[Alcoholism--development and treatment from the psychoanalytic viewpoint].
Based on psychoanalytical explanatory models 4 groups of alcoholics can be distinguished: 1. Alcoholics with severe character disorder use their drug as a mean of self-punishment by self-destruction. 2. Alcoholics with low ego strength use alcohol as a stimulus barrier in an attempt at self-healing. 3. In predominantly neurotic patients alcohol consumption is considered as a regression to an oral level of drive satisfaction. 4. Alcoholism as a reaction to adverse life events is not adequately taken into account by classical analytical theory. Depending on the predominant level of personal pathology differential treatment indications are recommended.


Recovery after abdominal wall reconstruction.
Incisional hernia is a common long-term complication to abdominal surgery, occurring in more than 20% of all patients. Some of these hernias become giant and affect patients in several ways. This patient group often experiences pain, decreased perceived body image, and loss of physical function, which results in a need for surgical repair of the giant hernia, known as abdominal wall reconstruction. In the current thesis, patients with a giant hernia were examined to achieve a better understanding of their physical and psychological function before and after abdominal wall reconstruction. Study I was a systematic review of the existing standardized methods for assessing quality of life after incisional hernia repair. After a systematic search in the electronic databases Embase and PubMed, a total of 26 studies using standardized measures for assessment of quality of life after incisional hernia repair were found. The most commonly used questionnaire was the generic Short-Form 36, which assesses overall health-related quality of life, addressing both physical and mental health. The second-most common questionnaire was the Carolinas Comfort Scale, which is a disease specific questionnaire addressing pain, movement limitation and mesh sensation in relation to a current or previous hernia. In total, eight different questionnaires were used at varying time points in the 26 studies. In conclusion, standardization of timing and method of quality of life assessment after incisional hernia repair was lacking. Study II was a case-control study of the effects of an enhanced recovery after surgery pathway for patients undergoing abdominal wall reconstruction for a giant hernia. Sixteen consecutive patients were included prospectively after the implementation of a new enhanced recovery after surgery pathway at the Digestive Disease Center, Bispebjerg Hospital, and compared to a control group of 16 patients included retrospectively in the period immediately prior to the implementation of the pathway. The enhanced recovery after surgery pathway included preoperative high-dose steroid, daily assessment of revised discharge criteria and an aggressive approach to restore bowel function (chewing gum and enema on postoperative day two). Patients who followed the enhanced recovery after surgery pathway reported low scores of pain, nausea and fatigue, and were discharged significantly faster than patients in the control group. A non-significant increase in postoperative readmissions and reoperations was observed after the introduction of the enhanced recovery after surgery pathway. Study III and IV were prospective studies of patients undergoing abdominal wall reconstruction for giant incisional hernia, who were compared to a control group of patients with an intact abdominal wall undergoing colorectal resection for benign or low-grade malignant disease. Patients were examined within a week preoperatively and again one year postoperatively. In study III, the respiratory function and respiratory quality of life were assessed, and the results showed that patients with a giant incisional hernia had a decreased expiratory lung function (peak expiratory flow and maximal expiratory pressure) compared to the predicted values and also compared to patients in the control group. Both parameters increased significantly after abdominal wall reconstruction, while no other significant changes were found in objective or subjective measures at one-year follow-up in both groups of patients. Lastly, study IV examined the abdominal wall- and extremity function, as well as overall and disease specific quality of life. We found that patients with a giant hernia had a significantly decreased relative function of the abdominal wall compared to patients with an intact abdominal wall, and that this deficit was offset at one-year follow-up. Patients in the control group showed a postoperative decrease in abdominal wall function, while no changes were found in extremity function in either group. Patients reported improved quality of life after abdominal wall reconstruction. In summary, the studies in this thesis concluded that; standardization of patient-reported outcomes after incisional hernia repair is lacking; enhanced recovery after surgery is feasible: after abdominal wall reconstruction and seems to lower the time to discharge; patients with giant incisional hernia have compromised expiratory lung function and abdominal wall function, both of which are restored one year after abdominal wall reconstruction.


Monotherapy of hypertension with darodipine: a new calcium-channel blocker.
Calcium-channel blockers are increasingly used as single agents for the treatment of essential hypertension. Following three weeks of single-blind placebo therapy, 43 patients with essential hypertension were randomized into four groups. Group 1 (10 patients) received placebo twice a day, Group 2 (13 patients) received darodipine (PY 108-068) 50 mg twice a day, Group 3 (9 patients) received darodipine 100 mg twice a day, and Group 4 (11 patients) received darodipine 150 mg twice a day. Patients were seen in the clinic weekly for 4 weeks. Clinical and laboratory evaluations were done on each patient. Darodipine caused a sustained decrease in the supine and standing systolic and diastolic blood pressure (p less than .001) and there were no significant pressure differences between the three drug dosages. The effects of the drug on heart rate were not consistent. Placebo had no effect on either blood pressure or heart rate. Side effects were few, mild, and consisted of headaches and peripheral edema, and did not necessitate discontinuation of the drug. No metabolic abnormalities were seen with either low or high doses of the drug. We conclude that: (1) darodipine is effective, safe, and well tolerated; (2) its antihypertensive effectiveness is similar at high and low doses, although the higher doses seemed to have a slightly greater effect on the diastolic arterial pressure; (3) the low dose may be preferable since side effects were dose related.


Electronic applications for the CFQ-R scoring.
Patient reported outcomes (PROs) have become widely accepted outcome measures in cystic fibrosis (CF) and other respiratory diseases. The Cystic Fibrosis-Questionnaire-Revised (CFQ-R) is the best validated and most widely used PRO for CF. Data collection can be time-intensive, and electronic platforms would greatly facilitate the feasibility, utility and accuracy of administration of the CFQ-R. Given that the CFQ-R is utilized in virtually all clinical trials worldwide and is increasingly integrated into clinical practice, we developed a software application that will help users to administer, score and save CFQ-R data for all versions. All codes are open access, which will enable other PRO users to design similar applications for other respiratory diseases, such as primary ciliary dyskinesia and non-CF bronchiectasis.


Mood instability and functional recovery in bipolar disorders.
The aim of this study was to identify psychopathological factors associated with long-term functional outcome in euthymic bipolar disorder patients and to test new measures of mood instability and symptoms intensity. Fifty-five patients with more than 12 months of follow-up were included. In addition to traditional clinical variables, the time spent ill was documented using a modified life-charting technique based on NIHM life-charting method. New measures, Mood Instability Factor, and Mood Intensity Factor were defined and assessed. Functioning Assessment Short Test (FAST) was used to assess disability. The follow-up period was 3.00 ± 1.51 years. Weeks with subsyndromal depressive symptoms (β = 0.133, t = 2.556, P = 0.014), weeks with mild manic symptoms (β = 1.441, t = 3.10, P = 0.003), and the Mood Instability Factor (β = 0.105, t = 3.593, P = 0.001) contributed to approximately 46% of the FAST total score variance. New methodologies including subsyndromal symptoms and mood instability parameters might contribute to understand the worse long-term functional outcome that affects a considerable percentage of BD patients even after episode remission. Concerns about therapeutic approaches are discussed.


Perioperative cardiac arrest in the operating room environment: a review of the literature.
Cardiac arrest in the operating room (OR) environment is a rare but potentially catastrophic event with mortality rates of more than 50%. Contributing factors are known, and the event is generally rapidly recognized, as patients are usually under full monitoring. The nature of the cardiac arrest in the OR is different to other environments as it is not only related to the patient's conditions but likewise to the anaesthetic and the surgical procedure. The aim of this article is to review recent literature on cardiac arrest in the immediate perioperative environment with a focus on incidence, causes and treatment. Retrospective analysis of literature published in PubMed. Several recent retrospective registry studies have investigated the incidence of perioperative cardiac arrest; in non-cardiac surgery patients, the incidence is reported to range from 0.2 to 1.1 per 10,000 adults and from 1.4 to 4.6 per 10,000 children. Successful management of cardiac arrest during surgery and beyond requires not only individual technical skills and a well-organized team response, but also an institutional safety culture embedded in everyday practice through continuous education, training and multidisciplinary cooperation. Evidence based guidelines and standardized treatment algorithms addressing the particularities of peri-operative cardiac arrest would be helpful to facilitate training. Existing guidelines are not comprehensive enough to cover specific aspects in depth; for the future, more detailed and more explicit guidelines are required.


Cost-effectiveness analysis of herpes simplex virus testing and treatment strategies in febrile neonates.
To determine the clinical effectiveness and cost-effectiveness of testing for and empirically treating herpes simplex virus (HSV) infection in neonates with fever aged from birth to 28 days. Cost-effectiveness analysis. Decision model. Neonates with fever with no other symptoms and neonates with fever with cerebrospinal fluid (CSF) pleocytosis. Four clinical strategies: (1) HSV testing and empirical treatment while awaiting test results; (2) HSV testing and treatment if test results were positive for HSV or the patient had symptoms of HSV; (3) treatment alone without testing; or (4) no HSV testing or treatment unless the patient exhibited symptoms. The 2 HSV testing methods used were CSF HSV polymerase chain reaction (PCR) and comprehensive evaluation with blood HSV PCR, CSF HSV PCR, and multiple viral cultures. Twelve-month survival and quality-adjusted life expectancy with a cost-effectiveness threshold of $100,000 per quality-adjusted life year (QALY) gained. Clinical strategy 1, when applied in febrile neonates with CSF pleocytosis, saved 17 lives per 10,000 neonates and was cost-effective using CSF HSV PCR testing ($55,652/QALY gained). The cost-effectiveness of applying clinical strategy 1 in all febrile neonates depended on the cost of the CSF HSV PCR, prevalence of disease, and parental preferences for neurodevelopmental outcomes. Clinical strategies using comprehensive HSV testing were not cost-effective in febrile neonates ($368,411/QALY gained) or febrile neonates with CSF pleocytosis ($110,190/QALY gained). Testing with CSF HSV PCR and empirically treating with acyclovir sodium saves lives and is cost-effective in febrile neonates with CSF pleocytosis. It is not a cost-effective use of health care resources in all febrile neonates.


