individual preservatives, BAC, SofZia, and Polyquad, were also examined. Langmuir surface balance measurements were used to examine the interactions between the pharmaceuticals and films of human meibum and rabbit corneal cell lipid extracts. Surface pressure-area isocycles were used to assess the sample's capability to compress and spread during dynamic area changes. The dilatational rheologic properties of human meibum films, pure and in the presence of preservatives, were probed by stress-relaxation studies. Lipid film morphology was monitored by Brewster angle microscopy. The viability of SofZia- and Polyquad-treated Statens Seruminstitut Rabbit Cornea (SIRC) cell cultures was also evaluated. The interactions between BAC-preserved eyedrops and lipids resulted in impaired lipid spread, formation of discontinuous nonuniform surface layers, and increased surface pressure-area hysteresis during compression/expansion. In contrast, TravatanZ, DuoTrav, and the individual preservatives SofZia and Polyquad proved to be safe to the lipid film structure and isothermal reversibility. The stress-relaxation experiments revealed that the viscoelastic properties of meibomian film are impaired by BAC, and remain unaffected by SofZia and Polyquad. SIRC cells' viability and capability to form confluent cellular monolayer were also maintained after exposure to SofZia and Polyquad. Surface chemistry studies present criteria for preclinical in vitro molecular scale characterization of the interactions between eyedrop compounds and TF constituents.


Phenotypic Intratumoral Heterogeneity of Endometrial Carcinomas.
Intratumoral heterogeneity has been shown to play an important role in diagnostic accuracy, development of treatment resistance, and prognosis of cancer patients. Recent studies have proposed quantitative measurement of phenotypic intratumoral heterogeneity, but no study is yet available in endometrial carcinomas. In our study we evaluated the phenotypic intratumoral heterogeneity of a consecutive series of 10 endometrial carcinomas using measures of dispersion and diversity. Morphometric architectural (%tumor cells, %solid tumor, %differentiated tumor, and %lumens) and nuclear [volume-weighted mean nuclear volume ((Equation is included in full-text article.))] parameters, as well as estrogen receptor, progesterone receptor, p53, vimentin, and beta-catenin immunoexpression (H-score) were digitally analyzed in 20 microscopic fields per carcinoma. Quantitative measures of intratumoral heterogeneity included coefficient of variation (CV) and relative quadratic entropy (rQE). In each endometrial carcinoma there was slight variation of architecture from field to field, resulting in globally low levels of heterogeneity measures (mean CV %tumor cells: 0.10, %solid tumor: 0.73, %differentiated tumor: 0.19, %lumens: 0.61 and mean rQE %tumor cells: 18.5, %solid tumor: 20.3, %differentiated tumor: 25.6, %lumens: 21.8). Nuclear intratumoral heterogeneity was also globally low (mean (Equation is included in full-text article.)CV: 0.23 and rQE: 27.3), but significantly higher than the heterogeneity of architectural parameters within most carcinomas. In general, there was low to moderate variability of immunoexpression markers within each carcinoma, but estrogen receptor (mean CV: 0.56 and rQE: 46.2) and progesterone receptor (mean CV: 0.60 and rQE: 39.3) displayed the highest values of heterogeneity measures. Intratumoral heterogeneity of immunoexpression was significantly higher than that observed for morphometric parameters. In conclusion, our study indicates that endometrial carcinomas present a variable but predominantly low degree of phenotypic intratumoral heterogeneity.


Gingival recession and root caries in the ageing population: a critical evaluation of treatments.
To review evidence for the treatments of gingival recession and root caries in older populations. A systematic approach was adopted to identify reviews and articles to allow us to evaluate the treatments for gingival recession and root caries. Searches were performed in PubMed, Medline and Embase, the Cochrane trials register and bibliographies of European and World Workshops. Gingival recession: We identified no articles that focussed specifically on older populations. Conversely, no evidence suggested that Miller class I and II lesions should be managed differently in older patients when compared to younger cohorts. Six systematic reviews included older patients and suggested that connective tissue grafts are the treatment of choice, alone or in combination with enamel matrix derivative. Root caries can be controlled at the population level by daily brushing with fluoride-containing toothpastes, whilst active decay may be inactivated using professional application of fluoride varnishes/solutions or self-applied high-fluoride toothpaste. Active root caries lesions that cannot be cleaned properly by the patient may be restored by minimally invasive techniques. Gingival recession and root caries will become more prevalent as patients retain their teeth for longer. Whilst surgical (gingival recession) and non-operative approaches (root caries) currently appear to be favoured, more evidence is needed to identify the most appropriate strategies for older people.


Anti-Quorum Sensing Activity of Forsythia suspense on Chromobacterium violaceum and Pseudomonas aeruginosa.
Quorum sensing (QS) plays an important role in the production of virulence factors and pathogenicity in Pseudomonas aeruginosa, and the interruption of QS will be a hopeful pathway to combat bacterial infection. In this study, we selected Forsythia suspense (Thunb.) Vahl from traditional Chinese herbal medicines for its anti-QS activity. Anti-QS of F. suspense extracts (FSE) was monitored using the Chromobacterium violaceum 12472 bioassay. Standard methods were used to investigate the effects of FSE on QS-controlled virulence factors production, swimming motility, and biofilm establishment in P. aeruginosa PAO1. FSE could obviously inhibit the violacein production in C. violaceum 12472 and also could inhibit quorum sensing-regulated virulence factors production and biofilm formation in P. aeruginosa in a concentration-dependent manner. The elastase activity and pyocyanin production were inhibited at a maximum of 40.97 and 47.58% when P. aeruginosa was grown in the presence of 0.25 g/mL FSE, which can also inhibit swimming motility of P. aeruginosa. The biofilm formation ability was decreased about 72.45% when in PAO1 cultured with the 0.25 g/mL FSE. The results suggested that FSE may be used as an alternative drug to control and handle harmful infections caused by bacterial pathogens based on QS inhibition. Forsythia suspense water extract could obviously inhibit the purple pigment production in C. violaceum 12472Forsythia suspense water extract could inhibit QS-regulated virulence factors production and biofilm formation in P. aeruginosa. Abbreviations used: QS: Quorum sensing, Pseudomonas aeruginosa P. aeruginosa, Forsythia suspense F. suspense, FSE: F. suspense extracts, Chromobacterium violaceum 12472 C. violaceum 12472, AIs: autoinducers, AHLs: N-acyl-homoserinelactones, LB: Luria-Bertani, MICs: Minimum inhibitory concentrations, CFU: Colony-Forming Units, ATCC: American Type Culture Collection, PBS: phosphate buffered saline.


