Evaluating the legal impact of Sexual Assault Nurse Examiner programs: an empirically validated toolkit for practitioners.
There has been sustained interest in the academic literature and in policy circles regarding how Sexual Assault Nurse Examiner (SANE) programs may bolster sexual assault prosecution rates in their communities, in addition to the health care they provide to their patients. To build evaluation capacity among forensic nurses so that they can evaluate their own programs, a practitioner-oriented, step-by-step evaluation toolkit (the SANE Practitioner Evaluation Toolkit) that can be used by SANE-A and SANE-P programs, and their community partners, to examine sexual assault prosecution rates in their local jurisdictions was created and validated. This article describes the process of creating and empirically validating the toolkit and presents the toolkit itself and accompanying resources that are available to practitioners. This article also provides recommendations regarding program readiness to engage in evaluation activities, without compromising program sustainability and patient care.


Reoperative surgery for periampullary adenocarcinoma.
In recent years, the morbidity, mortality, and long-term survival of patients undergoing surgery for periampullary adenocarcinoma have improved. These changes have prompted us to reoperate on patients who have previously undergone pancreatobiliary surgery, many of whom were initially considered to have unresectable lesions. From 1979 to 1990, 38 patients with pancreatic and 17 patients with nonpancreatic periampullary adenocarcinoma underwent reexploratory surgery at The Johns Hopkins Hospital, Baltimore, Md. Thirty-three (60%) of these 55 patients had resection at the time of second laparotomy. Of the 46 patients undergoing reexploratory surgery with an intent to resect, the overall resection rate was 72% (33), 64% (16/25) for pancreatic and 100% for nonpancreatic periampullary adenocarcinoma. Postoperative complications occurred in 21 patients (38%), but only one patient (2%) died following surgery. Mean survivals from reexploratory surgery were 6.9 months for the 22 patients with pancreatic cancer undergoing palliative surgery, 20.5 months for the 16 patients with resectable pancreatic cancer, and 33.0 months for the 17 patients with nonpancreatic periampullary adenocarcinoma undergoing resection. We conclude that in carefully selected patients, reoperative surgery for periampullary cancer (1) provides a significant resection rate, (2) can be performed safely, and (3) offers a chance for long-term survival.


Two conformations of archaeal Ssh10b. The origin of its temperature-dependent interaction with DNA.
The DNA-binding protein Ssh10b from the hyperthermophilic archaeon Sulfolobus shibatae is a member of the Sac10b family, which has been speculated to be involved in the organization of the chromosomal DNA in Archaea. Ssh10b affects the DNA topology in a temperature dependent fashion that has not been reported for any other DNA-binding proteins. Heteronuclear NMR and site-directed mutagenesis were used to analyze the structural basis of the temperature-dependent Ssh10b-DNA interaction. The data analysis indicates that two forms of Ssh10b homodimers co-exist in solution, and the slow cis-trans isomerization of the Leu61-Pro62 peptide bond is the key factor responsible for the conformational heterogeneity of the Ssh10b homodimer. The T-form dimer, with the Leu61-Pro62 bond in the trans conformation, dominates at higher temperature, whereas population of the C-form dimer, with the bond in the cis conformation, increases on decreasing the temperature. The two forms of the Ssh10b dimer show the same DNA binding site but have different conformational features that are responsible for the temperature-dependent nature of the Ssh10b-DNA interaction.


Standardized determination of real-time PCR efficiency from a single reaction set-up.
We propose a computing method for the estimation of real-time PCR amplification efficiency. It is based on a statistic delimitation of the beginning of exponentially behaving observations in real-time PCR kinetics. PCR ground fluorescence phase, non-exponential and plateau phase were excluded from the calculation process by separate mathematical algorithms. We validated the method on experimental data on multiple targets obtained on the LightCycler platform. The developed method yields results of higher accuracy than the currently used method of serial dilutions for amplification efficiency estimation. The single reaction set-up estimation is sensitive to differences in starting concentrations of the target sequence in samples. Furthermore, it resists the subjective influence of researchers, and the estimation can therefore be fully instrumentalized.


Scoliosis in Herlyn-Werner-Wunderlich syndrome: a case report and literature review.
Herlyn-Werner-Wunderlich syndrome (HWWS) is a congenital Müllerian duct anomaly characterized by uterine didelphys, obstructed hemivagina, and ipsilateral renal agenesis. Little is reported about spinal deformity associated with this syndrome. This study presents a case of scoliosis occurring in the setting of HWWS and explores the possible association between the 2 diseases. A previously unreported scoliosis in HWWS is described. The patient is a 12-year-old Chinese female with scoliosis that underwent a posterior correction at thoracic 5-thoracic 12 (T5-T12) levels, using the Moss-SI (Johnson & Johnson, American) spinal system. At 24-month follow-up, the patient was clinically pain free and well balanced. Plain radiographs showed solid spine fusion with no loss of deformity correction. Six months after scoliosis correction surgery, the patient went to our clinics for the treatment of HWWS. She was performed a vaginal septum resection and detected with pyocolpos. Her follow-up was symptom free at the fourth postoperative month. The prevalence of scoliosis among patients with HWWS was 8.57% that is much higher than the incidence of congential scoliosis among general population (1/1000). To the best of our knowledge, this is the first report of HWWS with thoracic scoliosis. During surgery, surgeons and anesthesiologists must pay particular attention to the Müllerian duct anomaly and renal agenesis associated with HWWS. There is a potential association between congenital scoliosis and HWWS.


The influence of methylene blue on the spontaneous contractity of the non-pregnant human myometrium and on the myometrial response to DEA/NO.
Nitric oxide (NO) is a potent inhibitor of spontaneous contractions of the human non-pregnant myometrium; however, the precise mechanism by which NO causes the myometrial smooth muscles to relax remains unclear. The aim of this study was to determine the influence of methylene blue (MB) on myometrial contractions and the response of the myometrium to DEA/NO in vitro. Concentration-response curves to DEA/NO were constructed in the absence and presence of MB (5x10(-6), 10(-4) and 10(-2) mol/l) and 5x10(-3) mol/l cystamine. Cystamine did not counteract the DEA/NO-induced relaxation of the myometrial strips. MB itself, excluding the lowest concentration, caused noticeable changes in spontaneous activity. The changes involved a concentration-dependent increase in the frequency of contractions, and a decrease in their amplitude. In conclusion, our results confirm that NO relaxes the human myometrium via a cGMP-independent mechanism. The results obtained in the presence of MB may be misleading because of its complex influence on myometrial contractile activity.


Anti-IL-5 treatment reduces deposition of ECM proteins in the bronchial subepithelial basement membrane of mild atopic asthmatics.
Eosinophil-derived TGF-beta has been implicated in remodeling events in asthma. We hypothesized that reduction of bronchial mucosal eosinophils with anti-IL-5 would reduce markers of airway remodeling. Bronchial biopsies were obtained before and after three infusions of a humanized, anti-IL-5 monoclonal antibody (mepolizumab) in 24 atopic asthmatics in a randomized, double-blind, placebo-controlled study. The thickness and density of tenascin, lumican, and procollagen III in the reticular basement membrane (RBM) were quantified immunohistochemically by confocal microscopy. Expression of TGF-beta1 mRNA by airway eosinophils was assessed by in situ hybridization, and TGF-beta1 protein was measured in bronchoalveolar lavage (BAL) fluid by ELISA. At baseline, airway eosinophil infiltration and ECM protein deposition was increased in the RBM of asthmatics compared with nonasthmatic controls. Treating asthmatics with anti-IL-5 antibody, which specifically decreased airway eosinophil numbers, significantly reduced the expression of tenascin, lumican, and procollagen III in the bronchial mucosal RBM when compared with placebo. In addition, anti-IL-5 treatment was associated with a significant reduction in the numbers and percentage of airway eosinophils expressing mRNA for TGF-beta1 and the concentration of TGF-beta1 in BAL fluid. Therefore eosinophils may contribute to tissue remodeling processes in asthma by regulating the deposition of ECM proteins.


Eosinophils are key regulators of perivascular adipose tissue and vascular functionality.
Obesity impairs the relaxant capacity of adipose tissue surrounding the vasculature (PVAT) and has been implicated in resultant obesity-related hypertension and impaired glucose intolerance. Resident immune cells are thought to regulate adipocyte activity. We investigated the role of eosinophils in mediating normal PVAT function. Healthy PVAT elicits an anti-contractile effect, which was lost in mice deficient in eosinophils, mimicking the obese phenotype, and was restored upon eosinophil reconstitution. Ex vivo studies demonstrated that the loss of PVAT function was due to reduced bioavailability of adiponectin and adipocyte-derived nitric oxide, which was restored after eosinophil reconstitution. Mechanistic studies demonstrated that adiponectin and nitric oxide are released after activation of adipocyte-expressed β3 adrenoceptors by catecholamines, and identified eosinophils as a novel source of these mediators. We conclude that adipose tissue eosinophils play a key role in the regulation of normal PVAT anti-contractile function.


Salmonella typhimurium infection in total knee arthroplasty: A case report with review of literature.
Salmonella enterica serotype Typhimurium is a rare cause of prosthetic joint infection (PJI). The recognized predisposing risk factors for Salmonella septic arthritis include diabetes mellitus, renal failure, human immunodeficiency virus infection and chronic corticosteroid use. We describe a case of PJI of the knee in a 74-year-old lady who was on antitubercular treatment. The patient presented with discharging sinus and raised inflammatory markers. She was successfully treated by the removal of prosthesis and debridement followed by ciprofloxacin therapy for 6 weeks. This case report highlights the potential virulence of Salmonella in immunocompromised patient with a joint prosthesis. Continuous monitoring and close collaboration of microbiologists and orthopedicians helped obtain the resolution of infection in our patient.


