Less outliers in pinless navigation compared with conventional surgery in total knee arthroplasty.
The aim of this study was to investigate the effectiveness of a new pinless navigation system (BrainLAB(®) VectorVision(®) Knee 2.5 Navigation System) as an intra-operative alignment check in total knee arthroplasty using conventional cutting jigs. 200 patients who underwent total knee arthroplasty using conventional technique or pinless navigation by a senior surgeon were included in the study and prospectively followed up. Intra-operative readings from the pinless navigation system were recorded, and post-operative long limb radiographic films were taken. The accepted values for normal alignment were 180 ± 3° for Hip-Knee-Ankle Angle and 90 ± 3° for Coronal Femoral-Component Angle or Coronal Tibia-Component Angle. There was no difference in the duration of surgery. The mean Coronal Femoral-Component Angle was 89.8 ± 2.0° and 91.3 ± 2.3° in the pinless navigation and conventional group, respectively (p < 0.001). For Hip-Knee-Ankle Angle, the proportion of outliers was 10 % in the pinless navigation group compared to 26 % in the conventional group (p = 0.005). For Coronal Femoral-Component Angle and Coronal Tibia-Component Angle, the proportion of outliers was 7 and 4 %, respectively, in the pinless navigation group, compared to 22 and 19 % in the conventional group (p = 0.004 and p = 0.001, respectively). The measurements of Coronal Femoral-Component Angle and Coronal Tibia-Component Angle on post-operative radiographic films were similar to intra-operative readings. This study showed that pinless navigation is an effective tool for reducing the proportion of outliers, without significantly increasing the duration of surgery. The authors recommend its use in total knee arthroplasty using conventional cutting jigs.


Risk factors for drug addiction and its outcome. A follow-up study over 25 years.
The aim of the study was to investigate factors related to initiation and abandonment of illegal drugs. A follow-up study on 53 drug addicts originally hospitalized because of parenterally acquired hepatitis was performed using questionnaires. The majority stated that curiosity and peer pressure were the main reasons for starting drug use. Family conflicts, school and mental problems were each reported by about 40% of the subjects. Thirty-nine patients (74%) had abandoned addictive drugs during the approximately 25 years that had elapsed since the hospital stay. All of these thought that own efforts had been most important in this achievement. Other important factors were help and support from family and friends, establishing a family or experiencing acute hepatitis or an overdose.


Heart and spleen "twin grafts" in rats: morphology and function in permanent survivals.
A new rat allograft model has been investigated for its potential to facilitate organ transplantation. In this procedure heart and spleen of male inbred LEW rat (RT1') were connected to the main abdominal vessels in inbred ACI rat (RT1a). With optimal surgical technique we obtain 64% permanent graft survival (5-14 months) in the splenectomized recipients. Cardiac histology ranged from preserved myocardium with moderate thickening of coronary artery walls to diffuse myocardial fibrosis with marked involutional changes of coronary arteries. Whereas palpation and EKG wrongly indicate good function beyond the fourth month, only the phonocardiogram shows the rapid functional loss which reflects the true morphologic involution.


Diagnostic and Therapeutic Knowledge and Practices in the Management of Congenital Syphilis by Pediatricians in Public Maternity Hospitals in Brazil.
The study aimed to assess conformity with Brazil's standard protocol for diagnostic and therapeutic practices in the management of congenital syphilis by pediatricians in public maternity hospitals. A cross-sectional study was conducted in 2015 with 41 pediatricians working in all the public maternity hospitals in Teresina, the capital of Piauí State, Northeast Brazil, through self-completed questionnaires. The study assessed the conformity of knowledge and practices according to the Brazilian Ministry of Health protocols. The study has made evident low access to training courses (54%) and insufficient knowledge of the case definition of congenital syphilis (42%) and rapid tests for syphilis (39%). Flaws were observed in the diagnostic workup and treatment of newborns. Requesting VDRL (88%) and correct treatment of neurosyphilis (88%) were the practices that showed the highest conformity with standard protocols. Low conformity with protocols leads to missed opportunities for identifying and adequately treating congenital syphilis. Based on the barriers identified in the study, better access to diagnostic and treatment protocols, improved recording on prenatal cards and hospital patient charts, availability of tests and medicines, and educational work with pregnant women should be urgently implemented, aiming to reverse the currently inadequate management of congenital syphilis and to curb its spread.


Endothelial-specific deletion of Ets-1 attenuates Angiotensin II-induced cardiac fibrosis via suppression of endothelial-to-mesenchymal transition.
Cardiac fibrosis is a common feature in chronic hypertension patients with advanced heart failure, and endothelial-tomesenchymal transition (EndMT) is known to promote Angiotensin II (Ang II)-mediated cardiac fibrosis. Previous studies have suggested a potential role for the transcription factor, ETS-1, in Ang II-mediated cardiac remodeling, however the mechanism are not well defined. In this study, we found that mice with endothelial Ets-1 deletion showed reduced cardiac fibrosis and hypertrophy following Ang II infusion. The reduced cardiac fibrosis was accompanied by decreased expression of fibrotic matrix genes, reduced EndMT with decreased Snail, Slug, Twist, and ZEB1 expression, as well as reduced cardiac hypertrophy and expression of hypertrophyassociated genes was observed. In vitro studies using cultured H5V cells further confirmed that ETS-1 knockdown inhibited TGF-β1-induced EndMT. This study revealed that deletion of endothelial Ets-1 attenuated Ang II-induced cardiac fibrosis via inhibition of EndMT, indicating an important ETS-1 function in mediating EndMT. Inhibition of ETS-1 could be a potential therapeutic strategy for treatment of heart failure secondary to chronic hypertension. [BMB Reports 2019; 52(10): 595-600].


[Expression of connective tissue growth factor in sciatic nerve after chronic compression injury and effect of rhodiola sachalinensis on its expression].
To investigate the expression of connective tissue growth factor (CTGF) in the chronic sciatic nerve compression injury and to explore the effect of rhodiola sachalinensis on the expression of CTGF. Forty-five adult male Sprague Dawley rats were randomly divided into groups A, B, and C: In group A (sham-operated group), only the sciatic nerve was exposed; in group B (compression group), sciatic nerve entrapment operation was performed on the right hind leg according to Mackinnon method to establish the chronic sciatic nerve compression model; and in group C (compression and rhodiola sachalinensis group), the sciatic nerve entrapment operation was performed on the right hind leg and rhodiola sachalinensis (2 g/mL) was given by gavage at a dose of 0.5 mL/100 g for 2 weeks. The nerve function index (SFI) was observed and neural electrophysiology was performed; histology, transmission electron microscope, real-time fluorescent quantitative PCR, and Western blot were performed to observe the morphological changes of the compressed nerve tissue and to determine the mRNA and protein levels of CTGF, collagen type I, and collagen type III at 2, 6, and 10 weeks after operation. At 6 and 10 weeks after operation, SFI of groups A and C were significantly better than that of group B (P < 0.05), but there was no significant difference between groups A and C (P > 0.05). The nerve function test showed that the nerve motor conduction velocity (MCV) and the amplitude of compound muscle action potential (CMAP) of group B were significantly lower than those of groups A and C, and distal motor latency (DML) was significantly prolonged in group B (P < 0.05), but there was no significant difference between groups A and C (P > 0.05). Histology and transmission electron microscope observations showed that myelinated nerve fibers degenerated and collagen fiber hyperplasia after sciatic nerve chronic injury in group B, and rhodiola sachalinensis could promote the repair of nerve fibers in group C. At 2 weeks postoperatively, the number of myelinated nerve fibers in groups B and C were significantly less than that of group A (P < 0.05), and the myelin sheath thickness of groups B and C were significantly larger than that of group A (P < 0.05). At 6 and 10 weeks postoperatively, the number of myelinated nerve fibers in groups B and C were significantly more than that of group A (P < 0.05); the myelin sheath thickness of group B was significantly less than that of groups A and C (P < 0.05). The effective area of nerve fiber had no significant difference among groups at each time point (P > 0.05). Real-time fluorescent quantitative PCR and Western blot results showed that the mRNA and protein expressions of CTGF, collagen type I, and collagen type III in group B were significantly higher than those in groups A and C at each time point (P < 0.05), but there was no significant difference between groups A and C (P > 0.05). Sciatic nerve fibrosis can be caused by chronic nerve compression. The increased expression of CTGF suggests that CTGF plays an important role in the process of neural injury and fibrosis. Rhodiola sachalinensis can significantly reduce the level of CTGF and plays an important role in nerve functional recovery.


NADPH oxidases in the gastrointestinal tract: a potential role of Nox1 in innate immune response and carcinogenesis.
The gastrointestinal epithelium functions as physical and innate immune barriers against commensal or pathogenic microbes. NADPH oxidase 1 (Nox1) and dual oxidase 2 (Duox2), highly expressed in the colon, are suggested to play a potential role in host defense. Guinea-pig gastric pit cells and human colonic epithelial cells (T84 cells) express Nox1. With regard to activation of Nox1, the gastric epithelial cells are primed with Helicobacter pylori lipopolysaccharide, whereas T84 cells preferentially use the Toll-like receptor (TLR) 5, rather than TLR4, against Salmonella enteritidis infection. Thus, gastric and colonic epithelial cells may use different TLR members to discern pathogenicities among bacteria, depending on their environments and to activate Nox1 appropriately for host defense. Nox1-derived reactive oxygen species (ROS) have been implicated in the pathogenesis of inflammation-associated tumor development. The human stomach does not express Nox1. Helicobacter pylori infection alone does not induce it, whereas Nox1 is specifically expressed in gastric adenocarcinomas. In the human colon, Nox1 is differentiation-dependently expressed, and its expression is upregulated in adenomas and well-differentiated adenocarcinomas. Although Nox1 expression may not be directly linked to mitogenic activity, Nox1-derived ROS may exert a cancer-promoting effect by increasing resistance to programmed cell death of tumor cells.


