Hip resurfacing as treatment for synovial chondromatosis.
Synovial chondromatosis is a rare condition of metaplastic cartilage development in the synovial membrane of joints. These foci can form free bodies and lead to mechanical arthrosis. The precise etiology is unknown. All synovial joints can be affected, with the hip and knee being most common. Patients with synovial chondromatosis are usually in their fifth decade and typically present with mechanical pain and diffuse swelling. Due to its rarity and nonspecific manifestations, diagnosis of synovial chondromatosis is often delayed until significant mechanical damage and arthrosis has occurred.Controversy exists regarding surgical treatment of synovial chondromatosis, especially with regard to the hip. Localized disease can be treated with resection of affected synovium (possibly arthroscopically), whereas patients with generalized disease require complete, open synovectomy. With articular damage, total hip replacement has been advocated along with synovectomy.This article presents a case of a young man with painful hip synovial chondromatosis who was successfully treated with hip resurfacing and synovectomy after failed hip arthroscopy. Hip resurfacing provides the surgeon with the opportunity to address not only local or generalized synovial disease, but articular damage as well. Furthermore, its bone-preserving properties make this option attractive in the management of this younger patient population. We feel resurfacing has a role in the surgical treatment of synovial chondromatosis. To our knowledge, this is the first case of hip resurfacing arthroplasty for the definitive treatment of synovial chondromatosis.


Health Care Service Price Comparison Suggests That Employers Lack Leverage To Negotiate Lower Prices.
Almost two-thirds of the 153 million nonelderly people in the United States who have health insurance through their employer are in self-insured plans. In contrast to fully insured plans, employers using self-insured plans assume responsibility for employees' medical costs and therefore have an incentive to reduce the prices of health care services. We compared prices for common services in self-insured plans with those in fully insured plans. Using the Health Care Cost Institute's data set of claims for one-third of the US population with employer-sponsored insurance, we found that unadjusted prices were higher in self-insured plans for most of the services we studied, with the largest differences found for endoscopies (approximately 8 percent higher in self-insured plans), colonoscopies (approximately 7 percent), laboratory tests (approximately 5 percent), and moderate-severity emergency department visits (4 percent). When patient characteristics, plan type, and geography were adjusted for, differences were generally smaller but were consistent with these findings. Higher prices in self-insured plans suggest that there may be opportunities for employers to lower prices and for policy makers to act where employers have limited leverage to negotiate with providers.


A Meta-Analysis on the Relations between EGFR R521K Polymorphism and Risk of Cancer.
The EGFR R521K polymorphism has been shown to reduce the activity of EGFR; however, the association between EGFR R521K polymorphism and the risk of cancer remains inconclusive; therefore we performed a meta-analysis to evaluate the relationship between EGFR R521K polymorphism and susceptibility to cancer. Our results suggest that the EGFR R521K polymorphism is not associated with risk of cancer, but the different chemosensitivity to anticancer drugs may need further investigation.


Oophorectomy hinders antioxidant adaptation promoted by swimming in Wistar rats.
Oxidative stress is associated with postmenopause and is also responsible for various metabolic alterations. The redox imbalance observed during ovarian decline can be induced experimentally by bilateral ovariectomy in rats. In addition to hormone replacement, regular moderate physical exercise is indicated to prevent several common postmenopausal diseases. This study aimed to assess the effect of daily swimming on the antioxidant defense system of oophorectomized Wistar rats. Control and oophorectomized groups were submitted to 1 h of daily swimming for 90 days. Levels of lipid peroxidation and glutathione content and the activities of superoxide dismutase enzyme and glutathione peroxidase in erythrocytes, liver, and brain were assessed every 30 days. The control group exhibited lower lipoperoxidation that was associated with a significant increase in superoxide dismutase enzyme activity, glutathione peroxidase activity, and glutathione content in erythrocytes and liver; however, swimming did not cause changes in antioxidant parameters in the brain over time. The oophorectomized group showed no antioxidant adaptation to daily swimming and had greater oxidative damage in the liver and blood. Our results suggest that ovariectomy hinders antioxidant adaptation in Wistar rats submitted to daily swimming.


Profiling the quality characteristics of the butter of Pentadesma butyracea with reference to shea butter.
Pentadesma butyracea is a tropical plant species. Its kernels are rich in edible butter similar to shea butter. This study evaluated the quality characteristics of the Pentadesma butter produced by cottage enterprises in Benin, using a quantitative survey approach and physicochemical and sensorial analysis methods. The butter of Pentadesma is mostly used for food preparation, cosmetic and therapeutic applications. It is characterized by a yellow colour, a hard texture, a relatively sweet taste and a bright appearance. Consumers preferred Pentadesma butter to shea butter for colour, taste, texture and appearance. Instrumental analysis showed that the average water content (6.5 g kg(-1) ) and peroxide value (0.74 mEq O2 kg(-1) ) of Pentadesma butter were lower than those of shea butter, for which average water content and peroxide values were 20.7g kg(-1) and 2.09 mEq O2 kg(-1) respectively. The fatty acid profile of Pentadesma butter is similar to that of shea butter. This study showed that the Pentadesma butyracea butter produced by cottage enterprises in Benin exhibited quality characteristics which are better than that of shea butter. The data generated can be used for a better exploitation of the butter in food and cosmetic industries.


[Establishment of a brain perfusion single photon emission computed tomography database in children by statistical imaging analysis].
We made a 3-dimensional, 99mTc-ECD brain perfusion single photon emission computed tomography (SPECT) database in children by a statistical analysis. We selected 52 individuals between 1 and 15 years of age whose brain SPECT and brain MRI findings were normal, and divided them into three age groups: 1-5, 6-10 and 11-15 years. By comparing databases obtained for each group, an age-dependent change of regional cerebral blood flow was investigated. The results showed that the relative blood flow increases in the frontal lobe and cerebeller hemisphere and decrease in the occipital lobe with increasing age, findings consistent with those of previous reports. This database enabled us to easily find 3-dimensional brain perfusion abnormality in individual patient by SPECT, and may help elucidate the pathophysiology of many brain disorders.


Molecular modeling of family GH16 glycoside hydrolases: potential roles for xyloglucan transglucosylases/hydrolases in cell wall modification in the poaceae.
Family GH16 glycoside hydrolases can be assigned to five subgroups according to their substrate specificities, including xyloglucan transglucosylases/hydrolases (XTHs), (1,3)-beta-galactanases, (1,4)-beta-galactanases/kappa-carrageenases, "nonspecific" (1,3/1,3;1,4)-beta-D-glucan endohydrolases, and (1,3;1,4)-beta-D-glucan endohydrolases. A structured family GH16 glycoside hydrolase database has been constructed (http://www.ghdb.uni-stuttgart.de) and provides multiple sequence alignments with functionally annotated amino acid residues and phylogenetic trees. The database has been used for homology modeling of seven glycoside hydrolases from the GH16 family with various substrate specificities, based on structural coordinates for (1,3;1,4)-beta-D-glucan endohydrolases and a kappa-carrageenase. In combination with multiple sequence alignments, the models predict the three-dimensional (3D) dispositions of amino acid residues in the substrate-binding and catalytic sites of XTHs and (1,3/1,3;1,4)-beta-d-glucan endohydrolases; there is no structural information available in the databases for the latter group of enzymes. Models of the XTHs, compared with the recently determined structure of a Populus tremulos x tremuloides XTH, reveal similarities with the active sites of family GH11 (1,4)-beta-D-xylan endohydrolases. From a biological viewpoint, the classification, molecular modeling and a new 3D structure of the P. tremulos x tremuloides XTH establish structural and evolutionary connections between XTHs, (1,3;1,4)-beta-D-glucan endohydrolases and xylan endohydrolases. These findings raise the possibility that XTHs from higher plants could be active not only on cell wall xyloglucans, but also on (1,3;1,4)-beta-D-glucans and arabinoxylans, which are major components of walls in grasses. A role for XTHs in (1,3;1,4)-beta-D-glucan and arabinoxylan modification would be consistent with the apparent overrepresentation of XTH sequences in cereal expressed sequence tags databases.


Screening for protein phosphorylation using nanoscale reactions on microdroplet arrays.
We present a novel and straightforward screening method to detect protein phosphorylations in complex protein mixtures. A proteolytic digest is separated by a conventional nanoscale liquid chromatography (nano-LC) separation and the eluate is immediately compartmentalized into microdroplets, which are spotted on a microarray MALDI plate. Subsequently, the enzyme alkaline phosphatase is applied to every second microarray spot to remove the phosphate groups from phosphorylated peptides, which results in a mass shift of n×-80 Da. The MALDI-MS scan of the microarray is then evaluated by a software algorithm to automatically identify the phosphorylated peptides by exploiting the characteristic chromatographic peak profile induced by the phosphatase treatment. This screening method does not require extensive MS/MS experiments or peak list evaluation and can be easily extended to other enzymatic or chemical reactions.


Colonization during a key developmental window reveals microbiota-dependent shifts in growth and immunity during undernutrition.
Childhood undernutrition is a major global health challenge with devastating lifelong consequences. Linear growth stunting due to undernutrition has been linked to poor outcomes, and mothers who experience stunting are more likely to give birth to stunted children. Murine models that capture the intergenerational and multifactorial nature of undernutrition are critical to understanding the underlying biology of this disorder. Here we report a gnotobiotic mouse model of undernutrition using microbiota from human infants with healthy or stunted growth trajectories. Intergenerational transmission of microbiota from parents to offspring leads to the development of growth and immune features of undernutrition and enteropathy, including reduced linear growth, intestinal villus blunting and accumulation of intraepithelial lymphocytes. In contrast, colonization after weaning reduces sensitivity to detect changes driven by distinct microbial communities. Overall, these results suggest intergenerational colonization is a useful approach with which to investigate microbiota-dependent growth and immunity in early life.


