Involvement of the nuclear factor-κB signaling pathway in the regulation of CXC chemokine receptor-4 expression in neuroblastoma cells induced by tumor necrosis factor-α.
Metastasis is a hallmark of malignant neuroblastoma and is the main reason for therapeutic failure and recurrence of the tumor. The CXC chemokine receptor-4 (CXCR4), a Gi protein-coupled receptor for the ligand CXCL12/stromal cell-derived factor-1α (SDF-1α), is expressed in various types of tumor. This receptor mediates the homing of tumor cells to specific organs that express the ligand, CXCL12, for this receptor and plays an important role in tumor growth, invasion, metastasis and angiogenesis. In the present study, the inflammatory cytokine, tumor necrosis factor‑α (TNF‑α) upregulated CXCR4 expression in neuroblastoma cells and increased migration to the CXCR4 ligand SDF‑1α. In addition, this effect was dependent upon NF-κB transcriptional activity, as blocking the NF-κB pathway with pyrrolidinedithiocarbamic acid ammonium salt suppressed TNF-α‑induced upregulation of CXCR4 expression and reduced the migration towards the CXCR4 ligand, SDF-1α. Treating neuroblastoma cells with TNF-α resulted in the activation of nuclear factor-kappa B (NF-κB) and subsequently, the translocation of NF-κB from the cytoplasm to the nucleus. Using immunohistochemistry, NF‑κB and CXCR4 were significantly correlated with each other (P=0.0052, Fisher's exact test) in a cohort of neuroblastoma samples (n=80). The present study indicates that the inflammatory cytokine, TNF-α, partially functions through the NF‑κB signaling pathway to upregulate CXCR4 expression to foster neuroblastoma cell metastasis. These findings indicate that effective inhibition of neuroblastoma metastasis should be directed against the inflammatory cytokine-induced NF‑κB/CXCR4/SDF‑1α signaling pathway.


Dopant-Free Hole Transport Materials with a Long Alkyl Chain for Stable Perovskite Solar Cells.
Hole transport materials are indispensable to high efficiency perovskite solar cells. Two new hole transporting materials (HTMs), named 4,4'-(9-nonyl-9H-carbazole-3,6-diyl)bis (N,N-bis(4-methoxyphenyl)aniline) (CZTPA-1) and 4,4'-(9-methyl-9H-carbazole-3,6-diyl)bis (N,N-bis(4-methoxyphenyl)aniline)(CZTPA-2), were developed by different alkyl substitution methods. The two compounds, containing a carbazole core and triphenylamine (TPA) groups with different lengths of the alkyl chain, were designed and synthesized through a two-step synthesis approach. The power conversion efficiency (PCE) was found to be affected by the length of the alkyl chain, reaching 7% for CZTPA-1 and 11% for CZTPA-2. Furthermore, the CZTPA-2 still maintained 89.7% of its original performance after 400 h. The proposed results demonstrate the effect of carbon chain substituents on the efficiency of perovskite solar cells (PSCs).


Deep dyspareunia and sex life after laparoscopic excision of endometriosis.
Among subjects with endometriosis and deep dyspareunia (DD), those with endometriosis of the uterosacral ligament (USLE) have the most severe impairment of sexual function. This study examines the effect of laparoscopic excision of endometriosis on DD and quality of sex life. This observational cohort prospective study included 68 women with endometriosis suffering DD (intensity of pain >or= 6 on a 10-cm visual analogue scale). Patients underwent laparoscopic full excision of endometriosis. Following surgery, they were asked to use nonhormonal contraception devices. Before surgery, at 6- and at 12-month follow-up, patients answered a self-administered questionnaire based on the Sexual Satisfaction Subscale of the Derogatis Sexual Functioning Inventory. At 6- and 12-month follow-up, women with and without USLE had significant improvement in DD. Subjects with USLE reported increased variety in sex life, increased frequency of intercourse, more satisfying orgasms with sex, relaxing more easily during sex and being more relaxed and fulfilled after sex. Similar improvements were observed among women without USLE; however, for some variables statistical significance was not reached. Surgical excision of endometriosis improves not only DD but also the quality of sex life.


[Morphology and function of the human spleen. Enzyme histochemical and electron microscopy studies of the splenic lymphatic vessels, nerves and connective tissue structures].
Many questions concerning the morphology of the spleen have been cleared up in the last 20 years by the application of new methods of investigation, especially electron microscopy and enzyme histochemistry. With but a few exceptions, however, only the splenic parenchyma (the red and white pulp) were studied. Such special structures of the human spleen as nerves, lymphatic vessels and their supporting tissue, which may play an important role in the coordination and integration of the different functions of the white pulp (secondary lymphatic organ) and the red pulp (blood filter), were hardly ever studied with modern techniques. Investigating these structures light and electron microscopically and enzyme histochemically it was attempted to complete our present knowledge of the histology of the human spleen. In addition, by comparing the study of special altered spleens with experimental data it was attempted to clarify the importance of these structures for the physiology and pathology of the spleen. A total of 151 normal and pathologically altered spleens from the bioptic and autopsy material of the Pathological Institute of the University of Kiel were examined. In addition to conventional light microscopy the spleens were investigated enzyme histochemically and cytochemically, fluorescence microscopically and electron microscopically. The following enzyme reactions were done: Alkaline and acid phosphatase, alpha-naphthylacetate-esterase, naphthol-AS-acetate-esterase, 5'-nucleotidase, ATPase, and acetylcholinesterase. The various enzyme reactions were sometimes done in combination and reticulum and collagenous fibers were investigated by a subsequent staining of argyrophilic fibers. The fine localization of the 5'-nucleotidase activity was studied ultrahistochemically. Adrenergic nerve fibers were investigated fluorescence microscopically using the glyoxylic acid method.


Phase I study of vinflunine administered as a 10-minute infusion on days 1 and 8 every 3 weeks.
Vinflunine is a novel vinca alkaloid developed through the selective modification of vinorelbine using super-acidic chemistry. In preclinical testing, vinflunine demonstrated significantly enhanced anti-tumour activity in human tumour xenograft models when compared to its parent compound. A phase I study was conducted to evaluate the safety and toxicity of vinflunine administered as a 10 minute intravenous infusion on days 1 and 8 every three weeks. Sixteen patients with advanced solid tumours were treated. Two of four patients experienced dose limiting toxicities (DLT) at 190 mg/m2 and this was established as the maximum tolerated dose (MTD). At the MTD, the DLT of vinflunine consisted of constipation and neutropenia. Fatigue was notable but not dose limiting. No objective responses were observed. A dose of 170 mg/m2 given on a day 1 and 8 schedule every three weeks would be suitable for future studies.


How to use the picnic results.
Integrity Consulting Partners (ICP) is an independent consulting firm, specialising in healthcare ICT support, with a range of major projects delivered for European public healthcare clients in the areas of systems specification and design, procurement and project management of system implementations. ICP has had a strategic relationship with the General Medical Services (Payments) Board (GMS(P)B) in Ireland over a six year period, and has undertaken many key projects for the Board during that time. Accordingly, when the GMS(P)B became a partner in PICNIC, ICP were contracted to assist in the delivery of the project. In Phase 2 of PICNIC, when the GMS(P)B became the PICNIC Project Co-ordinator, project management and technical support in this role were provided by ICP. David Piggott lead the firm's work on PICNIC and facilitated the development of many key PICNIC deliverables, including the PICNIC Architecture and Exploitation Strategy. This chapter summarises the recommended approach to the implementation of the PICNIC concepts and standards, including a suggested way forward for procuring support on the deployment of the PICNIC products.


Preparation of a dispersible PEGylate nanostructured lipid carriers (NLC) loaded with 10-hydroxycamptothecin by spray-drying.
Nanostructured lipid carriers (NLC) are based on mixture of solid lipids with spatially incompatible liquid lipids, which offer advantages of improving drug loading capacity and release properties. In the present study, hydroxycamptothecin (HCPT) loaded polyethylene glycol (PEG) modified NLC (PEG-NLC) was prepared by high pressure homogenize and spray drying method. PEG-NLC showed spherical particle with smooth surface in scanning electron microscopic (SEM) analysis. The crystallinity of lipid matrix within PEG-NLC was evaluated by powder X-ray diffraction and differential scanning calorimetry (DSC). The less ordered crystals or amorphous state of matrix were found in nanoparticles. A small, homogeneous particle size and high drug loading with fine entrapment efficiency of HCPT was obtained in PEG-NLC system. HCPT releasing from PEG-NLC showed a sustained release trend, and no significantly difference was found between two release curves of PEG-NLC before or after spray drying. After storage for 6 months, PEG-NLC powder after spray drying showed no significantly changes in particle size, drug loading and entrapment efficiency, crystal form and in vitro release. PEG modification statistically decreased the phagocytosis of NLC by RAW 264.7 cells, and spray drying process did not influence the cellular uptake of PEG-NLC. These results suggest that PEG-NLC prepared by spray drying is a stable and high-performance delivery system for HCPT.


Diagnostic significance of angiographically observed visceral aneurysms with regard to polyarteritis nodosa.
During a 10-year period, intraparenchymal aneurysms were found in 38 of 748 patients at selective abdominal angiography with magnification technique. According to strict criteria, 17 patients were classified as suffering from necrotizing vasculitis of the polyarteritis nodosa group (PAN), 7 from severe arterial hypertension, and 3 from rheumatoid arthritis. The diagnoses of 5 patients remained to be confirmed, and each of the remaining 6 patients suffered from various other diseases. PAN was diagnosed histopathologically in 2 patients without angiographic aneurysms. Based on the 156 patients in whom the indication for angiography was suspicion of arteritis, the angiographic diagnosis of PAN had a sensitivity of 89 percent and a specificity of 90 percent, a positive predictive value of 55 percent and a negative predictive value of 98 percent. The mean number of both renal and hepatic aneurysms was higher in patients with PAN than in the other patients (p less than 0.01 and p less than 0.05, respectively). Five PAN patients had numerous and large aneurysms, whereas the aneurysms of the other 12 PAN patients did not differ from those of patients with other diseases. Patients with PAN had renal infarcts more often than the other patients (p less than 0.05). Our findings suggest that visceral angiography is useful in establishing the diagnosis of PAN, but the angiographic finding of aneurysms is not pathognomonic.