Combination of bleomycin and adriamycin with and without radiation on the treatment of inoperable esophageal cancer. A randomized study.
In a prospective randomized study, 31 patients with inoperable esophageal cancer were treated with a combination of bleomycin and adriamycin, and with a combination of these cytostatics and radiation. Evaluation of treatment results showed 3 partial remissions and 2 stable-disease cases in the group of 16 patients treated by cytostatic drugs alone; in all other cases, the disease progressed. The response rate achieved in this group was 19%. In the group including 15 patients who were irradiated with a dose of 3600--4000 rad and received simultaneously the same cytostatics with a somewhat lower dose of adriamycin, there were 3 complete remissions, 6 partial remissions, and 4 stable-disease cases, while in 2 cases the disease progressed. The response rate was 60%, which was statistically significant (P less than 0.025) when compared with the results achieved by the group receiving the bleomycin adriamycin combination. The average duration of remissions in the complete-response cases was 11 months, and in the partial-response cases, 5.2 months with combined treatment, and 4.2 months with combination chemotherapy. The toxic side-effects were tolerable for the patients, albeit more intensive with the combined-treatment modality. Four esophagobronchial fistulas (four disease progressions) and one rupture of the aorta were noted during treatment. This study has shown the advantages of chemoradiotherapeutic treatment of inoperable esophageal cancer.


The clinical implications of left ventricular diastolic dysfunction in systemic sclerosis.
We sought to quantify the burden of left ventricular diastolic dysfunction (LVDD) and heart failure with preserved ejection fraction (HFpEF) in systemic sclerosis (SSc) and assess the progression of LVDD over time and its prognostic importance. Two-hundred and twenty-five participants enrolled in the Australian Scleroderma Cohort Study were included and LVDD was assessed according to 2016 ASE/EACVI Guidelines. Logistic regression analyses and generalised estimating equations were performed to evaluate the relationship between LVDD and SSc disease characteristics and symptoms and signs of heart failure, respectively. The relationship between LVDD and mortality was assessed using Kaplan-Meier survival estimates. Thirty-four (15%) participants were diagnosed with LVDD. A further 89 (40%) participants had indeterminate diastolic function. Older age (p<0.01), hypertension (p=0.02), impaired systolic function (p=0.03) and interstitial lung disease (p=0.01) were all associated with the presence of LVDD. There was no association between the presence of LVDD and clinical signs of heart failure, however, LVDD was associated with more breathlessness and worse functional class (p=0.03). LVDD was observed to progress over time, with significant worsening of parameters of left ventricular filling pressure. There was no significant relationship between LVDD and mortality (p=0.23). Abnormal diastolic function is a common finding in SSc, progresses over time and is associated with more severe dyspnoea. Whilst patients with LVDD are more breathless, LVDD is not clearly associated with clinical findings of heart failure demonstrating that LVDD may be of importance in explaining symptoms even in the absence of HFpEF in SSc.


Unusual crystalline inclusions in a case of AIDS-related complex.
A lymph node of a patient with AIDS-related complex was studied with light and electron microscopic techniques. In numerous plasma cells and follicular center cells amorphous and unusual crystalline structures which probably consist of abnormal immunoglobulin could be found.


The different expression patterns of interleukin-1 receptor antagonist in systemic lupus erythematosus.
The interleukin-1 receptor antagonist (IL1RN or IL-1Ra) is a natural antagonist of IL-1-beta. Using IL1RN as a possible marker in patients with systemic lupus erythematosus (SLE), we evaluated whether uIL1RN single nucleotide polymorphisms (SNPs) were associated with the pathogenesis of SLE in Taiwanese, and specifically whether IL1RN (rs315952) was significantly associated with end-stage renal disease. We examined IL1RN isoform expression patterns in patients with SLE to determine whether the expressions play a role in the pathogenesis of SLE. Both case-control and family-based association studies were used. For the case-control study, 104 patients with SLE and 97 normal controls were recruited, and for the family-based study, 11 families with SLE without renal disorder were recruited from the 104 patients with SLE. Eight IL1RN SNPs (rs2234678, rs2234679, rs315951, rs315952, rs419598, rs432014, rs447713, and rs451578) were selected for the family-based study. Reverse-transcriptase-polymerase chain reaction (RT-PCR) was used to determine the expression pattern of each isoform. Our results showed that IL1RN (rs315952) was significantly associated with SLE in patients without renal disorder in the family-based study, after disease stratification, but was not significantly associated with SLE in the case-control study. In the family-based study, the haplotype of IL1RN (AGCCTTAG) was significantly associated with SLE (chi2 = 11.714, P < 0.001). Using RT-PCR to determine the expression pattern of the IL1RN isoforms, we found different expression patterns between normal controls and patients with SLE, with an addition of IL1RN isoform4 or the low expression of IL1RN isoform1. We concluded that IL1RN and its isoforms were involved in the pathogenesis of SLE.


Multifunctional Peroxidase-Encapsulated Nanoliposomes: Bioetching-Induced Photoelectrometric and Colorimetric Immunoassay for Broad-Spectrum Detection of Ochratoxins.
In this study, a versatile dual-modal readout immunoassay platform was achieved for sensitive and broad-spectrum detection of ochratoxins based on the photocurrent response of flexible CdS/ZnO nanorod arrays/reduced graphene oxide and the localized surface plasmon resonance (LSPR) peak shift of Au nanobipyramids (Au NBPs). By using nanoliposomes as the vehicle to carry the secondary antibody and encapsulate horseradish peroxidase (HRP), the photocurrent change and the peak shift can be greatly amplified. The reaction mechanism was investigated in detail, indicating that HRP can trigger enzymatic bioetching in the presence of H2O2. In the photoelectrochemical detection, the oxidized HRP can etch CdS on the photoelectrode, resulting in the photocurrent change, while in the colorimetric detection, HRP can oxidize H2O2 to produce hydroxyl radicals that can etch Au NBPs to form multiple color changes and LSPR shifts. Compared with the common single-modal immunoassay for ochratoxins, such dual-modal immunoassay is more precise and reliable, owing to the completely independent signal conversion and transmission mechanism. Therefore, we hope that this accurate, simple, and visualized strategy may create a new avenue and provide innovative inspiration for food analysis.


Airway dysfunction in elite swimmers: prevalence, impact, and challenges.
The prevalence of airway dysfunction in elite swimmers is among the highest in elite athletes. The traditional view that swimmers naturally gravitate toward swimming because of preexisting respiratory disorders has been challenged. There is now sufficient evidence that the higher prevalence of bronchial tone disorders in elite swimmers is not the result of a natural selection bias. Rather, the combined effects of repeated chlorine by-product exposure and chronic endurance training can lead to airway dysfunction and atopy. This review will detail the underpinning causes of airway dysfunction observed in elite swimmers. It will also show that airway dysfunction does not prevent success in elite level swimming. Neither does it inhibit lung growth and might be partially reversible when elite swimmers retire from competition.


Alternative Confidence Interval Methods Used in the Diagnostic Accuracy Studies.
Background/Aim. It is necessary to decide whether the newly improved methods are better than the standard or reference test or not. To decide whether the new diagnostics test is better than the gold standard test/imperfect standard test, the differences of estimated sensitivity/specificity are calculated with the help of information obtained from samples. However, to generalize this value to the population, it should be given with the confidence intervals. The aim of this study is to evaluate the confidence interval methods developed for the differences between the two dependent sensitivity/specificity values on a clinical application. Materials and Methods. In this study, confidence interval methods like Asymptotic Intervals, Conditional Intervals, Unconditional Interval, Score Intervals, and Nonparametric Methods Based on Relative Effects Intervals are used. Besides, as clinical application, data used in diagnostics study by Dickel et al. (2010) has been taken as a sample. Results. The results belonging to the alternative confidence interval methods for Nickel Sulfate, Potassium Dichromate, and Lanolin Alcohol are given as a table. Conclusion. While preferring the confidence interval methods, the researchers have to consider whether the case to be compared is single ratio or dependent binary ratio differences, the correlation coefficient between the rates in two dependent ratios and the sample sizes.


[Distribution of calcitonin gene related peptide positive neurofibers in local skin tissues of "Neiting"(ST 44), "Zusanli" (ST 36) and "Futu" (ST 32) regions in the rat].
To observe the distribution of calcitonin gene related peptide (CGRP)-positive neurofibers in local tissues of "Neiting"(ST 44), "Zusanli" (ST 36) and "Futu" (ST 32) regions in the hind limbs of rats. Five adult male SD rats were used in the present study. The local skin tissues of acupoint "Neiting" (ST 44), "Zusanli" (ST 36) and "Futu" (ST 32) regions were dissected from the rat that underwent transcardiac perfusion with 4% paraformaldehyde, and cut into sections (20 microm in thickness), followed by staining with CGRP fluorescent immunohistochemical method and with phalloidin and DAPI, respectively. After that, CGRP-positive neurofibers of the samples were observed and recorded using a laser confocal microscope. CGRP-positive nerve fibers were found to distribute in the dermis and subcutaneous layers of local tissues of acupoint ST 44, ST 36 and ST 32, mainly concentrating around the vessel-like structure. The number and length of CGRP-positive nerve fibers were most in the ST 44 region, more in the ST 36 region and fewer in the ST 32 region, in turn (P<0.01). The distribution of the vessel-like structure also presented a decreasing trend in the above-mentioned three acupoint regions in turn. CGRP-positive neurofibers are an important element in the local tissues of acupoint ST 44, ST 36 and ST 32 regions, and present a decreasing tendency in the number from the distal to the proximal part of the hind-limb, showing a similar tendency of needling sensation in the human body in which a more hypersensitivity exists in the distal part of the limb.


Tenofovir-based oral preexposure prophylaxis prevents HIV infection among women.
Despite tremendous promise as a female-controlled HIV prevention strategy, implementation of preexposure prophylaxis (PrEP) among women has been limited, in part because of disparate efficacy results from randomized trials in this population. This review synthesizes existing evidence regarding PrEP efficacy for preventing HIV infection in women and considerations for delivering PrEP to women. In three efficacy trials, conducted among men and women, tenofovir-based oral PrEP reduced HIV acquisition in subgroups of women by 49-79% in intent-to-treat analyses, and by >85% when accounting for PrEP adherence. Two trials did not demonstrate an HIV prevention benefit from PrEP in women, but substantial evidence indicates those results were compromised by very low adherence to the study medication. Qualitative research has identified risk perception, stigma, and aspects of clinical trial participation as influencing adherence to study medication. Pharmacokinetic studies provide supporting evidence that PrEP offers HIV protection in women who are adherent to the medication. Tenofovir-based daily oral PrEP prevents HIV acquisition in women. Offering PrEP as an HIV prevention option for women at high risk of HIV acquisition is a public health imperative and opportunities to evaluate implementation strategies for PrEP for women are needed.


