A Review of Symptomatic Lumbosacral Transitional Vertebrae: Bertolotti's Syndrome.
Lumbosacral transitional vertebrae (LSTV) are increasingly recognized as a common anatomical variant associated with altered patterns of degenerative spine changes. This review will focus on the clinical significance of LSTV, disruptions in normal spine biomechanics, imaging techniques, diagnosis, and treatment. A Pubmed search using the specific key words "LSTV," "lumbosacral transitional vertebrae," and "Bertolotti's Syndrome" was performed. The resulting group of manuscripts from our search was evaluated. LSTV are associated with alterations in biomechanics and anatomy of spinal and paraspinal structures, which have important implications on surgical approaches and techniques. LSTV are often inaccurately detected and classified on standard AP radiographs and MRI. The use of whole-spine images as well as geometric relationships between the sacrum and lumbar vertebra increase accuracy. Uncertainty regarding the cause, clinical significance, and treatment of LSTV persists. Some authors suggest an association between LSTV types II and IV and low back pain. Pseudoarticulation between the transverse process and the sacrum creates a "false joint" susceptible to arthritic changes and osteophyte formation potentially leading to nerve root entrapment. The diagnosis of symptomatic LSTV is considered with appropriate patient history, imaging studies, and diagnostic injections. A positive radionuclide study along with a positive effect from a local injection helps distinguish the transitional vertebra as a significant pain source. Surgical resection is reserved for a subgroup of LSTV patients who fail conservative treatment and whose pain is definitively attributed to the anomalous pseudoarticulation. Due to the common finding of low back pain and the wide prevalence of LSTV in the general population, it is essential to differentiate between symptoms originating from an anomalous psuedoarticulation from other potential sources of low back pain. Further studies with larger sample sizes and longer follow-up time would better demonstrate the effectiveness of surgical resection and help guide treatment.


Early treatment with intravenous immunoglobulin in patients with Kawasaki disease.
To determine if a shorter interval between Kawasaki disease (KD) treatment with intravenous immunoglobulin (IVIG) and fever onset results in increased treatment failures, need for adjunctive therapy, or development of coronary artery lesions. Patients with KD (n = 178; 89 matched pairs) diagnosed between 1987 and 1999 were included in this case-control study. All patients had fever plus at least 4 of the 5 clinical criteria for KD. Eighty-nine patients who received IVIG at day 5 or earlier were matched to patients diagnosed within 4 weeks and given IVIG at days 6 to 9 of fever. Compiled data from a detailed chart review included demographics, clinical features, fever duration, investigations, disease course, and response to therapy. Differences between matched case and control pairs were analyzed by means oft tests and McNemar tests. No demographic differences were noted between the two groups. Patients treated on day 5 or less of fever had a shorter total fever duration (5.2 +/- 1.9 days vs 8.0 +/- 1.8 days, P <.0001), longer fever after IVIG treatment (1.5 +/- 1.9 days vs 0.8 +/- 1.3 days, P =.008), and less coronary artery ectasia at 1 year after KD onset (4% vs 16%, P =.02). There was no significant difference between cases and control patients in the number of patients with KD recrudescence, need for repeat courses of IVIG, need for corticosteroids, length of hospitalization, or development of coronary artery aneurysms within the first 3 months. Patients who were treated on day 5 or less of fever had higher levels of serum albumin (36 +/- 5 g/L vs 33 +/- 5 g/L, P <.01) and serum ALT (115 +/- 155 U/L vs 46 +/- 49 U/L, P <.001) as well as a lower platelet count (354 +/- 131 vs 403 +/- 166, P =.02) than did control patients during the acute phase. Early treatment of KD resulted in less coronary ectasia at 1 year after KD onset but was not associated with a quicker resolution of fever, an increased number of treatment failures, an increased need for adjunctive therapy, length of hospitalization, nor development of coronary artery lesions. In children with fever and classic clinical and laboratory findings of KD, treatment with IVIG on or before 5 days of fever resulted in better coronary outcomes and decreased the total length of time of clinical symptoms.


Implementation of routine genomic surveillance provided insights into a locally acquired outbreak caused by a rare clade of Salmonella enterica serovar Enteritidis in Queensland, Australia.
Salmonellosis is a significant public health problem globally. In Australia, Salmonella enterica serovar Enteritidis is one of the main causes of salmonellosis. This study reports how the implementation of routine genetic surveillance of isolates from human S. Enteritidis cases enabled identification of the likely source of an outbreak that occurred in a remote town in Far North Queensland, Australia. This study included patient, food and water samples collected during an outbreak investigation. S. Enteritidis of the novel sequence type 5438 was isolated from all seven patient samples and one bore water sample but not any of the food samples. Both whole-genome single nucleotide polymorphism (SNP) and core-genome multilocus sequence typing analysis revealed that S. Enteritidis isolated from outbreak-related patient samples and the bore water isolates clustered together with fewer than five SNP differences and ten allelic differences. This genetic relatedness informed the outbreak response team around public health interventions and no further cases were identified post-treatment of the bore water. This disease cluster was identified through the routine sequencing of S. Enteritidis performed by the state public health laboratory in an actionable time frame. Additionally, genomic surveillance captured a case with unknown epidemiological links to the affected community, ruled out a simultaneous outbreak in an adjacent state as the source and provided evidence for the likely source preventing further transmission. Therefore, this report provides compelling support for the implementation of whole-genome sequencing based genotyping methods in public health microbiology laboratories for better outbreak detection and management.


Differential Behavior of Eicosapentaenoic and Docosahexaenoic Acids on the Organization, Dynamics, and Fusion of Homogeneous and Heterogeneous Membranes.
Membrane fusion is a common course in innumerable biological processes that helps in the survival of eukaryotes. Enveloped viruses utilize this process to enter the host cells. Generally, the membrane lipid compositions play an important role in membrane fusion by modulating the membrane's physical properties and the behavior of membrane proteins in the cellular milieu. In this work, we have demonstrated the role of polyunsaturated fatty acids (PUFAs), such as eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids, on the organization, dynamics, and fusion of homogeneous and heterogeneous membranes. We have exploited arrays of steady-state and time-resolved fluorescence spectroscopic methods and polyethylene glycol-induced membrane fusion assay to elucidate the behavior of EPA and DHA on dioleoyl phosphatidylcholine (DOPC)/cholesterol (CH) homogeneous and DOPC/sphingomyelin/CH heterogeneous membranes. Our results suggest that EPA and DHA display differential effects on two different membranes. The effects of PUFAs in homogeneous membranes are majorly attributed to their flexible chain dynamics, whereas the ability of PUFA-induced cholesterol transfer from the lo to the ld phase rules their behavior in heterogeneous membranes. Overall, our results provide detailed information on the effect of PUFAs on homogeneous and heterogeneous membranes.


Structural Properties and UV-Visible Absorption Spectroscopy of Retinal-pyridyl-CN Re(I) Carbonyl Bipyridine Complex: A Theoretical Study.
The structural, electronic, and optical properties of the all-trans and five cis conformers of [Re(CO)3(bpy)(ret-pyr-CN)](+) (bpy = 2,2'-bipyridine; ret-pyr-CN = pyridyl-CN-3,7-dimethyl-9-(2,6,6-trimethylcyclohex-2-n)-none-(2,4,6,8-tetraen) were studied in solvent by means of density functional theory (DFT) and time-dependent DFT. The isolated retinal-like chromophore ret-pyr-CN was investigated as well for comparison. By coordination to the complex the two lowest intraligand (IL) states localized on the retinal group are slightly red-shifted from 627 to 690 nm and from 415 to 450 nm, respectively. Several isomerization pathways are open upon irradiation of the Re(I) complex by visible light (400-450 nm), especially to two cis conformers corresponding to the isomerization of the two double bonds of the retinal-like ligand close to the pyridyl group linked to the Re(I) fragment. The metal-to-ligand charge transfer states localized either on the retinal group or on the bpy ligand should play a minor role in the isomerization process itself but could improve its efficiency via ultra-fast intersystem crossing.


[The status of hearing aid technology from the audiologic viewpoint].
Although hearing aid technology has made considerable progress in the past, some important audiological demands are still unfulfilled. In particular, speech perception in noisy conditions must be improved. Traditional approaches to this fundamental problem, e.g. base cut, open mould fitting, horn equipped ear moulds, external receivers, in the ear hearing aids, directional microphones and audio-input, are discussed, as well as modern concepts of automatic signal processing to improve signal-to-noise (S/N) ratio. The results of a study of speech discrimination with dual channel hearing aids with AGC in the low frequency channel reveal efficient noise reduction in specific S/N situations. However, in the USA self-adaptive noise filter systems in head-worn hearing aids, have proven to be inadequate using the present set of processing parameters. Multichannel and digital signal processing introduce additional unsolved problems into hearing aid fitting.