[Disposal of insulin syringes by diabetic patients. Report of 100 patients].
Elimination of syringes and needles is regulated in hospitals. However, the regulations remain unknown of diabetic patients who do not eliminate correctly their syringes of insulin. We propose to analyze the present situation concerning the management of used syringes of insulin by diabetic patients. This study was conducted in a clinic for diabetics and it involved 100 diabetic patients treated with insulin. The results of this study shaved an insufficiency in the management of syringes of insulin by diabetic patients. Thus, education and a conscionsness-raising of diabetic patients on management and correct use of syringes are necessary.


First-Trimester Pregnancy Exposure to Venlafaxine or Duloxetine and Risk of Major Congenital Malformations: A Systematic Review.
Major depressive disorder is common among women in child-bearing age, and medical treatment is subject to substantial discussions and controversies. For Selective Serotonin reuptake inhibitors, SSRIs, a vast amount of data are available. For the newer antidepressant group of serotonin and noradrenaline reuptake inhibitors, SNRIs, significantly less data are available. Following the PRISMA guideline for systematic reviews, we performed a systematic search on the risk of major congenital malformations after first trimester in utero exposure to venlafaxine or duloxetine. We identified eight cohort studies reporting on the outcome upon in utero exposure to venlafaxine or duloxetine during the first trimester. The cumulated data for venlafaxine were 3186 exposed infants and 107 major malformations, resulting in a relative risk estimate and 95% confidence interval of 1.12 (0.92-1.35). The corresponding data for duloxetine were 668 infants and 16 major malformations, resulting in a relative risk estimate and 95% confidence interval of 0.80 (0.46-1.29). First-trimester in utero exposure to venlafaxine is not associated with an increased risk of major congenital malformations. The amount of data for duloxetine are significantly smaller but does not suggest a clinically important increased risk.


Myosin-10 and actin filaments are essential for mitotic spindle function.
Mitotic spindles are microtubule-based structures responsible for chromosome partitioning during cell division. Although the roles of microtubules and microtubule-based motors in mitotic spindles are well established, whether or not actin filaments (F-actin) and F-actin-based motors (myosins) are required components of mitotic spindles has long been controversial. Based on the demonstration that myosin-10 (Myo10) is important for assembly of meiotic spindles, we assessed the role of this unconventional myosin, as well as F-actin, in mitotic spindles. We find that Myo10 localizes to mitotic spindle poles and is essential for proper spindle anchoring, normal spindle length, spindle pole integrity, and progression through metaphase. Furthermore, we show that F-actin localizes to mitotic spindles in dynamic cables that surround the spindle and extend between the spindle and the cortex. Remarkably, although proper anchoring depends on both F-actin and Myo10, the requirement for Myo10 in spindle pole integrity is F-actin independent, whereas F-actin and Myo10 actually play antagonistic roles in maintenance of spindle length.


Putting the "receive" in accounts receivable.
There isn't a practice in the United States that doesn't have a concern about accounts receivable. The financial success of any practice depends on the care and feeding of the accounts receivable. This is not an area of practice management that can be taken lightly or delegated to someone who is not attentive to detail and doggedly persistent. In this article, we will discuss how to identify problematic accounts receivable and what can be done to bring the accounts receivable under control. We will provide you with a plan of action that can be adopted by any practice regardless of size, number of physicians, or whether the practice uses in-house billing or outsources its billing arrangements.


Extensive mitochondrial heteroplasmy in the neotropical ants of the Ectatomma ruidum complex (Formicidae: Ectatomminae).
We assembled mitogenomes from 21 ant workers assigned to four morphospecies (E. ruidum spp. 1-4) and putative hybrids of the Ectatomma ruidum complex (E. ruidum spp. 2x3), and to E. tuberculatum using NGS data. Mitogenomes from specimens of E. ruidum spp. 3, 4 and 2 × 3 had a high proportion of polymorphic sites. We investigated whether polymorphisms in mitogenomes are due to nuclear mt paralogues (numts) or due to the presence of more than one mitogenome within an individual (heteroplasmy). We did not find loss of function signals in polymorphic protein-coding genes, and observed strong evidence for purifying selection in two haplotype-phased genes, which indicate the presence of two functional mitochondrial genomes coexisting within individuals instead of numts. Heteroplasmy due to hybrid paternal leakage is not supported by phylogenetic analyses. Our results reveal the presence of a fast-evolving secondary mitochondrial lineage of uncertain origin in the E. ruidum complex.


Trans-optic suture fixation of malpositioned intraocular lenses.
To report a technique for fixating posterior chamber intraocular lenses (PCIOLs) to the sclera by passing sutures through the lens material. Cases in which PCIOLs were fixated to the sclera using trans-optic sutures were included in this series. Intra and post-operative complications were recorded, and lens position was assessed using slit-lamp examination. Fourteen cases were included in this series. In nine cases, the procedure was performed using 9-0 polypropylene in pseudophakic eyes to correct subluxation, centration, tilt or to replace a broken haptic. In five cases, this technique was used for primary PCIOL fixation using a flanged 6-0 polypropylene suture in aphakic eyes. In all cases, the lenses remained centered and stable at the end of follow-up, and no post-operative complications occurred. Trans-optic suturing is a safe and effective alternative method for fixation of IOLs in a variety of pseudophakic and aphakic clinical scenarios.


Culturally and linguistically diverse patients' views of multimorbidity and general practice care.
It is recognised that patients who are culturally and linguistically diverse (CALD) have challenges in accessing health care and understanding health advice or instructions. Those with multimorbidity (MM) are likely to have additional difficulties. In New Zealand, little is known about how this patient group view their health and general practice health care. This study examined the views of multimorbid CALD patients about MM and the health care available in a Very Low Cost Access general practice. This qualitative study recruited Samoan, Cook Island Ma¯ori , and Cambodian patients with diabetes and more than three other long-term conditions. Two individual interviews and two language-specific focus groups were undertaken to yield themes representing the experience of these CALD patients with MM. Participants described MM as having considerable impact on their life. They reported feeling responsible for supporting their own health and many detailed self-management techniques. However, they also expressed confusion, lack of information and limited understanding of MM, in particular about managing medication. Not all patients were aware of the range of available general practice services and some described difficulties in accessing general practice care. Despite being motivated to self-manage, this patient group report challenges in understanding their conditions and how to manage them, which may also be influenced by health beliefs. Available general practice services are not well known by CALD patients with MM. There is likely to be value in developing a specific structured, yet patient-centred, model of care for this group of patients.


Identification of a male-produced aggregation pheromone in the western flower thrips Frankliniella occidentalis.
Two major components have been detected in the headspace volatiles of adult male Frankliniella occidentalis (Pergande) (Thysanoptera: Thripidae) that are not present in the headspace volatiles of adult females. The compounds were identified as (R)-lavandulyl acetate and neryl (S)-2-methylbutanoate by comparison with synthetic standards using gas chromatography (GC), GC mass spectrometry (MS), and chiral GC. Field trials were conducted with synthetic compounds in naturally infested crops of sweet pepper grown in large plastic greenhouses in Spain. The catch of adult females and males on blue sticky traps was increased by neryl (S)-2-methylbutanoate alone or by a 1:1 blend of (R)-lavandulyl acetate and neryl (S)-2-methylbutanoate, but (R)-lavandulyl acetate was not active alone. This is the first identification of an aggregation pheromone in the order Thysanoptera. The possible role of (R)-lavandulyl acetate is discussed.


Distinguishing direct from indirect interactions in oscillatory networks with multiple time scales.
We propose a method to infer the coupling structure in networks of nonlinear oscillatory systems with multiple time scales. The method of partial phase synchronization allows us to infer the coupling structure for coupled nonlinear oscillators with one well-defined time scale. The case of oscillators with multiple time scales has remained a challenge until now. Here, we introduce partial recurrence based synchronization analysis to tackle this challenge. We successfully apply the proposed method to model systems and experimental data from coupled electrochemical oscillators. The statistical significance of the results is evaluated based on a surrogate hypothesis test.


A new phenylpropanoid and a new isoflavone glycoside from Shenqi Fuzheng Injection.
A new phenylpropanoid and a new isoflavone glycoside were isolated from Shenqi Fuzheng Injection. Their structures were elucidated as (αS)-α-ethenyl-4-hydroxy-3-methoxy-benzenemethanol (1) and calycosin 7-O-[α-d-glucopyranosyl (1 → 4)]-β-d-glucopyranoside (2) by means of spectroscopic methods including UV, IR, HR-ESI-MS, and NMR. The absolute configurations of 1 and 2 were confirmed by quantum chemical calculation and acid hydrolysis.


Carumonam versus ceftazidime for urinary tract infections.
Carumonam is a new monobactam antibiotic with potent activity against gram-negative aerobes. To study the efficacy and safety of carumonam for treatment of complicated and uncomplicated urinary tract infections, 54 patients were randomized to therapy with either carumonam or ceftazidime. Of 42 patients who could be evaluated, 82% of the carumonam-treated patients and 80% of the ceftazidime-treated patients were cured clinically. At 5 to 9 days posttherapy, microbiologic criteria indicated that 13 carumonam-treated patients (48%) and 8 ceftazidime-treated patients (53%) were cured. Patients with indwelling bladder catheters at the end of therapy had a markedly worse microbiologic outcome than those without catheters. Enterococcus sp. reinfection was common in both groups. Possible adverse clinical and laboratory reactions occurred in six carumonam-treated patients (21%) and four ceftazidime-treated patients (27%). Most reactions occurred at the end of therapy and resolved with discontinuation of the study drug. In this small study, carumonam appeared as safe and as effective as ceftazidime for the treatment of complicated and uncomplicated urinary tract infections.


Characteristic Muscular FDG Uptake Patterns Related to the Transportation Means Used by Patients to Visit the Hospital.
It is well-known that physiological FDG uptake in the skeletal muscles is affected by serum insulin levels and the extent to which the muscles contract before the examination. Patients are instructed to refrain from strenuous exercise, talking too much, and taking meals at least 4 hours before the administration of the tracer. Even if the patient does not intend to exercise, muscular accumulation related to specific behaviors can still be visualized in the images. In this manuscript, we present FDG PET/CT images from 4 cases reflecting the mode of transportation used by the patients to visit the hospital.


[Leiomyoma of the large bowel].
The authors present a case study of a 48 year old man who was admitted to the hospital because of gall stone disease and a palpable abdominal tumour. Diagnostic laparoscopy was performed: chronic cholecystitis and an apple size tumour were found. The tumour was connected with colon ascendens. Laparotomy was performed and both the tumour and gallbladder were removed. The histological examination showed leiomyoma of the large bowel.


