Cyclic adenosine monophosphate differently affects the response of mouse pancreatic beta-cells to various amino acids.
1. The membrane potential of mouse beta-cells was measured in parallel with 86Rb+ efflux and insulin release from mouse islets during stimulation by three types of amino acids and modulation of their effects by glucose and cyclic adenosine monophosphate (cyclic AMP) (forskolin being used to activate the adenylate cyclase). 2. In the absence of glucose, alanine and arginine accelerated 86Rb+ efflux, whereas leucine decreased it. They all depolarized the beta-cell membrane and slightly increased insulin release. Forskolin had little effect on 86Rb+ efflux, consistently potentiated insulin release but induced electrical activity only in the presence of leucine. 3. The effects of the three amino acids on 86Rb+ efflux and beta-cell membrane potential were not qualitatively altered by a non-stimulatory concentration of glucose (3 mM). However, the release of insulin induced by leucine alone or with forskolin was markedly amplified, in contrast to that of alanine or arginine, which was inhibited. 4. In the presence of a threshold concentration of glucose (7 mM), the three amino acids accelerated 86Rb+ efflux and depolarized the beta-cell membrane. With alanine and arginine, spike activity was transiently observed and coincided with a short-lived increase in insulin release. With leucine, slow waves with superimposed bursts of spikes occurred and were accompanied by a sustained release of insulin. Forskolin alone also triggered slow waves and bursts of spikes, and increased insulin release. Both effects were larger in the presence of arginine, but not in the presence of alanine. Forskolin considerably increased the electrical and secretory effects of leucine. 5. A higher concentration of glucose (10 mM) induced slow waves with bursts of spikes in all cells and stimulated insulin release. Alanine, arginine and leucine increased 86Rb+ efflux, electrical activity and insulin release. However, the changes produced by the three amino acids displayed different time course, amplitude and characteristics. Forskolin potentiated insulin release and electrical activity induced by glucose alone. These effects were not augmented by alanine, but markedly amplified by arginine or leucine. 6. Several conclusions can be drawn from this study. The three types of amino acids depolarize the beta-cell membrane by different mechanisms and produce distinct patterns of electrical activity. Slow waves with bursts of spikes occur only if a decrease in K+ permeability contributes to the depolarization.(ABSTRACT TRUNCATED AT 400 WORDS)


Re-evaluation of capillaroscopy of finger nailfold in vibration-exposed workers.
Two hundred and ninety-four vibration-exposed workers were examined for vibration disease (VD) for the worker's accident compensation. Most subjects were male. Their ages ranged from 24 to 68 years. Duration of vibration exposure ranged from 3 to 30 years. After acclimatization at 25 degrees C to 27 degrees C for at least an hour, the nailfold capillaries of the ring (or middle) finger were studied with a light microscope. A cold water immersion test (5 degrees C, 10 min) was then performed. The morphological findings of the nailfold capillaries were classified based on the criteria by Fagrell & Lundberg. A hundred and eighty subjects were diagnosed as VD and 75 as non VD, even without taking the capillaroscopic findings into consideration. The classification of the capillarograms retrospectively investigated were as follows, i.e. in 98 VD subjects 40 cases were stage A, 42 stage B, and 16 cases stage C. In 26 nonVD subjects 13 cases were stage A, 10 stage B, and 3 cases stage C, respectively. When the borderline of VD and nonVD existed between stage A and stages B and C, the sensitivity was 59.2%, specificity was 50.0%, and false positive and negative were 50.0% and 40.8%. Relationship between the capillary stage and recovery (%) of the skin temperature during the cold water immersion test was also studied. The recovery in stage C was not always lower than that in stage A. Among them, arteriography was performed in 57 cases. Despite the use of vasodilator, markedly delayed perfusion of the finger tips was observed in 28 cases. Their capillary stages were A in 12 cases, B in 11 and C in 3. The peripheral microcirculatory state in VD should be carefully evaluated in combination with appropriately selected examinations, including finger nailfold capillaroscopy.


[Prognostic value of epicardial fat thickness in coronary heart disease patients after myocardial revascularization].
Objective To study the role of epicardial adipose tissue (EAT) in determination of risk for adverse course of ischemic heart disease (IHD) in patients after myocardial revascularization.Materials and Methods This study included 217 subjects, 182 IHD patients and 35 evaluated individuals without IHD. Percutaneous coronary intervention (PCI) was performed for 104 patients and coronary bypass (CB) was performed for 78 patients. Also echocardiography (EchoCG) and cardiac computed tomography were performed.Results In IHD patients, EAT volume and thickness were greater than in evaluated subjects without IHD. The composite endpoint (CEP) was observed after PCI more frequently than after CB. In IHD patients with an EAT thickness of 8.5 to 10.2 mm measured with EchoCG in the atrioventricular groove, the risk of CEP was 4.3 times higher after myocardial revascularization than with thicker or thinner EAT regardless of the revascularization method.Conclusion An EAT thickness of 8.5 to 10.2 mm in the atrioventricular groove as measured with EchoCG was associated with a risk of adverse IHD course in patients who have underwent myocardial revascularization.


Structure and dynamics of 1-N-alkyl-3-N-methylimidazolium tetrafluoroborate + acetonitrile mixtures.
A detailed investigation of the binary mixtures of the ionic liquids (ILs) 1-N-R-3-N-methylimidazolium tetrafluoroborate (R = ethyl, n-butyl, n-hexyl) with the important molecular solvent acetonitrile (AN) over the entire composition range has been made at 25 °C using broadband dielectric spectroscopy. All spectra showed two modes: a Cole-Cole (CC) mode centered at ~2 GHz and a Debye mode centered at ~50 GHz. However, detailed analysis indicated both relaxations were composites. The Debye mode arises from the rotational diffusion of free AN molecules with contributions from ultrafast vibrations and librations of the ILs. The CC mode corresponds to the jump rotation of the imidazolium cations and the hindered rotational diffusion of "slow" AN molecules solvating them. At very low IL concentrations 1:1 contact ion pairs are dominant. Overall, these IL + AN mixtures can be divided into two broad regions: at IL mole fraction (x(IL)) ≲ 0.2 the IL behaves as a rather weakly associated conventional electrolyte while at x(IL) ≳ 0.2 it takes on its IL characteristics, "lubricated" by the AN.


The urokinase-type plasminogen activator system as drug target in retinitis pigmentosa: New pre-clinical evidence in the rd10 mouse model.
Retinitis pigmentosa (RP) is characterized by progressive loss of vision due to photoreceptor degeneration leading to secondary inflammation. The urokinase-type plasminogen activator (uPA) system contributes to retinal inflammation, but its role in RP is unknown. In the rd10 mouse model of RP, we addressed this question with the use of the peptide UPARANT designed to interact with the uPA system. UPARANT was systemically administered from post-natal day (PD) 10 to PD30 when its efficacy in RP rescue was investigated using electroretinographic recordings, Western blot and immunocytochemistry. Temporal profile of protein expression in the uPA system was also investigated. UPARANT reduced both Müller cell gliosis and up-regulated levels of inflammatory markers and exerted major anti-apoptotic effects without influencing the autophagy cascade. Rescue from retinal cell degeneration was accompanied by improved retinal function. No scotopic phototransduction was rescued in the UPARANT-treated animals as determined by the kinetic analysis of rod-mediated a-waves and confirmed by rod photoreceptor markers. In contrast, the cone photopic b-wave was recovered and its rescue was confirmed in the whole mounts using cone arrestin antibody. Investigation of the uPA system regulation over RP progression revealed extremely low levels of uPA and its receptor uPAR both of which were recovered by HIF-1α stabilization indicating that HIF-1 regulates the expression of the uPA/uPAR gene in the retina. Ameliorative effects of UPARANT were likely to occur through an inhibitory action on up-regulated activity of the αvβ3 integrin/Rac1 pathway that was suggested as a novel target for the development of therapeutic approaches against RP.


Safety and efficacy of a glycoPEGylated rFVIII (turoctocog alpha pegol, N8-GP) in paediatric patients with severe haemophilia A.
Turoctocog alfa pegol (N8-GP, Novo Nordisk, Bagsværd, Denmark), an extended half-life glycoPEGylated recombinant factor VIII (rFVIII), is being developed for prophylaxis and treatment of bleeds in haemophilia A patients. pathfinder™5 is a multinational, open-label, single-arm trial to assess safety, efficacy and pharmacokinetics of N8-GP in paediatric (<12 years), previously treated patients. Boys with severe haemophilia A (<1 % FVIII), no history of inhibitors and previously treated with FVIII products (>50 exposure days [ED] for patients aged 0-5 years [younger cohort]; >150 ED for patients aged 6-11 years [older cohort]) were included. For prophylaxis, N8-GP was dosed at 50-75 IU/kg twice weekly; bleeds were treated with 20-75 IU/kg. Half-life was estimated for the patients' previous FVIII product and for N8-GP. Sixty-eight patients received N8-GP; none developed inhibitors and no other concerns were identified. Median annualised bleeding rate was 1.95 (1.94 and 1.97 in the younger and older cohorts, respectively). Twenty-nine patients (42.6 %; 15 younger and 14 older children, respectively) did not report any bleeding while on N8-GP prophylaxis; 39 patients (57.4 %; 19 younger and 20 older children, respectively) reported 70 bleeds (all mild/moderate). N8-GP treatment was successful for 78.6 % of bleeds in all patients, 80.0 % in younger and 77.5 % in older patients. Most bleeds (80.0 %) were treated with ≤2 injections. Half-life ratio between N8-GP and the patients' previous FVIII product was 1.85. N8-GP was well tolerated and provided effective prophylaxis and treatment of bleeds in paediatric patients with severe haemophilia A.


Severe Ketoacidosis After One Anastomosis Gastric Bypass Surgery.
BACKGROUND Bariatric surgeries, such as one anastomosis gastric bypass (OAGB), has become a popular treatment option for managing obesity and associated comorbidities, including type-2 diabetes mellitus (T2DM). However, severe starvation ketoacidosis is a rare but potentially life-threatening complication that can occur postoperatively in patients with T2DM. Despite the increasing prevalence of these surgeries, the existing literature has limited information on severe starvation ketoacidosis as a postoperative complication. It is essential for healthcare professionals to be aware of this complication, its manifestations, and risk factors to ensure patient safety and improve outcomes. Therefore, this article aims to address the current gap in the literature and provide a comprehensive review of severe starvation ketoacidosis as a postoperative complication of bariatric surgeries, specifically OAGB, and its associated risk factors and manifestations. CASE REPORT A 38-year-old man with severe obesity and inadequately managed T2DM underwent OAGB surgery. On the second postoperative day, the patient experienced severe starvation ketoacidosis, exhibiting symptoms such as drowsiness, fatigue, weakness, and Kussmaul breathing. Blood gas analysis indicated significant metabolic acidosis. He was quickly transferred to the Intensive Care Unit (ICU) and given intravenous glucose and insulin therapy. Following this intervention, he showed rapid recovery and normalization of blood gases. He was discharged 6 days after surgery with normal clinical examination results and laboratory indices. CONCLUSIONS This case study emphasizes the significance of thorough preoperative glycemic control, comprehensive perioperative multidisciplinary management, and close postoperative monitoring for diabetic patients undergoing metabolic and bariatric surgeries. By implementing these strategies, healthcare professionals can reduce the risk of complications such as hypoglycemia or hyperglycemia/diabetic ketoacidosis (DKA) and enhance patient outcomes. The case also highlights the need for continuous education and training for healthcare providers to identify and manage such rare complications effectively.