Effect of the image resolution on the statistical descriptors of heterogeneous media.
The characterization and reconstruction of heterogeneous materials, such as porous media and electrode materials, involve the application of image processing methods to data acquired by scanning electron microscopy or other microscopy techniques. Among them, binarization and decimation are critical in order to compute the correlation functions that characterize the microstructure of the above-mentioned materials. In this study, we present a theoretical analysis of the effects of the image-size reduction, due to the progressive and sequential decimation of the original image. Three different decimation procedures (random, bilinear, and bicubic) were implemented and their consequences on the discrete correlation functions (two-point, line-path, and pore-size distribution) and the coarseness (derived from the local volume fraction) are reported and analyzed. The chosen statistical descriptors (correlation functions and coarseness) are typically employed to characterize and reconstruct heterogeneous materials. A normalization for each of the correlation functions has been performed. When the loss of statistical information has not been significant for a decimated image, its normalized correlation function is forecast by the trend of the original image (reference function). In contrast, when the decimated image does not hold statistical evidence of the original one, the normalized correlation function diverts from the reference function. Moreover, the equally weighted sum of the average of the squared difference, between the discrete correlation functions of the decimated images and the reference functions, leads to a definition of an overall error. During the first stages of the gradual decimation, the error remains relatively small and independent of the decimation procedure. Above a threshold defined by the correlation length of the reference function, the error becomes a function of the number of decimation steps. At this stage, some statistical information is lost and the error becomes dependent on the decimation procedure. These results may help us to restrict the amount of information that one can afford to lose during a decimation process, in order to reduce the computational and memory cost, when one aims to diminish the time consumed by a characterization or reconstruction technique, yet maintaining the statistical quality of the digitized sample.


A Call to Validate the Stress Continuum Model.
Since the start of the Global War on Terrorism, exponential demands have been put on military personnel, their families, and the military health care system. In response to a Department of Defense Task Force on Mental Health, the U.S. military began developing and fielding programs to promote the psychological health of its personnel. As part of these initiatives, the Navy and Marine Corps developed the Stress Continuum model. The Stress Continuum is a stress classification system ("ready," "reacting," "injured," and "ill") that provides a common language for identifying, engaging, and intervening when stress reactions or stress injuries are present in military personnel. It is the foundation for resilience and prevention efforts across the Navy and Marine Corps. Although the Stress Continuum has strong face validity, is consistent with current theory, and has been agreed up by expert consensus, it has yet to be empirically validated. The goal of the current article is to begin to empirically validate the Stress Continuum using validated measures of psychological stress. We conducted a retrospective analysis of Stress Continuum data (n = 2,049) collected as part of a program evaluation of two Navy operational stress control programs. Receiver operating characteristic (ROC) curves and analyses were conducted to determine the classification quality of the Stress Continuum using a validated measure of stress (a brief version of the Perceived Stress Scale [PSS-4]). For the first ROC curve, we used the "ill" category (vs. the other three categories) to identify the cut point on the PSS-4. PSS-4 cut point values of 9 and 10, respectively, maximized sensitivity and 1-specificity values. Using the chi-square test, we further found that a more accurate prediction for those in the "ill" category was using the cut point of 9 (79%) relative to 10 (71.8%). For the second and the third ROC curves, we used the "ill" and "injured" categories (vs. the other two categories) and "ill," "injured," and "reacting" categories (vs. the "ready" category), respectively. No optimal cut points on the PSS-4 were identified for these models, indicating that the PSS-4 could not reliably differentiate true-positive and false-positive rates. We found that the "ill" category of the Stress Continuum was predictive of higher levels of stress on the validated measure of perceived stress. Thus, our findings strongly suggest that the individuals in the "ill" zone likely warrant some type of intervention by a trained professional. The Navy has recently leveraged the Stress Continuum to create the Stress-o-Meter to support the fundamental principles of early recognition, peer intervention, and connection to services at the unit level. The Stress-o-Meter serves as a prevention tool that has the capability to collect information about stress levels throughout the entire unit at any time. Continued work on validating the Stress Continuum model and making it easily accessible to military units will ensure service members get the support they need and leaders are able to address the psychological health of their units.


[Differential reaction of polytene chromosome segments to high doses of actinomycin D].
The inhibition of RNA synthesis by a high dose of actinomycin D (10 and 50 mg/ml) in Chironomus thummi polytene chromosomes was followed by drastic changes in the ultrastructure of puffs and some bands: 1) in some puffs, the number of puff granules was sharply reduced, and such puffs were collapsed, 2) in other puffs, the number of puff particles did not decrease but puff granules were substituted by thin fibrils. These puffs remained in an decondensed state and even increased their size, 3) in some puffs, large droplets or thick fibrils appeared never observed in these puffs in normal conditions, 4) some bands are decondensed like the puffs, 5) band segregation (particularly in centromere regions) into two substances with low and high electron densities has been described for the first time. A low electron dense substance was Bernhard--positive and contained RNA. The phenomenon of band segregation has been compared with nucleolar segregation. The results are discussed in relation to the ultrastructural organization of the transcription complex and puff products in polytene chromosomes.


Methylcellulose cultures clotted and stained for permanent record.
Whereas methylcellulose cultures have been valuable for biochemical studies on hemopoiesis in vitro, it has been difficult to study cellular morphology in these cultures. We have found that clotting factors can be added at any time during the culture period and non-adherent cells become entrapped in a semisolid clot. The clot can be removed, fixed and stained for detailed microscopic examination.


Pneumococcal pneumonia on the job: Uncovering the past story of occupational exposure to metal fumes and dust.
The objectives of this study are to elucidate the early history of risk for pneumococcal pneumonia from occupational exposure to metal fumes and dusts, and to demonstrate the importance of searching older literature when performing reviews. We performed manual searching for articles in the Library of the Surgeon General's Office (the precursor to Index Medicus), in the Hathi Trust database, in PubMed, andby screening reference lists in literature appearing before the introduction of PubMed. An early body of literature, from the 1890s onward, recognized that pneumonia was linked to "Thomas slag," a steel industry byproduct containing iron, manganese, and lime. Researchers, mainly in Germany, showed that workers in metal-dust-exposed occupations, especially using manganese, manifested an increased incidence of pneumococcal pneumonia. An outbreak of pneumococcal pneumonia in the 1930s implicated manganese fume in its etiology. In the immediate post-World War II period, there was a brief flurry of interest in pneumonia from exposure to potassium permanganate that was soon dismissed as a chemical pneumonitis. After a hiatus of two decades, epidemiologic investigations drew attention to the pneumonia risks of welding and related metal fume exposure, bringing renewed interest to the forgotten role of pneumococcal pneumonia as an occupational disease. Occupational or environmental inhalation of manganese, iron, or irritants may be causally related to increased pneumococcal pneumonia risk. In particular, the risk associated with manganese seems to be overlooked in recent literature. An important conclusion is the importance of obtaining additional evidence through a deeper assessment of the literature in a broad historical context.


Biomass, productivity and density of the seagrass Thalassia testudinum at three sites in Cahuita National Park, Costa Rica.
The basic ecology of seagrass beds was investigated by comparing biomass, productivity and density of Thalassia testudinum (turtle grass) at three sites: Puerto Vargas, Punta Cahuita and Rio Perezoso, in Cahuita National Park, Limón, Costa Rica, over a two month period (March-April 1999). Above ground biomass, density, and productivity were highest in the Puerto Vargas site while Punta Cahuita had the least non-green above ground biomass was significantly lower in total biomass than Puerto Vargas. Punta Cahuita was distinguished by the largest grain size, a very hard substrate, and shallower water. Rio Perezoso, on the other hand, had extremely fine sediment and lower salinity, while Puerto Vargas was intermediate both in sediment size and environmental conditions. It appears, therefore, that higher biomass and productivity result from a combination of moderate environmental characteristics and an intermediate sediment size.


Molecular Interactions and Hydration States of Ultrathin Functional Films at the Solid-Liquid Interface.
We significantly improve the infrared analysis of ultrathin films in aqueous environments by employing in situ infrared ellipsometry. Combining it with rigorous optical modeling avoids otherwise typical misinterpretations of spectral features and enables the simultaneous quantification of chemical composition, hydration states, structure, and molecular interactions. We apply this approach to study covalently end-grafted, nanometer-thin brushes of poly(N-isopropylacrylamide), a thermoresponsive model polymer for proteins at solid-liquid interfaces. Quantitative analyses are based on a dielectric layer model that accounts for film swelling and deswelling, hydration of hydrophilic amide and hydrophobic isopropyl side groups, as well as molecular interactions of the polymer's amide moieties. We thereby quantify the hydration and structure dependence of intra- and intermolecular C═O···H-N and C═O···H2O hydrogen bonds, elucidating their role in the brush's temperature-induced phase separation. The presented method is directly applicable to functional and biorelated films like polymer and polypeptide layers, which is of topical interest for interface studies, such as membrane processes and protein unfolding.


Regulation of beta-adrenergic receptors by guanyl-5'-yl imidodiphosphate and other purine nucleotides.
Guanyl-5'-yl imidodiphosphate (Gpp(NH)p), GTP, and other purine nucleotides selectively decrease the binding affinity of the beta-adrenergic receptors of frog erythrocyte membranes for beta-adrenergic agonists but not antagonists. Shifts in binding affinity were assessed by determining the ability of unlabeled ligands to compete with (-)-[3H]dihydroalprenolol for the membrane-bound receptors. The magnitude of the"right" shift in the binding displacement curve for any of 13 ligands tested was directly related to the intrinsic activity (maximal stimulatory capacity) of that agent for stimulation of the frog erythrocyte membrane adenylate cyclase. Thus, Gpp(NH)p-induced shifts in binding affinity were greatest for full agonists such as isoproterenol, intermediate for partial agonists such as soterenol, and no shifts were observed for antagonists such as propranolol. Shifts in binding affinity were observed only in preparations where agonist binding to the receptors leads to "coupling" of the receptors with adenylate cyclase. In solubilized preparations where the beta-adrenergic receptors and adenylate cyclase are functionally "uncoupled", Gpp(NH)p did not cause right shifts in agonist receptor binding displacement curves. In particulate preparations the Km of Gpp(NH)p for stimulation of adenylate cyclase was identical with that for its effect on beta-adrenergic agonist binding affinity, 1 to 2 muM. Moreover, the ability of several other nucleotides to cause shifts in receptor binding affinity directly paralleled their previously determined affinities for the nucleotide regulatory sites on adenylate cyclase. Gpp(NH)p also shifted agonist dose-response curves for stimulation of adenylate cyclase, but to the left. As with the effects on the receptor binding curves, the effects of Gpp(NH)p on the "apparent affinities" of agonists for enzyme stimulation were directly related to their intrinsic activities. Gpp(NH)p also markedly increased the intrinsic activity of partial agonists. These results appear to indicate that conformational alterations in adenylate cyclase caused by occupation of nucleotide regulatory sites by Gpp(NH)p are capable of inducing alterations in the beta-adrenergic receptors. These receptor alterations are induced only when the receptors are "coupled" to the enzyme by virtue of agonist binding. The nucleotide-altered conformation of the beta-adrenergic receptors is characterized by decreased binding affinity for agonist but increased functional efficacy in stimulating the enzyme.