A bilaterally recurring exophytic mass on the lower jaw.
Brown tumour is a rare focal giant-cell lesion that arises as a direct result of the effect of parathyroid hormone on bone tissue in patients with hyperparathyroidism (HPT). The lesions localise in areas of intense bone resorption, and the bone defect becomes filled with fibroblastic tissue. It can affect the mandible, maxilla, clavicle, ribs and pelvic bones. Therefore, diagnosis requires a systemic investigation for lesion differentiation. The authors present a case of a 27-year-old woman, with a rare case of brown tumour of mandible due to HPT secondary to osteomalacia. The lesion showed a tendency to recur even after excision till her parathyroid levels became normal.


Fine-grained data reveal segregated mobility networks and opportunities for local containment of COVID-19.
Deriving effective mobility control measures is critical for the control of COVID-19 spreading. In response to the COVID-19 pandemic, many countries and regions implemented travel restrictions and quarantines to reduce human mobility and thus reduce virus transmission. But since human mobility decreased heterogeneously, we lack empirical evidence of the extent to which the reductions in mobility alter the way people from different regions of cities are connected, and what containment policies could complement mobility reductions to conquer the pandemic. Here, we examined individual movements in 21 of the most affected counties in the United States, showing that mobility reduction leads to a segregated place network and alters its relationship with pandemic spread. Our findings suggest localized area-specific policies, such as geo-fencing, as viable alternatives to city-wide lockdown for conquering the pandemic after mobility was reduced.


Neuroendocrine tumors of the appendix.
The vast majority of neuroendocrine neoplasms of the appendix are carcinoid tumors. Most are of enterochromaffin (EC) cell type, although rare examples are of L cell type. EC cell carcinoids of the appendix differ from those encountered elsewhere in the gastrointestinal system. For example, they are remarkably common given the small size of the appendix, are usually benign, occur in younger patients, and typically contain sustentacular cells that express S-100. Origin from subepithelial neuroendocrine cells could explain these characteristics. It has also been suggested that most appendiceal carcinoids are hyperplastic rather than neoplastic, although this hypothesis requires further study. Nevertheless, truly neoplastic EC cell carcinoids of the appendix undoubtedly occur, and those greater than 2 cm in diameter have a significant risk of producing distant metastases. Carcinoid syndrome is a very rare presentation. Tubular carcinoids are unusual benign neoplasms; it has been proposed that they represent L cell carcinoids with a predominant tubular pattern of growth. Goblet cell carcinoids tend not to produce a grossly visible tumor mass but diffusely infiltrate the wall. They typically exhibit tight clusters of goblet cells, usually with scattered neuroendocrine cells and sometimes with Paneth cells, sometimes surrounding a small lumen. They may behave as a low-grade malignancy. The distinction between goblet cell carcinoid and other types of tumor is of great importance because of the implications for treatment and prognosis. Frank adenocarcinoma can arise from goblet cell carcinoids, and tumors with both components are classified as mixed goblet cell carcinoid-adenocarcinoma. The carcinoma component of the latter determines their prognosis, which would be worse than for a goblet cell carcinoid alone.


Effect of fenvalerate technical grade on acetyl cholinesterase activity in Indian bullfrog Haplobatrachus tigerinus (Daudin).
Indian bullfrog Haplobatrachus tigerinus (Daudin) was exposed to sublethal dose (1/3 of LC50 I.E. 1.166 mg/kg) of fenvalerate technical grade and the effect was studied on the specific activity of acetyl cholinesterase in the different tissues of frog viz., brain, muscle, liver, kidney and testis at different time periods viz., 3,6, 12, 24, 48 and 72 hours. The inhibition of specific activity of acetyl cholinesterase was in the order of kidney > brain > muscle > liver > testis. A significant inhibition was noticed in kidney at 12 hours (-64.33%) and no effect was noticed at 3 hours in testis (+0.67%). The AChE activity was inhibited in first three hours of administration of fenvalerate in all the tissue tested. The inhibition continued upto 6 hours or 2 hours in different tissue but the recovery was started by 24 hours and almost completed by 72 hours.


Long-term follow-up results of umbilical hernia repair.
Multiple suture techniques and various mesh repairs are used in open or laparoscopic umbilical hernia (UH) surgery. To compare long-term follow-up results of UH repair in different hernia surgery groups and to identify risk factors for UH recurrence. A retrospective analysis of 216 patients who underwent elective surgery for UH during a 10-year period was performed. The patients were divided into three groups according to surgery technique (suture, mesh and laparoscopic repair). Early and long-term follow-up results including hospital stay, postoperative general and wound complications, recurrence rate and postoperative patient complaints were reviewed. Risk factors for recurrence were also analyzed. One hundred and forty-six patients were operated on using suture repair, 52 using open mesh and 18 using laparoscopic repair technique. 77.8% of patients underwent long-term follow-up. The postoperative wound complication rate and long-term postoperative complaints were significantly higher in the open mesh repair group. The overall hernia recurrence rate was 13.1%. Only 2 (1.7%) patients with small hernias (< 2 cm) had a recurrence in the suture repair group. Logistic regression analysis showed that body mass index (BMI) > 30 kg/m2, diabetes and wound infection were independent risk factors for umbilical hernia recurrence. The overall umbilical hernia recurrence rate was 13.1%. Body mass index > 30 kg/m2, diabetes and wound infection were independent risk factors for UH recurrence. According to our study results, laparoscopic medium and large umbilical hernia repair has slight advantages over open mesh repair concerning early postoperative complications, long-term postoperative pain and recurrence.


Playfulness and New Technologies in Hand Therapy for Children With Cerebral Palsy: Scoping Review.
Innovative technologies such as game consoles and smart toys used with games or playful approaches have proven to be successful and attractive in providing effective and motivating hand therapy for children with cerebral palsy (CP). Thus, there is an increased interest in designing and implementing interventions that can improve the well-being of these children. However, to understand how and why these interventions are motivating children, we need a better understanding of the playful elements of technology-supported hand therapy. This scoping review aims to identify the playful elements and the innovative technologies currently used in hand therapy for children with CP. We included studies that design or evaluate interventions for children with CP that use innovative technologies with game or play strategies. Data were extracted and analyzed based on the type of technology, description of the system, and playful elements according to the Lenses of Play, a play design toolkit. A total of 31 studies were included in the analysis. Overall, 54 papers were included in the analysis. The results showed high use of consumer technologies in hand therapy for children with CP. Although several studies have used a combination of consumer technologies with therapeutic-specific technologies, only a few studies focused on the exclusive use of therapeutic-specific technologies. To analyze the playfulness of these interventions that make use of innovative technologies, we focused our review on 3 lenses of play: Open-ended Play, where it was found that the characteristics of ludus, such as a structured form of play and defined goals and rules, were the most common, whereas strategies that relate to paidia were less common. The most commonly used Forms of Play were physical or active form and games with rules. Finally, the most popular Playful experiences were control, challenge, and competition. The inventory and analysis of innovative technology and playful elements provided in this study can be a starting point for new developments of fun and engaging tools to assist hand therapy for children with CP.


Transcriptome Analysis of the Small Brown Planthopper, Laodelphax striatellus Carrying Rice stripe virus.
Rice stripe virus (RSV), the type member of the genus Tenuivirus, transmits by the feeding behavior of small brown planthopper (SBPH), Laodelphax striatellus. To investigate the interactions between the virus and vector insect, total RNA was extracted from RSV-viruliferous SBPH (RVLS) and non-viruliferous SBPH (NVLS) adults to construct expressed sequence tag databases for comparative transcriptome analysis. Over 30 million bases were sequenced by 454 pyrosequencing to construct 1,538 and 953 of isotigs from the mRNA of RVLS and NVLS, respectively. The gene ontology (GO) analysis demonstrated that both libraries have similar GO structures, however, the gene expression pattern analysis revealed that 17.8% and 16.8% of isotigs were up- and down-regulated significantly in the RVLS, respectively. These RSV-dependently regulated genes possibly have important roles in the physiology of SBPH, transmission of RSV, and RSV and SBPH interaction.