Can 18F-FDG-PET response during radiotherapy be used as a predictive factor for the outcome of head and neck cancer patients?
We investigated if (18F) fluoro-2-deoxy-D-glucose positron emission tomography (F-FDG-PET) during radiotherapy or concurrent chemoradiotherapy adds information about the treatment outcome compared with an FDG-PET study before treatment. Forty-three patients with head and neck cancer were treated with helical tomotherapy. F-FDG-PET was performed at baseline and during the treatment after 47 Gy. Tracer accumulation at the tumor site was assessed visually and semiquantitatively using the maximal standardized uptake values (SUV(max)). With median SUV(max) of both the studies as cutoff, patients were categorized into low and high SUV(max) groups. For visual analysis, two independent observers classified patients as complete metabolic responders (CMR) or noncomplete metabolic responders (NCMR). At baseline the median SUV(max) was 8.11 (2.41-15.13). The overall survival (OS) and disease-free survival (DFS) were 81 and 67% versus 50 and 40% for the low and high SUV(max), respectively. OS was significantly different (P=0.027). During therapy, median SUV(max) was 4.03 (1.94-7.58). OS and DFS were 82 and 63%, versus 47 and 42% for the low and high SUV(max) group, respectively. OS was significantly different (P=0.026). No significant differences between CMR versus NCMR in OS (72 vs. 60%), and DFS (56 vs. 49%) were found. Categorizing patients on the basis of a semiquantitative approach resulted in significant differences in OS for both the scans before and during therapy. Future work on a larger number of patients is warranted to determine SUV(max) cutoff values which could be used for the early identification of patients with poor treatment outcome or perhaps other therapeutic approaches.


Dopant ionization and efficiency of ion and electron ejection from helium nanodroplets.
Photoionization spectroscopy and mass spectrometry of doped helium (He) nanodroplets rely on the ability to efficiently detect ions and/or electrons. Using a commercial quadrupole mass spectrometer and a photoelectron-photoion coincidence spectrometer, we systematically measure yields of ions and electrons created in pure and doped He nanodroplets in a wide size range and in two ionization regimes-direct ionization and secondary ionization after resonant photoexcitation of the droplets. For two different types of dopants (oxygen molecules, O2, and lithium atoms, Li), we infer the optimal droplet size to maximize the yield of ejected ions. When dopants are ionized by charge-transfer to photoionized He nanodroplets, the highest yield of O2 and Li ions is detected for a mean size of ∼5×104 He atoms per nanodroplet. When dopants are Penning ionized via photoexcitation of the He droplets, the highest yield of O2 and Li ions is detected for ∼103 and ∼105 He atoms per droplet, respectively. At optimum droplet sizes, the detection efficiency of dopant ions in proportion to the number of primary photoabsorption events is up to 20% for charge-transfer ionization of O2 and 2% for Li, whereas for Penning ionization it is 1% for O2 and 4% for Li. Our results are instrumental in determining optimal conditions for mass spectrometric studies and photoionization spectroscopy of molecules and complexes isolated in He nanodroplets.


Comparison of CREB- and NF-kappaB-mediated transactivation by human T lymphotropic virus type II (HTLV-II) and type I (HTLV-I) tax proteins.
The function of the transactivator protein Tax from HTLV-II subtype A, subtype B, Brazilian subtype C, and African subtype D isolates was compared to that of Tax from an HTLV-I isolate. HTLV-II subtypes A, B, and C were less active in the transactivation of a NF-kappaB reporter compared to HTLV-I Tax in 293T but not Jurkat T cells. In both cell types there were no significant differences between the functions of HTLV-II B, C, and D and HTLV-I Tax proteins on either a full-length HTLV-I LTR or a 21-bp repeat reporter, suggesting that there is equivalent CREB-mediated transactivation between the viruses and these subtypes. In contrast, Tax of some but not all HTLV-II subtype A isolates, including the prototype Mo, had a greatly decreased ability to transactivate, and this could be directly correlated with a decrease in protein expression. Employment of cDNA clones encoding both Rex and Tax demonstrated that Rex was unable to rescue the expression or activity of the IIA Mo isolate. These studies demonstrate that with the exception of some HTLV-IIA subtypes there are no significant differences in Tax transactivation via the CREB and NF-kappaB pathways between the two viruses and suggest that the HTLV-II Tax may have a pathogenic potential equivalent to that of HTLV-I.


Effect of vitamin E supplementation on various functional properties of macrophages and neutrophils obtained from weaned piglets.
Sixteen piglets were used to determine the effect of vitamin E supplementation on several functional properties of macrophages and neutrophils obtained from weaned piglets. Piglets, immediately following weaning, were assigned to one of three experimental groups: control (no vitamin E supplementation), low level of vitamin E supplementation (100 mg DL-alpha-tocopheryl acetate/kg diet) and high level of vitamin E supplementation (300 mg DL-alpha-tocopheryl acetate/kg diet). Supplementation of vitamin E lasted for a period of 36 days, following a 3-day adaptation period after weaning. Blood samples were collected on days 0, 12, 24 and 36 of the experimental period, monocytes/macrophages and neutrophils were isolated and the following parameters were determined in macrophages and neutrophils activated by phorbol myristate acetate: total cell-associated and membrane-bound urokinase plasminogen activator (u-PA) activity and superoxide anion production. Results showed that macrophages and neutrophils isolated from piglets that received supplemental vitamin E had higher (P < 0.05) total and membrane-bound u-PA activities as well as higher (P < 0.05) superoxide anion production compared with the values of the corresponding cells obtained from control piglets on day 12 of the experimental period. Both levels of vitamin E supplementation (low and high) were equally effective. In contrast, vitamin E supplementation had no effect (P > 0.05) on total and membrane-bound u-PA activities and superoxide anion production by porcine macrophages and neutrophils on days 24 and 36 of the experimental period. In conclusion, the low level of vitamin E supplementation is recommended for piglets for the first 2 weeks after weaning.


Impact of traumatic injuries to the permanent teeth on the oral health-related quality of life in 12-14-year-old children.
There are no data on the impacts on daily living of traumatic injuries to the permanent teeth. The aim of the present study was to assess the socio-dental impacts of untreated fractured anterior teeth in Brazilian schoolchildren. A population-based matched case-control study was used and a 2 : 1 control-to-case ratio was adopted. The cases were 68 children 12-14 years old, having non-restored teeth, with fracture involving dentine. The controls were 136 children without any traumatic dental injury. They were matched by age, sex and socio-economic status. The Oral Impact on Daily Performances (OIDP) index was used to measure the impacts. The response rate was 100%. Results of conditional logistic regression showed that children with fractured teeth were 20 times (95% CI = 2.2-45.6) more likely to report any impact on their daily living than children with no traumatic dental injury. These results remained statistically significant for the items of the OIDP separately, 'smiling' (P < 0.001), 'maintaining emotional state' (P < 0.001), 'eating' (P < 0.01), 'enjoying contact with people' (P < 0.01) and the overall OIDP (P < 0.001), after adjusting for confounding variables such as the Aesthetic Component of the Index of Orthodontic Treatment Need and DMFT index in a multiple conditional logistic regression. Children with untreated dental fracture of permanent teeth had more impacts on their daily living than children without any traumatic injury.


Microscopic Observation of Living Cells Stained with Fluorescent Probes.
Fluorescence imaging of living cells provides a unique opportunity to follow dynamic behavior of specific molecules under physiological conditions. In the fission yeast Schizosaccharomyces pombe, expression of a target protein genetically fused with a fluorescent protein such as the jellyfish green fluorescent protein (GFP) is widely used. In addition, fluorescent chemical reagents are also used to stain specific molecules (e.g., Hoechst 33324 to stain DNA). Specimens of S. pombe cells for live cell imaging are prepared by either of two methods: sandwiching the cells between glass coverslips and by mounting the cells on a glass-bottom culture dish. For time-lapse observation, it is necessary to immobilize fission yeast cells on the glass surface of the glass-bottom dish because they are nonadherent and tend to move easily as a result of stage movement, convection flow of culture medium, and the contact and pushing of neighboring cells during cell growth. Either concanavalin A or soybean lectin, which bind to S. pombe cell walls, can be used for immobilization. Considerations for sample preparations and observation conditions are described.


Mental health, suicidality and hopelessness among university students in Turkey.
Psychological symptoms of university students can affect perceptions of physical and mental health and can influence the emergence of suicidal behavior. We investigated the association among psychological symptoms, suicidal thoughts, perceptions of physical and mental health in university students. 4330 students at Onsekiz Mart University completed an internet-based questionnaire. 15.1% of the students reported suicidal thoughts at least once in their lifetime. The severity of mental symptoms was found to increase with a decrease in perceived physical and mental health. 28.2% of the students had depression, 33.1% had anxiety. This research aims to contribute to the extensive body of work done regarding the mental health, suicidal thoughts and hopelessness among university students.


Crystal structure of a complex between anthrax toxin and its host cell receptor.
Anthrax toxin consists of the proteins protective antigen (PA), lethal factor (LF) and oedema factor (EF). The first step of toxin entry into host cells is the recognition by PA of a receptor on the surface of the target cell. Subsequent cleavage of receptor-bound PA enables EF and LF to bind and form a heptameric PA63 pre-pore, which triggers endocytosis. Upon acidification of the endosome, PA63 forms a pore that inserts into the membrane and translocates EF and LF into the cytosol. Two closely related host cell receptors, TEM8 and CMG2, have been identified. Both bind to PA with high affinity and are capable of mediating toxicity. Here, we report the crystal structure of the PA-CMG2 complex at 2.5 A resolution. The structure reveals an extensive receptor-pathogen interaction surface mimicking the non-pathogenic recognition of the extracellular matrix by integrins. The binding surface is closely conserved in the two receptors and across species, but is quite different in the integrin domains, explaining the specificity of the interaction. CMG2 engages two domains of PA, and modelling of the receptor-bound PA63 heptamer suggests that the receptor acts as a pH-sensitive brace to ensure accurate and timely membrane insertion. The structure provides new leads for the discovery of anthrax anti-toxins, and should aid the design of cancer therapeutics.