Comparison of imaging-based and pathological dimensions in pancreatic neuroendocrine tumors.
To establish the ability of magnetic resonance (MR) and computer tomography (CT) to predict pathologic dimensions of pancreatic neuroendocrine tumors (PanNET) in a caseload of a tertiary referral center. Patients submitted to surgery for PanNET at the Surgical Unit of the Pancreas Institute with at least 1 preoperative imaging examination (MR or CT scan) from January 2005 to December 2015 were included and data retrospectively collected. Exclusion criteria were: multifocal lesions, genetic syndromes, microadenomas or mixed tumors, metastatic disease and neoadjuvant therapy. Bland-Altman (BA) and Mountain-Plot (MP) statistics were used to compare size measured by each modality with the pathology size. Passing-Bablok (PB) regression analysis was used to check the agreement between MR and CT. Our study population consisted of 292 patients. Seventy-nine (27.1%) were functioning PanNET. The mean biases were 0.17 ± 7.99 mm, 1 ± 8.51 mm and 0.23 ± 9 mm, 1.2 ± 9.8 mm for MR and CT, considering the overall population and the subgroup of non-functioning- PanNET, respectively. Limits of agreement (LOA) included the vast majority of observations, indicating a good agreement between imaging and pathology. The MP further confirmed this finding and showed that the two methods are unbiased with respect to each other. Considering ≤ 2 cm non-functioning-PanNET, no statistical significance was found in the size estimation rate of MR and CT (P = 0.433). PBR analysis did not reveal significant differences between MR, CT and pathology. MR and CT scan are accurate and interchangeable imaging techniques in predicting pathologic dimensions of PanNET.


TNF-alpha induces Lnk expression through PI3K-dependent signaling pathway in human umbilical vein endothelial cells.
A better understanding of activation process of endothelial cells (ECs) might reveal new ways of controlling inflammation. Adaptor proteins play crucial roles in ECs activation. Lnk is a newly discovered adaptor protein that has been proposed as a negative regulator of cytokine signaling. While limited information is available about Lnk in human ECs. This study was conducted to investigate the effect of TNF-alpha on Lnk expression in ECs and to identify the signal transduction pathway that is associated with Lnk regulation. Primary human umbilical vein endothelial cells (HUVECs) were cultured with designated doses of TNF-alpha and harvested at designated time points. Then Lnk mRNA and protein were detected using real-time polymerase chain reaction, immunoprecipitation and Western blot analysis, respectively. The data demonstrated that Lnk mRNA and protein expression are induced significantly (P < 0.05) by TNF-alpha in a dose- and time-dependent manner. This inductive effect was abolished while phosphatidylinositol 3-kinase (PI3K) pathway was blocked by the PI3K inhibitor LY294002 and Wortmannin. These results suggest that TNF-alpha induces Lnk expression through PI3K-dependent signaling pathway in HUVEC. This may indicate a role for this new adaptor protein in the regulation of TNF-alpha-induced ECs activation.


Quality properties of puffed corn snacks incorporated with sesame seed powder.
Puffed corn snacks are tasty and affordable cereal-based food products which have a relatively poor nutritional quality. Sesame seed is a rich source of essential amino and fatty acids, phenolic compounds, tocopherols, and antioxidants. In this study, puffed corn snacks were produced by incorporating sesame powder at 0% (control sample), 5%, 10%, and 15% levels in its formulation and stored at room temperature (24°C) for 60 days. Fatty acid composition, tocopherol, sesamin and sesamolin, phenolic compounds, peroxide value (PV), acidity (AV), and sensory evaluation of the samples were determined. The results indicate that oleic acid content increased and palmitic acid decreased significantly (p < .05) in all the samples at 10% and 15% inclusion levels. The content of phenolic compounds, γ-tocopherols, sesamin, and sesamolin had significant increases in all the formulated samples. PV results indicated that the formulated samples had a higher stability when the ratio of sesame powder was increased, while the AV values showed a significant increase during storage. Incorporation of 10% sesame powder in the snack formulation had a positive effect on the stability, sensory, and nutritional quality of the product. This approach can be used to modify nutritional quality of this food product and introduce to food market as a relatively healthy snack.


Social network advice during pregnancy: myths, misinformation, and sound counsel.
One hundred eighty-five low-income, inner-city women were interviewed after they gave birth. They were allowed to report on up to 30 members of their social networks, including household members, relatives, and friends. Questions were asked regarding the types and nature of health advice given to them by these individuals, the relationship of each advisor, and his or her age and sex. Respondents received between 0 and 211 (median 20) pieces of advice related to pregnancy health from 0 to 19 (median 5) members of their social networks. Both folk beliefs and information aligned with accepted medical views of health promotion were communicated to individual women. Most advice rendered was sound, but often the rationale for the recommended health action was poorly understood. Some respondents received advice that, if followed, could be harmful to health. This suggests that for some low-income, inner-city women, social networks serve as important resources for health information. However, the advice they convey may cause unnecessary worry or come into conflict with recommendations of health care providers. Therefore, new educational strategies are required to address the informational needs not just of individual women, but of their social networks as well.


[Acute fatal non-occlusive intestinal ischemia during treatment with a cardiotonic glucoside].
After presenting the case of a 70 year old woman who presented a massive mesenteric infarction as a result of non-occlusive intestinal ischaemia ( NOII ), the authors review the principal features of this particular form of intestinal ischaemia. This condition is seen principally in elderly people with a syndrome of low cardiac output, resulting in marked mesenteric vasoconstriction. It is a complication of either severe decompensated heart disease treated with digitaloids or to a state of hypovolaemic or septic shock. The diagnosis of NOII should be suggested by the combination of abdominal signs with a state of shock and/or treated heart disease. The diagnosis is confirmed by selective mesenteric arteriography which reveals a patent but spastic vessel. The treatment is initially medical, consisting of the correction of haemodynamic disturbances and the in situ injection of vasodilator products, which may need to be completed by a surgical operation. However, the prognosis of NOII remains serious, particularly because of the frequent delay in making the diagnosis.


[Review of wireless energy transmission system for total artificial heart].
This paper sums up the fundamental structure of wireless energy transmission system for total artificial heart, and compares the key parameters and performance of some representative systems. After that, it is discussed that the future development trend of wireless energy transmission system for total artificial heart.


[Treatment with L-thyroxine for differentiated thyroid carcinoma].
Differentiated thyroid carcinoma (DTC) is one of malignant neoplasms with a very good prognosis and low mortality rate provided a proper therapy and its systematic monitoring is given. DTC treatment consists of surgery, radioiodine and L-thyroxine therapy. L-thyroxine therapy in DTC should be both substitutive and suppressive. Substitutive therapy consists in the removal of the lack of thyroid hormones symptoms so that the serum TSH is about 1 mU/l. Suppressive therapy consists in complete inhibition of TSH secretion by pituitary gland. This prevents from the regrowth and inhibition of carcinoma progress in patients with evident or residual neoplasmic disease. Although complete suppressive therapy (TSH less than 0.05 mU/l) is the most recommended one, in patients with low recurrence risk incomplete suppression can be used (TSH = 0.1-0.3 mU/l). Suppressive L-thyroxine doses may give side-effects such as: cardiac signs (arrhythmia, coronary or heart insufficiency), decrease in bone mineral density with osteopoenia or osteoporosis or subclinical hyperthyroidism. However, the side-effects of the suppressive L-thyroxine doses may be symptomatically treated (with beta-blockers, biphosphoniates).


Computational modeling of fatigue crack propagation in butt welded joints subjected to axial load.
This article addresses the study of crack behavior elicited on axial fatigue in specimens joined by butt weld made of steel ASTM A36 by using fracture mechanics and simulation software of finite elements (Ansys APDL, Franc3D). The computational model was initially to define the geometry model by using CAD software. Specimens with Weld Reinforcement of 2 mm and 3mm were simulated. Subsequently, the type of element for the mesh, the information inclusion concerning material mechanical properties and load conditions were selected. By using Franc3D software, the crack propagation phenomenon is analyzed, and its growth parameters have been established. In this way, it is possible to calculate the magnitude of stress intensity factor (SIF) along the crack front. It is concluded that the stress located in the weld toe is maximized proportionately to the size of the weld reinforcement due to the concentration effect of geometric stress. In addition, it is observed that the propagation rate obtained from Paris law has a similar behavior for the studied weld reinforcements; the latter as there were short cracks.


Quantifying increased hepatic arterial flow with test balloon occlusion of the splenic artery in liver transplant recipients with suspected splenic steal syndrome: quantitative digitally subtracted angiography correlation with arterial Doppler parameters.
The purpose of this study is to quantify hepatic arterial flow (HAF) in liver transplants with splenic steal syndrome (SSS) pre- and post-test balloon occlusion of the splenic artery utilizing Doppler ultrasound (DUS) and quantitative digitally subtracted angiography (Q-DSA). A total of 193 liver transplants were evaluated retrospectively. Hepatic arterial velocity (HAV) and HAF were calculated utilizing DUS and Q-DSA (i-flow prototype, Siemens) pre- and post-splenic artery balloon occlusion. The rate of HAF increase, total HAF, and peak contrast density (PKD) by Q-DSA were compared with HAF by DUS. Of all, 4 suspected SSS cases underwent test-balloon occlusion with DUS and Q-DSA. Using DUS, HAV and HAF increased by 1.6- to 1.8-fold and 1.7- to 2.6-fold, respectively. Using Q-DSA, the HAF rate, total HAF, and PKD increased by 1.1 to 12.8, 1.5 to 7.6, and 1.3 to 5.3, respectively. Occlusion of the splenic artery in liver transplants with SSS doubles the HAF (+1.7- to 2.6-fold). The Q-DSA parameters correlate qualitatively but overestimate the resultant increased HAF.


