[Comparative in vitro activity of garenoxacin (BMS-284756). Sentry program, Spain (1999-2000)].
To evaluate the in vitro activity of the new des-fluoro quinolone, garenoxacin (BMS-284756), compared to activities of ciprofloxacin, levofloxacin, and gatifloxacin in clinical isolates recovered over 1999 and 2000 within the SENTRY antimicrobial surveillance program. Quinolone-MICs were performed using the standard NCCLS microdilution technique in 2599 isolates recovered from Hospital Ramón y Cajal (Madrid), Virgen Macarena (Sevilla), and Bellvitge (Barcelona). The modal MIC range value exhibited by garenoxacin ( < or = 0.03-0.12 mg/L) for Enterobacteriaceae was similar to that of the other quinolones tested. A total of 70% of Pseudomonas aeruginosa isolates were susceptible to garenoxacin and 85% to ciprofloxacin and levofloxacin. Garenoxacin exhibited the highest activity in Staphylococcus aureus, including both methicillin-susceptible and -resistant isolates, with MIC90 values of < or = 0.03 and 2 mg/L, respectively. All Streptococcus pneumoniae isolates were susceptible to garenoxacin, regardless of their penicillin susceptibility status; in terms of MIC90, garenoxacin was 16 times more active than ciprofloxacin and levofloxacin and 4-8 times more active than gatifloxacin. All 6 ciprofloxacin-resistant S. pneumoniae strains showed garenoxacin MIC values ranging from < or = 0.03 to 0.5 mg/L. In Haemophilus influenzae and Moraxella catarrhalis, garenoxacin displayed excellent in vitro activity (MIC < or = 0.06 mg/L), similar to that of the other quinolones tested. Garenoxacin activity was similar to the activity of other quinolones in Enterobacteriaceae, but was lower in P. aeruginosa. Garenoxacin activity was clearly higher than that of other quinolones in gram-positive isolates, including methicillin-resistant S. aureus and S. pneumoniae with reduced penicillin susceptibility.


Metabolic fluxes in skeletal muscle in relation to obesity and insulin resistance.
The present article addresses the hypothesis that inefficient skeletal muscle lipid utilization may relate to the development of obesity and insulin resistance. In practice, there is evidence of impaired muscle fatty acid utilization in the obese state, and studies indicate that differences in muscle fatty acid oxidative capacity might play a role in the pathogenesis of obesity. The link between obesity and insulin resistance has been recognized for many years. There is accumulating evidence that a disturbed muscle fat oxidative capacity results in the accumulation of the lipid intermediates diacylglycerol and Fatty acid acyl coenzyme A (CoA), which may interfere with insulin signaling and result in an inhibition of insulin-mediated glucose uptake. Underlying mechanisms for disturbed fatty acid handling may relate to impaired adipose tissue lipolysis, abnormal muscle fatty acid uptake and a reduced ability to oxidize fat. Many of these abnormalities have been reported both in the obese and the type 2 diabetic state. The role of obesity per se in these disturbances is an important question that needs to be addressed.


Satellite-based assessment of electricity restoration efforts in Puerto Rico after Hurricane Maria.
A real-time understanding of the distribution and duration of power outages after a major disaster is a precursor to minimizing their harmful consequences. Here, we develop an approach for using daily satellite nighttime lights data to create spatially disaggregated power outage estimates, tracking electricity restoration efforts after disasters strike. In contrast to existing utility data, these estimates are independent, open, and publicly-available, consistently measured across regions that may be serviced by several different power companies, and inclusive of distributed power supply (off-grid systems). We apply the methodology in Puerto Rico following Hurricane Maria, which caused the longest blackout in US history. Within all of the island's settlements, we track outages and recovery times, and link these measures to census-based demographic characteristics of residents. Our results show an 80% decrease in lights, in total, immediately after Hurricane Maria. During the recovery, a disproportionate share of long-duration power failures (> 120 days) occurred in rural municipalities (41% of rural municipalities vs. 29% of urban municipalities), and in the northern and eastern districts. Unexpectedly, we also identify large disparities in electricity recovery between neighborhoods within the same urban area, based primarily on the density of housing. For many urban areas, poor residents, the most vulnerable to increased mortality and morbidity risks from power losses, shouldered the longest outages because they lived in less dense, detached housing where electricity restoration lagged. The approach developed in this study demonstrates the potential of satellite-based estimates of power recovery to improve the real-time monitoring of disaster impacts, globally, at a spatial resolution that is actionable for the disaster response community.


Distinguishing lies from jokes: theory of mind deficits and discourse interpretation in right hemisphere brain-damaged patients.
Right-hemisphere brain damaged (RHD) patients and a normal control group were tested for their ability to infer first- and second-order mental states and to understand the communicative intentions underlying ironic jokes and lies. Subjects listened to stories involving a character who had either a true or a false belief about another character's knowledge. Stories ended either with an ironic joke or a lie by this character. In the joke stories, the speaker knew that the listener knew the truth (a true second-order belief) and did not expect the listener to believe what was said; in the lie stories, the speaker did not know that the listener actually knew the truth (a false second-order belief) and thus did expect the listener to believe what was said. RHD patients performed significantly worse than control subjects on one of two measures of second-order belief, which suggests that the ability to make second-order mental state attributions is fragile and unreliable following right-hemisphere damage. RHD patients in addition performed worse than controls when asked to distinguish lies from jokes, confirming their known difficulties with discourse interpretation. For both groups, the ability to distinguish lies from jokes was strongly correlated with two measures of the ability to attribute correctly second-order beliefs. These results suggest that the fragility of RHD patients' understanding of second-order mental states underlies a portion of their difficulties in discourse comprehension, but that the underlying impairment is not restricted to right hemisphere dysfunction.


Progress towards measles elimination in Eritrea: 2003 - 2018.
The Expanded Program on Immunisation (EPI) has been operational in Eritrea since 1980. Eritrea has endorsed the resolution of the Regional Committee of the World Health Organisation African region, committing to a measles elimination goal for 2020 in the African Region. The country is implementing the recommended strategies. We reviewed administrative coverage and WHO UNICEF coverage estimates for Diphtheria-Pertussis-Tetanus (DPT) and measles routine vaccination, as well as for measles supplemental immunization activities. We reviewed national surveillance performance and analyzed the epidemiological trends of measles as reported in the case-based surveillance database. Eritrea has maintained more than 90% coverage with the first dose of measles vaccine at national level since 2001 and 88% MCV2 coverage from 2015 - 2017 according to the WHO-UNICEF coverage estimates. Since 2011, the country has not met the surveillance performance target of at least 80% districts reporting suspected measles cases with blood specimen. Measles incidence was between 16.8 - 24.7 cases per million population in the period 2015 - 2018. The mean and median age of confirmed measles cases was more than 10 years in 8 of the 14 years covered by the analysis. In 2017, Eritrea reported 1,199 cases of measles which differs significantly from the 185 suspected cases in the case based surveillance database for the same year. Eritrea has maintained high coverage for MCV1 and MCV2 and made progress towards measles elimination. However, the country has gaps in surveillance performance which may mask the true incidence of measles. In order to attain elimination of measles, Eritrea needs to implement measures to improve surveillance quality, to conduct regular risk assessment and implement targeted measures to close immunity gaps. In addition, setting up a national committee for the verification of measles elimination will help the country document progress and also to highlight and advocate for addressing issues related to data quality and performance gaps.


[The diagnosis of occupational diseases: a specific task of occupational doctors].
The Authors examine the problem dealing with Occupational disease diagnosis focusing five main points: diseases of probable/possible occupational origin; chronic and acute diseases; diseases due to biological agents; presumptive causation in legal compensation; public health statistics and medical reports. They conclude that new rules are needed and more advice from Occupational Medicine is required.


Advances in histopathological diagnosis of keratoacanthoma.
Keratoacanthoma is a common epithelial lesion, but its nature is controversial. Although a distinct crateriform appearance is a hallmark of keratoacanthoma, other benign or malignant skin lesions may show a similar architecture. Moreover, as lesions diagnosed as conventional keratoacanthoma may show malignant behavior, some authors consider keratoacanthoma to be a variant of squamous cell carcinoma, whereas others consider it as a distinct self-resolving squamous proliferative lesion. The controversy seems to originate from the diverse behavior of keratoacanthoma-like epithelial lesions. However, a reproducible histopathological classification criterion has been recently proposed in the diagnosis of keratoacanthoma-like epithelial lesions, and its validity is supported by several reports that deal with the natural course or molecular aspects of these lesions. This article attempts to provide a comprehensive review on recent insights and advances in the histopathological diagnosis of keratoacanthoma or related lesions, as well as summary of related published works.


24-month outcomes of XEN45 gel implant versus trabeculectomy in primary glaucoma.
To compare the efficacy and safety profiles of XEN implant versus trabeculectomy as a surgical intervention for primary glaucoma. A retrospective cohort study of mild to moderate stage glaucoma patients, who had undergone either XEN implantation or trabeculectomy with adjunctive mitomycin C, was performed in a tertiary eye center. Fifty-seven eyes for XEN implant and 57 eyes for trabeculectomy with medically uncontrolled glaucoma were included. Preoperative IOP was 16-33 mmHg. Visual field mean deviation was -9.11±6.93 dB in XEN group, and -9.67±5.06 dB in trabeculectomy group (p = 0.195). At the 24-month timepoint, mean IOP was reduced from 21.6±4.0 to 14.6±3.5 mmHg (32.4% reduction) in the XEN group (p<0.001), and from 22.5±5.8 to 12.5±4.1 mmHg (44.4% reduction) in the trabeculectomy group (p<0.001). Final IOP in XEN was significantly higher than trabeculectomy (p = 0.008) with lesser mean IOP percentage reduction at month 24 (p = 0.045). Mean number of medications was reduced from 2.2±1.4 to 0.5±0.7 in XEN group (p<0.001), and from 2.4±0.7 to 0.8±1.3 in trabeculectomy group (p<0.001). Final number of medications was not different between the groups (p = 0.225). Surgical success was comparable between XEN and trabeculectomy group. Overall success was 71.4% vs. 73.3% (p = 0.850), and complete success was 62.9% vs. 62.2% (p = 0.954), respectively. XEN had lower rate of numerical hypotony than trabeculectomy. No serious complication occurred in either procedure group. At 24 months, XEN showed a rate of success comparable to that of trabeculectomy. Although XEN had a higher final IOP than trabeculectomy, XEN achieved 32% IOP reduction, and achieved final IOP in mid-teen level. No serious complication occurred in either group. XEN can be applied for treatment of mild to moderate stages of glaucoma in Southeast Asian patients.