Recognizing spiritual distress.
Recent research suggests that while attending worship services may extend life, spiritual distress may cut lives shorter. Although authors of this research agree that more study is needed, they recognize that elderly ill men and women who experience a religious struggle with their illnesses appear to be at risk for an earlier death, even after controlling for baseline health, mental health, and demographic factors. This article examines the patient-professional relationship within the framework of virtue ethics and spiritual distress. A case study is presented.


High Incidence of Stress Fractures in Military Cadets During Training: A Point of Concern.
Stress fractures occur due to repetitive cumulative micro trauma on the bone over a period of time. Stress fractures in military cadets is a rising cause of concern. It increases morbidity, long periods of absence from training and economic losses. The purpose of this prospective study was to determine the incidence and distribution of stress fracture (SFs) in Border Security Forces (BSF) cadets in Bangalore during their basic training tenure. A detailed analysis of history and physical assessment was performed of those presenting with symptoms of pain, swelling or deformity. These cadets then underwent radiographic imaging for the evaluation of symptoms. All cadets with clinical and radiological diagnosis of SFs were appropriately managed and followed up every two weeks till the time of union. Three hundred BSF candidates had clinical and radiological signs of SF with an overall incidence rate of 15%. The average age of the patients with SFs was 23 years (range 20-26). The incidence of SFs was highest during their physical training exercises and reached maximum at 12 weeks of the training schedule. Overall, the most common sites of bone injuries were the tibia (87.66%), fibula (7.8%), and metatarsals (2%). There were 5 femur fractures including one bilateral femur(1.67%) and two neck of femur (0.67%). Three tibia, three femur shaft and two neck femur fractures were operated and rest treated conservatively. All fractures healed in an average period of seven weeks. All cadets returned to their full activity in an average period of nine weeks. The study provides evidence that SF among BSF cadets occur frequently during their training period with undoubtedly high incidence rate which is probably underrated in Indian setting. To prevent stress fractures, modifiable causes and risk factors must be identified and a proactive approach which can help the cadets withstand intense physical activity should be adopted.


[Severe complications after cholecystectomy by celioscopy: lessons from yesterday and today].
The case of a series of grave complications after a laparoscopic cholecystectomy is reported: a common bile duct section diagnosed rather late, hemoperitoneum, inappropriate common bile duct reconstruction and late anastomic leakage, stenosis of an hepatico-jejunal anastomosis, haemorrhage through the external biliary drainage and iterating sepsis. The final outcome was good. The stenotic hepatico-jejunal anastomosis was dilated by a Gianturco self-expanding prosthesis percutaneously placed. As an evidence, this alternative treatment is only exceptional, the treatment of choice for postsurgical benign strictures being surgical repair.


Burden of chronic physical conditions and mental disorders in primary care.
The World Health Organization (WHO) has stated that the three leading causes of burden of disease in 2030 are projected to include HIV/AIDS, unipolar depression and ischaemic heart disease. To estimate health-related quality of life (HRQoL) and quality-adjusted life-year (QALY) losses associated with mental disorders and chronic physical conditions in primary healthcare using data from the diagnosis and treatment of mental disorders in primary care (DASMAP) study, an epidemiological survey carried out with primary care patients in Catalonia (Spain). A cross-sectional survey of a representative sample of 3815 primary care patients. A preference-based measure of health was derived from the 12-item Short Form Health Survey (SF-12): the Short Form-6D (SF-6D) multi-attribute health-status classification. Each profile generated by this questionnaire has a utility (or weight) assigned. We used non-parametric quantile regressions to model the association between both mental disorders and chronic physical condition and SF-6D scores. Conditions associated with SF-6D were: mood disorders, beta = -0.20 (95% CI -0.18 to -0.21); pain, beta = -0.08 (95%CI -0.06 to -0.09) and anxiety, beta = -0.04 (95% CI -0.03 to -0.06). The top three causes of QALY losses annually per 100 000 participants were pain (5064), mood disorders (2634) and anxiety (805). Estimation of QALY losses showed that mood disorders ranked second behind pain-related chronic medical conditions.


Photoinduced Current Transient Spectroscopy on Metal Halide Perovskites: Electron Trapping and Ion Drift.
Metal halide perovskites (MHPs) are disruptive materials for a vast class of optoelectronic devices. The presence of electronic trap states has been a tough challenge in terms of characterization and thus mitigation. Many attempts based on electronic spectroscopies have been tested, but due to the mixed electronic-ionic nature of MHP conductivity, many experimental results retain a large ambiguity in resolving electronic and ionic charge contributions. Here we adapt a method, previously used in highly resistive inorganic semiconductors, called photoinduced current transient spectroscopy (PICTS) on lead bromide 2D-like ((PEA)2PbBr4) and standard "3D" (MAPbBr3) MHP single crystals. We present two conceptually different outcomes of the PICTS measurements, distinguishing the different electronic and ionic contributions to the photocurrents based on the different ion drift of the two materials. Our experiments unveil deep level trap states on the 2D, "ion-frozen" (PEA)2PbBr4 and set new boundaries for the applicability of PICTS on 3D MHPs.


Replacement of chemical rocket launchers by beamed energy propulsion.
Microwave Rocket is a beamed energy propulsion system that is expected to reach space at drastically lower cost. This cost reduction is estimated by replacing the first-stage engine and solid rocket boosters of the Japanese H-IIB rocket with Microwave Rocket, using a recently developed thrust model in which thrust is generated through repetitively pulsed microwave detonation with a reed-valve air-breathing system. Results show that Microwave Rocket trajectory, in terms of velocity versus altitude, can be designed similarly to the current H-IIB first stage trajectory. Moreover, the payload ratio can be increased by 450%, resulting in launch-cost reduction of 74%.