Hair Diameter Variation in Different Vertical Regions of the Occipital Safe Donor Area.
Little is known concerning hair diameter variation within the safe donor area for hair transplantation surgery. Thicker or thinner hair may be needed, depending on the recipient area, hairline design, and the purpose of surgery. Twenty-seven patients (7 men and 20 women; mean age, 28 years; range, 20-47 years) were included in this study. The midoccipital point was used as the reference point on the horizontal plane at the upper border of the helical rim. The target area width was 15 cm (7.5 cm to the right and left of the reference point) and the height was 8 cm (2 cm above and 6 cm below the reference point). The study area was divided horizontally into 3 5-cm sections (A, B, C) and vertically into 4 2-cm sections (1-4), creating a total of 12 zones. Ten anagen hairs were randomly obtained from each zone and their diameters were measured. Hair diameter in the 4 vertical sections varied significantly, gradually decreasing from sections 1 (superior) to 4 (inferior) in all 3 horizontal sections (A, B, and C). Our results suggest that sections 1 and 2 of the occipital safe donor area would be useful for obtaining thicker hair, such as in procedures to treat male- and female-pattern hair loss, whereas hair from zones 3 and 4 could be useful for transplantation surgery requiring thinner hair, such as eyebrows, eyelashes, and female hairline correction. Our results may be clinically valuable for planning hair transplant surgery and choosing the optimal donor region.


Idiotypes expressed early in experimental Schistosoma mansoni infections predict clinical outcomes of chronic disease.
In murine Schistosoma mansoni infections, schistosome-specific cross-reactive idiotypes (CRI) are present in the sera of mice with moderate splenomegaly syndrome (MSS) at 20 wk after infection. In contrast, sera from animals that have the more severe hypersplenomegaly syndrome (HSS) at 20 wk of infection do not express these CRI in their sera. To examine when these regulatory CRI first appear in mice that eventually develop MSS, sera from infected animals were monitored for CRI from 1.5 to 20 wk of infection. In mice that eventually developed MSS, CRI were detected by 5 to 6 wk after infection, plateaued by 8 to 10 wk, and persisted through 20 wk of infection. Animals that developed HSS pathology or that died before 20 wk of infection never expressed CRI. Moreover, CRI levels present in the sera of mice at 6 wk of infection were inversely correlated with splenomegaly and hepatic fibrosis, but not with parasitologic measures, at 20 wk after infection. These results suggest that critical events occur very early in some schistosome infections that induce the production of regulatory idiotypes and that the presence or absence of these idiotypes predicts, and possibly determines, subsequent morbidity.


Direct Visualization of Model Membrane Remodeling by α-Synuclein Fibrillization.
The interaction of α-synuclein (αS) with membranes is thought to be critical in the etiology of Parkinson's disease. Besides oligomeric αS aggregates that possibly form membrane pores, the aggregation of αS into amyloid fibrils has been reported to disrupt membranes. The mechanism by which aggregation affects the integrity of membranes is, however, unknown. Here, we show that whereas mature αS fibrils only weakly adhere to POPC/POPG giant unilamellar vesicles (GUVs), fibrillization of αS on the membrane results in large-scale membrane remodeling. Fibrils that grow on the vesicle surface stiffen the membrane and make the initially spherical membrane become polyhedral. Additionally, membrane-attached fibrils extract lipids. The lipid extraction and membrane remodeling of growing fibrils can consume the complete bilayer surface and results in loss of vesicle content. These observations suggest that there are several mechanisms by which growing fibrils can disrupt membrane function.


Laparoscopic excision of a mesenteric cyst.
Benign abdominal cystic tumors are rare. They include retroperitoneal, mesenteric, and omental cysts. Most of these lesions present with vague abdominal pain and nausea. Less commonly they will present with bowel obstruction due to external compression. The diagnosis of these tumors is by abdominal ultrasound or computed tomography. Surgical enucleation is the treatment of choice. Laparoscopic surgical techniques are replacing or complimenting open abdominal surgical procedures. As the indications for these techniques increase, newer applications will arise. Presented here is a case of laparoscopic excision of a mesenteric cyst.


Catheter-based renal denervation for treatment of resistant hypertension.
Activation of renal sympathetic nerves is associated with the development of hypertension. Catheter-based renal sympathetic denervation with radiofrequency energy ablation is a new promising treatment option for resistant hypertension. We here report the first Danish experiences and results with this technique. Nine patients with resistant hypertension and a day-time 24-hour ambulatory blood pressure (BP) of 152/89 mmHg ± 10/10 (standard deviation) mmHg despite treatment with 5.4 ± 1.4 anti-hypertensive drugs underwent catheter-based renal sympathetic denervation with the Symplicity catheter. No periprocedural complications or adverse events during follow-up were observed. Seven patients received complete ablation and two patients only partial ablation. Five patients responded to the treatment with a reduction in day-time 24-hour ambulatory BP from 158/94 ± 13/9 mmHg to 139/82 ± 10/8 mmHg (p < 0.05) at the one month follow-up and a reduction in the number of anti-hypertensive drugs from 5.4 ± 1.6 to 3.4 ± 0.9 (p < 0.05). BP in the remaining four patients was not significantly changed and antihypertensive therapy was not changed. Catheter-based renal sympathetic denervation is a feasible and in several cases also effective treatment option for patients with resistant hypertension. Adequately designed controlled trials are needed to assess the long-term safety and the full potential of this treatment.


[Computer tomography findings of orbital changes within the scope of juvenile neurofibromatosis].
The computerized tomography of 9 cases of neurofibromatosis is compared with routine X-rays. Gliomas of the optic nerve, sphenoidal dysplasias, plexiform neurofibromas and buphthalmos are shown in detail. CT today is an indispensable procedure for the diagnosis of neurofibromatosis of the orbit. Often it is up to the ophthalmologist to initiate CT in collaboration with other disciplines. This holds for diagnosis, surgical interventions and the follow-up examinations.


[Home intermittent negative pressure ventilation in a case of chronic respiratory failure due to old tuberculous pleuritis].
A 64-year-old male with a history of tuberculous pleuritis at age 29 had received home oxygen therapy since age 58 because of chronic respiratory failure. He was admitted with symptoms of dyspnea at rest and myoclonus at age 62. Because CO2 narcosis occurred twice, we performed intermittent negative pressure ventilation (INPV) after short-term positive pressure ventilation with transnasal intubation. He has received INPV for 7 hours every day at his home for 20 months without acute exacerbation of respiratory failure, and his activity of daily life subsequently improved. In conclusion, INPV seems to be useful for patients with chronic hypercapnic respiratory failure due to lung disease.


Mouse tales from Kresge: the deafness mouse.
Mouse models for human deafness have not only proven instrumental in the identification of genes for hereditary hearing loss, but are excellent model systems in which to examine gene function as well as the resulting pathophysiology. One mouse model for human nonsyndromic deafness is the deafness (dn) mouse, a spontaneous mutation in the curly-tail (ct) stock. The dn gene is on mouse Chromosome 19 and it was recently shown to be a novel gene called Tmc1. A mutation in Tmc1 is also found in Beethoven (Bth), which is another deaf mouse mutant. In humans, one autosomal dominant form of nonsyndromic hearing loss (DFNA36) and two autosomal recessive forms (DFNB7 and DFNB11) are associated with mutations in TMC1, the human homologue of Tmc1. The transmembrane protein encoded by this gene is required for normal cochlear hair cell function and the mouse models will facilitate the elucidation of the molecular pathway that is disrupted when mutations are present.


Recent advances in Bacteroides genetics.
Bacteroides are Gram-negative, obligate anaerobes that are present in high concentrations within the intestinal tracts of humans and animals. Bacteroides are also important opportunistic pathogens of humans and animals. Methods for genetic manipulation of these important organisms have only recently begun to emerge. Shuttle vectors which can be transferred by conjugation between Escherichia coli to Bacteroides are now available. A method for transforming some strains of Bacteroides has been developed. Two Bacteroides transposons, Tn4351 and Tn4400, have been found and one of them, Tn4351, has been used for transposon mutagenesis of Bacteroides. Several different Bacteroides genes have now been cloned, including a gene that codes for resistance to clindamycin, genes that code for polysaccharidases (chondroitin lyase and pullulanase), and a gene that codes for a fimbrial subunit. These cloned genes have been used to study the organization and regulation of Bacteroides genes.


DHA/EPA (Omega-3) and LA/GLA (Omega-6) as Bioactive Molecules in Neurodegenerative Diseases.
Neurodegenerative diseases are characterized by neuroinflammation, neuronal depletion and oxidative stress. They coincide with subtle chronic or flaring inflammation, sometimes escalating with infiltrations of the immune system cells in the inflamed parts causing mild to severe or even lethal damage. Thus, neurodegenerative diseases show all features of autoimmune diseases. Prevalence of neurodegenerative diseases has dramatically increased in recent decades and unfortunately, the therapeutic efficacy and safety profile of available drugs is moderate. The beneficial effects of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) polyunsaturated fatty acids (omega-3 PUFAs) are nowadays highlighted by a plethora of studies. They play a role in suppression of inflammation, gene expression, cellular membrane fluidity/permeability, immune functionality and intracellular/exocellular signaling. The role of omega-6 polyunsaturated fatty acids, such as linoleic acid (LA), gamma linolenic acid (GLA), and arachidonic acid (AA), on neuroprotection is controversial, as some of these agents, specifically AA, are proinflammatory, whilst current data suggest that they may have neuroprotective properties as well. This review provides an overview of the existing recent clinical studies with respect to the role of omega-3 and omega-6 PUFAs as therapeutic agents in chronic, inflammatory, autoimmune neurodegenerative diseases as well as the dosages and the period used for testing.


Clinical and prognostic value of spot urinary creatinine in chronic heart failure-An analysis from GISSI-HF.
This study aimed to identify patient characteristics associated with low urinary creatinine in morning spot urine and investigate its association with clinical outcome. Twenty-four-hour creatinine excretion is an established marker of muscle mass in heart failure and other populations. Spot urine creatinine might be an easy obtainable, cheap marker of muscle wasting and prognosis in heart failure (HF) patients. Spot urine creatinine concentration was measured in 2130 patients included in the GISSI-HF trial. We evaluated the prognostic value of urinary creatinine and its relation with clinical variables. Median spot urinary creatinine was 0.80 (IQR 0.50-1.10) g/L. Lower spot urinary creatinine was associated with older age, smaller height and weight, higher NYHA class, worse renal function and more frequent spironolactone and diuretic use (all P<.02). During a median follow-up of 2.8 years, 655 patients (31%) experienced the combined endpoint of all-cause mortality or HF hospitalization. Lower urinary creatinine was independently associated with an increased risk of all-cause mortality or HF hospitalization (HR, 1.59 [1.21-2.08] per log decrease, P=.001), and all-cause mortality (HR, 1.75 [1.25-2.45] per log decrease, P=.001). Lower urinary creatinine, measured in morning spot urine in patients with chronic HF, is associated with worse renal function, smaller body size, more severe HF and is independently associated with an increased risk of all-cause death and HF hospitalization.