[Experimental study on hemostasis of thermosensitive chitosan hemostatic film].
To investigate the hemostasis of thermosensitive chitosan hemostatic film. Fifty adult Sprague Dawley rats, male or female and weighing 190-210 g, were made the models of liver injury. The models were randomly divided into 5 groups (n=10) depending on different hemostatic materials. The incision of the liver was covered with the hemostatic materials of 2.0 cm x 1.0 cm x 0.5 cm in size: thermosensitive chitosan hemostatic film (group A), chitosan hemostatic film (group B), cellulose hemostatic cotton (group C), gelatin sponge (group D), and no treatment (group E), respectively. The bleeding time and bleeding amount were recorded. After 4 weeks, the incisions of the liver were observed with HE staining. Gross observation showed better hemostatic effect and faster hemostatic time in groups A, B, and C; group D had weaker hemostatic effect and slower hemostatic time; group E had no hemostatic effect. The bleeding time and bleeding amount of groups A, B, C, and D were significantly lower than those of group E (P < 0.05). The bleeding time and bleeding amount of groups A, B, and C were significantly lower than those of group D (P < 0.05), but no significant difference was found among groups A, B, and C (P > 0.05). The liver cells of group A had milder edema and ballooning degeneration than other 4 groups through histological observation. The thermosensitive chitosan hemostatic film has good hemostasis effect on the liver incision of rats.


[Main proteolytic inhibitors in ocular herpes].
Alterations in content of main inhibitors of proteolysis alpha 1-antitrypsin and alpha 2-macroglobulin as well as activity of neutral proteases in blood serum were studied in herpetic impairment of human and rabbit retina. Unspecific protective reaction of the blood proteolytic inhibitors developed in ophthalmoherpes. In the acute period of the disease content of alpha 1-antitrypsin was increased and the content of alpha 2-macroglobulin was decreased. Slow development of the disease was observed when the content of alpha 1-antitrypsin was decreased at the period of acute inflammation. Estimation of proteolytic inhibitors might serve as an useful test for characteristics and prognosis of herpetic keratitis.


Bone Marrow Mesenchymal Stem Cell-Derived Exosomal miRNA-29c Decreases Cardiac Ischemia/Reperfusion Injury Through Inhibition of Excessive Autophagy via the PTEN/Akt/mTOR Signaling Pathway.
Cardiac ischemia/reperfusion (I/R) injury will cause a large amount of cardiomyocyte loss and cascade reactions such as apoptosis, mitochondrial dysfunction, and excessive autophagy. Mesenchymal stem cells (MSCs) are promising therapeutic tools to replace damaged cardiomyocytes, but the underlying mechanism is still unknown.Methods and Results:Exosomes contain many microRNAs and protein, which are believed to have multiple biological functions. This study explored the role of bone marrow MSCs (BMMSCs)-derived exosomes under different oxidation levels in heart protection and miRNA-related mechanisms. Exosomes extracted from BMMSCs contained a high level of miR-29c, and its expression level changed after cells were treated under hypoxia/reoxygenation (H/R) conditions. In vivo I/R experiments also confirmed an expression change of miR-29c, and PTEN-Akt-mTOR is one of the predominant pathways that regulate autophagic change during this process. This study highlighted the role of miR-29c in regulating autophagy under cardiac I/R injury, which also extended existing mechanisms of a stem cell and its derivative to explore potential therapeutic interventions in ischemic heart diseases.


Antimicrobial resistance trends among Salmonella isolates obtained from dairy cattle in the northeastern United States, 2004-2011.
Monitoring antimicrobial resistance trends among bacteria isolated from food animals and people is necessary to inform public policy regarding appropriate antimicrobial use. Our objectives were to describe the antimicrobial resistance status of Salmonella isolates from dairy cattle in the northeastern United States and to identify trends in resistance to various antimicrobial agents over time. Data were collected retrospectively for all bovine Salmonella isolates that were obtained from samples submitted to Cornell University's Animal Health Diagnostic Center between January 1, 2004 and December 31, 2011. Temporal trends in the prevalence of resistant Salmonella were investigated for each antimicrobial agent using the Cochran-Armitage trend test. Antimicrobial susceptibility testing was performed on 2745 bovine Salmonella isolates from clinical samples submitted during the study period. Overall resistance to each antimicrobial agent ranged from 0% (amikacin, ciprofloxacin, and nalidixic acid) to 72.0% (sulfadimethoxine). There was evidence of a significantly decreasing trend in prevalence of resistance to most agents: amoxicillin/clavulanic acid (AUG), ampicillin (AMP), cefoxitin (FOX), ceftiofur (TIO), ceftriaxone (AXO), chloramphenicol (CHL), chlortetracycline (CTET), florfenicol (FFN), kanamycin (KAN), neomycin (NEO), oxytetracycline (OXY), spectinomycin (SPE), streptomycin (STR), sulfadimethoxine (SDM), sulfisoxazole (FIS), and tetracycline (TET). Among the 265 isolates that were tested using the National Antimicrobial Resistance Monitoring System (NARMS) panel, the most common resistance patterns were pansusceptible (54.0%), AUG-AMP-FOX-TIO-AXO-CHL-KAN-STR-FIS-TET (18.1%), and AUG-AMP-FOX-TIO-AXO-CHL-STR-FIS-TET (12.1%). Increasing prevalence of S. enterica serovar Cerro over the course of the study period presumably had an impact on the observed resistance trends. Nevertheless, these results do not support the notion that the current level of antimicrobial use in dairy cattle is driving an increase in the emergence and dissemination of drug-resistant Salmonella in the region served by the laboratory.


An orthopantomographic study of hypodontia in permanent teeth of Japanese pediatric patients.
Hypodontia of permanent teeth was evaluated from orthopantomograms of 2072 apparently healthy pediatric patients at The Hospital of Nihon University School of Dentistry at Matsudo. The prevalence of congenitally missing teeth (CMT) was 8.7% in boys and 10.8% in girls, and 9.4% for both sexes combined. Most cases (67.8%) involved either one or two missing teeth. There were in total 574 CMT, and on average 2.8 teeth were missing per child. The most commonly absent tooth was the mandibular second premolar. On the other hand, no first molars were missing in any case. A high frequency of CMT mandibular incisors (18.82%) was observed, and this seems to be a characteristic peculiar to individuals of Asian ethnicity. Oligodontia (6 or more CMT excluding the third molar) ranged from 6 to 14 teeth, with a prevalence of 1.4% in general: 1.8% for girls and 0.9% for boys. Symmetry of CMT was predominant: 214 pairs for bilateral symmetry and 107 pairs for symmetry between two antagonistic quadrants. The distribution of CMT between maxillary and mandibular hypodontia in the right and left quadrants for boys and girls no had significant association (P < 0.05).


Presence of Mycobacterium leprae genotype 4 in environmental waters in Northeast Brazil.
This study quantified Mycobacterium leprae bacilli in environmental water samples from five municipalities in the State of Ceará by quantitative polymerase chain reaction (qPCR) and compared the identified genotypes with those obtained from leprosy patient biopsies. We collected five replicas from each of the 30 selected reservoirs and skin lesion biopsies from 25 new leprosy cases treated at a reference center in Fortaleza, Ceará from 2010 to 2013. The 16S rRNA gene region of M. leprae was amplified by qPCR and a standard curve was created with the pIDTBlue 16SrRNAMlep plasmid. The Juazeiro do Norte water samples and the biopsies were genotyped (single nucleotide polymorphism [SNP] 1 to 4) and the SNP 4 genotypes were subtyped. Of the 149 water samples analyzed, 54.4% were positive for the M. leprae DNA. The M. leprae bacilli copy number ranged from 1.42 × 10 -1 to 1.44 × 10 + 2 . Most biopsies showed SNP type 4 (64%), while all samples from Juazeiro do Norte were SNP type 4, with subtype 4-N appearing at the highest frequency. We suggest that environmental waters containing M. leprae bacilli play an important role in disease transmission, justifying PGL-1 seropositivity in individuals living in areas where there is no reported case, and in leprosy cases individuals who report no previous contact with other case. Therefore, further investigation is needed to clarify disease transmission in this region and to explore the role of the environment. We also suggest that in this area surveillance for leprosy cases should be intensified.


Morphological evidence for a motile behavior by plasma cells.
Immunofluorescence microscopy of the adherent layer of human long-term bone marrow cultures (HLTBMCs) consistently revealed motility-associated features in a part of the plasma cells. Not only were small surface blebs observed, but also long extensions whose morphology was reminiscent of neuronal axons. The observations were made in all HLTBMCs established with normal as well as myelomatous bone marrow (BM). Plasma cells with long extensions were also noticed on May-Grünwald-Giemsa smears of original uncultured BM from normal individuals and patients with myelomatous disorders. This suggests that the motility-associated morphological features occur in vivo as well as in vitro. The observations were most striking in the one case of plasma cell leukemia, both in culture as well as in the BM smear.