[A retrospective study of outcome of percutaneous endoscopic gastrostomy in older adults with advanced cognitive impairment and severely reduced activities of daily living].
To investigate the outcome of percutaneous endoscopic gastrostomy (PEG) in elderly patients with swallowing difficulties who required high-level nursing care. We extracted the data of 57 patients (24 men and 33 women) who were admitted to our hospital with a diagnosis of pneumonia over a 5-year study period between January 2006 and December 2010. Evaluation included activities of daily living (ADL), nursing care level (NCL) based on assessment of care requirement, pre-existing disease, blood test data, swallowing function before PEG, and outcome. The mean age of the patients was 84.7±8.3 years old. The mean total functional independence measure (FIM) score was 29.7±16.2 and the median NCL value was 4. The most frequently observed pre-existing diseases were degenerative central nervous system disorders including Alzheimer's disease and cerebrovascular disease, which occurred in approximately 80% of participants. A low serum albumin value and high c-reactive protein (CRP) level were also often observed, suggesting chronic inflammatory conditions. For swallowing function, the median value according to the Fujishima swallowing grading system was 5, and aspiration and pharyngeal residues were observed on videofluoroscopic examination of swallowing (VF) (82.5% and 100% of all cases, respectively). The median survival time after PEG was 451.0±79.7 days, with a one-year survival rate of approximately 56%. A total of 51 patients (89.5%) died after PEG and the mean duration from the PEG to death was 518.5±471.7 days. Of these 51, 45 (88.2%) died of pneumonia. In patients with advanced cognitive impairment and severely reduced ADL, there appears to be little benefit on ADL and the prevention of pneumonia by PEG, and most outcomes following PEG were not favorable in the current results.


A new evolutionary optimization method for osteoporotic bone augmentation.
Bone augmentation is a preventative osteoporosis intervention, comprising the injection of bone cement into an osteoporotic bone. As injection of excessive amounts of bone cement may result into thermal necrosis of bone tissue or even embolism, the minimum cement volume required to achieve a predefined level of augmentation must be sought. To this end, the present paper introduces a new evolutionary optimization method, applicable to any osteoporotic bone. The method was numerically evaluated through a typical case of femoral augmentation and compared to another powerful optimization method. The results demonstrate the efficiency and low computational cost of the proposed method.


Genomic Features for Therapeutic Insights of Chemotherapy-Resistant, Primary Mediastinal Nonseminomatous Germ Cell Tumors and Comparison with Gonadal Counterpart.
Primary mediastinal nonseminomatous germ cell tumors (PMNSGCT) frequently become refractory to chemotherapy, and no effective salvage therapy exists. We performed genomic profiling on a series of 44 PMNSGCT and compared the results with those from chemorefractory, metastatic pure seminomatous (Sem, n = 22) and nonseminomatous (NS, n = 86) testicular germ cell tumors. Archival tissues were sequenced by a hybrid capture-based technology (FoundationONE; Foundation Medicine, Inc., Cambridge, MA). Microsatellite instability (MSI) and tumor mutational burden (TMB, mutations [mut]/Mb) were determined.Statistically significant differences in genomic alterations (GA) of PMNSGCT versus NS included higher TP53 pathway GA (p < .0001), PIK3CA pathway GA (p < .0001), and lower cell-cycle pathway GA (p = .0004). There were no MSI-high PMNSGCT cases. Mean TMB was similar between the groups, but there were more ≥10 mut/Mb in the PMNSGCT group versus NS (11.4% vs. 4.6%).The GA identified in PMNSGCT were similar to the findings from NS, with differential opportunities for targeted therapies and immunotherapies. Further study of precision treatments appears warranted.


Preclinical enantioselective pharmacology of (R)- and (S)- ketorolac.
Many of the nonsteroidal anti-inflammatory drugs (NSAIDs) are marketed as racemic mixtures, composed of (R)- and (S)- enantiomers. Racemic NSAIDs are potent cyclooxygenase (COX) inhibitors only through the action of the (S)- enantiomers, as the (R)- enantiomers do not exhibit COX inhibition. However, the (R)- enantiomer of ketoprofen exhibits potent analgesic activity and minimal ulcerogenic potential. To extend these observations, we examined the (R)- and (S)- enantiomers of RS- ketorolac, (S)- ketorolac exhibited potent COX1 and COX2 enzyme inhibition, whereas (R)- ketorolac was > 100-fold less active on both COX subtypes. Both enantiomers did not affect norepinephrine or serotonin uptake sites, and nitric oxidase or lipoxygenase activities, nor did they demonstrate any affinity for opioid receptors (mu, delta, or kappa). In experimental models, (S)- ketorolac exhibited about 10-fold greater activity than (R)- ketorolac in the murine phenylquinone writhing model. In this model, morphine sulfate was effective at much lower doses, however, and neither (R)- nor (S)- ketorolac showed any morphine-sparing effect. In the rat gait test for analgesia in the foot paw after injection of brewers yeast suspension, neither (R)- nor (S)- ketorolac affected paw volume. However, both provoked changes in gait scores, the (S)- enantiomer being 30-fold more potent than the (R)- enantiomer. A similar reduction was observed with respect to ulcerogenic potential, measured by direct microscopic changes after test conclusion. These findings suggest that (R)- ketorolac may possess analgesic activity that is independent of COX inhibition and may be associated with reduced ulcerogenic potential compared to effects exhibited by (S)- ketorolac.


A Practical Approach to Condition Assessment of Asphalt-Covered Concrete Bridge Decks on Korean Expressways by Dielectric Constant Measurements Using Air-Coupled GPR.
The main objectives of this study are to investigate the variations of the dielectric constant of concrete on Korean expressways by using a 1 GHz air-coupled Ground Penetrating Radar (GPR) system and to develop a practical approach to the condition assessment of concrete bridge decks with asphalt overlay on Korean expressways by dielectric constant measurements. A total of 684 GPR investigations of 601 actual concrete bridge decks, which are in service between 2 and 43 years, were carried out during the period between 1999 and 2013. Statistical analysis revealed that the dielectric constant of asphalt-covered concrete bridge decks reduced with service age and this trend continued until service age of over 40 years. As a result, this study provides a practical dielectric constant curve that could be used for condition evaluation of top concrete in asphalt-covered bridge decks with consideration of concrete age. Based on regression analyses of the GPR field survey data and experiences through the field survey, a double cut-off dielectric constant criterion was proposed for condition assessment of asphalt-covered concrete bridge decks on Korean expressways. In addition, a GPR field survey was performed at an actual bridge on the Yeongdong expressway in Korea to test the proposed GPR signal interpretation method. The field survey results provide fundamental data to better understand the variation of the dielectric constant of concrete in actual bridges with asphalt overlay and to develop a practical approach to condition assessment of asphalt-covered concrete bridge decks on Korean expressways by dielectric constant measurements using air-coupled GPR.


[Pathophysiology of acne].
Several pathogenic factors contribute to the development of acne, among them, seborrhea, follicular hyperkeratosis, propionibacteria, and inflammatory events. This article reviews current knowledge of these pathogenic factors.