Lifetime of micrometer-sized drops of oil pressed by buoyancy against a planar interface.
Emulsion stability simulations are used to estimate the coalescence time of one drop of hexadecane pressed by buoyancy against a planar water/hexadecane interface. In the present simulations, the homophase is represented by a big drop of oil at least 500 times larger than the approaching drop (1-10 microm). Both deformable and nondeformable drops are considered along with six different diffusion tensors. In each case, van der Waals, electrostatic, steric, and buoyancy forces are taken into account. The coalescence times are estimated as the average of 1000 random walks. It is found that the repulsive potential barrier has a significant influence in the results. The experimental data can only be reproduced assuming negligible repulsive barriers, as well as nondeformable drops that move with a combination of Stokes and Taylor tensors as they approach the interface.


Correlation of aspiration results with periprosthetic sepsis in revision total hip arthroplasty.
A retrospective chart review was performed of all patients who had undergone revision total hip arthroplasty with a synovial aspiration with greater than 100 WBC since the institution of our electronic medical record. Infection was defined using a combination of criteria. A diagnosis of periprosthetic sepsis was established in 52 of the 253 included hips. No significant differences existed with respect to gender, age, BMI, Deyo-Charlson Comorbidity Index, or the cause of initial hip degeneration. Using receiver-operating characteristic curves accuracy was maximized for WBC of 745 or segmented cell count of 73.5% with a sensitivity of 98%, specificity of 37%, negative predictive value of 99% and accuracy of 50%. Application of the current American Academy of Orthopaedic Surgery Clinical Practice Guidelines (AAOS CPG) thresholds revealed a similar accuracy of 49%.


Analytical Strategies Involved in the Detailed Componential Characterization of Biooil Produced from Lignocellulosic Biomass.
Elucidation of chemical composition of biooil is essentially important to evaluate the process of lignocellulosic biomass (LCBM) conversion and its upgrading and suggest proper value-added utilization like producing fuel and feedstock for fine chemicals. Although the main components of LCBM are cellulose, hemicelluloses, and lignin, the chemicals derived from LCBM differ significantly due to the various feedstock and methods used for the decomposition. Biooil, produced from pyrolysis of LCBM, contains hundreds of organic chemicals with various classes. This review covers the methodologies used for the componential analysis of biooil, including pretreatments and instrumental analysis techniques. The use of chromatographic and spectrometric methods was highlighted, covering the conventional techniques such as gas chromatography, high performance liquid chromatography, Fourier transform infrared spectroscopy, nuclear magnetic resonance, and mass spectrometry. The combination of preseparation methods and instrumental technologies is a robust pathway for the detailed componential characterization of biooil. The organic species in biooils can be classified into alkanes, alkenes, alkynes, benzene-ring containing hydrocarbons, ethers, alcohols, phenols, aldehydes, ketones, esters, carboxylic acids, and other heteroatomic organic compounds. The recent development of high resolution mass spectrometry and multidimensional hyphenated chromatographic and spectrometric techniques has considerably elucidated the composition of biooils.


Canonical and alternative transcript expression of PAX6 and CXCR4 in pancreatic cancer.
Pancreatic cancer is a lethal disease with a propensity for invading and metastasizing into the surrounding tissues, including the liver and intestines. A number of factors are aberrantly overexpressed in this tumor type and actively promote cancer progression and metastasis. The present study demonstrates that paired box transcription factor 6 (PAX6) and C-X-C chemokine receptor 4 (CXCR4) are frequently co-expressed in primary pancreatic adenocarcinoma tumors and established cell lines. Expression analysis methods used in the present study included evaluation of protein expression by western blot analysis and immunofluorescence, transcript expression levels by reverse transcription-quantitative polymerase chain reaction (RT-qPCR), and luciferase assays utilizing regulatory elements from the CXCR4 gene locus. Canonical PAX6 and alternative splice variant PAX6(5a) proteins are expressed in pancreatic cancer and can drive gene expression through a conserved enhancer element within the first intron of the CXCR4 gene. As demonstrated by the introduction of an exogenous reporter construct with or without the intronic enhancer, loss of this element inhibited gene expression within numerous pancreatic cancer cell lines including Panc1, MIA-PaCa2 and BxPC3. All of the pancreatic cancer cell lines expressed the canonical CXCR4B transcript in addition to the alternatively spliced variant CXCR4A as determined by RT-qPCR experiments. The discovery of variant transcripts in pancreatic cancer cells may provide new candidates for future targeted therapies.


Choosing a Hyperacute Stroke Imaging Protocol for Proper Patient Selection and Time Efficient Endovascular Treatment: Lessons from Recent Trials.
Recently, several prospective randomized control trials regarding endovascular treatment for patients with intracranial large artery occlusions causing acute ischemic stroke have been successfully reported. Effort to minimize time delays to endovascular treatment, patient selection and the use of retrievable stent were important factors for the success of these trials. The inclusion and exclusion criteria for each of these trials did include differences in imaging protocols. In this review, we focus on the importance of baseline non-invasive angiography prior to deciding endovascular treatment. Then imaging protocols are described for each trial according to measurement of infarct volume and collateral grading.


Ocular hypotensive efficacy, safety and systemic absorption of AR-12286 ophthalmic solution in normal volunteers.
To evaluate the ocular hypotensive efficacy, ocular and systemic safety, and systemic exposure of two formulations of 0.5% AR-12286 Ophthalmic Solution. This was a double-masked, single-centre, crossover study in 18 normal adult volunteers. Volunteers were randomised to one of two dosing sequences: Formulation A once daily, both eyes (OU) for 8 days, a 7-day minimum washout, and then Formulation B, or the reverse. The main outcome measures were ocular tolerability, intraocular pressure (IOP) and blood levels of AR-12286 and its metabolites. Systemic absorption was low, with a majority of subjects showing no measurable drug concentration in plasma (<1 ng/ml) at any time point with either formulation. The most frequent ocular adverse events were conjunctival hyperaemia, eye irritation, instillation site reaction, increased lacrimation, and blurred vision which were relatively short-lived and judged as not clinically significant. Both formulations of AR-12286 produced substantial reductions from baseline IOP ranging from 3 to 7 mm Hg (p<0.0001). No differences were noted in ocular safety between formulations of AR-12286 0.5%, dosed once daily in the morning for 8 days. AR-12286 produced little systemic exposure to the parent compound or two known metabolites. Clinically and statistically significant reductions in IOP were seen in these normotensive subjects.


Implications of a Multi-Step Trigger of Retinal Regeneration in the Adult Newt.
The newt is an amazing four-limbed vertebrate that can regenerate various body parts including the retina. In this animal, when the neural retina (NR) is removed from the eye by surgery (retinectomy), both the NR and the retinal pigment epithelium (RPE) eventually regenerate through the process of reprogramming and proliferation of RPE cells. Thus far, we have pursued the onset mechanism of adult newt retinal regeneration. In this study, using an in vitro system, we found that both mitogen-activated protein kinase (MAPK)/extracellular signal-regulated kinase (ERK) kinase (MEK)-ERK and β-catenin were involved in cell cycle re-entry of RPE cells. MEK-ERK signaling activity in RPE cells was strengthened by retinectomy, and nuclear translocation of β-catenin in RPE cells was induced by attenuation of cell-cell contact, which was promoted by incision of the RPE or its treatment with ethylene glycol tetraacetic acid (EGTA). EGTA is a Ca2+ chelator that disrupts cadherin-mediated cell-cell adhesion. Reinforcement of MEK-ERK signaling activity was a prerequisite for nuclear translocation of β-catenin. These results suggest that retinectomy followed by attenuation of cell-cell contact may trigger cell cycle re-entry of RPE cells. This study, together with our previous findings concerning the proliferation and multipotency of adult newt RPE cells, provides insight into the mechanism of the multi-step trigger in which the onset of retinal regeneration in the adult newt is rigorously controlled.


Scanning-free grazing emission x-ray fluorescence by means of an angular dispersive arrangement with a two-dimensional position-sensitive area detector.
We report on the application of a two-dimensional position-sensitive area detector towards grazing emission x-ray fluorescence (GEXRF) spectroscopy. GEXRF allows for surface-sensitive studies with nanometer-scale accuracy in the depth direction by measuring the intensity variation of an x-ray fluorescence line with the grazing emission angle. The presented experimental setup is based on a fixed sample-detector arrangement and does not require any moving components. We show that the dispersion of the grazing emission angle along a position-sensitive detector allows to acquire with an excellent angular resolution a full GEXRF profile in a single measurement. Moreover, the use of a two-dimensional detector allows to perform experiments with an increased solid angle of detection per emission angle. This results in combination with the nonsequential and simultaneous acquisition of the GEXRF profiles of different emission lines in considerably reduced acquisition times. The realization, the demands, and the main characteristics of the scanning-free GEXRF setup will be presented. A few experimental examples will serve to illustrate the analytical possibilities offered by the presented setup.


One-year stability of the mandibular advancement and counterclockwise rotation for correction of the skeletal class II malocclusion and high mandibular plane angle: Dental and skeletal aspect.
The purpose of this study was to evaluate the stability on dental and skeletal aspect after surgical advancement and counterclockwise rotation for the correction of the mandibular deficiency in patients with high mandibular plane angle (MPA). We analyzed the records of patients who had undergone surgical treatment for dentofacial deformities with mandibular deficiency and high MPA. Clinical and radiological data were taken 1 month before surgery (T0), 6 weeks after surgery (T1) and 1 year after surgery (T2). Cephalometric values of the MPA were recorded and compared. The cephalometric changes in the different time periods were defined as follows: A: postsurgical changes (T0-T1), B: one-year changes (T1-T2), and C: short term changes (T0-T2). Twenty-seven patients had prominent mandibular deficiency with an MPA of over 35° (high angle). The mean age of patients at surgery was 29.7 years. Seven patients had a single jaw procedure, 20 patients had bilateral sagittal split osteotomy (BSSO) combined with a Le Fort I osteotomy, and 14 patients had additional genioplasty. MPA values differed significantly between the time periods (p < 0.05) with an observed relapse of the angle. However, satisfactory clinical improvement was achieved in the dental and skeletal presentation. The overjet improvement was evident from 8.815 ± 2.085 mm (T0) to 3.426 ± 1.253 mm (T2). Counterclockwise surgical advancement of the mandible to correct mandibular deficiency in patients with a high mandibular plane angle showed an overall acceptable stability during one-year follow-up.