The impact of training on outcomes in primary vascular access surgery.
There is evidence that the outcome of arteriovenous fistula surgery is dependent on the surgeon performing the operation. Vascular access surgery provides excellent technical training for surgical trainees. The effect of surgical trainees on the outcome of fistulas was evaluated. The grade of the main operator for all first attempted (primary) upper limb arteriovenous fistulas, between February 1998 and August 2001, was identified. Median follow-up was 18.0 months (IQR, 6.5-30.1 months). Successful use of fistula for dialysis, fistula patency and survival were assessed. 441 primary fistulas were formed in the study period. Median age was 67.5 years (IQR, 54.0-75.2 years). 71% of all fistulas were formed at the wrist. Trainees performed 31.1% of all operations. The two groups (trainees and consultants) were well matched for age, sex, diabetes, and fistula type. Only 70.5% of patients proceeded to long-term haemodialysis. There were no significant differences in the successful use of AVF for dialysis or patency rates between the two groups. One and two year fistula survival in this group was 87.7% and 78.3% for trainees and 80.8% and 71.1% for consultants (P = 0.288 log rank). Surgical trainees can perform primary AVF surgery without significantly reducing fistula outcomes. Vascular access surgery can be utilised as a training operation.


Patent foramen ovale-associated stroke repeatedly misdiagnosed as cerebral small vessel disease: A case report.
Transthoracic echocardiography (TTE) is the most commonly used screening method for cardiac structural abnormalities. However, it may lead to a missed diagnosis of partial patent foramen ovale (PFO)-associated stroke. A 60-year-old male was admitted to the hospital for recurrent left limb weakness with or without slurred speech for 14 months. No stroke-related cardiac structural abnormality was detected during repeated TTE, and the patient was diagnosed with cerebral small vessel disease. Finally, right-to-left shunt was detected by contrast-enhanced transcranial Doppler. Subsequently, the patient was diagnosed with PFO-associated stroke by transesophageal echocardiography and contrast transesophageal echocardiography. TTE has a low detection rate of PFO, such that it is easily missed. Contrast-enhanced transcranial Doppler is easy to operate and should be promoted as a supplementary measure to stroke etiological investigation and primary PFO screening.


Genetic Relationships among Different Chemotypes of Lupinus sulphureus.
Lupines (Lupinus spp.) are a common plant legume species found on western U.S. rangelands. Lupinus spp. may contain quinolizidine and/or piperidine alkaloids that can be toxic and/or teratogenic to grazing livestock. Alkaloid profiles may vary between and within a species. The objectives of this study were to (1) further explore the characteristic alkaloid profiles of Lupinus sulphureus using field collections and (2) explore the phylogenetic relationship of the different populations and chemotypes of L. sulphureus using the amplified fragment length polymorphism method of DNA fingerprinting, thus providing possible explanations to the phenomena of multiple chemotypes within a species. A total of 49 accessions of L. sulphureus were classified into seven chemotypes. The DNA profiles showed that one L. sulphureus chemotype, chemotype A, is genetically divergent from the other chemotypes of L. sulphureus, suggesting that it represents an unresolved lupine taxon, possibly a new lupine species. Additionally, the different chemotypes of L. sulphureus represented different genetic groups, as shown by Bayesian cluster analysis and principle component analysis.


Effects of coenzyme Q(10) on LDL oxidation in vitro.
Coenzyme Q(10), a lipid soluble benzoquinone, has excellent antioxidant and membrane stabilizing properties in the cardiac tissue. The present study quantitatively investigated the effects of coenzyme Q(10) on in vitro LDL oxidation. The formation of conjugated dienes, malondialdehyde (MDA) and electrophoretic mobility were monitored as markers of the oxidation of LDL, respectively. Coenzyme Q(10) showed a decrease the formation of conjugated dienes and MDA, respectively, against oxidation in vitro. Coenzyme Q(10) also reduced electrophoretic mobility of the oxidized human LDL. Thus, results showed that the coenzyme Q(10) exhibits strong antioxidant activity in CuSO(4)-mediated oxidation of LDL (P<0.05) in vitro. The inhibitory effects of the coenzyme Q(10) on LDL oxidation were dose-dependent at concentrations ranging from 20 nM to 300 nM. Moreover, the effects of coenzyme Q(10) on LDL oxidation were compared with vitamin E and vitamin C. This study showed that coenzyme Q(10) is a potent antioxidant to protect LDL against oxidation in vitro and may be a good alternative to reduce the risk of atherosclerosis and coronary heart disease and other free radical associated health problems.


Oxygen activation with transition-metal complexes in aqueous solution.
Coordination to transition-metal complexes changes both the thermodynamics and kinetics of oxygen reduction. Some of the intermediates (superoxo, hydroperoxo, and oxo species) are close analogues of organic oxygen-centered radicals and peroxides (ROO(*), ROOH, and RO(*)). Metal-based intermediates are typically less reactive, but more persistent, than organic radicals, which makes the two types of intermediates similarly effective in their reactions with various substrates. The self-exchange rate constant for hydrogen-atom transfer for the couples Cr(aq)OO(2+)/Cr(aq)OOH(2+) and L(1)(H(2)O)RhOO(2+)/L(1)(H(2)O)RhOOH(2+) was estimated to be 10(1+/-1) M(-1) s(-1). The use of this value in the simplified Marcus equation for the Cr(aq)O(2+)/Cr(aq)OOH(2+) cross reaction provided an upper limit k(CrO,CrOH) <or= 10((-2+/-1)) M(-1) s(-1) for Cr(aq)O(2+)/Cr(aq)OH(2+) self-exchange. Even though superoxo complexes react very slowly in bimolecular self-reactions, extremely fast cross reactions with organic counterparts, i.e., acylperoxyl radicals, have been observed. Many of the intermediates generated by the interaction of O(2) with reduced metal complexes can also be accessed by alternative routes, both thermal and photochemical.


Fabrication of superhydrophobic bionic surface integrating with VOF simulation studies of liquid drop impacting.
Superhydrophobic surface has wide application in self-cleaning, anti-pollution, anti-adhesion, drag reduction, but the stable and efficient manufacture of bionic superhydrophobic surfaces is a challenge. We have reproduced the microscopic structure of natural plants and achieved superhydrophobic surface preparation without chemical modification by mechanical process. This program need many experiments to generate processing parameters based on the bionic surface structure. To solve this problem, based on the natural Green Bristlegrass superhydrophobic surface, an optimized bio-inspired striped configuration was presented and the computational fluid dynamics approach was integrated into the fabrication, which was estimated the superhydrophobicity of bio-inspired surface. The volume of fluid (VOF) model and the Level Set function were used to determine the position of the interface during the liquid impact process by solving the change of the volume fraction of each phase in the mixed fluid, thus tracking the gas-liquid phase interface. According to the simulation of striped surface structure, we have processed the bionic samples successfully and they showed an excellent superhydrophobic property, the contact angle was 154° ± 2° and the sliding angle was <5°. The contact time of bionic sample was 12.8 ms. This article used the VOF simulation method to evaluate the design and parameters of the structure, so that the selection of processing parameters were more optimized. Furthermore, the study was essential to access the bio-inspired design and fabrication procedure of superhydrophobic surface.


Electrical and mechanical responses of the bovine retractor penis to nerve stimulation and to drugs.
The responses of the bovine retractor penis muscle to field stimulation of intramural nerves in vitro was investigated using micro-electrode and extracellular (sucrose gap) techniques. In the absence of tone single pulses or trains of stimuli (1-50 Hz 0.1-0.5 m.sec) produced e.j.p.s and a decrease in membrane resistance; spike potentials were not observed. E.j.p.s often small in amplitude (3-5 mV to single pulse) and accompanied by contractions in almost all preparations were noradrenergic, abolished by guanethidine (1-3 x 10(-5) M) and tetrodotoxin (3.5 x 10(-6) M) but not by prazosin (0.05 - 1.4 x 10(-6) M). Prazosin abolished the depolarization and contraction produced by added NA (0.02 - 2 x 10(-8) moles). TEA (10(-2) M) depolarized the membrane and initiated spontaneous activity; e.j.p.s and contractions were enhanced and prolonged but no spikes were observed. Atropine (0.5 x 10(-6) M) increased and physostigimine (1-5 x 10(-6) M) decreased e.j.p.s and contractions indicating a cholinergic regulatory component in the release of the excitatory transmitter. In the presence of tone, nerve stimulation produced i.j.p.s. and relaxations which were unaffected by apamin (5 x 10(-7) M), atropine (3 x 10(-6) M), guanethidine (3 x 10(-5) M), phentolamine (5 x 10(-6) M) and propranolol (4 x 10(-6) M) but were abolished by tetrodotoxin (3.5 x 10(-7) M) suggesting their mediation by non-adrenergic non-cholinergic (NANC) nerves. Sodium nitroprusside (10(-10) - 10(-8) moles), which increases cyclic GMP, also hyperpolarized the membrane and relaxed the BRP. Those responses and those to inhibitory nerve stimulation were antagonized by oxyhaemoglobin which inhibits guanylate cyclase. 2-O-propoxyphenyl-8-azapurin-6-one (M & B 22948 3-9 x 10(-6) M) which inhibits cGMP-specific phosphodiesterase, enhanced the relaxation but not the i.j.p. TEA (10(-2) M) initially depolarized the membrane potential and raised tone. In the sucrose gap inhibitory potentials were abolished; the mechanical relaxation was not and a small contractile component emerged. Electrical and mechanical inhibitory components in the bovine retractor penis may not be correlated.


Indicator to predict the movement of phosphorus from soil to subsurface flow.
The movement of phosphorus (P) in subsurface flow can contribute to losses from agricultural land. This study aims to identify a soil P threshold above which P loss is likely to accelerate as a function of soil and management type. Lysimeters (25 cm i.d. by 30 cm deep) were taken of four soils from agricultural watersheds in Pennsylvania and New York. The soils had a range of Mehlich-3 extractable P (7-517 mg of P kg(-1)) in surface soil (0-7.5 cm for grassland and 0-23 cm for cultivated/arable) and reactive P, filtered <0.45 microm (RP(<0.45 microm) in subsurface flow (0.007-1.53 mg of P L(-1)). The loss of P from lysimeters increased greatly when Mehlich-3 extractable P was in excess of a mean concentration of 280 mg kg(-1), the degree of saturation of P sorption sites exceeded 38%, and the corrected P sorption strength (corrected for desorption) derived from the monolayer Langmuir equation was less than 0.07 L of P mg(-1). Of these variables, P sorption strength was most consistently related to RP(<0.45 microm) in subsurface flow across a range of soil managements. Use of the corrected Langmuir sorption strength parameter to estimate subsurface flow RP(<0.45 microm) derived from four U.S. soils was tested on four soils of different physiochemical characteristics (one calcareous) from the U.K. The U.K. soils showed similar concentration trends to the U.S. soils, with elevated RP(<0.45 microm) below a sorption strength of 0.07 L of P mg(-1). We propose that the P sorption strength derived from the monolayer Langmuir equation may be used to estimate the potential for P loss in subsurface flow, when simpler environmental tests such as P saturation derived from acid ammonium oxalate extraction are unclear or unsuitable.