Characterization and evaluation of potential reuse options for wastewater sludge and combined sewer system sediments in Mexico.
Combined sewer systems generate sediments that have characteristics similar to those of primary sludge. Mexico City has such a system composed of a network of pipes, regulation structures (dams, basins) and open channels. The annual generation of sediments is estimated at 2.8 Mm3, which includes 0.41 Mm3 of sludge. As a result, the total capacity for transporting water is reduced considerably, making it necessary to extract yearly an approximate 0.85 Mm3 of those materials and to send them to a final disposal site with a capacity that is being exhausted. As part of the local Governmental effort, this project evaluates the quality of sediments from 6 dams, 4 regulation basins, 2 open channels, and 3 transfer stations. Also, sludge from 20 wastewater treatment plants was sampled. The results showed an important presence of lead and hydrocarbons in some sediments, and some sludge samples contained arsenic and nickel above the limits. Moreover, microbial levels exceeded the limits in all the sediments and sludge samples. Erosion was linked to the generation of an important amount of sediments based on lead concentration. A classification was established to determine the degree of contamination of the sediments as well as the required treatment to allow their potential reuse.


Angiography of pulmonary emboli: digital studies and balloon-occlusion cineangiography.
The value of digital pulmonary arteriography and balloon-occlusion cineangiography was investigated in 118 selected patients. In one series of 40 patients, digital pulmonary arteriography correctly identified pulmonary emboli in 20 (75%) of 26 positive examinations when interpretation was confined to the first three divisions of the pulmonary artery. In a second series of 78 patients with peripheral radionuclide perfusion scan defects, 40 of whom had pulmonary emboli, adjunctive balloon-occlusion cineangiography demonstrated emboli in four patients not seen on standard selective catheter pulmonary magnification studies with cut films. These two procedures (i.e., digital pulmonary arteriography and balloon-occlusion cineangiography) are important adjuncts to radionuclide perfusion scans and selective catheter pulmonary arteriography in the evaluation of patients with pulmonary emboli.


The success of microsurgical penile revascularization in treating arteriogenic impotence.
The treatment of arteriogenic erectile dysfunction with revascularization techniques has been controversial both in terms of its use and the type of surgical repair. Success rates reported in the literature are based almost exclusively on patient testimonial, without the use of objective post-operative criteria. At our institution from 7/88 through 8/91, 18 patients were treated for arteriogenic impotence using microsurgical penile revascularization. The patient population ranged in age from 23 to 64 years, and each patient underwent a complete history and physical examination, serum hormone testing, psychological evaluation of patient and partner, biothesiometry, penile plethysmography, nocturnal penile tumescence/rigidity testing with a Rigiscan device, and selective pudendal arteriography. One patient was status post a pelvic fracture, 2 lacked identifiable risk factors, 2 had diabetes, 6 were heavy smokers, and 7 had hypertension. Pre-operatively each patient had a suspicious medical history, abnormal plethysmography, abnormal Rigiscan testing, and a hemodynamically significant lesion on angiography. Revascularization was done by anastomosing the inferior epigastric artery to the deep dorsal veing and dorsal artery, or the deep dorsal vein alone if both arteries were atretic. Postoperatively, all 18 patients underwent a personal interview, repeat penile plethysmography, and repeat Rigiscan testing. Six patients reports successful coitus and an additional four were having coitus with the aid of intracavernous pharmacotherapy. Seventy-eight percent (14/18) had improved tracings on penile plethysmography, and 56% (10/18) had normal erectile capability by Rigiscan testing.(ABSTRACT TRUNCATED AT 250 WORDS)


Vagal and sympathetic contributions to the heart rate at rest and during isometric and dynamic exercise in young healthy men.
Six young healthy males received on four different occasions 0.4 mg/kg i.v. of propranolol. 0.04 mg/kg i.v. of atropine, atropine following propranolol or saline. heart rate and blood pressure were recorded at rest (supine, sitting, and standing) and during isometric and dynamic exercise. On the basis of heart rate changes under the influence of drugs, the sympathetic contribution to heart rate was 25% at supine rest, 33% in the standing position, 45% during handgrip, and 74% during bicycle exercise that raised heart rate to 153/min. These results suggest that with increasing muscular activity the contribution of parasympathetic tone to heart rate decreases from about 75% at supine rest to about 25% at submaximal exercise. Extrapolation of the heart rate plots indicate that parasympathetic tone is virtually abolished at exercise loads resulting in a heart rate of about 200 beats/min.


Intraoperative ultrasonography as a guide to patient selection for duraplasty after suboccipital decompression in children with Chiari malformation Type I.
Indications for duraplasty in treatment of Chiari malformation Type I (CM-I) remain unclear. In the present study, the authors evaluate their surgical experience to determine whether intraoperative ultrasonography is effective in the selection of patients with CM-I who can be adequately treated with craniectomy alone without duraplasty. The authors reviewed the records of 256 children who underwent first-time hindbrain decompression for CM-I. Craniectomy alone (without duraplasty) was performed when intraoperative ultrasonography suggested adequate decompression of the subarachnoid spaces ventral and dorsal to the tonsils after suboccipital craniectomy alone. Duraplasty was performed if intraoperative ultrasonography demonstrated persistent dural compression of the tonsils following craniectomy. Symptom recurrence as a function of time was compared between cases of duraplasty versus suboccipital decompression alone stratified by extent of tonsillar herniation. Duraplasty was performed in 140 patients (55%), and suboccipital decompression alone was performed in 116 patients (45%). Patients underwent follow-up for 29 +/- 15 months. Symptoms included headache in 192 patients (75%) and lower cranial nerve and brainstem dysfunction in 68 (27%). In 38 patients (15%) there was tonsillar herniation rostral to the C-1 lamina, in 195 (76%) it extended between the C-1 and C-2 lamina, and in 23 patients (9%) there was herniation caudal to the lower border of the C-2 lamina. In children with tonsillar herniation caudal to C-1, ultrasonography-guided suboccipital decompression alone was associated with a 2-fold increase in the risk of symptom recurrence compared with those who also underwent duraplasty (p = 0.01). In children with tonsillar herniation rostral to C-1, outcome was equivalent between suboccipital decompression alone and duraplasty (p = 0.41). In the setting of moderate-to-severe tonsillar CM-I, intraoperative ultrasonography demonstrating decompression of the subarachnoid spaces ventral and dorsal to the tonsils may not effectively select patients in whom bone decompression alone is sufficient. Duraplasty may be warranted in cases of tonsillar herniation that extends below the C-1 lamina regardless of intraoperative ultrasonography findings. More objective cerebrospinal fluid flow or volumetric measures may be needed intraoperatively to guide duraplasty in patients with more pronounced tonsillar herniation.