[Cerebral amyloid angiopathy and dementias].
Amyloid deposit in the brain causes neurologicaldiseases characterized by dementia. These depositsare constituted by fibrilar proteins with beta-planarshape whose origin is due to mutations, infectionsor exogenous alterations. Treatment of cerebralamyloid angiopathy depends on the cause and atpresent, the manipulation of the synthesis of theresponsible peptides, their chemical solubilizationor extraction outside of the nervous system, arebeing investigated.


Left ventricular diastolic dysfunction in elderly hypertensives: results of the APROS-diadys study.
A number of patients with chronic heart failure (CHF) have diastolic but not systolic dysfunction. This occurs particularly in the elderly and in hypertension, but the prevalence of diastolic dysfunction in elderly hypertensives without CHF has never been investigated systematically. The Assessment of PRevalence Observational Study of Diastolic Dysfunction (APROS-diadys) project was a cross-sectional observational study on elderly (age >/= 65 years) hypertensives without systolic dysfunction [left ventricular ejection fraction (LVEF) >/= 45%] consecutively attending hospital outpatient clinics in Italy, in order to establish the prevalence of echocardiographic signs of diastolic dysfunction according to various criteria, and to correlate them with a number of demographic and clinical characteristics. Primary criteria for diastolic dysfunction was an E/A ratio (ratio between transmitral peak velocities of E and A waves) < 0.7 or > 1.5 on echocardiographic Doppler examination. Secondary criteria were: E/A < 0.5 and deceleration time (DT) > 280 ms, or isovolumic relaxation time (IVRT) > 105 ms or pulmonary vein (PV) peak systolic/peak diastolic flow (S/D) ratio > 2.5 or PV atrial retrograde flow (PV A) > 35 cm/s. Throughout Italy, 27 447 patients were screened in 107 clinics, with 24 141 excluded according to protocol. Among the remaining 3336 patients, 754 (22.6%) had signs of CHF. After exclusion of 37 protocol violators, 2545 patients (49.0% men, mean age 70.3 years, 95.4% under antihypertensive treatment) were studied ultrasonographically. Diastolic dysfunction (primary criteria) was found in 649 (25.8%) patients. Multiple logistic regression analysis found age, gender, left ventricular mass, systolic and pulse pressures and midwall shortening fraction as significant covariates. Using secondary criteria, the prevalence of diastolic dysfunction was higher (45.6%), mostly because of IVRT > 105 ms or PVA flow > 35 cm/s. CHF and diastolic dysfunction are highly prevalent in elderly hypertensives attending hospital clinics.


Comparing Effects of Intrinsic and Extrinsic Social Values Between Younger and Older Employees.
Socioemotional selectivity theory proposes that older adults emphasize emotional goals and interpersonal closeness to a greater extent than do younger adults, suggesting that holding social work-related values (SWVs) may be beneficial to older employees. This project aimed at examining two dimensions of SWVs, intrinsic and extrinsic SWVs, and tested whether age and work situation would moderate their effects on self-rated job performance. A cross-sectional survey (Study 1, N = 357) and a 14-day experience sampling study (Study 2, N = 77) were conducted among Chinese managerial employees. Study 1 showed that the direct effect of intrinsic SWVs on self-rated job performance was stronger in older employees than in younger employees. Study 2 demonstrated that older employees who valued intrinsic SWVs while being in social situations performed much better than when they did not value intrinsic SWVs but being in social situations; however such positive effect was not shown in younger employees. Findings of this project reveal that the effect of SWVs varies across locus of effect (intrinsic versus extrinsic), age, and work situation. Among older employees, the positive effect of intrinsic SWVs is more crucial than that of extrinsic SWVs on self-rated job performance. Findings of this project imply that intrinsically rewarding incentives would be more effective in motivating older employees to reach peak performance.


History of trauma and the association with baseline symptoms in an Ultra-High Risk for psychosis cohort.
Few studies have addressed the correlates of trauma in young people at Ultra-High Risk (UHR) of developing a psychotic disorder. We aimed to examine baseline differences in intensity, form and content of attenuated positive psychotic symptoms, other clinical symptomatology and comorbidity between UHR patients with and without a history of trauma. In a sample of 127 UHR individuals (53 male, 74 female; mean age 18.2 years, range 14-26) we assessed trauma history and baseline symptomatology using an audit tool developed to retrieve data from patient medical records. 56% of the subjects had experienced at least one type of trauma. The intensity of perceptual abnormalities was significantly higher in the group with a history of physical abuse and 'other trauma' compared to those without a trauma history. Physical abuse was related to higher levels of visual disturbances, suspiciousness, grandiose beliefs and low mood compared to those without a history of physical abuse. Sexual trauma was related to perceptual disturbances with abusive content and PTSD symptoms. The prevalence of previous trauma in people at UHR of developing psychosis is high. Our findings tentatively suggest that different types of trauma may impact differently on initial presentation to UHR services.


Alterations in the Staphylococcus epidermidis biofilm transcriptome following interaction with whole human blood.
Staphylococcus epidermidis biofilm formation on the surface of intravenous catheters is responsible for 22% of the cases of bloodstream infections, in patients in intensive care units in the USA. The ability of S. epidermidis to withstand the high bactericidal activity of human blood is therefore crucial for systemic dissemination. To identify the genes involved in the bacterium's survival, the transcriptome of S. epidermidis biofilms, upon contact with human blood, was assessed using an ex vivo model. Our results showed an increased transcription of genes involved in biosynthesis and metabolism of amino acids, small molecules, carboxylic and organic acids, and cellular ketones. One of the striking changes observed 4 h of S. epidermidis exposure to human blood was an increased expression of genes involved in iron utilization. This finding suggests that iron acquisition is an important event for S. epidermidis survival in human blood.


Effects of pesticides on the bacterial production of pyrrolnitrin.
Pyrrolnitrin is a halogenated bacterial metabolite with antifungal and antibacterial activities which served as a lead structure of synthetic fungicides. Several pyrrolnitrin-producing bacteria are considered to be promising biopesticides. However, the application of these microorganisms is not straightforward since many synthetic pesticides usually coexist in agricultural fields and inevitably affect the efficacy of biocontrol agents. In this regard, effects of 25 xenobiotics, including 18 pesticides, were investigated for pyrrolnitrin biosynthesis by Burkholderia sp. O33 and Pseudomonas fluorescens Pf-5. Strong inhibition of pyrrolnitrin synthesis was observed in 9 chemicals, including 6 pesticides, while glyphosate and validamycin enhance biosynthesis. Fenpiclonil and fludioxonil strongly inhibit the oxidative transformation of aminopyrrolnitrin to pyrrolnitrin. Halogenation reaction to aminopyrrolnitrin was reduced by methimazole, a well-known flavin-dependent monooxygenase inhibitor. Most pesticides gave moderate growth inhibitory effects. The results suggested that synthetic chemicals can modulate the efficacy of pyrrolnitrin producing bacteria, through the inhibition of cell growth or pyrrolnitrin biosynthesis. Pathway specific inhibition by fenpiclonil, fludioxonil, and methimazole will give structural insights of corresponding enzymes.


Reliability of measurements of patient health status: a comparison of physician, patient, and caregiver ratings.
The purpose of this preliminary study was to investigate the inter-rater reliability among physician, patient, and caregiver ratings on the Hoehn & Yahr (H & Y) and Schwab & England (S & E) rating instruments. We also examined differences in ratings between patients who attended clinic with and without caregivers (spouses and adult children). Patients and caregivers coming for an appointment at Colorado Neurological Institute were asked to independently complete the H & Y and S & E scales. Physicians rated the patients during the exam. In the group of patients who came to clinic with caregivers, there was significant agreement on both the H & Y and S & E (P<0.001). For patients not accompanied by caregivers, patients rated themselves as more debilitated on the S & E than physicians (P<0.001). Patients without caregivers rated themselves as more functional than patients with caregivers on both scales (P<0.001). Physicians also rated patients without caregivers as more functional on both scales (P<0.001). Results indicated there was consistency among ratings of physicians and patients accompanied by caregivers on both scales. Patients attending clinic alone rated themselves as worse on the S & E than physicians. Patients alone were rated as more functional than patients accompanied by caregivers on both scales regardless of rater.


Stability, vigor, and inherent versatility of novel amino linker and spacer phosphoramidites.
Novel amino linker and spacer phosphoramidites were synthesized from methoxyoxalamido (MOX) percursors possessing a secondary hydroxyl, which when phosphitylated endowed stability to the corresponding phosphoramidites. The synthetic strategy is robust, and the chemistry is reactive towards a variety of primary aliphatic diamines and amino alcohols to produce distinctly unique phosphoramidites. The selection of building blocks determines the length and physico-chemical properties of the phosphoramidite tethering arms, and the synthesis can be specifically tailored to suit individual requirement.


Treatment of giant pyogenic granuloma with the Nd/YAG holmium laser: a case report.
Pyogenic granuloma (PG) is a common vascular tumor that can be treated using various means. However, some large lesions and those located on some difficult-to-treat body sites may represent a formidable selection to the clinician because of the residual pain after treatment, difficulties in surgical excision at one trial and covering with one dressing, and the risk of sequelae. We report a successful treatment of such a giant lesion that arises in the scar which was left because of port wine stain, using a Nd/YAG holmium pulsed dye laser.


