Methodological considerations for assessing trauma history via self-report.
One must first experience a traumatic event (Criterion A in the Diagnostic and Statistical Manual of Mental Disorders; 5th ed.; DSM-5; American Psychiatric Association [APA], 2013) to be diagnosed with posttraumatic stress disorder (PTSD). Standard procedures for assessing Criterion A (i.e., the "worst-event" method) may result in misidentification of trauma exposure status. The purpose of this Internet-based study was to obtain an estimate of the percent of an adult sample that is misidentified as non-Criterion A through use of this method. Two separate samples completed the extended version of the Life Events Checklist for DSM-5 (LEC-5; Weathers, Blake, et al., 2013b). Sample 1 participants (N = 579) completed the LEC-5 via the traditional worst-event method, while Sample 2 participants (N = 569) completed follow-up questions for every event endorsed on the LEC-5, as well as a measure of posttraumatic stress symptoms. The majority of each sample identified a worst event that met Criterion A (Sample 1 = 58.5%; Sample 2 = 54.3%). Of the 202 participants in Sample 2 whose worst event did not meet Criterion A, 69.6% reported at least one other Criterion A event. Additionally, posttraumatic stress symptoms (i.e., severity and factor structure) in Sample 2 did not differ between those with a worst event that met Criterion A and those with a secondary event that met Criterion A, even though the identified worst event did not. When assessing trauma exposure via self-report, a written narrative and follow-up questions should be requested for all events that are endorsed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


[Results of clinical epidemiology and intervention trial of hyperlipidemia in Japan].
Recently, three large-scale clinical studies on hypercholesterolemia have been reported in Japan. The Kyushu Lipid Intervention Study(KLIS) was initiated investigate the effect of pravastatin, as compared with conventional hypolipidemic treatment, in the primary prevention of not only coronary events but also cerebral infarction in Japanese men with serum total cholesterol levels of 220 mg/dl or greater. A total of 5,640 patients were recruited. Adjusted relative risks of outcomes combined coronary events and cerebral infarction for pravastatin versus conventional treatment was 0.81(p = 0.08). The Pravastatin Anti-atherosclerosis Trial in the Elderly(PATE) is a prospective randomized controlled trial to determine the effectiveness of pravastatin on the incidence of cardiovascular events by comparing the effect of low dose(group L, 5 mg/day, n = 334) with the standard dose(group S, 10-20 mg/day, n = 331) in elderly patients aged more than 60 years old. The risk ratio for group S compared with group L was 0.674(95% confidence interval: 0.423-1.074). The Japan Lipid Intervention Trial(J-LIT) is the first nation-wide study conducted to determine a relationship between serum lipid concentrations and the development of CHD under simvastatin treatment. The J-LIT study enrolled 52,421 men and women with total cholesterol(TC) more than 220 mg/dl. Patients were treated with open-labeled simvastatin at a dose of 5 to 10 mg/day for 6 years. Simvastatin reduced serum concentrations of TC, LDL-C and TG by 18.4, 26.8 and 16.1%, respectively. LDL-C positively correlated with the CHD events and the relative risk of CHD was higher significantly more than 160 mg/dl of LDL-C.


Tick-borne encephalitis vaccines: past and present.
Vaccines to protect against tick-borne encephalitis (TBE) are produced by two manufacturers and are widely used in European and Asian countries, where TBE virus is endemic. General trends in vaccine development during recent decades and extensive postmarketing experience resulted in several modifications to their formulations and practical implications for use. Modifications were made to the production process, such as the change of the virus master bank from mouse brain to primary cells; to the excipients, especially the stabilizers and preservative; and to include formulations for children. Additionally, a rapid vaccination schedule has been developed for persons who require a fast onset of protection. Recent data from clinical studies and postmarketing surveillance indicate that both vaccines are safe, efficacious and interchangeable. Further (major) changes to formulation or alternative targets for vaccine development are not anticipated in the next 5 years. Recent serologic studies indicate that the persistence of protective immunity was longer than expected. Thus, recommendations for prolongation of TBE booster intervals have been made in several European countries, and a harmonization for booster recommendations is predicted within the European Union. Based on epidemiologic trends, the use of TBE vaccines will continue to increase in all age groups, including children.


Working With Lesbian, Gay, Bisexual, and Transgender Clients: Occupational Therapy Practitioners' Knowledge, Skills, and Attitudes.
A lack of health care provider knowledge and training has been identified as one factor that contributes to health disparities for sexual and gender minority (SGM) populations. To explore occupational therapy practitioners' self-reported knowledge about, clinical preparedness for, and attitudes toward working with lesbian, gay, bisexual, and transgender (LGBT) clients. Online survey of occupational therapy practitioners. Respondents were recruited by means of snowball sampling through social media groups, state occupational therapy association websites, and emails. Surveys were posted to electronic occupational therapy social media sites. Knowledge, clinical preparedness, and attitudes were measured using the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS). Information about demographic characteristics, education, and workplace was also collected. Five hundred eighty-nine occupational therapy practitioners responded to the survey. Degree level (master's vs. bachelor's or less), continuing education (minimum 1-2 hr of LGBT-specific training), practice setting (mental health), minority sexual orientation, and having a close friend or family member who identifies as SGM were associated with higher mean scores on the LGBT-DOCSS. Higher religiosity and frequency of religious practice were associated with lower scores on knowledge and attitudinal awareness. Occupational therapy practitioners often care for clients from backgrounds and cultures that differ from their own. Identifying gaps in education and opportunities for fostering LGBT-positive attitudes can facilitate the development of programs to improve practice with LGBT clients and help measure the effectiveness of such programs. What This Article Adds: This study provides evidence that a basic level of continuing education can improve occupational therapy practitioners' knowledge of and skills for working with LGBT populations and highlights the need to examine and change structural biases.


Development and Validation of a Model for Predicting Diabetic Nephropathy in Chinese People.
To develop a risk model for predicting later development of diabetic nephropathy (DN) in Chinese people with type 2 diabetes mellitus (T2DM) and evaluate its performance with independent validation. We used data collected from the project 'Comprehensive Research on the Prevention and Control of Diabetes', which was a community-based study conducted by the Jiangsu Center for Disease Control and Prevention in 2013. A total of 11,771 eligible participants were included in our study. The endpoint was a clear diagnosis of DN. Data was divided into two components: a training set for model development and a test set for validation. The Cox proportional hazard regression was used for survival analysis in men and women. The model's performance was evaluated by discrimination and calibration. The incidence (cases per 10,000 person-years) of DN was 9.95 (95% CI; 8.66-11.43) in women and 11.28 (95% CI; 9.77-13.03) in men. Factors including diagnosis age, location, body mass index, high-density-lipoprotein cholesterol, creatinine, hypertension, dyslipidemia, retinopathy, diet control, and physical activity were significant in the final model. The model showed high discrimination and good calibration. The risk model for predicting DN in people with T2DM can be used in clinical practice for improving the quality of risk management and intervention.


[Clustering of cardiovascular risk factors in obese offspring of parents with essential hypertension].
The prevalence of obesity in industrialized countries is increasing and is closely related to essential hypertension (EHT) in adolescents. To analyze the prevalence of obesity and its association with other known cardiovascular risk factors in a sample of children and young adults with at least one parent with EHT. The EHT group consisted 51 children and young adults (28 males [aged 5.4-25.6 years]) with at least one parent with EHT. The control group comprised 73 healthy normotensive children and young adults (43 males [aged 7.2-25.2 years]) who completed the follow-up visits of the RICARDIN study. Blood pressure (BP) was measured with a standardized technique using a mercury sphygmomanometer. A 12-hour fasting blood sample was taken for lipid profile and high sensitivity C-reactive protein (CRP) determinations. Financial support: FIS 03/0350, ESV Foundation Grant, 2003. The prevalence of obesity was five times higher in the EHT group than in controls (19.6% vs. 4.1%, p = 0.007). In this group, obese subjects showed higher systolic BP (122.0 vs. 110.4 mmHg p = 0.004) and lower high-density lipoprotein cholesterol (HDL-C) levels (47.6 vs. 58.0 mg/dl, p < 0.05). After adjustment for age and systolic BP, obese subjects in the EHT group showed significantly higher CRP values than non-obese subjects in this group (p = 0.024). The prevalence of obesity is higher in the offspring of parents with EHT than in non HT-prone subjects. Clustering of other additional risk factors indicates the need for high-risk preventive interventions in this group of children and young adults.


Acute compartment syndrome of the contralateral thigh following reconstructive shoulder surgery done for multidirectional shoulder instability in lateral decubitus position.
A man in his early 40s had revision reconstructive surgery on his left shoulder while in a right lateral decubitus position. The prolonged surgery (7 hours) caused acute compartment syndrome (ACS) in the contralateral (right) thigh. Moderate pain and swelling of the contralateral thigh ('well limb') was first noted in the recovery room. After progression to severe swelling and numbness in his right toes, fasciotomies of the right thigh were performed, confirming ACS. Thirteen months later he returned to his prior work without lower extremity discomfort or limitations, and he reported a good result from the revision shoulder surgery. Non-traumatic ACS of a well limb is a rare complication of surgery performed in the lateral decubitus position. We suggest that moving the patient temporarily, or to a new position (eg, beach chair), should be considered when the duration of surgery approaches 4.5 hours.


Combined miglustat and enzyme replacement therapy in two patients with type 1 Gaucher disease: two case reports.
Intravenous enzyme replacement therapy is a first-line therapy for Gaucher disease type 1, and substrate reduction therapy represents an oral treatment alternative. Both enzyme replacement therapy and substrate reduction therapy are generally used as monotherapies in Gaucher disease. However, one randomized study and several case reports have described combination therapy over short time periods. We report two female Gaucher disease type 1 patients of mainly Anglo-Saxon descent, where combined enzyme replacement therapy and miglustat substrate reduction therapy were administered to overcome refractory clinical symptoms. The first patient was diagnosed at age 17 and developed Gaucher disease-related bone manifestations that worsened despite starting imiglucerase enzyme replacement therapy. After switching to miglustat substrate reduction therapy, her bone symptoms improved, but she developed tremors and eventually switched back to enzyme replacement therapy. Miglustat was later recommenced in combination with ongoing enzyme replacement therapy due to continued bone pain, and her bone symptoms improved along with maintained visceral manifestations. Enzyme replacement therapy was subsequently tapered off and the patient has since been successfully maintained on miglustat. The second patient was diagnosed aged 3, and commenced imiglucerase enzyme replacement therapy aged 15. After 9 years on enzyme replacement therapy she switched to miglustat substrate reduction therapy and her core symptoms were maintained/stable for 3 years. Imiglucerase enzyme replacement therapy was later added as a boost to therapy and her symptoms were subsequently maintained over a 2.3-year period. However, miglustat was discontinued due to her relocation, necessitating an increase in enzyme replacement therapy dose. Overall, both patients benefited from combination therapy. While the majority of Gaucher disease type 1 patients will not need treatment with both substrate reduction therapy and enzyme replacement therapy, the current case reports demonstrate that judicious use of combination therapy may be of benefit in some cases.