Synthesis of high solids content low surfactant/polymer ratio nanolatexes.
A new two-stage strategy for the synthesis of high-solids-content low-surfactant/polymer ratio nanolatexes was developed. In the first stage, the knowledge-based strategy is used to obtain 18 wt % nanolatexes with the maximum number of particles and using a fraction of the surfactant. In the second stage, the rest of the surfactant is employed to stabilize these particles while they are growing to reach the target solids content. The final particle size results from the interplay between limited particle coagulation and secondary homogeneous nucleation during the second stage. Smaller particle sizes were obtained for surfactants able to desorb from the existing particles and diffuse quickly to the newly formed particles. Waterborne nanoparticles as small as 32 nm in diameter were obtained with 36 wt % solids content and solids content/(surfactant/polymer) ratio higher than 26. This represents a substantial improvement with respect to the best results reported in the literature (dp = 32 nm; 23 wt % solids, and solids content/(surfactant/polymer) = 21).


Intraocular pressure lowering, change of antiapoptotic molecule expression, and neuroretinal changes by dorzolamide 2%/timolol 0.5% combination in a chronic ocular hypertension rat model.
The aim of this study was to examine intraocular pressure lowering, change of antiapoptotic molecules expression, and neuroretinal changes by a commercially available dorzolamide 2%/timolol 0.5% combination in a chronic ocular hypertension rat model. Chronic ocular hypertension was induced by three episcleral vein cauterizations. The expression of antiapoptotic molecules and the effect of dorzolamide 2%/timolol 0.5% combination in chronic ocular hypertensive retina were evaluated. Retinal ganglion cell (RGC) retrograde labeling and quantification with 4-di-10-ASP (DiA) and expression of glial fibrillary acidic protein (GFAP) were detected before and after the administration of dorzolamide 2%/timolol 0.5%. Treatment of ocular hypertensive eyes with dorzolamide 2%/timolol 0.5% significantly reduced, intraocular pressure when compared to the control eyes. Labeling of RGCs with DiA showed a significant decrease in RGC loss after the administration of dorzolamide 2%/timolol 0.5%. GFAP expression revealed a significant decrease in retinal damage after dorzolamide 2%/timolol 0.5% administration. However, dorzolamide 2%/timolol 0.5% did not affect Bcl-2 and Bcl-xL mRNA expression. In conclusion, dorzolamide 2%/timolol 0.5% may have neuroprotective potential in the animal model, which is not mediated by Bcl-2 or Bcl-xL. The mechanism of neuroprotection by dorzolamide 2%/timolol 0.5% in chronic glaucoma models requires further investigation.


Mobile zoned/exponential LAF screen: a new concept in ultra-clean air technology for additional operating room ventilation.
A mobile screen (0.5 x 0.4 m) producing ultra-clean exponential LAF (air-flow central zone 0.6 m/s and peripheral zone 0.4 m/s) was investigated as an addition to conventional turbulent/mixing operating room ventilation. The evaluation was performed during strictly standardized sham operations reflecting conditions during major surgery. The study consisted of a pilot experiment designed to give high counts of sedimenting aerobic colony forming units (cfu). In a second main study, recording dust particles, air-borne and sedimenting aerobic cfu, the screen was associated with optimal operating room clothing. In the pilot experiment the use of the screen resulted in a substantial reduction of sedimenting bacteria from 3835-4940 to 0-390 cfu/m(2)/h. In the main study, the use of the additional LAF reduced the surface contamination from 416-329 to 7-78 cfu/m(2)/h up to 1.6 m from the screen (P=0.001-0.0001). Measured in the wound area the screen reduced the air counts of bacteria from 9-14 to 0.2-0.4 cfu/m(3) (P=0.008-0.0001) and a marked reduction of air-borne dust particles was recorded (P=0.007-0.009). In conclusion, the additional mobile LAF screen reduced the counts of aerobic air-borne and sedimenting bacteria-carrying particles as well as dust particles to the levels gained with complete ultra-clean LAF room ventilation. Thus, the screen might prove a valuable addition to operating room ventilation as well as in other areas where asepsis is essential.


The Akt-regulated forkhead transcription factor FOXO3a controls endothelial cell viability through modulation of the caspase-8 inhibitor FLIP.
FLICE-inhibitory protein (FLIP) is a homolog of caspase-8 that lacks catalytic activity and has been shown to be important in protecting endothelial cells from apoptosis. The serine/threonine kinase Akt/PKB was recently reported to promote FLIP expression in endothelial and tumor cells. Here we examined the role of the forkhead transcription factor FOXO3a, a downstream target of Akt, in controlling FLIP regulation in endothelial cells. FOXO3a nuclear translocation was regulated by Akt in human umbilical vein endothelial cells. Transduction of a nonphosphorylatable, constitutively active mutant of FOXO3a (TM-FOXO3a) led to the down-regulation of FLIP levels. Transduction with TM-FOXO3a also increased caspase-8 activity and promoted apoptosis in endothelial cells. Conversely, transduction of a dominant-negative mutant of FOXO3a up-regulated FLIP levels and protected endothelial cells from apoptosis under serum deprivation conditions. Restoration of intracellular FLIP blocked caspase-8 activation and inhibited apoptosis in TM-FOXO3a-transduced cells. These data suggest that FOXO3a is a downstream target of Akt in endothelial cells that can promote apoptosis via FLIP down-regulation and activation of the extrinsic apoptotic pathway.


Pentoxifylline, propentofylline and pentifylline for acute ischaemic stroke.
Methylxanthine derivatives are vasodilators. They also inhibit platelet aggregation and thromboxane A2 synthesis, decrease the release of free radicals and may be neuroprotective. NOTE: This review covers an area where no active research is taking place. It will be updated if relevant information becomes available, e.g. on completion of an appropriate study. To assess the effect of intravenous or oral methylxanthines (pentoxifylline, propentofylline, or pentifylline) in patients with acute ischaemic stroke. We searched the Cochrane Stroke Group trials register (last searched November 2003). For the first version, we also searched EMBASE (1980 to 1999), MEDLINE (1966 to 1999), Science Citation Index (1981 to 1999) and the Ottawa Stroke Trials Registry. We also contacted the manufacturers of methylxanthines and the principal investigators of the identified trials. Randomised trials comparing pentoxifylline, propentofylline or pentifylline with placebo or control in patients with definite or presumed acute ischaemic stroke. Trials were included if treatment was started within one week of stroke onset. Two reviewers independently applied the inclusion criteria. Trial quality was assessed. Five trials were included. Four trials tested pentoxifylline in 763 people, and one tested propentofylline in 30 people. No trials of pentifylline were found. The odds of early death (within four weeks) was non-significantly reduced in patients given a methylxanthine drug as compared with those given placebo (odds ratio (OR) 0.64, 95% confidence interval (CI) 0.41 to 1.02). This non-significant trend to less deaths was due mainly to one pentoxifylline trial that found a highly significant reduction in early deaths. Two trials reported early death or disability and found a non-significant reduction (OR 0.49, 95% CI 0.20 to 1.20). There was no significant difference in late death (beyond four weeks), as reported in the propentofylline trial involving 30 patients, although the confidence interval was wide (OR 0.70, 95% CI 0.13 to 3.68). Data for neurological impairment and disability were not in a form suitable for analysis. Data on quality of life, stroke recurrence, thromboembolism and bleeding were not reported. There is not enough evidence to assess adequately the effectiveness and safety of methylxanthines after acute ischaemic stroke.


Dentin dysplasia type I: report of atypical cases in the permanent and mixed dentitions.
Dentin dysplasia type I is a rare hereditary disturbance of dentin formation characterized clinically by nearly normal appearing crowns and severe hypermobility of teeth. Radiographic analysis shows obliteration of all pulp chambers, short, blunted, and malformed roots, and periapical radiolucencies of noncarious teeth. This paper presents 2 cases demonstrating both classic and atypical features of type I dentin dysplasia in the mixed and permanent dentitions. The clinical, radiographic, and histopathologic\findings of this condition and treatment are described.


New limits on the drift of fundamental constants from laboratory measurements.
We have remeasured the absolute 1S-2S transition frequency nu(H) in atomic hydrogen. A comparison with the result of the previous measurement performed in 1999 sets a limit of (-29+/-57) Hz for the drift of nu(H) with respect to the ground state hyperfine splitting nu(Cs) in 133Cs. Combining this result with the recently published optical transition frequency in 199Hg+ against nu(Cs) and a microwave 87Rb and 133Cs clock comparison, we deduce separate limits on alpha/alpha=(-0.9+/-2.9) x 10(-15) yr(-1) and the fractional time variation of the ratio of Rb and Cs nuclear magnetic moments mu(Rb)/mu(Cs) equal to (-0.5+/-1.7) x 10(-15) yr(-1). The latter provides information on the temporal behavior of the constant of strong interaction.


Periodontal disease and recurrent cardiovascular events in survivors of myocardial infarction (MI): the Western New York Acute MI Study.
Periodontal disease and cardiovascular disease (CVD) have been the focus of much research, but little is known about their roles in the recurrent event risk in patients with CVD. This study investigates whether periodontal disease is related to recurrent CVD events and mortality in survivors of incident myocardial infarction (MI). Participants (668 males and 216 females; mean age: 54 + or - 8.5 years) were recruited (1997 through 2004) from two western New York county hospitals and completed an interviewer-administered questionnaire regarding lifestyle habits, clinical measurements, and a comprehensive dental examination. The periodontal disease status was measured by the mean clinical attachment loss (AL). Follow-up surveys assessed hospitalizations or medical procedures; cardiovascular events were validated by medical records. A National Death Index (NDI) Plus search was conducted. The outcome was recurrent fatal and non-fatal cardiovascular events (International Classification of Diseases codes 390 to 450). After an average follow-up of 2.9 years, 154 events were reported. Among never-smokers, the adjusted hazard ratio (95% confidence interval) for the mean clinical AL (millimeters) was 1.43 (1.09 to 1.89). No associations were found in ever-smokers (clinical AL by smoking interaction: P <0.05). These findings indicate that periodontal disease may be an important factor in determining recurrent cardiovascular events in MI patients and not merely a marker for the effects of cigarette smoking.


Structure and function of proparts in zymogens for aspartic proteinases.
Alignment of amino-acid sequences of zymogens for aspartic proteinases shows homology among the proparts corresponding to that observed for the active enzymes. The alignment indicates that all zymogens have a lysine residue at position p36 (porcine pepsinogen numbering). In the tertiary structure of porcine pepsinogen this residue is located between the two aspartic residues that participate in the catalytic mechanism of the active enzyme. It is suggested that Lys (p36) is essential for the correct folding of the zymogen molecule. Activation models and pathways are discussed.