Sepik granuloma.
An unusual infection occuring in the East Sepik Province of Papua New Guinea is reported. The patients come from villages on the Sepik River or its tributaries. The lesions consist of cutaneous nodules and papillomas which are slowly progressive. An unidentified organism, apparently a gram positive bacillus, is seen in large numbers in the lesions; a natural habitat in soil or water or on vegetation seems likely.


A Mixed-Method Study on Correlates of HIV-Related Stigma Among Gay and Bisexual Men in the Southern United States.
Societal prejudice against people living with HIV infection is a formidable public health challenge that can negatively impact health and well-being. We recruited a multiethnic sample of 129 gay and bisexual men living with HIV who completed a brief survey; a subset of participants completed semi-structured qualitative interviews to contextualize the data. In bivariate analyses, stigma was positively and significantly correlated with depression (r = .402, p < .001) and negatively correlated with social support (r = -.482, p < .001). Qualitative interview results captured the mental suffering caused by stigma and coping strategies the men had developed. Although some of the coping strategies reduced the likelihood of experiencing acts of stigmatization, they also exacerbated the psychological stress of living with a stigmatized disease and limited the potential for social support. Our results highlight the need to scale up stigma-reduction programs, particularly those that can bolster social support networks.


Hepatitis E virus: seroprevalence and frequency of viral RNA detection among US blood donors.
Hepatitis E virus (HEV) is a nonenveloped emerging virus of increasing worldwide interest. Antibody prevalence, RNA frequencies, and transfusion transmissions have been reported. We investigated the HEV RNA and antibody frequencies in US blood donors. Individual-donation HEV RNA testing was performed on 18,829 donations from six US geographic regions using a CE-marked nucleic acid test (95% limit of detection, 7.9 IU/mL). Repeat-reactive donations were confirmed by in-house, real-time polymerase chain reaction (PCR; 10.3 IU/mL). Total HEV seroprevalence in a randomly selected subset of donations (n = 4499) was assessed by a direct, double-antigen sandwich assay; reactives were further tested for immunoglobulin (Ig)G and IgM. As part of the total antibody confirmatory algorithm, the cutoff was adjusted. Two donations tested confirmed-positive for RNA (PCR not quantifiable, IgM/IgG positive; and 14 IU/mL, antibody negative) for a frequency of 1 in 9500 (95% confidence interval [CI], 1:2850-1:56,180) and 99.96% specificity (95% CI, 99.92%-99.98%); both donors were from the Midwest United States. Antibody prevalence was 9.5% (95% CI, 8.7-10.5) before the cutoff adjustment and 7.7% (95% CI, 7.0%-8.5%) after adjustment; 0.58% (95% CI, 0.39%-0.85%) were IgM positive. We confirmed comparatively low rates and low viral loads of HEV RNA in US blood donors indicating the need for individual-donation testing if screening is implemented. Antibody prevalence rates were comparable to those reported by one US study using a different assay, but lower than those reported in another study using yet a third assay. We did not answer the question of whether US blood donation screening is warranted. Selective strategies involving providing HEV-negative blood to severely immunosuppressed patients at risk of developing hepatitis may be considered.


Immune dysregulation in patients with PTEN hamartoma tumor syndrome: Analysis of FOXP3 regulatory T cells.
Patients with heterozygous germline mutations in phosphatase and tensin homolog deleted on chromosome 10 (PTEN) experience autoimmunity and lymphoid hyperplasia. Because regulation of the phosphoinositide 3-kinase (PI3K) pathway is critical for maintaining regulatory T (Treg) cell functions, we investigate Treg cells in patients with heterozygous germline PTEN mutations (PTEN hamartoma tumor syndrome [PHTS]). Patients with PHTS were assessed for immunologic conditions, lymphocyte subsets, forkhead box P3 (FOXP3)+ Treg cell levels, and phenotype. To determine the functional importance of phosphatases that control the PI3K pathway, we assessed Treg cell induction in vitro, mitochondrial depolarization, and recruitment of PTEN to the immunologic synapse. Autoimmunity and peripheral lymphoid hyperplasia were found in 43% of 79 patients with PHTS. Immune dysregulation in patients with PHTS included lymphopenia, CD4+ T-cell reduction, and changes in T- and B-cell subsets. Although total CD4+FOXP3+ Treg cell numbers are reduced, frequencies are maintained in the blood and intestine. Despite pathogenic PTEN mutations, the FOXP3+ T cells are phenotypically normal. We show that the phosphatase PH domain leucine-rich repeat protein phosphatase (PHLPP) downstream of PTEN is highly expressed in normal human Treg cells and provides complementary phosphatase activity. PHLPP is indispensable for the differentiation of induced Treg cells in vitro and Treg cell mitochondrial fitness. PTEN and PHLPP form a phosphatase network that is polarized at the immunologic synapse. Heterozygous loss of function of PTEN in human subjects has a significant effect on T- and B-cell immunity. Assembly of the PTEN-PHLPP phosphatase network allows coordinated phosphatase activities at the site of T-cell receptor activation, which is important for limiting PI3K hyperactivation in Treg cells despite PTEN haploinsufficiency.


Fatal Enterococcus durans aortic valve endocarditis: a case report and review of the literature.
Most enterococcal endocarditis is caused by Enterococcus faecalis and Enterococcus faecium. Enterococcus durans is a rare member of non-faecalis, non-faecium enterococcal species and is found in the intestines of animals. E durans endocarditis is a very rare infection-only two cases of endocarditis in humans have been reported in the literature-and usually associated with good outcomes when treated with appropriate antibiotics. We report the first case of fatal E durans endocarditis. This patient had end-stage liver disease with associated compromised immune status that likely contributed to the progression of disease in spite of appropriate antibiotic coverage and clearance of bacteraemia.


Glioma Single-Cell Biomechanical Analysis by Cyclic Conical Constricted Microfluidics.
Determining the grade of glioma is a critical step in choosing patients' treatment plans in clinical practices. The pathological diagnosis of patient's glioma samples requires extensive staining and imaging procedures, which are expensive and time-consuming. Current advanced uniform-width-constriction-channel-based microfluidics have proven to be effective in distinguishing cancer cells from normal tissues, such as breast cancer, ovarian cancer, prostate cancer, etc. However, the uniform-width-constriction channels can result in low yields on glioma cells with irregular morphologies and high heterogeneity. In this research, we presented an innovative cyclic conical constricted (CCC) microfluidic device to better differentiate glioma cells from normal glial cells. Compared with the widely used uniform-width-constriction microchannels, the new CCC configuration forces single cells to deform gradually and obtains the biophysical attributes from each deformation. The human-derived glioma cell lines U-87 and U-251, as well as the human-derived normal glial astrocyte cell line HA-1800 were selected as the proof of concept. The results showed that CCC channels can effectively obtain the biomechanical characteristics of different 12-25 μm glial cell lines. The patient glioma samples with WHO grades II, III, and IV were tested by CCC channels and compared between Elastic Net (ENet) and Lasso analysis. The results demonstrated that CCC channels and the ENet can successfully select critical biomechanical parameters to differentiate the grades of single-glioma cells. This CCC device can be potentially further applied to the extensive family of brain tumors at the single-cell level.


Complement levels of C4, C3C, factor B, and C1 inactivator in peripheral and retroplacental blood of parturient women with EPH gestosis.
The complement levels were determined in 54 parturient women with EPH gestosis, in 32 normal parturient women and in 24 normal non pregnant women. Complement components: C4, C3c, factor B /Bf/ and C1 inactivator /C1 INA/ were measured by radial immunodiffusion. Peripheral and retroplacental blood were examined. Concentrations of C4, C3c, Bf in peripheral blood of both groups of parturient women were significantly higher than in normal non pregnant women. Peripheral blood of parturient women with EPH gestosis contained significantly higher concentrations of C3c than in normal parturient women. Complement Bf levels of normal parturient women were lower in the retroplacental blood than in the peripheral. The levels of C4 were significantly decreased and C3c increased in the retroplacental blood of parturient women with EPH gestosis when results were compared with retroplacental blood of normal parturient women. Results of present study suggest that complement activation could contribute to the pathogenesis of EPH gestosis.