First population norms for the EQ-5D-3L in the Russian Federation.
The EQ-5D survey instrument is routinely applied to general and patient specific populations in many countries, as a means of measuring Health Related Quality of Life (HRQOL) and/or informing Health Technology Assessment. The instrument is the subject of growing interest in the Russian Federation, as too is Health Technology Assessment. This research is the first to systematically present the EQ-5D-3L nationally representative population norms and to examine the socioeconomic and socio-demographic characteristics of the instrument among a representative sample of the Russian population. Based on a nationally representative health and well-being survey of the Russian population, conducted in November 2017, we establish the descriptive results, including the EQ-VAS and the EQ-5D Index, by age and gender, examine the correspondence between the EQ-5D health classifications and the separate EQ-VAS scores, and draw on a set of augmented logistic regressions to evaluate the association between the presence of problems in each dimension and various socio-economic and health-related characteristics. We find strong evidence that the EQ-5D instrument is sensitive to underlying observed and latent health experiences, that it mirrors many of the characteristics familiar from other settings but that there are Russian specificities which merit further research, particularly with respect to the anxiety/depression dimension of the instrument. This research represents an important landmark for HRQOL studies in Russia as well as for the prospects of continuing to develop the scholarly and practical infrastructure necessary for Russian Health Technology Assessment to advance.


Mechanisms underlying hemodynamic and neuroendocrine stress reactivity at different phases of the menstrual cycle.
This study examined the association of menstrual cycle phase with stress reactivity as well as the hormonal and neuroendocrine mechanisms contributing to cycle effects. Fifty-seven women underwent a modified Trier Social Stress Test during the early follicular, late follicular, and luteal phases of the menstrual cycle. Greater increases in cardiac index (CI) and greater decreases in vascular resistance index (VRI) during speech were observed in the luteal phase relative to other phases, while greater increases in epinephrine (EPI) was observed during the late follicular and luteal phases compared to the early follicular phase. Luteal phase estradiol predicted luteal EPI reactivity but not CI or VRI reactivity, while luteal phase EPI reactivity predicted luteal phase CI and VRI reactivity. Thus, cycle-related changes in EPI reactivity may be a stronger determinant of cycle effects on hemodynamic reactivity than sex hormones per se.


Treatment of grade IIIB opens tibial fracture by Ilizarov hybrid external fixator.
We evaluated the results of patients who were treated with Ilizarov hybrid external fixator for type IIIB open tibial fractures. 35 Gustilo grade IIIB tibial fractures of age between 18 to 42 years (22 male and 13 female) in which 12 distal fourth tibia (D/4) of C1.1 (6), C1.3 (6), 12 upper fourth Tibia (U/4) of A2 (8) and A3 (4) according to AO classification and 11 Tibial plateau fractures of Schatzker type VI (5) , V(5), IV(1) . All tibial plateau, proximal fourth fractures and lower fourth fractures of tibia and fibula (Reversed Hybrid), treated with Ilizarov hybrid fixator using two Ilizarov 5/8 rings and AO External fixator were followed up to 12-52 months. D/4 fractures were united at 31.16678.3046 wks, U/4 at 24.005.2915 and Tibial plateau at 15.5454.160 weeks (p-0.00). ROM in tibial plateau type IV 130 degrees +/- 00, type V 124 degrees +/- 8.94 degrees, type VI 125 degrees +/- 7.0711 degrees, D/4 of type C1.1 (50 degrees +/- 0.00), type C1.3 (43 degrees +/- 5.7755) whereas full ROM in U/4 fractures. Pin tract infection occurred in 21% of cases. Pain on walking in 20% of cases of type VI tibial plateau fractures and 80% of cases of type IV and V. Problem free in rest of parameter of function of VI and 100% problem in IV and V. Pain at rest observed in 20% of cases in type V. In 66.67% U/4 fractures had pain on walking but no other functions were compromised. In 33% D/4 fractures of C1.1 type had pain on walking only and had 1cm of shortening. On the basis of our experience, we suggest adopting this method for functional limb salvage after extensive complex high-energy injuries. This fixator is safe and versatile, effective in providing stability and allowing early rehabilitation, although the indications for its use are very relatively specific.


[Corneal confocal microscopy in Fabry patients with cornea verticillata].
To study the changes in corneal microstructure and nerve fibers in patients with cornea verticillata in Fabry disease. The study included patients with a confirmed diagnosis of Fabry disease. All patients underwent standard ophthalmological examination. Corneal confocal microscopy was performed when slit-lamp examination revealed cornea verticillata. Cornea verticillata was found in 64.5% of patients. Corneal microscopy revealed hyperreflective deposits in the basal cell layer of corneal epithelium in all patients with cornea verticillata. Characteristic features were desquamation of epithelial cells with islands of epithelial cells deficiency, as well as hyperreflective intracellular deposits in the basal layer. Changes in keratocytes in the form of perinuclear white microdots were found in the stroma of 25.8% of patients. Endothelial layer was not changed and had normal cell density, reflectivity and morphology in all patients with cornea verticillata. Corneal confocal microscopy is a valuable diagnostic tool in patients with Fabry disease and may be important in evaluation of disease progression and monitoring of treatment efficacy.


Synthesis of Mesoporous γ-Alumina-Supported Co-Based Catalysts and Their Catalytic Performance for Chemoselective Reduction of Nitroarenes.
Mesoporous γ-alumina (γ-MA)-supported cobalt oxides (Co3O4) with large surface areas and narrow pore size distributions were first prepared through one-pot hydrolysis of metal nitrates. The obtained Co3O4/γ-MA materials were impregnated with a water-ethanol solution of 1,10-phenanthroline, followed by treatment at 700 °C in N2 atmosphere, generating Co-NC/γ-MA catalysts containing N-doped graphitic carbon (NC). The Co-NC/γ-MA catalysts maintained the mesoporous structure of γ-MA, and Co3O4 was reduced to metallic Co nanoparticles highly dispersed in the γ-MA frameworks. Metallic Co species had a strong interaction with NC in the matrices, avoiding the surface oxidation of Co particles. The Co-NC/γ-MA catalysts exhibited superior catalytic activity and quantitatively reduced a variety of functionalized nitroarenes to the corresponding arylamines with hydrazine hydrate in ethanol at near room temperature, affording yields of >99%. The recycling test of 2-chloronitrobenzene as a model reaction showed no detectable change in catalyst performance after 10 cycle reactions.


[Etiological studies of salmonellosis in swine].
A total of 25,114 samples taken from fetuses, pigs, adult swine, feces, environmental objects, etc. in 6 regions of this country were studied bacteriologically in 1976-1980, and in 1970-1975 a retrospective analysis was made of data of investigations with pigs in the same regions. The sample study led to the isolation of 1,495 strains of 21 Salmonella species of the B, C, D, and E groups. At the same time 9 Salmonella species were isolated from pigs, while during the second period the number of the isolated Salmonella spp. was 16. It was found that the strains belonging to S. cholerae-suis were highest in number (87.61 per cent of all isolated strains), whereupon beside the autochtonic var. kunzendorf there were also findings of var. america. By frequency of isolation the ubiquitous S. typhi-murium ranked four as isolated from pigs, and washings from environmental objects as well as from sewage water, rats, and common flies. Of the exotic Salmonella species more important proved S. agona, S. jerusalem var. 14, S. tennessee, and others. Considerable diversity was established with the Salmonella species in pigs on the industrial complexes (17 spp.), the farms of the Agro-Industrial and the Industrial Agrarian Complexes (8 spp.), and on some other farms (5 spp.). Only two species of Salmonellae were found in pigs on the private farms, and one species--on the auxilliary farms.


Treatment outcomes of Acinetobacter baumannii -associated pneumonia and/or bacteraemia at the intensive care unit of Universitas Academic Hospital, Bloemfontein, South Africa.
Nosocomial infection with multidrug-resistant (MDR) Acinetobacter baumannii is associated with high mortality rates and the optimal treatment regimen is uncertain. To compare outcomes, as well as ICU and in-hospital survival rates of patients with A. baumannii pneumonia and/or bacteraemia who were treated with colistin monotherapy v. colistin/tigecycline combination therapy. This was a retrospective cross-sectional study of patients admitted to the multidisciplinary ICU of Universitas Academic Hospital, Bloemfontein, South Africa, between 1 January 2018 and 31 December 2019. Sixteen patients were included in the study. Nine patients were treated with a combination of colistin and tigecycline, while 7 patients were treated with colistin only. Seven out of 9 (77.8%) patients in the colistin/tigecycline combination therapy group were treated successfully and survived until discharge from ICU, as opposed to 2 out of 7 (28.6%) in the colistin monotherapy group (relative risk (RR) 2.7; 95% CI 0.80 - 9.24). Five out of 9 (55.6%) in the colistin/tigecycline combination therapy group v. 2 out of 7 (28.6%) in the colistin monotherapy group survived until discharge from hospital (RR 1.94; 95% CI 0.53 - 7.20). Although ICU survival in patients with A. baumannii infection was better when treated with colistin/tigecycline combination therapy compared with colistin monotherapy, a statistically significant difference could not be detected. Adequately powered prospective clinical trials are required to detect statistically significant differences in treatment outcomes.


[Resection of pelvic sarcomas. Reconstruction techniques without use of endoprostheses].
Advances in preoperative imaging techniques and surgical expertise now permit limb sparing resections of pelvic sarcomas to be performed in appropriate patients with an acceptable risk of local recurrence. Reconstruction of the skeletal defect remains, however, problematic. Many techniques have been employed, all with advantages and disadvantages. Arthrodesis for the unstable pelvis has been our preferred reconstructive procedure. When successful, we find this a durable and pain-free reconstruction for the young, active patient.


Synthesis of gold nanosheets at a liquid/liquid interface using an amphiphilic polyoxometallate/surfactant hybrid photocatalyst.
Control of the morphology of gold nanoparticles has received considerable attention because the physical and chemical properties of gold depend significantly on its size and shape. A novel route for obtaining 2-D gold nanostructures has been developed in which chloroaurate ions (AuCl (4)(-)) are reduced at the 2-D interface between water and chloroform using an amphiphilic polyoxometallate (SiW (12)O (40)(4-))/surfactant (dimethyldioctadecylammonium; DODA) hybrid photocatalyst under UV irradiation at room temperature in air. This simple method can readily produce large single-crystalline gold nanosheets (lateral size, ca. 20 microm; thickness, ca. 150 nm).