NMR studies of the AMP-binding site and mechanism of adenylate kinase.
NMR has previously been used to determine the conformation of enzyme-bound MgATP and to locate the MgATP-binding site on adenylate kinase [Fry, D. C., Kuby, S. A., & Mildvan, A. S. (1985) Biochemistry 24, 4680-4694]. To determine the conformation and location of the other substrate, AMP, distances have been measured from Cr3+AMPPCP, a linear competitive inhibitor with respect to MgATP, to six protons and to the phosphorus atom of AMP on adenylate kinase, with the paramagnetic probe-T1 method. Time-dependent nuclear Overhauser effects (NOEs) have been used to measure five interproton distances on enzyme-bound AMP. These distances were used to determine the conformation of bound AMP in addition to its position with respect to metal-ATP. Enzyme-bound AMP exhibits a high anti-glycosyl torsional angle (chi = 110 +/- 10 degrees), a 3'-endo,2'-exo ribose pucker (delta = 105 +/- 10 degrees), and gauche-trans orientations about the C4'-C5' bond (gamma = 180 +/- 10 degrees) and the C5'-O5' bond (beta = 170 +/- 20 degrees). The distance from Cr3+ to the phosphorus of AMP is 5.9 +/- 0.3 A, indicating a reaction coordinate distance of approximately 3 A, which is consistent with an associative SN2 mechanism for the phosphoryl transfer. Ten intermolecular NOEs, from protons of the enzyme to those of AMP, were detected, indicating the proximity of at least three hydrophobic amino acids to bound AMP. These constraints, together with the conformation of AMP and the intersubstrate distances, were used to position AMP into the X-ray structure of adenylate kinase. The AMP binding site is found to be near (less than or equal to 4 A from) Leu-116, Arg-171, Val-173, Val-182, and Leu-190; all of these residues have been found to be invariant in muscle-type rabbit, calf, human, porcine [Kuby, S. A., Palmieri, R. H., Frischat, A., Fischer, A. H., Wu, L. H., Maland, L., & Manship, M. (1984) Biochemistry 23, 2393-2399], and chicken adenylate kinase [Kishi, F., Maruyama, M., Tanizawa, Y., & Nakazawa, A. (1986) J. Biol. Chem. 261, 2942-2945].


Serum Osteocalcin as a Diagnostic Biomarker for Primary Osteoporosis in Women.
Osteoporosis, a major health problem in elderly population, especially in post-menopausal females, is diagnosed basically on clinical suspicion and bone mineral density measurement. Dual energy x-ray absorptiometry (DEXA) scan though a gold standard of diagnosis becomes unfit for screening purpose due to its prohibitive cost, unportability and lack of availability of machine. To assess the diagnostic potential of serum osteocalcin levels in primary osteoporosis. In a case-control study, 82 post-menopausal females, between 40-70 years, were subjected to measurements of bone mineral density and serum osteocalcin levels. Based on the results of DEXA scan they were divided into two: a) Control group and B) Case group. Case group was further subdivided as Osteopenia and Osteoporosis depending on their t-scores. Correlation between different BMD grades and the levels of serum osteocalcin were analysed statistically. A negative correlation was found between serum osteocalcin levels and BMD grading. Significant association of age and years since menopause (YSM) was found with serum osteocalcin levels and BMD. No association of BMI and serum osteocalcin was observed with BMD. Statistically significant difference between values of serum osteocalcin in postmenopausal non-osteoporotic women, post-menopausal women with low bone mass (osteopenia) and post-menopausal women with osteoporosis were seen. Serum osteocalcin level measurement can be used for screening purpose in post-menopausal patients. Subjects can be further assessed by DEXA scan to, if indicated.


Hepatocellular carcinoma with child Pugh-A Cirrhosis treated with stereotactic body radiotherapy.
To evaluate the control, survival, and hepatic function for Child Pugh (CP)-A patients after Stereotactic body radiotherapy (SBRT) in hepatocellular carcinoma (HCC). From 2009 to 2016, 40 patients with Barcelona Liver Clinic (BCLC) stages 0-B HCC and CP-A cirrhosis completed liver SBRT. The mean prescription dose was 45 Gy (40 to 50 Gy in 4-5 fractions). Local relapse, defined as recurrence within the planning target volume was assessed with intravenous multiphase contrast computed tomography or magnetic resonance imaging every 4-6 mo after completion of SBRT. Progression of cirrhosis was evaluated by CP and Model for End Stage Liver Disease scores every 3-4 mo. Toxicities were graded per the Common Terminology Criteria for Adverse Events (v4.03). Median follow-up was 24 mo. Forty-nine HCC lesions among 40 patients were analyzed in this IRB approved retrospective study. Median tumor diameter was 3.5 cm (1.5-8.9 cm). Six patients with tumors ≥ 5 cm completed planned selected transarterial chemoembolization (TACE) in combination with SBRT. Eight patients underwent orthotropic live transplant (OLT) with SBRT as a bridging treatment (median time to transplant was 12 mo, range 5 to 23 mo). The Pathologic complete response (PCR) rate in this group was 62.5%. The 2-year in-field local control was 98% (1 failure). Intrahepatic control was 82% and 62% at 1 and 2 years, respectively. Overall survival (OS) was 92% and 60% at 1 and 2 years, with a median survival of 41 mo per Kaplan Meier analysis. At 1 and 2 years, 71% and 61% of patients retained CPA status. Of the patients with intrahepatic failures, 58% developed progressive cirrhosis, compared to 27% with controlled disease (P = 0.06). Survival specific to hepatic failure was 92%, 81%, and 69% at 12, 18, and 24 mo. There was no grade 3 or higher toxicity. On univariate analysis, gross tumor volume (GTV) < 23 cc was associated with freedom from CP progression (P = 0.05), hepatic failure-specific survival (P = 0.02), and trended with OS (P = 0.10). SBRT is safe and effective in HCC with early cirrhosis and may extend waiting time for transplant in patients who may not otherwise be immediate candidates.


Lupus anticoagulant and the skin. A longterm follow-up study of SLE patients with special reference to histopathological findings.
Skin manifestations were described in lupus anticoagulant (LA) positive and in LA negative SLE patients. Necrotic ulcers appearing at the beginning of the disease process characterized the 33 LA positive patients. Thirteen patients had a "peripheral vascular syndrome"; small leg ulcers of livedoid vasculitis type following deep venous thromboses, in 3 patients developing into pyoderma gangrenosum like ulcers and in 2 patients into pseudo-sarcoma Kaposi. The lesions were histologically characterized by capillary angiogenesis with extravasated red blood cells, sparse inflammatory cell infiltrates and microthromboses. Three patients had ulcers clinically and histologically resembling those seen in Degos' disease. Five patients had anetoderma showing elastic tissue depletion and microthromboses histologically. A different pattern of skin changes was seen in the LA negative patients. Our findings suggest that antiphospholipid antibodies play a pathogenetic role in the described skin manifestations of LA positive SLE patients.


[Pancreas Bed Recurrence Resection Combined with Celiac and Common Hepatic Arterial Resection after Distal Pancreatectomy for Pancreatic Cancer].
A 53-year-old male underwent distal pancreatectomy with splenectomy for pancreatic body cancer. An increasing mass in the soft tissue around the common hepatic artery was detected 1 year after the primary resection and he was referred to our hospital. A low density mass measuring 16mm in length was detected around the common hepatic artery by dynamic contrast enhanced computed tomography. We diagnosed as pancreatic cancer recurrence in the pancreas bed. We performed a recurred mass resection combined with celiac and common hepatic artery resection, portal vein resection and reconstruction. Pathological examination revealed the cancer recurrence in connective tissue including nerve plexus. Adenocarcinoma cells expanded along with the nerve plexus. The tumor invaded the adventitia of the common hepatic artery. R0 resection was confirmed without exposure of cancer cells to margin. He was discharged on postoperative day 12 without any complication. He survived for 6 months after recurrence resection without metastasis. We experienced a case of local recurrence of pancreatic cancer successfully performed R0 resection in combination with CHA and CEA resection.


Metabolism and disposition of MM-433593, a selective FAAH-1 inhibitor, in monkeys.
MM-433593 is a highly potent and selective inhibitor of fatty acid amide hydrolase-1 (FAAH-1) with potential utility as an orally administered treatment of pain, inflammation, and other disorders. In this study, we investigated the metabolism and pharmacokinetics of MM-433593 in monkeys, and compared plasma and urine metabolites of this compound to the in vitro metabolites produced by monkey hepatocytes. Intravenous administration of MM-433593 to cynomolgus monkeys produced a rapid distribution phase and slower elimination phase with a mean systemic clearance rate of 8-11 mL/min/kg. Absolute oral bioavailability was determined to be 14-21% with maximum plasma concentrations reached ∼3 h (T max) following a 10 mg/kg oral dose. The average terminal half-life of MM-433593 was 17-20 h, and there were no qualitative sex differences in the metabolite profile of MM-433593. The major site of metabolism was oxidation of the methyl group at the five position of the indole ring, which was confirmed by chromatography and mass spectrometry comparison to a synthesized authentic standard. This metabolite was further oxidized to the corresponding carboxylic acid and/or conjugated with sulfate, glucuronide, or glutathione. In all, 18 metabolites were found in plasma and urine. In vitro incubations of MM-433593 with monkey hepatocytes yielded 13 metabolites, all of which were found in vivo, indicating a good correlation between the in vitro and in vivo metabolism data. A comprehensive pathway for the metabolism of MM-433593 is proposed, including a plausible, five-step biotransformation for the formation of N-acetylcysteine conjugate metabolite (M18) from the hydroxylated parent (M5).


Molecular design of new inhibitors of peroxidase activity of cytochrome c/cardiolipin complexes: fluorescent oxadiazole-derivatized cardiolipin.
Interaction of a mitochondria-specific anionic phospholipid, cardiolipin (CL), with an intermembrane protein, cytochrome c (cyt c), yields a peroxidase complex. During apoptosis, the complex induces accumulation of CL oxidation products that are essential for detachment of cyt c from the mitochondrial membrane, induction of permeability transition, and release of proapoptotic factors into the cytosol. Therefore, suppression of the peroxidase activity and prevention of CL oxidation may lead to discovery of new antiapoptotic drugs. Here, we report a new approach to regulate the cyt c peroxidase activity by using modified CL with an oxidizable and fluorescent 7-nitro-2,1,3-benzoxadiazole (NBD) moiety (NBD-CL). We demonstrate that NBD-CL forms high-affinity complexes with cyt c and blocks cyt c-catalyzed oxidation of several peroxidase substrates, cyt c self-oxidation, and, most importantly, inhibits cyt c-dependent oxidation of polyunsaturated tetralinoleoyl CL (TLCL) and accumulation of TLCL hydroperoxides. Electrospray ionization mass spectrometry and fluorescence analysis revealed that oxidation and cleavage of the NBD moiety of NBD-CL underlie the inhibition mechanism. We conclude that modified CL combining a nonoxidizable monounsaturated trioleoyl CL with a C(12)-NBD fragment undergoes a regiospecific oxidation thereby representing a novel inhibitor of cyt c peroxidase activity.