[Delays in the diagnosis of lung cancer].
To study the clinical and demographic factors associated with delays in the diagnosis of lung cancer. A 2-year prospective study of patients admitted to the respiratory medicine ward with a suspected diagnosis of lung cancer. We studied demographic factors, health care received, place of residence, and delays in carrying out diagnostic procedures. The following diagnostic time periods were defined: consultation (from first symptom to first medical visit), middle period (from first medical visit to hospital admission) and diagnostic (from hospital admission to histological diagnosis and clinical staging). One hundred thirteen patients with a mean age of 65 years (range, 36-90), 103 men and 10 women, were studied. The most frequent symptoms leading to consultation were coughing (10.6%), hemoptysis (19.5%), chest pain (26.5%), and shortness of breath (9.7%). First visits were to a primary care physician for 72%, to the hospital emergency room for 22%, or to a pulmonologist for 6%. Forty-four percent of the patients visited the doctor 2 or 3 times. The mean SD, numbers of days for the different time periods were as follows: consultation, 30.3 60; diagnosis, 18.6 19; middle period 37.9 63. The mean total time from first symptom to diagnosis was 85.7 87 days. The middle period, the time in hospital until diagnosis, and the total time were shorter when patients were referred by the primary care physician to the emergency room or were directly admitted to the hospital (P<.001). Only 25.7% of the staged lung cancers were operable. Delays in lung cancer diagnosis are long. The attitudes of primary care physicians and their relations with specialized care providers are crucial for reducing delays.


Violence against women as a public health issue.
Violence can be considered "infectious" in rape-prone cultures that celebrate violence and domination. The number of annual injuries and deaths due to violence against women and girls is high enough to demand the type of active interventions and public policies that have been targeted at infectious diseases by public health agencies. In this article, we review data on the physical and mental health effects that violence has on victims of domestic violence, rape, stalking, and sexual harassment. We also focus on the economic costs to the health care system, business and industry, families, and the broader society that accrue as a result of the widespread violence against women and girls. Victims' suffering can never be accounted for by economic data, but those data may be helpful in pushing governments to allocate funds and agencies to take preventive actions.


Proteomic approaches to the study of malignant lymphoma: analyses on patient samples.
We describe the application of proteomic techniques for protein profiling and biomarker discovery in malignant lymphoma. Hematologic malignancies are primarily characterized by their clinical, morphological, immunophenotypical, and molecular-genetic features. However, when based on these parameters, apparently identical lymphomas may show distinct clinical courses, suggesting underlying biological heterogeneity. Recent proteomic analyses have identified differences in protein expression both with regard to subclassification of the malignant lymphoma entities, as well as in correlation with clinical outcome. In this review, studies on quantification of differential protein expression in and between malignant lymphoma entities are included. Studies are included that are based on patient samples, that is, serum/plasma or cytological specimens, as well as intact tumor tissues, together with studies that focus on tumor cells alone, or in conjunction with the tumor microenvironment. For biomarker discovery in malignant lymphoma, these approaches are used to uncover the underlying biological mechanisms and identify proteins with potential diagnostic and prognostic utility, either as predictive biomarkers or as novel future treatment targets.


Right atrial rupture due to blunt chest trauma.
Violent injury currently accounts for the majority of deaths among young people. Cardiac trauma is responsible for 15% of deaths from thoracic injury, and the incidence of cardiac injury in blunt chest trauma is as high as 76% in some clinical series. Many of these cardiac injuries consist of myocardial contusions. Recently, however, there has been increasing recognition of chamber disruption caused by blunt chest trauma. Cardiac injury is usually the result of direct compression of the heart between the sternum and the dorsal spine. These patients are frequently in extremis, with signs of pericardial tamponade, hypotension, and/or massive hemothorax. Successful management is dependent upon prompt diagnosis and surgical repair. To date there have been only 28 survivors (including the three patients in this report) of this catastrophic and frequently unrecognized injury.


Proton magnetic resonance spectroscopic imaging in brain tumor diagnosis.
The current state of standard tumor diagnostics using contrast-enhanced MRI and biopsy is assessed in this review, and the progress of proton magnetic resonance spectroscopy (MRS) over the last 15 years is discussed. We summarize MRS basics and describe a typical magnetic resonance session for noninvasive routine tumor diagnostics at 1.5 T, including two-dimensional magnetic resonance spectroscopic imaging (MRSI). The results that can be obtained from such procedures are illustrated with clinical examples. Attention is turned to cutting-edge methodologic and clinical research at 3 T, with examples using high-resolution or very short echo-time three-dimensional MRSI. The current status and limitations in proton MRSI are discussed, and we look to the potential of faster data collection and even higher field strength.


Influence of treatment modality in outcomes for different stages of resectable esophageal adenocarcinomas.
There is no consensus on the most effective modality for the treatment of resectable esophageal adenocarcinomas (EAC). We theorized that treatment modality may influence survival differently depending on the stage of disease. A single-institution, retrospective examination of resectable EAC between 2000 and 2008 was performed. Resectable EAC were stratified into early disease (stage 2a or less) and late disease (stage 2b or more) based on pretreatment endoscopic ultrasound (EUS). Patients with T4, >N2, and/or distant disease were excluded. A total of 156 patients were included in this study. Most patients were white (97 %), male (83 %), and over 60 years of age (51 %). Patients with early disease on pretreatment EUS exhibited improved overall survival compared to patients with late disease (P < 0.001). Irrespective of treatment modality, there were no significant differences in overall 5-year survival for patients with early or late disease. Early and late disease patients whose disease responded to neoadjuvant chemotherapy (NAC) had significantly improved overall survival compared to nonresponsive disease (P < 0.05). The only negative independent predictors of overall 5-year survival were late stage disease on pretreatment EUS (hazard ratio 2.402, 95 % confidence interval 1.24-4.67, P = 0.01) and late stage disease on final pathological stage (hazard ratio 2.29, 95 % confidence interval 1.22-4.31, P = 0.01). Our data lack statistical power but reveal no difference in survival with the addition of neoadjuvant therapies to surgery for early or late resectable EAC. However, patients with disease that responded to NAC had improved outcomes at 5 years for both groups. Therefore, the prognosis for patients undergoing NAC may be optimized by immediate surgical resection if neoadjuvant therapies do not result in a dramatic clinical response.


Clothing Flammability and Burn Injuries: Public Opinion Concerning an Overlooked, Preventable Public Health Problem.
The objective of this study was to describe knowledge of clothing flammability risk, public support for clothing flammability warning labels, and stronger regulation to reduce the risk. As part of a national survey of homeowners about residential sprinkler systems, the authors included questions about clothing flammability. The authors used an online web panel to sample homeowners and descriptive methods to analyze the resulting data. The sample included 2333 homeowners. Knowledge of clothing flammability and government oversight of clothing flammability risk was low. Homeowners were evenly split about the effectiveness of current standards; however, when presented with clothing-related burn injury and death data, a majority (53%) supported stricter standards. Most homeowners (64%) supported warning labels and indicated that such labels would either have no effect on their purchasing decisions (64%) or be an incentive (24%) to purchase an item. Owners of sprinkler-equipped homes were more likely to support these interventions than owners of homes without sprinkler systems. Public knowledge about clothing flammability risks is low. Most homeowners supported clothing labels to inform consumers of this risk and increased government intervention to reduce the risk.


Novel PCR-EIA method for the detection of Chlamydia pneumoniae in respiratory specimens.
We report the development of a microtitre plate-based PCR-EIA assay (ELAHA; Enzyme Linked Amplification and Hybridization Assay) for the sensitive and specific detection of Chlamydia pneumoniae in sputum samples from patients with chronic obstructive airways disease (COAD). Following PCR amplification of a segment of the chlamydial heat shock 60 protein gene, the 587 bp sized amplicon is captured onto the streptavidin coated surface of a microtitre plate using a C. pneumoniae specific biotinylated probe and the level of captured product is subsequently determined via a colorimetric reaction using an automated plate reader. The ELAHA is a simple, rapid and inexpensive method for detection of low levels of infectious agents and is readily adaptable to current clinical laboratory equipment. The assay was evaluated with a cohort of hospital respiratory patients: (i) COAD patients with acute exacerbation, (ii) COAD patients without exacerbation (stable) and (iii) a non-respiratory control group. The ELAHA produced 6/12 (50%) C. pneumoniae positives in the COAD with exacerbation group, 3/13 (23%) positives in the COAD without exacerbation group and only 1/6 (17%) positives in the control non-respiratory group. This sensitive and robust PCR-EIA method can provide clinically relevant diagnostic evidence of current C. pneumoniae infection contributing to serious respiratory tract diseases such as COAD.


Influence of professional dance training on peak torque and proprioception at the ankle.
To investigate the influence of professional dance training on the peak torque ratio of plantar flexion to dorsiflexion (PF/DF), angle replication ability, and balance in comparison to age-matched and gender-matched controls. The effects of injuries sustained before and during the study time period were also assessed. Prospective age-matched and gender-matched nonrandomized intervention study. Premises of the Orthopedic University Hospital, Heidelberg, where measuring apparatus belonging to the hospital was used for the tests. One group of 42 dancers (31 female, 11 male) in professional training (State Academy) and 40 age-matched and gender-matched controls with no prior dance or specific sport training. Isokinetic tests for peak torque at 30 degrees /s and 120 degrees /s, a passive angle-replication test (Biodex system 3), and a test of 1-legged standing were each carried out on 2 measurement dates (M1, M2): at the beginning of a season of professional dance training (M1) and after 5 months of such training (M2). Symptoms and/or injuries sustained during this period were ascertained continuously by means of questionnaires and interviews. A significant increase in peak torque in PF was observed in both dancer groups and male controls between M1 and M2. A significant increase in PF/DF peak torque ratio at 30 degrees /s was observed in both male groups between M1 and M2. At M2, no significant differences in PF/DF peak torque ratio could be found between male dancers and controls, but at 30 degrees /s between the female groups. However, in both female groups, the PF/DF ratio was not found to increase significantly between M1 and M2. In the angle-replication and 1-legged standing test, no consistent improvement was observed between M1 and M2 in either dancers or controls. In the angle-replication test, there were no significant differences between dancers and controls at M2. In the 1-legged standing test, the dancers did significantly better than controls. A total of 7 ankle injuries were recorded, but no difference was found between injured and uninjured subjects in the proprioceptive tests either at M1, as the predicator, or at M2 as the residual. Dance training did not increase the peak torque ratio of PF/DF within 5 months, but a group difference was found between the women groups. Ballet training alone without concurrent additional coordinative training does not lead to improvements in ankle joint position sense or improved measures of balance within this period of observation.