Inelastic transport in vibrating disordered carbon nanotubes: scattering times and temperature-dependent decoherence effects.
By using an order N quantum transport methodology, and treating on the same footing static and dynamical disorders, we report on the theoretical exploration of quantum interferences tuned by electron-phonon mediated decoherence mechanisms in disordered carbon nanotubes (with length up to 10 microm). This allows the extraction of inelastic scattering times together with temperature-dependent coherence lengths, which favorably compare with available experimental data at a quantitative level, and clarify the role of localization phenomena up to room temperature.


[Establishment of sandwich ELISA with McAbs to measure histidine-rich glycoprotein in plasma].
The objective of this paper is to establish a method using sandwich ELISA with McAbs to measure plasma histidine-rich glycoprotein (HRG). The results showed that this method, with a working range from 2.5 ng.ml-1 to 80 ng.ml-1, provided the lower limit of detection of 1 ng.ml-1, the average intra-assay CV, the interassay CV and the recovery rate of HRG were 8.2%, 11.5% and 89.1%, respectively. Interference by antithrombin III and human albumin was not significant. With this method, the concentration of plasma HRG from healthy donors was (110.3 +/- 9.7) mg.L-1, and the value of plasma HRG in liver cirrhosis was (79.5 +/- 12.6) mg.L-1. These results suggest that sandwich ELISA with McAbs is high sensitive, precise and specific.


The dissociation of renin and aldosterone during critical illness.
A syndrome of elevated PRA accompanied by inappropriately low plasma aldosterone (ALDO) levels has been identified in some critically ill patients. To determine whether this phenomenon is due to a disturbance in factors that stimulate ALDO, we measured PRA, angiotensin II (AII), potassium (K+), and ACTH levels in 83 patients admitted to an intensive care unit. In 59 patients, PRA was greater than 2.0 ng/ml X h. Of these, 24 had an ALDO to PRA ratio (ALDO/PRA) below 2 (group I), and 35 had an ALDO/PRA ratio of 2 or more (group II). An ALDO/PRA ratio below 2 was deemed inappropriately low. Despite markedly elevated PRA [34 +/- 12 (+/- SE) ng/ml X h], the group I patients had inappropriately low ALDO levels (19 +/- 5 ng/dL). Patients in group II had significantly higher ALDO levels (48 +/- 6 ng/dL) despite lower PRA (9 +/- 1 ng/ml X h). AII levels were appropriately elevated in group I (39 +/- 26 pg/mL) and significantly greater (P less than 0.5) than those in group II. PRA correlated well with AII in both groups. There were no differences in plasma ACTH or K+ in these 2 groups, and plasma cortisol levels were similarly elevated in both groups of patients. Of 66 consecutively studied patients, 14 (21%) had inappropriate ALDO (group I). Mortality was significantly greater in group I (75%) than in group II (46%; P less than 0.001). In summary, a significant subset (21%) of seriously ill patients have inappropriately low ALDO levels despite elevated PRA. This dissociation is not due to an impairment of AII production or changes in plasma ACTH or K+. This phenomenon is associated with a higher mortality during critical illness. In light of evidence of decreased adrenal androgen secretion during severe illness, this dissociation of renin and aldosterone may represent an additional adrenal adaptation designed to promote cortisol production in critically ill patients.


[Diagnostic consistency for observing endodontic files in digital radiographs displayed on different electronic devices].
Objectives: To evaluate the diagnostic consistency of working lengths by observing endodontic files in root canals and periapical subtle structures in digital intraoral radiographs presented in two smartphones, a tablet and a laptop computer. Methods: A dried human skull embedded in an acrylic compound was used for exposing radiographs of the upper and lower second premolars and first molars with two endodontic files (Kerr files size 10 and 15) positioned to the full length of the roots or 1.5 mm short of apexes. A total of 100 radiographs were taken for each of the file sizes. Five observers were asked to assess all the 200 digital radiographs according to a 5-category scale in smartphone A (HUAWEI P9 Plus), smartphjone B (Apple iPhone 7), tablet (Apple iPad 2018) and laptop computer (Lenovo Thinkpad E480), respectively. The gold standard for receiver operating characteristic curve (ROC) analysis was determined with the endodontic Kerr file size 20. A total of 150 roots with files were radiographed, 75 of which with files reaching the radiographic apexes of the respective roots and 75 of which with files 1.5 mm short of the radiographic apexes for each endodontic file size. Results from ROC analysis was analyzed with one-way ANOVA and independent sample t test. Results: For the Kerr file size 10, the area under the ROC curve for laptop, tablet and two smartphones were 0.891±0.037, 0.869±0.037, 0.870±0.017 and 0.849±0.037, while for the Kerr file size 15 the ROC values were 0.957±0.02, 0.961±0.02, 0.961±0.01 and 0.961±0.02, respectively. There were no significant differences for diagnostic accuracy for observing endodontic file positions among digital radiographs presented in the two smartphones, one tablet and one laptop devices (endodontic file size 10: F=1.39, P=0.281; endodontic file size 15: F=0.05, P=0.985). A significant difference was found in the diagnostic accuracy of endodontic file positions between size 10 and 15 files in different display devices (t=-10.65, P<0.001). Conclusions: There was a high diagnostic consistency in the determination of working length and periapical subtle structures of roots by observing digital radiographs displayed on smartphones, tablet and laptop computer.


What is needed by staff to implement PROMs into routine oncology care? A qualitative study with the multi-disciplinary team.
The aim of this study was to identify strategies to implement patient-reported outcome measures (PROMs) into routine oncology outpatients' clinical care. Qualitative focus groups were conducted with staff from multiple disciplines using a semistructured interview guide, with supporting data collected in field notes. Data were analysed using a Directed Content Analysis guided by an implementation science framework. The synthesis of the extracted data aimed to identify key requirements which correspond to intrinsic enablers and barriers for implementation. 52 staff members from the multi-disciplinary team participated. Data extracted showed five key themes and three key requirements regarding implementation of PROMs. Staff would consider using PROMs if there was strong research evidence that demonstrates benefits for patient outcomes, if PROM data was relevant to current clinical practice, and if applied appropriately in the specific setting. These findings add pragmatic detail and new knowledge to the current evidence on pathways to PROM implementation. This data can be used to inform implementation of PROMs into health services. Staff have valuable tacit knowledge of what works in practice that offers a unique opportunity to increase successful implementation of a PROM intervention for patient symptom reporting.


Radiological manifestations of pulmonary tuberculosis.
Pulmonary tuberculosis (TB) is a common worldwide lung infection. The radiological features show considerable variation, but in most cases they are characteristic enough to suggest the diagnosis. Classically, tuberculosis is divided into primary, common in childhood, and postprimary, usually presenting in adults. The most characteristic radiological feature in primary tuberculosis is lymphadenopathy. On enhanced CT, hilar and mediastinal nodes with a central hypodense area suggest the diagnosis. Cavitation is the hallmark of postprimary tuberculosis and appears in around half of patients. Patchy, poorly defined consolidation in the apical and posterior segments of the upper lobes, and in the superior segment of the lower lobe is also commonly observed. Several complications are associated with tuberculous infection, such as hematogenous dissemination (miliary tuberculosis) or extension to the pleura, resulting in pleural effusion. Late complications of tuberculosis comprise a heterogeneous group of processes including tuberculoma, bronchial stenosis bronchiectasis, broncholithiasis, aspergilloma, bronchoesophageal fistula and fibrosing mediastinitis. Radiology provides essential information for the management and follow up of these patients and is extremely valuable for monitoring complications.


A Rasch Model Analysis of the Mindful Attention Awareness Scale.
The Mindful Attention Awareness Scale was developed to measure individual differences in the tendency to be mindful. The current study examined the psychometric properties of the Mindful Attention Awareness Scale in a heterogeneous sample of 565 nonmeditators and 612 meditators using the polytomous Rasch model. The results showed that some items did not function the same way for these two groups. Overall, meditators had higher mean estimates than nonmeditators. The analysis identified a group of items as highly discriminating. Using a different model, Van Dam, Earleywine, and Borders in 2010 identified the same group of items as highly discriminating, and concluded that they were the items with the most information. Multiple pieces of evidence from the Rasch analysis showed that these items discriminate highly because of local dependence, hence do not supply independent information. We discussed how these different conclusions, based on similar findings, result from two very different paradigms in measurement.


Evaluation of Autofluorescence in Identifying Parathyroid Glands by Measuring Parathyroid Hormone in Fine-Needle Biopsy Washings.
Near-infrared autofluorescence imaging has potentially great value for assisting endocrine surgeons in identifying parathyroid glands and may dramatically change the surgical strategy of endocrine surgeons in thyroid surgery. This study is designed to objectively evaluate the role of near-infrared autofluorescence imaging in identifying parathyroid glands during thyroid surgery by measuring intraoperative parathyroid hormone in fine-needle aspiration biopsy washings. This study was conducted at a tertiary referral teaching hospital in China from February 2020 to June 2020. Patients undergoing total thyroidectomy with or without neck lymph node dissection were consecutively included. The surgeon used near-infrared autofluorescence imaging to identify parathyroid glands during thyroid surgery and confirmed suspicious parathyroid tissues by measuring their intraoperative parathyroid hormone. Nanocarbon was injected into the thyroid gland if the thyroid autofluorescence intensity was too strong. The sensitivity and accuracy of near-infrared autofluorescence imaging and vision for identifying parathyroid glands, and the difference in autofluorescence intensity in various tissues were the main outcomes. Overall, 238 patients completed the trial. Based on the pathological and aIOPTH results, the sensitivity of near-infrared autofluorescence imaging for detecting parathyroid glands (568 of 596 parathyroid glands; 95.30%)was significantly higher than that of vision (517 of 596 parathyroid glands; 86.74%, P<.001). The accuracy of near-infrared autofluorescence imaging (764 of 841 tissues; 90.84%) was significantly higher than that of vision (567 of 841 tissues; 67.42%, P<.001) when the evaluations of certain tissues were inconsistent. There was a significant difference between the autofluorescence intensity of the parathyroid glands and that of the lymph nodes (74.19 ± 17.82 vs 33.97 ± 10.64, P<.001). The use of near-infrared autofluorescence imaging, along with intraoperative parathyroid hormone and nanocarbon for the identification of parathyroid glands in thyroid surgery may increase the number of confirmed parathyroid glands. Using near-infrared autofluorescence imaging can effectively distinguish lymph nodes and parathyroid glands during lymph node dissection.