Assessment of the relation between initial culprit vessel patency in acute ST-elevation myocardial infarction and endothelial function.
To assess whether better endothelial function increases the likelihood of patients with acute ST-elevation myocardial infarction (STEMI) having initially patent culprit vessels. Clinical data on the relation between endothelial function and culprit vessel patency in STEMI patients are scarce. In this prospective cohort study in 71 patients with STEMI, endothelial function was non-invasively assessed by use of the reactive hyperaemia peripheral artery tonometry (RH-PAT) method at four to six weeks after the primary percutaneous coronary intervention (PPCI). The RH-PAT index measured on average 1.90±0.58. In patients with patent culprit vessels before PPCI (n=33, 46.5%), endothelial function was significantly better than in patients with occluded vessels (n=38, 53.5%) (RH-PAT index 2.08±0.34 vs. 1.75±0.35; p<0.007). Compared to patients with normal endothelial function, the patients with severe endothelial dysfunction had a fivefold higher risk of presenting with an occluded culprit vessel (OR 5.1, 95% CI: 1.8-14.2). Logistic regression analysis revealed that this relation between endothelial function and vessel patency became even stronger after adjustment for potential confounders (adjusted OR 7.1, 95% CI: 2.1-23.6). In this series of patients with acute STEMI, better endothelial function was independently associated with a higher likelihood of presenting with an initially patent culprit vessel.


Phase II trial of tamoxifen in metastatic carcinoma of the prostate.
Fifty-one patients with advanced metastatic carcinoma of the prostate were treated with the antiestrogen tamoxifen. Thirty-eight of these patients were refractory to prior hormonal manipulation with estrogens and/or orchiectomy, and five (13%) achieved an objective response (partial regression or stable disease using the National Prostate Cancer Project criteria). Median survival of the responders was significantly longer than that of the nonresponders (P less than 0.05). An additional 13 patients who had not previously received hormonal manipulation were treated with tamoxifen; one partial response and three disease stabilizations were noted. Response was separately evaluated for 15 patients with objectively measurable lesions using standard Phase II response criteria. Only 1/15 (7%) partial response and 3/15 (20%) disease stabilizations were documented. Subjective benefit in terms of significant pain relief was noted in 17/50 (34%) of patients. Toxicity was mild, but two possible "tumor flares" were noted. These results do not support the continued investigation of tamoxifen in advanced carcinoma of the prostate.


Organizing pain control and rehabilitation service in a cancer centre.
A unique programme of rehabilitation and pain control has been created within the Istituto Nazionale per lo Studio e la Cura dei Tumori in Milan. Rehabilitation of mastectomy, amputee and ostomy patients has been very active and, particularly in this last group, a good rehabilitative outcome may be observed. Pain evaluation was one of the main problems. The treatment modalities have been refined in order to obtain the maximum pain relief with the minimum trauma possible. These treatments are based on a closely monitored analgesic drug administration and on percutaneous thermocontrolled lesions. The growing needs of the Cancer Institution have brought to about 30 000 the number of treatments performed by the Service during the last year. Nevertheless, enormous efforts are necessary to break the barrier of indifference to this problem that still persists in the oncologic field.


In situ ion exchange synthesis of strongly coupled Ag@AgCl/g-C₃N₄ porous nanosheets as plasmonic photocatalyst for highly efficient visible-light photocatalysis.
A novel efficient Ag@AgCl/g-C3N4 plasmonic photocatalyst was synthesized by a rational in situ ion exchange approach between exfoliated g-C3N4 nanosheets with porous 2D morphology and AgNO3. The as-prepared Ag@AgCl-9/g-C3N4 plasmonic photocatalyst exhibited excellent photocatalytic performance under visible light irradiation for rhodamine B degradation with a rate constant of 0.1954 min(-1), which is ∼41.6 and ∼16.8 times higher than those of the g-C3N4 (∼0.0047 min(-1)) and Ag/AgCl (∼0.0116 min(-1)), respectively. The degradation of methylene blue, methyl orange, and colorless phenol further confirmed the broad spectrum photocatalytic degradation abilities of Ag@AgCl-9/g-C3N4. These results suggested that an integration of the synergetic effect of suitable size plasmonic Ag@AgCl and strong coupling effect between the Ag@AgCl nanoparticles and the exfoliated porous g-C3N4 nanosheets was superior for visible-light-responsive and fast separation of photogenerated electron-hole pairs, thus significantly improving the photocatalytic efficiency. This work may provide a novel concept for the rational design of stable and high performance g-C3N4-based plasmonic photocatalysts for unique photochemical reaction.


The Arabidopsis thiamin-deficient mutant pale green1 lacks thiamin monophosphate phosphatase of the vitamin B1 biosynthesis pathway.
Thiamin diphosphate (TPP, vitamin B1 ) is an essential coenzyme present in all organisms. Animals obtain TPP from their diets, but plants synthesize TPPde novo. We isolated and characterized an Arabidopsis pale green1 (pale1) mutant that contained higher concentrations of thiamin monophosphate (TMP) and less thiamin and TPP than the wild type. Supplementation with thiamin, but not the thiazole and pyrimidine precursors, rescued the mutant phenotype, indicating that the pale1 mutant is a thiamin-deficient mutant. Map-based cloning and whole-genome sequencing revealed that the pale1 mutant has a mutation in At5g32470 encoding a TMP phosphatase of the TPP biosynthesis pathway. We further confirmed that the mutation of At5g32470 is responsible for the mutant phenotypes by complementing the pale1 mutant with constructs overexpressing full-length At5g32470. Most plant TPP biosynthetic enzymes are located in the chloroplasts and cytosol, but At5g32470-GFP localized to the mitochondrion of the root, hypocotyl, mesophyll and guard cells of the 35S:At5g32470-GFP complemented plants. The subcellular localization of a functional TMP phosphatase suggests that the complete vitamin B1 biosynthesis pathway may involve the chloroplasts, mitochondria and cytosol in plants. Analysis of PALE1 promoter-uidA activity revealed that PALE1 is mainly expressed in vascular tissues of Arabidopsis seedlings. Quantitative RT-PCR analysis of TPP biosynthesis genes and genes encoding the TPP-dependent enzymes pyruvate dehydrogenase, α-ketoglutarate dehydrogenase and transketolase revealed that the transcript levels of these genes were upregulated in the pale1 mutant. These results suggest that endogenous levels of TPP may affect the expression of genes involved in TPP biosynthesis and TPP-dependent enzymes.


[Clinical study on effect of chuankezhi injection in treating children with bronchial asthma].
To evaluate the efficacy and safety of chuankezhi injection to children with bronchial asthma. Sixty-eight children suffered from asthma and/or asthma complicated with allergic rhinitis were randomly divided into the treated group and the control group, who received treatment of chuankezhi injection and Ginkgo injection respectively. Clinical observation on daily-symptom scores, and lung functions as peak expiratory flow (PEF), and forced expiratory volume in one second (FEV1) were conducted. After treatment the median of symptomatic scores in the treated group was 6.0 (M25-M75: 4.9-21.5) and that in the control group was 10.0 (M25-M75: 6.19-27.5), showing significant difference between groups; significant improvement was shown in the treated group, in which the PEF variance rate was reduced to 4.3 +/- 5.1%, while in the control group, it was 5.9 +/- 6.7%, the difference between the two groups was significant. Similar result also showed in comparison of FEV1 rate. Chuankezhi is helpful in improving clinical symptoms, reducing PEF variance rate and enhancing lung function in children with bronchial asthma, so as to be benefit to the long-term stable alleviation of asthma.


An animal model demonstration of enhanced clearance of nontypable Haemophilus influenzae from the respiratory tract after antigen stimulation of gut-associated lymphoid tissue.
An animal model of the clearance of nontypable Haemophilus influenzae has been developed to determine both optimal immunization strategies for controlling colonization of the respiratory tract in patients with damaged airways and mechanisms of action of immune clearance. It was demonstrated that stimulation of gut-associated lymphoid tissue (GALT) (either by direct injection or by ingestion of antigen) followed by local administration of antigen into the bronchus was required to enhance clearance in this model. The primary effect of GALT immunization persisted for at least 6 wk; it was specific and could not be replaced by systemic immunization. Failure to stimulate locally in the bronchus was associated with protracted clearance. No clear correlation between local or systemic antibody and bacterial clearance was demonstrated; however, immunized rats were shown to have faster recruitment of phagocytic cells to the bronchial spaces, and these phagocytes had a higher activity state than cells harvested from nonimmunized animals. It is probable that bacterial clearance is accelerated in immunized animals due in part to factors mediating a change in the behavior of luminal phagocytes.


The heterogeneity of negative problem orientation in Chinese adolescents: A latent profile analysis.
Negative problem orientation (NPO) has become an essential construct for comprehending social problem-solving deficits. However, the heterogeneity of NPO has not yet been explored. With a sample of Chinese adolescents (N = 2,174), four latent profiles were identified as lower NPO, moderate NPO, self-inefficacy and negative outcome expectancy (SI&NOE), and dysfunctional NPO. Compared to the lower NPO and moderate NPO, a greater percentage of boys in the SI&NOE and dysfunctional NPO profiles than were girls. In addition, lower grades and younger adolescents tended to engage in the moderate NPO and SI&NOE profiles. The dysfunctional NPO reported higher levels of worry, depressive symptoms, anxiety, and stress, and worse sleep quality than the other profiles. The implications of these findings are discussed herein.


High-affinity no-carrier-added 99mTc-labeled chemotactic peptides for studies of inflammation in vivo.
Nalpha-for-Nle-Leu-Phe-Nle-Tyr-Lys, a chemotactic peptide that binds with high affinity to the chemoattractant receptor on granulocytes and monocytes, was labeled with 99mTc using the diaminedithiol (DADT) chelating system to coordinate the Tc. 99mTc labeling of the DADT-coupled peptide was accomplished in 84% overall yield (room temperature for 10 min) using [99mTc]glucoheptonate as the donor of prereduced Tc. HPLC analysis showed two major 99mTc-labeled peptide peaks, 99mTc-DADT-Pep-I and 99mTc-DADT-Pep-II, were obtained in a ratio of 1:0.85. Using an iodoacetamide-derivatized gel to remove unlabeled peptide from the 99mTc labeling mixtures, essentially no-carrier-added (nca) high-specific activity 99mTc-labeled chemotactic peptides were obtained. The 99Tc analogues of the peptides were synthesized (72% yield) in a similar fashion and correlated with 99mTc complexes I and II by HPLC. In vitro competitive receptor binding assays of the isolated 99Tc analogues were performed against the tritiated chemotactic peptide [3H]N-for-Met-Leu-Phe ([3H]fMLF) using isolated granulocytes. The 99Tc-derivatized peptides showed similar binding affinities to the chemoattractant receptor as the unlabeled Nalpha-for-Nle-Leu-Phe-Nle-Tyr-Lys. The nca 99mTc-labeled peptides gave high contrast images of experimental inflammation in rabbits without causing neutropenia. Thus, it is feasible to attach the Tc-DADT chelate to low-molecular weight receptor binding chemotactic peptides and retain substantial binding to the receptor. Chemotactic peptides labeled with 99mTc via the DADT ligand system have the potential for imaging focal sites of inflammation without toxic effects, an important consideration in the successful utilization of chemotactic peptide agonists.