Mechanism of the hydrogen transfer from the OH group to oxygen-centered radicals: proton-coupled electron-transfer versus radical hydrogen abstraction.
High-level ab initio electronic structure calculations have been carried out with respect to the intermolecular hydrogen-transfer reaction HCOOH+.OH-->HCOO.+H(2)O and the intramolecular hydrogen-transfer reaction .OOCH2OH-->HOOCH(2)O.. In both cases we found that the hydrogen atom transfer can take place via two different transition structures. The lowest energy transition structure involves a proton transfer coupled to an electron transfer from the ROH species to the radical, whereas the higher energy transition structure corresponds to the conventional radical hydrogen atom abstraction. An analysis of the atomic spin population, computed within the framework of the topological theory of atoms in molecules, suggests that the triplet repulsion between the unpaired electrons located on the oxygen atoms that undergo hydrogen exchange must be much higher in the transition structure for the radical hydrogen abstraction than that for the proton-coupled electron-transfer mechanism. It is suggested that, in the gas phase, hydrogen atom transfer from the OH group to oxygen-centered radicals occurs by the proton-coupled electron-transfer mechanism when this pathway is accessible.


Second hematopoietic stem cell transplantation in pediatric patients: overall survival and long-term follow-up.
Despite potent intensive conditioning regimens, hematopoietic stem cell transplantation (HSCT) may fail because of either relapse of the malignancy or the rejection of the graft. We report on 27 pediatric patients who received a second HSCT from an allogeneic donor for relapsed malignancy or graft failure. One-year, 5-year, and 10-year probabilities of survival for all patients were 53%, 36%, and 24%, respectively. Twenty patients received second HSCTs for relapsed malignancy, of whom 6 were alive and disease free at the time of this report. Seven patients received a second HSCT for graft failure, of whom 3 were alive and well as of this report. Twenty-five patients were tested for immune reconstitution following their second HSCT. Sixteen patients developed antigen-specific T-lymphocyte responses; the median time to development of antigen-specific responses was 13 months. There was no significant neurocognitive decline in patients tested 1 to 3 years following their second HSCT. Endocrine evaluations revealed deficiencies in growth hormone (7 patients), gonadal function (3 patients), and thyroid function (2 patients). Three patients developed significant abnormalities of tooth development, including absence of secondary teeth. These results show that a second HSCT offers curative therapy for selected pediatric patients whose first HSCT failed. Although toxicity is considerable following a second transplantation, the major causes of mortality continue to be relapse and infection.


Learning to expect and monitor the future: How fast do anticipatory saccades toward future action consequences emerge?
When an action contingently yields the same effect, we form bidirectional action-effect associations that allow us to anticipate the effects of our actions. Importantly, our eyes already move toward the expected future location of our actions' effects in anticipation of them, that is, we perform anticipatory saccades. These anticipatory saccades are linked to a proactive effect-monitoring process that prepares the comparison of expected and actual effect. However, how fast such anticipatory saccades emerge (i.e., how fast learning leads to monitoring) is unknown. To address this question, correct left/right responses were followed by a visual effect either on the same side (response-effect compatible) or on the opposite side (response-effect incompatible). In Experiment 1, action-effect compatibility switched after sequences of four, eight, or 12 trials (randomly allocated; partly predictable environment). In Experiment 2, random trials (two to seven) separated sequences of three, five, or seven experimental trials. Again, action-effect compatibility switched after a sequence of trials and sequences were randomly allocated (unpredictable environment). In both experiments, participants started to perform anticipatory saccades toward future effects after experiencing a new action-effect mapping once/twice (response-effect compatible/incompatible). That is, a single to two action-effect (re-)learning instances were sufficient to develop action-effect associations that trigger attentional shifts toward the expected future consequences of our actions (i.e., monitoring processes), whereas influences on action selection are only observed after a substantially larger number of (re-)learning instances. These results suggest that monitoring processes modulate the expression of action-effect associations in action planning based on observed action-effect contingencies. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Weight gain is associated with medial contact site of subthalamic stimulation in Parkinson's disease.
The aim of our study was to assess changes in body-weight in relation to active electrode contact position in the subthalamic nucleus. Regular body weight measurements were done in 20 patients with advanced Parkinson's disease within a period of 18 months after implantation. T1-weighted (1.5T) magnetic resonance images were used to determine electrode position in the subthalamic nucleus and the Unified Parkinson's disease rating scale (UPDRS-III) was used for motor assessment. The distance of the contacts from the wall of the third ventricle in the mediolateral direction inversely correlated with weight gain (r = -0.55, p<0.01) and with neurostimulation-related motor condition expressed as the contralateral hemi-body UPDRS-III (r = -0.42, p<0.01). Patients with at least one contact within 9.3 mm of the wall experienced significantly greater weight gain (9.4 ± (SD)4.4 kg, N = 11) than those with both contacts located laterally (3.9 ± 2.7 kg, N = 9) (p<0.001). The position of the active contact is critical not only for motor outcome but is also associated with weight gain, suggesting a regional effect of subthalamic stimulation on adjacent structures involved in the central regulation of energy balance, food intake or reward.


The science and art of testing in ice hockey: a systematic review of twenty years of research.
Ice hockey is a complex sport requiring multiple athletic and technical attributes. Considering the variety of tests developed, on-ice testing protocols have been created to measure the physiological and mechanical attributes associated with performance. To our knowledge, a lack of technical resources exists to help stakeholders opt for on-ice protocols from among those developed. It becomes crucial for researchers and practitioners to select relevant and context-specific procedures. This systematic review of the literature outlines an inventory of the on-ice tests that have been used in the domain of ice hockey research over the last twenty years, and summarize protocols mostly used in major athletic components. A search was performed on three databases (PubMed, SPORTDiscus and Scopus) by following the PRISMA guidelines. Specific keywords were selected to find publications using on-ice testing protocols in the methodology. Four aspects of athletic attributes were used to categorize the protocols: aerobic capacity, acceleration-speed, agility-change of direction and ability to repeat skating sprints. Analyses were conducted regarding four categories of observations: population under study, on-ice reported test(s), outcomes measures and main findings. A total of 107 articles were included, resulting in 55 on-ice tests related to the on-ice assessments of four major athletic components: aerobic capacity (n = 7), acceleration-speed (n = 6), agility and change of direction (n = 23) and repeated skating sprint ability (n = 19). Testing in male and older cohorts (≥16 years old) predominates, with a primary focus on the competitive amateur level. The selected tests were mainly designed for assessing on-ice physiological responses and fitness (n = 38), talent identification-team selection (n = 19), efficiency of interventions (n = 17) and validation purposes (n = 16). A prevalence of on-ice skating tests to assess the ability to repeat intense efforts, agility, acceleration and speed components exists, which are relevant and linked to match requirement. The wealth of on-ice tests used in the literature reflects the need to adapt the on-ice evaluation process to the population, constraints, and goals. This review is a valid toolbox and can benefit for researchers and practitioners interested in testing hockey players from different levels, with a variety of aims and needs, by helping them to select the relevant procedures to their environment and practice context.


Gene-sequence-tag expression analyses of 1,800 genes related to chloroplast functions.
Quantification of the expression levels of nuclear genes encoding plastid proteins under different genetic or environmental conditions can contribute to the genetic dissection of plastid functions. To facilitate such measurements, a set of 1,827 Arabidopsis thaliana genes coding for plastid proteins was PCR-amplified from genomic DNA and spotted on nylon membranes to generate an array of chloroplast-specific gene-sequence-tags (GSTs). The sensitivity and reliability of the experimental system was evaluated and a procedure was developed for detecting differential gene expression. The GST array was found to serve as a reliable monitor of changes in gene expression induced by environmental and genetic alteration of chloroplast functions. Based on comparisons of dark- versus light-grown seedlings, and wild-type versus prpl11-1 plants, lists of differentially expressed genes are provided which include 193/7 and 25/42 up/down-regulated genes, respectively. The cut-off values for differential expression were 2.5-times (up) and 0.40 (down). Additional up-regulated genes with relatively low expression ratios (from 1.5- to 2.5-times) or down-regulated with relatively high ratios (0.4-0.67) can be accessed at the website: http://www.mpiz-koeln.mpg.de/~richly/GST-array.html. A sample of genes analysed by quantitative reverse transcription PCR confirmed the expression profiles monitored by the GST array. Differential hybridisation experiments with the prpl11-1 mutant revealed the existence of regulatory networks sensing the protein state of the chloroplast and transmitting the signal to the nucleus.


Targeting Future Customers: An Introductory Biobanking Course for Undergraduate Students of Life Sciences.
Biobanking is a relatively new concept in the Arab region. Targeting different stakeholders to introduce the concept of biobanking and develop an acceptance of it among them is important for the growth of biobanking in the region. Undergraduate students of life sciences represent an important segment of stakeholders, since they constitute potential future biobank customers. Limited funding, lack of awareness of the existence of the term "biobanking" itself among these students, and questions regarding best marketing strategies presented challenges to planning for the most effective message delivery to this target group. A specific course was designed for undergraduate students of life sciences, which was conducted at the Faculty of Medicine, Cairo University, Egypt. The course was conducted twice in 2016 and included lectures covering biobanking, quality, ethics, information technology, and translational research. Facebook and word-of-mouth were used for marketing and advertising. A total number of 125 participants attended both courses cumulatively. Facebook appeared to have been an effective marketing outlet, especially when paid advertisements were used. Evaluation of knowledge, measured using a pretest and posttest, demonstrated some improvement in knowledge of participants. Evaluation forms filled after the course showed positive attitude toward content and message delivery by a majority of participants. Facebook was also used as an evaluation method through analysis of engagement with posts created after course completion. Biobanking education can be carried out effectively with limited resources. Understanding the needs of the target group and using appropriate methods of communication are essential prerequisites to a well-tailored curriculum and effective message delivery. Using Facebook appears to be an effective and affordable method of communication and advertising. Targeting undergraduate students of life sciences interested in research is a good investment and can be very effective in increasing awareness about biobanking inside the research community.