Off-label uses of the Pipeline embolization device: a review of the literature.
The Pipeline embolization device (PED) is the most widely used flow diverter in endovascular neurosurgery. In 2011, the device received FDA approval for the treatment of large and giant aneurysms in the internal carotid artery extending from the petrous to the superior hypophyseal segments. However, as popularity of the device grew and neurosurgeons gained more experience, its use has extended to several other indications. Some of these off-label uses include previously treated aneurysms, acutely ruptured aneurysms, small aneurysms, distal circulation aneurysms, posterior circulation aneurysms, fusiform aneurysms, dissecting aneurysms, pseudoaneurysms, and even carotid-cavernous fistulas. The authors present a literature review of the safety and efficacy of the PED in these off-label uses.


Compensatory anabolic signaling in the sarcopenia of experimental chronic arthritis.
Inflammatory activity in rheumatoid arthritis may alter the regulation of muscle mass leading to a secondary sarcopenia, commonly termed rheumatoid cachexia (RC). We characterized alterations to muscle structure and various pro-inflammatory, catabolic and regenerative markers in an animal model of RC. Antigen induced arthritis (AiA) was performed in 20 male adult rabbits. AiA animals exhibited significantly less weight gain, a markedly elevated serum C-reactive protein (CRP), lighter muscles with shorter cross-sectional diameter and increased myonuclei when compared to controls. Atrogin-1 and MuRF-1 were up-regulated alongside an increase in IL-1β, active NF-κB and a higher ratio of phosphorylated to inactive p38 MAPK. CCL-2 and TNF levels were reduced and IL-6 was unchanged between groups. We observed decreased pSTAT3, unchanged pSTAT1 and Myf5, but increased Pax7, MyoD and myogenin. AiA rabbits had a reduction in myostatin from gastrocnemii and synovium with a congruent decrease in serum myostatin compared to controls. Chronic arthritis induced an RC-like secondary sarcopenia with increased muscle protein breakdown. Elevated IL-1β may trigger proteolysis via elevated NF-κB and p38 MAPK signaling with a compensatory anabolic response suggested by myonuclear expansion, increased Pax7, MyoD and myogenin, reduced pSTAT3 as well as reduced serum, synovial and muscular myostatin.


What makes workers with disabilities happy? The importance of non-pecuniary characteristics.
The paper examines the determinants of the levels of job satisfaction reported by non-disabled and disabled workers, with special attention to the contribution of non-pecuniary job aspects. Using longitudinal data from the German Socio-Economic Panel, we estimate job satisfaction equations for non-disabled and disabled workers. The existence of unhealthy environments, hard manual work, capacity to learn and good relationships with colleagues and supervisors all have a greater influence on job satisfaction for disabled workers than for their non-disabled counterparts.


Large scale extraction of pyrrolizidine alkaloids from tansy ragwort (Senecio jacobaea).
A new technique of large-scale pyrrolizidine alkaloid (PA) extraction was developed in response to toxicity studies on food animals. Results of toxicity experiments on cattle vary from those on rodents (2); therefore, dose/response studies need to be germaine to the appropriate species. This new technique for extraction utilizes protonation of the ring nitrogen and partition of solvent to preferentially extract the alkaloid. The primary equipment used in the system we developed includes a large stainless-steel extraction/separation tank, holding tanks, and a 100-liter vacuum distillation system. From 23 kg of plant material of Senecio jacobaea , our system was able to produce 8-10 g of alkaloid per run, compared to the 3 g which we achieved using other extraction methods (2,4). Additional advantages of our system include a lower labor cost and the ability to recycle the organic solvent.


Using Twitter to Examine Web-Based Patient Experience Sentiments in the United States: Longitudinal Study.
There are documented differences in access to health care across the United States. Previous research indicates that Web-based data regarding patient experiences and opinions of health care are available from Twitter. Sentiment analyses of Twitter data can be used to examine differences in patient views of health care across the United States. The objective of our study was to provide a characterization of patient experience sentiments across the United States on Twitter over a 4-year period. Using data from Twitter, we developed a set of 4 software components to automatically label and examine a database of tweets discussing patient experience. The set includes a classifier to determine patient experience tweets, a geolocation inference engine for social data, a modified sentiment classifier, and an engine to determine if the tweet is from a metropolitan or nonmetropolitan area in the United States. Using the information retrieved, we conducted spatial and temporal examinations of tweet sentiments at national and regional levels. We examined trends in the time of the day and that of the week when tweets were posted. Statistical analyses were conducted to determine if any differences existed between the discussions of patient experience in metropolitan and nonmetropolitan areas. We collected 27.3 million tweets between February 1, 2013 and February 28, 2017, using a set of patient experience-related keywords; the classifier was able to identify 2,759,257 tweets labeled as patient experience. We identified the approximate location of 31.76% (876,384/2,759,257) patient experience tweets using a geolocation classifier to conduct spatial analyses. At the national level, we observed 27.83% (243,903/876,384) positive patient experience tweets, 36.22% (317,445/876,384) neutral patient experience tweets, and 35.95% (315,036/876,384) negative patient experience tweets. There were slight differences in tweet sentiments across all regions of the United States during the 4-year study period. We found the average sentiment polarity shifted toward less negative over the study period across all the regions of the United States. We observed the sentiment of tweets to have a lower negative fraction during daytime hours, whereas the sentiment of tweets posted between 8 pm and 10 am had a higher negative fraction. Nationally, sentiment scores for tweets in metropolitan areas were found to be more extremely negative and mildly positive compared with tweets in nonmetropolitan areas. This result is statistically significant (P<.001). Tweets with extremely negative sentiments had a medium effect size (d=0.34) at the national level. This study presents methodologies for a deeper understanding of Web-based discussion related to patient experience across space and time and demonstrates how Twitter can provide a unique and unsolicited perspective from users on the health care they receive in the United States.


Radical scavenging activity of Trianthema triquetra in male albino rats intoxicated with CCl4.
Radical scavenging activity of ethanolic extract of Trianthema triquetra root was investigated against CCl4 in rats. The rats were treated with T. triquetra (100 mg, 200 mg/kg b.w.) for a period of 7 days. Antihepatotoxic effect was studied by assaying the activities of thiobarbituric acid (TBARS), reduced glutathione (GSH), glutathione peroxidase (GPx),catalase (CAT), super oxide dismutase (SOD) and vitamin C (Vit. C). Lipid peroxidation is evidenced by an increase in the value of TBARS and also a distinct diminution in the level of GSH, Vit. C at 200 mg/kg b.w. The activity of antioxidant enzymes, such as GPx, CAT SOD and Vit. E is significantly recovered towards an almost normal level in animals coadministrated with T. triquetra. The maximum protection against CCl4 induced hepatic injury was afforded by the dose of 200 mg/kg b.w. of Trianthema triquetra.


Oxidative Modification of Proteins: From Damage to Catalysis, Signaling, and Beyond.
Significance: The systematic investigation of oxidative modification of proteins by reactive oxygen species started in 1980. Later, it was shown that reactive nitrogen species could also modify proteins. Some protein oxidative modifications promote loss of protein function, cleavage or aggregation, and some result in proteo-toxicity and cellular homeostasis disruption. Recent Advances: Previously, protein oxidation was associated exclusively to damage. However, not all oxidative modifications are necessarily associated with damage, as with Met and Cys protein residue oxidation. In these cases, redox state changes can alter protein structure, catalytic function, and signaling processes in response to metabolic and/or environmental alterations. This review aims to integrate the present knowledge on redox modifications of proteins with their fate and role in redox signaling and human pathological conditions. Critical Issues: It is hypothesized that protein oxidation participates in the development and progression of many pathological conditions. However, no quantitative data have been correlated with specific oxidized proteins or the progression or severity of pathological conditions. Hence, the comprehension of the mechanisms underlying these modifications, their importance in human pathologies, and the fate of the modified proteins is of clinical relevance. Future Directions: We discuss new tools to cope with protein oxidation and suggest new approaches for integrating knowledge about protein oxidation and redox processes with human pathophysiological conditions. Antioxid. Redox Signal. 35, 1016-1080.


Ethnicity, ability, aspirations and social status attainment.
In this study longitudinal data were used to examine relationships among children's intellectual ability, adolescents' aspirations and young adults' social-status attainment. The sample included 21-year-old Australians from Anglo-Australian, Greek and Southern Italian families. Regression surfaces were constructed from hierarchical models that examined possible linear, interaction and curvilinear associations among the variables. Typically, the findings indicated that in each ethnic group adolescents' aspirations had moderate to strong associations with status attainment. For Anglo-Australian and Greek young adults the relationships between ability and attainment were, in general, mediated by adolescents' aspirations. In contrast, for Southern Italians, ability continued to be associated with the educational and occupational attainment of the young adults.


Metallothioneins alter macrophage phenotype and represent novel therapeutic targets for acetaminophen-induced liver injury.
Acetaminophen (APAP) intoxication is the foremost cause of drug-induced liver failure in developed countries. The only pharmacologic treatment option, N-acetylcysteine (NAC), is not effective for patients who are admitted too late and/or who have excessive liver damage, emphasizing the need for alternative treatment options. APAP intoxication results in hepatocyte death and release of danger signals, which further contribute to liver injury, in part by hepatic monocyte/macrophage infiltration and activation. Metallothionein (MT) 1 and 2 have important danger signaling functions and might represent novel therapeutic targets in APAP overdose. Therefore, we evaluated hepatic MT expression and the effect of anti-MT antibodies on the transcriptional profile of the hepatic macrophage population and liver injury following APAP overdose in mice. Hepatic MT expression was significantly induced in APAP-intoxicated mice and abundantly present in human livers. APAP intoxication in mice resulted in increased serum transaminase levels, extended necrotic regions on liver histology and induced expression of proinflammatory markers, which was significantly less pronounced in mice treated with anti-MT antibodies. Anti-MT antibody therapy attenuated proinflammatory macrophage polarization, as demonstrated by RNA sequencing analyses of isolated liver macrophages and in LPS-stimulated bone marrow-derived macrophages. Importantly, NAC and anti-MT antibodies were equally effective whereas administration of anti-MT antibody in combination with NAC exceeded the efficiency of both monotherapies in APAP-induced liver injury (AILI). We conclude that the neutralization of secreted MTs using a monoclonal antibody is a novel therapeutic strategy as mono- or add-on therapy for AILI. In addition, we provide evidence suggesting that MTs in the extracellular environment are involved in macrophage polarization.