High resolution magnetic resonance imaging using surface coils.
There is, of course, an intense activity directed at the improvement of MR imaging capabilities. Surface-coil techniques offer the possibility of improving the SNR sufficiently to permit the reduction of pixel sizes to values that would not be possible with conventional head and body coils. The successful application of surface-coil techniques to MR imaging suggests that this technique will be widely used in future MR imaging systems. This provides a fertile field for new research. This includes opportunities for mathematical and physical research into optimizing coil design. It also includes many opportunities for clinical research into the utilization of surface coils and high resolution MR imaging.


Breast cancer therapy by laser-induced Coulomb explosion of gold nanoparticles.
Laser-induced Coulomb explosion of gold nanoparticles for breast cancer has been studied by nanophotolysis technique. This study aimed to investigate whether laser-induced bubble formation due to Coulomb explosion can provide an effective approach for selective damage of breast cancer with gold nanoparticles. Numerical method involves laser-induced Coulomb explosion of gold nanoparticles. Different parameters related to nanophotolysis such as laser fluence, tumor depth, cluster radius, laser pulse duration, and bubble formation is studied numerically. Numerical simulation was performed using Mat lab. The gold nanoparticles of 10, 20, 30, 40, and 50 nm in radius could penetrate into tumor 1.14, 1.155, 1.189, 1.20 and 1.22 cm in depth respectively. The maximum penetration depth in tumor could be obtained with nanoparticles of 50 nm radius. Short laser pulse of 40 ns with nanoparticles of 10 nm radius could penetrate into tumor 1.14 cm in depth. Bubbles with a radius of 9 µm could effectively kill breast cancer cells without damaging healthy ones. The bubble radius increased from 4 to 9 µm with an increase in pulse duration in the range of 10 to 30 ns. Gold nanoparticles with increasing radius and bubble formation for selective damage of breast cancer cells are successfully probed. The present calculated results are compared with other experimental findings, and good correlation is found between the present work and previous experimental values. It was demonstrated that bubble formation in tumor may further increase the efficacy of breast cancer treatment.


[The Fantoni translaryngeal tracheostomy: perioperative complications In a series of 220 consecutive patients].
To evaluate problems arisen du-ring Fantoni translaryngeal tracheostomy (TLT). intensive care unit. 220 patients (aged from 18 to 87). coagulopathy, difficult intubation, local infections, previous neck surgery, suspected cervical spine lesion, severe hypoxemia, hemodynamic instability, patients close to be discharged from ICU. Operation: TLT was performed in general anesthesia, using the technique described by Fantoni in 206 cases; in the other 14 cases changes were made. Perioperative clinical complications were separated from instrumental problems. Clinical complications were 28 (12.7% of TLT): 20 (9.1% of total TLT, 71.4% of total complications) were considered minor and ascribed to medical staff training; among these the complete drawing of the cannula and the difficulty in pushing it in trachea. Eight complications (3.6% of TLT, 28.6% of total complications) were considered major; they were: the impossibility to place the cannula in trachea, the displacement of the prothesis in the peritracheal tissue, the rupture of tracheal ring, the bleeding and the infection of tracheostomy, the dental uprooting. Among instrumental problems, the faulty closure of the ring nut, the overdimension of rigid tracheoscope, and the difficult change of the cannula were observed. With expert medical staff, this technique is effective and safe, with a low rate of complications. Major complications were rare, and occurred in spite of patients selection, often needing changing of TLT in surgical tracheostomy.


[German-speaking midwifes prefer vaginal mode of delivery to elective Caesarean].
Increasing ceasarean section rates are a world wide concern in obstetrics. One of the latest contributing factors is the elective caesarean section in uncomplicated singleton pregnancy at term. The preference for this mode of delivery was primarily brought forward by obstetric practitioners (Al Mufty, McCarthy, Fisk 1996). A questionnaire, which mainly aimed to ask germanspeaking midwifes in Austria, Germany and Switzerland about their personal choice of delivery mode, was included in one of the issues of the German-language midwifery journal "Die Hebamme". This questionnaire contained 5 half-closed/half open questions describing specific obstetric occurrences. The midwifes were asked to express their preferred mode of delivery and describe their reason for choosing. 446 questionnaires (12 %) were returned. The majority (100 %) of the german speaking midwifes preferred a normal vaginal delivery in an uncomplicated singleton pregnancy at term with a child in cephalic presentation. The rating was about the same (97 %) in the presence of general risk factors which don't indicate a primary caesarean section. Breech presentation and macrosomia are a matter of concern to the midwifes. Midwifes arguing for a first child in breech presentation or with macrosomia > 4.5 kg vote highly significantly more frequently for elective caesarean section than midwifes arguing for at least the second child. The first-rate reasons for the preference of vaginal delivery concern the natural and physiological way of delivery, the personal experience of delivery, the higher risks of caesarean section and the possibility of a later caesarean section in case of fetal distress during first or second stage of labour. Concerns are expressed about the maintenance of competence amongst practitioners, thus influencing the choice of mode of delivery in obstetrics.


Contemporary practice patterns and beliefs regarding tocolysis among u.s. Maternal-fetal medicine specialists.
To estimate maternal-fetal medicine specialists' practice patterns and perceived risks and benefits to tocolysis. We performed a mail-based survey of all Society for Maternal-Fetal Medicine (SMFM) members in the United States. Subjects were asked whether they would recommend tocolysis and what would be their first-line tocolytic in five scenarios: 1) acute preterm labor; 2) maintenance tocolysis after arrested preterm labor; 3) repeat acute preterm labor; 4) preterm premature rupture of membranes (PROM) without contractions; and 5) preterm PROM with contractions. A total of 827 (46%) SMFM members responded. Ninety-six percent, 56%, 56%, 32%, and 29% would recommend tocolysis for acute preterm labor, repeat acute preterm labor, preterm PROM with contractions, preterm PROM without contractions, and maintenance tocolysis, respectively. The most common first-line tocolytic was magnesium for acute preterm labor (45%) and repeat acute preterm labor (41%); nifedipine was the most common maintenance tocolysis (79%). Eighty percent believed tocolysis was associated with moderate or significant benefit in the setting of acute preterm labor; however, fewer than 50% responded similarly for the other four scenarios. In all five scenarios, more than 50% of respondents indicated there was minimal or no risk associated with tocolysis. Having a nonacademic practice was independently associated with the recommendation for tocolysis. Almost all maternal-fetal medicine specialists recommend tocolysis in the setting of acute preterm labor, and many recommend tocolysis for other indications. Magnesium and nifedipine are the most commonly prescribed first-line tocolytics. III.