Cytologically negative pericardial effusion complicating combined modality therapy for localized small-cell carcinoma of the lung.
A 17% frequency of cytologically negative pericardial effusion (CNPE), accompanied in some cases by tamponade, occurred a median of 12.6 months from the onset of treatment for localized small-cell carcinoma of the lung. CNPE was apparently caused by toxicity of radiation/chemotherapy treatment rather than recurrent cancer. The occurrence of CNPE does not appear to represent enhanced toxicity of immediate (as opposed to delayed) concurrent chemoradiotherapy, but may be a consequence of the superior survival status of patients treated in this way. The onset of chest pain and/or dyspnea associated with increase in cardiac silhouette and positive echocardiogram allowed accurate diagnosis. Each instance was relatively easily managed by catheter drainage, and, for some patients, with the addition of nonsteroidal antiinflammatory drugs. It is important to recognize the possibility that a radiation/chemotherapy-related syndrome of pericardial effusion/tamponade may occur so that early diagnosis can be made and the risk of fatal tamponade avoided.


Treatment of patients with multiple myeloma: an overview of systematic reviews.
Individual studies rarely provide definitive answers to questions related to the effects of treatments. Whether the treatment is associated with more good than harm is best answered by considering the totality of evidence on the topic through the methodology of systematic reviews. The objective of this overview is to summarize all existing systematic reviews on treatments in multiple myeloma (MM), which accounts for 14% of new cases of hematological malignancies each year. Therefore, MEDLINE and the Cochrane Database of Systematic Reviews were systematically searched to identify systematic reviews of interventions. Data were extracted on patients, interventions, control and outcomes. Methodological quality of the systematic reviews was assessed using the AMSTAR assessment tool. Eleven systematic reviews on treatment of MM were included in the overview. Ten addressed seven unique questions and also performed a meta-analysis. One addressed 21 clinical questions related to treatment decisions in myeloma. The quality of systematic reviews varied. The results from the overview show that early treatment does not offer survival benefit. Thalidomide is associated with improved survival when added to standard chemotherapy regimens as induction or maintenance therapy but at the expense of an increased risk of serious adverse events, such as venous thromboembolism. High-dose therapy with single autologous hematopoietic stem cell transplant (AHCT) is associated with superior event-free but not overall survival compared to chemotherapy. Tandem AHCT does not prolong survival but is associated with better event-free survival in comparison to single AHCT. In addition, combination treatment with bisphosphonates reduces pathological vertebral fractures and pain, but does not prolong survival. We found no systematic review evaluating the effects of other novel agents, such as bortezomib or lenalidomide, as single agents or in combinations. Several key clinical questions have been successfully answered by conducting systematic reviews. However, currently many questions of importance for the management of patients with myeloma continue to be dealt with in individual studies instead of synthesized evidence. There is urgent need to perform research synthesis of data related to the effects of novel agents.


The anabolic activity of bone tissue, suppressed by disuse, is normalized by brief exposure to extremely low-magnitude mechanical stimuli.
It is generally believed that mechanical signals must be large in order to be anabolic to bone tissue. Recent evidence indicates, however, that extremely low-magnitude (<10 microstrain) mechanical signals readily stimulate bone formation if induced at a high frequency. We examined the ability of extremely low-magnitude, high-frequency mechanical signals to restore anabolic bone cell activity inhibited by disuse. Adult female rats were randomly assigned to six groups: baseline control, age-matched control, mechanically stimulated for 10 min/day, disuse (hind limb suspension), disuse interrupted by 10 min/day of weight bearing, and disuse interrupted by 10 min/day of mechanical stimulation. After a 28 day protocol, bone formation rates (BFR) in the proximal tibia of mechanically stimulated rats increased compared with age-matched control (+97%). Disuse alone reduced BFR (-92%), a suppression only slightly curbed when disuse was interrupted by 10 min of weight bearing (-61%). In contrast, disuse interrupted by 10 min per day of low-level mechanical intervention normalized BFR to values seen in age-matched controls. This work indicates that this noninvasive, extremely low-level stimulus may provide an effective biomechanical intervention for the bone loss that plagues long-term space flight, bed rest, or immobilization caused by paralysis.


Self-Reported Usage, Functional Benefit, and Audiologic Characteristics of Cochlear Implant Patients Who Use a Contralateral Hearing Aid.
Ninety-four unilateral CI patients with bimodal listening experience (CI plus HA in contralateral ear) completed a questionnaire that focused on attitudes toward hearing aid use postimplantation, patterns of usage, and perceived bimodal benefits in daily life. Eighty participants continued HA use and 14 discontinued HA use at the time of the questionnaire. Participant responses provided useful information for counseling patients both before and after implantation. The majority of continuing bimodal (CI plus HA) participants reported adapting to using both devices within 3 months and also reported that they heard better bimodally in quiet, noisy, and reverberant conditions. They also perceived benefits including improved sound quality, better music enjoyment, and sometimes a perceived sense of acoustic balance. Those who discontinued HA use found either that using the HA did not provide additional benefit over the CI alone or that using the HA degraded the signal from the CI. Because there was considerable overlap in the audiograms and in speech recognition performance in the unimplanted ear between the two groups, we recommend that unilateral CI recipients are counseled to continue to use the HA in the contralateral ear postimplantation in order to determine whether or not they receive functional or perceived benefit from using both devices together.


Laser desorption mass spectrometry of synthetic lipid A-like compounds.
The applicability and the present limitations of the laser microprobe mass analyser LAMMA -500 as an instrument for the structural analysis of higher molecular weight, non-volatile, bio-organic compounds (less than or equal to 2000 u) were investigated. For this purpose mass spectra of various synthetic and natural compounds representing cell wall components of Gram-negative bacteria, e.g. phospholipids and lipid A-like molecules were studied. In several cases these spectra exhibited relatively simple and interpretable patterns with a prominent quasi-molecular ion originating from alkali attachment. For one group of the compounds studied--synthetic lipid A-like molecules containing a phosphate moiety--the spectra were rather complicated and lacked pronounced quasi-molecular peaks. Possible reasons for this observation are discussed.


Laser-induced liquid-to-droplet extraction of chlorophenol: photothermal phase separation of aqueous triethylamine solutions.
Thermal phase separation of aqueous triethylamine (TEA) solutions (TEA wt % = 6.5-6.7 in H2O) was induced by irradiating a focused 1064-nm laser beam (spot size approximately 1 mum) under an optical microscope, and this produced a single micrometer-sized TEA droplet as demonstrated by in situ Raman microspectroscopy. Since H2O absorbs 1064-nm light, heat is generated at the focal spot of the incident laser beam, giving rise to photothermal phase separation of the aqueous TEA solution. The TEA droplet produced by phase separation was trapped simultaneously by the incident laser beam. In the presence of p-chlorophenol (CP) in an aqueous TEA solution, laser-induced photothermal phase separation and simultaneous TEA droplet formation brought about extraction/concentration of CP from the surrounding solution phase to the TEA droplet (approximately 15-mum diameter and 1.7-pL volume). Raman microspectroscopy demonstrated that the distribution coefficient of CP (KD) between the solution phase and the single TEA droplet was KD(drop) = approximately 21, while that in a bulk TEA/H2O system was KD(bulk) = 4.7. The larger KD(drop) value as compared to KD(bulk) was discussed in terms of radiation pressure exerted on CP in the TEA droplet.


The diagnosis of autism and autism spectrum disorder in low- and middle-income countries: Experience from Jamaica.
The administration requirements of the Autism Diagnostic Observation Schedule and the Autism Diagnostic Interview-Revised, widely used in high-income countries, make them less feasible for diagnosis of autism spectrum disorder in low- and middle-income countries. The flexible administration requirements of the Childhood Autism Rating Scale have resulted in its use in both high-income countries and low- and middle-income countries. This study examines the agreement between assessments using the Childhood Autism Rating Scale with those using the Autism Diagnostic Observation Schedule or Autism Diagnostic Observation Schedule, Second Edition and Autism Diagnostic Interview-Revised in Jamaica. Children aged 2-8 years (n = 149) diagnosed with autism by an experienced clinician using the Childhood Autism Rating Scale were re-evaluated using the Autism Diagnostic Observation Schedule and Autism Diagnostic Interview-Revised. The proportion diagnosed with autism spectrum disorder using the Autism Diagnostic Observation Schedule, Autism Diagnostic Observation Schedule, Second Edition, and Autism Diagnostic Interview-Revised was determined and mean domain scores compared using analysis of variance (ANOVA). The mean age was 64.4 (standard deviation = 21.6) months; the male:female ratio was 6:1. The diagnostic agreement of the Childhood Autism Rating Scale with the Autism Diagnostic Observation Schedule and Autism Diagnostic Observation Schedule, Second Edition was 100.0% and 98.0%, respectively. Agreement with the Autism Diagnostic Interview-Revised was 94.6%. Domain scores were highest for children with more severe symptoms (p < 0.01). Despite a high level of agreement of the Childhood Autism Rating Scale with the Autism Diagnostic Observation Schedule, Autism Diagnostic Observation Schedule, Second Edition, and Autism Diagnostic Interview-Revised, the Childhood Autism Rating Scale should be evaluated further with a broader range of autism spectrum disorder symptomatology, and by clinicians with varying experience before recommendation for use in low- and middle-income countries.


Observational study on the use of remifentanil in general anesthesia. Drug utilisation research.
The use of remifentanil in routine clinical practice during the induction and maintenance of general anesthesia as well as the quality of awakening after anesthesia and post-operative pain management have been assessed. A total of 123 Italian anesthetists were involved; data of 1 295 patients (ASA I-IV) undergoing surgical interventions (range duration of intervention 30-240 min), in which remifentanil was used according to internal anesthesiologic procedures, have been collected. The most common modality of anesthesia induction is to use a syringe pump to start remifentanil administration. The remifentanil dosage mainly used to start the infusion was 0.2 mg/kg/min (29.2% of patients), as well as at the beginning of maintenance of anesthesia (35.1%). During maintenance of anesthesia, 36% of surgical interventions did not need changes of remifentanil infusion rate, whereas in the rest of the intervention 1 to 4 changes were done. The induction of anesthesia is predominantly intravenous with concomitant use of propofol and TPS, whereas the agents most frequently used during maintenance were sevoflurane (49.8%), nitrous oxide (43.7%) and propofol (35.2%). Awakening was mainly judged rapid in 93% of interventions; the postoperative pain at awakening was judged nil in 61% of cases and severe in 1.5%. The administration of analgesic treatment mainly started prior to the end of intervention (70% cases). This Drug Utilisation Research study demonstrated that the use of remifentanil according to its peculiar pharmacological profile, such as potent opioid with rapid onset and offset of action, the synergistic effect with propofol and the right management of post-operative pain are widely consolidated in Italian clinical practice.