Physical stature and intelligence as predictors of the timing of baby boomers' very first dates.
The paper analyses to what extent the timing of the very first date of American adolescents in the 1960s correlated with their physical stature and cognitive ability. Using an event history approach, it was found that intelligence and a weight slightly above the average raised the odds of arranging a first rendezvous, whereas the effect of height was gender-specific. Tallness improved chances among boys, whereas girls whose height was slightly below the average had the highest odds. This pattern was mirrored by the adolescents' evaluation of their own physical stature. The fact that the estimated associations are remarkably similar to those observed in the literature on fertility and wages suggests that these attributes are selection criteria in situations of social interaction already among adolescents.


Energy Intake Derived from an Energy Balance Equation, Validated Activity Monitors, and Dual X-Ray Absorptiometry Can Provide Acceptable Caloric Intake Data among Young Adults.
Assessments of energy intake (EI) are frequently affected by measurement error. Recently, a simple equation was developed and validated to estimate EI on the basis of the energy balance equation [EI = changed body energy stores + energy expenditure (EE)]. The purpose of this study was to compare multiple estimates of EI, including 2 calculated from the energy balance equation by using doubly labeled water (DLW) or activity monitors, in free-living adults. The body composition of participants (n = 195; mean age: 27.9 y; 46% women) was measured at the beginning and end of a 2-wk assessment period with the use of dual-energy X-ray absorptiometry. Resting metabolic rate (RMR) was calculated through indirect calorimetry. EE was assessed with the use of the DLW technique and an arm-based activity monitor [Sensewear Mini Armband (SWA); BodyMedia, Inc.]. Self-reported EI was calculated by using dietitian-administered 24-h dietary recalls. Two estimates of EI were calculated with the use of a validated equation: quantity of energy stores estimated from the changes in fat mass and fat-free mass occurring over the assessment period plus EE from either DLW or the SWA. To compare estimates of EI, reporting bias (estimated EI/EE from DLW × 100) and Goldberg ratios (estimated EI/RMR) were calculated. Mean ± SD EEs from DLW and SWA were 2731 ± 494 and 2729 ± 559 kcal/d, respectively. Self-reported EI was 2113 ± 638 kcal/d, EI derived from DLW was 2723 ± 469 kcal/d, and EI derived from the SWA was 2720 ± 730 kcal/d. Reporting biases for self-reported EI, DLW-derived EI, and SWA-derived EI are as follows: -21.5% ± 22.2%, -0.7% ± 18.5%, and 0.2% ± 20.8%, respectively. Goldberg cutoffs for self-reported EI, DLW EI, and SWA EI are as follows: 1.39 ± 0.39, 1.77 ± 0.38, and 1.77 ± 0.38 kcal/d, respectively. These results indicate that estimates of EI based on the energy balance equation can provide reasonable estimates of group mean EI in young adults. The findings suggest that, when EE derived from DLW is not feasible, an activity monitor that provides a valid estimate of EE can be substituted for EE from DLW.


[Usefulness of a Transbrachial Guide Sheath Specifically Designed for Direct Common Carotid Artery Cannulation in Common Carotid Artery Stenting].
The transfemoral approach is a common technique for carotid artery stenting(CAS)and involves the risk of distal embolism when a high-grade stenosis occurs at the common carotid artery(CCA). In this study, to minimize the risk of thromboembolic complications, we used a guide sheath that was specifically designed for direct cannulation to the CCA without the use of a guidewire or coaxial catheter. This study included 5 patients who underwent CAS of the CCA by using a guide sheath. Of these patients, 2 had right CCA stenosis and the other 3 had left CCA lesions. In all cases, direct cannulation to the target CCA by using the guide sheath was achieved, and CAS was performed safely. The median time from puncture to the end of the procedure was 61 min(interquartile range: 53-63). No periprocedural complications or cardiovascular events occurred within 30 days after CAS. CAS was safely and successfully performed for CCA stenosis by using the transbrachial guide sheath that was specifically designed for direct cannulation to the CCA.


Sentinel lymph nodes in endometrial cancer: is hysteroscopic injection valid?
We aimed to describe hysteroscopic peritumoral tracer injection for detecting sentinel lymph nodes (SLNs) in patients with endometrial cancer and to evaluate tolerance of the procedure, detection rate and location of SLNs. Five patients with early endometrial cancer underwent hysteroscopic radiotracer injection followed by lymphoscintigraphy, then by surgery with hysteroscopic peritumoral blue dye injection, and radioactivity measurement using an endoscopic handheld gamma probe. SLNs and other nodes were sent separately to the pathology laboratory. SLNs were evaluated by hematoxylin-eosin-saffron staining and, when negative, by immunohistochemistry. Tolerance of the injection by the patients was poor (mean visual analog scale score, 8/10). SLNs were detected in only two patients (external iliac and common iliac+paraaortic, respectively). Detection rates were 1/5 by radiotracer, 1/5 by dye, and 2/5 by the combined method. One SLN was involved in a patient whose other nodes were negative. In three patients no SLNs were found by radiotracer or blue dye. Of the 83 non sentinel nodes removed from these patients, none was involved. Hysteroscopic peritumoral injection may be more difficult than cervical injection and, in our experience, carries a lower SLN detection rate.


Perinatal mortality audit in a Zimbabwean district.
Perinatal deaths were systematically investigated over a 25-month period in a Zimbabwean district and were classified into pathological subgroups according to Wigglesworth. There were 319 perinatal deaths (a rate of 30.6 per 1000) including 83 normally formed macerated stillbirths, 28 cases of congenital malformation, 79 deaths associated with immaturity, 111 due to asphyxial conditions developing in labour and 18 specific problems. Syphilis infection was a contributory factor among 27 cases, hypertension in 39 cases, amniotic fluid infection in 31 cases and diabetes in 11 cases. An avoidable factor was detected among 242 cases (75.6%) involving the mother in 120 cases, the maternity centres in 28 and the hospital in 94. These data suggest that educational programmes should try to convince all the pregnant women to attend an antenatal clinic at least once. A further perinatal mortality reduction might be obtained through treatment for syphilis, hypertension, diabetes and amniotic fluid infection, closer monitoring of the fetal condition during labour and skillful management of dystocia.


Microfluidic devices for the analysis of apoptosis.
Apoptosis is the outcome of a metabolic cascade that results in cell death in a controlled manner. Due to its important role in maintaining balance in organisms, in mechanisms of diseases, and tissue homeostasis, apoptosis is of great interest in the emerging fields of systems biology. Research into cell death regulation and efforts to model apoptosis processes have become powerful drivers for new technologies to acquire ever more comprehensive information from cells and cell populations. The microfluidic technology promises to integrate and miniaturize many bioanalytical processes, which offers an alternative platform for the analysis of apoptosis. This review aims to highlight the recent developments of microfluidic devices in measuring the hallmarks as well as the dynamic process of cellular apoptosis. The potential capability and an outlook of microfluidic devices for the study of apoptosis are addressed.


Reduction of Pressure-Related Complications With an Improved Method of Securing Endotracheal Tubes in Burn Patients With Facial Burns.
Facial burns are extremely common in the burn population, as is the need for endotracheal intubation. However, securing the endotracheal tube in these patients can be difficult. Our institution's historically preferred method of securing tubes with twill tape was effective but had a high rate of device-related pressure ulcers. The introduction of new silicone pressure-reducing strips for use in conjunction with twill tape was effective in reducing the incidence of pressure ulcers in this patient population from 21% to 5% (P = .032).


Extramedullary guides versus portable, accelerometer-based navigation for tibial alignment in total knee arthroplasty: a randomized, controlled trial: winner of the 2013 HAP PAUL award.
Extramedullary (EM) tibial alignment guides have demonstrated a limited degree of accuracy in total knee arthroplasty (TKA). The purpose of this study was to compare the tibial component alignment obtained using a portable, accelerometer-based navigation device versus EM alignment guides. One hundred patients were enrolled in this prospective, randomized controlled study to receive a TKA using either the navigation device, or an EM guide. Standing AP hip-to-ankle and lateral knee-to-ankle radiographs were obtained at the first, postoperative visit. 95.7% of tibial components in the navigation cohort were within 2° of perpendicular to the tibial mechanical axis, versus 68.1% in the EM cohort (P<0.001). 95.0% of tibial components in the navigation cohort were within 2° of a 3° posterior slope, versus 72.1% in the EM cohort (P=0.007). A portable, accelerometer-based navigation device decreases outliers in tibial component alignment compared to conventional, EM alignment guides in TKA.


Crystal structure of the prothrombinase complex from the venom of Pseudonaja textilis.
The prothrombinase complex, composed of the protease factor (f)Xa and cofactor fVa, efficiently converts prothrombin to thrombin by specific sequential cleavage at 2 sites. How the complex assembles and its mechanism of prothrombin processing are of central importance to human health and disease, because insufficient thrombin generation is the root cause of hemophilia, and excessive thrombin production results in thrombosis. Efforts to determine the crystal structure of the prothrombinase complex have been thwarted by the dependence of complex formation on phospholipid membrane association. Pseutarin C is an intrinsically stable prothrombinase complex preassembled in the venom gland of the Australian Eastern Brown Snake (Pseudonaja textilis). Here we report the crystal structures of the fX-fV complex and of activated fXa from P textilis venom and the derived model of active pseutarin C. Structural analysis supports a single substrate binding channel on fVa, to which prothrombin and the intermediate meizothrombin bind in 2 different orientations, providing insight into the architecture and mechanism of the prothrombinase complex-the molecular engine of blood coagulation.


The expression of NOV and WT1 in renal cell carcinoma: a quantitative reverse transcriptase-polymerase chain reaction analysis.
The NOV gene was first identified as an aberrantly expressed gene in avian nephroblastomas induced by myeloblastosis-associated virus. Its expression has been shown to be altered in avian and human nephroblastomas, and to be a target of WT1 regulation. We analyzed the mRNA level of human NOV together with the mRNA level of WT1 in sporadic renal cell carcinoma (RCC). We quantified NOV and WT1 mRNA levels in surgical specimens from 57 patients with RCC using quantitative real-time polymerase chain reaction analysis. NOV mRNA levels decreased significantly in RCC compared with normal kidney tissue (p <0.001). The NOV mRNA level was higher in papillary than in clear cell RCCs (p = 0.040) and higher in G1 than G2 and 3 tumors (p = 0.01). WT1 was down-regulated in RCCs. No significant relationship was found for NOV and WT1 mRNA levels in our study. To our knowledge this is the first study to investigate the expression level of the NOV gene in a panel of human RCC tissues together with paired normal renal tissue. Our data indicate that NOV is associated with carcinogenesis and the progression of RCC, and the NOV expression level is different in papillary-type and clear cell-type RCC. There is a possibility that the regulation of NOV expression is different from the pathway regulated by WT1.