Expression of Bub1 gene correlates with tumor proliferating activity in human gastric carcinomas.
Bub1 plays an important role at the spindle assembly checkpoint to prevent cell cycle progression following spindle damage. We examined the expression of human Bub1 mRNA in 20 gastric carcinoma tissues and corresponding nonneoplastic mucosas by reverse transcriptase-polymerase chain reaction and analyzed the relation with proliferative activity monitored by the expression of proliferating cell nuclear antigen (PCNA) on Western blotting as well as Ki-67 labeling index by immunohistochemistry. Increased expression of Bub1 mRNA was detected in 8 (40%) of the gastric carcinomas in comparison with their nonneoplastic counterparts, while 4 (20%) expressed Bub1 at lower levels. The expression of Bub1 mRNA was confirmed by in situ hybridization. The expression levels of Bub1 mRNA were well correlated with the levels of PCNA protein in 16 (80%) gastric carcinoma cases. The examination of Ki-67 labeling indices proved the close correlation between the expression levels of Bub1 and proliferating activity. These findings suggest that mRNA expression of human Bub1 gene is closely associated with the tumor-proliferating activity. Since genetic alterations of human Bub1 rarely occur in gastrointestinal cancers, the functional machinery of Bub1 to prevent cell cycle progression into anaphase might be well preserved in gastric carcinomas even with high proliferative activity.


Cyclophilins in atherosclerosis: a new therapeutic target?
Atherosclerosis is a chronic disease with a significant inflammatory component. Recent studies indicate a role of extracellular cyclophilins as contributors to endothelial inflammation and pathogenesis of atherosclerosis. In this article, we review current literature on pro-inflammatory activities of extracellular cyclophilins and discuss possible approaches to selectively target this novel proinflammatory factor.


Comparison of three dimensional reconstruction and conventional computer tomography angiography in patients undergoing zero-ischemia laparoscopic partial nephrectomy.
With the development of three dimensional (3D) reconstruction and printing technology, it has been widely using in the field of urology. However, there have been few studies reporting the role of 3D reconstruction in zero-ischemia partial nephrectomy (PN). The aim of this study was to assess the role of 3D reconstruction and conventional computer tomography angiography (CTA) in zero-ischemia laparoscopic partial nephrectomy (LPN). A total of 60 consecutive patients undergoing zero-ischemia LPN between October 2017 and March 2018 who underwent CTA (CTA group including 30 patients) and 3D reconstruction (3D group including the remaining 30 patients) preoperatively were included. 3D reconstruction and CTA images were prepared which were used to demonstrate the number and spatial interrelationships of the location of renal tumors and tumor feeding arteries. These radiological findings were directly correlated with intraoperative surgical findings at laparoscopy. Baseline, perioperative variables and the rate of accurate tumor feeding artery orientation were compared between groups. All LPNs were completed without conversion to renal hilar clamping or open surgery. Preoperative 3D reconstruction identified that 15 patients had only one tumor feeding artery, 12 had two, and another 3 had three, while the conventional CTA revealed that 22 patients had one tumor feeding artery, 8 had two (P > 0.05). The mean operation time was shorter and estimated blood loss was less in the 3D group (P < 0.05) and the rate of accurate tumor feeding artery dissection was higher in the 3D group (91.7%) in comparison with the CTA group (84.2%). The baseline characteristics and renal function outcomes had no statistical differences between groups. 3D reconstruction can provide comprehensive information for the preoperative evaluation and intraoperative orientation about tumor feeding arteries that may facilitate tumor resection during zero-ischemia LPN for renal tumors.


Sirolimus alters lung pathology and viral load following influenza A virus infection.
Inhibitors of mTOR, such as sirolimus, have been shown to induce thymus involution and inflammatory lung disease in mice. The latter effect supports the role of this serine/threonine kinase in ameliorating lung inflammation. Other studies have shown sirolimus reduces/delays lung disease associated with various strains of influenza A virus (IAV). Thus, the effects of mTOR inhibitors on influenza infection deserve further studies. Here, we examined the changes in lung viral copies, pathology and pulmonary function associated with IAV (A/PR/8/34) infection in mice treated with sirolimus. Body weight loss peaked between days 6-11 post-infection and was more severe in IAV-infected mice that were administered sirolimus as compared to mice that received IAV alone (p = 0.030). Natural log viral gene copies, mean ± SD per mg lung tissue, in IAV-infected mice that were administered sirolimus were 17.31 ± 1.27 on day 4, 19.31 ± 7.46 on day 10, and 0 on day 25. The corresponding number of copies in mice that received IAV alone were 18.56 ± 0.95 on day 4 (p = 0.132), 1.52 ± 1.39 on day 10 (p = 0.008), and 0 on day 25. Lung pathology was evident on days 4, 10, and 25 post infection, with mean ± SD inflammatory score of 9.0 ± 4.5 in IAV-infected mice that were administered sirolimus, as compared to 11.5 ± 4.5 (p = 0.335) in mice received IAV alone (maximum score, 26.0). Impaired lung function was evident in IAV-infected mice on days 4 and 10, as demonstrated by increased airway resistance and decreased compliance. In this model, the effects of sirolimus on influenza infection included severe weight loss and modified viral replication, respiratory function and lung inflammation. The adverse events associated with sirolimus treatment are consistent with its potent immunosuppressive activity and, thus, preclude its use in IAV infection.