Regulation of the transcription of parathyroid-hormone/parathyroid-hormone-related peptide receptor mRNA by dexamethasone in ROS 17/2.8 osteosarcoma cells.
Previous studies have shown that dexamethasone enhanced the expression of parathyroid-hormone/parathyroid-hormone-related peptide (PTH/ PTHrP) receptor mRNA in ROS 17/2.8 osteosarcoma cells. The aim of this study was to determine whether the induction of PTH/PTHrP receptor expression in such osteoblast-like cells is regulated at the gene level. Dexamethasone increased the steady-state levels of PTH/PTHrP receptor mRNA twofold at 6 h, and nearly threefold at 24 h. The half-life of the PTH/PTHrP receptor mRNA, in the presence of actinomycin D, was 6 h both in untreated and in dexamethasone-treated cells. When measured by nuclear run-on assay, the rate of PTH/PTHrP receptor gene transcription was increased twofold at 24 h. PTH/PTHrP receptor mRNA expression was blocked completely after 24 h of treatment with cycloheximide. The binding of PTH/PTHrP to their receptor required the synthesis of new protein and was shown to be specifically dependent on the interaction of dexamethasone with the glucocorticoid receptor. These data indicate that the enhancing effect of dexamethasone on PTH/PTHrP receptor expression is rapid, requires de novo protein synthesis, and increases the transcription rate of the PTH/PTHrP receptor gene.


First transcatheter valve-in-valve implantation in an apicoaortic conduit.
Apicoaortic conduit surgery is an option for treating severe aortic stenosis. The implanted conduit valve may eventually fail and require replacement; this is usually performed by repeat surgery. Treating the conduit valve with a standard transcatheter heart valve is an option that has become feasible in recent years. We describe a case of a failed 23 mm CE bioprosthesis that was successfully treated with a 23 mm Sapien XT valve as a valve-in-valve procedure. © 2017 Wiley Periodicals, Inc.


Integration of graphene and two-dimensional ferroelectrics: properties and related functional devices.
Ferroelectric (FE) thin films have been investigated for many years due to their broad applications in electronic devices. It was recently demonstrated that FE functionality persists in ultrathin films, possibly even in monolayers of two-dimensional (2D) FEs. However, the feasibility of 2D-based FE functional devices remains an open challenge. Here, we employ density-functional-theory calculations to propose and document the possible integration of graphene with 2D FE materials on metal substrates in the form of functional FE devices. We show that monolayers of proposed M2O3 (M = Al, Y) in the quintuple layer (QL) In2Se3 structure are stable 2D FE materials and that QL-M2O3 is a functional tunnel barrier in a graphene/QL-M2O3/Ru heterostructure. The QL-M2O3 barrier width can be modulated by its polarization direction, whereby the heterostructure can function as a prototype ferroelectric tunnel junction. Moreover, alternating the polarization of QL-M2O3 modulates the doping type of graphene, enabling the fabrication of graphene p-n junctions. By design, the proposed heterostructures can in principle be fabricated by intercalation, which is known to produce high-quality, large-scale 2D-based heterostructures.


Human botfly infestation: the tip of the iceberg.
A retired man in his 60s was referred to the on call orthopaedic team by his general practitioner following several attempts to extricate a human botfly larva from his forearm. While on holiday in Belize with his daughter 8 weeks previously they both were bitten by some insects. She developed an infestation which was treated locally. Once back in the UK, he subsequently reported of localised itching and discomfort. A botfly larva was successfully removed in the emergency department following local anaesthetic infiltration.


Factors affecting the continuing education of hospital CEOs and their senior managers.
This article examines the influences on executives' continuing education in hospitals. It uses data from a national survey on professional development conducted in 2009 by the American College of Healthcare Executives (ACHE) to explore how organizational and individual characteristics are related to the amount of continuing education (CE) taken by chief executive officers (CEOs) and the commitment to CE by their senior managers. Our findings suggest that the organizational characteristics of ownership, size, and region and the individual characteristics of gender, professional affiliation, and the focus of CE may influence how much CE CEOs take. CEOs from for-profit, larger hospitals and ACHE members tend to take less CE. Likewise, senior managers' commitment to CE is influenced by region, gender, the CEO's personal CE hours, and the focus of the CE. Surprisingly, ACHE membership is associated with lower amounts of personal CEO CE. Also, female CEOs appear to engender greater commitment to CE in their senior managers. Finally, CE focused on change increases the senior managers' commitment, while a focus on new technology lessens it. For those organizations seeking to meet current and future challenges by creating a learning organization, CE is essential. Understanding factors that influence the amount of and commitment to CE is important. We hope our research adds to this understanding and that leaders will seek to improve the dedication and value of CE in their organizations.


Smile Restoration of a Dental Anxiety Patient Using Same-Day Chairside CAD/CAM and Esthetic Zirconia.
This clinical case study describes the smile restoration of a 33-year-old female patient who exhibited severe dental anxiety, multiple cavities, discoloration, and a fractured tooth. The patient's complex dental history and anxiety-driven treatment preferences posed challenges that were met with a minimally invasive strategy. The case involved meticulous diagnosis, leveraging advanced diagnostic wax-ups, and a comprehensive treatment plan. Esthetic zirconia material was utilized to enable the preservation of tooth structure while achieving visually appealing and functional outcomes, and CAD/CAM technology facilitated same-day restorations with superior marginal fit, aided by the precision of a digital intraoral scanner. The patient's dental anxiety strongly influenced the treatment approach, leading to the integration of smile enhancement alongside caries treatment. The use of a single cement and bond product simplified the final cementation process, while the versatility of the zirconia CAD/CAM material allowed for fabrication of various restoration types with minimal tooth reduction. This streamlined workflow expedited treatment, which was especially crucial for the anxious patient undergoing sedation.


Crystals in an oligodendroglioma: an optical, histochemical, and ultrastructural study.
The report describes an oligodendroglioma that was examined in four biopsies and contained a large number of intracytoplasmic crystals. The crystals appeared in neoplastic cells with eosinophilic cytoplasms and eccentric nuclei. They were positive to periodic acid-Schiff stain and resistant to diastase. A lysosomal genesis of the crystals is proposed on the basis of a transition observed between lysosomal bodies with lipid droplets and those with crystalloid electron-dense structures. The morphologic and histochemical features of these crystals are compared to those in other tumors, lesions, and nonneoplastic cells.


Analysis of the Spinopelvic Parameters in Patients with Fragility Fractures of the Pelvis.
We investigated the spinopelvic parameters of lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS) in patients with fragility fractures of the pelvis (FFPs). We hypothesized that these parameters differ from asymptomatic patients. All patients treated for FFPs in a center of maximal care of the German Spine Society (DWG) between 2017 and 2021 were included. The inclusion criteria were age ≥ 60 years and the availability of a standing lateral radiograph of the spine and pelvis in which the spine from T12 to S1 and both femoral heads were visible. The baseline characteristics and study parameters were calculated and compared with databases of asymptomatic patients. The two-sample t-Test was performed with p < 0.05. The study population (n = 57) consisted of 49 female patients. The mean age was 81.0 years. The mean LL was 47.9°, the mean PT was 29.4°, the mean SS was 34.2° and the mean PI was 64.4°. The mean value of LLI was 0.7. LL, LLI and SS were significantly reduced, and PI and PT were significantly increased compared to asymptomatic patients. The spinopelvic parameters in patients with FFPs differ significantly from asymptomatic patients. In patients with FFPs, LL, LLI and SS are significantly reduced, and PI and PT are significantly increased. The sagittal spinopelvic balance is abnormal in patients with FFPs.


Isolation of a cytoplasmic polyhedrosis virus by physical and immunological techniques.
Procedures are described for the separation and purification of cytoplasmic polyhedrosis viruses obtained from multiply infected Heliothis armigera larvae. Separation was achieved by differential centrifugation and density gradient zone electrophoresis followed by complexing with nuclear polyhedrosis virus specific antibody. The yield of cytoplasmic polyhedrosis virus was increased by passage in larvae reared on synthetic media.


Estimation of resting state effective connectivity in epilepsy using direct-directed transfer function.
There has been an increasing demand among neuroscientists to understand the complex network of functionally connected neural assemblies in the human brain. For this purpose, computational EEG research is widely used by researchers due to its remarkable advantage in providing high temporal resolution, and ease of analysis across different frequency bands. Here we analyzed Electrocorticographic (ECoG) signals of electrodes placed on frontal-parietal neocortex brain region of 8 pediatric epileptic patients. In order to evaluate the directed causal relationship among different brain regions, we employed a Granger causality based multivariate connectivity estimator named direct Directed Transfer Function (dDTF) to identify signal propagations among the selected set of electrode in the frequency range 1-50Hz. A consistent network pattern emerged that was unique to each patient. The fidelity of such dDTF-derived connectivity patterns can support a clearer understanding of effective connectivity in epileptic networks.


Prevalence of Bovine Tuberculosis in Egyptian Cattle and the Standardization of the Interferon-gamma Assay as an Ancillary Test.
Bovine tuberculosis (bTB) caused primarily by Mycobacterium bovis continues to cause significant losses in the cattle industry and is a major public health problem. Despite its worldwide application, the IFN-γ assay has not been applied in Egypt. The aim of this study was to determine the appropriate cut-off value of IFN-γ assay to complement the skin test screening in Egypt. The relative sensitivity (Ser ) of PPD and antigen cocktail-based IFN-γ assays (IFN-γ-BA and IFN-γ-EC) was analysed retrospectively, relative to bTB confirmatory tests (culture and PCR), using single cervical tuberculin (SCT) test reactors during 2011-2013. The absolute specificity (Sp) was studied using blood samples collected from cattle from one bTB-free herd. Analysis of the bTB database-generated sheets indicates the infection rate had decreased from 2009 to 2012 and then increased in 2013. The disease is concentrated in the Egyptian Nile Delta and Valley relative to elsewhere in the country. The cut-offs for IFN-γ-EC assay could be optimized to provide higher sensitivity, comparable to cut-offs for IFN-γ-BA assay. Data analysis suggests (PPDbOD > 0.1, PPDbOD - NILOD > 0.05 and PPDbOD > PPDaOD ) and (ECOD - NILOD ≥ 0.1) cut-off strategies to get optimal IFN-γ-BA and IFN-γ-EC assays results respectively. To our knowledge, this is the first report describing the prevalence of bTB in cattle in Egypt and pointing out the appropriate cut-off criteria to optimize IFN-γ assay as a routine ancillary test for diagnosis of bTB in Egypt.