A New Adaptive Gamma Correction Based Algorithm Using DWT-SVD for Non-Contrast CT Image Enhancement.
The performances of medical image processing techniques, in particular CT scans, are usually affected by poor contrast quality introduced by some medical imaging devices. This suggests the use of contrast enhancement methods as a solution to adjust the intensity distribution of the dark image. In this paper, an advanced adaptive and simple algorithm for dark medical image enhancement is proposed. This approach is principally based on adaptive gamma correction using discrete wavelet transform with singular-value decomposition (DWT-SVD). In a first step, the technique decomposes the input medical image into four frequency sub-bands by using DWT and then estimates the singular-value matrix of the low-low (LL) sub-band image. In a second step, an enhanced LL component is generated using an adequate correction factor and inverse singular value decomposition (SVD). In a third step, for an additional improvement of LL component, obtained LL sub-band image from SVD enhancement stage is classified into two main classes (low contrast and moderate contrast classes) based on their statistical information and therefore processed using an adaptive dynamic gamma correction function. In fact, an adaptive gamma correction factor is calculated for each image according to its class. Finally, the obtained LL sub-band image undergoes inverse DWT together with the unprocessed low-high (LH), high-low (HL), and high-high (HH) sub-bands for enhanced image generation. Different types of non-contrast CT medical images are considered for performance evaluation of the proposed contrast enhancement algorithm based on adaptive gamma correction using DWT-SVD (DWT-SVD-AGC). Results show that our proposed algorithm performs better than other state-of-the-art techniques.


Return of research results from pharmacogenomic versus disease susceptibility studies: what's drugs got to do with it?
One of the most controversial ethical issues in genomics research is the return of individual research results to research subjects. As new technologies, including whole-genome sequencing, provide an increased opportunity for researchers to find clinically relevant research results, the questions related to if, when and how individual research results should be returned become more central to the ethical conduct of genomic research. In the absence of federal guidance on this issue, many groups and individuals have developed recommendations and suggestions to address these questions. Most of these recommendations have focused on the return of individual results from disease susceptibility studies. However, in addition to predicting the development of disease, genomic research also includes predicting an individual's response to drugs, especially the risk of developing adverse events. This article evaluates and compares the return of individual research results from disease susceptibility studies versus pharmacogenomic studies.


Evaluation of the New York City Green Carts program.
Access to fresh fruits and vegetables is a concern, particularly among low-income populations. Mobile vending is one strategy to expand produce availability and access to increase consumption. In 2008, New York City launched a mobile vending initiative, Green Carts. We report on the evaluation. Three waves of cross-sectional observational surveys of produce availability, variety, and quality were conducted during the summers of 2008, 2009, and 2011 in a stratified random sample of stores and carts comparing establishments in Green Cart neighborhoods (n = 13) with comparison neighborhoods (n = 3). Bivariate analyses for availability, variety, and quality comparing Green Cart and comparison neighborhoods were presented across years, and logistic and negative binomial regressions were used to test whether fruit and vegetable availability, variety, and quality increased in Green Cart compared with comparison neighborhoods, adjusting for clustering and neighborhood demographics. Establishments selling fruits and vegetables in Green Cart neighborhoods increased between 2008 and 2011 (50% to 69%, p <0.0001); there was no comparable increase in comparison neighborhoods. Establishments selling more than 10 fruits and vegetables types increased from 31% to 38% (p = 0.0414) in Green Cart neighborhoods; there was no change in comparison neighborhoods. Produce quality was high among comparison establishments, with 95% and 94% meeting the quality threshold in 2008 and 2011, while declining in Green Cart neighborhood establishments from 96% to 88% (p < 0.0001). Sustained produce availability was found in Green Cart neighborhoods between 2008-2011. Green Carts are one strategy contributing to improving produce access among New Yorkers.


[The effect of maternal exercise on the fetal heart rate].
The effect of maternal exercise (the two-step test of Master) on the fetus was studied in 28 pregnant women. These subjects consisted of 5 cardiac cases, 5 cases with IUGR, 5 cases with preeclampsia and 13 normal pregnant women. Overt deceleration of the FHR was found after exercise only in 3 cardiac cases whose FHR tracings had been normal before. Slight changes such as a small rise or a small fall in FHR after exercise were seen in 4 of 7 cases who had shown decelerations in FHR before, and in a normal case. Fetal tachycardia appeared in 2 normal cases immediately before exercise; in one case the FHR tracing appeared not to be influenced by exercise; in the other case it rested at the normal baseline level after exercise. In most cases the amplitude of baseline variability remained unchanged or decreased after exercise. The severity of deceleration before exercise did not correlate well with the results of the exercise test. The exercise test did not reveal any new patients who might have placental insufficiency, suggesting that this procedure may not be warranted for evaluating a patient with placental insufficiency. Fetal response to exercise, however, may disclose a maternal hemodynamic problem. The exercise test with FHR monitoring should be recommended to a patient with heart disease.


Aseptic laboratory techniques: volume transfers with serological pipettes and micropipettors.
Microorganisms are everywhere - in the air, soil, and human body as well as on inanimate surfaces like laboratory benches and computer keyboards. The ubiquity of microbes creates a copious supply of potential contaminants in a laboratory. To ensure experimental success, the number of contaminants on equipment and work surfaces must be minimized. Common among many experiments in microbiology are techniques involving the measurement and transfer of cultures containing bacterial cells or viral particles. To do so without contacting non-sterile surfaces or contaminating sterile media requires (1) preparing a sterile workspace, (2) precisely setting and accurately reading instruments for aseptic transfer of liquids, and (3) properly manipulating instruments, cultures flasks, bottles and tubes within a sterile field. Learning these procedures calls for training and practice. At first, actions should be slow, deliberate, and controlled with the goal being for aseptic technique to become second nature when working at the bench. Here we present the steps for measuring volumes using serological pipettes and micropipettors within a sterile field created by a Bunsen burner. Volumes range from microliters (μl) to milliliters (ml) depending on the instrument used. Liquids commonly transferred include sterile broth or chemical solutions as well as bacterial cultures and phage stocks. By following these procedures, students should be able to: ·Work within the sterile field created by the Bunsen burner flame. ·Use serological pipettes without compromising instrument sterility. ·Aspirate liquids with serological pipettes, precisely reading calibrated volumes by aligning the meniscus formed by the liquid to the graduation marks on the pipette. ·Keep culture bottles, flasks, tubes and their respective caps sterile during liquid transfers. ·Identify different applications for plastic versus glass serological pipettes. ·State accuracy limitations for micropipettors. ·Precisely and accurately set volumes on micropipettors. ·Know how to properly use the first and second stop on a micropipettor to aspirate and transfer correct volumes.


Cholesteryl esters are bound by a peptide-initiation and a peptide-elongation factor.
Significantly higher quantities of cholesteryl 14-methylhexadecanoate than of cholesteryl laurate and cholesteryl palmitate are bound by a homogeneous peptide-initiation factor and purified peptide-elongation factor 1. Cholesteryl 14-methylhexadecanoate may function as a specific allosteric modifier changing the conformation of protein synthesis factors and thus modulating the activity of their binding sites.


Long-term response to zonisamide in patients with West syndrome.
The long-term effectiveness of zonisamide (ZNS) was evaluated in 11 patients with West syndrome (7 symptomatic) who had cessation of spasms with ZNS monotherapy. During the follow-up period (24 to 79 months, mean = 53 months), this response was maintained in 7 patients (3 symptomatic, relapse rate = 36%), including 2 children in whom ZNS was successfully discontinued. No serious adverse reactions were noted. ZNS may be both effective and well tolerated for the treatment of West syndrome.


Metabolic profiling to identify potential serum biomarkers for gastric ulceration induced by nonsteroid anti-inflammatory drugs.
Nonsteroid anti-inflammatory drugs (NSAIDs) are among the most frequently prescribed drugs currently available. The most frequently reported serious side effects associated with NSAIDs are gastric mucosal ulceration and gastric hemorrhage. Presently, these side effects are only detectable by endoscopy, however, and no biomarkers have yet been identified. The ability to identify serum biomarkers would likely improve the safety of NSAID use. In this study we performed capillary electrophoresis-mass spectrometry (CE-MS)-based metabolomic profiling in stomach extract and serum from rats administered NSAIDs. Results showed drug-induced decreases in levels of citrate, cis-aconitate, succinate, 3-hydroxy butanoic acid, o-acetyl carnitine, proline, and hydroxyproline. We consider that these changes are due to NSAID-induced depression of mitochondrial function and activation of collagenase by lesions in the stomach. In addition, four of these changes in metabolite levels in the stomach were significantly correlated with changes in the serum. While further study is needed to clarify the mechanism of change in the level of these biomarkers, limitation of indications, and extrapolation to humans, these new serum biomarker candidates of gastric injury may be useful in the monitoring of NSAID-induced tissue damage.


Role of myometrial activity in sperm transport through the genital tract and in fertilization in sows.
The effects of stimulation and suppression of uterine contractility at about the time of insemination on sperm distribution and fertilization in multiparous sows are described. For assessment of fertilization, sows were inseminated about 28 h before (synchronized) ovulation and killed at day 5 after ovulation (n = 53). For assessment of sperm distribution, sows were inseminated about 20 h before expected ovulation and were killed 12 h later (n = 26). At 10 min before insemination, sows received an intrauterine infusion of one of three solutions: (i) saline (control); (ii) 0.60 mg clenbuterol hydrochloride to suppress contractility; or (iii) 1 mg cloprostenol to stimulate contractility. Both clenbuterol and cloprostenol reduced median fertilization rate (P < 0.05) and median number of accessory sperm cells (P < 0.05). Distribution of sperm cells was also affected by treatments. Clenbuterol increased, and cloprostenol decreased, the number of sperm cells (P < 0.05) in the proximal 20 cm of the uterine horn and in the uterotubal junction. In addition, clenbuterol tended to increase and cloprostenol tended to decrease the number of sperm cells in the isthmus, although these effects were not significant. However, relative to the number of sperm cells in the uterus, clenbuterol treatment reduced the number of sperm cells in the uterotubal junction and oviduct, in contrast to cloprostenol. Cloprostenol increased the reflux of semen during insemination. It is hypothesized that suppression of uterine contractility increases transuterine transport time, reducing the ability of sperm cells to enter the uterotubal junction and the oviduct. Stimulation of uterine contractility above a certain level probably increases reflux and impedes transuterine transport of sufficient numbers of sperm cells.