Separation of mononuclear bone marrow cells using the Cobe 2997 blood cell separator.
In the present study, we report the results of our evaluation of the use of the continuous-flow cell separator Cobe 2997 to isolate from human bone marrow (BM) aspirates the mononuclear cell (MNC) fraction containing hematopoietic stem cells. This MNC concentrate is isolated in 15% of the original BM volume and contains 23% of the initial nucleated cells. It is enriched as concerns the BM MNC fraction (lymphocytes + monocytes recovery; 80%), whereas the contamination with granulocytes, red blood cells and platelets is reduced to 7.2, 1.5% and 41%, respectively, of the cells initially present in the BM suspensions. Furthermore, it is demonstrated that this MNC concentrate is highly enriched in granulocyte-macrophage-colony-forming cells (CFU-GM; recovery 83%). The method is simple, inexpensive, efficient and reproducible. It allows rapid processing of a large volume of BM without substantial loss of hematopoietic progenitor cells. It represents a valuable method of BM MNC concentration prior to further in vitro manipulations such as T cell or tumor cell depletion or cryopreservation.


Metastasizing mammary carcinomas in H19 enhancers-Igf2 transgenic mice.
The insulin-like growth factor II is mitogenic for a number of cell types and can inhibit apoptosis. The frequent expression of this gene in human and experimental animal tumors indicates that insulin-like growth factor-2 may play an important role in tumor development. It has also been hypothesized that overexpression of this growth factor may be responsible for the increased incidence of childhood tumors in patients with Beckwith-Wiedemann syndrome. To assess the effects of Igf2 on tumor development we produced six transgenic mouse lines that express the gene under the control of the H19 enhancers. Transgenic expression was initiated in the embryonic period but remained high in several adult tissues, including the mammary gland, lung, and liver. Adult transgenic females from five of the transgenic lines developed often multiple mammary tumors that had the ability to metastasize. Increased incidence of other solid tumors was also noted in older mice. These findings indicate that Igf2 expression increases the probability of malignant transformation and that the mammary gland is at a particularly high risk of tumor development in response to chronic increase in Igf2 gene dosage.


Assembly of Human Umbilical Vein Endothelial Cells on Compliant Hydrogels.
Angiogenesis is the process by which endothelial cells grow and disassemble into functional blood vessels. In this study, we examine the fundamental processes that control the assembly of endothelial cells into networks in vitro. Network assembly is known to be influenced by matrix mechanics and chemical signals. However, the roles of substrate stiffness and chemical signals in network formation is unclear. In this study, human umbilical vein endothelial cells (HUVECs) were seeded onto RGD or GFOGER functionalized polyacrylamide gels of varying stiffness. Cells were either treated with bFGF, VEGF, or left untreated and observed over time. We found that cells form stable networks on soft gels (Young's modulus 140 Pa) when untreated but that growth factors induce increased cell migration which leads to network instability. On stiffer substrates (Young's modulus 2500 Pa) cells do not assemble into networks either with or without growth factors in any combination. Our results indicate that cells assemble to networks below a critical compliance, that a critical cell density is needed for network formation, and that growth factors can inhibit network formation through an increase in motility.


Unified, Efficient, and Scalable Synthesis of Halichondrins: Zirconium/Nickel-Mediated One-Pot Ketone Synthesis as the Final Coupling Reaction.
Unified, efficient, and scalable syntheses of the halichondrin natural products are reported. A newly developed Zr/Ni-mediated one-pot ketone synthesis was used to couple the two halves of the final product at a late stage in the synthesis. With the use of a slight excess of the left halves, the desired ketones were isolated in yields of 80-90 %. The halichondrins were obtained from these ketones in two steps, namely desilylation and [5,5]-spiroketal formation. The new synthetic route was effective for the total synthesis of all members in the homohalichondrin subgroup. The scalability of this process was demonstrated with halichondrin B; 150 mg of halichondrin B (68 % overall yield) were obtained from 200 mg of the right-half precursor.


Comparison of cochlear implant performance after round window electrode insertion compared with traditional cochleostomy.
To compare speech perception after undergoing round window (RW) electrode insertion with those who underwent traditional cochleostomy (C) cochlear implant (CI) surgery. Case series with chart review. Academic cochlear implant center. Patients who met CI criteria with favorable intraoperative RW anatomy who underwent RW CI electrode insertion. Patients who underwent traditional C surgery were matched for age, duration of deafness, and preoperative hearing. Postoperative speech performance using the consonant-nucleus-consonant (CNC) test, Northwestern University Children's Perception of Speech (NUCHIPS), and Hearing in Noise Test (HINT) between 3 and 48 months after CI. A total of 84 patients underwent RW insertion between 2004 and 2011. Of these, 55 had pre- and postoperative speech perception data for analysis. Average age of implantation ranged from 2.4 to 87.3 years (mean ± SD, 42.1 ± 24.2 years) for RW patients. Average age of implantation for matched traditional C patients ranged from 2.3 to 85.6 years (mean ± SD, 43.3 ± 25.0 years). No significant differences in postoperative CI speech perception scores were noted between the RW and C groups at 12 months post-CI (RW group, 55.28% ± 23.26% vs C group, 53.19% ± 24.14%; P = .70). Our study found that patients with favorable RW anatomy who underwent RW CI electrode insertion demonstrated comparable speech perception compared with the traditional cochleostomy insertion group.


[Early postmortem course of washerwoman's skin of the fingers].
Studies were carried out systematically in both corpses and the hands of corpses in order to find out when " washerwoman 's skin" begins. The temperatures ranged between 10 degrees and 18 degrees C and the time of the experiments did not exceed 300 min. The initial formation of washerwoman 's skin could be observed after 20-30 min at the fingertips and after 50-60 min in the entire finger. The longest intervals observed were 100 or 150 min, respectively. These long intervals were interpreted as being exceptions from the norm, probably due to either extraordinarily heavy strips of fat on the fingers or abnormally hard skin on the hands. The course of washerwoman 's skin obviously depends on the water temperature, and afterwards it disappears rather slowly--even after a short immersion--in the open air. We will carry out additional experiments in the future.


Genotypic, phenotypic, biochemical, physiological and pathogenicity-based categorisation of Acanthamoeba strains.
The genus Acanthamoeba includes more than 20 morphological species, but classification is problematical. Recently, the discovery of substantial interstrain differences in ribosomal DNA (rDNA) sequences has prompted questions about the relatedness of strains of the same species. In this study, therefore, we have investigated relationships between two isolates of A. polyphaga, CCAP 1501/3c and ATCC 30871, using morphological, biochemical, physiological, molecular and cytotoxicity assays. We observed that A. polyphaga ATCC 30871 exhibited up to six arms in endocyst while A. polyphaga CCAP 1501/3c exhibited a maximum of 5 arms thus indicating their position in group 2 and 3, respectively. Acanthamoeba polyphaga ATCC 30871 exhibited growth at 37 degrees C and growth on 1M mannitol plates while A. polyphaga CCAP 1501/3c did not. In addition, both isolates exhibited differences in isoenzyme banding patterns and rDNA restriction fragment polymorphisms. More importantly, A. polyphaga ATCC 30871 produced cytotoxicity on corneal epithelial cells while A. polyphaga CCAP 1501/3c had no effects, suggesting differences in pathogenicity. Thus, all the results provide evidence for significant differences between the strains and further provided the basis for reclassification of the isolates. Implications of these results in the clinical diagnosis of pathogenic Acanthamoeba are discussed.


N-Doped Graphenelike Nanostructures from p-Nitro Aniline-Based Foam: Formation, Structure, and Applications as a Nanofiller.
Production of snake foam based on p-nitro aniline (PNA) was considered fun in old-school chemistry laboratories. Herein, we report the fabrication of a new carbon nanomaterial from PNA-based foam. The resulting material, resembling graphene and consisting of nitrogen heteroatoms, is N-doped graphenelike nanostructures, and their morphology, structure, and stability are comprehensively examined using combined techniques including C-13 NMR spectroscopy, X-ray photoelectron spectroscopy (XPS), and X-ray diffraction (XRD). An optimized route was also established for their large-scale production. Further experimental validation of them as a nanofiller in polymer [SEBS (20 wt %) and paraffin wax (80 wt %)]-based nanocomposites was carried out, and we found that the thermomechanical properties of the nanocomposites were synchronously improved, which was attributed to the enshrouding effect of the nanofiller to the polymer chains. Owing to their good thermomechanical property and low-cost feature, these new nanomaterials can be further explored as a promising candidate for applications in energy storage, catalysis, and CO2 capture.


Study on the biodegradation of crude oil by free and immobilized bacterial consortium in marine environment.
Five strains of bacteria, namely, Exiguobacterium sp. ASW-1, Pseudomonas aeruginosa strain ASW-2, Alcaligenes sp. ASW-3, Alcaligenes sp. ASS-1, and Bacillus sp. ASS-2, were isolated from the Zhejiang coast in China. The mixed flora of the five strains performed well with degrading 75.1% crude oil (1%, w/v) in 7 days. The calcium alginate-activated carbon embedding carrier was used to immobilize bacterial consortium. Immobilized cells performed better than free ones in variations of environmental factors containing incubated temperature, initial pH, salinity of the medium and crude oil concentration. The degradation process of crude oil by immobilized bacteria was accelerated compared with that of the free ones. Bacterial consortium showed better performance on biodegradation of normal alkanes than that of PAHs. Improvement of immobilization on the biodegradation efficiency of normal alkanes (31.9%) was apparently high than that of PAHs (1.9%).


[Predictors of in-hospital mortality in adult postcardiotomy cardiacgenic shock patients successfully weaned from venoarterial extracorporeal membrane oxygenation].
Objective: To assess the factors associated with outcome of patients undergoing extracorporeal membrane oxygenation (ECMO) in a large ECMO center. Methods: Patients aged >18 years who received ECMO support for postcardiotomy cardiogenic shock were identified between January 2011 and December 2015. One hundred and seventy-seven patients (64.8%) successfully weaned from ECMO. These patients were divided into two groups depending on whether they could survive to hospital discharge: the survival group (group S, n=119) and death group (group D, n=58). Multivariate logistic regression was performed to identify risk factors independently associated with in-hospital mortality. Results: Compared to those from group D, patients in group S exhibited a younger age[(53.4±11.7) vs (58.9±11.5) years], a lower inotrope score at the beginning of ECMO [25(15, 60) vs 35.0(23, 60)], a lower average platelets transfusion [4.0(2.0, 5.2) vs 5.0(3.0, 7.2)U] (all P<0.05). There were shorter duration of ECMO support [95.0(73.0, 131.0) vs 120.0(95.8, 160.2) h], shorter ventilation time [137.0(70.0, 236.8) vs 215.0(164.0, 305.0) h], shorter stay in ICU [182.0(140.0, 236.0) vs 259.0(207.0, 382.0) h] and longer hospital stay after weaned from ECMO [14(11, 24) vs 8(4, 16) d] in group S patients compared to those in group D (all P<0.05). Age>65 years (P=0.046), neurologic complications (P<0.001) and lower extremity ischemia (P<0.001) during ECMO support, left ventricular ejection fraction<35% (P=0.011) and central venous pressure (CVP)>12 cmH(2)O(P=0.018) when weaned from ECMO, and the multi-organ function failure (P<0.001) after weaned from ECMO were independently associated with in-hospital mortality. Conclusions: Neurologic complications and lower extremity ischemia that occurred during ECMO, multi-organ function failure after weaned from ECMO had a significant impact on in-hospital mortality. Further studies are needed to prevent neurologic complications and lower extremity ischemia in these patients. Interventions that could reduce these complications may improve outcome.