Frozen raspberries and hepatitis A.
An outbreak of 24 cases of hepatitis A in Aberdeen was traced to a large hotel in the city by epidemiological investigation. Food-specific questioning of those affected, their fellow diners and hotel staff, coupled with serological studies, implicated raspberry mousse prepared from frozen raspberries as the source of the infection. The raspberries were probably contaminated at the time of picking.


A 13CO2 breath test to assess the metabolism of triglyceride-rich lipoprotein remnants in mice.
Remnant-like emulsions were prepared with lipid compositions similar to remnants derived from triacylglycerol-rich lipoproteins. When injected into the bloodstream of conscious mice the remnant-like emulsions labeled with cholesteryl[13C]oleate were metabolized in the liver and the appearance of 13CO2 in the breath was measured. In control mice injected with remnant-like emulsions labeled with cholesteryl[13C]oleate, enrichment of 13CO2 in the breath peaked at 45 min and then decreased markedly by 3 h. In apoE-deficient (-/-) mice no enrichment was found and in low density lipoprotein receptor (LDLr)-deficient (-/-) mice the appearance of 13CO2 in the breath was markedly decreased. These findings were consistent with the ability of the breath test to detect defects in remnant metabolism. The breath test was useful in detecting a defect in remnant metabolism in LDLr heterozygote (+/-) mice, in which the appearance of 13CO2 in the breath was less by 45 min but remained elevated for the duration of the experiment when compared with control mice. In hepatic lipase-deficient (-/-) mice no defect in remnant metabolism was found. Under fasting conditions, the enrichment of 13CO2 in the breath after injection of emulsion was markedly increased when compared with fed mice, indicating that the metabolism of the injected remnant-like emulsion was probably competed for by post-prandial particles under fed conditions. Our findings show that a 13C breath test can be used to assess the metabolism of remnants. The test provides a useful and sensitive method for non-invasive testing of remnant metabolism in experimental animals.


Biomimetic Nanotubes Based on Cyclodextrins for Ion-Channel Applications.
Biomimetic membrane channels offer a great potential for fundamental studies and applications. Here, we report the fabrication and characterization of short cyclodextrin nanotubes, their insertion into membranes, and cytotoxicity assay. Mass spectrometry and high-resolution transmission electron microscopy were used to confirm the synthesis pathway leading to the formation of short nanotubes and to describe their structural parameters in terms of length, diameter, and number of cyclodextrins. Our results show the control of the number of cyclodextrins threaded on the polyrotaxane leading to nanotube synthesis. Structural parameters obtained by electron microscopy are consistent with the distribution of the number of cyclodextrins evaluated by mass spectrometry from the initial polymer distribution. An electrophysiological study at single molecule level demonstrates the ion channel formation into lipid bilayers, and the energy penalty for the entry of ions into the confined nanotube. In the presence of nanotubes, the cell physiology is not altered.


Attributable deaths due to influenza: a comparative study of seasonal and pandemic influenza.
Influenza epidemics lead to an increase in hospitalizations and deaths. Up to now the overall impact of attributable deaths due to seasonal and pandemic influenza viruses in Austria has not been investigated in detail. Therefore we compared the number and age distribution of influenza associated deaths during ten influenza epidemic seasons to those observed during the pandemic influenza A(H1N1)2009 season. A Poisson model, relating age and daily deaths to week of influenza season using national mortality and viral surveillance data adjusted for the confounding effect of co-circulating Respiratory Syncytial Virus was used. We estimated an average of 316 influenza associated deaths per seasonal influenza epidemic (1999/2000-2008/2009) and 264 for the pandemic influenza season 2009/2010 in the area of Vienna, Austria. Comparing the mortality data for seasonal and pandemic influenza viruses in different age groups revealed a statistically significant increase in mortality for pandemic A(H1N1)2009 influenza virus in the age groups below 34 years of age and a significant decrease in mortality in those above 55 years. Our data adjusted for co-circulating RSV confirm the different mortality pattern of seasonal and pandemic influenza A(H1N1)2009 virus in different age groups.


[Experimental study on effect of platelet-rich plasma in repair of bone defect].
To study the effect of platelet-rich plasma in the repair of bone defect. Segmental bone defects of 1 cm were created in the mid-upper part of bilateral radius of 24 New Zealand white rabbits. One side was randomly chosen as the experimental side, which was filled with artificial bone with platelet-rich plasma (PRP). The other side filled with artificial bone without PRP as the control. After 2, 4, 8 and 12 weeks of implantation, the gross, radiological, histological observations, and computer graphic analysis were performed to investigate the bone healing of the defect in both sides. Two weeks after operation, new bone and fibrous tissue formation in both the experimental and the control sides were observed only in the areas adjacent to the cut ends of the host bone, but the amount of new tissue in the experimental side was much more than that in the control side. In the 4th and 8th weeks, the surface of the artificial bone was covered with a large amount of new bones, the artificial bone was bridged tightly with the host bone by callus in the experimental side, while new bone was limited mainly in the cut ends and was less mature in the control side. In the 12th weeks, bone defects were entirely healed in the experimental side, which were covered completely with cortical bone, while new bone formation was only observed in the ends of artificial bone and there were not continuous bone callus on the surface in the control side. Artificial bone with PRP is effective in the repair of segmental bone defects, and PRP could improve the healing of bone defect.


Robotic right segmental hepatectomy for the treatment of a giant hepatic hemangioma-a case report.
Hemangioma is the most common benign hepatic tumor. We present the case of a patient with a giant symptomatic hemangioma, treated with segmental liver resection using the Da Vinci Robotic System. A 38-year-old woman presented to our surgical out-patient Department complaining about abdominal discomfort and recurrent episodes of acute abdominal pain. CT-scan and MRI imaging of the abdomen revealed the presence of a giant hepatic hemangioma (>5 cm) involving segments VI and VII. Robotic right segmental hepatectomy was performed. The procedure was successfully completed in 120 min and with intraoperative blood loss of only 450 ml. Postoperative period was uneventful and the patient was discharged on the second postoperative day. In case of giant hemangiomas, a minimally invasive robotic major hepatic resection is a viable option that can be performed with minimal complications. A careful preoperative and intraoperative strategy is required, while significant experience in liver and robotic surgery is mandatory.


[Distal intraarticular humerus fractures in elderly patients. Treatment with combined percutaneous screw fixation and an external fixator].
Intra-articular distal humerus fractures are relatively uncommon. Due to osteoporosis in elderly patients, stable fixation still remains a problem despite new implants providing angular stability. The treatment of choice is open reduction and plate fixation requiring an extended approach with olecranon osteotomy often combined with additional postoperative immobilisation in a long arm cast. We describe a technique using closed reduction and percutaneous osteosynthesis with cannulated screws combined with external fixation. Morbidity due to surgical exposure and potential risks are diminished while functional results are comparable to open reduction and internal fixation . In contrast to plasters or casts, the use of an external fixator allows stable and safety protection of the elbow joint, preserving wrist function as well as forearm rotation and increasing the patient's comfort during immobilisation. We have used this technique on ten patients aged 76.2 years (range 67-88 years). According to the AO classification, there were three B-1/B-2 fractures, four C-1 and three C-2/C-3 fractures without severe comminution. The duration of external fixation was 6.3 weeks (range 4-8 weeks) before fracture union was achieved. This allows the initiation of physiotherapy and motion of the elbow. There was only one revision caused by the necessary replacement of an aseptic loosened Schanz screw. At follow-up 3 months postoperatively, the range of motion of the elbow was 95 degrees (65 degrees-105 degrees ), average extension 25 degrees (10 degrees-35 degrees ) and mean flexion was 115 degrees (100 degrees-120 degrees ) with all patients exhibiting full pro/supination.


Upper eyelid angiolipoma associated friction in the glide zone.
A 74-year-old man was examined for a mass in the left upper eyelid. It was inconspicuous in inspection. There was no visual restriction, however a feeling of friction on the superior orbit during lid movement. Through eyelid crease lid incision, a solitary lesion appeared in the preaponeurotic space that orginated from the upper tarsal plate. Excisional biopsy revealed adipose proliferation with patch form vessels. This case represents the second reported angiolipoma of the eyelid in English literature.