Resection and simultaneous reconstruction of the infrarenal aorta and inferior vena cava (case report).
A non-standard surgicall approach in malignant retroperitoneal tumor treatment was used, which includes simultaneous resection and reconstruction of the infrarenal segment of aorta and inferior vena cava. The total vascular recunstrustion time was 40 minutes and 15 minutes out of total time was arterial ischemia. The postoperative period was complicated by the right urethral fistula and the limited fluid concentration in the surgical area. On day 25th of the post-operative period patient discharged from the hospital. We believe that such a tactic can be safe and effective in case of meticulous patients selection and the multidisciplinary and multi-team approaches application.


Cd, Cr, Cu, Pb, and Zn concentrations in Ulva lactuca, Codium fragile, Jania rubens, and Dictyota dichotoma from Rabta Bay, Jijel (Algeria).
Concentrations of Cd, Cr, Cu, Pb, and Zn were determined in algae samples collected from the Rabta Bay in the Mediterranean Sea, Algeria. The levels of heavy metals in the macroalgae, Ulva lactuca, Codium fragile (green algae), Jania rubens (red algae), and Dictyota dichotoma (brown algae) recorded high concentrations except for Cd. Moreover, Zn was the most predominant metal in the seaweeds. The obtained HM contents indicate that different species demonstrate various degree of metal accumulation and the obtained higher values in site 1 of the studied zone can be attributed to the discharge influence of two rivers (Mouttas and Larayeche Rivers), entering the Mediterranean Sea and local pollutant emissions. The abundance of heavy metal concentrations in the macroalgae samples was found in the order below: Zn > Cu > Pb > Cr > Cd from the studied zone. The highest amounts of heavy metals in algae samples were Cd, Cu, and Pb in brown algae, and Cr and Zn in green and brown algae from the studied zone (Rabta Bay).


Isolation and structural elucidation of chemical constituents from the fruits of Morinda citrifolia Linn.
The fruits of Morinda citrifolia, Linn. afforded a new constituent, morinaphthalenone (1), and three known constituents, scopoletin (2), 1, 3-dimethoxy-anthraquinone (3) and 1, 2-dihydroxy-anthraquinone (4). The structures of these isolated compounds were determined by spectroscopic methods, including 1D- and 2D-NMR (COSY-45, HMQC, HMBC) techniques, as well as by comparison with published values.


Dynamic modeling of cis-regulatory circuits and gene expression prediction via cross-gene identification.
Gene expression programs depend on recognition of cis elements in promoter region of target genes by transcription factors (TFs), but how TFs regulate gene expression via recognition of cis elements is still not clear. To study this issue, we define the cis-regulatory circuit of a gene as a system that consists of its cis elements and the interactions among their recognizing TFs and develop a dynamic model to study the functional architecture and dynamics of the circuit. This is in contrast to traditional approaches where a cis-regulatory circuit is constructed by a mutagenesis or motif-deletion scheme. We estimate the regulatory functions of cis-regulatory circuits using microarray data. A novel cross-gene identification scheme is proposed to infer how multiple TFs coordinate to regulate gene transcription in the yeast cell cycle and to uncover hidden regulatory functions of a cis-regulatory circuit. Some advantages of this approach over most current methods are that it is based on data obtained from intact cis-regulatory circuits and that a dynamic model can quantitatively characterize the regulatory function of each TF and the interactions among the TFs. Our method may also be applicable to other genes if their expression profiles have been examined for a sufficiently long time. In this study, we have developed a dynamic model to reconstruct cis-regulatory circuits and a cross-gene identification scheme to estimate the regulatory functions of the TFs that control the regulation of the genes under study. We have applied this method to cell cycle genes because the available expression profiles for these genes are long enough. Our method not only can quantify the regulatory strengths and synergy of the TFs but also can predict the expression profile of any gene having a subset of the cis elements studied.


Ontogeny of infantile oral reflexes and emerging chewing.
The ontogeny of rooting, lip, lateral tongue, mouth opening, biting, and Babkin reflexes and emerging chewing behaviors were observed in 2 normal infants from 1 week to 35 weeks of age. These behaviors were videotaped at 9 monthly test sessions, and their movement patterns analyzed during slow-motion playback. The reflex responses were elicited in both infants through 35 weeks of age. They consisted of those characteristic movements described in the literature plus additional movements that elaborated the characteristic pattern. The complexity of the reflexes and the quality of movement changed with age. Components of chewing, which emerged sequentially from 1 week of age, were cyclical mandibular elevation and depression, lateral tongue movements, transport of the bolus from lateral to medial oral position, mandible retrusion, lateralization and protrusion movements in association with mandibular elevation and depression, increase in speed of rhythmical chewing movements to the mature speed of 1 cycle per second, and mastication. Chewing and oral reflexes contained similar movements but differed in the relative frequency of certain characteristic movements and in the stimulus response relationship.


The house advancement anoplasty for treatment of anal disorders.
Anal advancement flaps treat a variety of anal disorders. In recent years the "House" advancement flap has been used with good success, the term referring to the shape of the flap used. It is simple with few shortcomings. We reviewed a single centre's experience of this procedure. All patients who underwent a house advancement flap between 1996 and 2001 were identified. The case notes were examined and data collected on indication for surgery, complications, follow-up and outcome. Thirteen consecutive patients were identified, mean age of 44 years. Indications for surgery were chronic anal fissure, fistulous disease and post surgical deformity or stenosis of the anal canal. Median follow-up was 37 months (25-84). In 9 patients the flaps healed within 4 weeks. In the remaining 4 patients the flaps healed by secondary intention over a median of 14 weeks (8-20). Postoperative complications occurred in 5 patients (3 donor site separation and 2 flap retraction). Two patients developed recurrence of their original disorder. Eleven patients have relief of pre-operative symptoms with fully healed flaps. This procedure is simple, easy to construct and robust. It can be performed for a variety of anal disorders with satisfactory results and few complications and should be in every Coloproctologist's armamentarium.


Physicochemical investigation of pulsed laser deposited carbonated hydroxyapatite films on titanium.
Carbonated hydroxyapatite (CHA)-coated titanium can find wide applications as bone substitute implant in bone and dental surgery and orthopedics, promoting osseointegration with a host bone and ensuring biocompatibility and bioactivity. In this work, carbonated hydroxyapatite films were prepared on titanium substrates by pulsed laser deposition at different substrate temperatures ranging from 30 to 750 degrees C. The properties of films were investigated by scanning electron microscopy, atomic force microscopy, energy-dispersive X-ray diffraction, and Fourier transform infrared spectroscopy. Vickers microhardness measurements of the composite film-substrate systems were performed, and the intrinsic hardness of films was separated from the composite hardness using a "law-of-mixtures" approach and taking into account the indentation size effect. The prepared CHA films are nearly stoichiometric with a Ca/P atomic ratio of 2.0-2.2. The films deposited in the 30-500 degrees C temperature range are about 9 microm thick, amorphous, having an average roughness of 60 nm. At higher temperature, 700-750 degrees C, the films are about 4 microm thick, show a finer surface morphology and an average roughness of 20 nm. At 750 degrees C the films are amorphous, whereas at 700 degrees C they are crystalline and textured along the (202) and (212) directions. The intrinsic hardness of the films increased with an increase in substrate temperature, being as low as 5 GPa at 30 degrees C and reaching a high value of 28 GPa at 700 degrees C. The rich information gained by the joint use of the mentioned techniques allowed a comprehensive characterization of this system.


Conducting a surveillance problem analysis on poor feedback from Reference Laboratory, Liberia, February 2016.
The laboratory plays a major role in surveillance, including confirming the start and end of an outbreak. Knowing the causative agent for an outbreak informs the development of response strategies and management plans for a public health event. However, issues and challenges may arise that limit the effectiveness or efficiency of laboratories in surveillance. This case study applies a systematic approach to analyse gaps in laboratory surveillance, thereby improving the ability to mitigate these gaps. Although this case study concentrates on factors resulting in poor feedback from the laboratory, practise of this general approach to problem analysis will confer skills required in analysing most public health issues. This case study was developed based on a report submitted by the district surveillance officer in Grand Bassa County, Liberia, as a resident of the Liberian Frontline Field Epidemiology Training Program in 2016. This case study will serve as a training tool to reinforce lectures on surveillance problem analysis using the fishbone approach. It is designed for public health training in a classroom setting and can be completed within 2 hours 30 minutes.


T cell tolerance to self antigens in New Zealand hybrid mice with lupus-like disease.
We determined if self-reactive T cells are able to escape thymic tolerance in autoimmune New Zealand mice. T cells utilizing V beta 17a and V beta 11 encoded receptors have been shown to be clonally eliminated in nonautoimmune mice expressing I-E because of their potential self-reactivity. Similarly, V beta 8.1+ and V beta 6+ T cells are tolerized in the thymus of nonautoimmune mice that express Mls-1a. These T cell subsets were quantitated in the lymph nodes and spleens of (NZB x NZW)F1 and (NZB x SWR)F1 mice. In young mice from both autoimmune strains, deletion was similar to that observed in control animals matched for I-Ed and Mls-1a expression. Furthermore, older female autoimmune mice with elevated levels of IgG antinuclear antibodies and severe lupus-like renal disease did not demonstrate evidence of a global tolerance defect. We also found that the levels of residual V beta 17a+ cells in MHC-matched control F1 strains were further reduced by up to 80% in autoimmune (NZB x SWR)F1 mice. The greater in vivo elimination corresponded to an enhanced ability of NZB spleen cells, compared with other H-2d spleen cells, to stimulate V beta 17a+ hybridomas in vitro. The increased stimulation in culture could not be attributed to quantitative differences in I-E Ag expression. The results suggest that autoreactive T cells have been eliminated in these autoimmune mice by normal mechanisms of self-tolerance. Furthermore, the data demonstrate the existence of an NZB minor locus not present in other H-2d strains that influences T cell repertoire and enhances stimulation of T cells potentially reactive to self class II MHC Ag.