Vehicle related factors that influence injury outcome in head-on collisions.
This study specifically investigated a range of vehicle-related factors that are associated with a lower risk of serious or fatal injury to a belted driver in a head-on collision. This analysis investigated a range of structural characteristics, quantities that describes the physical features of a passenger vehicle, e.g., stiffness or frontal geometry. The study used a data-mining approach (classification tree algorithm) to find the most significant relationships between injury outcome and the structural variables. The algorithm was applied to 120,000 real-world, head-on collisions, from the National Highway Traffic Safety Administration's (NHTSA's) State Crash data files, that were linked to structural attributes derived from frontal crash tests performed as part of the USA New Car Assessment Program. As with previous literature, the analysis found that the heavier vehicles were correlated with lower injury risk to their drivers. This analysis also found a new and significant correlation between the vehicle's stiffness and injury risk. When an airbag deployed, the vehicle's stiffness has the most statistically significant correlation with injury risk. These results suggest that in severe collisions, lower intrusion in the occupant cabin associated with higher stiffness is at least as important to occupant protection as vehicle weight for self-protection of the occupant. Consequently, the safety community might better improve self-protection by a renewed focus on increasing vehicle stiffness in order to improve crashworthiness in head-on collisions.


Inhibition by Z-Pro-D-Leu of development of tolerance to and physical dependence on morphine in mice.
The peptide-Z-Pro-D-Leu, injected daily in mice receiving morphine chronically, was found to prevent development of physical dependence as measured by changes in body temperature and body weight due either to abrupt or to naloxone-induced withdrawal. On the other hand, administration of Z-Pro-D-Leu only on the last day of morphine treatment did not alter the overt signs of withdrawal. Daily administration of Z-Pro-D-Leu was also effective in blocking the development of tolerance to the analgesic and the hypothermic effects of subsequent challenge doses of morphine. However, the peptide treatment did not alter the acute effects of a challenge dose of morphine on either analgesia or body temperature. No effects on memory were noted, as evaluated in a one-trial passive avoidance task. Clinical implications of the use of Z-Pro-D-Leu are discussed.


Human sex reversal due to impaired nuclear localization of SRY. A clinical correlation.
SRY, an architectural transcription factor encoded by the sex-determining region of the Y chromosome, initiates testicular differentiation in mammalian embryogenesis. The protein contains a high-mobility group (HMG) box, a DNA-bending motif conserved among a broad class of nuclear proteins. Mutations causing human sex reversal (46, XY pure gonadal dysgenesis) are clustered in this domain. Basic N- and C-terminal regions of the HMG box are each proposed to provide nuclear localization signals. The significance of the C-terminal basic cluster (SRY residues 130-134) is uncertain, however, as its activity in cell culture varies with assay conditions. To test its importance, we have investigated a C-terminal sex-reversal mutation (R133W, position 78 of the HMG box). This de novo mutation impairs nuclear localization but not specific DNA binding or sharp DNA bending. Correlation between these properties and the phenotype of the patient suggests that nuclear localization of SRY is required for testicular differentiation and directed in part by the C-terminal basic cluster. To our knowledge, these results provide the first example of impaired organogenesis due to a nuclear localization signal mutation.


Cortisol awakening response in children and adolescents with autism spectrum disorder: a systematic review and meta-analysis.
The cortisol awakening response (CAR) is characterised by an increase in cortisol in the 30 to 60 min after waking. Research has found significant associations between an atypical CAR and symptoms of stress and anxiety in typically developing (TD) children and adolescents. A number of studies have explored the CAR in autism spectrum disorder (ASD), but no evidence synthesis is available to date. Based on a preregistered protocol (PROSPERO: CRD42017051187), we carried out a systematic review (SR) and meta-analysis (MA) of CAR studies to explore potential significant differences between children and adolescents with ASD and TD controls. Web of Science, PubMed and PsychInfo were searched until January 2019. A random-effects model was used to pool studies and we used the Newcastle-Ottawa scale (NOS) to assess study quality and risk of bias. The SR retrieved a total of nine studies, with mixed findings on the comparison of the CAR between children and adolescents with ASD and TD controls. The MA, based on four studies (ASD; n=117 and TD n=118), suggested no differences between the CAR in ASD and TD populations (SMD: -0.21, 95% CI -0.49 to 0.08). In terms of NOS items, no study specified Representativeness of the cases and Non-response rate. DISCUSSION AND CLINICAL IMPLICATIONS: Given the relatively few studies and lack of appropriately matched TD controls, additional research is needed to further understand and recommend the utility of the CAR as a reliable marker to differentiate ASD and TD.


Ivory vertebra appearing photopenic on Tc-99m MDP bone scan: demonstration by SPECT/CT.
We report the case of a 72-year-old man with prostate cancer, in whom Tc-99m MDP bone scintigraphy revealed a "superscan" pattern, except in a dorsal vertebra, which appeared photopenic. A low-dose SPECT/CT acquisition demonstrated that the lack of tracer uptake corresponded to a blastic lesion with no lytic component. Surprisingly, the cold vertebra appeared as an "ivory vertebra" on the CT part of the SPECT/CT acquisition. In the present case, the photopenic appearance is thought to be due to a concomitant blastic lesion and spine infarct.


Clinical and economic outcomes of infective endocarditis.
In France, the estimated annual incidence of infective endocarditis (IE) is 33.8 cases per million residents. Valvular surgery is frequently undergone. We report an epidemiological and economic study of IE for 2007-2009 in a French region, using the hospital discharge database (HDD). The population studied concerned all the patients living in Centre region, France, hospitalized for IE. We extracted hospital stay data for IE from the regional HDD, with a definition based on IE-related diagnosis codes. The predictive positive value (PPV) and sensitivity (Se) of the definition were 87.4% and 90%, respectively, according to the Duke criteria (definite IE frequency 74.4%). Hospitalization costs were estimated, taking into account the fixed hospital charges of the diagnosis-related group (DRG) and supplementary charges due to intensive care unit (ICU) stay. The analysis included 578 patients. The annual average incidence was 45.4 cases per million residents. Valvular surgery was performed in 19.4% of cases. The hospital mortality was 17.6%. Multivariate analysis identified as risk factors for mortality an age ≥ 70 years (odds ratio (OR) = 3.03, 95% confidence interval (CI) = 1.78-5.18), staphylococcal IE (OR = 3.3, 95% CI = 1.9-5.7), chronic renal insufficiency (OR = 2.04, 95% CI = 1.00-4.15), ischemic stroke (OR = 2.55, 95% CI = 1.19-5.47), and hemorrhagic stroke (OR = 5.7, 95% CI = 1.9-17.3). The average cost per episode was $20 103 (€15 281). We report a higher incidence of IE than described by the French national study of 2008. Valvular surgery was considerably less frequent than in the published data, whereas mortality was similar. IE generates substantial costs.


Reconstruction of Through-and-through Oromandibular Defect: Comparison of Four Different Techniques.
Through-and-through oromandibular defects originate from surgical intervention of tumors of the oral cavity involving external skin, soft tissue, bone, and oral lining. Reconstruction of such composite defects is primarily achieved by 4 methods using distinct flaps in Chang Gung Memorial Hospital, including a single anterolateral thigh (ALT) flap, a single fibula flap, an osteomyocutaneous peroneal artery-based combined flap, and a combination of a fibular flap and an ALT flap, also known as a double flap. In this retrospective study, 41 patients with through-and-through oromandibular defects reconstructed in Chang Gung Memorial Hospital Linkou branch from July 2007 to June 2009 using either of the 4 flaps were evaluated. Patients were divided into 4 groups according to the choice of flap, and their surgical outcomes, immediate and late complications, and their general condition were studied. Group 1 included 12 patients reconstructed with a single ALT flap, whereas group 2 included 15 patients using fibular flaps. Group 3 included 8 patients with osteomyocutaneous peroneal artery-based combined flaps, and group 4 included 6 patients who underwent reconstruction with double flaps. Among all statistical results, we found that none of the differences regarding either patient demography or surgical outcomes between groups were statistically significant, except for squamous cell carcinoma staging. Although the results were insignificant, trends within the data could be seen that support previous notions regarding each reconstruction method. For future studies, we strongly recommend a larger sample size.


Physicochemical properties of maltosyl and glucosaminyl derivatives of beta-lactoglobulin.
Maltosyl and glucosaminyl derivatives of beta-lactoglobulin (b-LG) were analyzed for their physicochemical properties: reduced viscosity, ultraviolet difference spectra, intrinsic fluorescence, hydrophobicity and circular dichroism. The viscosity of these derivatives increased as the mass of the carbohydrates covalently linked to b-LG increased. The ultraviolet difference spectra and the intrinsic fluorescence of these proteins revealed that the microenvironments of aromatic amino acid residues of b-LG were increasingly exposed to the surface of the protein as the extent of modification increased; and the polarity of these residues also increased as modification increased. The hydrophobicities of M-b-LG derivatives decreased as the extent of modification increased while the hydrophobicities of G-b-LG derivatives were relatively unchanged. The circular dichroic analysis of these proteins indicated that the order secondary structures of the extensively modified derivatives of b-LG were partially unfolded. Thus, the carbohydrates covalently linked to b-LG altered many physiochemical properties. These physicochemical changes of b-LG apparently resulted from an alteration of forces stabilizing the structure of the protein.