A multifunctional transparent superhydrophobic gel nanocoating with self-healing properties.
Inspired by mussels we designed a novel green superhydrophobic gel nanocoating with good transparency and stability through a facile copolymerization reaction at room temperature and a subsequent trimethyl silyl modified process, which is applicable to various substrates via a simple spray process without requiring toxic substances. Importantly, this well-designed nanocoating has rapid self-healing superhydrophobicity induced by usual organic solvents to face complicated work conditions, which satisfies the need of daily life and can be applied in industry as well.


Prevalence and Risk Factors for Diabetes Mellitus in A State in South East Nigeria: Results of a Population Based House to House Survey.
Population based studies on diabetes mellitus (DM) are scarce in Nigeria. This was a population-based house to house survey aimed at determining the prevalence of DM and assessing the risk factors associated with DM in a state in Southeast Nigeria. This was a cross-sectional observational study in which 1680 adults were recruited using a multistage sampling method to randomly select not more than two suitable participants of both sex in each household from four enumeration areas (EAs) in each local government area (LGA) and the three senatorial zones in the state. A modified World Health Organization (WHO) Stepwise Approach to Surveillance questionnaire was used for data collection and random blood glucose (RBG) was measured after anthropometric assessment. Test statistics used were chi-square, t-test, and logistic regression. The overall prevalence of DM in this study was 3.3%. A positive family history of DM was significantly higher in patients with diabetes: 18.2% vs. 9.6% (p=0.036). The mean (SD) of weight, body mass index (BMI), hip circumference (HC) and waist circumference (WC) were significantly higher in patients with DM(p=0.001,<0.001,<0.001,<0.001, respectively).The odd ratio (95% CI) of a person>35years developing DM was 3.89(1.11-13.60). The OR (95% CI) for waist-hip ratio (WHR) was 3.04 (1.02-9.03) and family history of DM had an OR of 2.62(0.88-6.50). The odd of developing DM is positively associated with age>35years, increased WHR, WC, family history of DM, BMI>25Kg/m2, and HC. The odd of developing DM was negatively associated with smoking. The prevalence of DM in this study was 3.3%. A BMI>25 kg/m2, WHR >0.85, family history of DM, HC, and older age were associated with significantly higher prevalence.


The SWI/SNF chromatin remodeling complex influences transcription by RNA polymerase I in Saccharomyces cerevisiae.
SWI/SNF is a chromatin remodeling complex that affects transcription initiation and elongation by RNA polymerase II. Here we report that SWI/SNF also plays a role in transcription by RNA polymerase I (Pol I) in Saccharomyces cerevisiae. Deletion of the genes encoding the Snf6p or Snf5p subunits of SWI/SNF was lethal in combination with mutations that impair Pol I transcription initiation and elongation. SWI/SNF physically associated with ribosomal DNA (rDNA) within the coding region, with an apparent peak near the 5' end of the gene. In snf6Δ cells there was a ∼2.5-fold reduction in rRNA synthesis rate compared to WT, but there was no change in average polymerase occupancy per gene, the number of rDNA gene repeats, or the percentage of transcriptionally active rDNA genes. However, both ChIP and EM analyses showed a small but reproducible increase in Pol I density in a region near the 5' end of the gene. Based on these data, we conclude that SWI/SNF plays a positive role in Pol I transcription, potentially by modifying chromatin structure in the rDNA repeats. Our findings demonstrate that SWI/SNF influences the most robust transcription machinery in proliferating cells.


Confidence intervals of effect size in randomized comparative parallel-group studies.
We have presented a new likelihood-based approach for constructing confidence intervals of effect size that are applicable to small samples. We also conduct a simulation study to compare the coverage probability of the new likelihood-based method with other three methods proposed by Hedges and Olkin and Kraemer and Paik. Simulation studies show that the confidence interval generated by the modified signed log-likelihood ratio method possesses essentially exact coverage probabilities even for small samples, although the coverage probabilities are consistently but slightly less than the nominal level. The methods are also applied to two examples.


["De novo" cancer after organ transplantation].
From March 1972 to 1st of January 1996, 804 kidney, liver and pancreas transplants were performed in 690 patients. 39 post transplant cancers occurred in 27 patients. 21 skin tumors (15 squamous cell carcinoma, 4 basocellular carcinomas, 1 squamous carcinoma, 1 melanoma), 4 squamous cancers (anus, esophagus, tongue, and parotid), 4 post-transplant lymphoproliferative disorders, 1 non-Hodgkin's lymphoma T, 4 gynecological tumors (breast, ovarian peritoneal carcinomatosis, 2 uterine cervix cancers), 4 miscellaneous tumors (larynx, right colon, brain, prostate, own kidney). 14 patients died (14/27: 52%). Post transplant de novo cancers are a major risk in transplant patients These cancers are mainly represented by skin tumors and lymphomas. Skin cancers are mainly spinocellular and occur in the areas which are exposed to the sun. Post transplant lymphoproliferative disorders are very close to Burkitt's lymphoma, they produced B lymphocyte proliferation due to the reduction of the control of T lymphocytes and induced by Epstein-Barr virus. They can disappear with the diminution of immunosuppression.


Biologically active constituents of a polyphenol extract from Geranium sanguineum L. with anti-influenza activity.
From the aerial roots of the medicinal plant Geranium sanguineum L. a polyphenol-rich extract with strong anti-influenza activity has been isolated. To investigate its active fractions, the extract was partitioned by solvents with increasing polarity. The n-BuOH fraction contained the majority of the in vitro antiviral activity; the EtOAc fraction was the most effective one in vivo. A bioassay-directed fractionation of the n-BuOH and EtOAc fractions was performed to obtain information about the nature of the chemical components of the plant extract, responsible for the antiviral effect. The individual constituents were identified by spectroscopic methods and comparison with authentic samples and by HPLC. The cell-toxic and virus-inhibitory effects of the fractions and some individual polyphenol compounds, found in Geranium sanguineum L., were studied using the replication of representative influenza viruses in cell cultures. This study showed that the presence of a variety of biologically active compounds as well as the possible synergistic interactions between them seem to be decisive for the overall antiviral effect.


[Primary empty sella syndrome. Observations on 71 cases].
Primary empty sella syndrome (ESS) is an anatomo-radiological picture characterized by the presence of an arachnoid herniation filled with liquor that compresses the pituitary against the sellar wall. ESS occurs particularly in obese, hypertensive, cephalgic women, it is often asymptomatic but it may be associated with ophthalmologic, neurologic and sometime non-characterizing endocrine disorders. We report here 71 cases of primary ESS observed and assessed during the last fourteen years. The following endocrinological diagnostic procedures were carried out: hormonal (RIA) basal profile: FT3, FT4, TSH, PRL, ACTH, FSH, LH, 8.00 a.m. and p.m. cortisolemia, Aldo, PRA, DHEA-S, FTe, E2, P, PTH, CT, and calcemia and phosphoremia; provocative tests: TRH, GnRH, insulin hypoglycemia, etc.; inhibition tests: "overnight" and high dose dexamethasone. Clinical, radiological (skull radiographs, CT and/or MRI) and ophthalmologic (fundus, visual fields) assessment were made. We found principally cephalgia (52/71: 73.2%), hypertension (42/71: 59.1%), obesity (47/71: 66.1%). But we found especially mental disorders (57/71: 80.2%), in our knowledge not previously reported in the literature, as anxiety or dysthymic disorders with behavioural disturbances (chiefly oral compulsion). We found endocrinopathies in 36/71 (50.7%), isolated or coexisting in some patients: hyperPRL (14%), hypopituitarism (10.4%), hypogonadism (7%), diabetes insipidus (2.8%), hyperACTH (1.4%), hypoGH (15.4%), pituitary adenomas (8.4%). Several hypothalamic illness show a clinical picture including mental disorders and obesity. The Authors hypothesize that the ESS may be a "new" hypothalamic syndrome (compression/stretching on hypophysis and/or hypophyseal stalk by arachnoidocele; disorder of some hormones and neurotransmitters as leptin, neuropeptide Y, orexins, POMC-derived peptides, etc).


Association Between Glycaemic Control and the Intake of Thiazide Diuretics, Beta Blockers and Levothyroxine in People Without Diabetes.
The pharmacological additional information for many medications includes warnings stating that the blood sugar control may be worsened by the intake of certain drugs. However a quantification of the effects is missing. This may result in confusion for patients as well as for their physicians. The aim of this study was to assess a potential association between medication (beta blockers, thiazides, levothyroxine) and HbA1c in people without diabetes. In this cross-sectional study we analysed data from 2 921 people (7 699 visits) without diabetes (age 46.6 y; 69.1% women; BMI 27.6±6.4 kg/m²; HbA1c 5.2%) who had at least one HbA1c determination and a complete documentation of their drug intake. An oral glucose tolerance test was not performed. The participants were divided in 8 groups (no regular drug intake, levothyroxine alone, beta blockers alone, thiazides alone, combination 2 of 3, combination of all 3). Patients with known distorting influences of the HbA1c were excluded. People with no regular drug intake had an HbA1c of 5.4% [35.8 mmol/mol]. The HbA1c of the group that took all 3 drugs in combination was 5.6% [38.2 mmol/mol]. A multiple linear mixed model showed an increase in HbA1c for thiazides (β=0.0558, p=0.025) and a decrease for combination of levothyroxine and thiazide (β=-0.0765, p=0.010). Thiazides and the combination of levothyroxine and thiazides were associated with slight changes in HbA1c. In this study there was no association between the intake of beta blockers and HbA1c. At least for people without diabetes these effects seem to be of minor importance.


Structural determinants involved in the regulation of CXCL14/BRAK expression by the 26 S proteasome.
The chemokine CXCL14/BRAK participates in immune surveillance by recruiting dendritic cells. CXCL14 gene expression is altered in a number of cancers, but protein expression levels have not been investigated. Here we report that CXCL14 protein can be expressed in primary epithelial cells; however, in several immortalized and cancer cell lines this protein is targeted for polyubiquitylation and proteasomal degradation. We determined the NMR structure of CXCL14 to identify motifs controlling its expression. CXCL14 adopts the canonical chemokine tertiary fold but contains a unique five amino acid insertion (41VSRYR45) relative to other CXC chemokines. Deletion or substitution of key residues within this insertion prevented proteasomal degradation. Furthermore, we defined a 15 amino acid fragment of CXCL14 that is sufficient to induce proteasomal degradation. This study elucidates a post-translational mechanism for the loss of CXCL14 in cancer and a novel mode of chemokine regulation.