Impact of silicone and metal port-a-cath implants on superficial hyperthermia treatment quality.
A port-a-cath is a device implanted under the skin for continuous drug administration. It is composed of a catheter and a silicone or metal reservoir. A simulation study was done to assess the impact of a port-a-cath implant on the quality of superficial hyperthermia treatments applied using the Lucite cone applicator (LCA). Specific absorption rate (SAR) and temperature distributions were predicted using SEMCAD-X (version 14.8). We simulated 72 arrangements: two LCA-implant set-ups (central port-a-cath or at an edge below the LCA footprint), six translations of the LCA per set-up, two LCA orientations (Parallel or perpendicular electric field direction) per set-up, two implant materials (silicon or metal) and a control without port-a-cath. Treatment quality was quantified by the average 1 g SAR coverage (CV25%), i.e. volume within the 25% iso-SAR surface, and the volume within the 40 °C iso-temperature surface (CV40 °C). CV25% reduced with a silicon port-a-cath located below the LCA footprint. In the worst scenario, only 64% of the CV25% of the control set-up was achieved. For a metal port-a-cath below the LCA aperture, dramatic reductions of CV25% were predicted: worst scenario down to 12.1% of the control CV25%. For the CV40 °C the worst case values were 74.5% and 6.5%, for silicon and metal implants, respectively. A silicone port-a-cath below the LCA had a smaller effect on treatment quality than a metal implant. Based on this study we recommend verifying heating quality by 3D patient-specific treatment planning when a port-a-cath is located below the footprint of the applicator.


Restoring Food Systems with Nutritious Native Plants: Experiences from the African Drylands.
Twenty-seven African countries have committed to restore more than 100 million hectares of degraded land by 2030 as part of the African Forest Landscape Restoration Initiative (AFR100). In addition, for the same period of time, the African-led Great Green Wall initiative seeks to restore 100 million hectares of degraded agro-sylvo-pastoral lands in the Sahel. The current UN Decade on Ecosystem Restoration (2021-2030) moreover marks an unprecedented opportunity to shape future landscapes, and forge more biodiverse and nutritious food systems. Yet most large-scale restoration actions continue to be largely isolated from socioeconomic challenges facing dryland communities, not least food security and acute malnutrition. Such isolations contribute to low restoration successes and outcomes in Africa's drylands. At the same time, international interventions aimed at improving acute malnutrition in the drylands have not adequately considered the agriculture-nutrition linkages, particularly "pre-farm gate"-including consumption pathways which optimize the use of native plant diversity. This article identifies priority action areas emerging from experiences over 5 years of restoration activities carried out in the Sahel through Food and Agriculture Organization's (FAO) Action Against Desertification Programme supporting the implementation of Africa's Great Green Wall. These actions aim to inform development and humanitarian interventions on the ground to render restoration interventions nutrition-sensitive and hence more effective in practice. Recognizing the symbiotic relationship between landscapes and livelihoods, FAO developed a blueprint for large-scale restoration that combines biophysical and socioeconomic aspects for the benefit of rural communities. The approach builds climate and nutritional resilience into its restoration interventions as a preventative approach to reverse land degradation and ultimately improve livelihoods, food security, and nutrition. FAO's experience demonstrated that what is planted and when has the potential to not only significantly improve biodiversity and reverse land degradation, but also positively influence nutrition outcomes. Future interventions in the drylands must involve joint efforts between nutritionists and natural resource managem prove both human and planetary health.


Genetic diversity and population structure of Culex modestus across Europe: does recent appearance in the United Kingdom reveal a tendency for geographical spread?
In mainland Europe, the mosquito species Culex modestus Ficalbi (1890) is a bridge vector for West Nile virus (WNV) from its natural bird-mosquito cycle to mammals. The present study assessed the genetic diversity of Cx. modestus, as well as related Culex species, using the mitochondrial COI DNA barcoding region and compared this with the population structure across Europe. A haplotype network was mapped to determine genealogical relationships among specimens. The intraspecific genetic diversity within individual Culex species was below 2%, whereas the interspecific genetic divergence varied from 2.99% to 13.74%. In total, 76 haplotypes were identified among 198 sequences. A median-joining network determined from 198 COI sequences identified two major lineages that were separated by at least four mutation steps. A high level of intraspecific genetic diversity was not detected in Cx. modestus in samples submitted from different European populations, which indicates that morphologically identified specimens represent a single species and not a species complex. Therefore, it is deduced that different populations of Cx. modestus will show a similar potential to transmit WNV, lending support to concerns that the population present in southeast England represents a risk of transmission to humans.


Cpf1 is a single RNA-guided endonuclease of a class 2 CRISPR-Cas system.
The microbial adaptive immune system CRISPR mediates defense against foreign genetic elements through two classes of RNA-guided nuclease effectors. Class 1 effectors utilize multi-protein complexes, whereas class 2 effectors rely on single-component effector proteins such as the well-characterized Cas9. Here, we report characterization of Cpf1, a putative class 2 CRISPR effector. We demonstrate that Cpf1 mediates robust DNA interference with features distinct from Cas9. Cpf1 is a single RNA-guided endonuclease lacking tracrRNA, and it utilizes a T-rich protospacer-adjacent motif. Moreover, Cpf1 cleaves DNA via a staggered DNA double-stranded break. Out of 16 Cpf1-family proteins, we identified two candidate enzymes from Acidaminococcus and Lachnospiraceae, with efficient genome-editing activity in human cells. Identifying this mechanism of interference broadens our understanding of CRISPR-Cas systems and advances their genome editing applications.


Kinetics of Melanin Polymerization during Enzymatic and Nonenzymatic Oxidation.
Melanin is an abundant biopigment in the animal kingdom, but its structure remains poorly understood. This is a substantial impediment to understanding the mechanistic origin of its observed functions. Proposed models of melanin structure include aggregates of both linear and macrocyclic units and noncovalently held monomers. Both models are broadly in agreement with current experimental data. To constrain the structural and kinetic models of melanin, experimental data of high resolution with chemical specificity accompanied by atomistic modeling are required. We have addressed this by obtaining electronic absorption, infrared, and ultraviolet resonance Raman (RR) spectra of melanin at several wavelengths of excitation that are sensitive to small changes in structure. From these experiments, we observed kinetics of the formation of different species en route to melanin polymerization. Exclusive chemical signatures of monomer 3,4-dihydroxyphenylalanine (dopa), intermediate dopachrome (DC), and early-time polymer are established through their vibrational bands at 1292, 1670, and 1616 cm-1 respectively. Direct evidence of reduced heterogeneity of melanin oligomers in tyrosinase-induced formation is provided from experimental measurements of vibrational bandwidths. Models made with density functional theory show that the linear homopolymeric structures of 5,6-dihydroxyindole can account for experimentally observed wavenumbers and broad bandwidth in Raman spectra of dopa-melanin. We capture resonance Raman (RR) signature of DC, the intermediate stabilized by the enzyme tyrosinase, for the first time in an enzyme-assisted melanization reaction using 488 nm excitation wavelength and propose that this wavelength can be used to probe reaction intermediates of melanin formation in solution.


Perceptions and behaviors related to noncommunicable diseases in Palau: a qualitative study.
The increasing burden of noncommunicable diseases (NCDs) is a major public health concern in Palau. This study aims to identify social and psychological factors related to NCDs among Palauan people using a qualitative approach. We conducted eight key informant interviews and eight focus group discussions, which were audio-recorded, transcribed and translated into English. Ideas of the respondents were extracted and labeled, and the labels were analyzed using an inductive multistage approach referred to as qualitative content analysis. Three themes emerged: (1) home education, (2) traditional local community, and (3) modernization and westernization of lifestyle. Respondents believed that the influence of the family on lifestyle was significant, but that disciplining children at home had become difficult. They considered that the traditional lifestyle was mostly healthy, and were reluctant to abandon certain unhealthy customs, such as serving abundant food to guests as a sign of fraternity. They also thought that they overate because of their stressful modernized lifestyle. This is the first qualitative study to analyze perception and behavior of the Palauan people in relation to NCDs. We found that the increase in NCDs was related to two concurrent trends: preserving certain traditional customs unfavorable to good health, and abandoning time-consuming healthy traditional lifestyle to adopt a modernized one. We also found that Palauan people were not confident in their ability to prevent NCDs. Therefore, health promotion activities should be designed to empower people to make positive changes.


[Nucleolar organizer regions and mitotic activity in non-Hodgkin's lymphoma].
Evaluation of nucleolar organizer regions (Ag-NOR) and mitotic regimen (MR) of normal lymph nodes and those with follicular hyperplasia (n = 10) as well as non-Hodgkin's lymphomas (NHL) of low and high grade of malignancy (n = 40) is performed in 50 cytograms stained after Pappenheim and with colloidal silver. Correlation of indices of MR and Ag-NOR with morphologic grade of malignancy of NHL was found. For blastic forms of NHL higher Ag-NOR, lager number of mitoses and their pathologic forms are characteristic compared with cytic ones (8.59 +/- 3.15; 13.60 +/- 4.9/1000; 37.9% and 2.06 +/- 0.63; 2.10 +/- 2.45/1000; 23.8%, respectively, p < 0.001). Calculation of Ag-NOR allowed to distinguish NHL of low grade and high grade of malignancy containing 1.13 to 3.68 and 4.76 to 18.22 Ag-grains per nucleus, respectively (the difference is statistically significant). This is important for differential diagnosis of "small cell" types of the tumor. Significant correlation between the number of Ag-NOR and mitotic activity of NHL is found (r = 0.772; p < 0.001) indicating that the number of Ag-NOR reflects cell kinetics of the tumor. The results of the activity evaluation of Ag-NOR and MR of cells may be used in differential diagnosis, gradation and definition of proliferative NHL status.