Heat-induced morphological alterations in non-tolerant and thermotolerant cells.
CHO cells were heated at 43 degrees C or 45 degrees C for various durations up to 300 min. Survival values varied from 5 x 10(-1) to 10(-7). Unheated, non-tolerant control cells were compared with cells made thermotolerant (TT) by incubating at 37 degrees C for 6 or 12 h after treatment with either sodium arsenite (100 microM-As) or 45.5 degrees C for 10 min, respectively. Groups also were included in which heat-induced TT cells were heated at 43 degrees C for 5 h immediately before they were challenged at 45 degrees C; in these groups, cycloheximide was sometimes added to inhibit protein synthesis before and/or during heating at 43 degrees C. Morphological alterations were quantified immediately and at various times after heating by using phase-contrast microscopy to determine the percentage of cells that were severely blebbed and rounded. About 800 cells were analysed per datum point. When effects of heat on thermotolerant cells were compared with effects of heat on non-tolerant cells, heat-induced thermotolerance (HTT) was observed by an increase in survival, and by a reduction in the percentage of cells with morphological alteration observed immediately after the challenging heat. After the As treatment, very little thermotolerance was observed for morphological alterations immediately after the challenging heat, although thermotolerance was observed for survival. However, as the cells were incubated for 12 or 24 h at 37 degrees C after the challenging heat treatment, recovery from morphological alterations was observed in the As-TT cells. Possible mechanisms for the difference between HTT and As-TT are discussed.


Palatinose-blended sugar compared with sucrose: different effects on insulin sensitivity after 12 weeks supplementation in sedentary adults.
We investigated the effects of daily palatinose intake on the risk factors of metabolic syndrome in sedentary non-obese Japanese adults. Japanese adults (40 females and 10 males, age: 53 +/- 9 years, range: 31-72 years old) were randomized into two groups for a double-blind, placebo-controlled intervention study and given either 40 g/day palatinose-blended sugar (PS group) or 40 g/day sucrose (S group) in their diet for 12 weeks. After the intervention, the insulin resistance index (HOMA-IR) had significantly decreased only in the PS group; the inter-group difference was significant at P = 0.006. Although the S group showed a significant increase in the leptin concentration and the systolic blood pressure, the PS group showed no significant changes; the inter-group differences were significant at P = 0.018 and P = 0.037, respectively. Palatinose intake possibly improves insulin sensitivity when compared with sucrose intake.


Fulminant hepatic failure and fatal encephalopathy associated with Epstein-Barr virus infection.
A case of fulminant hepatic failure, associated with infectious mononucleosis, in a previously healthy 14-year-old girl is reported. Despite intensive therapy, which included the use of acyclovir, charcoal haemoperfusion, and measures to control her raised intracranial pressure (guided by serial EEG and auditory brainstem-evoked response recordings), the outcome was fatal.


Method for identifying nonspecific protein-protein interactions in nanoelectrospray ionization mass spectrometry.
The nonspecific self-association of proteins in nanoflow electrospray ionization mass spectrometry (nanoES-MS), and the influence of experimental conditions thereon, are investigated using the protein ubiquitin (Ubq) as a model system. Extents of nonspecific protein association generally increase with protein concentration and, interestingly, with decreasing ES spray potential. The extent of self-association is also sensitive to the duration of the accumulation event in an external rf hexapole. Notably, the relative abundance of metal (Na+ and K+) adducts generally increases with the size of nonspecific Ubq multimer. This result suggests that the gaseous ions of monomeric and nonspecific multimeric Ubq have, on average, different ES droplet histories, with monomer ions originating earlier in the ES process than the nonspecific multimeric complexes. This finding forms the basis for a new method for distinguishing between specific and nonspecific protein complexes in ES-MS. A reporter molecule (Mrep), which does not bind specifically to the proteins and protein complexes of interest, is added to the ES solution at high concentration. The distribution of Mrep bound nonspecifically to gaseous ions of the proteins and protein complexes, as determined from the ES mass spectrum, is used to determine whether a given protein complex originates in solution or whether it forms from nonspecific binding during the ES process. The method is demonstrated in cases where the ions of protein complexes detected by nanoES-MS originate exclusively from nonspecific association, exclusively from specific interactions in solution, or from both specific and nonspecific interactions.


Clinical manifestations of tension pneumothorax: protocol for a systematic review and meta-analysis.
Although health care providers utilize classically described signs and symptoms to diagnose tension pneumothorax, available literature sources differ in their descriptions of its clinical manifestations. Moreover, while the clinical manifestations of tension pneumothorax have been suggested to differ among subjects of varying respiratory status, it remains unknown if these differences are supported by clinical evidence. Thus, the primary objective of this study is to systematically describe and contrast the clinical manifestations of tension pneumothorax among patients receiving positive pressure ventilation versus those who are breathing unassisted. We will search electronic bibliographic databases (MEDLINE, PubMed, EMBASE, and the Cochrane Database of Systematic Reviews) and clinical trial registries from their first available date as well as personal files, identified review articles, and included article bibliographies. Two investigators will independently screen identified article titles and abstracts and select observational (cohort, case-control, and cross-sectional) studies and case reports and series that report original data on clinical manifestations of tension pneumothorax. These investigators will also independently assess risk of bias and extract data. Identified data on the clinical manifestations of tension pneumothorax will be stratified according to whether adult or pediatric study patients were receiving positive pressure ventilation or were breathing unassisted, as well as whether the two investigators independently agreed that the clinical condition of the study patient(s) aligned with a previously published tension pneumothorax working definition. These data will then be summarized using a formal narrative synthesis alongside a meta-analysis of observational studies and then case reports and series where possible. Pooled or combined estimates of the occurrence rate of clinical manifestations will be calculated using random effects models (for observational studies) and generalized estimating equations adjusted for reported potential confounding factors (for case reports and series). This study will compile the world literature on tension pneumothorax and provide the first systematic description of the clinical manifestations of the disorder according to presenting patient respiratory status. It will also demonstrate a series of methods that may be used to address difficulties likely to be encountered during the conduct of a meta-analysis of data contained in published case reports and series. PROSPERO registration number: CRD42013005826.


The role of insulin-like growth factor I and hypoxia inducible factor 1α in vascular endothelial growth factor expression in type 2 diabetes.
Vascular endothelial growth factor (VEGF) plays an important role in diabetic vascular complications, and its expression is affected directly or indirectly by hypoxia inducible factor-1α (HIF-1α) and insulin-like growth factor-I (IGF-I) in tumors and certain normal cell lines. However, little is known about the role of HIF-1α/ IGF-I in VEGF expression in patients with diabetic vascular complications. The aim of this study was to elucidate the associations between HIF-1α, IGF-I, and VEGF in type 2 diabetes mellitus (T2DM) patients with or without vascular complications. Sixty patients with T2DM, with(A), and without vascular disease (B) and 26 controls were enrolled. Clinical parameters, HIF-1α, IGF-I and VEGF were assessed in the study and associations among them were analyzed by Spearman rank correlation. Serum levels of VEGF, HIF-1α and IGF-I were significantly higher in the diabetic patients than in the controls. Positive correlations existed between VEGF and HIF-1α and between HIF-1α and IL-6 in both groups A and B and in the control group. Our data demonstrate that HIF-1α and IL-6 could regulate VEGF expression, and that higher levels of HIF-1α, IL-6, and VEGF may contribute to the pathogenesis of diabetic micro-angiopathy.


DNA analysis of histocompatibility antigens: identification of new DQw specificities and of DPw patterns.
1. The HLA-D region of the major histocompatibility complex has several subregions, the most important of which are DR, DQ and DP. The genes coding for the beta chains of these proteins present most of the polymorphisms which result in the large variety of class II antigens observed. 2. We have studied the restriction fragment length polymorphism (RFLP) of the DQ beta and DP beta genes in order to establish accurate typing patterns. 3. The data show that DQ typing based on RFLP permits the identification of the recently described DQw1 splits (new antigenic specificities), DQw5 and DQw6. The TA10-monoclonal antibody-positive split of DQw3, designated DQw7, is associated with specific DNA fragments after digestion with four different enzymes: Taq I, Hind III, Pvu II and Bgl II. Furthermore, the recently reported specificity DQw4 (formerly typed as a blank) is associated with a specific 2.4-kb fragment when the DNA is digested with EcoRV. 4. DP typing proved to be more difficult even though six enzymes were used, and only broad groups could be identified.


Distinct nuclear and spindle pole body population of cyclin-cdc2 in fission yeast.
Cyclins, as subunits of the protein kinase encoded by the cdc2 gene are major controlling elements of the eukaryotic cell cycle. The fission yeast Schizosaccharomyces pombe has a B-type cyclin, which is a nuclear protein encoded by the cdc13 gene. Here we demonstrate the presence of two spatially distinct cdc13 cyclin populations in the nucleus of S. pombe, one of which is associated with the mitotic spindle poles. Both populations colocalize with the product of the cdc2 gene (p34cdc2). Treatment of cells with the antimicrotubule drug thiabendazole prevents cyclin degradation and blocks the tyrosine dephosphorylation and activation of cdc2. These results suggest a key regulatory role of the cdc2-cyclin complex in the initiation of mitotic spindle formation and also that mitotic microtubule function is required for cdc2 activation.


Synaptic targeting of rabphilin-3A, a synaptic vesicle Ca2+/phospholipid-binding protein, depends on rab3A/3C.
rab3A, a low molecular weight GTP-binding protein of synaptic vesicles with a putative function in synaptic vesicle docking, interacts in a GTP-dependent manner with rabphilin-3A, a peripheral membrane protein that binds Ca2+ and phospholipids. We now show that rabphilin-3A is an evolutionarily conserved synaptic vesicle protein that is attached to synaptic vesicle membranes via its N terminus and exhibits a heterogeneous distribution among synapses. In rab3A-deficient mice, rabphilin-3A is decreased in synapses belonging to neurons that primarily express rab3A and accumulates in the perikarya of these neurons. In contrast, neurons expressing significant levels of rab3C still contain normal levels of rabphilin-3A in a synaptic pattern, and rabphilin-3A binds rab3C in vitro. These results suggest that analogous to the membrane recruitment of raf by ras, rab3A and rab3C may function in recruiting rabphilin-3A to the synaptic vesicle membrane in a GTP-dependent manner.


Iridium(I)-catalyzed vinylic C-H borylation of 1-cycloalkenecarboxylates with bis(pinacolato)diboron.
Ir(I)-catalyzed C-H borylation of 1-cycloalkenecarboxylic derivatives with bis(pinacolato)diboron affords various alkenylboronates with functional groups in excellent yields. This reaction was also used in a one-pot borylation/Suzuki-Miyaura cross-coupling procedure.


Monoclonal antibodies against sensory neuron specific antigens define the extent of neuronal abnormality in the mf mutant rat.
The mutant rat mutilated foot (mf) is affected by a sensory neuropathy which does not involve the parts of the body innervated by the thoracic cord. The possibility that sensory cells subserving clinically normal regions may be functionally spared by the mutation has been investigated by studying the expression of cell surface oligosaccharides by dorsal root ganglia (DRG) and their central processes in the spinal cord. The study included 3 lactoseries epitopes (TC6, LD2 and LA4) and the globoseries epitope SSEA3. The results show that at cervical and lumbar levels in mf rats there are reduced numbers of DRG cells reacting with the various antibodies and less immunostaining in the dorsal horns. The unexpected finding that thoracic ganglia and cord share similar appearances suggests that, in spite of being normal in number and able to produce normal amounts of substance P, thoracic DRG cells in mf rats take part in the mutation as shown by their inability to produce normal amounts of oligosaccharides and to transport them to the axon terminals.