Hydroxyapatite fortified mango mousse: Formulation, characterization, and sensory data evaluation using fuzzy logic.
In this experimental study, hydroxyapatite (HAp), as a valuable calcium source, was extracted from discarded goat bone; raw and nano-biogenic powders were prepared through calcination and ultra-sonication. Resultant powders were characterized by using various spectroscopy techniques. As per the findings of atomic absorption spectroscopy, raw and nano-biogenic powders depicted 1439.7 ± 0.12 and 3194.8 ± 0.07 ppm calcium content, respectively. The range of particle size of nano-biogenic and raw powders was 47-139 and 183 nm, respectively. X-ray diffraction (XRD) confirmed crystalline behavior whereas laser-induced breakdown spectroscopy (LIBS)-derived Ca/P-ratio endorsed excellence in nano-biogenic 1.76 against 1.63 in raw powder. In vitro bioavailability of calcium in raw and nano-biogenic powder was ∼36% and ∼39%, respectively. Next, the powders were further used to develop calcium-fortified mango mousse with varied formulations. A maximum overrun of 23.31% was found in the case of "Raw-A," whereas a maximum viscosity of 8489.98 mPa s was found in the case of "Nano-A." Sensory data of mango mousse were obtained by fuzzy logic method, and PCA ranked the Nano-B and Nano-A samples the best in terms of overall acceptability. Meanwhile, the consumer responses toward product likeness and/or dislikeness were recorded by the hedonic scale that endorsed Nano-A and Nano-B formulations as the most preferred samples. PRACTICAL APPLICATION: The revolution in the eating habits of consumers from traditional foods to fast food imposes the development of new products having good nutritional values. Different waste biogenic food sources can provide an acceptable powdered form of ingredients for the development of novel food products. In this regard, the development of novel food products using calcium supplements has gained space in the food industry.


A comparison of methods of aesthetic assessment in root coverage procedures.
To evaluate the reliability of professional qualitative scoring methods used in evaluating aesthetic results after root coverage therapy and to evaluate the relationship between subjective and objective measurements. A review panel of seven professional and non-professional, trained and untrained observers used photographic records to assess the overall cosmetic results of 162 root coverage surgical procedures in 133 patients (mean follow-up 17.51+/-17.37 months). Two different methods were used. In the before-after panel scoring system, observers evaluated the difference between preoperative and postoperative views, whereas in the random panel scoring system, observers rated each photograph independently. For both methods, intrarater agreement ranged from substantial to almost perfect for the periodontists. The best interrater agreement was found for trained periodontists using the five-point ordinal scale of the before-after panel scoring system (kappa=0.68). Neither root coverage percentage nor gingival augmentation was correlated to cosmetic assessment. The before-after scoring system is an acceptable and reliable method for professional cosmetic assessment of root coverage therapy. The overall cosmetic evaluation does not appear to be related to the percentage of root coverage.


Prediction of T- and H-Phase Two-Dimensional Transition-Metal Carbides/Nitrides and Their Semiconducting-Metallic Phase Transition.
The discovery of various two-dimensional (2D) nanomaterials with different phases is fundamentally and technologically intriguing, leading to diverse physical and chemical properties for expanded applications. Herein, we performed systematic first-principles calculations to explore a series of single-layer MXenes (M2 X: M=Sc, Ti, V, Cr, Mn, Zr, Nb, Mo, Hf, Ta; X=C, N). The new H-phase MXenes are firstly predicted, which are compared with the usually synthesized MXenes named as T-phase MXenes on their structure and electronic properties. Semiconducting-metallic transitions could be realized by T-/H- phase transition for Sc2 CO2 , Sc2 CO2 H2 , and Ti2 CO2 . Besides, the differences between MXenes and MoS2 on energy storage are discussed. Our work will provide valuable directions for the discovery of new MXene phases and give a systematic understanding of 2D MXenes.


Similar brain activation patterns for writing logographic and phonetic symbols in Chinese.
This event-related functional MRI study examined the neural correlates for Chinese writing, by comparing the writing of logographic characters and that of pinyin, a phonetic notation system for Chinese characters. The temporal profile of the activations indicated that the middle frontal gyrus, superior parietal lobule, and posterior inferior temporal gyrus reflected more central processes for writing. Although pinyin writing elicited greater activity overall than character writing, the critical finding is that the two types of symbols recruited essentially the same brain regions. The results were compared with studies in Japanese showing dissociation between logographic kanji and phonetic kana writing and frequency of use was suggested to be an important factor in accounting for result differences across the two writing systems.


Biocompatible interface films deposited within porous polymers by Atomic Layer Deposition (ALD).
Ultrathin ceramic films were deposited throughout highly porous poly(styrene-divinylbenzene) (PS-DVB) particles using a low-temperature atomic layer deposition (ALD) process. Alumina and titania films were deposited by alternating reactions of trimethylaluminum and H2O at 33 degrees C and of titanium tetrachloride and H2O2 (50 wt % in H2O) at 100 degrees C, respectively. Analytical characterization revealed that conformal alumina and titania films were grown on internal and external polymer surfaces. The improved bioactivity of the polymer substrates was revealed on the basis of the formation of hydroxyapatite (HA) in simulated body fluid. The accelerated formation of HA on the ALD-modified polymer surface was caused by the negatively charged surface provided by the ultrathin ceramic interface. The potential for ALD films to support cell attachment was demonstrated.


Morningness-eveningness and social anxiety symptoms: the influence of depression symptoms on the indirect effect through punishment sensitivity and experiential avoidance.
Social anxiety has recently been linked to morningness-eveningness; however, the psychological mechanisms underlying this relationship are not well known. As such, the purpose of the current study is to propose a model by which morningness-eveningness is related to social anxiety symptoms through punishment sensitivity and experiential avoidance within an adult American, community sample recruited via Amazon's Mechanical Turk (MTurk). It was hypothesized that experiential avoidance and punishment sensitivity would be associated with increased social anxiety symptoms and that morningness-eveningness would be negatively related to social anxiety symptoms. Furthermore, eveningness was hypothesized to be associated with increased punishment sensitivity and in turn, greater experiential avoidance. Lastly, the relationship between morningness-eveningness and social anxiety was hypothesized to be mediated by punishment sensitivity among the group with high depression levels, but not among the group with lesser depression symptoms. The results indicated that eveningness was related to social anxiety symptoms through experiential avoidance, and that depression symptoms influenced the relationship between morningness-eveningness and punishment sensitivity such that, in those high in depression symptoms, there was a significant association between eveningness and punishment sensitivity, but not among those with lower depression levels. The study findings build upon existing chronobiological research and addresses inconsistencies in previous literature.


Plasma patterns of tumor necrosis factor-alpha (TNF) and TNF soluble receptors during acute meningococcal infections and the effect of plasma exchange.
In 39 patients with acute meningococcal infections, the plasma concentrations of tumor necrosis factor-alpha (TNF) and its soluble receptors (sRs) TNFsR-p55 and TNFsR-p75 were measured from admission till recovery. At admission, patients with shock had significantly higher TNF, TNFsR-p55, and TNFsR-p75 values than patients without shock. In addition, during the first 24 hours, patients with shock had higher TNFsR-p75 to TNFsR-p55 ratios, indicating that in shock the increase of TNFsR-p75 exceeds that of TNFsR-p55. TNF measured more than 12 hours after admission failed to differentiate between shock and nonshock because TNF concentrations normalized within 12-24 hours. However, because concentrations of TNFsRs remained elevated for 5-6 days, at that time plasma TNFsRs still differentiated between shock and nonshock. Plasma exchange or whole blood exchange (PEBE), performed in 20 patients with shock, accelerated the decrease of plasma TNFsRs. However, because of a rebound after each PEBE session, the overall half-lives of both TNFsRs were not affected by PEBE.


Chordal replacement for leaflet prolapse in a posterior mitral valve with a calcified mitral annulus.
Mitral annular calcification (MAC) is sometimes associated with Carpentier type 2 mitral valve regurgitation and is a challenge to repair. Complete annular decalcification and mitral valve reconstruction is considered the ideal treatment. This report demonstrates the success of chordal replacement and band annuloplasty without resection of the leaflet and MAC. We have followed the patient for 7 years postoperatively, with no progression of MAC and no regurgitation by echocardiography.


Combined computed tomography venography and pulmonary angiography for the diagnosis PE and DVT in the ED.
The purpose of this study is to evaluate the usefulness of combined computed tomography venography and pulmonary angiography (CTVPA) in the diagnosis of venous thromboembolic (VTE) disease in the emergency department (ED). CTVPA images and clinical data of 73 nonselected patients with suspected pulmonary embolism (PE) and/or deep venous thrombosis (DVT) were retrospectively assessed. CTVPA correctly identified 33 of 34 patients with VTE disease, including 7 patients with PE alone, 11 patients with DVT alone, and 16 patients with both PE and DVT. Among the 27 patients with DVT, CTVPA disclosed thrombosis involving the abdominal and pelvic veins in 4 patients, and isolating to the inferior vena cava and iliac vein in one patient. CTVPA showed high accuracy in the diagnosis of both PE and DVT, in comparison with lower extremity venous sonography and ventilation-perfusion scintigraphy. In 26 (66%) of the 39 patients without of evidence VTE, CTVPA provided important ancillary information that suggests additional or alternative diagnoses. CTVPA is therefore an appropriate single diagnostic tool for evaluation VTE disease in the ED.


Public health impact on drug residues in animal tissues.
Consumers have expressed concern regarding the health impact of drug residues in their food. Animal residues in animal tissues above the legal tolerance clearly have an impact on human health. Tolerances represent the maximal level or concentration of antimicrobial residues permitted in animal tissues at the time of slaughter. The tolerances are intended to ensure that residual drugs will have no harmful effects if ingested. This paper describes the existing evidence for specific health hazards for certain pharmacological classes of drugs and explains the risks associated with drug residues in meat and poultry above the established tolerance. The primary focus is on possible public health consequences that may occur as a result of acute exposure to illegal residues. In addition, long-term effects are discussed with added comments about the effect of residues on the intestinal flora. Most residues of veterinary drugs occur in food at such low levels that they rarely pose a chronic or long-term health hazard to consumers. The importance of food safety through the reduction of residues in our food supply cannot be overemphasized. Food safety remains a major challenge confronting contemporary society.