Patterns and Consequences of Whole Colony Growth in the Compound Ascidian Polyclinum planum.
The size and shape of colony-forming modular animals can convey ecological advantages, but many patterns and consequences of colony-level growth are not well understood. I carried out a longitudinal study on an intertidal population of the pedunculate ascidian Polyclinum planum to determine the patterns and consequences of its colony growth. I found that each P. planum colony is a nonfragmenting genet, and that colony size is limited by water-flow forces and reproductive state. P. planum mitigates the effects of water-flow forces by having an attenuating pattern of growth and by producing a laterally flattened, zooid-bearing lobe atop its tough flexible peduncle. Growth slows as the colony nears a size limit set by the environment and as it becomes reproductively active. The laterally flattened lobe allows colonies to increase their surface-to-volume ratio, to house increased numbers of zooids (thereby increasing reproductive potential), and to minimize the effects of the acceleration reaction of water. P. planum's growth pattern fits predictions for colonies living in wave- or surge-impacted environments. The growth of P. planum provides insight into how indeterminate modular growth conveys ecological and reproductive advantage, even amidst a physically stressful environment.


Effectiveness of psychoeducational support on quality of life in early-stage breast cancer patients: a systematic review and meta-analysis of randomized controlled trials.
Most breast cancer patients receive psychosocial support interventions. However, the effectiveness of these interventions has not yet been clarified. Quality of life (QOL) was an important construct that should be considered when assessing these interventions. The purpose was to evaluate the effectiveness of psychosocial and especially psychoeducational support interventions for early-stage breast cancer patients since the follow-up was bound up to 6 months after finishing the intervention. We conducted a systematic review and meta-analysis to identify randomized controlled trials with early-stage breast cancer patients receiving psychosocial (psychoeducational and other) support in which QOL was measured as a treatment outcome. We compared mean differences at less than 6 months post-intervention with a control group. The primary outcome was Global Health Status/QOL scale (Global QOL), and secondary outcomes were the subscales of QOL. No significant effect was observed for Global QOL; however, individuals receiving psychosocial support scored higher on the Breast Cancer Symptoms subscale. For psychoeducational support in the psychosocial support, significant effect was observed on the Emotional subscale. Our analysis strengthens the evidence of the effectiveness of psychosocial support in improving breast cancer symptoms and psychoeducational support in improving emotional well-being within 6 months post-intervention.


Performance of people with diabetes in the labor market: An empirical approach controlling for complications.
This paper introduces a framework for modelling the impact that diabetes has on employment status and wages, improving the existing literature by controlling for diabetes-related complications. Using the last wave of the Spanish National Health Survey, we find that 1710 adults out of the original sample of 36,087 have diabetes, reporting higher rates of unemployment. Our empirical results suggest that persons with diabetes, compared with non-diabetic persons, have poorer labor outcomes in terms of length of unemployment and lower income. However, diabetes is not significantly associated with unemployment probabilities, suggesting that the burden of diabetes on employment is mediated by lifestyle factors and clinical and functional complications. In addition, there are mixed outcomes to this econometric approach, depending on age and gender, among other factors. This interesting finding has several implications for research and policy on strategies to get lower health inequalities.


Synthesis of α,β-Unsaturated N-Sulfonyl Imides through Zinc-Catalyzed Intermolecular Oxidation of N-Sulfonyl Ynamides.
A novel zinc-catalyzed intermolecular oxidation of N-sulfonyl ynamides has been developed. A variety of functionalized α,β-unsaturated N-sulfonyl imides are readily accessed by utilizing this approach, thus providing a viable alternative to synthetically useful α,β-unsaturated imides. Importantly, the reaction is proposed to proceed by a vinyligous E2-type elimination pathway, but not metal carbene pathway.


Reduction of the minimum alveolar concentration of isoflurane by dexmedetomidine.
alpha 2-Adrenergic agonists have been shown to reduce anesthetic requirements of other anesthetics, and they may even act as complete anesthetics by themselves at high doses in animal models. The present study was designed to define the interaction of intravenous infusion of dexmedetomidine, an alpha 2-adrenergic agonist, and isoflurane in patients having surgery by using the minimum alveolar concentration (MAC) of isoflurane as the measure of anesthetic potency. Forty-nine women scheduled for abdominal hysterectomy were randomly allocated to receive either a placebo infusion (n = 16) or a two-stage infusion of dexmedetomidine with target plasma concentration of 0.3 ng/ml (n = 17) or 0.6 ng/ml (n = 16). The study drug infusion was commenced 15 min before induction of anesthesia with thiopental and alfentanil and was continued until skin incision. The end-tidal concentration of isoflurane for each patient was predetermined according to the "up-down" method of Dixon, and it was maintained for at least 15 min before the patient's response to skin incision was assessed. The MAC of isoflurane was 0.85% end-tidal in the control group, 0.55% end-tidal with the low dose of dexmedetomidine, and 0.45% end-tidal with the high dose of dexmedetomidine. The MAC of isoflurane in the control group was lower than that reported previously in similar patients having surgery, probably due to anesthesia induction with thiopental and alfentanil. Nevertheless, with the high dose of dexmedetomidine, the MAC of isoflurane was still 47% less than that without dexmedetomidine.


Focused ultrasound for blood-brain disruption and delivery of therapeutic molecules into the brain.
Noninvasive, transient and local image-guided blood-brain barrier disruption can be accomplished using focused ultrasound exposure with intravascular injection of preformed microbubbles. MRI-guided blood-brain barrier disruption has been demonstrated and has been shown to heal in within a few hours after exposure. The delivery of several marker molecules has been demonstrated in different animal models with minimal or no damage to the brain tissue. Most notably, the delivery of antibodies and liposomal doxorubicin has been shown. The method may potentially open a new era in CNS drug delivery and perhaps also aid in molecular imaging and targeting. However, effective clinical devices and methods need to be developed further and the clinical feasibility demonstrated.


[Determination of atomization efficiency in graphite furnace with V-boat].
Based on that the absorbance is proportional to the effective length of the absorbing layer of atoms, a simple foumula is derived by which the atomization efficiency. Two atomization efficiencies were calculated: beta1 and beta2, which gave the fraction of calculated the total number of analytical atoms that enter the analysis volume during each stage of atomization. It is based on two different calculated ways for the mean residence time of atoms, and the beta1 and beta2 values of Ga and Tl in furnace with V-boat in various atomization temperatures were determined. Influence of the loss process of atomic vapor on the atomization efficiency value was discussed.


Iranian staff nurses' views of their productivity and human resource factors improving and impeding it: a qualitative study.
Nurses, as the largest human resource element of health care systems, have a major role in providing ongoing, high-quality care to patients. Productivity is a significant indicator of professional development within any professional group, including nurses. The human resource element has been identified as the most important factor affecting productivity. This research aimed to explore nurses' perceptions and experiences of productivity and human resource factors improving or impeding it. A qualitative approach was used to obtain rich data; open, semi-structured interviews were also conducted. The sampling was based on the maximum variant approach; data analysis was carried out by content analysis, with the constant comparative method. Participants indicated that human resources issues are the most important factor in promoting or impeding their productivity. They suggested that the factors influencing effectiveness of human resource elements include: systematic evaluation of staff numbers; a sound selection process based on verifiable criteria; provision of an adequate staffing level throughout the year; full involvement of the ward sister in the process of admitting patients; and sound communication within the care team. Paying attention to these factors creates a suitable background for improved productivity and decreases negative impacts of human resource shortages, whereas ignoring or interfering with them would result in lowering of nurses' productivity. Participants maintained that satisfactory human resources can improve nurses' productivity and the quality of care they provide; thereby fulfilling the core objective of the health care system.


Prevalence and determinants of stillbirth among women attended deliveries in Aksum General Hospital: a facility based cross-sectional study.
In Ethiopia skilled deliveries are increasing but stillbirth is not reducing as required. However; there are limited numbers of up to date studies done related to stillbirth in the study area. Therefore this was aimed to assess the prevalence and determinants of stillbirth using facility based cross-sectional study among women attended deliveries at Aksum General Hospital in 2018. Systematic random sampling method was used to select 573 study participants from the deliveries attended during the study period. The data was entered into Epi-data version 3.1 and exported to Statistical Package for Social Science version 21 for analysis. Bivariate and multivariable logistic regression analysis were conducted to identify significant predictors and strength of association was measured based on adjusted odds ratio with 95% confidence level and statistical significance was declared at p-value less than 0.05. The prevalence of stillbirth was 3.68% in this study area. Maternal age 20-35 (AOR = 0.25; 95% CI (0.08, 0.80)), not using partograph (AOR = 8.66; 95% CI (2.88, 26.10)) and gestational age < 37 weeks (AOR = 3.86; 95% CI (1.27, 11.69)) were the independent factors affecting the stillbirth.


SEM localization of cell-surface-associated fibronectin in the cranium of chick embryos utilizing immunolatex microspheres.
Fibronectin has been localized to basement membranes and cell surfaces with the light microscope by fluorescent staining of thick sections, and with the TEM by immunoperoxidase reaction. However, these methods are limited because it is difficult to appreciate the patterned distribution of fibronectin from sectioned material. We have developed a probe for fibronectin that facilitates its identification with the SEM. Our probe consists of two parts; the first component is a derivatized methacrylate microsphere 90 nm in diameter, linked to purified sheep anti-rabbit IgG. The second component is anti-fibronectin IgG raised in rabbits. Stage-3 to -12 chick embryos were fixed and the ectoderm covering the cranial mesoderm was removed. Embryos were treated with testicular hyaluronidase, exposed to rabbit anti-fibronectin IgG and finally to sheep anti-rabbit IgG conjugated microspheres. As expected, the basal lamina of surface and neural ectoderm as well as the remaining fibrous ECM were heavily decorated with microspheres, whereas control embryos treated with preimmune serum were beadless. Fibronectin was localized on the cell soma and processes of primary mesenchyme as early as stage 3. In addition, it was possible to decorate to various extents, populations of prosencephalic, mesencephalic, and rhombencephalic cranial neural crest cells. Our studies suggest that fibronectin is present in the cranium of chick embryos at earlier times than heretofore realized, and that fibronectin accumulates in a cranial to caudal gradient that reflects the sequential differentiation of the embryonic axis.