Structural variations during mitosis in the chick embryo.
Selected tissues from chick embryos were fixed in 2% glutaraldehyde and 1% OsO(4), both buffered at pH 7.6 with Veronal-acetate, and were embedded in Maraglas or Araldite. Two types of cell division have been noted. Generally, epithelial cells divide predominantly by a shortening of the chromosome-to-pole distance rather than by spindle elongation; mesenchymal cells undergo extensive spindle elongation. The presence of numerous continuous microtubules in cells that undergo extensive spindle elongation functionally implicates these tubules in the elongation process. In most embryonic epithelia, the cleavage furrow converges to a fixed site forming a mid-body near the anchoring desmosomes at the free surface; symmetrical furrow formation is typical of mesenchymal cells which lack desmosomes. The hypothesis of cleavage furrow formation and the fate of the mid-body that is formed during cytokinesis are discussed.


Evaluation of disparities in perceived healthcare discrimination among BRCA1/2-positive women from medically underserved populations.
The current study evaluated associations between disparities relating to race/ethnicity, poverty status, educational status, and odds of experiencing healthcare discrimination among women with BRCA1/2 mutations. We conducted a cross-sectional study of United States (US)-based women (18+ years) who have tested positive for BRCA1/2 mutations within the past 5 years and who identify with one or more medically underserved populations. 211 women were recruited from BRCA1/2-oriented support groups and completed an online survey. Adjusted odds ratios (aORs) and 95 percent confidence intervals (CIs) were estimated using multivariable logistic regression models for associations between race/ethnicity, poverty status, education, and perceived healthcare discrimination adjusting for covariates. 182 women were included (31.3 percent were cancer survivors). Most were NHW (67.2 percent) and younger than 50 years (83.2 percent). Racial/ethnic minorities were 2.6 times more likely to report receiving poorer service than NHW women (95 percent CI, 1.26-5.33, p = .01). Associations with poverty status, education, and healthcare discrimination outcomes were not statistically significant. Improving patient-provider interactions that can contribute to medical mistrust should become a priority for the care of high-risk US minority women with BRCA1/2 mutations.


Effects of a community-based early intervention program on the subjective well-being, institutionalization, and mortality of low-income elders.
This study examined the effects of an early interventive social service program on the subjective well-being, permanent institutionalization, and mortality risk of low-income community-dwelling elders. From a waiting list for community-based services, 105 "moderately at-risk" community-dwelling elders were recruited. Forty of these persons were randomly assigned to receive the intervention, and the remainder did not receive the intervention. Participants were interviewed every 3 months for 18 months. Primary outcome measures were depression, satisfaction with social relationships, environmental mastery, life satisfaction, permanent institutionalization, and mortality. No significant differences in sociodemographic or health characteristics were found between the intervention and control groups at baseline. Those elders who received the intervention had significantly higher subjective well-being and were less likely to be institutionalized or die than those in the comparison group across the 18-month period. The results make a strong case for the importance of community-based programs to the well-being of elders. Practitioners and policy makers should continue the search for community-based programs that are cost-effective and improve the quality of life for elders.


No suppression of respiratory function of mitochondrial isolated from the hearts of anesthetized rats with high-dose pentobarbital sodium.
Pentobarbital sodium is a widely used anesthetic for animal experiments. We have already reported that a high dose of pentobarbital sodium (100 mg/kg i.p., twice the usual anesthetic dose) depresses myocardial mechanoenergetics in the canine heart. Furthermore, it has been reported that a high concentration of pentobarbital sodium inhibits myocardial contractility and mitochondrial electron transport and energy transfer. Therefore, we were afraid that the mitochondrial respiratory function would be impaired by pentobarbital anesthesia and that pentobarbital sodium would be an inappropriate anesthetic for cardiac mechanoenergetic studies. In this study, we investigated the respiratory function of mitochondria isolated from the hearts of anesthetized rats with high-dose pentobarbital sodium. We examined the mitochondrial respiratory function by the ADP/O ratio, respiratory control index (RCI), oxygen consumption rate in state III (State III O2) by oximetry, and membrane potential using a fluorescent dye, 3,3'-dipropylthiodicarbocyanine iodide (diS-C3-(5). The ADP/O ratio, RCI, and State III O2 values and changes in membrane potential induced by various respiratory substances were not significantly different between the rats with and without anesthesia. These results indicate that the respiratory function is not suppressed in the isolated myocardial mitochondria of rat hearts after high-dose pentobarbital anesthesia, although the pentobarbital sodium blood concentration was of the same order as that which exerts mitochondrial uncoupling in rat isolated mitochondrial preparation. Therefore, pentobarbital sodium anesthesia up to 100 mg/kg i.p. is applicable for mechanoenergetic studies of excised rat hearts, at least from the energetic aspect.


Temporomandibular joint ankylosis: review of the literature and report of two cases of bilateral involvement.
The factors predisposing to ankylosis and the probable pathogenesis are discussed, as treatment, both past and present. Arthroplasty with Silastic interposition is presented as an acceptable means of managing ankylosis, as shown in two case reports. The ultimate postoperative result is dependent on surgical timing, surgical technique, and attention to postsurgical physiotherapy.


Advances and prospects for the Human BioMolecular Atlas Program (HuBMAP).
The Human BioMolecular Atlas Program (HuBMAP) aims to create a multi-scale spatial atlas of the healthy human body at single-cell resolution by applying advanced technologies and disseminating resources to the community. As the HuBMAP moves past its first phase, creating ontologies, protocols and pipelines, this Perspective introduces the production phase: the generation of reference spatial maps of functional tissue units across many organs from diverse populations and the creation of mapping tools and infrastructure to advance biomedical research.


Pituitary response to synthetic luteinizing hormone-releasing hormone in patients with Turner's syndrone.
Synthetic luteinizing hormone-releasing hormone (LHRH) was administered intravenously in a dose of 25 mug to 9 patients with Turner's syndrome of 45,XO karyotypes, 5 normal menstruating women, and 5 postmenopausal women. In patients with Turner's syndrome, the basal serum LH level was higher than that of the normal subjects and lower than that of postmenopausal women. The LH response to LHRH, when expressed as a percent of control, was comparable to that of the normal luteal phase and significantly higher than that of postmenopausal women. The basal FSH level was more elevated than the basal LH level. The FSH response to LHRH, when expressed as a percent of control, was similar to that of postmenopausal women and lower than that of normal subjects. The results suggest that pituitary function is preserved in patients with Turner's syndrome. I interpret the pituitary responsiveness and/or reserve of patients with Turner's syndrome as larger than that of postmenopausal women. A greater response of LH than of FSH to LHRH was observed in this study and is contrary to findings reported by others on teenage patients with Turner's syndrome. This suggests that the sensitivity of gonadotropins changes with age in Turner's syndrome.


Sorption Capacity of Polydimethylsiloxane Foams Filled with Thermal-Treated Bentonite-Polydimethylsiloxane Composite Foams for Oil Spill Remediation.
The spillage of oil causes severe and long-lasting impacts on both the environment and human life. It is crucial to carefully reconsider the methods and techniques currently employed to recover spilled oil in order to prevent any possible secondary pollution and save time. Therefore, the techniques used to recover spilled oil should be readily available, highly responsive, cost-effective, environmentally safe, and, last but not least, they should have a high sorption capacity. The use of sorbents obtained from natural materials is considered a suitable approach for dealing with oil spills because of their exceptional physical characteristics that support sustainable environmental protection strategies. This article presents a novel sorbent material, which is a composite siloxane foam filled with bentonite clay, aimed at enhancing the hydrophobic and oleophilic behavior of the material. The thermal treatment of bentonite optimizes its sorption capacity by eliminating water, and increasing the surface area, and, consequently, its interaction with oils. In particular, the maximum sorption capacity is observed in kerosene and naphtha for the bentonite clay thermally treated at 600 °C, showing an uptake at saturation of 496.8% and 520.1%, respectively. Additionally, the reusability of the composite foam is evaluated by squeezing it after reaching its saturation point to determine its sorption capacity and reusability.


D. Alan Shewmon and the PCBE's White Paper on Brain Death: are brain-dead patients dead?
The December 2008 White Paper (WP) on "Brain Death" published by the President's Council on Bioethics (PCBE) reaffirmed its support for the traditional neurological criteria for human death. It spends considerable time explaining and critiquing what it takes to be the most challenging recent argument opposing the neurological criteria formulated by D. Alan Shewmon, a leading critic of the "whole brain death" standard. The purpose of this essay is to evaluate and critique the PCBE's argument. The essay begins with a brief background on the history of the neurological criteria in the United States and on the preparation of the 2008 WP. After introducing the WP's contents, the essay sets forth Shewmon's challenge to the traditional neurological criteria and the PCBE's reply to Shewmon. The essay concludes by critiquing the WP's novel justification for reaffirming the traditional conclusion, a justification the essay finds wanting.