Targeting homologous repair deficiency in breast and ovarian cancers: Biological pathways, preclinical and clinical data.
Mutation or epigenetic silencing of homologous recombination (HR) repair genes is characteristic of a growing proportion of triple-negative breast cancers (TNBCs) and high-grade serous ovarian carcinomas. Defects in HR lead to genome instability, allowing cells to acquire the multiple genetic alterations essential for cancer development. However, this deficiency can also be exploited by using DNA damaging agents or by targeting compensatory repair pathways. A noteworthy example is treatment of TNBC and epithelial ovarian cancer harboring BRCA1/2 germline mutations using platinum salts and/or PARP inhibitors. Dramatic responses to PARP inhibitors may support a wider use in the HR-deficient population beyond those with mutated germline BRCA1 and 2. In this review, we discuss HR deficiency hallmarks as predictive biomarkers for platinum salt and PARP inhibitor sensitivity for selecting patients affected by TNBC or epithelial ovarian cancer who could benefit from these therapeutic options.


Analysis of electron-transfer rate constant in condensed media with inclusion of inelastic tunneling and nuclear quantum effects.
We have developed a theoretical formulation for evaluating the nonadiabatic electron-transfer (ET) rate constant in condensed medium which takes into account both inelastic electron tunneling and nuclear quantum effects. The derived formula allows us to calculate the ET rate as a function of the free-energy gap between the ET donor and acceptor states using the information on the spectral density associated with environmental polarization fluctuation and the temporal correlation function of electronic tunneling matrix element. Model calculations have been performed illustratively.


[Blood neutrophil lesion reaction in burn patients].
The allergy level to staphylococcus was studied through the V.A. Fradkin reaction of neutrophile injury (RNI) in vitro in 160 thermal burn cases depending on the severity and dynamics of burn disease. The results of the study have proved that at the RNI in vitro the specific sensibilization to staphylococcus in the burned gets evident by the 15-30th day after trauma; the degree of RNI manifestation rises with the time (by the 90--180th day and later after trauma), especially in patients with deep and vast burns. It reaches very high level during the convalescense period. The direct interrelation between the allergy level, severity of the burn trauma and general immunological reactivity of the body has been shown.


Downstream E-box-mediated regulation of the human telomerase reverse transcriptase (hTERT) gene transcription: evidence for an endogenous mechanism of transcriptional repression.
Regulation of the hTERT gene encoding the telomerase catalytic subunit plays an important role in human cell senescence, immortalization, and carcinogenesis. By examining the activity of various deleted or mutated hTERT promoter fragments, we show that an E-box element downstream of the transcription initiation site is critical to differential hTERT transcription between the telomerase/hTERT-positive renal cell carcinoma cell line (RCC23) and its telomerase/hTERT-negative counterpart containing a transferred, normal chromosome 3 (RCC23+3). This E-box element mediated repression of hTERT transcription in RCC23+3 but not in RCC23. A copy number-dependent enhancement of the repression suggested active repression, rather than loss of activation, in RCC23+3. Endogenous expression levels of c-Myc or Mad1, which could activate or repress hTERT transcription when overexpressed, did not account for the differential hTERT transcription. Gel mobility shift assays identified the upstream stimulatory factors (USFs) as a major E-box-binding protein complex in both RCC23 and RCC23+3 and, importantly, detected an RCC23+3-specific, E-box-binding factor that was distinct from the USF and Myc/Mad families. The E-box-mediated repression was also active in normal human fibroblasts and epithelial cells and inactive in some, but not all, telomerase/hTERT-positive cancer cells. These findings provide evidence for an endogenous, repressive mechanism that actively functions in telomerase/hTERT-negative normal cells and becomes defective during carcinogenic processes, e.g., by an inactivation of the telomerase repressor gene on chromosome 3.


Capecitabine: fulfilling the promise of oral chemotherapy.
Capecitabine is a synthetic oral fluoropyrimidine carbamate that is sequentially activated in a three-step process, which results in the preferential production of 5-fluorouracil in tumours, rather than in the normal surrounding tissue. Capecitabine is proven to be as effective as the combination of 5-fluorouracil and leucovorin administered on the Mayo clinic schedule in patients with metastatic colorectal cancer. It has also been proven to be effective in patients with metastatic breast cancer that has progressed despite prior anthracyclines and taxoids. More recently, it has also been shown to increase survival in combination with docetaxel in patients with metastatic breast cancer in comparison to docetaxel alone. This article reviews the pharmacology and clinical activity of capecitabine, as well as combinations of capecitabine with other chemotherapeutic agents and future directions of investigation with this convenient and widely active antitumour therapy.


Base substitutions in transposable element IS1 cause DNA duplication of variable length at the target site for plasmid co-integration.
We demonstrate that base substitutions in the IS1 sequence affect the length of the nucleotide sequence which is duplicated during IS1-mediated co-integration. IS1K, an IS1 variant present in the Escherichia coli chromosome, has seven base substitutions in its sequence as compared with that of IS1R derived from the plasmid R100. All substitutions are located in the internal region of IS1K. We have constructed plasmids containing IS1R, IS1K and hybrids between them: one contains four base substitutions causing an amino acid substitution in the insA gene and the other has three substitutions producing an amino acid substitution in the insB gene. We have isolated co-integrate plasmids formed by each IS1 and analysed nucleotide sequences of the target sites duplicated at the co-integration junctions. The results show that IS1K generates duplications of 8 or 14 bp as well as 9 bp, while IS1R exclusively generates the 9-bp duplications. Both hybrid IS1s also create 8- or 7-bp target duplications in addition to 9-bp duplications. These results indicate that the base substitutions in either insA or insB are sufficient for the occurrence of unusual target duplications, suggesting that both genes are involved in the target duplication.


The validity of military screening for mental health problems: diagnostic accuracy of the PCL, K10 and AUDIT scales in an entire military population.
Depression, alcohol use disorders and post-traumatic stress disorder (PTSD) are serious issues among military personnel due to their impact on operational capability and individual well-being. Several military forces screen for these disorders using scales including the Kessler Psychological Distress Scale (K10), Alcohol Use Disorders Identification Test (AUDIT), and Post-traumatic Stress Disorder Checklist (PCL). However, it is unknown whether established cutoffs apply to military populations. This study is the first to test the diagnostic accuracy of these three scales in a population-based military cohort. A large sample of currently-serving Australian Defence Force (ADF) Navy, Army and Air Force personnel (n = 24,481) completed the K10, AUDIT and PCL-C (civilian version). Then, a stratified sub-sample (n = 1798) completed a structured diagnostic interview detecting 30-day disorder. Data were weighted to represent the ADF population (n = 50,049). Receiver operating characteristic (ROC) analyses suggested all three scales had acceptable sensitivity and specificity, with areas under the curve from 0.75 to 0.93. AUDIT and K10 screening cutoffs closely paralleled established cutoffs, whereas the PCL-C screening cutoff resembled that recommended for US military personnel. These self-report scales represent a cost-effective and clinically-useful means of screening personnel for disorder. Military populations may need lower cutoffs than civilians to screen for PTSD.


Abundance matters: role of albumin in diabetes, a proteomics perspective.
Human serum albumin (HSA) is a multifaceted protein with vital physiological functions. It is the most abundant plasma protein with inherent capability to bind to diverse ligands, and thus susceptible to various post-translational modifications (PTMs) which alter its structure and functions. One such PTM is glycation, a non-enzymatic reaction between reducing sugar and protein leading to formation of heterogeneous advanced glycation end products (AGEs). Glycated albumin (GA) concentration increases significantly in diabetes and is implicated in development of secondary complications. Areas covered: In this review, we discuss in depth, formation of GA and its consequences, approaches used for characterization and quantification of GA, milestones in GA proteomics, clinical relevance of GA as a biomarker, significance of maintaining abundant levels of albumin and future perspectives. Expert commentary: Elevated GA levels are associated with development of insulin resistance as well as secondary complications, in healthy and diabetic individuals respectively. Mass spectrometry (MS) based approaches aid in precise characterization and quantification of GA including early and advanced glycated peptides, which can be useful in prediction of the disease status. Thus GA has evolved to be one of the best candidates in the pursuit of diagnostic markers for prediction of prediabetes and diabetic complications.


Asymmetric high energy dual optical parametric amplifier for parametric processes and waveform synthesis.
We report on an asymmetric high energy dual optical parametric amplifier (OPA) which is capable of having either the idlers, signals, or depleted pumps, relatively phase locked at commensurate or incommensurate wavelengths. Idlers and signals can be locked on the order of 200 mrad rms or better, corresponding to a 212 as jitter at λ=2 µm. The high energy arm of the OPA outputs a combined 3.5 mJ of signal and idler, while the low energy arm outputs 1.5 mJ, with the entire system being pumped with a 1 kHz, 18 mJ Ti:Sapphire laser. Both arms are independently tunable from 1080 nm-2600 nm. The combination of relative phase locking, high output power and peak intensity, and large tunability makes our OPA an ideal tool for use in difference frequency generation (DFG) in the strong pump regime, and for high peak field waveform synthesis in the near-infrared. To demonstrate this ability we generate terahertz radiation through two color waveform synthesis in air plasma and show the influence of the relative phase on the generated terahertz intensity. The ability to phase lock multiple incommensurate wavelengths at high energies opens the door to a multitude of possibilities of strong pump DFG and waveform synthesis.


Antidepressant combinations: widely used, but far from empirically validated.
This paper reviews the evidence on combining antidepressants (ADs) for treatment of major depressive disorder. Although widely used and usually safe, the efficacy of even the most widely prescribed combinations of ADs has not been established by properly controlled, adequately powered, clinical trials. This stands in contrast to several adjunctive strategies for AD nonresponders, including adjunctive lithium, thyroid hormone, or newer-generation antipsychotics. The wide use of AD combinations no doubt reflects the limited efficacy of commonly used ADs and the unmet need for effective strategies for patients with treatment-resistant depression. Although of unproven efficacy, potential merits of combining selected ADs include: (1) avoiding discontinuation-emergent symptoms and cross-titration schedules, (2) at worst, the second AD should be as effective in combination as it would be as a monotherapy following a switch, and (3) the possibility of complementary neuropharmacologic effects that may enhance efficacy or improve tolerability. The dearth of controlled studies of such a commonly used strategy for such a highly prevalent condition is symptomatic of shortcomings in the way clinically relevant research is funded, points to the need for industry-academic-federal collaborations, and underscores the need for large, practice-based, research groups that can efficiently complete publicly funded studies of high public health impact.