Selective laser sintering scaffold with hierarchical architecture and gradient composition for osteochondral repair in rabbits.
Osteochondral defects cannot be adequately self-repaired due to the presence of the sophisticated hierarchical structure and the lack of blood supply in cartilage. Thus, one of the major challenges remaining in this field is the structural design of a biomimetic scaffold that satisfies the specific requirements for osteochondral repair. To address this hurdle, a bio-inspired multilayer osteochondral scaffold that consisted of the poly(ε-caprolactone) (PCL) and the hydroxyapatite (HA)/PCL microspheres, was constructed via selective laser sintering (SLS) technique. The SLS-derived scaffolds exhibited an excellent biocompatibility to support cell adhesion and proliferation in vitro. The repair effect was evaluated by implanting the acellular multilayer scaffolds into osteochondral defects of a rabbit model. Our findings demonstrated that the multilayer scaffolds were able to induce articular cartilage formation by accelerating the early subchondral bone regeneration, and the newly formed tissues could well integrate with the native tissues. Consequently, the current study not only achieves osteochondral repair, but also suggests a promising strategy for the fabrication of bio-inspired multilayer scaffolds with well-designed architecture and gradient composition via SLS technique.


Reduced intensity haemopoietic stem-cell transplantation for treatment of non-malignant diseases in children.
Transplantation of allogeneic haemopoietic stem cells can cure several non-malignant disorders in children. Transplantation with reduced intensity preparation might achieve the same goals but with less toxicity. We undertook a pilot study to determine engraftment rates, kinetics of engraftment, toxicity, and acute graft-versus-host disease (GVHD) associated with a uniform reduced intensity haemopoietic stem-cell transplant (HSCT) regimen for children with non-malignant diseases. We studied 13 paediatric patients with non-malignant disorders who underwent reduced intensity HSCT at Children's Memorial Hospital from January, 2000, to February, 2004. Stem-cell sources included unrelated donor, matched-sibling peripheral blood stem cells, and unrelated cord blood. A uniform preparative regimen was used, consisting of fludarabine, busulfan, and anti-thymocyte globulin. Major endpoints were engraftment, transplant-related mortality at day 100, short-term toxicities, and incidence of acute GVHD. 72% of evaluable patients achieved full donor engraftment. There was rapid reconstitution of platelets (median 13.5 days) and neutrophils (median 18 days). Short-term toxicities were minimal, as seen by a median length of hospital stay of 7 days (between days 0-100). Incidence of grade II-IV acute GVHD was 8%. Two patients died before day 100 from underlying disease and viral infection, respectively (day 100 transplant-related mortality of 15%). The 1-year overall survival was 84% (95% CI 64-100). Most patients with immunodeficiencies and metabolic disorders had excellent donor engraftment and disease resolution or stabilisation, but most of those with haemoglobinopathies rejected their graft. This reduced intensity regimen followed by HSCT provides a good alternative to myeloablative HSCT for children with non-malignant disorders, except for haemoglobinopathies, in which engraftment is poor. Even patients with unrelated donor haemopoietic stem-cell transplants had adequate engraftment with acceptable toxicities.


Effect of 5-fluorouracil on the growth of bacteriophage R17.
Graham, A. F. (The Wistar Institute of Anatomy and Biology, Philadelphia, Pa.), and Clare Kirk. Effect of 5-fluorouracil on the growth of bacteriophage R17. J. Bacteriol. 90:928-935. 1965.-When added to Escherichia coli within 2 min after phage R17, 5-fluorouracil (FU), at a concentration of 10(-4)m, completely inhibited the synthesis of infectious ribonucleic acid (RNA) and phage. If the addition of FU was made later than 5 min after infection, infectious RNA synthesis was blocked but infectious phage was still formed; the infectious RNA made before the addition of FU continued to be incorporated into mature phage. These properties of the inhibitor were used to determine the kinetics of phage RNA synthesis and the size of the phage precursor RNA pool. At a concentration of 2.2 x 10(-5)m FU, the yield of phage was reduced to 15% of that in an uninhibited control, 28% of the phage RNA uracil was replaced with FU, and the specific infectivity of the phage was unaltered.


Iron-Catalyzed Cyclotrimerization of Terminal Alkynes by Dual Catalyst Activation in the Absence of Reductants.
Catalyzing C-C bond-forming reactions with earth-abundant metals under mild conditions is at the heart of sustainable synthesis. The cyclotrimerization of alkynes is a valuable atom-efficient reaction in organic synthesis that is enabled by several metal catalysts, including iron. This study reports an effective iron-catalyzed cyclotrimerization for the regioselective synthesis of 1,2,4-substituted arenes (1 mol % catalyst, toluene, 20 °C, 5 min). A dual activation mechanism (substrate deprotonation, reductive elimination) renders the simple FeII precatalyst highly active in the absence of any reductant.


Magnetic Tissue Engineering for Voice Rehabilitation - First Steps in a Promising Field.
The voice is one of the most important instruments of communication between humans. It is the product of intact and well-working vocal folds. A defect of these structures causes dysphonia, associated with a clear reduction of quality of life. Tissue engineering of the vocal folds utilizing magnetic cell levitation after nanoparticle loading might be a technique to overcome this challenging problem. Vocal fold fibroblasts (VFFs) were isolated from rabbit larynges and cultured. For magnetization, cells were incubated with superparamagnetic iron oxide nanoparticles (SPION) and the loading efficiency was determined by Prussian blue staining. Biocompatibility was analyzed in flow cytometry by staining with annexin V-fluorescein isothiocyanate propidium iodide, 1,1',3,3,3',3'-hexamethylindodicarbo-cyanine iodide [DiIC1(5)] and propidium idodide-Triton X-100 to monitor phosphatidylserine exposure, plasma membrane integrity, mitochondrial membrane potential and DNA degradation. Isolated VFFs can be successfully loaded with SPION, and optimal iron loading associated with minimized cytotoxicity represents a balancing act in magnetic tissue engineering. Our data are a firm basis for the next steps of investigations. Magnetic tissue engineering using magnetic nanoparticle-loaded cells which form three-dimensional structures in a magnetic field will be a promising approach in the future.


Globalization and loss of plant knowledge: challenging the paradigm.
The erosion of cultural knowledge and traditions as a result of globalization and migration is a commonly reported phenomenon. We compared one type of cultural knowledge about medicinal plants (number of plants reported to treat thirty common health conditions) among Dominican laypersons who self-medicate with plants and live in rural or urban areas of the Dominican Republic (DR), and those who have moved to New York City (NYC). Many plants used as medicines were popular Dominican food plants. These plants were reported significantly more often by Dominicans living in NYC as compared to the DR, and this knowledge was not age-dependent. These results contradict the popular paradigm about loss of cultural plant knowledge and is the first study to report a statistically measurable increase in this type of knowledge associated with migration.


Can admission and fasting glucose reliably identify undiagnosed diabetes in patients with acute coronary syndrome?
Our objectives were to determine the prevalence of previously undiagnosed abnormal glucose tolerance, i.e., diabetes and impaired glucose tolerance (IGT) in patients with acute coronary syndrome and to assess the utility of admission and fasting glucose in identifying diabetes in these patients. Glycemic status was characterized on the basis of admission plasma glucose (APG), fasting plasma glucose (FPG), and an oral glucose tolerance test (OGTT) in 140 patients admitted to the hospital with acute coronary syndrome, who were not known to have diabetes (mean +/- SD age 67.3 +/- 13.4 years; 79% men). OGTTs were performed on days 5-7 after admission. The prevalences of diabetes and IGT were 27 and 39%, respectively, according to OGTT criteria. Receiver operating characteristic curves showed that the area under the curve for diagnosing diabetes was 0.83 (P < 0.001) for FPG, 0.79 (P < 0.001) for APG, and 0.84 (P < 0.001) for FPG and APG applied in combination. A FPG cutoff >or=5.6 mmol/l (100 mg/dl) and/or APG >or=7.8 mmol/l (140 mg/dl) yielded a sensitivity of 89.5% and a positive predictive value of 43.6% for detecting diabetes. A high prevalence of abnormal glucose tolerance was seen in patients with acute coronary syndrome. The combination of FPG >or=5.6 mmol/l (100 mg/dl) and/or APG >or=7.8 mmol/l (140 mg/dl) was highly sensitive for identifying diabetes. Although weakly specific, this simple algorithm could offer a practical initial screening tool at the acute setting in the high-risk population with acute coronary syndrome.


Decreased Prolidase Activity in Patients with Posttraumatic Stress Disorder.
Many neurochemical systems have been implicated in the development of Posttraumatic Stress Disorder (PTSD). The prolidase enzyme is a cytosolic exopeptidase that detaches proline or hydroxyproline from the carboxyl terminal position of dipeptides. Prolidase has important biological effects, and to date, its role in the etiology of PTSD has not been studied. In the present study, we aimed to evaluate prolidase activity in patients with PTSD. The study group consisted of patients who were diagnosed with PTSD after the earthquake that occurred in the province of Van in Turkey in 2011 (n=25); the first control group consisted of patients who experienced the earthquake but did not show PTSD symptoms (n=26) and the second control group consisted of patients who have never been exposed to a traumatic event (n=25). Prolidase activities in the patients and the control groups were determined by the ELISA method using commercial kits. Prolidase activity in the patient group was significantly lower when compared to the control groups. Prolidase activity was also significantly lower in the traumatized healthy subjects compared to the other healthy group (p<0.01). The findings of the present study suggest that the decrease in prolidase activity may have neuroprotective effects in patients with PTSD.


Genetic analysis of bacteriophage P4 using P4-plasmid ColE1 hybrids.
A set of plasmids that contain fragments of the bacteriophage P4 genome has been constructed by deleting portions of a P4-ColE1 hybrid. A P4 genetic map has been established and related to the physical map by examining the ability of these plasmids to rescue various P4 mutations. The P4 virl mutation and P4 genes involved in DNA replication (alpha), activation of P2 helper genes (delta and epsilon), polarity suppression (psu) and head size determination (sid) have been mapped, as has the region responsible for synthesis of a nonessential P4 protein. One of the deleted plasmids contains only 5900 base pairs (52%) of P4 but will form plaques if additional DNA is added to increase its total size to near that of P4. This plasmid is also unique in that it will not form stable associations with P2 lysogens of E. coli which are recA+. P4 alpha mutants can be suppressed as a result of replication under control of the ColE1 part of the hybrid.