Dynamic changes in brain structure in patients with post-traumatic stress disorder after motor vehicle accident: A voxel-based morphometry-based follow-up study.
To investigate the dynamic changes of emotional and memory-related brain regions in post-traumatic stress disorder (PTSD) patients and trauma-exposed subjects, who experienced motor vehicle accident (MVA). Functional Magnetic Resonance imaging (fMRI) and general data were collected from trauma victims who had experienced MVA within 2 days, and their social support and coping style were evaluated. The PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5) is used for screening and diagnosis. Subsequently, 17 PTSD patients and 23 car accident trauma-exposed individuals completed a second fMRI scan at 2 months. Data were analyzed by using voxel-based morphometry (VBM) to examine the volume changes of relevant brain regions. Correlation analysis was used to assess the correlation between the regions of interest (ROIs) and the total scores on the clinical scales. Subsequently, the relationship between the total PCL-5 scores and the individual dimensions of the Simplified Coping Style Questionnaire (SCSQ) and the Social Support Rate Scale (SSRS) was studied. In comparison with the control group, the results showed a reduction in right SFG volume in the PTSD group at 2 months. Similarly, a comparison within the PTSD group revealed a reduction in the left STG volume at 2 months. Compared with the control group, PTSD patients showed a more negative coping style and worse performance in objective and subjective support. In addition, the total PCL-5 scores were negatively associated with positive coping, objective support, and subjective support. The occurrence of PTSD may be related to reduced volume of the right SFG and left STG, and that patients with PTSD receive less social support and tend to cope in a negative manner in the face of stressful events. These results suggest that within 2 months of the MVA, changes in gray matter volume have occurred in some brain regions of those suffering from PTSD. We believe the results of our study will provide useful insights into the neuropsychological mechanisms underlying PTSD.


Classical trajectory calculations of intramolecular vibrational energy redistribution. I. Methanol-water complex.
Intramolecular vibrational energy redistributions of the O-H stretching (nuOH) vibration for the methanol monomer and its water complex, the methanol-water dimer, are investigated by using ab initio full-dimensional classical trajectory calculations. For the methanol monomer, in the high-energy regime of the 5nuOH overtone, the time dependence of the normal-mode energies indicates that energy flowed from the initial excited O-H stretching mode to the C-H stretching mode. This result confirms the experimental observation of energy redistribution between the O-H and C-H stretching vibrations [L. Lubich et al., Faraday Discuss. 102, 167 (1995)]. Furthermore, a lot of dynamical information in the time domain is contained in the power spectra, whose density is given by the Fourier transformation of the total momentum obtained from trajectory calculations. For the methanol-water hydrogen-bonded complex, at the high-energy level of the 5nuOH overtone, the calculated power spectrum shows considerable splitting and broadening, indicating significant energy redistribution through strong coupling between the O-H stretching vibration and other vibrations. It is thus clear that the A-H...B hydrogen-bond formation facilitates energy redistribution subsequent to the vibrational excitation of the hydrogen-bonded A-H stretching mode.


[Analysis on epidemiological and temporal-spatial distribution characteristics of hemorrhagic fever with renal syndrome in Shandong province, 2010-2016].
Objective: To analyze the epidemiological and temporal-spatial distribution characteristics of hemorrhagic fever with renal syndrome (HFRS) in Shandong province during 2010-2016 and provide references for developing prevention and control measures. Methods: Based on the data of Infectious Disease Reporting Information System in China, the incidence and temporal-spatial distribution of HFRS in Shandong from 2010 to 2016 were analyzed by spatial autocorrelation and space-time scan statistics. Results: A total of 9 114 HFRS cases were reported in Shandong during this period. The cases were mainly distributed in age group 30-70 years, and the male to female ratio of the cases was 2.63 ∶ 1. Most cases were farmers. The higher incidence rate was reported in southeastern Shandong, while the lower incidence rate was reported in northwestern Shandong. Among the epidemic periods, the highest incidence rate was 1.87/100 000 in 2013. The results of spatial autocorrelation and space-time scanning indicated that the high-high clusters of HFRS were concentrated in southeastern Shandong and then spread to central Shandong. The cluster mainly occurred from the end of 2011 to the first half of 2015. Both the incidence rate and the cluster decreased in 2016. Conclusions: The epidemic and cluster of HFRS still existed in Shandong from 2010 to 2016. The key areas for the prevention and control of HFRS were in southeastern and central Shandong.


Understanding the implications of NICE guidance on infection control.
Following the publication of Getting Ahead of the Curve (Department of Health, 2001), greater emphasis has been placed on infection control in primary and community care (called community care throughout this article). For years, guidance on reducing the incidence of preventable health care-associated infections in community care has been based on standards developed for acute care settings. But in many cases, practices common in acute care are not directly transferable to the community. Also, shorter hospital stays mean care previously provided in hospital is increasingly carried out in the community.


Gallstone-induced perforation of the common bile duct in pregnancy.
Spontaneous perforation of the extrahepatic biliary system is a rare presentation of ductal stones. We report the case of a twenty-year-old woman presenting at term with biliary peritonitis caused by common bile duct (CBD) perforation due to an impacted stone in the distal common bile duct. The patient had suffered a single herald episode of acute gallstone pancreatitis during the third trimester. The patient underwent an emergency laparotomy, bile duct exploration, and removal of the ductal stone. The postoperative course was uneventful.


Vertical transmission of hepatitis B virus despite maternal lamivudine therapy.
Lamivudine given during the last weeks of pregnancy in women with chronic hepatitis B has been reported to be safe. We report a case of chronic hepatitis B virus (HBV) infection in a newborn, despite suppression of HBV DNA to undetectable levels in the mother by prolonged lamivudine therapy. The newborn had raised alanine aminotransferase concentrations and was positive for HBV DNA at birth which persisted until 9 months of age, despite neonatal vaccination, treatment with hepatitis B immune globulin, and high concentrations of anti-HBs. On HBV DNA sequencing, complete sequence homology and a similar precore mutation was found in the mother and child, indicating vertical transmission. Lamivudine therapy might not prevent perinatal transmission of HBV infection in every newborn.


Defect in ND2, COX2, ATP6 and COX3 mitochondrial genes as a risk factor for canine mammary tumour.
The aim of this study was to identify mutations in ND2, COX2, ATP6 and COX3 mitochondrial genes in canine mammary tumour, determine their association with the process of neoplastic transformation, and phenotypic traits of dogs. In total, 93 biological samples, including blood, normal and neoplastic tissue samples from 31 dogs with diagnosed malignant canine mammary tumours were analysed. DNA sequencing of genes as well as bioinformatics and statistical analyses were performed. A total of 28 polymorphic loci and 11 mutations were identified. One of the mutations was blood heteroplasmy and two of the mutations caused an amino acid change in p.N117S and p.A184T. For the first time, mutations in mitochondrial genes were detected in dogs with mammary tumours. A statistically significant association between the presence of mutations and the size and age of dogs was demonstrated. Some of these changes may imply that these are the hotspot mutations of canine mammary tumour.


Enzymatic synthesis of DNA complementary to purified 14S messenger RNA of immunoglobulin light chain.
The 14S messenger RNA, which contains poly(adenylic acid), of MOPC 41 (mouse plasmocytoma) immunoglobulin light chain, purified to a single peak as shown by polyacrylamide gel electrophoresis, was used to synthesize complementary DNA with the RNA-dependent DNA polymerase of avian myeloblastosis virus. DNA synthesis is entirely dependent on added RNA template and oligo(dT) primer. Both the size and the concentration of the primer affect the reaction. The product behaves similarly to DNA during centrifugation in cesium sulfate density gradients. It is shown by hybridization that the DNA made is complementary to the purified template, light-chain mRNA. The high specific activity of the complementary DNA should make it suitable for gene-dosage experiments. According to alkaline sucrose gradient analyses, some complete complementary DNA transcripts of the 14S mRNA seem to be made. Oligo(dG) can also function as a primer for DNA synthesis, possibly by annealing to an internal cluster of cytidines in the mRNA, that correspond to the bases coding for amino-acids 119 and 120 of the MOPC 41 light chain.


Developmentally regulated responses of human granulosa cells to insulin-like growth factors (IGFs): IGF-I and IGF-II action mediated via the type-I IGF receptor.
In experimental animal models, insulin-like growth factors (IGFs) have been found to be more potent stimulators of ovarian function than insulin. In human theca cells, however, insulin, IGF-I, and IGF-II have similar effects on androgen production. The relative effects of insulin and IGFs on human granulosa cell steroidogenesis is unknown. Furthermore, it is unclear whether effects of IGF-II on steroidogenesis are mediated by the type-I or type-II IGF receptor. The effects of insulin, IGF-I, and IGF-II on human granulosa cell steroidogenesis were compared in vitro. As expected, insulin, IGF-I, and IGF-II enhanced steroidogenesis. Previously, IGF-II has been shown to enhance granulosa cell steroid production after insulin preincubation. In this study, an effect of IGF-II, independent of insulin priming, also was observed. In granulosa cell cultures from small antral follicles (< or = 13 mm), insulin and IGF-I stimulated steroid production to a similar degree, whereas IGF-II was less effective. In contrast, IGFs were more effective than insulin (IGF-I > IGF-II > insulin) in granulosa cells isolated from preovulatory follicles. IGF-I and IGF-II actions were mediated via the type-1 IGF receptor. The increased responsiveness of mature granulosa cells to IGFs may be an important mechanism by which granulosa cells increase their steroidogenic output in the preovulatory follicle.


Human Factors Associated With the Use of Manual Bulb Suction Devices.
Manual bulb suction is commonly used to promote naso-oropharyngeal airway clearance. Human factors of hand placement (radial vs. axial) and relative negative pressure generated are not known. This study is the first step in developing clinical guidelines for safe and effective mechanical use of manual bulb suction to reduce and prevent upper airway injury. The aim of this study was to determine the negative pressure generated when a 2-oz. manual bulb suction device is compressed and released, and hand placement is either in a radial or axial position. A total of 87 subjects were recruited using a convenience sampling method to identify hand placement and predicted negative pressures emitted during bulb compression and release. A pressure transmitter system was developed and tested with 666 negative pressure measurements to verify internal consistency and reliability in predicting negative pressure. The majority of subjects compressed the bulb radially (55%). Suction pressures ranged from -42 mm Hg to -81 mm Hg, with a standard deviation of -7 mm Hg. Males tended to have statistically significant higher negative pressures (U = 170, p = .021) when radially compressing the bulb. Females generated statistically significant higher negatives pressures (U = 71.50, p = .001) when axially compressing the bulb. A 2-oz. manual bulb suction device creates negative pressures less than 85 mm Hg when using moderate compression regardless of hand placement (radial or axial placement). Further studies are needed to explore additional healthcare provider and patient human factor variables related to the mechanical use of manual bulb suction.