Promising potential of machine learning-assisted MALDI-TOF MS as an effective detector for Streptococcus suis serotype 2 and virulence thereof.
To the best of our knowledge, this study reveals a strong correlation between mass spectra pattern and virulence phenotype among S. suis for the first time. In order to make the findings applicable and to excavate the intrinsic information in the spectra, the classifiers based on the machine learning algorithms were established, and RF (Random Forest)-based models have achieved an accuracy of over 90%. Overall, this study will pave the way for virulent SS2 (Streptococcus suis serotype 2) rapid detection, and the important findings on the association between genotype and mass spectrum may provide a new idea for the genotype-dependent detection of specific pathogens.


Directly lighting up RNA G-quadruplexes from test tubes to living human cells.
RNA G-quadruplexes (G4s) are one of the key components of the transcriptome that act as efficient post-transcriptional regulatory elements in living cells. To conduct further studies of the unique biological functions of RNA G4s, techniques need to be developed that can efficiently recognize RNA G4 structures under various conditions, in fixed cells and living cells, as well as in vitro. This paper presents the development of such a method, a new technique using a cyanine dye called CyT, which can detect both canonical and non-canonical RNA G4 structures from test tubes to living human cells. The ability of CyT to distinguish between G4 and nonG4 RNA offers a promising tool for future RNA G4-based biomarker discovery and potential diagnostic applications.


Use of left atrial automated functional myocardial imaging to identify patients with paroxysmal atrial fibrillation at high risk of stroke.
Left atrial automated functional myocardial imaging (AFILA) is a new software program for analyzing the structure and function of the left atrium (LA). The present study sought to analyze the correlation between the LA function parameters as measured by AFILA echocardiography and the risk of cerebral ischemic stroke (CIS) in patients with non-valvular paroxysmal atrial fibrillation (NVPAF) to explore the diagnostic value of LA strain in patients with congestive heart failure, hypertension, age of ≥75 years (doubled), diabetes mellitus, stroke or transient ischemic attack (TIA) (doubled), age of 65-74 years, and sex category (female) (CHA2DS2-VASc) scores of <2. A total of 205 patients with NVPAF were included in the study and divided into the no-CIS group (154 patients) and the CIS group (51 patients). The baseline clinical data for the 2 groups were analyzed, and routine echocardiography examinations were performed. AFILA was used to evaluate the LA function of all the patients. Compared to the no-CIS group, the LA emptying fraction and the LA reservoir strain were decreased, the LA contractile strain (S_CT) was increased, and the S_CT value changed from negative to positive in the CIS group, and the difference between the 2 groups were statistically significant (P<0.001). However, there were no significant differences in the volume at the onset of LA contraction, LA evacuation volume, LA minimum volume, LA maximum volume, and LA conduit strain between the 2 groups. The multifactorial regression analysis showed that age, hypertension, and the S_CT were independently associated risk factors for patients with CIS. After correcting for the clinical factors included in the CHA2DS2-VASc score, the S_CT was shown to predict to NVPAF with stroke [odds ratio (OR): 1.234, 95% confidence interval (CI): 1.101-1.383, P=0.000]. In addition, we included the CHA2DS2-VASc score (instead of age, diabetes, coronary artery disease, and hypertension) in a multiple regression analysis, and found that the S_CT was still significant (OR: 1.252, 95% CI: 1.118-1.402, P=0.000). The difference between the 2 groups in the CHA2DS2-VASc score for the S_CT was statistically significant, especially when the CHA2DS2-VASc score was <2. The S_CT equaled -4.5% was the cut-off value for the presence or absence of CIS in the NVPAF patients, with an area under the curve (AUC) of 0.866, sensitivity of 0.80, and specificity of 0.75 (P<0.0001). Comparison with LA volume parameter, measuring LA strain by AFILA provides a better index for the dynamic assessment of impaired LA function in patients with NVPAF combined with CIS, especially in those with a CHA2DS2-VASc score of <2. In addition, a LA S_CT of >-4.5% is a valuable cut-off for patients with NVPAF. The results of the current study may form the basis for a large prospective multicenter interventional study in which patients with impaired LA S_CT are randomized to receive oral anti-coagulant (OAC) therapy or no OAC therapy for the primary prevention of stroke.


Successful salvage surgery followed by second ALK-TKI after alectinib failure in a patient with ALK-positive NSCLC.
Anaplastic lymphoma kinase (ALK)-tyrosine kinase inhibitors (TKIs) have been approved for the therapy of locally advanced non-small cell lung cancer (NSCLC) caused by ALK rearrangement. However, its treatment after failure of initial ALK-TKI therapy remains controversial. A 47-year-old woman with a hemosputum was diagnosed with adenocarcinoma of the left lung (cT2bN3M0, stage IIIB). Gene mutation analysis indicated positive ALK translocation. Alectinib was selected as the first-line treatment. Although the treatment effect was determined as a partial response, the main tumor regrew. Alectinib was discontinued, and salvage surgery was performed without causing morbidity. The pathological diagnosis was pleomorphic carcinoma without lymph node metastasis (yp-T2bN0). After surgery, lorlatinib was administered as the second-line treatment for 8 months until the patient could not tolerate continuation. Computed tomography scan revealed no lung cancer recurrence 14 months after discontinuation. Our experience with this case suggests that salvage surgery after alectinib treatment followed by lorlatinib therapy may be effective for initially unresectable ALK-positive NSCLC.


Tremor: clinical phenomenology and assessment techniques.
Tremors are among the most common movement disorders. As there can be considerable variability in the manner in which clinicians assess tremor, objective quantitative tools such as electromyography, accelerometry, and computerized, spiral analysis can be very useful in establishing a clinical diagnosis and in research settings. In this review, we discuss the various methods of quantitative tremor analysis and the classification and pathogenesis of tremor. The most common pathologic tremors and an approach to the diagnosis of tremor etiology are described. Pathologic tremors are common, and the diagnosis of underlying etiology is not always straightforward. Computerized quantitative tremor analysis is a valuable adjunct to careful clinical evaluation in distinguishing tremulous diseases from physiologic tremors, and can also help shed light on their pathogenesis.


A single bout of prior resistance exercise attenuates muscle atrophy and declines in myofibrillar protein synthesis during bed-rest in older men.
Impairments in myofibrillar protein synthesis (MyoPS) during bed rest accelerate skeletal muscle loss in older adults, increasing the risk of adverse secondary health outcomes. We investigated the effect of prior resistance exercise (RE) on MyoPS and muscle morphology during a disuse event in 10 healthy older men (65-80 years). Participants completed a single bout of unilateral leg RE the evening prior to 5 days of in-patient bed-rest. Quadriceps cross-sectional area (CSA) was determined prior to and following bed-rest. Serial muscle biopsies and dual stable isotope tracers were used to determine rates of integrated MyoPS (iMyoPS) over a 7 day habitual 'free-living' phase and the bed-rest phase, and rates of acute postabsorptive and postprandial MyoPS (aMyoPS) at the end of bed rest. Quadriceps CSA at 40%, 60% and 80% of muscle length significantly decreased in exercised (EX) and non-exercised control (CTL) legs with bed-rest. The decline in quadriceps CSA at 40% and 60% of muscle length was attenuated in EX compared with CTL. During bed-rest, iMyoPS rates decreased from habitual values in CTL, but not EX, and were significantly different between legs. Postprandial aMyoPS rates increased above postabsorptive values in EX only. The change in iMyoPS over bed-rest correlated with the change in quadriceps CSA in CTL, but not EX. A single bout of RE attenuated the decline in iMyoPS rates and quadriceps atrophy with 5 days of bed-rest in older men. Further work is required to understand the functional and clinical implications of prior RE in older patient populations. KEY POINTS: Age-related skeletal muscle deterioration, linked to numerous adverse health outcomes, is driven by impairments in muscle protein synthesis that are accelerated during periods of disuse. Resistance exercise can stimulate muscle protein synthesis over several days of recovery and therefore could counteract impairments in this process that occur in the early phase of disuse. In the present study, we demonstrate that the decline in myofibrillar protein synthesis and muscle atrophy over 5 days of bed-rest in older men was attenuated by a single bout of unilateral resistance exercise performed the evening prior to bed-rest. These findings suggest that concise resistance exercise intervention holds the potential to support muscle mass retention in older individuals during short-term disuse, with implications for delaying sarcopenia progression in ageing populations.


micF RNA in ompB mutants of Escherichia coli: different pathways regulate micF RNA levels in response to osmolarity and temperature change.
The repressor RNA, micF RNA, is regulated by temperature, osmolarity, and other stress conditions during growth of Escherichia coli. Northern (RNA) blot analyses showed that levels of micF RNA differ widely in various ompB mutant strains when cells are grown at 24 degrees C in LB broth. For example, relative to the parental strain MC4100, the ompR101 mutant strain (which contains no functional OmpR) had about a 10-fold reduction in micF RNA, whereas the envZ11 strain showed about a 5-fold increase. At 37 degrees C, however, micF RNA levels in the ompR101 and envZ11 strains and other ompB mutants differed by less than two-fold compared with the level in strain MC4100, thus indicating that a factor(s) independent of the ompB locus regulates micF RNA expression with temperature increase and that there is an additional control mechanism(s) which maintains the levels of micF RNA in these mutants close to that of the wild type during growth at high temperatures. In a plasmid strain containing the micF gene but without the upstream OmpR-binding site, steady-state levels of micF RNA increased with temperature increase but did not change with osmolarity increase. This showed that osmolal regulation but not temperature regulation of micF depends on these upstream sequences and suggested that while osmolal regulation of the micF gene depends on OmpR, thermal regulation does not.


Serological Evidence of Anaplasma phagocytophilum and Spotted Fever Group Rickettsia spp. Exposure in Horses from Central Italy.
Anaplasma phagocytophilum and Rickettsia spp. are tick-borne bacteria of veterinary and human concern. In view of the One-Health concept, the present study wanted to evaluate the spreading of these pathogens in horses living in central Italy. In particular, the aim of the investigation was to verify the exposure to A. phagocytophilum in order to update the prevalence of this pathogen in the equine population from this area, and to spotted fever group (SFG) Rickettsia spp. to evaluate a possible role of horses in the epidemiology of rickettsiosis. Indirect immunofluorescent assay was carried out to detect antibodies against A. phagocytophilum and SFG (spotted fever group) Rickettsia spp. in blood serum samples collected from 479 grazing horses living in central Italy during the period from 2013 to 2018. One hundred and nine (22.75%) horses were positive for A. phagocytophilum, 72 (15.03%) for SFG Rickettsia spp., and 19 (3.96%) for both antigens. The obtained results confirm the occurrence of A. phagocytophilum in equine populations, and also suggest the involvement of horses in the epidemiology of SFG rickettsiosis. In both cases, in view of the zoonotic aspect of these pathogens and the frequent contact between horses and humans, the monitoring of equine populations could be useful for indication about the spreading of the tick-borne pathogens in a certain geographic area.