A new method for determining the optimal lagged ensemble.
We propose a general methodology for determining the lagged ensemble that minimizes the mean square forecast error. The MSE of a lagged ensemble is shown to depend only on a quantity called the cross-lead error covariance matrix, which can be estimated from a short hindcast data set and parameterized in terms of analytic functions of time. The resulting parameterization allows the skill of forecasts to be evaluated for an arbitrary ensemble size and initialization frequency. Remarkably, the parameterization also can estimate the MSE of a burst ensemble simply by taking the limit of an infinitely small interval between initialization times. This methodology is applied to forecasts of the Madden Julian Oscillation (MJO) from version 2 of the Climate Forecast System version 2 (CFSv2). For leads greater than a week, little improvement is found in the MJO forecast skill when ensembles larger than 5 days are used or initializations greater than 4 times per day. We find that if the initialization frequency is too infrequent, important structures of the lagged error covariance matrix are lost. Lastly, we demonstrate that the forecast error at leads ≥10 days can be reduced by optimally weighting the lagged ensemble members. The weights are shown to depend only on the cross-lead error covariance matrix. While the methodology developed here is applied to CFSv2, the technique can be easily adapted to other forecast systems.


Effects of chronic social defeat stress on behaviour, endoplasmic reticulum proteins and choline acetyltransferase in adolescent mice.
The present study investigated the effects of social defeat stress on the behaviours and expressions of 78-kDa glucose-regulated protein (Grp78), CCAAT/enhancer-binding protein (C/EBP) homologous protein (CHOP) and choline acetyltransferase (Chat) in the brains of adolescent mice. Adolescent male C57BL/6J mice were divided into two groups (susceptible and unsusceptible) after 10 d social defeat stress. In expt 1, behavioural tests were conducted and brains were processed for Western blotting on day 21 after stress. In expt 2, social avoidance tests were conducted and brains were subsequently processed for Western blotting on day 12 after stress. Chronic social defeat stress produced more pronounced depression-like behaviours such as decreased locomotion and social interaction, increased anxiety-like behaviours and immobility, and impaired memory performance in susceptible mice. Moreover, susceptible mice showed greater expression of Grp78 and CHOP in the amygdala (Amyg) on days 12 and 21 compared with the other groups. Susceptible and unsusceptible groups showed significant increases in Grp78 and CHOP expression in the prefrontal cortex (PFC) and hippocampus (Hipp) on day 12 compared with the control group; this persisted until day 21. The levels of Chat measured on days 12 and 21 were significantly lower in the PFC, Amyg and Hipp of all defeated mice compared with controls. The findings of the behavioural tests indicate that chronic social defeat in adolescents produces anxiety-like behaviours, social withdrawal, despair-like behaviours and cognitive impairment. The Grp78, CHOP and Chat results suggest that the selective response of endoplasmic reticulum stress proteins in the Amyg plays an important role in the vulnerability-stress model of depression.


Overnutrition and Scholastic Achievement: Is There a Relationship? An 8-Year Follow-Up Study.
The aim of this study was to assess the association between overnutrition and scholastic achievement (SA). A representative and proportional sample of 477 children of the 5th elementary school grade of both genders was randomly chosen during 2010, in the Metropolitan Region of Chile. SA was measured through the 2009 Education Quality Measurement System (SIMCE) tests of language (LSA), mathematics (MSA) and understanding of the natural environment (UNESA). Current nutritional status was assessed through the body mass index Z-score (Z-BMI). Nutritional quality of diet, schedule exercise, socioeconomic status, family, and educational variables were also recorded. Four and 8 years later, SA was assessed through the 2013 SIMCE and the University Selection Test (2017 PSU), respectively. Socioeconomic status, the number of repeated school years, and maternal schooling were strong predictors of 2009 SIMCE and the independent variables with the greatest explanatory power for LSA (Model R2 = 0.178; p < 0.00001) variances, besides of gender for MSA (Model R2 = 0.205; p< 0.00001) and UNESA (Model R2 = 0.272; p < 0.00001). Overnourished children did not have significantly lower 2009 and 2013 SIMCE and 2017 PSU outcomes. These results confirm that overnourished children did not achieve significantly lower SA.


Temporal control of gene expression in transgenic mice by a tetracycline-responsive promoter.
Promoters whose temporal activity can be directly manipulated in transgenic animals provide a tool for the study of gene functions in vivo. We have evaluated a tetracycline-responsive binary system for its ability to temporally control gene expression in transgenic mice. In this system, a tetracycline-controlled trans-activator protein (tTA), composed of the repressor of the tetracycline-resistance operon (tet from Escherichia coli transposon Tn10) and the activating domain of viral protein VP16 of herpes simplex virus, induces transcription from a minimal promoter (PhCMV*-1; see below) fused to seven tet operator sequences in the absence of tetracycline but not in its presence. Transgenic mice were generated that carried either a luciferase or a beta-galactosidase reporter gene under the control of PhCMV*-1 or a transgene containing the tTA coding sequence under the control of the human cytomegalovirus immediate early gene 1 (hCMV IE1) promoter/enhancer. Whereas little luciferase or beta-galactosidase activity was observed in tissues of mice carrying only the reporter genes, the presence of tTA in double-transgenic mice induced expression of the reporter genes up to several thousand-fold. This induction was abrogated to basal levels upon administration of tetracycline. These findings can be used, for example, to design dominant gain-of-function experiments in which temporal control of transgene expression is required.


Application of global metabolomic profiling of synovial fluid for osteoarthritis biomarkers.
Osteoarthritis affects over 250 million individuals worldwide. Currently, there are no options for early diagnosis of osteoarthritis, demonstrating the need for biomarker discovery. To find biomarkers of osteoarthritis in human synovial fluid, we used high performance liquid-chromatography mass spectrometry for global metabolomic profiling. Metabolites were extracted from human osteoarthritic (n = 5), rheumatoid arthritic (n = 3), and healthy (n = 5) synovial fluid, and a total of 1233 metabolites were detected. Principal components analysis clearly distinguished the metabolomic profiles of diseased from healthy synovial fluid. Synovial fluid from rheumatoid arthritis patients contained expected metabolites consistent with the inflammatory nature of the disease. Similarly, unsupervised clustering analysis found that each disease state was associated with distinct metabolomic profiles and clusters of co-regulated metabolites. For osteoarthritis, co-regulated metabolites that were upregulated compared to healthy synovial fluid mapped to known disease processes including chondroitin sulfate degradation, arginine and proline metabolism, and nitric oxide metabolism. We utilized receiver operating characteristic analysis to determine the diagnostic value of each metabolite and identified 35 metabolites as potential biomarkers of osteoarthritis, with an area under the receiver operating characteristic curve >0.9. These metabolites included phosphatidylcholine, lysophosphatidylcholine, ceramides, myristate derivatives, and carnitine derivatives. This pilot study provides strong justification for a larger cohort-based study of human osteoarthritic synovial fluid using global metabolomics. The significance of these data is the demonstration that metabolomic profiling of synovial fluid can identify relevant biomarkers of joint disease.


[Clinicopathological differences in laterally spreading tumors between rectum and colon].
To investigate the clinicopathological differences in laterally spreading tumor (LST) from the rectum and colon. Methods: Clinicopathological records of 198 patients with LST (116 cases in rectum, 82 cases in colon) from the Second Xiangya Hospital of Central South University between January 2012 and January 2017 were evaluated. Results: A total of 198 colorectal LST were included. According to the endoscopic classification, nodular mixed type (LST-GM), homogeneous type (LST-GH), flat elevated type(LST-FE) and pseudodepressed type (LST-PD) were 127(64.1%), 13(6.6%), 41(20.7%) and 17(8.6%), respectively. LST-GM was predominant in the rectum (71.7%), while LST-FE was predominant in the colon (78.0%), with significant difference (P<0.01). The mean size of LST was (52.03±35.62) mm or (25.37±11.56) mm in the rectum or the colon, with significant difference between them (P<0.01). High grade intraepithelial neoplasia frequency was higher in the rectum than that in the colon (31.0% vs 18.3%), while the low grade intraepithelial neoplasia frequency was lower in the rectum than that in the colon (61.2% vs 75.6%) (both P<0.05). The mean size of LST-GM and LST-GH diameter were larger in the rectum than that in the colon, and the malignant potential of LST-GM was higher in the rectum than that in the colon. The percentage of high grade intraepithelial neoplasia + invasive carcinoma was 41.8% and 22.2%, respectively (both P<0.05). LST in colon was mostly treated with endoscopic mucosal resection, while LST in rectum was treated by endoscopic submucosal dissection predominantly. Conclusion: LSTs from the rectum and colon show different clinicopathological characteristics to some extent. LST-GM is predominant in the rectum, while LST-FE is predominant in the colon. The malignant potential of LST-GM is higher in the rectum than that in the colon.


Human tryptophan transfer ribonucleic acid synthetase. Composition, function of thiol groups, and structure of thiol peptides.
Human tryptophanyl-tRNA synthetase resembles its counterpart in Escherichia coli in quaternary structure (alpha2), but differs in molecular weight, amino acid composition, the number of thiol groups, and the relationship of the thiol groups to enzyme activity. Nevertheless, one of the thiol groups resides in a heptapeptide sequence homologous to a heptapeptide sequence containing a thiol group in the E. coli enzyme. Each subunit of the enzyme has 6 half-cystine residues, and four thiol groups are readily titrated with 5,5'-dithiobis(2-nitrobenzoic acid). Titration of these four thiol groups inactivates the enzyme, and the inactivation is partially reversible by reduction with dithiothreitol. One thiol group reacts rapidly unless L-tryptophan, ATP, and Mg2+ are present together.


Salt-dependent Blood Pressure in Human Aldosterone Synthase-Transgenic Mice.
Hypertension is one of the most important, preventable causes of premature morbidity and mortality in the developed world. Aldosterone is a major mineralocorticoid hormone that plays a key role in the regulation of blood pressure and is implicated in the pathogenesis of hypertension and heart failure. Aldosterone synthase (AS, cytochrome P450 11B2, cyp11B2) is the sole enzyme responsible for the production of aldosterone in humans. To determine the effects of increased expression of human aldosterone synthase (hAS) on blood pressure (BP), we established transgenic mice carrying the hAS gene (cyp11B2). We showed that hAS overexpression increased levels of aldosterone in hAS+/- mice. On high salt diet (HS), BPs of hAS+/- mice were significantly increased compared with WT mice. Fadrozole (an inhibitor of aldosterone synthase) treatment significantly reduced BPs of hAS+/- mice on HS. This is the first time overexpression of AS in a transgenic mouse line has shown an ability to induce HP. Specifically inhibiting AS activity in these mice is a promising therapy for reducing hypertension. This hAS transgenic mouse model is therefore an ideal animal model for hypertension therapy studies.