Phacoemulsification in vitrectomized eyes: Maintaining the stability of the anterior chamber via a new technique.
Fluctuating anterior chamber depth and reverse pupillary block are the most common problems encountered during phacoemulsification following pars plana vitrectomy in cases of cataracts. The sudden deepening of the anterior chamber makes the surgical procedure more cumbersome and increases the risk of intraoperative complications. To solve this problem, we describe a method of balancing the pressure of the anterior and posterior chamber by using a syringe with a flushing needle to inject balanced salt solution into the posterior chamber via the gap between the iris and the anterior capsule of the lens. This technique is especially suitable for complicated cataracts following previous pars plana vitrectomy and high myopia-complicated cataracts. This technique yielded promising results in reducing the difficulties that occur during surgical procedures, reduced the risk of intraoperative complications and simplified the intraocular lens implantation.


Impella 5.0 is associated with a reduction in vasoactive support and improves hemodynamics in cardiogenic shock: A single-center experience.
Treatment of cardiogenic shock (CS) often requires the use of vasopressors and inotropic agents, which are associated with an increase in mortality. Data on change in vasopressor and inotrope requirements post Impella 5.0 placement is scarce. Thus, we aimed to study the ability of Impella 5.0 to reduce these requirements. Retrospective analysis of consecutive patients with CS receiving Impella 5.0 was performed. Vasopressor-Inotrope Score (VIS) and a Modified Catecholamine Equivalent score (MCES) was calculated prior to and up to 72 h post-Impella implantation. Primary outcome was change in MCES from baseline to 48-h post implantation and secondary outcomes included change in VIS, changes in MCES according to SCAI Stage and to underlying etiology, and freedom from mortality at 30-days. Twenty-eight patients with median age of 61 (48, 67) years were included. Impella 5.0 was associated with significant reduction in MCES from baseline [9.7 (5.3, 17)] to 48 h [5.7 (3.8, 7.5), p = 0.001]. VIS was also significantly reduced from baseline [8.3 (3.8, 19.9)] to 48 h [5.0 (2.5, 8), p = 0.003]. MCES at 48 h was significantly reduced in patients with SCAI Stage E versus Stage C (p = 0.026) and with acute myocardial infarction versus acute decompensated heart (p = 0.003). Thirty-day survival was 0% in patients that had a baseline MCES ⩾ 10 without a reduction in MCES of at least 5 at 24 h. Impella 5.0 is associated with a significant reduction in MCES and VIS scores in patients presenting with CS with 30-day survival being dependent on MCES.


Head and Tibial Acceleration as a Function of Stride Frequency and Visual Feedback during Running.
Individuals regulate the transmission of shock to the head during running at different stride frequencies although the consequences of this on head-gaze stability remain unclear. The purpose of this study was to examine if providing individuals with visual feedback of their head-gaze orientation impacts tibial and head accelerations, shock attenuation and head-gaze motion during preferred speed running at different stride frequencies. Fifteen strides from twelve recreational runners running on a treadmill at their preferred speed were collected during five stride frequencies (preferred, ±10% and ±20% of preferred) in two visual task conditions (with and without real-time visual feedback of head-gaze orientation). The main outcome measures were tibial and head peak accelerations assessed in the time and frequency domains, shock attenuation from tibia to head, and the magnitude and velocity of head-gaze motion. Decreasing stride frequency resulted in greater vertical accelerations of the tibia (p<0.01) during early stance and at the head (p<0.01) during early and late stance; however, for the impact portion the increase in head acceleration was only observed for the slowest stride frequency condition. Visual feedback resulted in reduced head acceleration magnitude (p<0.01) and integrated power spectral density in the frequency domain (p<0.01) in late stance, as well as overall of head-gaze motion (p<0.01). When running at preferred speed individuals were able to stabilize head acceleration within a wide range of stride frequencies; only at a stride frequency 20% below preferred did head acceleration increase. Furthermore, impact accelerations of the head and tibia appear to be solely a function of stride frequency as no differences were observed between feedback conditions. Increased visual task demands through head gaze feedback resulted in reductions in head accelerations in the active portion of stance and increased head-gaze stability.


Associations Between Executive Functions and Physical Fitness in Preschool Children.
Considering the current agreement on the significance of executive functions, there is growing interest in determining factors that contribute to the development of these skills, especially during the preschool period. Although multiple studies have been focusing on links between physical activity, physical fitness and executive functions, this topic was more investigated in schoolchildren and adults than in preschoolers. The aim of the current study was to identify different levels of physical fitness among pre-schoolers, followed by an analysis of differences in their executive functions. Participants were 261 5-6-years old children. Inhibitory control and working memory were positively linked with physical fitness. Cognitive flexibility was not associated with physical fitness. The research findings are considered from neuropsychological grounds, Jean Piaget's theory of cognitive development, and the cultural-historical approach.


Measuring Potentially Avoidable Acute Care Transfers From Long-Term Care Homes in Quebec: a Cross Sectional Study.
Potentially avoidable emergency department transfers (PAEDTs) and hospitalizations (PAHs) from long-term care (LTC) homes are two key quality improvement metrics. We aimed to: 1) Measure proportions of PAEDTs and PAHs in a Quebec sample; and 2) Compare them with those reported for the rest of Canada. We conducted a repeated cross-sectional study of residents who were received at one tertiary hospital between April 2017 and March 2019 from seven LTC homes in Quebec, Canada. The MedUrge emergency department database was used to extract transfers and resident characteristics. Using published definitions, PAEDTs and PAHs were identified from principal emergency department and hospitalization diagnoses, respectively. PAEDT and PAH proportions were compared to those reported by the Canadian Institute for Health Information. A total of 1,233 transfers by 692 residents were recorded, among which 36.3% were classified as being potentially avoidable: 22.8% 'PAEDT only', 11.6% 'both PAEDT & PAH', and 1.9% 'PAH only'. Shortness of breath was the most common reason for transfer. Pneumonia was the most common diagnosis from the 'both PAEDT & PAH' category. PAEDTs and PAHs accounted for 95% and 37% of potentially avoidable transfers, respectively. Among 533 hospitalizations, 31.3% were PAHs. These proportions were comparable to the rest of Canada, with some differences in proportions of transfers due to congestive heart failure, urinary tract infection, and implanted device management. PAEDTs far outweigh PAHs in terms of frequency, and their monitoring is important for quality assurance as they may inform LTC-level interventions aimed at their reduction.


Pseudoaneurysm of left colic artery after Tenckhoff catheter removal, with unrecognized fungal peritonitis.
A 42-year-old continuous ambulatory peritoneal dialysis patient had presented to us with symptoms and signs of peritonitis, complicated by intestinal obstruction. On fourth day after admission, the Tenckhoff catheter was removed, as there was no response to intraperitoneal antibiotic. He developed hypotension during one of the hemodialysis sessions and was found to have low hemoglobin of 4 g/dL. Computed tomography revealed high-density fluid suggestive of fresh blood and clots in the peritoneal cavity. Conventional visceral angiogram with selective inferior mesenteric arterial cannulation revealed pseudoaneurysm arising from the descending branch of the left colic artery. An effort to embolize the pseudoaneurysm failed on 2 occasions. At laparotomy the pseudoaneurysm of the left colic artery was identified after evacuation of blood clots. The pseudoaneurysm was then excised and a lateral rent in the descending branch of left colic artery was repaired. The pus showed septate hyphae on potassium hydroxide mount. He was treated with injections of amphotericin B and oral voriconazole as the culture showed growth of Aspergillus flavus. The early fibrinous, ''easy'' flimsy adhesions formed during the initial intestinal obstruction phase might have resulted in formation of the pseudoaneurysm when the Tenckhoff catheter was removed with traction. The removal of the Tenckhoff catheter, drop in hemoglobin and distension of the abdomen were temporally so closely related that the pseudoaneurysm as a result of the traction removal of the catheter was undeniable. A controlled trial would provide firm evidence either in favor or against formal dissection for the removal of Tenckhoff catheters.


Ectopic sebaceous glands in the esophagus: report of three new cases and review of the literature.
Ectopic sebaceous glands in the esophagus are a very rare anomaly which have, until now, been described in only 14 living individuals. We describe here the macroscopic, pathological, and clinical features of three new endoscopically diagnosed cases of this benign condition. One of the three patients showed a very high number of lesions (more than 100) distributed throughout the esophagus. A review of the existing literature is presented and the possible pathogenetic mechanisms involved are discussed.


Rare case of bladder chondroma causing lower urinary tract symptoms.
An extraosseous or soft tissue chondroma is a rare, benign cartilaginous tumour characterised by the formation of mature hyaline cartilage. The majority of osseous chondromas are located within the medullary cavity of long bones. Soft tissue chondromas are extremely rare with only five cases affecting the bladder being reported in the literature. Soft tissue chondroma of the bladder is a rare cause of lower urinary tract symptoms and abdominopelvic pain. All reported cases of soft tissue chondromas of the bladder have occurred in women in their fifth to seventh decades of life. We describe the case of a 65-year-old woman diagnosed with a soft tissue chondroma of her bladder while being investigated for lower urinary tract symptoms.


Preparation of Bi0.15Fe0.15TiO2 Nanocomposites for the Highly Selective Enrichment of Phosphopeptides.
Novel Bi0.15Fe0.15TiO2 nanocomposites (B0.15F0.15TNs) were synthesized for the first time by a modified sol-gel technology and successfully applied to selective extraction and enrichment of phosphopeptides from digested protein mixture solutions and real samples (tissue protein extract from human liver). The codoping of Bi and Fe into TiO2 results in a significant enhancement in both the enrichment efficiency and selectivity. Compared with the commercial available TiO2 extractant, the proposed B0.15F0.15TNs possess a lower detection limit (2 × 10-9 M) and higher selectivity at a low weight ratio of 1:1200 (phosphopeptides/nonphosphopeptides). Additionally, a total of 223 phosphorylation sites were identified from the human liver lysate after enrichment by the B0.15F0.15TNs. In addition, the synthesis of B0.15F0.15TNs is quite easy, of high yield, and inexpensive.


Tunnel restorations using glass ionomer or glass cermet: in vitro marginal ridge fracture and microleakage.
The purpose of this in vitro study was to compare the marginal ridge fracture resistance and microleakage following restorations of partial tunnel preparations using glass ionomer and glass cermet cements. Sixty eight sound premolars were selected for this study and were divided randomly into six groups. A standardized partial tunnel preparation was done on all the teeth except specimens belonging to Group I. The partial tunnel preparations of Groups III & V were restored with glass ionomer and that of Groups IV & VI were restored with glass cermet. The teeth belonging to Groups I, II, III & IV were subjected to marginal ridge fracture resistance testing. The teeth of Groups V & VI were tested for microleakage after immersing them in 5% methylene blue solution for 4 hours. The results indicated that the teeth restored with glass cermet were marginally better than that with glass ionomer in terms of marginal ridge fracture resistance. Both the materials failed to reinforce the marginal ridge to the level of an intact tooth. The microleakage which occurred around both the materials were statistically insignificant, but on comparison glass ionomer showed better results. Hence, glass ionomer is preferred as a restorative material for partial tunnel preparations because of additional inherent advantages like superior esthetics and fluoride leachability.