Use of vaginal concretions of calcium carbonate to detect ovulation in hamsters.
Concretions of calcium carbonate normally appear every third and fourth da of the 4-da hamster cycle da 1 = day of ovulation). We presently found that the 2-da relation between ovulation and concretion formation was maintained even after ovulation was delayed 1 or more da by centrally acting drugs or by exposing the hamsters to constant light. It is therefore possible to identify days of ovulation in vaginal washing records of both normal and treated hamsters by counting back 2 da from each sequence of concretions.


Do Cultures Obtained During Primary THA Predict the Likelihood of Revision?
There can be unexpectedly positive culture results during elective hip arthroplasty, but the degree to which these are associated with an increased risk of subsequent premature revision is not known. Are unexpectedly positive culture results obtained during elective THA associated with an increased likelihood of revision within 5 years of the procedure? Between March 2007 and March 2011, the hip unit at our institution performed elective primary THA in 829 patients. We systematically collected three samples in 52% (428 of 829) of the interventions. Of those, 26 patients were excluded because of sampling errors; 94% (402 of 428) had samples that were collected systematically and were eligible for the study. We only considered one hip randomly in bilateral procedures (4% [15 of 428]); patients presenting with acute (< 3 months) periprosthetic joint infection undergoing open debridement (4% [16 of 402]) and patients who died before 5 years of follow-up (2% [seven of 402]) were excluded from the study, leaving 91% (364 of 402) eligible for analysis in this retrospective study of a previous prospective trial. No patient included in the final analysis was lost to follow-up within 5 years from the index surgery. The patient group consisted of 52% (188 of 364) women, with a mean ± SD age of 64.8 ± 13.9 years. Positives culture results were associated with a higher risk of revision within 5 years of the index surgery. The proportion of revision surgery was higher in the group with positive culture results than in those with negative results (10% [eight of 77] versus 2% [seven of 290]; p = 0.01). The difference was mainly attributable to a higher proportion of aseptic loosening in those with positive culture results than in those with negative results (8% [six of 74] versus 1% [four of 290]; p = 0.01). After a multivariable analysis, the only independent variable associated with 5-year revision surgery was the presence of positive results during THA (odds ratio 4.9 [95% confidence interval 1.72 to 13.99]). Our findings suggest that bacterial contamination during THA is associated with an increased likelihood of early revision. This higher risk of revision is mainly because of presumed aseptic loosening; thus, efforts should focus on the need to rule out infection. These results not only open new questions that should be answered in new prospective and well-designed studies, but also may help to better select patients to obtain a more favorable outcome after THA. Level III, therapeutic study.


Effects of different dopaminergic antagonists on bromocriptine-induced inhibition of norepinephrine release.
In this study we evaluated the effects of placebo or acute bromocriptine (BC) administration (2.5 mg orally) on plasma catecholamines, systolic and diastolic blood pressure (BP), heart rate, and plasma PRL in six normal subjects [group I, mean age 33.2 +/- 5.4 (SD) yr] in the supine as well as upright position. BC induced a significant decrease in plasma norepinephrine in the supine [167.7 +/- 16.8 (SEM) vs. 101.9 +/- 33.7 pg/ml, P less than 0.005] and upright positions [397.3 +/- 27.7 vs. 211.3 +/- 26.7 pg/ml, P less than 0.005], a decrease in systolic and diastolic BP and a decrease in plasma PRL (P less than 0.01). After standing, epinephrine levels increased significantly (53.6 +/- 11.8 vs. 226.4 +/- 71.0 pg/ml, P less than 0.05). The study was repeated in a second group of seven normal subjects (mean age, 32.3 +/- 12.9 yr) after placebo or metoclopramide (20 mg orally) plus BC. In this group metoclopramide, a central and peripheral antidopaminergic agent, counteracted the BC-induced effects found in group I, both in the basal and stimulated conditions. Plasma PRL increased significantly (P less than 0.025). Finally, to assess the effect of peripheral dopaminergic blockade on BC-induced changes in sympathetic outflow, we repeated the study in seven normal subjects (group III, mean age, 30.1 +/- 5.0 yr) after placebo or domperidone (20 mg orally) plus BC. Domperidone blocked the effects of BC on norepinephrine and BP in the supine position. On standing there was a significant decrease in systolic (P less than 0.05) and diastolic (P less than 0.05) BP and an increase in epinephrine levels (58.9 +/- 12.2 vs. 109.8 +/- 24.6 pg/ml, P less than 0.05) was still observed. Plasma PRL increased significantly (P less than 0.025). The results of this study suggest that the inhibition of sympathetic outflow induced by BC is peripherally mediated. As peripheral dopamine receptor blockade did not counteract all the effects after BC during standing, dopaminergic modulation of central reflex sympathetic activation is suggested.


The Role of Self-Compassion in Buffering Symptoms of Depression in the General Population.
Self-compassion, typically operationalized as the total score of the Self-Compassion Scale (SCS; Neff, 2003b), has been shown to be related to increased psychological well-being and lower depression in students of the social sciences, users of psychology websites and psychotherapy patients. The current study builds on the existing literature by examining the link between self-compassion and depressive symptomatology in a sample representative of the German general population (n = 2,404). The SCS subscales of self-judgment, isolation, and over-identification, and the "self-coldness", composite score, which encompass these three negative subscales, consistently differed between subsamples of individuals without any depressive symptoms, with any depressive syndromes, and with major depressive disorder. The contribution of the positive SCS subscales of self-kindness, common humanity, and mindfulness to the variance in depressive symptomatology was almost negligible. However, when combined to a "self-compassion composite", the positive SCS subscales significantly moderated the relationship between "self-coldness" and depressive symptoms in the general population. This speaks for self-compassion having the potential to buffer self-coldness related to depression--providing an argument for interventions that foster self-caring, kind, and forgiving attitudes towards oneself.


Ultra-wideband tunable metamaterial perfect absorber based on vanadium dioxide.
A dynamically adjustable ultra-wideband metamaterial perfect absorber (MPA) is proposed which consists of three resonance rings based on vanadium dioxide (VO2) and a metal ground layer separated by a dielectric spacer. The simulation results show that the terahertz (THz) absorption bandwidth of more than 90% absorptance reaches 3.30 THz, which covers from 2.34 to 5.64 THz, under different incident polarization angles. The range is better than that of previous VO2-based reports. Moreover, when the conductivity of VO2 changes from 200 S/m to 2×105 S/m, the absorption peak intensity can be adjusted continuously from 4% to 100%. The key is to optimize the geometric structure through interference cancellation and impedance matching theory, to achieve better absorption bandwidth and efficiency. Besides, the terahertz absorber has a wide-angle absorption effect both in TE and TM waves. Thus, the designed absorber may have many potential applications in modulating, sensing and imaging technology.


Extensive contribution of embryonic stem cells to the development of an evolutionarily divergent host.
The full potential of embryonic stem (ES) cells to generate precise cell lineages and complex tissues can be best realized when they are differentiated in vivo-i.e. in developing blastocysts. Owing to various practical and ethical constraints, however, it is impossible to introduce ES cells of certain species into blastocysts of the same species. One solution is to introduce ES cells into blastocysts of a different species. However, it is not known whether ES cells can contribute extensively to chimerism when placed into blastocysts of a distantly related species. Here, we address this question using two divergent species, Apodemus sylvaticus and Mus musculus, whose genome sequence differs by approximately 18% from each other. Despite this considerable evolutionary distance, injection of Apodemus ES cells into Mus blastocysts led to viable chimeras bearing extensive Apodemus contributions to all major organs, including the germline, with Apodemus contribution reaching approximately 40% in some tissues. Immunostaining showed that Apodemus ES cells have differentiated into a wide range of cell types in the chimeras. Our results thus provide a proof of principle for the feasibility of differentiating ES cells into a wide range of cell types and perhaps even complex tissues by allowing them to develop in vivo in an evolutionarily divergent host-a strategy that may have important applications in research and therapy. Furthermore, our study demonstrates that mammalian evolution can proceed at two starkly contrasting levels: significant divergence in genome and proteome sequence, yet striking conservation in developmental programs.


Defining normal ambulatory blood pressure in relation to target organ damage and prognosis.
It is premature to state that ambulatory blood pressure (ABP) values below a given level should be considered normal, and those above it abnormal, in terms of prognostic implications on cardiovascular (CV) morbidity. We do not know whether CV morbidity in hypertensive subjects with apparently normal ABP (white coat hypertension) is less than that in patients with higher ABP levels and similar to that of healthy normotensive subjects, or whether the effects of antihypertensive drug treatment on CV morbidity are superior to placebo in white coat hypertension. It is important to achieve agreement on a temporary working definition of normal ABP to be used to test two main hypotheses: 1) in subjects with white coat hypertension, CV morbidity is less than that in patients with higher ABP levels; and 2) drug treatment is not superior to placebo in reducing CV morbidity in white coat hypertension. Normal ABP values can be derived empirically from population based samples, in selected groups of healthy subjects, or from meta-analyses. However, the significance of the definition of a normal ABP range is the identification of clinically hypertensive patients at low risk of future CV morbid events. Using echocardiographic left ventricular (LV) mass as a surrogate outcome measure, we found that the coexistence of mean daytime ABP levels < 134 mm Hg systolic and < 90 mm Hg diastolic, regardless of gender (< 136/87 mm Hg in men and 131/86 mm Hg in women) identifies a subgroup of clinically hypertensive subjects with echocardiographic LV mass, and associated prevalence of left ventricular hypertrophy (LVH) similar to those found in healthy normotensive control subjects.(ABSTRACT TRUNCATED AT 250 WORDS)


Detection of hepatic metastases in diffuse fatty infiltration by CT: the complementary role of imaging.
Six patients undergoing computed tomographic (CT) evaluation for possible abdominal and pelvic metastases were shown to have diffuse fatty infiltration of the liver and findings indeterminate for hepatic metastases. In two patients with diffuse fatty infiltration and no focal hepatic lesions on CT, technetium-99m sulfur colloid imaging demonstrated focal hepatic defects confirmed to represent metastases. In four patients with diffuse fatty infiltration and hyperdense liver foci on CT, radionuclide imaging demonstrated normal uptake in the hyperdense foci confirmed to represent areas of normal liver spared by fatty infiltration. In each of the six patients, clinical management was altered by the radionuclide findings.