Identification and expression analysis of a novel stylicin antimicrobial peptide from Kuruma shrimp (Marsupenaeus japonicus).
Antimicrobial peptides (AMPs) are important components of the innate immune system and function as the first line of defense against invading pathogens. In current study we identified, cloned and characterized a novel stylicin AMP from Kuruma shrimp Marsupenaeus japonicus (Mj-sty). The full-length cDNA of Mj-sty was 428 bp with an open reading frame of 315 bp that encoded 104 amino acids. The theoretical molecular mass of mature Mj-sty was 8.693 kDa with an isoelectric point (pI) of 4.79. A proline-rich N-terminal region and a C-terminal region contained 13 cysteine residues were identified. Genomic sequence analysis with respect to its cDNA showed that Mj-sty was organized into two exons interrupted by one intron. Tissue-specific expression revealed that Mj-sty was mainly transcribed in gills and hemocytes. Expression of Mj-sty in early developmental stages demonstrated that Mj-sty mRNA were present from fertilized eggs to post-larvae of 17 days (PL17), and the expression levels showed a significant variation in different developmental stages. After challenge of white spot syndrome virus (WSSV), the time-dependent expression pattern of Mj-sty in both gills and hepatopancrease showed down-regulation at the early hours of infection, subsequently up-regulation and down-regulation, and then up-regulation at the end hours to almost the half of the controls. The results indicate that Mj-sty is potentially involved in the ontogenesis and immune responses against WSSV.


Natural history of precancerous and early cancerous lesions of the uterine cervix.
A prospective study of cervical dysplasia cases and control cases matched for age and parity was undertaken in search of factors related to cervical carcinogenesis. Cytologic examination of 66,736 women revealed negative findings in 28.5%, inflammation in 70.3%, dysplasia in 1.4% and carcinoma in 0.1% of the cases. Data on epidemiologic features, cytomorphologic characteristics and serologic findings of antibodies to herpes simplex virus (HSV) were collected for proven cancer patients, dysplasia cases and control subjects. Cancer patients revealed significantly elevated antibodies to HSV as compared to the controls. The analysis revealed a higher proportion of dysplasia cases with an age at consummation of marriage of less than or equal to 15 years as compared to controls, with a relative risk of 1.5 (P less than .05). Similarly, a higher proportion of women with dysplasia had HSV-II-specific antibodies as compared to control women. The relative risk was found to be 1.3, which was not statistically significant (P greater than .05). The Mantel-Haenszel summary relative risk between antibodies to HSV and the two groups (dysplasia cases and controls), adjusted for the age at consummation of marriage, worked out to be 1.38, which was also statistically not significant (P greater than .05). The overall progression rate of dysplasia to malignancy was found to be 11.7% at the end of 54 months (during a total follow-up period of 84 months). Progression to cancer was highest in severe dysplasia cases and less in mild dysplasia cases. The progression rates were also significantly higher in the group of women who revealed antibodies to HSV II. Similar differences in the progression rates were observed with regard to the age at consummation of marriage.


Cryptic Species in Proechimys goeldii (Rodentia, Echimyidae)? A Case of Molecular and Chromosomal Differentiation in Allopatric Populations.
The spiny rats of the genus Proechimys have a wide distribution in the Amazon, covering all areas of endemism of this region. We analyzed the karyotype and cytochrome b (Cyt b) sequences in Proechimys goeldii from 6 localities representing 3 interfluves of the eastern Amazon. A clear separation of P. goeldii into 2 monophyletic clades was observed, both chromosomally and based on Cyt b sequences: cytotype A (2n = 26x2640;/27x2642;, NF = 42) for samples from the Tapajos-Xingu interfluve and cytotype B (2n = 24x2640;/25x2642;, NF = 42) for samples from the Xingu-Tocantins interfluve and east of the Tocantins River. The karyotypes differ in a pericentric inversion and a centric fusion/fission and an average nucleotide divergence of 6.1%, suggesting cryptic species. Meiotic analysis confirmed the presence of a XX/XY1Y2 multiple sex chromosome determination system for both karyotypes. The karyotypes also vary from the literature (2n = 24, NF = 42, XX/XY). The autosome translocated to the X chromosome is different both in size and morphology to P. cf. longicaudatus, which also has a multiple sex chromosome determination system (2n = 14x2640;/15x2640;x2642;/16x2640;/17x2642;, NF = 14). The Xingu River is a barrier that separates populations of P. goeldii, thus maintaining their allopatric nature and providing an explanation for the molecular and cytogenetic patterns observed for the Xingu River but not the Tocantins River.


Molecular recognition of neonicotinoid insecticides: the determinants of life or death.
Until the mid-20th century, pest insect control in agriculture relied on largely inorganic and botanical insecticides, which were inadequate. Then, the remarkable insecticidal properties of several organochlorines, organophosphates, methylcarbamates, and pyrethroids were discovered, leading to an arsenal of synthetic organics. The effectiveness of these insecticides, however, diminished over time due to the emergence of resistant insect strains with less sensitive molecular targets in their nervous systems. This created a critical need for a new type of neuroactive insecticide with a different yet highly sensitive target. Nicotine in tobacco extract was for centuries the best available agent to prevent sucking insects from damaging crops, although this alkaloid was hazardous to people and not very effective. The search for unusual structures and optimization revealed a new class of potent insecticides, known as neonicotinoids, which are similar to nicotine in their structure and action as agonists of the nicotinic acetylcholine receptor (nAChR). Fortunately, neonicotinoids are much more toxic to insects than mammals due in large part to differences in their binding site interactions at the corresponding nAChRs. This Account discusses the progress that has been made in defining the structural basis of neonicotinoid and nicotinoid potency and selectivity. The findings are based on comparisons of two acetylcholine binding proteins (AChBPs) with distinct pharmacological profiles that serve as structural surrogates for the extracellular ligand-binding domain of the nAChRs. Saltwater mollusk (Aplysia californica) AChBP has high neonicotinoid sensitivity, whereas freshwater snail (Lymnaea stagnalis) AChBP has low neonicotinoid and high nicotinoid sensitivities, pharmacologies reminiscent of insect and vertebrate nAChR subtypes, respectively. The ligand-receptor interactions for these AChBPs were established by photoaffinity labeling and X-ray crystallography. Both azidopyridinyl neonicotinoid and nicotinoid photoprobes bind in a single conformation with Aplysia AChBP; this is consistent with high-resolution crystal structures. Surprisingly, though, the electronegative nitro or cyano moiety of the neonicotinoid faced in a reversed orientation relative to the cationic nicotinoid functionality. For the Lymnaea AChBP, the azidoneonicotinoid probes modified two distinct and distant sites, while the azidonicotinoid probes, surprisingly, derivatized only one point. This meant that the neonicotinoids have two bound conformations in the vertebrate receptor model, which are completely inverted relative to each other, whereas nicotinoids appear buried in only one conserved conformation. Therefore, the unique binding conformations of nicotinic agonists in these insect and vertebrate receptor homologues define the basis for molecular recognition of neonicotinoid insecticides as the determinants of life or death.


Enhancement of antitumor effect of hyperthermia with glucose administration in murine mammary carcinoma.
Antitumor effects of hyperthermia are enhanced by lowering the pH in the tumor tissue with administration of glucose. This decreased pH in the tumor tissue with glucose administration was determined using mouse experimental tumors. 31P-MRS microelectrodes were used for the measurement of pH. By using these two measurement methods, time course change in the tumor tissue was determined in the controls and the groups treated with 6 g/kg of intraperitoneal glucose. The determination of pH with 31P-MRS was calculated from the chemical shift of the peak of creatine phosphate (Pcr) and that of inorganic phosphate (Pi). Following glucose administration, the tumor tissue showed a decrease of 0.3 pH units with the microelectrode method, but did not show any significant decrease in pH with the MRS determination. This finding suggested that 31P-MRS showed intracellular pH (pHi) due to the localization of Pi and that the microelectrode indicated interstitial or extracellular pH (pHe). The ATP/Pi ratio obtained in tumor tissue 24 h after heat treatment (with, without glucose) was correlated with tumor inhibition.


Possible dual roles for prostacyclin in human pregnancy and labor.
During pregnancy, the muscular layer of the uterine wall known as the myometrium, which is composed mainly of smooth muscle cells, is maintained in a state of relative quiescence. A switch from myometrial quiescence to myometrial activation is required to establish uterine contractions during labor. Researchers have long been perplexed by the fact that the major prostaglandin produced by the uterus just prior to labor, prostacyclin, is a smooth muscle relaxant. In this issue of the JCI, Fetalvero et al. provide data that they propose explains this paradox, at least in part (see the related article beginning on page 3966). The authors examined uterine tissue from pregnant women near term and found that prostacyclin stimulation, which raises cAMP levels that were previously thought to affect only myometrial quiescence, can promote myometrial activation over time by increasing the expression of a select group of proteins thought to be indicative of a uterine contractile state.


[Transitional care between hospital and ambulatory care: risks, interventions and new perspectives].
Transitional care interventions aim to ensure continuity of care during the transfer of patients from one care setting to another. Hospital readmission is a potentially preventable consequence in 5,5 % of patients leaving a hospital medical service, often resulting from poor coordination between health care providers. In this article, we describe the risks associated with hospital discharge, and how to identify patients at high risk of readmission by using the HOSPITAL score. New transitional care approaches are currently being developed, such as the extensivist doctor or the possibility of being hospitalized in a hotel, and may provide new perspectives in this area.


A nursing fellowship--building leadership skills.
A postgraduate nursing fellowship helps future nursing leaders deal with constant change, focus on learning and development, think systemically and mobilize resources through team building and goal directedness. An administrative fellowship program helps to develop future leaders, with the skills necessary to assume key positions in health care. Core competencies--leadership criteria, roles of the fellow and preceptor, skills of the fellow and preceptor and fellowship projects--are described.


Efficient Capture of Cancer Cells by Their Replicated Surfaces Reveals Multiscale Topographic Interactions Coupled with Molecular Recognition.
Cell-surface topographic interactions can direct the design of biointerfaces, which have been widely used in isolation of circulating tumor cells or fundamental cell biological research. By using three kinds of cancer cell-replicated surfaces with differentiated structures, we uncover that multiscale-cooperative topographic interactions (at both nanoscale and microscale) coupled with molecular recognition enable efficient and specific isolation of cancer cells. The cell replicas precisely inherit the structural features from the original cancer cells, providing not only preferable structures for matching with cancer cells but also a unique platform to interrogate whether certain cancer cells can optimally match with their own replicated surfaces. The results reveal that cancer cells do not show preferential recognitions to their respective replicas, while the capture agent-modified surfaces with hierarchical structures exhibit improved cancer cell capture efficiencies. Two levels of topographic interactions between cancer cells and cell replica surfaces exist. Nanoscale filopodia on cancer cells can topographically interact with different nanostructures on replica surfaces. In addition, microscale concave/convex on surfaces provide suitable sites for trapping cancer cells. This study may promote smart design of multiscale biofunctional materials that can specifically recognize cancer cells.