The clinical and diagnostic consequences of Poly Implant Prothèse silicone breast implants, recalled from the European market in 2010.
Recently, Poly Implant Prothèse silicone breast implants were recalled from the European market. The authors studied 112 women and previously published data on rupture prevalence. Women are presenting with symptoms they feel may be a result of ruptured implants. The authors' aim was to study the clinical consequences of Poly Implant Prothèse implants. One hundred twelve women with 224 proven Poly Implant Prothèse implants after 10 years of implantation were enrolled in this study. All women underwent physical examination and magnetic resonance imaging and were interviewed regarding symptoms. Details of the explantations of 35 women with at least one ruptured implant were documented. Tissue from 10 women was sent for pathologic investigation. Of 112 women, 34 (30.4 percent) had symptoms attributable to their implants. Physical examination showed that 12 of the 121 women (10.7 percent) had findings suggestive of rupture, most commonly pain. Three had lymphadenopathy that seemed to correlate with implant rupture or excessive "gel bleed." Pathologic findings showed no malignancies. Eight women who underwent explantation had no implant rupture. Excessive gel bleed was documented in half of them. Clinical consequences of women with Poly Implant Prothèse implants are comparable to those reported in the literature of other manufacturers. Neither complaints nor findings at physical examination had a significant correlation with implant rupture at explantation. Magnetic resonance imaging is still the preferred method compared with physical examination for diagnosing rupture. The low specificity was probably caused by the difficulty in differentiating between rupture and excessive gel bleed in these implants.


[The structure of the diagnosis of neuromuscular diseases (the examination chart of outpatients for computer analysis)].
To provide a prophylactic medical examination (PME) as well as to improve the quality of diagnosis and treatment in a local medical institutions special coded card case sheets for patients with neuro-muscular disease adapted for computer analyzes are proposed. Such sheets facilitated determination of the diagnosis, objective patient's state during PME and correction of the scheme of therapy. The sheets were elaborated for long-term observation of 3153 patients with different neuro-muscular diseases and syndromes. The scheme of the diagnosis included such indices as character of damage of motor unit, type of heritability, age of onset of the disease, main systems of muscular atrophies, rate of the progress of pathological process, severity of the patient's state.


Effect of results-based financing on facility-based maternal mortality at birth: an interrupted time-series analysis with independent controls in Malawi.
The aim of this study was to assess the impact of a results-based financing (RBF) programme on the reduction of facility-based maternal mortality at birth. Malawi is a low-income country with high maternal mortality. The Results-Based Financing For Maternal and Newborn Health (RBF4MNH) Initiative was introduced at obstetric care facilities in four districts to improve quality and utilisation of maternal and newborn health services. The RBF4MNH Initiative was launched in April 2013 as a combined supply-side and demand-side RBF. Programme expansion occurred in October 2014. Controlled interrupted time series was used to estimate the effect of the RBF4MNH on reducing facility-based maternal mortality at birth. The study sample consisted of all obstetric care facilities in 4 intervention and 19 control districts, which constituted all non-urban mainland districts in Malawi. Data for obstetric care facilities were extracted from the Malawi Health Management Information System. Facility-based maternal mortality at birth was calculated as the number of maternal deaths per all deliveries at a facility in a given time period. The RBF4MNH effectively reduced facility-based maternal mortality by 4.8 (-10.3 to 0.7, p<0.1) maternal deaths/100 000 facility-based deliveries/month after reaching full operational capacity in October 2014. Immediate effects (changes in level rather than slope) attributable to the RBF4MNH were not statistically significant. This is the first study evaluating the effect of a combined supply-side and demand-side RBF on maternal mortality outcomes and demonstrates the positive role financial incentives can play in improving health outcomes. This study further shows that timeframes spanning several years might be necessary to fully evaluate the impact of health-financing programmes on health outcomes. Further research is needed to assess the extent to which the observed reduction in facility-based mortality at birth contributes to all-cause maternal mortality in the country.


Biostabilization of cadmium contaminated sediments using indigenous sulfate reducing bacteria: Efficiency and process.
Sulfate reducing bacteria (SRB) was used to stabilize cadmium (Cd) in sediments spiked with Cd. The study found that the Cd in sediments (≤600 mg kg-1) was successfully stabilized after 166 d SRB bio-treatment. This was verified by directly and indirectly examining Cd speciation in sediments, mobilization index, and Cd content in interstitial water. After 166 d bio-treatment, compared with control groups, Cd concentrations in interstitial water of Cd-spiked sediments were reduced by 77.6-96.4%. The bioavailable fractions of Cd (e.g., exchangeable and carbonate bound phases) were reduced, while more stable fractions of Cd (e.g., Fe-Mn oxide, organic bound, and residual phases) were increased. However, Cd mobilization in sediment was observed during the first part of bio-treatment (32 d), leading to an increase of Cd concentrations in the overlying water. Bacterial community composition (e.g., richness, diversity, and typical SRB) played an important role in Cd mobilization, dissolution, and stabilization. Bacterial community richness and diversity, including the typical SRB (e.g., Desulfobacteraceae and Desulfobulbaceae), were enhanced. However, bacterial communities were also influenced by Cd content and its speciations (especially the exchangeable and carbonate bound phases) in sediments, as well as total organic carbon in overlying water.


A novel large deletion in CCM1 gene in a Tunisian family.
Familial CCM is a rare entity associated with the mutation of three genes: CCM1 (KRIT1), CCM2 (MGC4607), and CCM3 (PDCD10). We report here the first description of a Tunisian familial CCMs composed of six members. The father and two daughters were affected and symptomatic. The two other kindred were healthy. Surgical treatment was performed in only one affected patient. Molecular analysis of KRIT1, MGC4607 and PDCD10 genes identified a large KRIT1 deletion of the first ten exons. To the best of our knowledge, this large deletion has never been reported before.


Micropropagation effect on the anti-carcinogenic activitiy of polyphenolics from Mexican oregano (Poliomintha glabrescens Gray) in human colon cancer cells HT-29.
Phenolic extracts obtained from spices are known to have anti-carcinogenic activities but little is known about the effect of micropropagation on these beneficial effects. The main objective of this study was to evaluate the cytotoxic activity of flavonoid-enriched extracts (FEE) from the leaves of wild (WT), in vitro (IN), and ex vitro (EX) grown oregano plants in colon cancer cells HT-29 and the non-cancer cells CCD-18Co. Cell proliferation of HT-29 cells was reduced to 50 % by WT, IN, and EX at concentrations of 4.01, 1.32, and 4.84 mg of gallic acid equivalents (GAE)/L, respectively. In contrast, in CCD-18Co cells, higher concentrations were required for the same cytotoxic effect. At 6 mg GAE/L, WT and IN reduced the production of reactive oxygen species (ROS) of lipopolysaccharides (LPS)-stimulated control cells to 59.89 and 59.43 %, respectively, and EX to 73.89 %. The mRNA of Caspase-3 was increased 1.53-fold when cells were treated with 4 mg GAE/L of IN extract, and tumor necrosis factor receptor superfamily, member 6 (FAS), and BCL2-associated X protein (BAX) mRNA increased 2.55 and 1.53 fold, respectively. Results on protein expression corroborated the apoptotic effects with a significant decrease of B-cell lymphoma 2 (BCL2) expression for all treatments but more remarkable for EX that also showed the most intense signal of BAX. Overall, FEE extracts derived from micropropagation had increased pro-apoptotic effects, however extracts from the in vitro plants produced more efficacy at the transcriptional level while extracts from the ex vitro plant were superior at the traductional level.


Multiplexing-oriented plasmon-MoS2 hybrid metasurfaces driven by nonlinear quasi bound states in the continuum.
Rapid progress in nonlinear plasmonic metasurfaces enabled many novel optical characteristics for metasurfaces, with potential applications in frequency metrology [Zimmermann et al. Opt. Lett. 29:310 (2004)], timing characterization [Singh et al. Laser Photonics Rev. 14:1 (2020)] and quantum information [Kues et al. Nature. 546:622 (2017)]. However, the spectrum of nonlinear optical response was typically determined from the linear optical resonance. In this work, a wavelength-multiplexed nonlinear plasmon-MoS2 hybrid metasurface with suppression phenomenon was proposed, where multiple nonlinear signals could to be simultaneously processed and optionally tuned. A clear physical picture to depict the nonlinear plasmonic bound states in the continuum (BICs) was presented, from the perspective of both classical and quantum approaches. Particularly, beyond the ordinary plasmon-polariton effect, we numerically demonstrated a giant BIC-inspired second-order nonlinear susceptibility 10-5m/V of MoS2 in the infrared band. The novelty in our study lies in the presence of a quantum oscillator that can be adopted to both suppress and enhance the nonlinear quasi BICs. This selectable nonlinear BIC-based suppression and enhancement effect can optionally block undesired modes, resulting in narrower linewidth as well as smaller quantum decay rates, which is also promising in slow-light-associated technologies.


Genomic diversity and post-admixture adaptation in the Uyghurs.
Population admixture results in genome-wide combinations of genetic variants derived from different ancestral populations of distinct ancestry, thus providing a unique opportunity for understanding the genetic determinants of phenotypic variation in humans. Here, we used whole-genome sequencing of 92 individuals with high coverage (30-60×) to systematically investigate genomic diversity in the Uyghurs living in Xinjiang, China (XJU), an admixed population of both European-like and East-Asian-like ancestry. The XJU population shows greater genetic diversity, especially a higher proportion of rare variants, compared with their ancestral source populations, corresponding to greater phenotypic diversity of XJU. Admixture-induced functional variants in EDAR were associated with the diversity of facial morphology in XJU. Interestingly, the interaction of functional variants between SLC24A5 and OCA2 likely influences the diversity of skin pigmentation. Notably, selection has seemingly been relaxed or canceled in several genes with significantly biased ancestry, such as HERC2-OCA2. Moreover, signatures of post-admixture adaptation in XJU were identified, including genes related to metabolism (e.g. CYP2D6), digestion (e.g. COL11A1), olfactory perception (e.g. ANO2) and immunity (e.g. HLA). Our results demonstrated population admixture as a driving force, locally or globally, in shaping human genetic and phenotypic diversity as well as in adaptive evolution.