Dietary pattern and growth of 10-12-year-old Bolivian girls and boys: Relation between altitude and socioeconomic status.
The purpose of the study was to determine the impact of nutrition and physical activity on growth and health of 228 native Bolivian prepubertal girls and boys 10-12 years of age, from high socioeconomic status (HSES) and low socioeconomic status (LSES), living at high altitude (HA) in La Paz (∼4,000 m) and at low altitude (LA) in St. Cruz (∼400 m). In the 4 years of the study, dietary information and daily physical activities were obtained with the 24-hour recall method by interviewing the child and mother. All food items were converted into grams, and nutrients were calculated by using food composition tables for Latin America. Physical activities were estimated in four intensity levels and calculated in terms of energy output. The results show that nutritional intake is influenced by socioeconomic status, but not by altitude. Overall, the energy and nutrient intake of the HSES girls and boys was significantly higher (P ≤ 0.01) than the intake of the LSES children at both altitudes; no sex effect was evident. HSES girls and boys consumed greater amounts of nutrients, especially protein and fat; they were taller but also fatter. The physical activity of LSES children was higher than that of HSES children. The lower energy intake and the higher energy expenditure of LSES children were reflected in their smaller body size. Am. J. Hum. Biol. 9:51-62 © 1997 Wiley-Liss, Inc.


The genetic signature of sex-biased migration in patrilocal chimpanzees and humans.
A large body of theoretical work suggests that analyses of variation at the maternally inherited mitochondrial (mt)DNA and the paternally inherited non-recombining portion of the Y chromosome (NRY) are a potentially powerful way to reveal the differing migratory histories of men and women across human societies. However, the few empirical studies comparing mtDNA and NRY variation and known patterns of sex-biased migration have produced conflicting results. Here we review some methodological reasons for these inconsistencies, and take them into account to provide an unbiased characterization of mtDNA and NRY variation in chimpanzees, one of the few mammalian taxa where males routinely remain in and females typically disperse from their natal groups. We show that patterns of mtDNA and NRY variation are more strongly contrasting in patrilocal chimpanzees compared with patrilocal human societies. The chimpanzee data we present here thus provide a valuable comparative benchmark of the patterns of mtDNA and NRY variation to be expected in a society with extremely female-biased dispersal.


Study of the knowledge about gamification of degree in primary education students.
Gamification refers to the use of game mechanics in non-recreational environments, such as the school environment, in order to enhance motivation, concentration, effort, commitment and other positive values common to all games. Gamification allows us to establish clear objectives that are presented to be overcome. It also offers constant feedback, shows the progression of students, recognizes their effort and it guides them over the course of the teaching and learning process. The aim is to measure the knowledge of future teachers about gamification as a didactic resource. The sample is composed of 164 students of the Degree in Primary Education in Galicia (Spain). The scale obtains a reliability of 0.94 α. The index of Kaiser-Meyer-Olkin (KMO) provides a value of 0.932 and Bartlett's test of sphericity (χ2 = 2739,793; gl = 351, p < .000), ensuring that the factor analysis is right, and the model achieves a good fit. The students of the Degree in Primary Education have not heard of the term gamification, but still consider feasible its implementation in the school environment. The students feel that they don't know enough about this teaching resource, and they are afraid of not achieving the curricular objectives using it as they have no control over the content to be taught.


Identification of diverse groups of endogenous gammaretroviruses in mega- and microbats.
A previous phylogenetic study suggested that mammalian gammaretroviruses may have originated in bats. Here we report the discovery of RNA transcripts from two putative endogenous gammaretroviruses in frugivorous (Rousettus leschenaultii retrovirus, RlRV) and insectivorous (Megaderma lyra retrovirus, MlRV) bat species. Both genomes possess a large deletion in pol, indicating that they are defective retroviruses. Phylogenetic analysis places RlRV and MlRV within the diversity of mammalian gammaretroviruses, with the former falling closer to porcine endogenous retroviruses and the latter to Mus dunni endogenous virus, koala retrovirus and gibbon ape leukemia virus. Additional genomic mining suggests that both microbat (Myotis lucifugus) and megabat (Pteropus vampyrus) genomes harbour many copies of endogenous retroviral forms related to RlRV and MlRV. Furthermore, phylogenetic analysis reveals the presence of three genetically diverse groups of endogenous gammaretroviruses in bat genomes, with M. lucifugus possessing members of all three groups. Taken together, this study indicates that bats harbour distinct gammaretroviruses and may have played an important role as reservoir hosts during the diversification of mammalian gammaretroviruses.


Current Controversies in Reverse Total Shoulder Arthroplasty.
Reverse total shoulder arthroplasty can restore forward elevation in pseudoparalytic shoulders, can reduce pain, and can increase quality of life for patients; however, there are a number of issues with regard to the design and ideal implantation technique of reverse total shoulder arthroplasties that remain controversial. Glenospheres with a Grammont, medialized center of rotation and designs with a more lateralized center of rotation have specific pros and cons. Medialized designs have historically decreased glenosphere loosening but increase scapular notching, and lateralized designs decrease notching and improve range of motion but historically have resulted in increased baseplate failure. As such, a concrete conclusion with regard to medialization or lateralization of the glenosphere cannot be made at this time. Caudal, inferior placement of the glenosphere increases internal rotation, external rotation, abduction, and adduction while reducing notching. Superior baseplate positioning and tilt are correlated with baseplate failure and therefore should be avoided. It remains unclear whether neutral or slightly inferior tilt is preferred. The ideal humerosocket inclination angle remains unclear. The 135[degrees] designs appear to have a lower rate of scapular notching than the Grammont-style 155[degrees] humerosockets. The implications of this angle for instability remain unclear as, to our knowledge, there have been no randomized comparisons and the largest meta-analysis was confounded by other implant variables.


Collective forward-looking responsibility of patient advocacy organizations: conceptual and ethical analysis.
Patient advocacy organizations (PAOs) have an increasing influence on health policy and biomedical research, therefore, questions about the specific character of their responsibility arise: Can PAOs bear moral responsibility and, if so, to whom are they responsible, for what and on which normative basis? Although the concept of responsibility in healthcare is strongly discussed, PAOs particularly have rarely been systematically analyzed as morally responsible agents. The aim of the current paper is to analyze the character of PAOs' responsibility to provide guidance to themselves and to other stakeholders in healthcare. Responsibility is presented as a concept with four reference points: (1) The subject, (2) the object, (3) the addressee and (4) the underlying normative standard. This four-point relationship is applied to PAOs and the dimensions of collectivity and prospectivity are analyzed in each reference point. Understood as collectives, PAOs are, in principle, capable of intentionality and able to act and, thus, fulfill one prerequisite for the attribution of moral responsibility. Given their common mission to represent those affected, PAOs can be seen as responsible for patients' representation and advocacy, primarily towards a certain group but secondarily in a broader social context. Various legal and political statements and the bioethical principles of justice, beneficence and empowerment can be used as a normative basis for attributing responsibility to PAOs. The understanding of responsibility as a four-point relation incorporating collective and forward-looking dimensions helps one to understand the PAOs' roles and responsibilities better. The analysis, thus, provides a basis for the debate about PAOs' contribution and cooperation in the healthcare sector.


[Endoprosthesis in ununited fractures and pseudarthroses of the femur neck in middle-aged and elderly patients].
An experience with the treatment of 92 patients with non-united fractures and false joints of the femoral neck is described. Among them there were 52 elderly and senile patients who were subjected to various kinds of endoprosthezing of the hip joint. The authors have established certain advantages of individual one-pole endoprostheses after A. V. Vorontsov as compared with a standard method of endoprostheses after Moore--CITO.


Structure-Based Engineering of an Artificially Generated NADP+-Dependent d-Amino Acid Dehydrogenase.
A stable NADP+-dependent d-amino acid dehydrogenase (DAADH) was recently created from Ureibacillus thermosphaericusmeso-diaminopimelate dehydrogenase through site-directed mutagenesis. To produce a novel DAADH mutant with different substrate specificity, the crystal structure of apo-DAADH was determined at a resolution of 1.78 Å, and the amino acid residues responsible for the substrate specificity were evaluated using additional site-directed mutagenesis. By introducing a single D94A mutation, the enzyme's substrate specificity was dramatically altered; the mutant utilized d-phenylalanine as the most preferable substrate for oxidative deamination and had a specific activity of 5.33 μmol/min/mg at 50°C, which was 54-fold higher than that of the parent DAADH. In addition, the specific activities of the mutant toward d-leucine, d-norleucine, d-methionine, d-isoleucine, and d-tryptophan were much higher (6 to 25 times) than those of the parent enzyme. For reductive amination, the D94A mutant exhibited extremely high specific activity with phenylpyruvate (16.1 μmol/min/mg at 50°C). The structures of the D94A-Y224F double mutant in complex with NADP+ and in complex with both NADPH and 2-keto-6-aminocapronic acid (lysine oxo-analogue) were then determined at resolutions of 1.59 Å and 1.74 Å, respectively. The phenylpyruvate-binding model suggests that the D94A mutation prevents the substrate phenyl group from sterically clashing with the side chain of Asp94. A structural comparison suggests that both the enlarged substrate-binding pocket and enhanced hydrophobicity of the pocket are mainly responsible for the high reactivity of the D94A mutant toward the hydrophobic d-amino acids with bulky side chains.IMPORTANCE In recent years, the potential uses for d-amino acids as source materials for the industrial production of medicines, seasonings, and agrochemicals have been growing. To date, several methods have been used for the production of d-amino acids, but all include tedious steps. The use of NAD(P)+-dependent d-amino acid dehydrogenase (DAADH) makes single-step production of d-amino acids from oxo-acid analogs and ammonia possible. We recently succeeded in creating a stable DAADH and demonstrated that it is applicable for one-step synthesis of d-amino acids, such as d-leucine and d-isoleucine. As the next step, the creation of an enzyme exhibiting different substrate specificity and higher catalytic efficiency is a key to the further development of d-amino acid production. In this study, we succeeded in creating a novel mutant exhibiting extremely high catalytic activity for phenylpyruvate amination. Structural insight into the mutant will be useful for further improvement of DAADHs.