Active biomonitoring with Corbicula for USEPA priority pollutant and metal sources in the Anacostia River (DC, Maryland, USA).
The freshwater Anacostia River watershed (Maryland, DC, USA) was surveyed for the sources of bioavailable US Environmental Protection Agency (USEPA) Priority Pollutants and toxic metals by active biomontoring (ABM) using the freshwater Asiatic clam Corbicula fluminea. The Anacostia River is a 456 km(2) tributary of the tidal freshwater Potomac River that includes the city of Washington, DC where edible fish are highly contaminated with PCBs and chlordane. From 1999 to 2011, Corbicula were collected for ABM from a Potomac reference site and translocated in cages placed at 45 sites in the tidal and nontidal Anacostia watershed. Minimum clam mortality and maximum contaminant bioaccumulation was with 2-week translocation. The clam tissues (28-50) were combined at sites and analyzed by TestAmerica for 66 USEPA Priority Pollutants plus technical chlordane, benz(e) pyrene, and 6 metals (As, Cd, Cr, Cu, Fe, Pb). Tissue contaminants reflected water, not sediment, levels. To compare sites, all contaminant data above detection or reference were grouped as total metals (TMET), total polycyclic aromatic hydrocarbons (TPAH), total PCB congeners (TPCB), total pesticides (TPEST), and total technical chlordane (TCHL). Tidal Anacostia ABM found highest TPAH and TCHL upstream at Bladensburg Marina (MD) except for TCHL at site PP near the confluence. Five nontidal MD subtributaries (94% of flow) had 17 sites with bioavailable TPAH, TPCB, or TCHL 2 to 3 times higher than found at the toxic-sediment "hotspots" near Washington. The only TMET noted was Fe at 1 site. TPAH in MD subtributaries was highest near industrial parks and Metro stations. A naphthalene spill was detected in Watts Branch. TPCB (low molecular weight) originated upstream at 1 industrial park. Total technical chlordane (80% of TPEST) was 2 to 5 times the US Food and Drug Administration action in 4 nontidal tributaries where heptachlor indicated legacy chlordane dumpsites. Total technical chlordane fell to reference below a stormwater pond, suggesting transport via suspended sediment. Controlling the formation and movement of contaminated TSS in MD should enable the uncontaminated-sediment capping of Washington DC's toxic-sediment "hot-spots" that are presently considered responsible for fish contamination. Integr Environ Assess Manag 2016;12:548-558. © 2015 SETAC.


Longitudinal Changes in, and Factors Associated with, the Frequency of Condomless Sex Among People in Care for HIV Infection, HIV Outpatient Study USA, 2007-2019.
During 2007-2019, the percentage of HIV Outpatient Study participants reporting anal or vaginal condomless sex in the past 6 months ranged from a low of 17% among heterosexual males to 59% for men who have sex with men (MSM). MSM reported having had condomless sex more frequently than heterosexual males and females and were the only group in which an increase in condomless sex was observed during the study period (from 39 to 59%). Although persons with undetectable HIV viral load have effectively no risk of transmitting HIV sexually (U = U), there is still the potential risk of transmission or acquisition of other sexually transmitted infections (STIs) when engaging in condomless sex. Continuing education about risks of HIV and STI transmission as well as ongoing screening for and treatment of STIs, retention in HIV treatment, and support for sexual health are critical components of care for people living with HIV.


[Surgical treatment of hallux valgus deformity at the Department of Orthopaedic Surgery, Zagreb School of Medicine, in the period 1981-2000].
The aim of this study is to evaluate operative treatment of hallux valgus deformity at the Department of Orthopedic surgery, Zagreb School of Medicine, and present our protocol for the management of hallux valgus deformity. In the time period from 1981 to 2000 operative procedures for hallux valgus deformity were performed on 1211 feet in 820 patients (788 females and 32 males). Criteria for operative treatment were: increased hallux valgus angle (HVA), increased first intermetatarsal angle (IMTA), first metatarsophalangeal joint arthritis, pain and cosmetic reasons. Radiographic observations as well as clinical and subjective evaluation were made preoperatively and after the surgery. Observations were classified using Helal's modification of Boney and McNab classification. Resection of the proximal end of the proximal phalanx was performed in 250 patients (402 feet) with 55% of excellent results (221 patients over 60 years of age). Distal first metatarsal Austin osteotomy was performed in 312 patients (429 feet) with 49% of excellent results (210 feet, mean patient age 50 years, mean HVA 27 degrees, mean IMTA 15 degrees). Distal first metatarsal Mitchell osteotomy was performed in 230 patients (380 feet) with 40% of excellent results (152 feet, mean patient age 24 years, mean HVA 26 degrees, mean IMTA 15 degrees). Our experience in the operative treatment of hallux valgus deformity suggests that in order to achieve excellent results after surgery, strict criteria for each operative method must be applied.


The relationships of self-care agency and self-care actions to caregiver strain as perceived by female family caregivers of elderly parents.
The relationships of self-care agency and self-care actions to perceived caregiver strain among female family caregivers of elderly parents were examined in this descriptive correlational study. The length of time in the caregiver role, the quantity of multiple roles, and types of caregiving tasks performed by the caregiver were examined with the self-care variables to note their association with caregiver strain. This study was based on Orem's (1991) conceptual model. A convenience sample of 131 primary caregivers completed. The Burden Interview, Denyes Self Care Agency Instrument and Denyes Self Care Practice Instrument by mail survey. Significant findings show an inverse relationship between self-care agency and caregiver strain; self-care actions mediated relationships between household tasks, emotional support, and caregiver strain; the moderating effects of multiple roles on self-care actions increased caregiver strain, and the moderator effects of personal care tasks on self-care actions decreased caregiver strain. These findings suggest the need for nurses to educate caregivers to use effective self-care actions and to assess for factors that may influence caregivers and affect caregiving outcomes.


The usefulness and costs of routine contrast studies after laparoscopic sleeve gastrectomy for detecting staple line leaks.
Although laparoscopic sleeve gastrectomy (LSG) has been shown to be a safe and effective treatment for severe obesity (body mass index ≥ 35), staple line leaks remain a major complication and account for a substantial portion of the procedure's morbidity and mortality. Many centres performing LSG routinely obtain contrast studies on postoperative day 1 for early detection of staple line leaks. We examined the usefulness of Gastrografin swallow as an early detection test for staple line leaks on postoperative day 1 after LSG as well as the associated costs. We conducted a retrospective review of a prospectively collected database that included 200 patients who underwent LSG for severe obesity between 2011 and 2014. Primary outcome measures were the incidence of staple line leaks and the results of Gastrografin swallow tests. We obtained imaging costs from appropriate hospital departments. Gastrografin swallow was obtained on postoperative day 1 for all 200 patients who underwent LSG. Three patients (1.5%) were found to have staple line leaks. Gastrograffin swallows yielded 1 true positive result and 2 false negatives. The false negatives were subsequently diagnosed on computed tomography (CT) scan. The sensitivity of Gastrografin swallow in this study was 33%. For 200 patients, the total direct cost of the Gastrografin swallows was $35 000. The use of routine upper gastrointestinal contrast studies for early detection of staple line leaks has low sensitivity and is costly. We recommend selective use of CT instead.


[The effects of hematopoietic stem cells on mice vascular endothelial cells of diabetic retinopathy].
The purpose of the study was to determine whether hematopoietic stem cell (HSCs) mobilization can regulate early diabetic retinopathy in mice. Mice were divided into four groups: control group, normal mice HSC-mobilized group, diabetic mice control group and diabetic mice HSC-mobilized group. Murine stem cell growth factor (SCF) and recombined human granulocyte colony stimulating factor (rhG-csf) were administered to the mice with diabetes and without diabetes for continuous 5 days to induce autologous HSCs mobilization, and subcutaneous injection of physiological saline was used as control. The changes associated with autologous HSCs mobilization were characterized using flow cytometry, Immunohistochemistry and semiquantitative RT-PCR. Evans blue quantitative test was used to measure the breakdown level of blood-retina barrier. HSCs were marked by CD34-/low and Sca1+ in this study. The acceleration of endothelial cell regeneration was observed. A decrease of VEGF expression due to autologous stem cell mobilization was found. HSCs could increase the content of VEGFR-2 in mouse retina and significantly downregulated the expression of VEGF and ang-2 in diabetic mice. The experiment suggest that autologous HSCs mobilization can be approach of therapeutic vascular reconstruction and functional restoration of blood-retina barrier in mice.


The usefulness of standardized uptake value in differentiation between benign and malignant thyroid lesions detected incidentally in 18F-FDG PET/CT examination.
In the last decade, (18)F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET and PET/CT) has become one of the major diagnostic tools used in oncology. A significant number of patients who undergo this procedure, due to non-thyroidal reasons, present incidental uptake of (18F-FDG) in the thyroid. The aim of the study was to compare the SUVmax (standardized uptake value) of thyroid focal lesions, which were incidentally found on PET/CT, in relation to the results of thyroid fine-needle aspiration biopsy (FNAB) and/or histopathological evaluation. Patients referred for PET/CT examination, due to non-thyroidal illness, presented focal 18F-FDG uptake in the thyroid and were advised to undergo ultrasonography (US), hormonal evaluation, FNAB and/or total thyroidectomy at our institution. 6614 PET/CT examinations performed in 5520 patients were analyzed. Of the 122 patients with focal thyroid 18F-FDG activity, 82 patients (67.2%) underwent further thyroid evaluation using FNAB. Benign lesions were diagnosed in 46 patients, malignant - in 19 patients (confirmed by post-surgical histopathology), while 17 patients had inconclusive results of cytological assessment. Mean SUVmax of benign lesions was 3.2±2.8 (median = 2.4), while the mean SUVmax value for malignant lesions was 7.1±8.2 (median = 3.5). The risk of malignancy was 16.7% for lesions with a SUVmax under 3, 43.8% for lesions with a SUVmax between 3 and 6, and 54.6% for lesions with a SUVmax over 6. In the group of malignant lesions, a positive correlation between the lesion's diameter and SUVmax was observed (p = 0.03, r = 0.57). Subjects with incidental focal uptake of 18F-FDG in thyroid are at a high risk of thyroid malignancy. A high value of SUVmax further increases the risk of malignancy, indicating the necessity for further cytological or histological evaluation. However, as SUVmax correlated with the diameter of malignant lesions, small lesions with focal uptake of 18F-FDG should be interpreted cautiously.