[New Developments in CKD-MBD. Strategies for the management of predilalysis CKD-MBD].
Abnormalities in bone and mineral metabolism begin to develop in the early stage of CKD. Serum phosphorus, calcium, PTH, and alkaline phosphatase are recommended to be measured from CKD stage 3, and it is suggested that these markers are maintained within the reference ranges of each facility. The management of phosphorus is essential and is composed of phosphorus restriction and phosphate binders. Small amount of VDRA suppresses PTH for secondary hyperparathyroidism and is expected to reduce mortality and proteinuria. The effects of the intervention to reduce the phosphorus load before hyperphosphatemia is manifested need to be investigated.


[Segmental unilateral priapism--a case report].
A case of segmental priapism in a 24-year-old man with congenital spherocytosis is presented. Preoperative cavernosography and computer tomography clearly revealed thrombosis of the left proximal corpus cavernosum. Because the lesion had already been in existence for 5 weeks irrigation to flush out the thrombosis was no longer possible.


[Combination of clinical homeopathy and dynamic neurostimulation for the restoration of male sexual function].
The impairment of sexual function diagnosed in approximately one third of apparently healthy men dictates the necessity of their rehabilitative treatment. The objective of the present study was to evaluate effectiveness of the combination of clinical homeopathy and dynamic electrical neurostimulation (DENS) for the restoration of disturbed sexual function. The study demonstrated that the efficiency of the proposed method in terms of dynamics of subjective and objective improvement surpasses that of isolated application of clinical homeopathy or DENS when compared against the use of placebo.


Quantitative evaluation of apical extrusion of intracanal bacteria using rotary ProTaper, K3XF, twisted and hand K-file system: An ex vivo study.
The aim of this study was to evaluate the number of intracanal bacteria extruded apically during root canal preparation using rotary ProTaper, K3XF, twisted, and hand K-file system. Seventy extracted single-rooted human mandibular premolar teeth were used. Access cavities were prepared and the teeth were mounted in glass vials. Root canals were then contaminated with a pure culture of Enterococcus faecalis (ATCC 29212) and incubated at 37°C for 24 h. The contaminated roots were divided into four experimental groups of 15 teeth each and one control group of 10 teeth. Group 1: ProTaper; Group 2: K3XF; Group 3: Twisted file; Group 4: Hand K-file; Group 5: Control group. Bacteria extruded from the apical foramen during instrumentation were collected into vials. The microbiological samples were incubated in culture media for 24 h. Colonies of bacteria were counted and the results were given as number of colony-forming units (CFU)/ml. The obtained data were analyzed using the Kruskal-Wallis one-way analysis of variance and Mann-Whitney U-tests. There was a significant difference between the rotary and hand instrumentation system related to the apically extruded intracanal bacteria. Both the rotary and hand instrumentation systems extruded intracanal bacteria through the apical foramen. K3XF file system showed least bacterial extrusion amongst all instrumentation groups.


[Vitamin status of diamond cutters].
Workers engaged in industrial treatment of diamonds manifested deficient supply of ascorbic acid, thiamine, riboflavin, pyridoxine and niacin in spring and autumn. This was ascertained on the basis of studying actual nutrition and specific indicators of the content of vitamins or their catabolites in the urine and blood and determination of metabolic functions of some vitamin-dependent enzymes.


Clinical management of multiple sclerosis and neuromyelitis optica with therapeutic monoclonal antibodies: approved therapies and emerging candidates.
Therapeutic monoclonal antibodies (mAbs) are a relatively novel class of drugs that has substantially advanced immunotherapy for patients with multiple sclerosis. The advantage of these agents is that they bind specifically and exclusively to predetermined proteins or cells. Natalizumab was the first mAb in neurology to obtain approval. It is also considered one of the most potent options for annualized relapse rate reduction among available therapeutic options. Alemtuzumab is currently also approved in several countries. Several mAbs have been tested in clinical studies in multiple sclerosis. Here, we review the history of drug development of therapeutic mAbs and their classification. Furthermore, we outline the putative mechanisms of action, clinical evidence and safety of approved mAbs and those in different stages of clinical development in multiple sclerosis and neuromyelitis optica.


Imagining Success: Multiple Achievement Goals and the Effectiveness of Imagery.
Imagery (richly imagining carrying out a task successfully) is a popular performance-enhancement tool in many domains. This experiment sought to test whether pursuing two achievement goals (vs. one) benefits performance after an imagery exercise. We examined mastery goals (aiming to improve skill level) and performance goals (aiming to outperform others) among 65 tennis players who were assigned to a mastery goal condition, a performance goal condition, or a mastery goal and performance goal condition. After reading instructions for a service task, which included the goal manipulation, participants completed 20 tennis services. They then completed an imagery exercise and, finally, completed another 20 services. Postimagery service performance was better in the dual-goal condition than in the other conditions.


A misdiagnosis of traumatic hypersupination of the distal radioulnar joint: a case report.
Traumatic hypersupination injury of the distal radioulnar joint is a rare injury, and occurs when sufficient supination force is applied to the joint so as to tear the volar radioulnar ligament, resulting in separation of the triangular fibrocartilage complex, and subluxation of the tendon of extensor carpi ulnaris. This allows the distal ulna to rotate such that the ulnar styloid comes to lie adjacent to the ulna notch of the radius. Treatment of this injury requires manipulation of the joint, under anaesthesia or sedation. We describe a case where posttraumatic radiological investigation of a patient with an anatomical variation of the wrist when in supination resembled a traumatic hypersupination injury of the distal radioulnar joint. A review of the literature has revealed this to be the first reported case of this type.


Effects of communal exercise with visual and auditory feedback provided by a smart application on gait ability and fear of falling in Parkinson's disease patients.
Parkinson's disease is a chronically developing neurodegenerative disease showing typical motor symptoms of the following triad: resting tremor, freezing of gait, and bradykinesia-hypokinesia. In the present study, we investigated the effects of a communal exercise program, using the visual and auditory feedback provided by a smart application, to assess gait ability, fear of falling, and fall efficacy in Parkinson's disease patients. Subjects consisted of 29 Parkinson's disease patients who were non-demented individuals. The subjects were randomly divided into three groups: the control group (n= 9, CG), the communal exercise group using the smart application (n= 10, CCEG), and the individual exercise group using the smart application (n= 10, ICEG). The communal exercise program consisted of a warm up (10 min) followed by communal exercise using the smart application (40 min), and a cool down (10 min) for 3 days per week over 10 weeks. The results presented here show that velocity and cadence were significantly increased among groups. Step and stride length were significantly increased among times. Fear of falling and fall efficacy were significantly different among groups and times. In particular, fear of falling was lower and fall efficacy was higher in the CCEG than in the ICEG and CG. These findings indicate that 10 weeks of the communal exercise program using the smart application can be effective in improving gait ability, fear of falling, and fall efficacy in Parkinson's disease patients.


Photodissociation spectroscopy of the dysprosium monochloride molecular ion.
We have performed a combined experimental and theoretical study of the photodissociation cross section of the molecular ion DyCl(+). The photodissociation cross section for the photon energy range 35,500 cm(-1) to 47,500 cm(-1) is measured using an integrated ion trap and time-of-flight mass spectrometer; we observe a broad, asymmetric profile that is peaked near 43,000 cm(-1). The theoretical cross section is determined from electronic potentials and transition dipole moments calculated using the relativistic configuration-interaction valence-bond and coupled-cluster methods. The electronic structure of DyCl(+) is extremely complex due to the presence of multiple open electronic shells, including the 4f(10) configuration. The molecule has nine attractive potentials with ionically bonded electrons and 99 repulsive potentials dissociating to a ground state Dy(+) ion and Cl atom. We explain the lack of symmetry in the cross section as due to multiple contributions from one-electron-dominated transitions between the vibrational ground state and several resolved repulsive excited states.


Identification of a freshness marker metabolite in stored soybean sprouts by comprehensive mass-spectrometric analysis of carbonyl compounds.
The objective of this study was to identify metabolites that quantitatively indicate degrees of freshness of soybean sprouts. Self-cultivated soybean sprouts were stored at 5 °C, 10 °C or 20 °C, and respiratory CO2 production rates were monitored using gas chromatography during storage. Carbonyl compounds (CCs) were analyzed comprehensively using mass-spectroscopic metabolomics analyses. CCs were derivatized using dansyl hydrazine (DH) and were then analyzed using high performance liquid chromatography-electrospray ionization tandem mass spectrometry (HPLC-MS/MS) with multiplexed multiple reaction monitoring (MRM). In the MRM chromatogram, 171 to 358 peaks were observed from stored soybean sprouts. Principle component analysis and discriminant analysis (PCA-DA) selected the CC-DH derivative ion with a m/z 512 at a retention time of 9.34 min as the most significant metabolite. Searching online metabolomics databases and matching fragment patterns of product ion mass spectra of an authentic standard revealed abscisic acid is a freshness marker of soybean sprouts.


Evaluating the neurotherapeutic potential of a water-soluble progesterone analog after traumatic brain injury in rats.
The poor aqueous solubility of progesterone (PROG) limits its potential use as a therapeutic agent. We designed and tested EIDD-1723, a novel water-soluble analog of PROG with >100-fold higher solubility than that of native PROG, as candidate for development as a field-ready treatment for traumatic brain injury (TBI). The pharmacokinetic effects of EIDD-1723 on morphological and functional outcomes in rats with bilateral cortical impact injury were evaluated. Following TBI, 10-mg/kg doses of EIDD-1723 or PROG were given intramuscularly (i.m.) at 1, 6 and 24 h post-injury, then daily for the next 6 days, with tapering of the last 2 treatments. Rats were tested pre-injury to establish baseline performance on grip strength and sensory neglect, and then retested at 4, 9 and 21 days post-TBI. Spatial learning was evaluated from days 11-17 post-TBI. At 22 days post-injury, rats were perfused and brains extracted and processed for lesion size. For the edema assay the animals were killed and brains removed at 24 h post-injury. EIDD-1723 significantly reduced cerebral edema and improved recovery from motor, sensory and spatial learning deficits as well as, or better than, native PROG. Pharmacokinetic investigation after a single i.m. injection in rats revealed that EIDD-1723 was rapidly converted to the active metabolite EIDD-036, demonstrating first-order elimination kinetics and ability to cross the blood-brain barrier. Our results suggest that EIDD-1723 represents a substantial advantage over current PROG formulations because it overcomes storage, formulation and delivery limitations of PROG and can thereby reduce the time between injury and treatment.