Three disparately regulated genes for sigma 32-like transcription factors in Bradyrhizobium japonicum.
Bradyrhizobium japonicum possesses a subclass of heat-shock genes whose members are transcribed from a sigma 32 consensus promoter. Having identified previously one gene (rpoH1) encoding a sigma 32-like RNA polymerase transcription factor, we report here the characterization of two additional rpoH-like genes (rpoH2 and rpoH3). B. japonicum thus represents the first example of an organism possessing an rpoH multigene family. All three rpoH genes encode functional proteins that are able to initiate transcription from the Escherichia coli groE promoter. Each rpoH gene is apparently regulated by a different mechanism. Although both rpoH1 and rpoH2 are transcribed from sigma 70-type promoters, transcription of the rpoH1 operon was found to be heat inducible by an unknown mechanism, whereas the level of rpoH2 mRNA decreased after heat shock. At extreme temperatures (48 degrees C), rpoH2 was transcribed from a second promoter that resembled the E. coli sigma E-type promoter. The rpoH3 gene was found to be associated with two upstream genes, ragA and ragB, coding for a classical two-component regulatory system. Transcription initiated from a promoter that mapped in front of the putative response regulator gene ragA, suggesting that ragA, ragB and rpoH3 are organized in an operon. The ragA promoter was similar to a sigma 32 consensus promoter. The three B. japonicum rpoH genes also varied in their significance to support growth of the organism. While the rpoH2 gene could not be eliminated by mutation, knock-out mutants of rpoH1 and/ or rpoH3 were readily obtained and shown to be indistinguishable from the wild type under aerobic growth conditions or during root-nodule symbiosis. We conclude that rpoH2 is essential for the synthesis of cellular proteins under physiological growth conditions, whereas rpoH1, and probably also rpoH3, are involved in their synthesis during the stress response.


Medication reconciliation during transitions of care as a patient safety strategy: a systematic review.
Medication reconciliation identifies and resolves unintentional discrepancies between patients' medication lists across transitions in care. The purpose of this review is to summarize evidence about the effectiveness of hospital-based medication reconciliation interventions. Searches encompassed MEDLINE through November 2012 and EMBASE and the Cochrane Central Register of Controlled Trials through July 2012. Eligible studies evaluated the effects of hospital-based medication reconciliation on unintentional discrepancies with nontrivial risks for harm to patients or 30-day postdischarge emergency department visits and readmission. Two reviewers evaluated study eligibility, abstracted data, and assessed study quality. Eighteen studies evaluating 20 interventions met the selection criteria. Pharmacists performed medication reconciliation in 17 of the 20 interventions. Most unintentional discrepancies identified had no clinical significance. Medication reconciliation alone probably does not reduce postdischarge hospital utilization but may do so when bundled with interventions aimed at improving care transitions.


Integrated state of subgenomic fragments of hepatitis B virus DNA in hepatocellular carcinoma from mainland China.
Hepatocellular carcinoma (HCC) samples from mainland China were examined for the presence and state of hepatitis B virus (HBV) DNA sequences. HBV DNA was detected by dot-blot hybridization in 13 of 17 cases of HCC from the Shanghai area and in three of six samples from Hangzhou. The HCC cases from Shanghai were then analyzed in more detail. Fifteen of the 17 patients had serologic evidence of past or present infection with HBV (with inadequate information available for the other two), and the 13 HCC samples positive for HBV DNA all came from serologically positive patients. Southern blot analysis showed that the HBV DNA sequences were always integrated in the HCC high-molecular-weight DNA; only one or two viral copies were present per tumor cell, and no common integration site was evident. Hybridization analyses using subgenomic probes of HBV DNA revealed that the tumors seldom retained an entire HBV genome. HBV S-region sequences were always present, X-region sequences were usually represented, and C-region sequences were rarely detectable in virus-positive tumors. A fragment within the HBV DNA X-region, between nucleotides 1441 and 1526, was found to hybridize nonspecifically with cellular DNA; reported sequence data indicated that this fragment would contain approximately 70% guanine + cytosine. Histologic sections were prepared from some of the frozen tissue specimens and stained by an indirect immunoperoxidase technique for hepatitis B surface antigen (HBsAg). Only 1 of 10 HBV DNA-positive samples contained HBsAg in the cytoplasm of tumor cells, although abundant HBsAg was present in adjacent normal cells in all 10 cases. There were no significant differences in histology between HCC that contained HBV DNA sequences and those that were virus negative. These data support the premise that HBV represents a major etiologic factor in the development of HCC in the Shanghai area of China, although the molecular basis of viral involvement remains obscure.


Alignment of the hydrogen molecule under intense laser fields.
Alignment of the electronically excited E,F state of the H2 molecule is studied using the velocity mapping imaging technique. Photofragment images of H+ due to the dissociation mechanism that follows the 2-photon excitation into the (E,F; ν = 0, J = 0) electronic state show a strong dependence on laser intensity, which is attributed to the high polarizability anisotropy of the H2 (E,F) state. We observe a marked structure in the angular distribution, which we explain as the interference between the prepared J = 0 and Stark-mixed J = 2 rovibrational states of H2, as the laser intensity increases. Quantification of these effects allows us to extract the polarizability anisotropy of the H2 (E,F J = 0) state yielding a value of 312 ± 82 a.u. (46 Å3). By comparison, CS2 has 10 Å3, I2 has 7 Å3, and hydrochlorothiazide (C7H8ClN3O4S2) has about 25 Å3 meaning that we have created the most easily aligned molecule ever measured, by creating a mixed superposition state that is highly anisotropic in its polarizability.


[Analysis of 39 children with acute necrotizing encephalopathy].
Objective: To investigate the risk factors for death in children with acute necrotizing encephalopathy (ANE) in pediatric intensive care unit (PICU). Methods: This was a multicenter retrospective study. Thirty-nine children with ANE were from PICUs in 4 centers from December 1, 2014 to December 1, 2020. The 4 participating centers were Beijing Children's Hospital, Shengjing Hospital of China Medical University, Hebei Children's Hospital, and Bao'an Maternity & Child Health Hospital. Patients were divided into survival and non-survival groups by the outcome at discharge, and the differences in clinical data between the two groups were compared. Risk factors for death in children with ANE and the odds ratios (OR) were analyzed by univariable Logistic regression. Results: Thirty-nine children with ANE were included. There were 18 males and 21 females. The median onset age was 30 months. The mortality at discharge was 41% (16/39). The onset age of most patients (74%, 29/39) was younger than 4 years old. Influenza virus was the most common precursor infection (80%, 20/25). Patients with shock at PICU admission were more common in the non-survival group (12/16 vs. 17% (4/23), P=0.001). Glasgow coma score (GCS) at PICU admission was significantly lower in the non-survival group than survival group (3 (3, 6) vs. 6 (5, 7), Z=-2.598, P=0.009). The optimal cut-off value was 4. The proportion of patients with GCS ≤ 4 at PICU admission was higher in the non-survival group (10/16 vs. 22% (5/23), P=0.018). ANE severity score (ANE-SS) at PICU admission was significantly higher in the non-survival group (5 (2, 6) vs. 2 (1, 4), Z=-2.436, P=0.015). The proportion of patients with high risk ANE-SS was higher in non-survival group than the survival group (9/16 vs. 22% (5/23), P=0.043). The proportion of application of high-dose methylprednisolone (20 mg/(kg·d)) was significantly higher in survival group than non-survival group (43% (10/23) vs. 1/13, P=0.031). Univariable Logistic regression indicated that risk factors for death in children with ANE were shock (OR=14.250, 95%CI 2.985-68.018, P=0.001), GCS≤4 (OR=6.000, 95%CI 1.456-24.733, P=0.013) and high risk ANE-SS (OR=4.629, 95%CI 1.142-18.752, P=0.032) at PICU admission. Conclusions: ANE usually occurs in children under 4 years old after influenza infection. Shock, GCS≤4 and high risk ANE-SS at PICU admission were risk factors for death in children with ANE. High-dose methylprednisolone may improve the prognosis of children with ANE.


Rectum adenocarcinoma metabolic subtypes analysis and a risk prognostic model construction based on fatty acid metabolism genes.
Fatty acid metabolism is an essential part of cancer research due to its role in cancer initiation and progression. However, its characteristics and prognostic value in rectum adenocarcinoma have not been systematically evaluated. We collected fatty acid metabolism gene expression profiles and clinical information from the cancer genome atlas and gene expression omnibus databases. After excluding individuals lacking clinical information and the presence of genetic mutations, we performed consistent clustering of the remaining patients and selected stable clustering results to group patients. Differentially expressed genes and gene set enrichment analysis were compared between subgroups, while metabolic signature identification and decoding the tumor microenvironment were performed. In addition, we explored the survival status of patients among different subgroups and identified signature genes affecting survival by least absolute shrinkage and selection operator regression. Finally, we selected signature genes to construct a risk prognostic model by multivariate Cox regression and evaluated model efficacy by univariate Cox regression and the receiver operating characteristic curve. By consensus clustering, patients were distinguished into 2 stable subpopulations, gene set enrichment analysis and metabolic signature identification effectively defined 2 completely different subtypes of fatty acid metabolism: fatty acid catabolic subtype and fatty acid anabolic subtype. Among them, patients with the fatty acid catabolic subtype had a poorer prognosis, with a significantly lower proportion of myeloid dendritic cells infiltration within the tumor microenvironment. Aquaporin 7 (hazard ratio, HR = 2.064 (1.4408-4.5038); P < .01), X inactive specific transcript (HR = (0.3758-0.7564), P = .045) and interleukin 4 induced 1 (HR = 1.34 (1.13-1.59); P = .034), were selected by multivariate Cox regression, which constructed a risk prognostic model. The independent hazard ratio of the model was 2.72 and the area under curve was higher than age, gender and tumor stage, showing better predictive efficacy. Our study revealed the heterogeneity of fatty acid metabolism in rectum adenocarcinoma, defined 2 completely distinct subtypes of fatty acid metabolism, and finally established a novel fatty acid metabolism-related risk prognostic model. The study contributes to the early risk assessment and monitoring of individual prognosis and provides data to support individualized patient treatment.