Facile synthesis of ternary dual Z-scheme g-C3N4/Bi2MoO6/CeO2 photocatalyst with enhanced 4-chlorophenol removal: Degradation pathways and mechanism.
The design of visible-light-driven photocatalysts has been rapidly developed due to the great application potential in environmental pollution remediation. The present work focused on the construction of a novel ternary g-C3N4/Bi2MoO6/CeO2 nanocomposite and the application for photocatalytic removal of 4-CP under irradiation. The g-C3N4/Bi2MoO6/CeO2 photocatalysts were successfully synthesized by a facile solid-state thermolysis assisted ultrasonic dispersion to introduce g-C3N4 nanosheets into Bi2MoO6/CeO2 composite. Morphology characterization revealed that the Bi2MoO6/CeO2 spherical structure uniformly dispersed on the g-C3N4 nanosheets and the close interface contact induced the generation of dual Z-scheme heterojunction. The as-prepared photocatalysts shown enhanced catalytic activity in comparison with binary Bi2MoO6/CeO2 composites and the optimal CBC-20% exhibited the highest degradation efficiency of 99.1% for 4-CP under 80 min illumination, which was attributed to the efficient separation of photogenerated e--h+ pairs under the dual Z-scheme charges transfer mode. Additionally, combined with trapping experiments and EPR analysis, 4-CP was decomposed mainly by the active species •O2- and h+ with a marginal assistance of •OH during the photocatalytic process. The intermediates for 4-CP degradation were analyzed and a reasonable degradation pathway was proposed.


The Impact of Age on the Outcomes of Minimally Invasive Lumbar Decompression for Lumbar Spinal Stenosis.
Minimally invasive lumbar decompression (mild ®) is an effective long-term therapy for patients with symptomatic lumbar spinal stenosis (LSS) resulting primarily from hypertrophic ligamentum flavum (HLF). Most subjects in clinical studies of the mild procedure have been older adults (age≥65). While the incidence of LSS increases with age, a substantial number of adults (age<65) also suffer from neurogenic claudication secondary to HLF. In this report, outcomes of mild were compared between adults and older adults. All prospective studies of the mild procedure with a 1-year follow-up completed since the beginning of 2012 that allowed the inclusion of adult patients of all ages were reviewed. Outcomes of visual analog scale (VAS), Oswestry Disability Index (ODI), Pain Disability Index (PDI), Roland Morris Low Back Pain and Disability Questionnaire (RMQ), standing time and walking distance were compared for adults and older adults. Four studies met the inclusion criteria, resulting in an analysis of 49 adults and 160 older adults. Patients in both age groups experienced significant mean improvements in all but one outcome measure at 6- and 12-month follow-up. Differences between the two age groups in all scores at 6 and 12 months were not statistically significant. Analysis of the four studies indicated that symptom improvements for adults and older adults were significant from baseline, and no statistically significant difference was observed between the two age groups. These results illustrate that mild can be an effective treatment for LSS due primarily to HLF, regardless of the adult patient age.


Adsorption of Anionic or Cationic Surfactants in Polyanionic Brushes and Its Effect on Brush Swelling and Fouling Resistance during Emulsion Filtration.
Atom transfer radical polymerization of ionic monomers from membrane surfaces yields polyelectrolyte brushes that swell in water and repel oil droplets to resist fouling during filtration of oil-in-water emulsions. However, surfactant adsorption to polyelectrolyte brushes may overcome this fouling resistance. This work examines adsorption of cationic and anionic surfactants in polyanionic brushes and the effect of these surfactants on emulsion filtration. In situ ellipsometry with films on flat surfaces shows that brushes composed of poly(3-sulfopropyl methacrylate salts) (pSPMK) swell 280% in water and do not adsorb sodium dodecyl sulfate (SDS). pSPMK-modified microfiltration membranes reject >99.9% of the oil from SDS-stabilized submicron emulsions, and the specific flux through these modified membranes is comparable to that through NF270 nanofiltration membranes. Moreover, the brush-modified membranes show no decline in flux over a 12 h filtration, whereas the flux through NF270 membranes decreases by 98.7%. In contrast, pSPMK brushes adsorb large quantities of cetyltrimethylammonium bromide (CTAB), and at low chain densities the brushes collapse in the presence of this cationic surfactant. Filtration of CTAB-stabilized emulsions through pSPMK-modified membranes gives minimal oil rejection, presumably due to the brush collapse. Thus, the fouling resistance of polyelectrolyte brush-modified membranes clearly depends on the surfactant composition in a particular emulsion.


[Animal health and animal health care concepts changing over time].
The term "animal health", in particular applied to herds and flocks of food animals, needs to be newly defined in the light of the growing societal concerns with modern husbandry systems and animal welfare. This paper deals with a definition of animal health, which is extended to the well being of the animals and to pre-harvest food safety aspects. The future activities of food animal veterinarians have to meet the new demands and societal expectations discussed in this paper.


Adaptation and validation of the Chinese version of the lung cancer screening health belief scales.
Health belief is an important factor affecting lung cancer screening in high-risk population, but the research based on Chinese cultural background is still insufficient. Therefore, we adapted the English version of the Lung Cancer Screening Health Belief Scales (LCSHB) into the Chinese version (LCSHB-C) and examined its psychometric characteristics. After obtaining authorization from the original author, the LCSHB-C was adapted based upon Brislin's translation model. Using a variety of community-based recruitment methods, a total of 353 participants were recruited in Fuzhou, Fujian province, China to complete the questionnaires. We combined the classical test theory and item response theory to examine the psychometric properties of the LCSHB-C. The Cronbach's alpha for the four subscales ranged from 0.83 ~ 0.93. The content validity index for the four subscales was ranged from 0.87 ~ 1.0. Confirmatory factor analysis supported each subscale structure model fit well. Rasch analysis results further validated the reliability and validity of the four subscales. The person reliability and separation index of each subscale ranged from 0.77 to 0.87 and 1.83 to 2.63, respectively. The LCSHB-C is a reliable and valid instrument used to measure health beliefs related to lung cancer screening among those high-risk for lung cancer in China, which facilitates the development of lung cancer screening programs and promotes the "three early prevention strategies" of lung cancer (i.e.,early detection, early diagnosis and early treatment).


Terawatt diode-pumped Yb:CaF2 laser.
We present what we believe to be the first terawatt diode-pumped laser employing single-crystalline Yb:CaF(2) as the amplifying medium. A maximum pulse energy of 420 mJ at a repetition rate of 1 Hz was achieved by seeding with a stretched femtosecond pulse 2 ns in duration, preamplified to 40 mJ. After recompression, a pulse energy of 197 mJ and a duration of 192 fs were obtained, corresponding to a peak power of 1 TW. Furthermore, nanosecond pulses containing an energy of up to 905 mJ were generated without optical damage.


[Psychological assessment of visual hemispatial neglect: standardization and approbation of the modified digit cancellation test].
To study the phenomena of visual-hemispatial neglect in healthy people and patients with brain diseases of different genesis. Eighty-eight patients with schizophrenia spectrum disorders, 68 patients with exogenous organic brain diseases and 240 healthy adults of different age were included in the study. The digit cancellation test modified by the authors was used. The validity of the modified digit cancellation test was approved and its age standards were obtained. In healthy right-handed people, there was the bias of attention focus to the left, the decrease of asymmetry intensity of visual-spatial inattention during physiological aging and the presence of some clinical peculiarities of neglect in schizophrenia spectrum disorders and lateralized organic damages of the brain. This variant of the test can be recommended for practical use as the sensitive psychometric tool.


Global Neural Network Potential with Explicit Many-Body Functions for Improved Descriptions of Complex Potential Energy Surface.
The high dimensional machine learning potential (MLP) that has developed rapidly in the past decade represents a giant step forward in large-scale atomic simulation for complex systems. The long-range interaction and the poor description of chemical reactions are typical problems of high dimensional MLP, which are mainly caused by the poor structure discrimination of the atom-centered ML model. Herein, we propose a low-cost neural-network-based MLP architecture for fitting global potential energy surface data, namely, G-MBNN, that can offer improved energy and force resolution on a complex potential energy surface. In G-MBNN, a set of many-body energy terms based on the local atomic environment are explicitly included in computing the total energy─the total energy of the system is written as the sum of atomic energy and many-body energy contributions. These extra many-body energy terms are computationally low-cost and, importantly, can provide easy access to delicate energy terms in complex systems such as very short repulsion, long-range attractions, and sensitive angular-dependent covalent interactions. We implement G-MBNN in the LASP code and demonstrate the improved accuracy of the new framework in representative systems, including ternary-element energy materials LiCoOx, TiO2 with defects, and a series of organic reactions.


[Granulocytic sarcoma of the prostate presenting with urinary obstruction which progressed to acute myeloid leukemia].
A 71-year-old man presented with progressive dysuria. Several imaging examinations indicated possibility of prostate tumor, therefore he underwent prostate biopsy. This resulted in a diagnosis of granulocytic sarcoma of the prostate. Since bone marrow appeared normal on aspiration biopsy, he was treated with local irradiation. Prostate swelling then markedly diminished and his symptoms disappeared. However, four months later he progressed to AML. He then received systemic chemotherapy and achieved complete remission. We discuss the management of granulocytic sarcoma when findings do not indicate overt leukemia at the time of diagnosis.