DNAM1 and TIGIT balance the T cell response, with low T cell TIGIT expression corresponding to inflammation in psoriatic disease.
Signals at the contact site of antigen-presenting cells (APCs) and T cells help orchestrate the adaptive immune response. CD155 on APCs can interact with the stimulatory receptor DNAM1 or inhibitory receptor TIGIT on T cells. The CD155/DNAM1/TIGIT axis is under extensive investigation as immunotherapy target in inflammatory diseases including cancer, chronic infection and autoimmune diseases. We investigated a possible role for CD155/DNAM1/TIGIT signaling in psoriatic disease. By flow cytometry, we analyzed peripheral blood mononuclear cells of patients with psoriasis (n = 20) or psoriatic arthritis (n = 21), and healthy individuals (n = 7). We measured CD155, TIGIT, and DNAM1 expression on leukocyte subsets and compared activation-induced cytokine production between CD155-positive and CD155-negative APCs. We assessed the effects of TIGIT and DNAM1 blockade on T cell activation, and related the expression of CD155/DNAM1/TIGIT axis molecules to measures of disease activity. High CD155 expression associates with tumor necrosis factor (TNF) production in myeloid and plasmacytoid dendritic cells (DC). In CD1c+ myeloid DC, activation-induced CD155 expression associates with increased HLA-DR expression. CD8 T cells - but not CD4 T cells - express high levels of TIGIT. DNAM1 blockade decreases T cell pro-inflammatory cytokine production, while TIGIT blockade increased T cell proliferation. Finally, T cell TIGIT expression shows an inverse correlation with inflammation biomarkers in psoriatic disease. CD155 is increased on pro-inflammatory APCs, while the receptors DNAM1 and TIGIT expressed on T cells balance the inflammatory response by T cells. In psoriatic disease, low TIGIT expression on T cells is associated with systemic inflammation.


Proton dissociation properties of arylphosphonates: Determination of accurate Hammett equation parameters.
Determination of the proton dissociation constants of several arylphosphonic acid derivatives was carried out to investigate the accuracy of the Hammett equations available for this family of compounds. For the measurement of the pKa values modern, accurate methods, such as the differential potentiometric titration and NMR-pH titration were used. We found our results significantly different from the pKa values reported before (pKa1: MAE = 0.16 pKa2: MAE=0.59). Based on our recently measured pKa values, refined Hammett equations were determined that might be used for predicting highly accurate ionization constants of newly synthesized compounds (pKa1=1.70-0.894σ, pKa2=6.92-0.934σ).


Health seeking and access to care for children with suspected dengue in Cambodia: an ethnographic study.
The continuing contribution of dengue fever to the hospitalization and deaths in hospital of infants and small children in Cambodia is associated with delays in presentation for medical attention, diagnosis and appropriate care. It is important to identify the reasons that influence these delays, in order to develop appropriate interventions to redress the impact of dengue. Data on health seeking were collected during an ethnographic study conducted in two villages in the eastern province of Kampong Cham, Cambodia in 2004. Interviews were conducted with mothers whose children had been infected with suspected dengue fever, or who had been sick for other reasons, in 2003 and 2004. Women selected a therapeutic option based on perceptions of the severity of the child's condition, confidence in the particular modality, service or practitioner, and affordability of the therapy. While they knew what type of health care was required, poverty in combination with limited availability and perceptions of the poor quality of care at village health centers and public referral hospitals deterred them from doing so. Women initially used home remedies, then sought advice from public and private providers, shifting from one sector to another in a pragmatic response to the child's illness. The lack of availability of financial resources for poor people and their continuing lack of confidence in the care provided by government centres combine to delay help seeking and inappropriate treatment of children sick with dengue.


Immunohistochemical distinction of lymphomatoid papulosis and pityriasis lichenoides et varioliformis acuta.
Lymphomatoid papulosis (LyP) and pityriasis lichenoides et varioliformis acuta (PLEVA) are benign self-healing cutaneous eruptions that may be clinically and histologically similar. However LyP has a 5% to 20% risk of associated lymphoid malignancy, whereas PLEVA does not. To determine whether the immunophenotype of lymphoid cells is useful in the distinction of these two disorders, the pattern of expression of lymphoid cell lineage and activation antigens in nine cases of LyP and seven cases of PLEVA were compared. In all cases of LyP most larger cells expressed the activation antigen Ki-1 (CD30) and lacked expression of the T-cell antigen CD7 and at least one other T-cell antigen (CD2, CD3, CD5). In contrast, CD30-antigen expression was rare or absent in PLEVA, CD3- and CD7-antigen expression was found in all cases, and diminished expression of T-cell antigens (CD2 and CD5) was seen in only one case. Diffuse expression of HLA-DR antigen by epidermal keratinocytes was found in a greater proportion of PLEVA cases (6 of 7) than LyP cases (3 of 6). In addition, CD8+ cells predominated at the dermal/epidermal junction in 3 of 6 cases of PLEVA but in only 1 of 7 cases of LyP. We conclude that LyP and PLEVA can be distinguished immunohistochemically in most, if not all, cases. Furthermore these results suggest that LyP and PLEVA are separate disorders, thus accounting for their variable prognoses.


Echinococcus multilocularis: mouse strain difference in hydatid development.
Female mice of nine inbred strains (A, AKR, BALB/c, C3H, C57BL/6, C57BL/10, CBA, DBA/1 and DBA/2) and H-2 congenic B10.D2, at 9-10 weeks of age, were infected with larval Echinococcus multilocularis by trans-portal injection of hydatid homogenate. Parasitized livers were histologically examined 9 or 13 weeks after infection. Hydatid development was quite different among mouse strains. Multivesiculation was prominent in C57BL/10, DBA/1, C57BL/6 and BALB/c. Protoscoleces were well developed in DBA/2, AKR, DBA/1 and CBA. H-2 congenic B10.D2, which has the background genes of C57BL/10 except for the H-2d gene of DBA/2, resembled C57BL/10 in prohibiting the development of protoscoleces. These data suggest that the qualitative difference in hydatid development may be regulated by non-H-2 gene(s).


Electron-microscopic observations on the muscular coat of swell bodies in human nasal mucosa.
Morphology and function of so-called nasal "swell bodies" or "cavernous tissue" have been studied by many investigators during the past 140 years. However, many details of this interesting and peculiar tissue remained unsolved, even though this vascular system plays an important role in a variety of rhinologic disorders. The present study describes electron-microscopic details of the muscular coat of the different venous structures that form human nasal swell bodies. The specimens were taken from patients requiring removal of conchal mucosa and septoplasty; semithin and ultrathin sections were obtained and examined with the optical and electron microscopes. The histologic evaluation showed differences in the venous wall structure depending on the location of the vessels. The muscular layers were significantly thinner in those parts of the swell bodies located adjacent to the epithelium. Electron-microscopic studies enabled us to determine the cytoplasmic components of smooth muscle cells, i.e., thin filaments, glycogen granules, caveolar plasmalemmal areas, cytoplasmic dense bodies (CDB), and membrane-associated dense bodies (MADB). Another interesting feature was the varying appearance of the basal lamina of smooth muscle cells of the cavernous tissue. Based on the findings of the present study, the morphologic peculiarities of nasal swell bodies are compared and discussed with the appropriate literature. Further immunohistochemical and molecular-biological studies will have to be performed to understand the complex functional mechanism of this unique vascular system.


Surface-Adaptive Capillarity Enabling Densified 3D Printing for Ultra-High Areal and Volumetric Energy Density Supercapacitors.
Endowing supercapacitors with higher energy density is of great practical significance but remains extremely challenging. In this work, an innovative densified 3D printing enabled by a surface-adaptive capillarity strategy is proposed for the first time. The printable ink formulated with pyrrole surface-modified reduced graphene oxide renders the printed electrodes excellent surface tension regulability to the subsequent capillary densification, creating an intensely condensed electrode with well-maintained structural integrity. Furthermore, simultaneous in situ nitrogen doping and hierarchical micro-meso porosity are readily realized upon post-carbonization, encouraging enhanced capacitance and fast reaction dynamics. As a result, the printed symmetric supercapacitor delivers a double leap in areal and volumetric energy densities in both aqueous and organic electrolytes, a rarely achieved yet gravely desired attribute for 3D printed energy storage devices.


Study of the Urinary TGF-β1 Profile in Diabetic Nephropathy: A Single-Center Experience From India.
Background Diabetic nephropathy is one of the important causes of end-stage kidney disease (ESKD). Of the various cytokines playing a role in the pathogenesis of diabetic nephropathy, transforming growth factor beta-1 (TGF-β1) is an important one. Its major role is to mediate extracellular matrix deposition. Increased renal expression of TGF-β1 is found in diabetic nephropathy and its urinary excretion can serve as a useful marker of outcomes. Material and methods A prospective observational study was conducted, which included 10 cases of diabetic nephropathy in group A with age ≥ 18 years and a urinary protein creatinine ratio (UPCR) value of > 0.5 mg/mg and 10 healthy controls in group B. Patients with active urinary tract infection, chronic kidney disease (CKD) stage Vd patients on maintenance hemodialysis, and renal transplant recipients were excluded from the study. Urinary TGF-β1 level estimation in a 24-hour urine sample, 24-hour urine protein, and other baseline laboratory investigations were done. Results In diabetic nephropathy cases (group A), the mean value of urinary TGF-β1 levels was 88.33± 12.44 ng/24 hours. In the control group (group B), the mean value of urinary TGF-β1 was 29.03 ± 3.23 ng/24 hours. Urinary TGF-β1 levels were significantly elevated in group A as compared to group B (p<0.001). There was no significant correlation between urinary TGF-β1 levels and estimated glomerular filtration rate (eGFR) (r=0.376, p= 0.285) as well as the urinary TGF-β1 levels and 24-hour urine protein levels (p = 0.334, r = 0.341) in diabetic nephropathy cases. Glycosylated hemoglobin (HbA1c) levels didn't correlate with the urinary TGF-β1 levels (r = -0.265, p = 0.46). Conclusion The urinary TGF-β1 levels were significantly elevated in diabetic nephropathy patients as compared to healthy controls. There was no significant correlation between urinary TGF-β1 levels and proteinuria, eGFR, or HbA1c levels in diabetic nephropathy patients.