Flutamide withdrawal plus hydrocortisone resulted in clinical complete response in a patient with prostate carcinoma.
Combined androgen blockade (CAB) (medical or surgical castration plus antiandrogen therapy) is considered by many to be the optimal endocrine maneuver for patients with metastatic prostate carcinoma. When progression occurs after CAB, the discontinuation of the antiandrogen is recommended. The authors present a patient that had a clinical complete response to flutamide withdrawal plus hydrocortisone that, at last follow-up, had been maintained for more than 46 months. A 71-year-old man with a positive family history of prostate carcinoma presented in 1989 with urinary frequency and a suspicious digital rectal examination. He was found to have a poorly differentiated adenocarcinoma (Gleason 4+4). He was started on CAB and his prostate specific antigen (PSA) concentration declined from 96 ng/mL to the normal range and was maintained for the next 24 months. In 1991 his PSA began to rise, and reached 64 ng/mL by 1993. The patient was enrolled on a clinical trial that discontinued the flutamide administration and hydrocortisone was initiated. Physical examination at the time of enrollment was unremarkable. His PSA declined to below the limits of detection after this maneuver and at last follow-up had been maintained there for more than 46 months. In 1995, the patient underwent a repeat biopsy of the prostate and all six tissue cores were negative for carcinoma. At last follow-up in December 1996, the patient had no evidence of disease and was being followed routinely; however, the authors were continuing treatment with testicular suppression (leuprolide) plus hydrocortisone. The authors believe the residual androgens and steroids produced by the adrenal cortex play a meaningful role in prostate carcinoma cell proliferation. Based on this case and data from trials supporting the activity of flutamide withdrawal plus adrenal suppression, it appears reasonable to evaluate prospectively the discontinuation of antiandrogen versus antiandrogen withdrawal plus adrenal suppression in individuals failing CAB.


Castration and emasculation in the Middle Age. The andrological conundrum of Peter Abelard.
Peter Abelard (1079-1142) is still considered one of the giants of philosophy, theology, and psychology, and the unsurpassed master of dialectical debate. Born in Le Pallet, near Nantes, Abelard became an academic and wandering cleric of great fame, founder of several schools that attracted students from all countries, arousing the admiration of his contemporaries and the profound envy of his colleagues. Around 1115, Abelard became master of the school of the Cathedral of Notre-Dame. Shortly after, the canon Fulbert asked him to take his niece, the equally famous and highly cultured Héloïse d'Argenteuil (1092-1164), as a pupil. Thus a relationship began, celebrated for centuries to come, characterized by burning sexual and intellectual passion, by the famous correspondence, which will be the archetype of sentimental education and the template of romantic love letters, bythe birth of a son and consequent marriage, and by the cowardly revenge of Fulbert, who, together with a band of servants, mutilated "those parts of my body with which I had done what was the cause of their pain," as Abelard wrote. While this unclear self-description has suggested to contemporaries and to posterity that Abelard was castrated, we aim to question this belief by analyzing in-depth this historical-andrological clinical case to understand if there is any evidence that could suggest that Abelard was instead the victim of an even more brutal punishment: penectomy. Signs and symptoms gleaned from the personal writings and historical perspectives of Abelard and his time are used here to provide a possible answer to a thousand-year-old question: what makes a man … a man?


Upregulation of placental indoleamine 2,3-dioxygenase by human chorionic gonadotropin.
We tested the hypothesis that hCG can upregulate human trophoblast indoleamine 2, 3-dioxygenase (INDO), which catalyzes the breakdown of tryptophan in villous circulation. The results revealed that it can. Treatment of human trophoblasts with hCG resulted in a time and dose dependent increase in INDO mRNA and protein levels and its enzyme activity. The hCG effect was hormone specific and required the dimer conformation of hCG. The hCG effect required its receptors and was mediated by a cAMP dependent, but protein kinase A independent, mitogen-activated protein kinase 3/1 (MAPK3/1) signaling mechanism. In summary, the present data demonstrate a novel hCG effect on human placental INDO, which probably plays a key role at maternal fetal interface in preventing fetal rejection.


Reconstruction of the deep femoral artery.
Deep femoral artery reconstruction was performed on 54 extremities. Best results were obtained in patients with severe rest pain and minor ischemic ulcerations. Intermittent claudication generally did not improve significantly. The mean operative flow to deep femoral artery was 170 mg/min. and the increase in peripheral pressure 20 mm Hg.


Enhanced reactive adsorption of hydrogen sulfide on the composites of graphene/graphite oxide with copper (hydr)oxychlorides.
Composites of copper (hydr)oxychlorides with graphite oxide or graphene were synthesized and used as adsorbents of hydrogen sulfide at dynamic conditions at ambient temperatures. The materials were extensively characterized before and after adsorption in order to link their performance to the surface features. X-ray diffraction, FTIR, thermal analysis, TEM, SEM/EDX, and adsorption of nitrogen were used. It was found that the composite with graphene has the most favorable surface features enhancing reactive adsorption of hydrogen sulfide. The presence of moisture in the H2S stream has a positive effect on the removal process owing to the dissociation process. H2S is retained on the surface via a direct replacement of OH groups and via acid-base reactions with the copper (hydr)oxide. Highly dispersed reduced copper species on the surface of the composite with graphene enhance activation of oxygen and cause formation of sulfites and sulfates. Higher conductivity of the graphene phase than that of graphite oxide helps in electron transfer in redox reactions.


Self-adjusting inverse design method for nanophotonic devices.
Nanophotonic devices, which consist of multiple cell structures of the same size, are easy to manufacture. To avoid the optical proximity effect in the ultraviolet lithography process, the cell structures must be maintained at a distance from one another. In the inverse design process, the distance is maintained by limiting the optimized range of the location. However, this implementation can weaken the performance of the devices designed during transmission. To solve this problem, a self-adjusting inverse design method based on the adjoint variable method is developed. By introducing artificial potential field method, the location of one cell structure is modified only when the distances between this cell structure and other cell structures are smaller than a threshold. In this case, the range of the location can be expanded, and thus the performance of the designed devices can be improved. A wavelength demultiplexer with a channel spacing of 1.6 nm is designed to verify the performance of the proposed method. The experiment reveals that the transmission of the designed devices can be improved by 20%, and the self-adjusting inverse design process is 100 times faster than the inverse-design process based on the genetic algorithm.


Child acute malnutrition and mortality in populations affected by displacement in the Horn of Africa, 1997-2009.
Drought and conflict in the Horn of Africa are causing population displacement, increasing risks of child mortality and malnutrition. Humanitarian agencies are trying to mitigate the impact, with limited resources. Data from previous years may help guide decisions. Trends in different populations affected by displacement (1997-2009) were analyzed to investigate: (1) how elevated malnutrition and mortality were among displaced compared to host populations; (2) whether the mortality/malnutrition relation changed through time; and (3) how useful is malnutrition in identifying high mortality situations. Under-five mortality rates (usually from 90-day recall, as deaths/10,000/day: U5MR) and global acute malnutrition (wasting prevalences, < -2SDs of references plus edema: GAM) were extracted from reports of 1,175 surveys carried out between 1997-2009 in the Horn of Africa; these outcome indicators were analyzed by livelihood (pastoral, agricultural) and by displacement status (refugee/internally displaced, local resident/host population, mixed); associations between these indicators were examined, stratifying by status. Patterns of GAM and U5MR plotted over time by country and livelihood clarified trends and showed substantial correspondence. Over the period GAM was steady but U5MR generally fell by nearly half. Average U5MR was similar overall between displaced and local residents. GAM was double on average for pastoralists compared with agriculturalists (17% vs. 8%), but was not different between displaced and local populations. Agricultural populations showed increased U5MR when displaced, in contrast to pastoralist. U5MR rose sharply with increasing GAM, at different GAM thresholds depending on livelihood. Higher GAM cut-points for pastoralists than agriculturalists would better predict elevated U5MR (1/10,000/day) or emergency levels (2/10,000/day) in the Horn of Africa; cut-points of 20-25% GAM in pastoral populations and 10-15% GAM in agriculturalists are suggested. The GAM cut-points in current use do not vary by livelihood, and this needs to be changed, tailoring cut points to livelihood groups, to better identify priorities for intervention. This could help to prioritize limited resources in the current situation of food insecurity and save lives.


The preferential antagonism of pentylenetetrazole proconflict responses differentiates a class of anxiolytic benzodiazepines with potential antipanic action.
With the use of the shock-induced suppression of water drinking in thirsty rats (Vogel's conflict paradigm) and the pentylenetetrazole-enhanced shock-induced suppression of drinking (proconflict paradigm) as animal models to test anxiolytic and antipanic agents, it was possible to distinguish two major classes of benzodiazepines (BZDs) and congeners on the basis of their antiproconflict index (ratio of anticonflict/antiproconflict potencies). Thus, typical low potency BZDs and congeners (diazepam, midazolam, zolpidem, alpidem) with anxiolytic/hypnotic properties have a low antiproconflict index (close to 1), whereas typical high potency BZDs (clonazepam, alprazolam, bretazenil) with reported antipanic properties have an antiproconflict index approximately 10-fold higher. The anticonflict and antiproconflict actions of BZDs with low or high antiproconflict indices are blocked by flumazenil but are potentiated differentially by the gamma-aminobutyric acid (GABA) reuptake blocker 1-2-[bis(trifluoromethyl)-phenyl]-methoxyethyl-1,2,5,6-tetrahydro-3- pyridine-carboxylic acid. Protracted administration of antianxiety and antipanic antidepressant drugs that do not act on GABAA receptors, directly, resulted in anticonflict and antiproconflict effects. However, the efficacy of these drugs is clearly inferior (20-30%) to that of BZDs. These data suggest that specific GABAA receptor subtypes mediate the pharmacological action of BZDs possessing low and high antiproconflict indices.