Avoidance of emotional facial expressions in social anxiety: The Approach-Avoidance Task.
The Approach-Avoidance Task (AAT) was employed to indirectly investigate avoidance reactions to stimuli of potential social threat. Forty-three highly socially anxious individuals (HSAs) and 43 non-anxious controls (NACs) reacted to pictures of emotional facial expressions (angry, neutral, or smiling) or to control pictures (puzzles) by pulling a joystick towards themselves (approach) versus pushing it away from themselves (avoidance). HSAs showed stronger avoidance tendencies than NACs for smiling as well as angry faces, whereas no group differences were found for neutral faces and puzzles. In contrast, valence ratings of the emotional facial expressions did not differ between groups. A critical discrepancy between direct and indirect measures was observed for smiling faces: HSAs evaluated them positively, but reacted to them with avoidance.


Dancing to our own tune: understandings of advanced nursing practice in British Columbia.
There has been ongoing confusion about the meaning of advanced nursing practice (ANP) and the nature of ANP roles in Canada and elsewhere. A broad range of roles and titles have been adopted throughout Canada in an attempt to delineate specialized and/or advanced roles within nursing. One key objective in a recent three-phase study of ANP in British Columbia was to clarify the role and understanding of advanced nursing practice and related roles within the larger healthcare system. Our intent in this paper is to describe the understandings of ANP that emerged in Phase I of this recent study and to compare registered nurses' understandings of ANP to the characteristics and competencies identified by the Canadian Nurses Association (2002) framework. (Note: The term "nurse," as used in this paper, refers to "registered nurse.") We conclude by identifying future directions for development of advanced practice roles.


Sex differences in stroke co-morbidities.
Males and females possess distinct biological differences that manifest in diverse risk profiles for acute and chronic diseases. A well-documented example of this is ischemic stroke. It has been demonstrated that older females have greater prevalence of, and worse outcome after, ischemic stroke than do males and younger females. Loss of estrogen after menopause is heavily implicated as a contributing factor for this phenomenon; however, there is mounting evidence to suggest that certain risk factors tend to occur more often in older females, such as hypertension and atrial fibrillation, while others more adversely affect females than they do males, such as diabetes and smoking. Sex-specific risk factors, such as oral contraceptive use and menopause, could also contribute to the discrepancy in stroke prevalence and outcome. Additionally, there is evidence to suggest that females tend to present with more nontraditional symptoms of acute stroke than do males, making it more difficult for clinicians to correctly identify the occurrence of a stroke, which may delay the administration of thrombolytic intervention. Finally, certain sociodemographic factors, such as the fact that females were more likely to live alone prior to stroke, may contribute to poorer recovery in females. This review will explore the various co-morbidities and sociodemographic factors that contribute to the greater prevalence of and poorer outcome after stroke in older females and will highlight the critical need for considering sex as a predisposing biological variable in stroke studies.


[The prevention of peritoneal dissemination of gastric cancer with intraperitoneal activated carbon particles absorbing mitomycin C].
A new drug dosage form comprising activated carbon particles absorbing mitomycin C (MMC-CH) has the advantage of being retained in the peritoneal cavity and distributes a larger amount of mitomycin C for a long time. Some 113 patients with gastric cancer and serosal infiltration were randomly assigned intraperitoneal treatment with MMC-CH and no anti-cancer drugs. There were significant differences in survival rate between the patients who have no visible peritoneal dissemination with MMC-CH and without. Thus, intraoperative intraperitoneal treatment with MMC-CH improves survival after gastrectomy for gastric cancer and seems effective against peritoneal recurrence.


Effect of Ocimum basilicum leaves extract on acetaminophen-induced nephrotoxicity in BALB/c mice.
Background Acetaminophen (APAP) is one of the most widely used drugs to treat pain. Its overdose is lethal causing liver and kidney failure. Nephrotoxicity and hepatotoxicity are mostly due to the overproduction of reactive oxygen species. Ocimum basilicum, known as basil, is a commonly used medicinal plant due to its versatile role as antibacterial, antifungal, and anti-oxidative. We aim in this study to investigate the preventive and protective effect of basil leaves aqueous extract against APAP-induced hepatorenal toxicity in BALB/c mice. Methods Acute kidney injury (AKI) was induced in mice using APAP. Mice were treated with basils extract pre and post AKI induction. Kidney and liver functions were assessed by measuring creatinine, urea, alanine transaminase, and aspartate transaminase levels in serum. Superoxide dismutase, catalase (CAT), and malondialdehyde levels of renal and hepatic tissues were assayed using Elisa. Kidney injury molecule (KIM-1) was quantified in kidney homogenate. Histopathological analysis of kidney and liver were examined. Results Significant increase in all serum parameters, in hepatic and renal MDA, and in renal KIM-1 levels was observed post AKI induction. Treatment with basils post AKI induction minimized APAP damage by reducing serum markers and MDA in both organs and by increasing SOD and CAT. However, pretreatment with basils extract caused additional increase in serum ALT and AST and MDA in liver, with a significant increase in renal antioxidant enzymes. These results were confirmed by histopathological examination. Conclusion Basil extract may act as a natural antioxidant to treat APAP-induced acute hepato-renal toxicity when used as a post-treatment.


The epidemiology of self-reported TMJ sounds and pain in young adults in Israel.
We investigated the prevalence of self-reported temporomandibular joint sounds (TMJS), masticatory muscle pain (MMP), and their interrelation in a young adult population. A large sample (n = 20,869) of young soldiers aged 18-21 years who attended dental clinics were asked about their experience of TMJ sounds and pain. The overall prevalence of TMJS was 8.4 percent (8.9% in females and 8.2% in males) and for masticatory pain was 4.0 percent for both males and females (P < .001 under chi-square test). Twenty-five percent of patients reporting positive TMJS also reported positive MMP compared to 2 percent in the negative TMJS group (P < .001). Fifty-three percent of patients reporting positive MMP also reported positive TMJS, compared to 6.5 percent in the negative MMP group (P < .001). The low prevalence of TMJ sounds and pain found in these study might be attributed to the different cultural and social environment, as well as to the uniformity in age of the study group.


Systemic lupus erythematosus causing subglottic stenosis.
Acute lupus erythematosus has manifested itself in many ways. Symptoms most often pertain to polyarthritis, arthralgias, skin lesions and those attributed to lupus nephritis. Recently documented lesions have been seen in the nose and larynx. The following case report shows evidence of subglottic stenosis due to SLE.


Evaluation of dairy allergy among ulcerative colitis patients.
The intestine is the largest mucosal organ of the body and also the first line immune homeostasis. Inflammatory bowel disease or IBD is divided into ulcerative colitis and Crohn's disease. One of the problems that can occur with UC is dietary allergy to some foods. This study aimed to evaluated the dairy allergy among patients with ulcerative colitis. This study is a Case - control study, that studied 72 patients with Ulcerative Colitis, after recording history of the disease, colonoscopy and confirmed by biopsy and 72 person without history of colitis. In this study, in order to investigate of food allergy, used of the EUROMMUM kit with an international code number DP3420-1601-11E. We used chi-square and Monte Carlo method for analysis of data. Among UC patients, 30.6% mild, 52.8% moderate and 16.6% of cases were in sever stage. 9.7% of them reported a history of abdominal surgery due to disease. According to the chi-square and Monte Carlo methods, dairy allergy (including: cow milk, cow milk UHT and casein) in UC group was significant (P=0.00). This study indicated that there is significant relationship between UC and cow milk, cow milk UHT and casein. UC patients who are allergic to dairy products and the use of dairy products can increase the severity of UC.


Bimetallic d10 -Metal Complexes of a Bipyridine Substituted N-Heterocyclic Carbene.
The hybrid ligand 3-(2,2'-bipyridine-6-ylmethyl)-1-mesityl-1H-imidazolylidene (NHCBipy ) featuring both carbene and N-donor sites, was selectively complexed with various d10 metal cations in order to examine its coordination behavior with regard to homo and heterometallic structures. Respective silver complexes can be obtained by the silver oxide route and are suitable transmetallation reagents for the synthesis of gold(I) compounds. Starting from the mononuclear complexes [(NHCBipy )AuCl], [(NHCBipy )Au(C6 F5 )] and [(NHCBipy )2 Au][ClO4 ], open-chain as well as cyclic heterobimetallic complexes containing Cu+ , Ag+ , Zn2+ , Cd2+ , and Hg2+ were synthesized. Furthermore, the homobimetallic species [(NHCBipy )2 M2 ][ClO4 ]2 (M=Cu, Ag) were obtained. All bimetallic compounds were fully characterized including single-crystal X-ray analysis. Their photoluminescence (PL) properties were investigated in the solid state at temperatures between 15 and 295 K and compared with those of the mononuclear species. There is a clear difference in PL properties between the open chain and the cyclic heterobimetallic complexes. The latter species show different PL properties, depending on the metals involved. In addition, collision-induced dissociation (CID) experiments were performed on electrosprayed cations of the cyclic heterobimetallic compounds, to compare the metal binding at the carbene and N-donor sites.


Trace Elements in Edible Flowers from Italy: Further Insights into Health Benefits and Risks to Consumers.
The use of edible flowers in cooking dates back to ancient times, but recently it is gaining success among the consumers, increasingly attentive to healthy and sustainable foods of high quality, without neglecting taste, flavour, and visual appeal. The present study aims to deepen the knowledge regarding the mineral composition of edible flowers, an aspect not widely investigated in scientific literature. The concentrations of Cd, Co, Cu, Fe, Mn, Ni, Pb, Sr, V, and Zn have been determined by Inductively Coupled Plasma Optical Emission Spectrometry (ICP OES) in flowers belonging to a wide variety of species. The study highlights that some floral species are characterized by significantly higher concentrations of certain trace elements, e.g., the flowers of Acmella oleracea for Mn, those of basil (Ocimum basilicum) and of pumpkins (Cucurbita moschata and C. pepo) for Cu and Sr, and those of orange daylily (Hemerocallis fulva) for Ni. Potentially toxic elements are present at low concentrations, often below the limit of the detection for Cd, Co, Ni, V. In all samples, Cd and Pb are well below the maximum permitted levels in foodstuffs. It can be concluded that the edible flowers analyzed can be considered a good source of essential elements and do not present risks for the consumer health as for the mineral composition.