Modifications in repair and expression of potentially lethal damage (alpha-PLD) as measured by delayed plating or treatment with beta-araA in plateau-phase Ehrlich ascites tumor cells after exposure to charged particles of various specific energies.
The ability of Ehrlich ascites tumor cells (EAT cells) to repair potentially lethal damage (alpha-PLD) as demonstrated by either an increase in survival after delayed plating or a decrease in survival after treatment with beta-arabinofuranosyladenine (beta-araA) was investigated after exposure to protons, deuterons, 3He, 4He, and heavy ions of various specific energies. A significant amount of repair or fixation was observed after delayed plating or treatment with beta-araA, respectively, in cells that were exposed to protons of 6-21 MeV energy, reflecting mainly variations in the survival curve shoulder width. Four-hour treatment with 80 microM/liter beta-araA resulted in an exponential survival curve for all proton energies tested. A decrease in particle energy increased killing and caused a reduction in Dq without a significant change in D0. The survival curve obtained after exposure of cells to 3.4 MeV protons had only a small shoulder and was only slightly modified by either delayed plating or treatment with beta-araA, suggesting a decrease in the induction rate of alpha-PLD. Similar results were also obtained after exposure to deuterons and 4He ions. The results are interpreted as indicating the importance of the specific particle energy and the delta-electron spectrum in the induction of alpha-PLD. When the results of delayed plating of cells exposed to protons, deuterons, or helium ions were pooled, an exponential relationship between Dq and penumbra radius was indicated. After exposure to 40Ar ions of 18 MeV specific energy, a shouldered survival curve was obtained, and beta-araA significantly enhanced killing by modifying Dq as well as D0, a result that also suggests induction of repairable damage by the delta particles produced and interaction of lesions induced within the core of the ion path with penumbra lesions. Based on these results a model is proposed assuming that alpha-PLD results from interaction, during the course of repair, of pairs of DNA lesions induced within a distance di. The model assumes the existence of a critical separation distance dic, with the property that pairs of lesions induced with separation distance shorter than dic (expressed as number of base pairs) will always be expressed as lethal, and the existence of a maximum separation distance dim, with the property that pairs of lesions induced with separation distance larger than dim will not interact.(ABSTRACT TRUNCATED AT 400 WORDS)


Characteristics of Ga-Rich Cu(In, Ga)Se2 Solar Cells Grown on Ga-Doped ZnO Back Contact.
Wide bandgap Cu(In,Ga)Se2 (CIGS) thin films were deposited on Ga-rich Ga:ZnO (GZO) or MoN/GZO by single-stage co-evaporation. CIGS/TCO interface phases, such as resistive n-type Ga2O3, which are likely to have formed during the high temperature growth of Ga-rich CIGS, can deteriorate the solar cell performance. Although some Ga accumulation was observed in both of the CIGS/GZO and CIGS/MoN/GZO interfaces formed at 520 degrees C, the Ga oxide layer was absent. On the other hand, their current-voltage characteristics showed strong roll-over behavior regardless of the MoN diffusion barrier. The strong Schottky barrier formation at the CLGS/GZO junction due to the low work function of GZO, was attributed to current blocking at a high forward bias.


The physical basis for the head-to-tail rule that excludes most fullerene cages from self-assembly.
In the companion article, we proposed that fullerene cages with head-to-tail dihedral angle discrepancies do not self-assemble. Here we show why. If an edge abuts a pentagon at one end and a hexagon at the other, the dihedral angle about the edge increases, producing a dihedral angle discrepancy (DAD) vector. The DADs about all five/six edges of a central pentagonal/hexagonal face are determined by the identities-pentagon or hexagon-of its five/six surrounding faces. Each "Ring"-central face plus specific surrounding faces-may have zero, two, or four edges with DAD. In most Rings, the nonplanarity induced by DADs is shared among surrounding faces. However, in a Ring that has DADs arranged head of one to tail of another, the nonplanarity cannot be shared, so some surrounding faces would be especially nonplanar. Because the head-to-tail exclusion rule is an implicit geometric constraint, the rule may operate either by imposing a kinetic barrier that prevents assembly of certain Rings or by imposing an energy cost that makes those Rings unlikely to last in an equilibrium circumstance. Since Rings with head-to-tail DADs would be unlikely to self-assemble or last, fullerene cages with those Rings would be unlikely to self-assemble.


[Pharmacoeconomic analysis of a maintenance strategy with lopinavir/ritonavir monotherapy in HIV-infected patients].
To conduct a cost-efficacy analysis of lopinavir/ritonavir (LPV/r) monotherapy as a maintenance regimen following induction of virological response with triple therapy including LPV/r. The pharmacoeconomic analysis was performed from the perspective of the Spanish public health system. A cost-efficacy analysis was performed in a phase IV-II, comparative, randomized, multicenter, open-label clinical trial evaluating the efficacy and safety of maintenance therapy with LPV/r monotherapy versus continuation of triple therapy in HIV-infected patients with a persistently undetectable viral load for 6 months. For the pharmacoeconomic analysis, efficacy was defined as the proportion of patients with plasma HIV RNA concentrations < 50 copies/mL at 48 weeks from the start of the study. An intent-to-treat analysis was performed. Only direct costs were considered. Cost, efficacy and the cost-efficacy ratio were calculated for each treatment option. The cost-efficacy ratio of LPV/r maintenance monotherapy was 5186 euros per unit of achieved effect (patient with plasma HIV RNA concentrations < 50 copies/mL at 48 weeks), whereas maintenance with triple therapy had a cost-efficacy ratio of 8688 euros per unit of achieved effect. The option of LPV/r monotherapy as maintenance therapy in HIV-infected patients following induction of virological response with triple therapy including LPV/r might be a more efficient alternative than maintaining triple therapy, as evidenced by a more favorable cost-efficacy ratio.


The small foramina of the orbit and periorbital region: assessment with multi detector computed tomography.
Familiarity with the variants of the foramina of the orbit and periorbital region is important in planning anesthesiological blocks and during orbital and maxillofacial surgery to avoid damage to nerves and vessels. To assess the visibility and the incidence of variants of the small foramina of the orbit by multidetector computed tomography (MDCT). The MDCT scans of 400 orbits from 200 patients were evaluated retrospectively. Slice thickness of the reconstructed images were in the range of 0.5-1.0 mm. The visibility and the variants of the foramen supraorbitale, the foramen infraorbitale, the foramen zygomaticofaciale, the foramen ethmoidale anterius et posterius, and the foramen cranio-orbitale were assessed using three-dimensional reconstruction tools. The foramen infraorbitale (100%; n = 400), foramen supraorbitale (99.5%, n = 398), foramen zygomaticofaciale (76.5%; n = 307), and foramen zygomatico-orbitale (74.5%; n = 298) were most reliably detected by MDCT, while the foramen ethmoidale anterius (58.7%; n = 235) et posterius (56.7%; n = 225) were depicted less frequently. The foramen cranio-orbitale could not be identified in any case. Doubling was found for the foramen supraorbitale in 3.25% (n = 13), the foramen infraorbitale in 1.75% (n = 7), the foramen zygomaticofaciale in 16% (n = 64), and the foramen zygomatico-orbitale 14% (n = 56). Three foramina zygomatico-orbitale and foramina infraorbitale were found in 1.5% (n = 6) and in 0.5% (n = 2) of orbits, respectively. The foramina supraorbitale, infraorbitale, zygomatico-orbitale, and zygomaticiofaciale and their variants are well visible on MDCT. Knowledge of the exact number of these small foramina is relevant for preoperative evaluation.