Particle-attached Microbes in Eelgrass Vegetation Areas Differ in Community Structure Depending on the Distance from the Eelgrass Bed.
Zostera marina (eelgrass) is a submerged flowering plant often found in the coastal areas of Japan. Large amounts of suspended particles form in highly productive environments, such as eelgrass beds, and the behavior of these particles is expected to affect the surrounding microbial community. We investigated the microbial community structure of suspended particles in three eelgrass fields (Ikuno-Shima Is., Mutsu Bay, and Nanao Bay) and inferred the formation and dynamics of suspended particles from a microbial community structure ana-lysis. Seawater samples were collected directly above each eelgrass bed (eelgrass-covering) and from locations dozens of meters away from the eelgrass bed (bare-ground). In consideration of the two different lifestyles of marine microbes, microbial communities were obtained from particle-attached (PA) and free-living (FL) states. Differences in microbial diversity and community structures were observed between PA and FL in all eelgrass beds. The FL microbial community was similar between the two sampling points (eelgrass-covering and bare-ground), whereas a significant difference was noted in the microbial community structure of suspended particles between the two sampling points. This difference appeared to be due to the supply of organic matter from the eelgrass sea ground and leaf-attached detritus produced by microbial activity. In addition, the classes Flavobacteriia, Alphaproteobacteria, and Gammaproteobacteria were abundant in the PA and FL fractions. Furthermore, many sequences of the key groups (e.g., Planctomycetes and Verrucomicrobia) were exclusively detected in the PA fraction, in which they may circulate nutrients. The present results provide insights into the microbial communities of suspended particles and provide the first step towards understanding their biogeochemical impact on the eelgrass bed.


Postmodern feminist emancipatory research: is it an oxymoron?
Many nurse-researchers who use feminist methods believe that postmodernism undermines the scientific and emancipatory aspirations of our discipline and they are therefore wary of postmodern theories. One of the main threats of postmodernism is the critique of humanism because humanism forms the ethical foundation for both nursing and feminism. These critiques expose the dark underside of humanistic ideals and show how, paradoxically, humanism has functioned to oppress people. The arguments presented here help emancipatory researchers to defend their practices, both in relation to research participants and in the ways in which the subjects is theorized. The conclusion is that postmodernism can be compatible with politically motivated, humanistically-based inquiry.


The origin of the anomalous superconducting properties of MgB(2).
Magnesium diboride differs from ordinary metallic superconductors in several important ways, including the failure of conventional models to predict accurately its unusually high transition temperature, the effects of isotope substitution on the critical transition temperature, and its anomalous specific heat. A detailed examination of the energy associated with the formation of charge-carrying pairs, referred to as the 'superconducting energy gap', should clarify why MgB(2) is different. Some early experimental studies have indicated that MgB(2) has multiple gaps, but past theoretical studies have not explained from first principles the origin of these gaps and their effects. Here we report an ab initio calculation of the superconducting gaps in MgB(2) and their effects on measurable quantities. An important feature is that the electronic states dominated by orbitals in the boron plane couple strongly to specific phonon modes, making pair formation favourable. This explains the high transition temperature, the anomalous structure in the specific heat, and the existence of multiple gaps in this material. Our analysis suggests comparable or higher transition temperatures may result in layered materials based on B, C and N with partially filled planar orbitals.


Research Participants' Preferences for Individual Results of Pharmacogenomics Research: A Case of a Ugandan HIV Research Institute.
Little is known about whether people living with HIV would like to receive their results from pharmacogenomics research. This study explored the factors influencing participants' preferences and the reasons for their desire to receive individual results from pharmacogenomics research. We employed a convergent parallel mixed methods study design comprising a survey of 225 research participants and 5 deliberative focus group discussions with 30 purposively selected research participants. Almost all (98%) participants wanted to receive individual pharmacogenomics research results. Reasons for the desire to receive results were reciprocity for valuable time and effort, preparing for future eventualities, and the right to information about their health. Overall, participants desire to receive feedback from pharmacogenomics research, particularly if results are well established and clinically actionable.


Emerging role of cardiovascular magnetic resonance imaging in the management of pulmonary hypertension.
Pulmonary hypertension (PH) is a clinical condition characterised by elevation of pulmonary arterial pressure (PAP) above normal range due to various aetiologies. While cardiac right-heart catheterisation (RHC) remains the gold standard and mandatory for establishing the diagnosis of PH, noninvasive imaging of the heart plays a central role in the diagnosis and management of all forms of PH. Although Doppler echocardiography (ECHO) can measure a range of haemodynamic and anatomical variables, it has limited utility for visualisation of the pulmonary artery and, oftentimes, the right ventricle. Cardiovascular magnetic resonance (CMR) provides comprehensive information about the anatomical and functional aspects of the pulmonary artery and right ventricle that are of prognostic significance for assessment of long-term outcomes in disease progression. CMR is suited for serial follow-up of patients with PH due to its noninvasive nature, high sensitivity to changes in anatomical and functional parameters, and high reproducibility. In recent years, there has been growing interest in the use of CMR derived parameters as surrogate endpoints for early-phase PH clinical trials. This review will discuss the role of CMR in the diagnosis and management of PH, including current applications and future developments, in comparison to other existing major imaging modalities.


The ABCs of CPR--again.
Survival rates for cardiac arrests that occur in hospitals and outside them continue to be low (17% and 6%, respectively), and fewer than one-third of patients who have an out-of-hospital cardiac arrest receive cardiopulmonary resuscitation (CPR). Consequently, a number of changes were made to the 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. The changes were intended to simplify CPR in order to increase its use and effectiveness by both clinicians and nonprofessionals. This article summarizes the primary changes to the recommendations, including a universal 30-to-2 compression-to-ventilation ratio for all lone rescuers, the need for compressions of sufficient depth and number, and the replacement of the three-shock model of initial defibrillation with one that recommends a single shock, now seen as an adequate precursor to CPR.


Inhibition of Alternaria stem canker on tomato by essential oils from Baccharis species.
The toxicity of four essential oils extracted from Baccharis articulata, Baccharis ochracea, Baccharis psiadioides and Baccharis trimera was tested against the phytopathogen Alternaria alternata, which causes Alternaria stem canker on tomatoes. Diseases caused by Alternaria fungi are responsible for great economic losses in terms of production and are controlled by synthetic fungicides; however, essential oils offer an alternative, since they have been proven to be effective for controlling against various plant pathogens. In this way, the antifungal activity of Baccharis essential oils was tested using potato dextrose agar medium with concentrations ranging from 0.1 to 20.0 µL mL-1. Baccharis trimera and Baccharis ochracea essential oils presented 100% mycelial growth inhibition of A. alternata and were also able to control Alternaria stem canker disease under greenhouse conditions. Tomato plants treated with these essential oils exhibited area under the disease progress curve (AUDPC) values of 230.10 and 241.42, differing from the control condition, which showed an AUDPC value of 268.92. The essential oils of B. trimera and B. ochracea can be an alternative for controlling Alternaria stem canker disease of tomatoes and should be formulated as a potential fungicide against the A. alternata pathogen.


A practical guide to political effectiveness. The case of federal funding for nursing research.
The future viability of nursing research depends on federal funding decisions, which in turn depend upon national and local action by researchers and other advocates of nursing research. Since successful action is facilitated by familiarity with national policy-making, the legislative process is reviewed and a plan for action at the state and local level is offered. Basic actions are suggested to organize, arouse public support, build coalitions, and gain access to legislators. All these must follow a developed work plan. Ideas for specific implementing steps are provided, but each local area requires specially designed activities appropriate for their own needs and resources. The goal is to build a grass roots system to support national lobbying to stabilize and increase federal funding for nursing research.


Highly Elevated Quantitative D-Dimer Assay Values Increase the Likelihood of Venous Thromboembolism.
Objectives In patients with suspected venous thromboembolism (VTE), the D-dimer assay is commonly utilized as part of the workup. The assay is primarily used to determine whether to proceed with radiographic imaging. We compared D-dimer levels in patients suspected of having VTE. We hypothesized that higher D-dimer values predict a higher likelihood of subsequent VTE diagnosis. Methods We conducted a secondary analysis of a multinational, prospective observational study of low- to intermediate-risk adult patients presenting to the emergency department with suspicion of VTE. Demographic and clinical data were collected in a structured manner. Advanced imaging including ultrasound, computed tomography (CT) pulmonary angiography, and ventilation/perfusion scanning was obtained at the discretion of the treating physicians. Imaging was evaluated by board-certified radiologists in real time. D-dimer values' bins were evaluated using a logistic regression model. Results We evaluated 1,752 patients for suspected deep vein thrombosis (DVT), with 191 (10.4%) DVT positive. We evaluated 1,834 patients for suspected pulmonary embolism (PE), with 108 (5.9%) PE positive. Higher D-dimer values in both groups were associated with higher likelihood of subsequent VTE diagnosis, with D-dimer values > 3,999 ng/mL in both groups having the highest incidence of VTE. More than 50% of those patients were VTE positive. Conclusions Increasing D-dimer values predict increased likelihood of being found VTE positive in this patient population. Among those in the highest D-dimer category, > 3,999 ng/mL, over half of patients were VTE positive. Further research could determine additional nuance in D-dimer as a tool to work up suspected VTE.


System-, teacher-, and student-level interventions for improving participation in online learning at scale in high schools.
Many school systems across the globe turned to online education during the COVID-19 pandemic. This context differs significantly from the prepandemic situation in which massive open online courses attracted large numbers of voluntary learners who struggled with completion. Students who are provided online courses by their high schools also have their behavior determined by actions of their teachers and school system. We conducted experiments to improve participation in online learning before, during, and right after the COVID-19 outbreak, with 1,151 schools covering more than 45,000 students in their final years of high school in Ecuador. These experiments tested light-touch interventions at scale, motivated by behavioral science, and were carried out at three levels: that of the system, teacher, and student. We find the largest impacts come from intervening at the system level. A cheap, online learning management system for centralized monitoring increased participation by 0.21 SD and subject knowledge by 0.13 SD relative to decentralized management. Centralized management is particularly effective for underperforming schools. Teacher-level nudges in the form of benchmarking emails, encouragement messages, and administrative reminders did not improve student participation. There was no significant impact of encouragement messages to students, or in having them plan and team-up with peers. Small financial incentives in the form of lottery prizes for finishing lessons did increase study time, but was less cost-effective, and had no significant impact on knowledge. The results show the difficulty in incentivizing online learning at scale, and a key role for central monitoring.