Renner-Teller effect in C2H2+(X2Pi u) studied by rotationally resolved zero kinetic energy photoelectron spectroscopy.
The Renner-Teller effect in C(2)H(2)(+)(X(2)Pi(u)) has been studied by using zero kinetic energy (ZEKE) photoelectron spectroscopy and coherent extreme ultraviolet (XUV) radiation. The rotationally resolved vibronic spectra have been recorded for energies up to 2000 cm(-1) above the ground vibrational state. The C triple bond C symmetric stretching (upsilon(2)), the CCH trans bending (upsilon(4)), and the CCH cis bending (upsilon(5)) vibrational excitations have been observed. The assigned vibronic bands are 4(1)(1)(kappa(2)Sigma(u)(+))(hot band), 4(1)(0)(mu/kappa(2)Sigma (u)(-/+)), 5(1)(0)(mu/kappa(2)Sigma (g)(+/-)), and 4(2)(0)(mu(2)Pi(u)), 4(2)(0)(kappa(2)Pi(u)), 4(1)(0)5(1)(0) (mu(2)Pi(g)), 0(0)(0)(X(2)Pi(u)), and 2(1)(0)(X(2)Pi(u)). The Renner-Teller parameters, the harmonic frequencies, the spin-orbit coupling constants, and the rotational constants for the corresponding vibronic bands have been determined by fitting the spectra with energy eigenvalues from the Hamiltonian that considers simultaneously Renner-Teller coupling, vibrational energies, rotational energies, and spin-orbit coupling interaction.


Radiofrequency and microwave ablation in a porcine liver model: non-contrast CT and ultrasound radiologic-pathologic correlation.
Purpose: The goal of this study was to compare intra-procedural radiofrequency (RF) and microwave ablation appearance on non-contrast CT (NCCT) and ultrasound to the zone of pathologic necrosis.Materials and methods: Twenty-one 5-min ablations were performed in vivo in swine liver with (1) microwave at 140 W, (2) microwave at 70 W, or (3) RF at 200 W (n = 7 each). CT and US images were obtained simultaneously at 1, 3, and 5 min during ablation and 2, 5, and 10 min post-ablation. Each ablation was sectioned in the plane of the ultrasound image and underwent vital staining to delineate cellular necrosis. CT was reformatted to the same plane as the ultrasound transducer and transverse diameters of gas and hypoechoic/hypoattenuating zones at each time point were measured. CT, ultrasound and gross pathologic diameter measurements were compared using Student's t-tests and linear regression.Results: Visible gas and the hypoechoic zone on US images were more predictive of the pathologic ablation zone than on NCCT images (p < 0.05). The zone of necrosis was larger than the zone of visible gas on US (mean 3.2 mm for microwave, 6.4 mm for RF) and NCCT (7.6 mm microwave, 13.9 mm RF) images (p < 0.05). The zone of visible gas and hypoechoic zone on US are more predictive of pathology with microwave ablations when compared with RF ablations (p < 0.05).Conclusion: When evaluating images during energy delivery, US is more accurate than CT and microwave- more predictable than RF-ablation based on correlation with in-plane pathology.


Hot Anchors: A Heuristic Anchors Sampling Method in RCNN-Based Object Detection.
In the image object detection task, a huge number of candidate boxes are generated to match with a relatively very small amount of ground-truth boxes, and through this method the learning samples can be created. But in fact the vast majority of the candidate boxes do not contain valid object instances and should be recognized and rejected during the training and evaluation of the network. This leads to extra high computation burden and a serious imbalance problem between object and none-object samples, thereby impeding the algorithm's performance. Here we propose a new heuristic sampling method to generate candidate boxes for two-stage detection algorithms. It is generally applicable to the current two-stage detection algorithms to improve their detection performance. Experiments on COCO dataset showed that, relative to the baseline model, this new method could significantly increase the detection accuracy and efficiency.


Hydantoin syndrome with holoprosencephaly: a possible rare teratogenic effect.
We report on a newborn girl with lobar holoprosencephaly and clinical signs of hydantoin syndrome. During pregnancy the mother was treated with diphenylhydantoin and primidon for psychomotor and petit mal seizures. The possible relationship between hydantoin syndrome, holoprosencephaly, and maternal intake of anticonvulsants during pregnancy is discussed.


Feeding behaviour of the nauplii of the marine calanoid copepod Paracartia grani Sars: Functional response, prey size spectrum, and effects of the presence of alternative prey.
Laboratory feeding experiments were conducted to study the functional response and prey size spectrum of the young naupliar stages of the calanoid copepod Paracartia grani Sars. Experiments were conducted on a range of microalgal prey of varying sizes and motility patterns. Significant feeding was found in all prey of a size range of 4.5-19.8 μm, with Holling type III functional responses observed for most prey types. The highest clearance rates occurred when nauplii fed on the dinoflagellate Heterocapsa sp. and the diatom Thalassiosira weissflogii (respectively, 0.61 and 0.70 mL ind-1 d-1), suggesting an optimal prey:predator ratio of 0.09. Additional experiments were conducted to examine the effects of the presence of alternative prey (either Heterocapsa sp. or Gymnodinium litoralis) on the functional response to the haptophyte Isochrysis galbana. In the bialgal mixtures, clearance and ingestion rates of I. galbana along the range of the functional response were significantly reduced as a result of selectivity towards the larger, alternative prey. Paradoxically, relatively large prey trigger a perception response in the nauplii, but most likely such prey cannot be completely ingested and a certain degree of sloppy feeding may occur. Our results are further evidence of the complex prey-specific feeding interactions that are likely to occur in natural assemblages with several available prey types.


Laparoscopic Cholecystectomy in the Cirrhotic: Review of Literature on Indications and Technique.
Cholelithiasis is twice more common in patients suffering from liver cirrhosis compared to overall population and in those patients, acute cholecystitis occurs significantly more often. Our goal was to review the literature and to overview the indications, contra-indications, and alternatives in the cirrhotic with biliary stones. We conducted a systematic review of the literature using the key words "Cirrhosis", "cholecystectomy", "laparoscopy"and "indications". Selected articles were reviewed for information specific to indications, contra-indications, and alternatives to laparoscopic cholecystectomy in cirrhotics. Results showed that laparoscopic cholecystectomy might offer several advantages in cirrhotic population, however cholecystectomy can be challenging: specific indications and alternatives to surgery must be discussed case by case. Laparoscopic cholecystectomy can be performed safely in selected patients with cirrhosis; special precautions are warranted regarding pneumoperitoneum pressure, trocar placement and increased safety with Indocyanine-green (ICG) fluorescence cholangiography. Nevertheless, in high-risk cirrhotic patients (Child C) and/or in common bile duct lithiasis endoscopic and non-surgical conservative treatments are preferable.


Neisseria gonorrhoeae Evades Calprotectin-Mediated Nutritional Immunity and Survives Neutrophil Extracellular Traps by Production of TdfH.
Neisseria gonorrhoeae successfully overcomes host strategies to limit essential nutrients, termed nutritional immunity, by production of TonB-dependent transporters (TdTs)-outer membrane proteins that facilitate nutrient transport in an energy-dependent manner. Four gonococcal TdTs facilitate utilization of iron or iron chelates from host-derived proteins, including transferrin (TbpA), lactoferrin (LbpA), and hemoglobin (HpuB), in addition to xenosiderophores from other bacteria (FetA). The roles of the remaining four uncharacterized TdTs (TdfF, TdfG, TdfH, and TdfJ) remain elusive. Regulatory data demonstrating that production of gonococcal TdfH and TdfJ are unresponsive to or upregulated under iron-replete conditions led us to evaluate the role of these TdTs in the acquisition of nutrients other than iron. In this study, we found that production of gonococcal TdfH is both Zn and Zur repressed. We also found that TdfH confers resistance to calprotectin, an immune effector protein highly produced in neutrophils that has antimicrobial activity due to its ability to sequester Zn and Mn. We found that TdfH directly binds calprotectin, which enables gonococcal Zn accumulation in a TdfH-dependent manner and enhances bacterial survival after exposure to neutrophil extracellular traps (NETs). These studies highlight Zn sequestration by calprotectin as a key functional arm of NET-mediated killing of gonococci. We demonstrate for the first time that N. gonorrhoeae exploits this host strategy in a novel defense mechanism, in which TdfH production hijacks and directly utilizes the host protein calprotectin as a zinc source and thereby evades nutritional immunity.


Spatial Analysis of Neonatal Congenital Hypothyroidism and Nitrate as an Environmental Pollutant in Isfahan Province During 2010-2013.
Thyroid absorption of iodine could be encumbered by nitrate drinking water when it is transported to the fetal thyroid gland. Therefore, nitrate potentially causes congenital hypothyroidism (CH) due to thyroid dysfunction. In this study, we have not only aimed at spatial determination of CH distribution and nitrate concentration (NC) existing in drinking water, but also we intended to evaluate the probable impact of nitrate on CH incidence. Annual average of nitrate in drinking-water as well as number of CH infants diagnosed through the screening program were applied to determine the incidence ratio of the disease for each town (from 2010 to 2013). Afterward, Arc GIS 9.3 was used to draw choropleth maps with quantile classification. Data were entered into SPSS 16.0 and Excel 2010 software. Finally, linear regression was applied for data analysis. The incidence rate of CH (considering transient and permanent cases) was about one in every 413 births. Khansar, Golpaygan, Naein, and Ardestan had the highest incidence rate of CH respectively. On the other hand, Tiran, Dehaghan, Khansar, and Fereydan had the highest level of nitrate drinking water. There was a strong relationship between the NC and incidence of CH in Khansar; however, this relationship was not significant (P = 0.392) in Isfahan province. Since there was not a significant relationship between NC in drinking-water and incidence of CH through linear regression analysis, more studies should be implemented to confirm or refute our observations.