Genome-wide association study reveals five nucleotide sequence variants for carcass traits in beef cattle.
Genetic associations of nucleotide sequence variants with carcass traits in beef cattle were investigated using a genome-wide single nucleotide polymorphism (SNP) assay. Three hundred and thirteen Korean cattle were genotyped with the Illumina BovineSNP50 BeadChip, and 39,129 SNPs from 311 animals were analysed for each carcass phenotype after filtering by quality assurance. Five sequence markers were associated with one of the meat quantity or quality traits; rs109593638 on chromosome 3 with marbling score, rs109821175 on chromosome 11 and rs110862496 on chromosome 13 with backfat thickness (BFT), and rs110228023 on chromosome 6 and rs110201414 on chromosome 16 with eye muscle area (EMA) (P < 1.27 × 10(-6) , Bonferonni P < 0.05). The ss96319521 SNP, located within a gene with functions of muscle development, dishevelled homolog 1 (DVL1), would be a desirable candidate marker. Individuals with genotype CC at this gene appeared to have increased both EMA and carcass weight. Fine-mapping would be required to refine each of the five association signals shown in the current study for future application in marker-assisted selection for genetic improvement of beef quality and quantity.


A combination of bimalleolar fracture and fracture on talar body and neck: A rare case report.
Talar fracture accompanied with malleolar fracture is rare, and its management is complex. Ankle soft tissue is much thinner than other parts of the human body, and the shape of the ankle makes wounds difficult to close immediately after surgery, which may result in poor skin condition if the wound tension is too high. However, joint congruity and osteonecrosis are the main concerns of talar fracture. A 57-year-old man presented at the emergency department following a motorcycle accident. Physical examination revealed swelling and tenderness of the left ankle and midfoot. The patient had comminuted talar fracture and was indicated for dual-screw fixation or even plate with screw fixation. We performed single screw fixation after assessing the soft tissue condition and employed a technique of using continuous longitudinal force to bring together fracture fragments (ankle ligamentotaxis) during surgery. Open reduction with a mini-hook plate and tension band wire was used for bimalleolar fracture repair using the combined anteromedial and anterolateral approach with extension of the incision. Kirschner wire for temporary fixation was performed using ligamentotaxis, and a 2.4 headless screw was inserted from the posteromedial to the anterolateral direction. The patient was discharged with a standard short leg splint and was instructed not to bear weight on the affected ankle for 2 months. The patient walked well without discomfort, and the Hawkins sign was clearly visible. Single screw fixation preserves the integrity of the talus bone as minimal space is used for this operative technique. Single screw fixation preserves more bony stock when most of the internal fixator is located within the bone. Additionally, surgery time is shorter than multiple implantations even when performing the same procedure; as a result, there was less ankle soft tissue swelling. This case provides evidence of using the single screw fixation technique for addressing both malleolar and talar fractures, and that talar fracture management can be less aggressive with limited weight bearing and initial limited range of motion given the presence of malleolar fracture. The alignment and stability of bony fragments also benefit from ankle ligamentotaxis.


The Actin Cytoskeleton at the Immunological Synapse of Dendritic Cells.
Dendritic cells (DCs) are considered the most potent antigen-presenting cells. DCs control the activation of T cells (TCs) in the lymph nodes. This process involves forming a specialized superstructure at the DC-TC contact zone called the immunological synapse (IS). For the sake of clarity, we call IS(DC) and IS(TC) the DC and TC sides of the IS, respectively. The IS(DC) and IS(TC) seem to organize as multicentric signaling hubs consisting of surface proteins, including adhesion and costimulatory molecules, associated with cytoplasmic components, which comprise cytoskeletal proteins and signaling molecules. Most of the studies on the IS have focused on the IS(TC), and the information on the IS(DC) is still sparse. However, the data available suggest that both IS sides are involved in the control of TC activation. The IS(DC) may govern activities of DCs that confer them the ability to activate the TCs. One key component of the IS(DC) is the actin cytoskeleton. Herein, we discuss experimental data that support the concept that actin polarized at the IS(DC) is essential to maintaining IS stability necessary to induce TC activation.


Non-beta-cell islet abnormalities in noninsulin-dependent diabetes mellitus.
Although there are abnormalities in the function of pancreatic alpha, delta, and PP cells in NIDDM, only in the case of the glucagon-secreting alpha cells is there sufficient evidence to indicate that these abnormalities may be metabolically important. But the cause of abnormal glucagon secretion remains to be established. Studies of delta-cell secretion have been hampered by the inability to determine the source of circulating somatostatin-like immunoreactivity and the failure to distinguish between the potential molecular species being measured. Pancreatic polypeptide remains a hormone in search of a metabolic function; the main use of its measurement may be in the study of parasympathetic nervous system function in NIDDM.


[Specific features of cognitive impairments in patients with predialysis chronic kidney disease].
To study the specific features of cognitive impairments (CI) in patients with predialysis chronic kidney disease (CKD). Examinations were made in 51 patients aged 52 +/- 10 years with CKD, including 20 patients with Stages I-II CKD (glomerular filtration rate (GFR) > or = 60 ml/min/1.73 m2; signs of kidney lesion), 20 with Stage III (GFR 60-30 ml/min/1.73 m2), and 11 with Stage IV (GFR 30-15 ml/min/1.73 m2). GFR was estimated using the Modification of Diet in Renal Disease (DMRD) formula. The authors made a questionnaire survey to identify day-to-day activity limitations and depressions and performed neuropsychological tests using the mini-mental state examination (MMSE), a frontal assessment battery (FAB) for frontal lobe dysfunction, a short-term and delayed memory test (Luria's 10 words test), and a regulatory function assessment test (RFAT). Magnetic resonance imaging (MRI) was carried out to clarify the etiology of CI. CI was detected more frequently in the patients with chronic renal failure (CRF) (Stages III-IV CKD) than in those without CRF (Stages I-II CKD) (in 90.3 and 35%, respectively (p < 0.001)). CI was statistically significantly more frequently found using MMSE (p < 0.001), FAB (p = 0.001), and RFAT (p < 0.001). There was a statistically significant rise in the magnitude of CI with the higher stage of CKD, as shown by MMSE, FAB, and RFAT, other than the short-term and delayed memory test. Brain MRI in the patients with CI revealed focal changes in 9 (30%) patients, leukoaraiosis in 7 (23.3%), lateral cerebral ventricular dilatation in 15 (50%), and markedly dilated hemispheric sulci in 3 (10%). The higher stage of CKD is associated with the increased incidence and magnitude of CI, as evidenced by MMSE, and with those of anterior brain dysfunctions. The comparisons of clinical and MRI findings suggest that cerebrovascular disorders underlie CI in CKD.


[Supportive care in bone marrow failure. Technical, immunological and clinical advances].
Supportive care with blood component transfusions has greatly improved prognosis in patients with bone marrow failure. This progress has made possible by newly developed techniques for separation of blood cells and by a better understanding of the antigenicity of human blood cells and of immunologic reactions following their transfusion. Transfusion of white cell and platelet-poor red cell preparations prevent alloimmunization to leukocyte and platelet-bound alloantigens, or non-hemolytic transfusion reactions in already alloimmunized patients. Alloimmunization can be circumvened and effective long-term platelet support to thrombocytopenic patients can be provided by matching donor and recipient for HL-A antigens. The place of granulocyte transfusion in clinical therapy has yet to be defined, although their usefulness in infected granulocytopenic patients is suggested by the few studies reported so far.


The neuroscience of positive memory deficits in depression.
Adults with unipolar depression typically show poor episodic memory for positive material, but the neuroscientific mechanisms responsible for this deficit have not been characterized. I suggest a simple hypothesis: weak memory for positive material in depression reflects disrupted communication between the mesolimbic dopamine pathway and medial temporal lobe (MTL) memory systems during encoding. This proposal draws on basic research showing that dopamine release in the hippocampus is critical for the transition from early- to late-phase long-term potentiation (LTP) that marks the conversion of labile, short-term memories into stable, long-term memories. Neuroimaging and pharmacological data from healthy humans paint a similar picture: activation of the mesolimbic reward circuit enhances encoding and boosts retention. Unipolar depression is characterized by anhedonia-loss of pleasure-and reward circuit dysfunction, which is believed to reflect negative effects of stress on the mesolimbic dopamine pathway. Thus, I propose that the MTL is deprived of strengthening reward signals in depressed adults and memory for positive events suffers accordingly. Although other mechanisms are important, this hypothesis holds promise as an explanation for positive memory deficits in depression.


The true toughness of human cortical bone measured with realistically short cracks.
Bone is more difficult to break than to split. Although this is well known, and many studies exist on the behaviour of long cracks in bone, there is a need for data on the orientation-dependent crack-growth resistance behaviour of human cortical bone that accurately assesses its toughness at appropriate size scales. Here, we use in situ mechanical testing to examine how physiologically pertinent short (<600 microm) cracks propagate in both the transverse and longitudinal orientations in cortical bone, using both crack-deflection/twist mechanics and nonlinear-elastic fracture mechanics to determine crack-resistance curves. We find that after only 500 microm of cracking, the driving force for crack propagation was more than five times higher in the transverse (breaking) direction than in the longitudinal (splitting) direction owing to major crack deflections/twists, principally at cement sheaths. Indeed, our results show that the true transverse toughness of cortical bone is far higher than previously reported. However, the toughness in the longitudinal orientation, where cracks tend to follow the cement lines, is quite low at these small crack sizes; it is only when cracks become several millimetres in length that bridging mechanisms can fully develop leading to the (larger-crack) toughnesses generally quoted for bone.


Best uses of p-values and complementary measures in medical research: Recent developments in the frequentist and Bayesian frameworks.
The p-value is a classical proposal of statistical inference, dating back to the seminal contributions by Fisher, Neyman and E. Pearson. However, p-values have been frequently misunderstood and misused in practice, and medical research is not an exception. In recent years, in several statistical and applied journals, a debate erupted about the need of clear guidelines in reporting p-values, which culminated with the publication of the ASA statement in 2016. In this paper, we assess strengths and limitations of p-values and we assert that in applied research the p-value should be supplemented by other measures, such as the Bayes factor, the Bayes false discovery rate and the local Bayes false discovery rate. We also review a recent proposal by Bayarri et al. from a Bayesian perspective that has the advantage of introducing an indicator, the rejection odds, which keeps into account both pre- and post-experimental information, and could also have a straightforward frequentist interpretation. We conduct a delimited numerical study that investigates on the relation of the Bayes factor with its maximum, and of the local Bayes false discovery rate with its minimum under different distributional assumptions and parameter choices. We illustrate the concepts expressed in theory with an example in clinical oncology, namely a randomized trial on the effectiveness of a new chemotherapy for patients with AIDS and Kaposi's sarcoma.