The influence of laparoscopic and open surgery on the concentration and structural modifications of insulin-like growth factor binding protein 3 in the human circulation.
Insulin-like growth factor binding protein 3 (IGFBP-3) is the most abundant insulin-like growth factor binding protein in the circulation. The aim of the present work was to investigate the influence of surgery (laparoscopy and open) on the concentration and carbohydrate content of IGFBP-3. The concentration of IGFBP-3 was measured using an immunoradiometric assay (IRMA), its protein profile was characterised using immunoblotting and its sialic acid content was examined by means of Sambucus nigra agglutinin (SNA) affinity chromatography. The concentration of IGFBP-3 was significantly (p < 0.001) lower in preoperative patients compared with healthy subjects. Only patients that underwent open surgery showed a further significant decrease in the concentration of IGFBP-3. Immunoblotting detected two intact IGFBP-3 isoforms, as well as proteolytic fragments. SNA-affinity chromatography showed that in patients that underwent surgery the ratio between the two IGFBP-3 glycoforms was lower than the ratio in healthy subjects. Patients with gallbladder inflammation that underwent laparoscopy had an increased percentage of specifically bound IGFBP-3 to SNA compared with healthy subjects. Our conclusion is that open surgery decreased the level of IGFBP-3 compared with laparoscopy, whereas patients with gallbladder inflammation that underwent laparoscopy had an increased content of sialic acid in IGFBP-3.


Autoimmune polyglandular syndrome type 2: an unusual presentation.
Autoimmune polyglandular syndrome (APS) type 2 is characterized by the presence of Addison's disease, in association with autoimmune thyroid disease and/or type 1 diabetes mellitus. APS type 2 occurs most often in middle aged females and is rare in children. Here an 11 year old boy is reported with Addison's disease who developed symptom's of diabetes mellitus, goiter, malabsorption, macrocytic anemia and keratitis. APS type 2 occurs most often in middle aged females and is quite rare in children but one should think to autoimmune poly glandular syndrome type II in patient at any age especially in patients with Addison's disease.


IFN-gamma secretion by CD8T cells inhibits allergen-induced airway eosinophilia but not late airway responses.
CD8+T cells can suppress allergen-induced late airway responses (LARs) and airway inflammation. To test the hypothesis that the suppression of LARs and airway eosinophilia by CD8+T cells is IFN-gamma mediated, we tested the effects of adoptively transferred CD8+T cells, in which IFN-gamma synthesis was inhibited by an antisense (AS) oligodeoxynucleotide (ODN), on the airway responses of a rat model of allergic asthma. CD8+T cells were harvested from the cervical lymph nodes of ovalbumin (OVA)-sensitized Brown Norway rats for administration to other actively sensitized syngeneic rats. CD8+T cells (2 x 10(6)) were incubated for 6 hours with 2 micromol/L AS ODN or sense ODN and were injected intraperitoneally into recipients; inhibition of IFN-gamma expression in vitro by AS ODN was shown by means of flow cytometry. Two days later, rats were challenged with aerosolized OVA. OVA-induced LAR and bronchoalveolar lavage (BAL) fluid eosinophilia were suppressed by sense ODN-treated CD8+T cells. IFN-gamma expression in BAL cells was elevated in these animals. IFN-gamma expression in BAL cells was at control levels in recipients of AS ODN-treated CD8+ cells, confirming the success of the AS treatment in vivo. BAL eosinophilia was also largely restored in the AS ODN treatment group. In contrast, the CD8+T cell-induced suppression of the LAR was not significantly affected by AS ODN pretreatment. These results indicate that CD8+T cells inhibit airway eosinophilia through secretion of IFN-gamma but may suppress the LAR by means of other mechanisms.


Detecting suspicious activities at sea based on anomalies in Automatic Identification Systems transmissions.
Automatic Identification Systems (AIS) are a standard feature of ocean-going vessels, designed to allow vessels to notify each other of their position and route, to reduce collisions. Increasingly, the system is being used to monitor vessels remotely, particularly with the advent of satellite receivers. One fundamental problem with AIS transmission is the issue of gaps in transmissions. Gaps occur for three basic reasons: 1) saturation of the system in locations with high vessel density; 2) poor quality transmissions due to equipment on the vessel or receiver; and 3) intentional disabling of AIS transmitters. Resolving which of these mechanisms is responsible for generating gaps in transmissions from a given vessel is a critical task in using AIS to remotely monitor vessels. Moreover, separating saturation and equipment issues from intentional disabling is a key issue, as intentional disabling is a useful risk factor in predicting illicit behaviors such as illegal fishing. We describe a spatial statistical model developed to identify gaps in AIS transmission, which allows calculation of the probability that a given gap is due to intentional disabling. The model we developed successfully identifies high risk gaps in the test case example in the Arafura Sea. Simulations support that the model is sensitive to frequent gaps as short as one hour. Results in this case study area indicate expected high risk vessels were ranked highly for risk of intentional disabling of AIS transmitters. We discuss our findings in the context of improving enforcement opportunities to reduce illicit activities at sea.


Transcatheter closure of the arterial duct without arterial access.
To evaluate the safety and efficacy of transcatheter occlusion of the arterial duct without femoral arterial catheterization. Patent arterial ducts have been closed percutaneously since the 1960s. It remains standard practice to use arterial access for aortography before, during, and after implantation of the device. Femoral arterial catheterisation has well recognised complications, and should be avoided unless absolutely necessary. We reviewed prospectively collected data relating to 389 occlusions of the arterial duct performed consecutively between 1994 and 2004. We inserted Cook detachable coils in 288 instances using the Amplatzer duct occluder in the remaining 101. Information was obtained regarding procedural success, displacement of the device, and re-intervention. We have followed out patients for a median of 1.15 years in those closed with the Amplatzer device, and 1.09 years in those closed with a coil. In the patients in whom we used coils, occlusion was possible in 75% using venous access alone. We reintervened in 25 patients, because of embolisation of the device in 6, haemolysis in 5, and residual shunting in 14. On follow-up, complete occlusion had been achieved in 98%. We found trivial stenosis of the left pulmonary artery in 3 patients. When using the Amplatzer device, closure using venous access alone was achieved in 82%, and 2 patients required reintervention because of embolisation of the device. Complete occlusion had been achieved in all patients as judged by follow-up at 1 year, and 2 patients had trivial stenosis of the left pulmonary artery. Arterial catheterisation is unnecessary in the great majority of patients undergoing occlusion of the arterial duct. Use of venous catheterisation alone is safe, and does not appear to increase the risk of device-related complications.


Regulation of Escherichia coli cell envelope proteins involved in protein folding and degradation by the Cpx two-component system.
We show that the two-component signal transduction system of Escherichia coli, CpxA-CpxR, controls the expression of genes encoding cell envelope proteins involved in protein folding and degradation. These findings are based on three lines of evidence. First, activation of the Cpx pathway induces 5- to 10-fold the synthesis of DsbA, required for disulfide bond formation, and DegP, a major periplasmic protease. Second, using electrophoretic mobility shift and DNase I protection assays, we have shown that phosphorylated CpxR binds to elements upstream of the transcription start sites of dsbA, degP, and ppiA (rotA), the latter coding for a peptidyl-prolyl cis/trans isomerase. Third, we have demonstrated increased in vivo transcription of all three genes, dsbA, degP, and ppiA, when the Cpx pathway is activated. We have identified a putative CpxR consensus binding site that is found upstream of a number of other E. coli genes. These findings suggest a potentially extensive Cpx regulon including genes transcribed by sigma70 and sigma(E), which encode factors involved in protein folding as well as other cellular functions.


Morphological analysis of the skeletal remains of Japanese females from the Ikenohata-Shichikencho site.
The aim of this study was to assess morphological differences between early-modern (Edo) Japanese and contemporary Japanese using recently uncovered human female remains at the Ikenohata-Shichikencho site in the Tokyo urban area. In this study, 30 female skeletal remains that still retained the upper and lower first molars and central incisors were selected [early-modern (Edo) Japanese group]. Forty contemporary female Japanese were selected as a control. Analyses by standard methods of geometric morphometrics revealed some morphological differences between the early-modern (Edo) Japanese group and the contemporary Japanese group. For example, the early-modern (Edo) Japanese group exhibited bimaxillary dentoalveolar protrusion, a flat occlusal plane, and a large S-N length. On the other hand, the contemporary Japanese group exhibited slight protrusion of the anterior nasal spine. These findings may be of interest to orthodontists who are studying age variation or temporal differences and could lead to a better understanding of morphological diversity and variability.


Woman With Hematochezia.
As a consequence of cirrhosis, portal hypertension causes resistance to blood flow and leads to the formation of varices. However, colonic variceal hemorrhages are rarely reported but could be a lethal cause of lower gastrointestinal hemorrhage. Currently, there is no consensus on the management of colonic variceal hemorrhage. Variceal ligation, injection sclerotherapy, transjugular intrahepatic portosystemic shunt placement, and balloon-occluded retrograde transvenous obliteration or a combination of the above therapies have been reported with inconsistent success rates. We advocate considering colonic variceal bleeding as a crucial differential diagnosis of lower gastrointestinal bleeding in cirrhotic patients and initiating time-sensitive, definite operative treatment or combination therapy as soon as possible in colonic variceal patients with life-threatening bleeding events, which are often refractory to conservative treatment.


Pallidotomy increases cortical inhibition in Parkinson's disease.
Pallidotomy helps parkinsonian symptoms. We tested the hypothesis that this might be due to changes in inhibition in the motor cortex. We examined 15 patients with parkinsonism before and after posteroventral pallidotomy. Magnetic stimuli were delivered over the motor cortex, while subjects maintained a 30% maximum voluntary contraction of the contralateral first dorsal interosseus (FDI). Weak stimuli inhibited voluntary muscle activity, while slightly stronger stimuli caused short latency facilitation from activation of the corticospinal neurons. After pallidotomy magnetic stimulation, at the threshold for the short latency facilitation, resulted in more inhibition than before. Pallidotomy increases cortical inhibition. This may be associated with improved control of movements.


Development of an integrated population pharmacokinetic model for oral levetiracetam in populations of various ages and ethnicities.
Levetiracetam [E Keppra(®)] is a second generation antiepileptic drug for different types of epilepsy in adults and children ≥1 month. The objective is to develop a population pharmacokinetic model to describe the pharmacokinetics of levetiracetam in Japanese children and adults as well as North American children, the purpose being to explore potential dosing recommendations in Japanese children. Levetiracetam plasma concentration-time data were obtained from Japanese adult and pediatric clinical studies. The data were analyzed through non-linear mixed effects modelling. The model was used to perform simulations and compare the exposure in Japanese children and adults. It was subsequently extended to North American children through an external validation. A one-compartment model with first-order absorption and first-order elimination adequately described the data. The exposure parameters determined based on the simulations in children were well within the adult range. The external validation against historical data from North American children was successful. The integrated population pharmacokinetic model provided a good description of the data, confirming the similarity of levetiracetam pharmacokinetics in these various populations. In Japanese children, a target dose of 10 to 30 mg/kg twice daily ensures the same exposure as the recommended dose in Japanese adults of 500 to 1,500 mg twice daily.