What are the Main Risk Factors Associated with Erectile Dysfunction in the Elderly? A Cross-Sectional Study of 2436 Brazilian Elderly Men.
Erectile dysfunction (ED) is a multifactorial medical disorder often neglected in clinical practice between elderly men, defined as the inability to achieve and/or maintain a penile erection sufficient for satisfactory sexual intercourse and a common clinical entity among men and associated with impaired quality of life and cardiovascular diseases in elderly men. The aim of this study is to evaluate the association between ED and clinical, demographic and behavioral parameters in elderly men. A total of 2436 males aged 60 years and over who participated in the health screening between January 2008 and December 2018 were included in this study. Laboratory exams, clinical and behavior profiles were analyzed. Logistic regression models were used. Men with ED were older (65.87±5.49 vs. 63.85±4.05 years old. p<0.001), higher prevalence of physical inactivity (23.8 vs. 19%, p = 0.039) and had a higher body mass index (BMI; 28.36±4.06 vs. 27.72±3.89 kg/m2. p<0.001) than men without ED. The multivariate model shown that hypertension (p = 0.001), diabetes mellitus (p<0.001), lower urinary tract symptoms (LUTS), depressive symptoms (p<0.001) and age (p<0.001), were strongly associated with ED. The main risk factors associated with ED in elderly men were hypertension, diabetes mellitus, LUTS, depressive symptoms and age.


Differential reactivities of carcinoembryonic antigen (CEA) and CEA-related monoclonal and polyclonal antibodies in common epithelial malignancies.
To evaluate the role of carcinoembryonic antigen (CEA) in solving problems of tumor histogenesis in surgical pathology, monoclonal antibodies to four distinct epitopes of CEA (E-Z-EM) were applied to paraffin sections of 303 epithelial neoplasms from multiple sites. Two epitopes were CEA specific (D14 and B7.1), one was shared with nonspecific cross-reacting antigen (NCA) (B7.8), and the fourth (B18) was common to CEA, NCA, and biliary glycoprotein antigen (BGP). A sample of the tumors (n = 110) was also stained with a polyclonal anti-CEA (DAKO). Gastrointestinal adenocarcinomas, including esophageal and gastric (n = 19), small intestinal (n = 8), colorectal (n = 56), biliary tract (n = 8), and pancreatic adenocarcinomas (n = 14), were consistently positive with all five antibodies. Other predominantly gland-forming carcinomas tested, comprising lung (n = 22), ovary (n = 18), and endometrium (n = 12), were either invariably negative with all five antibodies (endometrial adenocarcinoma, non-mucinous ovarian adenocarcinoma) or demonstrated selective and variable positivity (lung: D14, 50%; ovarian mucinous: D14, 50%). Among large polygonal cell carcinomas (hepatocellular carcinoma, renal cell carcinoma, melanoma, and adrenal carcinoma), only hepatomas stained positively, showing a distinctive canalicular staining pattern with the B18 (BGP epitope) (55%) and polyclonal antibody (50%). In the small polygonal cell carcinoma category, true CEA positivity was rare in breast (D14, 10% and B7.1, 14%) and never seen in prostatic carcinomas and carcinoid tumors. A subset of these breast (8 of 42), prostate (4 of 22), and carcinoids (4 of 7) showed exclusive positivity for the B18 antibody (NCA/BGP epitope). Ovarian serous papillary carcinomas (n = 14), papillary carcinomas of thyroid (n = 12), transitional cell carcinomas of the bladder (n = 11), and mesotheliomas (n = 3) were negative with all monoclonal antibodies. Metastatic carcinomas (n = 74) showed a similar pattern of reactivity to primary tumors. The authors conclude that CEA immunostaining may assist in identifying the histogenesis of epithelial tumors in several morphologic categories; that differential reactivities of the CEA monoclonal antibody panel exceed those of the polyclonal antibody; and that the discriminating power of the monoclonal panel is related to whether (1) CEA is or is not produced or (2) NCA or BGP is produced without concomitant CEA production. There is little evidence to support a concept of site-specific CEA species.


Experimental Observation of "Shadowing" in Optical Transition Radiation.
We report the observation of shadowing between two optical transition radiation (OTR) sources from a 205 MeV electron beam. The total optical intensity is measured as a function of the distance d between the sources, covering the range 0<d<4L_{v}, where L_{v} is the formation length of the particles. Data show that the total optical intensity starts decreasing due to shadowing when d approaches L_{v} until it becomes undetectable for very short distances d/L_{v}→0. A model based solely on interference between the two OTR sources is in good agreement with experimental data. To the knowledge of the authors this is the first systematic experimental observation of shadowing in OTR.


In Situ Neutron Diffraction Studies of the Ion Exchange Synthesis Mechanism of Li2Mg2P3O9N: Evidence for a Hidden Phase Transition.
Motivated by predictions made using a bond valence sum difference map (BVS-DM) analysis, the novel Li-ion conductor Li2Mg2P3O9N was synthesized by ion exchange from a Na2Mg2P3O9N precursor. Impedance spectroscopy measurements indicate that Li2Mg2P3O9N has a room temperature Li-ion conductivity of about 10-6 S/cm (comparable to LiPON), which is 6 orders of magnitude higher than the extrapolated Na-ion conductivity of Na2Mg2P3O9N at this temperature. The structure of Li2Mg2P3O9N was determined from ex situ synchrotron and time-of-flight neutron diffraction data to retain the P213 space group, though with a cubic lattice parameter of a = 9.11176(8) Å that is significantly smaller than the a = 9.2439(1) Å of Na2Mg2P3O9N. The two Li-ion sites are found to be very substantially displaced (∼0.5 Å) relative to the analogous Na sites in the precursor phase. The non-molten salt ion exchange method used to prepare Li2Mg2P3O9N produces a minimal background in powder diffraction experiments, and was therefore exploited for the first time to follow a Li+/Na+ ion exchange reaction using in situ powder neutron diffraction. Lattice parameter changes during ion exchange suggest that the reaction proceeds through a Na2-xLixMg2P3O9N solid solution (stage 1) followed by a two-phase reaction (stage 2) to form Li2Mg2P3O9N. However, full Rietveld refinements of the in situ neutron diffraction data indicate that the actual transformation mechanism is more complex and instead involves two thermodynamically distinct solid solutions in which the Li exclusively occupies the Li1 site at low Li contents (stage 1a) and then migrates to the Li3 site at higher Li contents (stage 1b), a crossover driven by the different signs of the local volume change at these sites. In addition to highlighting the importance of obtaining full structural data in situ throughout the ion exchange process, these results provide insights into the general question of what constitutes a thermodynamic phase.


Development and bioassessment of high nutria-omega 5 cookies through animal modeling.
The food industry generates a diverse range of waste byproducts during fruit processing, which can be repurposed to create functional foods and other valuable commodities. In this particular study, leftover agro-waste from pomegranate juice was valorized to obtain pomegranate seed oil (PSO), while utilizing sunflower oilseed cake to produce sunflower meal protein concentrate (SMPC). These two extracted components were then combined as ingredients to produce High Nutria Omega 5 (HNO5) cookies. To ensure the quality and viability of pomegranate seed oil, a comprehensive set of laboratory analytical procedures were employed to evaluate its characteristics. Subsequently, different ratios of pomegranate seed oil and sunflower meal protein concentrate were utilized to develop the HNO5 cookie products. These cookies underwent thorough sensory, physicochemical, storage, and proximate evaluations as well as efficacy studies to assess their overall nutritional quality and shelf-life properties. As compared to the control feed, the findings of the renal and liver functional tests indicated a favorable effect on ALT, AST, ALP, serum urea, creatinine, albumin, globulins, total proteins, and A/G ratio. The results revealed that PSO and SMPC cookies containing 15% PSO and 15% SMPC exhibited stability in numerous physicochemical and sensory assessments. The punicic acid in HNO5 cookies significantly reduced the effects of starvation in rats and progressively improved several metabolic processes and overall health profiles. Graphical Abstract.


Anorexia nervosa in black adolescents.
Anorexia nervosa has been considered rare or nonexistent among blacks. A report of the presentation and clinical course of this disorder in two black female adolescents illustrates a serious medical psychiatric problem that may be increasingly detected among predisposed teenagers of the black middle and professional classes. Unrecognized and incorrectly treated, the disease may run a fatal course in 20 percent of the cases. Differential diagnosis, etiology, and treatment of the condition are reviewed.