Membranous urethral length and urinary incontinence following robot-assisted radical prostatectomy: a systematic review and meta-analysis.
To provide an update on the association between preoperative membranous urethral length (MUL) and postoperative urinary incontinence (UI) in men who undergo robot-assisted radical prostatectomy (RARP)/robot-assisted laparoscopic prostatectomy (RALP). Urinary incontinence is common after RARP/RALP, and early recovery of continence is one of the most important functional outcomes following surgery. MUL has been identified as a factor associated with continence recovery after RARP/RALP. A systematic review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using PubMed, Embase, and Scopus databases. Inclusion criteria were English language full journal articles authored within the last 5 years that assessed continence using the Expanded Prostate Cancer Index Composite. The Critical Appraisal Skills Programme tool for retrospective cohort studies was used to evaluate study quality. A random-effects meta-analysis was performed to pool odds ratios (ORs) from available studies relating to continence as a function of MUL. The Grading of Recommendations, Assessment, Development and Evaluations framework was used to synthesise evidence. Six studies including 970 patients reported an association between MUL and continence at 12 months. Longer MUL was associated with reduced UI odds at 12 months after surgery (pooled OR 0.74, 95% confidence interval 0.68-0.87, P < 0.001). Significant methodological and statistical heterogeneity was encountered. Preoperative MUL measured on magnetic resonance imaging (MRI) is significantly associated with postoperative continence in men undergoing RARP/RALP. We recommend consideration of MRI measurement of MUL prior to RARP/RALP to guide treatment decisions in this population.


Tunable thermal conduction force without macroscopic temperature gradients.
Ubiquitous thermal conduction makes its force effect particularly important in diverse fields, such as electronic engineering and biochemistry. However, regulating thermal conduction force is still challenging due to two stringent restrictions. First, a temperature gradient is essential for inducing the force effect. Second, the force direction is fixed to the temperature gradient in a specific material. Here, we demonstrate that thermal conduction force can exist unexpectedly at a zero average temperature gradient in dielectric crystals. The wavelike feature of thermal conduction is considered, i.e., the second sound mode. Based on the momentum conservation law for phonon gases, we analyze thermal conduction force with the plane, zeroth-order Bessel, and first-order Bessel second sounds. Remarkably, the force direction is highly tunable to be along or against the second sound direction. These results provide valuable insights into thermal conduction force in those environments with temperature fluctuations, and they open up possibilities for practical applications in manipulating the local thermal conductivity of crystals.


The effects of multi mineral-vitamin D and vitamins (C+E) supplementation in the prevention of preeclampsia: An RCT.
Several studies have reported the uncertain role of multi-minerals and vitamins in the prevention of preeclampsia. The present study aims to investigate the effect of multimineral-vitamin D supplements (calcium, magnesium, zinc and Vitamin D) and vitamins (C+ E) in the prevention of preeclampsia. In this randomized clinical trial, 90 pregnant women were divided into three groups: group A received Ferrous sulfate (1 tablet/day) + one tablet of Claci-care multimineral-vitamin D containing 800mg calcium, 200mg magnesium, 8mg zinc and 400 IU Vitamin D3 per day; group B received Ferrous sulfate (1 tablet/day) + 250 mg vitamin C + 55 mg vitamin E; and the controls received only one Ferrous sulfate tablet daily. The incidence of preeclampsia in group A was significantly lower than the control group (p=0.03), while there was no significant difference between group B and controls (p=0.50), as well as groups A and B (p=0.063). The incidence of neonatal complications in the group A was significantly lower than the control group (p=0.01), while there was no significant difference between group B and control (p=0.48). According to the results, calcium, magnesium, and zinc supplements have a significant effect on the prevention of preeclampsia. In addition, prescription of multimineral-vitamin D during pregnancy can be a low-cost and affordable way to reduce the incidence of preeclampsia in women who are at high risk of preeclampsia.


[Control rate of increased low-density lipoprotein cholesterol levels in cardiology outpatients with coronary heart disease in Beijing].
To investigate the low-density lipoprotein cholesterol (LDL-C) levels in outpatients with coronary heart disease (CHD) visiting cardiology outpatient clinics of 8 hospitals in Beijing. A total of 903 outpatients with CHD were enrolled from 4 three-tier hospitals and 4 two-tier hospitals in Beijing. All patients were asked to finish the questionnaire including demographic data, CHD history, the knowledge on cholesterol, and the use of statins. Blood lipid was examined and the LDL-C control rate and related factors were then analyzed. Questionnaire was obtained from 876 patients [619 male: 70.7%, mean age: (64.9 ± 10.7) years old] and blood lipid data were available in 709 patients. The general LDL-C control rate was 36.9% (262/709) and was 13.5% (27/173) in very high risk CHD patients, and lower in patients treated in two-tier hospitals than patients treated in three-tier hospitals[31.3% (121/386) vs. 43.7% (141/323), P < 0.01], in female patients than in male patients [27.1% (60/261) vs. 41.3% (201/496), P < 0.01] and in diabetic patients than in non-diabetic patients [13.5% (27/200) vs. 44.7% (197/441), P < 0.01]. The LDL-C control rate was lower in patients less than 60 years old and patients over 80 years old than that in 60-70 years old patients and 70 - 80 years old patients (P < 0.05). LDL-C control rate was not affected by the history of hypertension, percutaneous coronary intervention or coronary artery bypass grafting, smoking, lipid examination frequency, knowledge on goal level of LDL-C, diet control and regularly physical exercising (all P > 0.05). There were 18.2% (129/709) patients not taking statins or not aware if they were taking statin or not. The main reason for not taking statin [47.9% (23/48)] was statin was no prescribed by doctors, followed by withdrawal by patients due to various reasons [27.1% (13/48)]. LDL-C control rate was low in patients with CHD visiting cardiology outpatient clinics in Beijing. The CHD patients and cardiologists should be encouraged to achieve better LDL-C control by following lipid lowering guidelines and it is also important to improve the drug compliance among CHD patients.


Joint testing of overall and simple effects for the two-by-two factorial trial design.
The two-by-two factorial design randomizes participants to receive treatment A alone, treatment B alone, both treatments A and B(AB), or neither treatment (C). When the combined effect of A and B is less than the sum of the A and B effects, called a subadditive interaction, there can be low power to detect the A effect using an overall test, that is, factorial analysis, which compares the A and AB groups to the C and B groups. Such an interaction may have occurred in the Action to Control Cardiovascular Risk in Diabetes blood pressure trial (ACCORD BP) which simultaneously randomized participants to receive intensive or standard blood pressure, control and intensive or standard glycemic control. For the primary outcome of major cardiovascular event, the overall test for efficacy of intensive blood pressure control was nonsignificant. In such an instance, simple effect tests of A versus C and B versus C may be useful since they are not affected by a subadditive interaction, but they can have lower power since they use half the participants of the overall trial. We investigate multiple testing procedures which exploit the overall tests' sample size advantage and the simple tests' robustness to a potential interaction. In the time-to-event setting, we use the stratified and ordinary logrank statistics' asymptotic means to calculate the power of the overall and simple tests under various scenarios. We consider the A and B research questions to be unrelated and allocate 0.05 significance level to each. For each question, we investigate three multiple testing procedures which allocate the type 1 error in different proportions for the overall and simple effects as well as the AB effect. The Equal Allocation 3 procedure allocates equal type 1 error to each of the three effects, the Proportional Allocation 2 procedure allocates 2/3 of the type 1 error to the overall A (respectively, B) effect and the remaining type 1 error to the AB effect, and the Equal Allocation 2 procedure allocates equal amounts to the simple A (respectively, B) and AB effects. These procedures are applied to ACCORD BP. Across various scenarios, Equal Allocation 3 had robust power for detecting a true effect. For ACCORD BP, all three procedures would have detected a benefit of intensive glycemia control. When there is no interaction, Equal Allocation 3 has less power than a factorial analysis. However, Equal Allocation 3 often has greater power when there is an interaction. The R package factorial2x2 can be used to explore the power gain or loss for different scenarios.


Heat Transfer in Health and Healing.
Our bodies depend on an exquisitely sensitive and refined temperature control system to maintain a state of health and homeostasis. The exceptionally broad range of physical activities that humans engage in and the diverse array of environmental conditions we face require remarkable strategies and mechanisms for regulating internal and external heat transfer processes. On the occasions for which the body suffers trauma, therapeutic temperature modulation is often the approach of choice for reversing injury and inflammation and launching a cascade of healing. The focus of human thermoregulation is maintenance of the body core temperature within a tight range of values, even as internal rates of energy generation may vary over an order of magnitude, environmental convection, and radiation heat loads may undergo large changes in the absence of any significant personal control, surface insulation may be added or removed, all occurring while the body's internal thermostat follows a diurnal circadian cycle that may be altered by illness and anesthetic agents. An advanced level of understanding of the complex physiological function and control of the human body may be combined with skill in heat transfer analysis and design to develop life-saving and injury-healing medical devices. This paper will describe some of the challenges and conquests the author has experienced related to the practice of heat transfer for maintenance of health and enhancement of healing processes.


The mouse seminal vesicle shape mutation is allelic with Fgfr2.
The mouse seminal vesicle shape (svs) mutation is a spontaneous recessive mutation that causes branching morphogenesis defects in the prostate gland and seminal vesicles. Unlike many other mutations that reduce prostatic and/or seminal vesicle branching, the svs mutation dramatically reduces branching without reducing organ growth. Using a positional cloning approach, we identified the svs mutant lesion as a 491 bp insertion in the tenth intron of Fgfr2 that results in changes in the pattern of Fgfr2 alternative splicing. An engineered null allele of Fgfr2 failed to complement the svs mutation proving that a partial loss of FGFR2(IIIb) isoforms causes svs phenotypes. Thus, the svs mutation represents a new type of adult viable Fgfr2 allele that can be used to elucidate receptor function during normal development and in the adult. In the developing seminal vesicles, sustained activation of ERK1/2 was associated with branching morphogenesis and this was absent in svs mutant seminal vesicles. This defect appears to be the immediate downstream effect of partial loss of FGFR2(IIIb) because activation of FGFR2(IIIb) by FGF10 rapidly induced ERK1/2 activation, and inhibition of ERK1/2 activation blocked seminal vesicle branching morphogenesis. Partial loss of FGFR2(IIIb) was also associated with down-regulation of several branching morphogenesis regulators including Shh, Ptch1, Gli1, Gli2, Bmp4, and Bmp7. Together with previous studies, these data suggest that peak levels of FGFR2(IIIb) signaling are required to induce branching and sustain ERK1/2 activation, whereas reduced levels support ductal outgrowth in the prostate gland and seminal vesicles.