Nutritional status of children and adolescents with Type 1 Diabetes Mellitus in Baghdad: a case-control study.
Diabetes mellitus (DM) is a major life-long non-communicable illness correlated with obesity and chronic undernutrition. It is particularly important to monitor the nutritional status of children with type 1 diabetes mellitus (T1DM), as they are still growing and may be affected by the disease or associated conditions like celiac disease. This study aimed to evaluate the nutritional status of children and adolescents with T1DM in Baghdad city and identify possible risk factors for undernutrition. A single-center, case-control study was conducted in Central Child's Teaching Hospital, Baghdad, Iraq, over 9 months from November 2021 to July 2022. The study included patients with T1DM and healthy controls. Detailed history, clinical examination, and anthropometric measures were performed for all participants in the study. The mean age of the sample was 10.0 ±3.73 years and 8.68±3.1 years in diabetic patients and controls, respectively. Anthropometric measures in patients with type 1 diabetes were significantly lower than those of controls (P<0.001). All patients within the undernourished group were from large-size families compared with 75.76% of the normally nourished group, with a significant difference. The mean age of disease onset in the normal nourished group was 6.61 ± 2.78 years which was significantly earlier than that of the undernourished group (8.83 ± 2.89). Weight-for-age and BMI z-score had a significant negative correlation with HbA1c (r=-0.312, p=0.004, and r=-0.295, p=0.006, respectively). Patients with T1DM had significantly lower anthropometric measures than the normal population. Older children, female gender, large family size, and disease duration are independent predictors of undernutrition in T1DM. BMI and weight-for-age have a significant negative correlation with metabolic control of diabetes represented by HbA1c.


Patient self-report of prior laser treatment reliably indicates presence of severe diabetic retinopathy.
To determine whether patient self-report of prior laser treatment can be used as a reliable tool for assessing the presence of severe diabetic retinopathy. This was a retrospective study on two groups of diabetic subjects. One hundred patients with diabetes were recruited from the general eye and retina clinics at the University of Chicago Hospitals. The patients were asked, "Have you ever received laser treatment for your diabetic eye disease (DED)?" A chart review was then conducted noting if the patient had received either focal laser treatment for diabetic macular edema or panretinal photocoagulation for proliferative diabetic retinopathy. Data from the Wisconsin Epidemiological Study of Diabetic Retinopathy (WESDR) were also analyzed. Participant responses to the question "Have you had laser photocoagulation treatment for your eyes?" were analyzed with documentation of photocoagulation scars determined by grading seven-standard field color fundus photographs. In the University of Chicago group, 96 of 100 (96%) of patients were accurate in reporting whether they had received previous laser treatment for DED (sensitivity 95.8%, specificity 96.1%, and positive predictive value 88.5%). In the WESDR analysis, 2,329 of 2,348 (99%) of participants were accurate in reporting whether they had prior laser treatment for DED (sensitivity 96.0%, specificity 99.5%, and positive predictive value 95.6%). The high sensitivity and specificity of our results validate the use of patient self-report as a useful tool in assessing past laser treatment for severe diabetic retinopathy. Patient self-report may be a useful surrogate to clinical examination or medical record review to determine the presence of severe diabetic retinopathy.


Expression of the Drosophila homeobox gene, Distal-less, supports an ancestral role in neural development.
Distal-less (Dll) encodes a homeodomain transcription factor expressed in developing appendages of organisms throughout metazoan phylogeny. Based on earlier observations in the limbless nematode Caenorhabditis elegans and the primitive chordate amphioxus, it was proposed that Dll had an ancestral function in nervous system development. Consistent with this hypothesis, Dll is necessary for the development of both peripheral and central components of the Drosophila olfactory system. Furthermore, vertebrate homologs of Dll, the Dlx genes, play critical roles in mammalian brain development. Using fluorescent immunohistochemistry of fixed samples and multiphoton microscopy of living Drosophila embryos, we show that Dll is expressed in the embryonic, larval and adult central nervous system and peripheral nervous system (PNS) in embryonic and larval neurons, brain and ventral nerve cord glia, as well as in PNS structures associated with chemosensation. In adult flies, Dll expression is expressed in the optic lobes, central brain regions and the antennal lobes. Characterization of Dll expression in the developing nervous system supports a role of Dll in neural development and function and establishes an important basis for determining the specific functional roles of Dll in Drosophila development and for comparative studies of Drosophila Dll functions with those of its vertebrate counterparts.


Pt cocatalyst morphology on semiconductor nanorod photocatalysts enhances charge trapping and water reduction.
In photocatalysis, metal-semiconductor hybrid structures have been proposed for ideal photocatalytic systems. In this study, we investigate the effect of morphology and surface nature of Pt cocatalysts on photocatalytic hydrogen evolution activity in Pt-tipped CdSe nanorods. Three distinct morphologies of Pt cocatalysts were synthesized and employed as visible light photocatalysts. The rough tips exhibit the highest activity, followed by the round and cubic tips. Kinetic investigations using transient absorption spectroscopy reveal that the cubic tips exhibit lower charge-separated states feasible for reacting with water and water reduction rates due to their defectless surface facets. In contrast, the rough tips show a similar charge-separation value but a two-fold higher surface reaction rate than the round tips, resulting in a significant enhancement of hydrogen evolution. These findings highlight the importance of rational design on metal cocatalysts in addition to the main semiconductor bodies for maximizing photocatalytic activities.


Broader autistic phenotype in parents of children with autism: Autism Spectrum Quotient-Turkish version.
The Autism Spectrum Quotient (AQ) is a self-assessment screening instrument for measuring the degree to which an individual of normal intelligence shows autistic traits. Genetic factors could be responsible for the relatives of individuals with autism exhibiting higher than normal rates of autism-related impairments, referred to as the 'broader autism phenotype' (BAP). The aim of this study was to test whether there is a difference between the parents of autistic and those of typically developing children (TDC) on AQ scores in a Turkish sample. The AQ total and subscale scores of the 100 parents (47 fathers, 53 mothers) of children with autistic disorder (AD) were compared with the 100 parents (48 fathers, 52 mothers) of TDC. The parents of AD children scored significantly higher than the TDC parents on total AQ score, and two of five subscale scores; social skills, and communication. The other three subscales (attention to detail, attention switching, imagination) did not differentiate groups. There was no significant difference between mothers and fathers on any AQ scores, neither in the AD nor TDC group. The group × gender interaction was not significant on the total or the five subscale scores of AQ. Social skill and communication subscales differentiate AD parents more successfully, and are more sensitive, as reported in other studies. The present findings confirm that social skill and communication impairments in parents of children with autism spectrum disorders are indicators of BAP.


Synthesis of ferroquine enantiomers: first investigation of effects of metallocenic chirality upon antimalarial activity and cytotoxicity.
Ferroquine (FQ) is a new antimalarial agent with a high blood schizotoncidal activity. Previous studies on this compound were done with racemate mixtures. As FQ possesses planar chirality, pure enantiomers were obtained by enzymatic resolution in order to compare their antimalarial activities and cytotoxicities. (+)-FQ and (-)-FQ were equally active in vitro, at nanomolar concentrations. Both enantiomers were slightly less active than the racemate in vivo; cytotoxicities were similar. Actually, the racemate represents the optimal formulation. To the best of our knowledge, this is the first investigation of biological activities of compounds with metallocenic chirality.


Blood Pressure Control and Prescription Pattern of Antihypertensive Drugs in Adherence to the 2020 International Society of Hypertension (ISH) Global Hypertension Practice Guidelines in Saudi Arabia: A Retrospective Study.
Background Hypertension is the leading risk factor for cardiovascular disease and death. Appropriate treatment of hypertension is necessary to reduce mortality. A prescription-based study is one of the most influential and helpful methods to examine physicians' irrational prescribing practices. This study was designed to investigate the antihypertensive prescription of physicians and their adherence to the treatment guidelines, as well as the blood pressure (BP) control rate in a general hospital in the Kingdom of Saudi Arabia. Methodology A retrospective, cross-sectional study was conducted between February 2020 and June 2021 in an outpatient department. Patients diagnosed with hypertension as per the 2020 International Society of Hypertension guidelines and those who received antihypertensive drugs were included. Study data included prescriptions, patient's age, duration of hypertension, comorbidities, BP, drug therapy type, and antihypertensive class. Results Overall, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (67.1%) were the most prescribed agents, followed by dihydropyridine-calcium channel blockers (62.6%), diuretics (26.1%), and β-blockers (10.1%). Comorbid and stage 2 hypertensive patients mainly received combination therapy (51.6%) rather than monotherapy (48.4%). The study revealed an 83.5% prescription adherence to the treatment guidelines. However, non-adherence was encountered in monotherapy, polytherapy, and elderly-treated patient groups. A 66.4% (at target BP in all cases <140/90 mmHg) and 39.3% (at target BP in comorbid patients <130/80 mmHg) rate of BP control was observed. Furthermore, the rate of BP control was significantly associated with prescription adherence (χ2 = 71.316; p < 0.001). Conclusions The degree of prescription adherence and rate of BP control were found to be compatible with other published hypertension studies. However, considerable scope exists for improvement in rational drug utilization and rate of BP control, particularly in high-risk patients. Therefore, treatment guidelines must be followed by clinicians to achieve BP goals and reduce cardiovascular events among the Saudi population.


Optimization of CdS Buffer Layer for High Efficiency CIGS Solar Cells.
In present work, effects of the thickness on the structural and optical properties of chemically deposited CdS thin films were investigated. In addition, we fabricated Cu(In, Ga)Se2 solar cells with various thicknesses of CdS buffer layer and optimized the thickness for a high efficiency. When the CdS thin films were thicker, the crystallinity improved but the transmittance decreased. The short-circuit current density (J(sc)) and the fill factor are the major efficiency limiting factors for the CIGS solar cells. As the thickness of the CdS buffer layer, the open-circuit voltage (V(oc)) and the fill factor increased, whereas the J(sc) slightly decreased. The improvement of the fill factor and thus efficiency resulted from larger shunt resistance. For the solar cells without a high resistive intrinsic ZnO layer, the highest efficiency was acquired at the thickness of 89 nm. With further increasing the thickness, the J(sc) decreased significantly, resulting in poor efficiency.