Calf vein compliance increases following bed rest after aortocoronary bypass surgery.
Early post-operative ambulation (< 3 days) is expected to decrease the risk of venous thrombosis, whereas late ambulation (> 7 days) increases the risk of orthostatic hypotension. The effect of post-operative bed rest on calf vein compliance was studied before (D - 1) and 7 days (D + 7) after aortocoronary bypass surgery in 50 patients (41 men and nine women, 65 +/- SD 10 years). Calf vein compliance was measured by strain gauge plethysmography and stepwise increases in thigh congestive pressure from 20 to 60 mmHg. Calf compliance [median (25 percentile-75 percentile)] increased significantly by 48% from D - 1 to D + 7 [0.044 (0.039-0.051) vs. 0.065 (0.048-0.083) ml (100 ml mmHg)-1, P < 0.001]. This increase was reflected as increased calf volume for the 50 mmHg [D-1 2.10 (1.75-2.65) vs. D + 7 2.60 (1.70-3.00) ml 100 ml-1, P < 0.01] and 60 mmHg [D - 1 2.50 (2.10-2.95) vs. D + 7 3.20 (2.30-4.00) ml 100 ml-1, P < 0.001] occlusion pressure levels. The associated pathologies (diabetes and arterial hypertension) and NYHA grades had no significant influence on the increase in compliance. Among the vasoactive therapeutic regimens, calcium channel blockers contributed significantly to the increased calf compliance, but only on D-1. The increase in venous compliance following aortocoronary bypass surgery is multifactorial but should be considered for prophylactic management of these patients.


A BODIPY-luminol chemiluminescent resonance energy-transfer (CRET) cassette for imaging of cellular superoxide.
Spectroscopic and in cellulo studies are here reported on the very first BODIPY-luminol chemiluminescent resonance energy-transfer (CRET) cassette where the luminol CL agent is covalently linked to the BODIPY energy-transfer acceptor in a molecular dyad. The efficiency of intramolecular CRET investigated for the BODIPY-luminol dyad was found to be 64% resulting in a dual emissive response. Successful in cellulo biochemiluminescence via CRET was achieved in PMA activated splenocytes.


Malformations attributed to the process of vascular disruption.
Several malformations have been attributed to the process of vascular disruption. The central hypothesis for this etiology is that blood flow to a structure has been altered after that structure had formed normally. The decreased blood flow leads to hypoxia, endothelial cell damage, hemorrhage, tissue loss, and repair. After recovery, some structures are normal and others show either tissue loss or structural abnormalities, such as syndactyly and constriction rings. The phenotypic features of the 7,020 infants with one or more malformations, who were born to women who had always planned to deliver at Brigham and Women's Hospital (BWH) between, 1972 and 2012, that is, maternal nontransfers, were reviewed. The phenotypes associated with vascular disruption, such as the amniotic band syndrome and terminal transverse limb defects (TTLD), were identified. One hundred and five fetuses and infants had malformations attributed to the process of vascular disruption. Some specific causes of the amniotic band limb deformity were identified. TTLD with associated small digit-like nubbins occurred at three levels: proximal forearm, wrist, and metacarpal-phalangeal joint. Other causes included severe hemoglobinopathies and exposures to misoprostol and to prenatal procedures. Malformations attributed to the process of vascular disruption were a distinctive entity, among the recognized etiologies. The timing of the causative event in the first trimester was established for infants with exposures to either the prostaglandin misoprostol or the prenatal diagnosis procedure chorionic villus sampling. One challenge is to identify the developmental steps in vascular disruption when no causative exposure can be identified.


Carbon-13 N.M.R. study of bleomycin-A2 protonation.
The acid-base titration of bleomycin-A2 in D2O solution at 35 +/- 5 degrees has been monitored by 13C n.m.r. spectroscopy at 67.89 MHz. The following pKDa values were obtained: 3.68 +/- 0.05 (secondary amine), 5.29 +/- 0.03 (imidazole), and 8.23 +/- 0.19 (primary amine), where KDa is the dissociation constant in D2O solution. The equilibrium isotope effects (pKDa--pKa in H2O) are: 0.70 +/- 0.06 (secondary amine), 0.28 +/- 0.04 (imidazole), and 0.85 +/- 0.19 (primary amine). Titration of the imidazole group of Bleo-A2 occurs at Npi, i.e. only Ntau is protonated in basic solution. Significant protonation shifts are almost completely limited to carbons of the N-terminal tetrapeptide, suggesting that the C-terminal tripeptide extends into the solvent and interacts to a minimal extent with the rest of the molecule. Long range protonation shifts associated with titration of the imidazole and secondary amine groups indicate that protonation of one or both of these sites is probably accompanied by significant conformational changes. The observed protonation shifts generally fail to correlate with Zn(II) complexation shifts reported by Dabrowiak et al. (1973, Biochemistry 17., 4090) indicating that ligation sites cannot unambiguously be determined from these complexation shifts. The complexation shifts previously attributed to coordination of the imidazole and carbamoyl groups probably result from conformational changes.


Residual pyruvate kinase activity in PKLR-deficient erythroid precursors of a patient suffering from severe haemolytic anaemia.
Here, we present a 7-year-old patient suffering from severe haemolytic anaemia. The most common cause of chronic hereditary non-spherocytic haemolytic anaemia is red blood cell pyruvate kinase (PK-R) deficiency. Because red blood cells rely solely on glycolysis to generate ATP, PK-R deficiency can severely impact energy supply and cause reduction in red blood cell lifespan. We determined the underlying cause of the anaemia and investigated how erythroid precursors in the patient survive. PK activity assays, Western blot and Sanger sequencing were employed to determine the underlying cause of the anaemia. Patient erythroblasts were cultured and reticulocytes were isolated to determine PK-R and PKM2 contribution to glycolytic activity during erythrocyte development. We found a novel homozygous mutation (c.583G>A) in the PK-R coding gene (PKLR). Although this mutation did not influence PKLR mRNA production, no PK-R protein could be detected in the red blood cells nor in its precursors. In spite of the absence of PK-R, the reticulocytes of the patient exhibited 20% PK activity compared with control. Western blotting revealed that patient erythroid precursors, like controls, express residual PKM2. We conclude that PKM2 rescues glycolysis in PK-R-deficient erythroid precursors.


Relationship between emotional intelligence, stress, and burnout among dental hygiene students.
Emotional intelligence (EI) is the recognition and management of emotions within oneself and others. Limited evidence exists that determine whether EI is related to stress and burnout. The purpose of this project was to determine whether relationships exist between EI, stress, and burnout levels among undergraduate dental hygiene students. This study used a quantitative cross-sectional research design. The study instrument consisted of 3 parts: (1) The Emotional Quotient Self-Assessment Checklist consisted of 30-questions in 6 domains and measured EI; (2) The Modified Dental Environment Stress Questionnaire consisted of 39 questions in 5 domains and measured stress; and (3) The Maslach Burnout Inventory-Health Services Survey consisted of 22 questions in 3 domains and measured burnout. The responses from 57 participants were used (response rate = 93.3%). A moderate negative correlation was found between self-control and personal stress and a moderate negative correlation was found between empathy and emotional evaluation. Moderate positive correlations were found between self-awareness, empathy, motivation, self-competence, self-confidence, and total EI scores and personal accomplishment. Multiple linear regression analysis found self-control was a significant predictor of personal stress (R2 = .023, P = .023); empathy and self-competence were significant predictors of clinical stress (R2 = .085, P = .034); empathy and self-awareness were significant predictors of emotional exhaustion (R2 = .071, P = 0.006); and empathy was a predictor of personal accomplishment (R2 = .150, P = 0.002). Subcomponents of EI were found to be significant predictors of stress and burnout levels. Future research is needed to improve EI levels to tolerate stress and minimize burnout levels.


The management of cytotoxic drug wastes in Shiraz, Iran: an overview of all government and private chemotherapy settings, and comparison with national and international guidelines.
Excessive use of cytotoxic drugs owing to a dramatic increase in malignancy incidence leads to the production of high amounts of cytotoxic wastes. In Iran, management of hazardous wastes has been neglected in recent decades. The aim of this study was to determine the amount of intravenous cytotoxic drug wastes, their collection and disposal status in chemotherapy wards, and to compare the current status with standard guidelines in Shiraz, Iran. This cross-sectional study was performed using data collected during 2 consecutive months, from 22 June to 22 August 2011, in all 13 chemotherapy wards in Shiraz. The amount of prescribed drugs, drugs waste, collection and disposal status of cytotoxic drugs were recorded. We then compared the current status of waste collection and disposal in our samples with our national guideline. The prescription of cytotoxic drugs and the amount of total drugs waste reached approximately 6 and 0.2 kilograms respectively. Total vials volume was calculated to be approximately 1000 l in order to estimate the volume of containers required for the encapsulation method. The results demonstrated that the current status of cytotoxic waste collection and disposal is inappropriate, and none of the facilities under study followed our guidelines perfectly. The adherence to all recommendations and guidelines was poorer in private wards than in government-run ones. The management of cytotoxic wastes is inappropriate and our existing national guidelines are lacking. Suggestions for the best management of cytotoxic waste are revising the existing guidelines, allocating a sufficient budget, training healthcare workers, providing multiple administration options of cytotoxic drugs and accomplishing a surveillance system.


Reprogramming phonologically similar utterances: the role of phonetic features in pre-motor encoding.
The effects of phonologic similarity on speech production latencies were investigated to explore the role of articulatory phonetic features and reprogramming operations during pre-motor stages of production. A form-based priming technique was used in five experiments to elicit rapid productions of single words. Subjects responded to visually presented pairs of minimally contrastive monosyllabic words, which varied with respect to the phonetic featural similarity of their onsets. Factors that were systematically manipulated across experiments included stimulus set size, duration of the interstimulus interval, and the use of feedback to subjects concerning their response latencies. Speech onset latencies obtained in a control condition in which no phonetic features were shared were compared to four other conditions in which the word initial phonemes of prime-target pairs did share features. Results revealed that shared manner was the most influential factor associated with the observed inhibitory phonologic similarity effect. In addition, smaller stimulus set size (6 words) yielded significantly slower overall response latencies than experiments employing larger stimulus sets (18 words). These findings suggested that inhibitory phonologic similarity effects did not stem from biomechanical constraints imposed by the articulatory system. Rather the methods employed in this investigation were supported as a means to investigate both the underlying units of representation and the processes involved in pre-motor planning apart from articulatory effects. The results of this investigation also supported the hypothesis that, during phonologic encoding, word form retrieval entails the selection and assembly of sublexical units into word form frames. No evidence of whole word retrieval during pre-motor encoding was obtained. The potential utility of this experimental paradigm in the investigation of pre-motor planning in disorders that putatively affect the processes involved in transforming word meaning into word form is also discussed.