Clinical manifestations of Takayasu arteritis in India and Japan--new classification of angiographic findings.
In this retrospective review 102 Indian and 80 Japanese patients with Takayasu arteritis were compared in regard to their clinical manifestations and angiographic findings. Regardless of nationality, most patients were initially affected in their teens or twenties. Japanese patients were female in a larger ratio compared with the ratio in India. Clinically, the two groups exhibited several different features. More Japanese patients were found to be pulseless (P < 0.01) whereas many Indian patients were hypertensive (P < 0.01). Inflammatory conditions in Japanese patients were more severe (P < 0.01) and tended to be more prolonged than those in the Indians. More Japanese patients suffered from aortic regurgitation (P < 0.01), but Indians suffered from hypertension (P < 0.01). Angiographic findings revealed that the aortic arch and its branches were mainly involved in Japanese patients (type I, IIa) whereas the abdominal aorta and its branches were mainly involved in Indian patients (type IV). However, the diffusely involved type (type V) was the one most commonly found in both countries. From the analyses of vascular lesions in both Indian and Japanese patients, 510 and 396, respectively, different progressions of vasculitis are speculated. In Japanese patients, vasculitis generally occurs in the ascending aorta, the aortic arch, and/or its branches and extends into the thoracic and abdominal aorta, subsequently forming various complicated lesions with prolonged inflammatory activity. On the other hand, in Indian patients, vasculitis generally occurs in the abdominal aorta involving renal arteries, subsequently extending into the thoracic aorta within one or two decades, simple vascular lesions being formed. Data analysis suggests that this morbid condition progresses differently in India and Japan, in spite of some common etiologic factor(s).


Axilla skin biopsy: a reliable test for the diagnosis of Lafora's disease.
Skin biopsies from the axilla were examined in 7 patients with clinical signs and symptoms of Lafora's disease, in 9 relatives (7 parents and 2 siblings), and in 17 patients with chronic or progressive degenerative neurological disorders and chronic epilepsy, who served as controls. In the biopsies of all patients with Lafora's disease, typical periodic acid-Schiff (PAS)-positive inclusions were present in the myoepithelial cells of the secretory acini of the apocrine glands and/or in the cells of the eccrine duct. No abnormalities were found in the biopsies from relatives and controls. We conclude that axilla skin biopsy is an easy and reliable test for diagnosing Lafora's disease, and is preferable to liver biopsy, but has no value for carrier detection.


Spinal anesthesia for elective cesarean section. Bupivacaine associated with different doses of fentanyl: randomized clinical trial.
Assess patients submitted to elective cesarean section under spinal anesthesia, and the efficacy of different doses of fentanyl associated with bupivacaine. The study included 124 pregnant women randomly distributed into 4 groups (n = 31) according to different doses of fentanyl (15 μg, 10 μg, 7.5 μg), Groups I, II, and III, respectively, and control group IV, associated with 0.5% hyperbaric bupivacaine (10 mg). An epidural catheter was inserted in case epidural top-up was required. We assessed the anesthetic blockage characteristics, negative maternal and neonatal outcomes, and maternal side effects. Statistical analysis was performed using Kruskal-Wallis, Fisher's exact and chi-square tests. The level of significance was 5% (p < 0.05). The quality of analgesia, time for the first complaint of pain and motor block recovery time were significantly better for groups that received fentanyl in comparison to controls (p < 0.001). None of the groups had negative maternal-fetal outcomes. Nausea was significantly more frequent in patients in Groups II (10 µg) and III (7.5 µg) when compared to Groups I (15 µg) and IV (no fentanyl). Vomiting was more frequent in Group III than in Group I (p = 0.006). The incidence of pruritus was significantly higher in the groups receiving fentanyl (p = 0.012). Among the solutions studied, the spinal anesthesia technique using 15 µg of fentanyl associated with 10 mg of hyperbaric bupivacaine provided satisfactory analgesia and very low incidence of adverse effects for patients submitted to cesarean section. UTN U1111-1199-0285. RBR-5XWT6T.


High dose cyclophosphamide performs better than monthly dose cyclophosphamide in quality of life measures.
In spite of current therapies, the overall health status of patients with SLE is poor. High-dose cyclophosphamide (50 mg/kg for 4 days) with or without stem-cell rescue has been introduced as a new therapy for severe SLE, including renal and central nervous system (CNS)-SLE. Long-term durable responses have been found to be 40%. A randomised clinical trial was completed comparing high-dose cyclophosphamide with monthly intravenous cyclophosphamide (750 mg/m squared bovine serum albumin) in patients with SLE who need cyclophosphamide for the first time. The primary outcome of the trial was complete clinical response. In this report, we compare the treatment groups with respect to quality of life. The patients in this study had a mean age of 35.3 +/- 10.1 years, were of Caucasian (35%), African-American (51%), Hispanic (8%) and Asian (6%) people, and 88% were women. The organ leading to treatment was renal lupus in 29%, CNS-lupus in 45% and other organs in 26%. Quality of life was measured at each visit using the Medical Outcome Study Short-Form 36 (SF-36). At 6 months, the patients in the high-dose cyclophosphamide trial arm had significantly greater improvement than patients in the monthly intravenous cyclophosphamide arm (P = 0.026; P = 0.0082, respectively) in the categories of general health and social functioning. At 18 months, the improvement in the role-physical score was significantly greater in the high-dose cyclophosphamide trial arm than in the monthly-dose cyclophosphamide arm (P = 0.025). At the end of the two and a half-year study, there were no significant differences between the groups with respect to changes in SF-36. By pooling the groups, at 30 months, there was a statistically significant (P < 0.05) improvement over baseline in 6 of the 8 SF-36 domains. This study shows earlier improvement in SF-36 measures at 6 months in the high-dose cyclophosphamide group but equal improvement in both arms at two and one and a half years. Eventual improvements in quality-of-life with both cyclophosphamide regimens are clinically meaningful to both patients and treating physicians.


[A biomechanical study of flexible penile implants].
The prostheses used are silicone elastomer flexible penile implants. They are not hard, but flexible and capable of being elongated without traction. These implants have the advantage of resisting axial pressure which facilitates intromission, even in the absence of erection. Their flexibility also allows the penis to hang when the patient is standing. For the penis to hang normally, it must be sufficiently long (hence the value of cavernopubic release) and the intracavernous cavity must be longer than the prosthesis. The prosthesis does not alter the cavernous artery, but markedly flattens the venous plexus (lakes and efferent veins).


The Immunomodulatory Effect of You-Gui-Wan on Dermatogoides-pteronyssinus-Induced Asthma.
The traditional Chinese medicine You-Gui-Wan (YGW) contains ten species of medicinal plants and has been used to improve health in remissive states of asthma for hundreds of years in Asia. However, little is known about the immunomodulatory mechanisms in vivo. Therefore, this study investigated the pathologic and immunologic responses to YGW in mice that had been repeatedly exposed to Dermatogoides-pteronyssinus (Der p). YGW reduced Der-p-induced airway hyperresponsiveness and total IgE in serum. It also inhibited eosinophil infiltration by downregulating the protein expression of IL-5 in serum and changed the Th2-bios in BALF by upregulating IL-12. Results of the collagen assay and histopathologic examination showed that YGW reduced airway remodeling in the lung. In addition, after YGW treatment there was a relative decrease in mRNA expression of TGF-β1, IL-13, eotaxin, RANTES, and MCP-1 in lung in the YGW group. The results of EMSA and immunohistochemistry revealed that YGW inhibited NF-κB expression in epithelial lung cells. YGW exerts its regulative effects in chronic allergic asthmatic mice via its anti-inflammatory activity and by inhibiting the progression of airway remodeling.


Donor T cells for CAR T cell therapy.
Adoptive cell therapy using patient-derived chimeric receptor antigen (CAR) T cells redirected against tumor cells has shown remarkable success in treating hematologic cancers. However, wider accessibility of cellular therapies for all patients is needed. Manufacture of patient-derived CAR T cells is limited by prolonged lymphopenia in heavily pre-treated patients and risk of contamination with tumor cells when isolating T cells from patient blood rich in malignant blasts. Donor T cells provide a good source of immune cells for adoptive immunotherapy and can be used to generate universal off-the-shelf CAR T cells that are readily available for administration into patients as required. Genome editing tools such as TALENs and CRISPR-Cas9 and non-gene editing methods such as short hairpin RNA and blockade of protein expression are currently used to enhance CAR T cell safety and efficacy by abrogating non-specific toxicity in the form of graft versus host disease (GVHD) and preventing CAR T cell rejection by the host.


Can productivity growth measures identify best performing hospitals? Evidence from the English National Health Service.
Health-care systems around the world face limited financial resources, and England is no exception. The ability of the health-care system in England to operate within its financial resources depends in part on continually increasing its productivity. One means of achieving this is to identify and disseminate throughout the system the most efficient processes. We examine the annual productivity growth achieved by 151 hospitals over five financial years, using the same methods developed to measure productivity of the National Health Service as a whole. We consider whether there are hospitals that consistently achieve higher than average productivity growth. These could act as examples of good practice for others to follow and provide a means of increasing system performance. We find that the productivity growth of some hospitals over the whole period exhibits better than average performance, but there is little or no evidence of consistency in the performance of these hospitals over adjacent years. Even the best performers exhibit periods of very poor performance and vice versa. We therefore conclude that accepted methods of measuring productivity growth for the health system as a whole do not appear suitable for identifying good performance at the hospital level.


Effects of long-term hormone replacement therapy on QT and corrected QT dispersion during resting and peak exercise electrocardiography in post-menopausal women.
It is known that the QT interval is longer in women than men. Estrogen is reported to account for the QT interval prolongation in several studies conducted with hormone replacement therapy (HRT) in postmenopausal women. Along with this, there are conflicting data as regards the effects of HRT on QT interval and dispersion. Moreover, there is no evidence about the effect of HRT on exercise QT parameters. We compared QT parameters obtained from surface electrocardiograms during resting and peak exercise before and after 6 months of HRT consisting of estrogen plus progesterone in healthy postmenopausal women. Twenty-four healthy postmenopausal women were given 0.625 mg/day conjugated estrogens and 2.5 mg/day medroxyprogesterone acetate for 6 months. Exercise stress testing using the Bruce protocol was performed before and after HRT. QT maximum, minimum, dispersion and corrected QT maximum, minimum and dispersion were calculated during resting and peak exercise. HRT resulted in a significant increase in estradiol plasma levels from 24+/-10 pg/mL to 117+/-66 pg/mL (P<0.001). There was no significant difference in resting QT parameters after HRT, whereas QT dispersion and corrected QT dispersion were significantly increased during peak exercise (20+/-7 versus 25+/-10 ms; P<0.05, 33+/-12 versus 41+/-16 ms; P<0.05, respectively). Nonetheless, the other exercise QT parameters were unchanged. The resting QT parameters are not affected by long term HRT consisting of estrogen plus progesterone, which leads to an increase in QT dispersion and corrected QT dispersion during peak exercise.