Difficult intubation following thoracic trauma.
A previously fit 20-year-old man presented with a large haemothorax following a stab wound to the left chest. Pre-operative airway assessment indicated that tracheal intubation would be routine. On induction of anaesthesia, visualisation of the larynx proved impossible because of soft tissue swelling. Successful intubation was eventually achieved with the aid of a gum elastic bougie. At operation, the patient's common carotid artery was found to have been perforated close to its origin on the aorta. The patient made an uneventful recovery.


The thalidomide analogue, CC-4047, induces apoptosis signaling and growth arrest in childhood acute lymphoblastic leukemia cells in vitro and in vivo.
Thalidomide and its analogues have shown promise in the treatment of multiple myeloma but their therapeutic potential has not been evaluated in models of acute lymphoblastic leukemia (ALL). We assessed the effects of the thalidomide analogue, CC-4047, on the growth and apoptosis signaling of human B cell precursor (BCP) ALL cell lines and freshly obtained childhood BCP-ALL cells grown with or without stromal cells. In addition, we studied the effects of CC-4047 on the progression and dissemination of xenotransplanted human BCP-ALL cells in nonobese diabetic/severe combined immunodeficiency mice. CC-4047 reduced the proliferation of human BCP-ALL cell lines in vitro. In contrast with the antileukemic effect of cytarabin, this was more pronounced when cell lines or freshly obtained childhood BCP-ALL cells were cocultured with stromal cells. CC-4047 induced the cleavage of caspase-3, caspase-9, and poly(ADP-ribose) polymerase in stroma-cocultured BCP-ALL cells. The inhibition of tumor growth, caspase-3 cleavage, and reduced microvessel density was observed in nonobese diabetic/severe combined immunodeficiency mice inoculated s.c. with childhood BCP-ALL cells upon CC-4047 treatment. After i.v. BCP-ALL xenotransplantation, CC-4047 reduced splenic dissemination. The thalidomide analogue, CC-4047, displays profound cytostatic effects on stroma-supported human ALL cells both in vitro and in vivo.


The near-global mesospheric potassium layer: Observations and modeling.
The meteoric metal layers act as unique tracers of chemistry and dynamics in the upper atmosphere. Existing lidar studies from a few locations show that K exhibits a semiannual seasonality (winter and summer maxima), quite unlike the annual seasonality (winter maximum and summer minimum) seen with Na and Fe. This work uses spaceborne observations made with the Optical Spectrograph and InfraRed Imager System instrument on the Odin satellite to retrieve the near-global K layer for the first time. The satellite data (2004 to mid-2013) are used to validate the implementation of a recently proposed potassium chemistry scheme in a whole atmosphere chemistry climate model, which provides a chemical basis for this semiannual seasonal behavior. The satellite and model data show that this semiannual seasonality is near global in extent, with the strongest variation at middle and high latitudes. The column abundance, centroid layer height, and root-mean-square width of the K layer are consistent with the limited available lidar record. The K data set is then used to investigate the impact of polar mesospheric clouds on the metal layers at high latitudes during summer. Finally, the occurrence frequency of sporadic K layers and their possible link to sporadic E layers are examined.


Complications after removal of mandibular third molars with special reference to local anaesthetics with different vasoactive properties.
Nhe symptoms after surgical removal of 379 mandibular wisdom teeth when Xylocain-Exadrin 2% and Citanest-Octopressin 3% were used, were evaluated according to a three grade scale. The severity of the symptoms, which were mild and normal in 53% and severe in 47%, did not demonstrably vary with the type of anaesthetic agent used. The symptoms were, on the average, more severe among the women than among the men. The symptoms were correlated with the duration of the operation, which was most obvious in the men. For the men the frequency of symptoms also increased with age. In the men there was also a tendency to a correlation between dry socket and long duration of operation. It thus appeared as if only the men reacted in the way expected from a biologic point of view. The investigation also showed that Xylocain-Exadrin had a better anaesthetic and ischemic effect.


Evaluation of Linearity and Interference Effect on SMBG and POCT Devices, Showing Drastic High Values, Low Values, or Error Messages.
When a patient with diabetes measures blood glucose levels using a simple blood glucose meter, an error message or abnormal value may be displayed because of interfering substances, potentially leading to unnecessary medical treatment. Here, we tested 10 self-monitoring of blood glucose (SMBG) and point-of-care testing (POCT) devices to investigate under what conditions they fail to measure blood glucose levels or display abnormal values instead. We also evaluated the influence and linearity of several well-known interfering substances and hematocrit (Ht). Each adjusted sample was measured by each device twice and the values compared with the reference values. Linearity was favorable in all but one model. The impact of the interfering substances and Ht has been confirmed in many SMBG and POCT devices. In particular, some models showed significant pseudo-high or -low levels for samples that contained ascorbic acid, which is used widely in infusion solutions. Three devices showed error messages to avoid presenting a false value. Since pseudo-high levels may result in the excessive administration of insulin and lead to adverse events, this report serves as a critical reminder of the importance of device choice for specific indications. Three new devices have safety functions that prevent the showing of false values.


Effects of airborne-particle abrasion, sodium hydroxide anodization, and electrical discharge machining on porcelain adherence to cast commercially pure titanium.
The aim of this study was to determine the effect of airborne-particle abrasion (APA), sodium hydroxide anodization (SHA), and electrical discharge machining (EDM) on cast titanium surfaces and titanium-porcelain adhesion. Ninety titanium specimens were cast with pure titanium and the alpha-case layer was removed. Specimens were randomly divided into three groups. Ten specimens from each group were subjected to APA. SHA was applied to the second subgroups, and the remaining specimens were subjected to the EDM. For the control group, 10 specimens were cast using NiCr alloy and subjected to only APA. Surfaces were examined by using scanning electron microscope and a surface profilometer. Three titanium porcelains were fused on the titanium surfaces, whereas NiCr specimens were covered with conventional porcelain. Titanium-porcelain adhesion was characterized by a 3-point bending test. Statistical analysis showed that the porcelain-metal bond strength of the control group was higher than that of the titanium-porcelain system (p < 0.05). There were no significant differences between the bond strengths of titanium groups (p 0.05), except the bond strengths of Noritake Super Porcelain TI-22 groups on which APA and SHA were applied (p < 0.05). SHA and EDM as surface treatment did not improve titanium-porcelain adhesion when compared to APA.