Oxidizing Capacity of Iron Electrocoagulation Systems for Refractory Organic Contaminant Transformation.
Iron electrocoagulation (Fe EC) is normally considered as a separation process. Here, we found that Fe(II)-O2 interactions in Fe EC systems could produce reactive oxidants, mainly hydroxyl radicals (•OH), for refractory organic contaminant transformation. Production of reactive oxidants, probed by benzoate conversion to p-hydroxybenzoic acid (p-HBA), depended on dissolved oxygen (DO) concentration and Fe(II) speciation. Measurable levels of DO were required for significant p-HBA production. Fe precipitates evolved from lepidocrocite to magnetite when DO decreased to below the detection limit. Both experiments and kinetic modeling suggest that the main Fe(II) species contributing to reactive oxidants (mainly •OH) production changed from aqueous Fe(II) initially to lepidocrocite-sorbed Fe(II) with progressive precipitates formation. When DO was not measurable at high currents (≥50 mA or 100 mA/L), reactive oxidant production was ineffective because of pH rise and Fe(II) preservation in magnetite, but it could be enhanced drastically by aeration. The reactive oxidants produced at 30 mA (or 60 mA/L) could degrade about 47% of 10 μM aniline and 34% of sulfanilamide within 6 h of Fe EC treatment. Our findings highlight the importance of reactive oxidants for refractory organic contaminants oxidation in Fe EC systems.


The effects of age at photostimulation and dietary protein intake on reproductive efficiency in three strains of broiler breeders varying in breast yield.
The effects of strain, age at photostimulation, and dietary CP intake during the early lay period on sexual maturation and egg production parameters in broiler breeder hens were determined. Three Arbor Acres strains, Classic, Feather Sexable Yield (FSY), and an experimental line (EXP), were reared in floor pens. At 19 wk of age, pullets were moved into individual cages. At 20 wk of age one-half of the birds were photostimulated by increasing the day length from 8L:16D to 15L:9D. The remaining birds were photostimulated at 23 wk of age. The birds were fed 16 or 18% CP diets from 19 to 32 wk of age. The Classic hens achieved sexual maturity 4 d before the EXP hens. Delaying photostimulation to 23 wk of age delayed sexual maturity but the rate of sexual maturation was accelerated after photostimulation occurred. Egg weight at sexual maturity was higher for the later photostimulated birds. The FSY and EXP hens, selected for more white-meat yield than the Classic hens, were heavier in BW but had lower settable egg production than the latter. Feeding 18% CP resulted in a higher BW throughout the trial, as compared to the 16% CP diet. There was a response to dietary CP and photostimulation age on initial egg weight and the number of double-yolked eggs. Early photostimulation was not advantageous because egg production parameters were not affected. Both Classic and FSY strains performed well when fed 18% CP; however, EXP hens benefited from 16% CP intake.


Amniography in prenatal diagnosis.
The increasing use of prenatal diagnostic methods, including sonography and amniotic fluid analysis, has made it possible to suspect certain fetal defects at an early gestational age. In selected cases, accurate diagnosis of the specific malformation may have an effect on fetal and neonatal prognosis, and on prenatal counseling of the parents. As part of a large regional screening program for neural tube defects, we performed 28 midtrimester amniograms. We found 14 neural tube defects (nine spina bifida, four anencephaly, one Meckel syndrome), four abdominal wall defects, two tumors, and eight normal examinations. Radiographic examples of these malformations are presented, including previously undescribed findings in meningomyeloceles. The place of amniography in prenatal diagnosis is discussed.


Virtual imprinting as a tool to design efficient MIPs for photosynthesis-inhibiting herbicides.
Molecular modelling and computational screening were used to identify functional monomers capable of interacting with several different photosynthesis-inhibiting herbicides. The process involved the design of a virtual library of molecular models of functional monomers containing polymerizable residues and residues able to interact with the template through electrostatic, hydrophobic, Van der Waals forces and dipole-dipole interactions. Each of the entries in the virtual library was probed for its possible interactions with molecular models of the template molecules. It was anticipated that the monomers giving the highest binding score would represent good candidates for the preparation of affinity polymers. Strong interactions were computationally determined between acidic functional monomers like methacrylic acid (MAA) or itaconic acid (IA) with triazines, and between vinylimidazole with bentazone and bromoxynil. Nevertheless, weaker interactions were seen with phenylureas. The corresponding blank polymers were prepared using the selected monomers and tested in the solid phase extraction (SPE) of herbicides from chloroform solutions. A good correlation was found between the binding score of the monomers and the affinities of the corresponding polymers. The use of computationally designed blanks can potentially eliminate the need for molecular imprinting, (adding a template to the monomer mixture to create specific binding sites). Data also showed that some monomers have a natural selectivity for some herbicides, which can be further enhanced by imprinting. Thus, in regard to retention on the blank polymer, we can estimate if the resulting imprinted polymer will be effective or not.


Smartphone videos to predict the severity of obstructive sleep apnoea.
Diagnosis of obstructive sleep apnoea (OSA) is made on overnight polysomnography (PSG). Given the widespread availability of smartphone video technology, we aimed to develop and test a standardised scoring system for smartphone videos and compare these scores to PSG results. Children aged 1-16 years undergoing PSG for suspected OSA were included. Parents were asked to take 1-2 min videos of the breathing they were concerned about. Videos were scored using a newly developed and tested tool on five components: inspiratory obstructive noises (1-4), presence of obstructive events (0-1), increased work of breathing (0-1), mouth breathing (0-1) and neck extension (0-1). Video scores and the Obstructive Apnoea Hypopnoea Index (OAHI) were compared using Spearman correlation. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for different cut-off scores to achieve the best results. Videos from 43 children (28 men (65.1%), median age 5.7 years (range 2.6-14.0 years), median OAHI 3.8/hour (range 0-82 events/hour) were included. Nine children (20.9%) had a video score of <3, all of whom had an OAHI of ≤5 events/hour. For a video score of ≥3, sensitivity was 100%; specificity was 36%; positive predictive value was 53%; and negative predictive value 100% for moderate to severe OSA (OAHI>5 events/hour) . We have developed and validated a simple clinical tool (the Monash Obstructive Sleep Apnoea Video Score) to quantify abnormalities in breathing seen on short video recordings made on a smartphone. A low score rules out moderate-severe OSA and may be valuable in the triage of children with symptoms of OSA.


High-resolution electron microscopy of muscovite.
Images of the (001) planes of muscovite were observed by electron microscopy after embedment of clay-size flakes in epoxy resin and sectioning by ultramicrotome. Dislocation or growth planes were indicated. Incomplete exchange of potassium for barium produced zones with 20-angstrom periodicity, suggesting regular interstratification.


Hydrocele and endometriosis of the canal of Nuck in two adults: a look at the imaging features.
We present a report of two adult females who presented to the surgery clinic at different time frames in our hospital with a swelling in the inguinal region. The swelling was painful for one of our patients. The first patient was evaluated with a contrast-enhanced CT and an MRI, while the second patient underwent a ultrasonography and an MRI. Imaging revealed the structure to be cystic in nature and confirmed the diagnosis as a hydrocele of the canal of Nuck in both patients. Our second patient was also found to have concomitant endometriosis, with internal septations seen in the hydrocele. Aspiration revealed altered blood with haemosiderin deposition, which established a diagnosis of endometriosis of the canal of Nuck. The first patient underwent excision, while the second patient refused a surgical approach and opted for medical management for endometriosis.


Placebo-controlled study of rTMS for the treatment of Parkinson's disease.
The objective of this study is to assess the safety and efficacy of repetitive transcranial magnetic stimulation (rTMS) for gait and bradykinesia in patients with Parkinson's disease (PD). In a double-blind placebo-controlled study, we evaluated the effects of 25 Hz rTMS in 18 PD patients. Eight rTMS sessions were performed over a 4-week period. Four cortical targets (left and right motor and dorsolateral prefrontal cortex) were stimulated in each session, with 300 pulses each, 100% of motor threshold intensity. Left motor cortex (MC) excitability was assessed using motor evoked potentials (MEPs) from the abductor pollicis brevis. During the 4 weeks, times for executing walking and complex hand movements tests gradually decreased. The therapeutic rTMS effect lasted for at least 1 month after treatment ended. Right-hand bradykinesia improvement correlated with increased MEP amplitude evoked by left MC rTMS after individual sessions, but improvement overall did not correlate with MC excitability. rTMS sessions appear to have a cumulative benefit for improving gait, as well as reducing upper limb bradykinesia in PD patients. Although short-term benefit may be due to MC excitability enhancement, the mechanism of cumulative benefit must have another explanation.


Environmentally friendly gamma-MnO2 hexagon-based nanoarchitectures: structural understanding and their energy-saving applications.
Although about 200,000 metric tons of gamma-MnO(2) are used annually worldwide for industrial applications, the gamma-MnO(2) structure is still known to possess a highly ambiguous crystal lattice. To better understand the gamma-MnO(2) atomic structure, hexagon-based nanoarchitectures were successfully synthesized and used to elucidate its internal structure for the present work. The structural analysis results, obtained from the hexagon-based nanoarchitectures, clearly show the coexistence of akhtenskite (epsilon-MnO(2)), pyrolusite (beta-MnO(2)), and ramsdellite in the so-called gamma-MnO(2) phase and verified the heterogeneous phase assembly of the gamma-MnO(2) state, which violates the well-known "De Wolff" model and derivative models, but partially accords with Heuer's results. Furthermore, heterogeneous gamma-MnO(2) assembly was found to be a metastable structure under hydrothermal conditions, and the individual components of the heterogeneous gamma-MnO(2) system have structural similarities and a high lattice matches with pyrolusite (beta-MnO(2)). The as-obtained gamma-MnO(2) nanoarchitectures are nontoxic and environmentally friendly, and the application of such nanoarchitectures as support matrices successfully mitigates the common problems for phase-change materials of inorganic salts, such as phase separation and supercooling-effects, thereby showing prospect in energy-saving applications in future "smart-house" systems.