Pharmacokinetics and pharmacodynamics of human chorionic gonadotropin (hCG) after rectal administration of hollow-type suppositories containing hCG.
To determine the effectiveness of human chorionic gonadotropin (hCG) administered rectally, we studied the pharmacokinetics and pharmacodynamics of hCG using a hollow-type suppository. HCG was not detected in plasma when only hCG was administered rectally, even at a higher dose (4,000 IU/kg body weight) than intravenous injection, because of its low bioavailability due to high molecular weight or degradation by proteolytic activity. To enhance the rectal absorption of hCG, the effectiveness of its coadministration with alpha-cyclodextrin (alpha-CyD), an absorption-enhancing agent, was investigated in male rabbits. HCG was detected in plasma following coadministration of hCG and alpha-CyD (10 mg/kg body weight) into the rectum. The plasma hCG concentration increased with increasing dose of alpha-CyD. The AUC(0-48) observed after coadministration of hCG and alpha-CyD at 30 mg/kg body weight was approximately four times higher than that of hCG and alpha-CyD at 10mg/kg body weight. HCG at a high concentration induced a rapid increase in the plasma testosterone concentration (74.2 +/- 3.4 ng/ml) 2 h after intravenous administration. However, the testosterone concentration 24 h after intravenous administration decreased to the physiological level (approximately 20 ng/ml) which had been observed before such administration. On the other hand, the maximum level of testosterone concentration (40.0 +/- 12.6 ng/ml) was observed 24 h after rectal administration of hCG (400 IU/kg body weight) in combination with alpha-CyD (30 mg/kg body weight). Moreover, the plasma testosterone concentration (31.0 +/- 11.4 ng/ml) obtained 72 h after rectal administration tended to be maintained at a higher level than that (14.4 +/- 0.9ng/ml) observed before the administration. These results suggest that the hollow-type suppository as a rectal delivery system of hCG is promising as a new mode of hCG therapy.


Acute Myeloid Leukemia Arising from Myelodysplastic Syndromes.
Myelodysplastic syndromes (MDS) are a group of myeloid neoplasms characterized by clonal hematopoiesis and abnormal maturation of hematopoietic cells, resulting in cytopenias. The transformation of MDS to acute myeloid leukemia (AML) reflects a progressive increase in blasts due to impaired maturation of the malignant clone, and thus MDS and many AML subtypes form a biological continuum rather than representing two distinct diseases. Recent data suggest that, in addition to previously described translocations, NPM1 mutations and KMT2A rearrangements are also AML-defining genetic alterations that lead to rapid disease progression, even if they present initially with less than 20% blasts. While some adult patients <20% blasts can be treated effectively with intensive AML-type chemotherapy, in the future, treatment of individual patients in this MDS/AML group will likely be dictated by genetic, biological, and patient-related factors rather than an arbitrary blast percentage.


Perineural Invasion of the Intratemporal Facial Nerve: How Far Proximally Do We Chase the Positive Margin?
To determine recurrence patterns in patients with head and neck cancers requiring facial nerve sacrifice and to determine the optimal management of the positive proximal facial nerve margin. Case series with chart review. Tertiary care center. One hundred fifty-five patients with head and neck malignancies who underwent sacrifice of the facial nerve between March 1, 1999 and October 31, 2020. Demographics, preoperative facial nerve function, prior oncologic treatment, histologic type, operative details, adjuvant treatment, recurrence patterns, and overall survival were reviewed. Recurrence rates and recurrence location. Thirteen patients (8%) had positive proximal margins on final pathologic evaluation. Six of 13 (46%) experienced disease recurrence. No disease recurred proximally along the facial nerve. The recurrence rate was 26% for negative proximal facial nerve margins. Segments of the facial nerve biopsied included: extratemporally (n = 78), at the stylomastoid foramen (36), mastoid segment (22), second genu (7), tympanic (6), geniculate (3), labyrinthine (1), and IAC (2). Median patient follow-up was 30.3 months. Our data suggest that a conservative approach to a positive proximal facial nerve margin is optimal with respect to operative planning, patient morbidity, and disease recurrence patterns. Recurrence proximally along the facial nerve is an exceedingly rare event and the necessity of biopsy proximal to the geniculate ganglion, and in some cases even to the second genu, is called into question.


Outbreak of adenoviral infections in a long-term paediatric facility, New Jersey, 1986/87.
During an 8-week period in the winter of 1986-87, there were 11 deaths from an adenovirus infection (case fatality rate = 39%, 11/28) in a long-term care paediatric facility in southern New Jersey. Among the 61 resident children, all with severe congenital and/or acquired disabilities, 28 developed a febrile respiratory illness compatible with adenovirus infection [attack rate (AR) = 46%]. Patients with tracheostomies were three times as likely to become ill [relative risk (RR) = 3.2, 95% confidence intervals (CI) = 1.8-5.6]. Twenty-three members of the staff had a similar febrile illness (AR = 22%, 23/106); nurses were more likely to be ill than other staff (RR = 3.0, 95% CI = 1.1-11.4). Adenovirus 7 was isolated from four of the case patients and adenovirus 1 from one. The findings suggest prolonged transmission between patients and nursing staff with lack of cohorting of ill patients probably contributing to the prolongation of the outbreak. This investigation indicates that adenoviral outbreaks, although rare, can have a high mortality in severely disabled children, and that future outbreak investigations should examine the use of vaccines or antiviral agents to reduce mortality and for outbreak control.


Gene mutation spectrum and genotype-phenotype correlation in a cohort of Chinese osteogenesis imperfecta patients revealed by targeted next generation sequencing.
The achievement of more accurate diagnosis would greatly benefit the management of patients with osteogenesis imperfecta (OI). In this study, we present the largest OI sample in China as screened by next generation sequencing. In particular, we successfully identified 81 variants, which included 45 novel variants. We further did a genotype-phenotype analysis, which helps make a better understanding of OI. This study aims to reveal the gene mutation spectrum and the genotype-phenotype relationship among Chinese OI patients by next generation sequencing (NGS). We developed a NGS-based panel for targeted sequencing of all exons of 14 genes related to OI, and performed diagnostic gene sequencing for a cohort of 103 Chinese OI patients from 101 unrelated families. Mutations identified by NGS were further confirmed by Sanger sequencing and co-segregation analysis. Of the 103 patients from 101 unrelated OI families, we identified 79 mutations, including 43 novel mutations (11 frameshift, 17 missense, 5 nonsense, 9 splice site, and 1 chromosome translocation) in 90 patients (87.4%). Mutations in genes encoding type I collagen, COL1A1 (n = 37), and COL1A2 (n = 29) accounts for 73.3% of all molecularly diagnosed patients, followed by IFITM5 (n = 9, 10%), SERPINF1 (n = 4, 4.4%), WNT1 (n = 4, 4.4%), FKBP10 (n = 3, 3.3%), TMEM38B (n = 3, 3.3%), and PLOD2 (n = 1, 1.1%). This corresponds to 75 autosomal dominant inherited (AD) OI patients and 15 autosomal recessive (AR) inherited patients. Compared with AD inherited OI patients, AR inherited patients had lower bone mineral density (BMD) at spine (P = 0.05) and less frequent blue sclera (P = 0.001). Patients with type I collagen qualitative defects had lower femoral neck BMD Z-score (P = 0.034) and were shorter compared with patients with type I collagen quantitative defects (P = 0.022). We revealed the gene mutation spectrum in Chinese OI patients, and novel mutations identified here expanded the mutation catalog and genotype and phenotype relationships among OI patients.


Antibacterial Co(II), Ni(II), Cu(II) and Zn(II) complexes of Schiff bases derived from fluorobenzaldehyde and triazoles.
Antibacterial Schiff bases derived from 1,2,4-triazoles as well as their metal complexes incorporating cobalt(II), nickel(II), copper(II) and zinc(II) have been synthesized and characterized. Physico-chemical studies suggest that an octahedral geometry for the cobalt(II), nickel(II) and zinc(II)and square-planer geometry for the copper(II) complexes. These complexes have been screened for antibacterial activity against three Gram-positive (Staphylococcus aureus, Staphylococcus epidermidis and Bacillus subtilis) and two Gram-negative (Salmonella typhi and Pseudomonas aeruginosa) bacterial strains, and results compared with the activity of the free ligands. The metal complexes were found to be more potent against one or more bacterial strains than the free ligands.


Are Physical Fitness and CRP Related to Framingham Risk Score in HIV+ Adults?
Background. People living with HIV (PLWH) have increased risk of cardiovascular disease (CVD). The Framingham Risk Score (FRS) predicts a 10-year CVD risk. Its relationships to physical fitness and C-reactive protein (CRP) are not well established. The current aim is to determine the links between FRS, physical fitness, and CRP in PLWH. Methods. Participants (n = 87) were assessed on multiple biomarkers. The FRS was calculated with the respective variables. Other variables that correlated significantly with FRS were entered into a regression equation to determine their relationship to FRS. Results. The FRS for men was more than twice that for women (12.8 vs 6.0, P < .001). Men were more fit than women, but most participants were not fit. Aerobic capacity was predictive of FRS in men, but not in women, and muscular strength was not predictive of FRS. Women had more than double the CRP compared with men (7.9 vs 3.5 mg/L, P < .01), and it was unrelated to FRS. Conclusions. In men, aerobic capacity was significantly predictive of FRS, but muscular strength and CRP were unrelated to FRS in both genders. These results do not conclusively demonstrate that physical fitness and CRP are related to FRS in PLWH.


Collaborative working in end-of-life care: developing a guide for health and social care professionals.
This article describes a project to develop collaborative working between palliative care nurse specialists and community matrons for patients with a non-cancer diagnosis. Pathways to clarify decision-making in end-of-life care were created as part of the project and were subsequently developed into a guide for use by health or social care professionals caring for any patient, irrespective of diagnosis. The guide is designed to facilitate best practice in end-of-life care, by identifying the key questions which need to be addressed and the appropriate responses at different stages of the patient journey. The project was supported by the Help the Hospices' Care Beyond Cancer programme, funded by the St James's Place Foundation. The programme is designed to identify models of effective, replicable end-of-life care provision for patients with a non-cancer diagnosis, and to widen access to specialist palliative care.