The influence of climatic conditions on long-term changes in the helminth fauna of terrestrial molluscs and the implications for parasite transmission in southern England.
The influence of climatic conditions on the prevalence and transmission of helminth parasites in a terrestrial mollusc population was studied in a grassland site in southern England between 1974 and 1983. Molluscs were sampled in each September of 5 years over this period (1974, 1976, 1979, 1981, 1983). Climatic conditions had a variable effect on parasite prevalence. Trematode sporocyst infections increased after wet summer and warm winter conditions and declined in hot, dry periods. Cestode infections increased after combined wet spring and summer weather and low winter temperatures, although trematode metacercariae and nematode infections were less likely to be influenced by climate. The effects on parasite transmission were undertaken by comparing parasite prevalences in the principal definitive hosts, the common shrew (Sorex araneus) and the wood mouse (Apodemus sylvaticus) in the same habitat over the period 1973-1983. Changes in parasite prevalences in the molluscan population were rarely replicated by changes in the small mammal population, except for trematode parasites in small mammals during a period of severe drought in 1976. These results suggest that only long-term persistent modifications in climate are likely to affect host-parasite dynamics.


Prevalence of hepatitis C in U.S. Army aircrew: do flaws in the data exist?
Hepatitis C virus (HCV) infection is a rare condition with unknown prevalence in Army aircrew. This is a retrospective serial prevalence study to determine the prevalence of HCV in Army aircrew and discuss whether this reflects the true prevalence rate. The Aviation Epidemiology Data Registry (AEDR) at the U.S. Army Aeromedical Center was queried by ICD-9-CM codes for cases of hepatitis from January 1988 to October 1999. These records were further reviewed for documented cases of HCV. Case details were extracted and then the data were evaluated. The prevalence rate in this population is exceedingly low at 0.000087 cases per year averaged over the 12 yr, or 1 case in 11,000 aircrew per year with an average of 24,077 records per year. The total number of cases was 31, with 22 of those involving pilots. Subjects averaged 15.26 yr of military service. The prevalence of HCV in aircrew is low and is much lower than in the general and military populations. These prevalence rates may be skewed low due to lack of universal reporting method, no screening, and asymptomatic nature of initial infection. Conversely, the prevalence may be accurate due to high fitness levels, population motivation, and required healthcare visits. Current prevalence rates do not support a need for universal screening, but the cost of case detection in lost training dollars and experience is significant. A definitive study would assess the true prevalence rate and determine if screening in this population is warranted.


A single electrical pulse within the protective zone of each cardiac cycle prevented reperfusion-induced ventricular tachycardia in conscious mice.
Early pioneering investigators discovered, in anesthetized dogs, a protective period within the cardiac cycle. The protective period was a time within the cardiac cycle when a precisely timed stimulus prevented the initiation of ventricular fibrillation caused by an earlier stimulus. Thus, in addition to the susceptible period of repolarization discussed by Wiggers and Wegria (Am. J. Physiol. 131:296, 1940; Am. J. Physiol. 128:500, 1940), there is also a nearby protective period. This report describes a protective period within the cardiac cycle of conscious mice when a precisely timed stimulus prevented the initiation of ventricular tachycardia caused by an earlier stimulus. In addition, we tested the hypothesis that this precisely timed pulse within the protective period prevents reperfusion-induced ventricular tachyarrhythmias in conscious mice. Mice (n = 6) were prepared to record arterial blood pressure and the electrocardiogram. In addition, a vascular occluder was placed around the left main coronary artery, and stimulating electrodes were secured onto the left ventricle. A single precisely timed electrical pulse (5 msec pulse width and 2.5 V) to the left ventricle arriving 13.9 ± 1.1 msec after the R-wave, caused ventricular tachycardia occurring 24.9 ± 0.9 msec after the R-wave. Importantly, a second precisely timed electrical pulse arriving 18.8 ± 0.5 msec after the first stimulus blocked the induction of ventricular tachycardia caused by the earlier stimulus. On an alternate day, the susceptibility to sustained ventricular tachycardia produced by 3.5 min of occlusion and reperfusion of the coronary artery was determined in conscious mice by use of the vascular occluder. Reperfusion resulted in ventricular tachycardia in all six mice. A precisely timed pulse within the protective period prevented ventricular tachycardia in all mice.


Dynamic lipidomics of the nucleus.
Once nuclear envelope membranes have been removed from isolated nuclei, around 6% of mammalian cell phospholipid is retained within the nuclear matrix, which calculations suggest may occupy 10% of the volume of this subcellular compartment. It is now acknowledged that endonuclear phospholipid, largely ignored for the past 40 years, provides substrate for lipid-mediated signaling events. However, given its abundance, it likely also has other as yet incompletely defined roles. Endonuclear phosphatidylcholine is the predominant phospholipid comprising distinct and highly saturated molecular species compared with that of the whole cell. Moreover, this unusual composition is subject to tight homeostatic maintenance even under conditions of extreme dietary manipulation, presumably reflecting a functional requirement for highly saturated endonuclear phosphatidylcholine. Recent application of new lipidomic technologies exploiting tandem electrospray ionization mass spectrometry in conjunction with deuterium stable isotope labeling have permitted us to probe not just molecular species compositions but endonuclear phospholipid acquisition and turnover with unparalleled sensitivity and specificity. What emerges is a picture of a dynamic pool of endonuclear phospholipid subject to autonomous regulation with respect to bulk cellular phospholipid metabolism. Compartmental biosynthesis de novo of endonuclear phosphatidylcholine contrasts with import of phosphatidylinositol synthesized elsewhere. However, irrespective of the precise temporal-spatial-dynamic relationships underpinning phospholipid acquisition, derangement of endonuclear lipid-mediated signaling from these parental phospholipids halts cell growth and division indicating a pivotal control point. This in turn defines the manipulation of compartmentalized endonuclear phospholipid acquisition and metabolism as intriguing potential targets for the development of future antiproliferative strategies.


SCExV: a webtool for the analysis and visualisation of single cell qRT-PCR data.
Single cell gene expression assays have become a powerful tool with which to dissect heterogeneous populations. While methods and software exist to interrogate such data, what has been lacking is a unified solution combining analysis and visualisation which is also accessible and intuitive for use by non-bioinformaticians, as well as bioinformaticians. We present the Single cell expression visualiser (SCExV), a webtool developed to expedite the analysis of single cell qRT-PCR data. SCExV is able to take any data matrix of Ct values as an input, but can handle files exported by the Fluidigm Biomark platform directly. In addition, SCExV also accepts and automatically integrates cell surface marker intensity values which are measured during index sorting. This allows the user to directly visualise relationships between a single cell gene expression profile and the immunophenotype of the interrogated cell. SCExV is a freely available webtool created to import, filter, analyse, and visualise single cell gene expression data whilst being able to simultaneously consider cellular immunophenotype. SCExV is designed to be intuitive to use whilst maintaining advanced functionality and flexibility in how analyses are performed.


Dynamic behavior of elastic strips near shape transitions.
Elastic strips provide a general motif for studying shape transitions. When actuated through rotation of its boundaries, a buckled strip exhibits, depending on the direction of rotation, three types of shape transitions: buckling, algebraic snap-through, or exponential snap-through. The transition dynamics is linked to the character of the bifurcation, which, in turn, is disclosed by the normal form of the system, but deriving normal forms is challenging. Recent work has used asymptotic methods to obtain this form for algebraic snap-through, but, to date, there is no methodology for extending this analysis to other transitions. Here we introduce a method to analyze the dynamic characteristics of an elastic strip near a transition and extend, in a straightforward manner, the previously proposed asymptotic analysis to exponential snap-through and buckling transitions. Importantly, we show that these normal forms dictate all the dynamic characteristics of the elastic strip near a shape transition. Our analysis provides reliable tools to diagnose and anticipate elastic shape transitions.


Management of hypercholesterolaemia in postmenopausal women.
Increased rates of coronary heart disease (CHD) occur with advancing age in both sexes, although CHD rates in women lag behind those of men by about 10 years. There is a sharp increase in CHD rate among women after approximately 50 years of age. The reasons for this are not completely understood and are undoubtedly multifactorial. Cross-sectional data from large-scale population studies suggest that around the time of the menopause, low-density lipoprotein (LDL)-cholesterol levels increase by approximately 15 to 25%. Because this increase is larger than that observed in men over the same age span and closely approximates that observed in women after oophorectomy, it is likely that reduced circulating estrogen levels associated with menopause play a role in the adverse changes in both blood lipid levels and CHD incidence. There is clear evidence that treating hypercholesterolemia reduces cardiovascular risk in women, as well as in men. In the US National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) guidelines, diet and other lifestyle changes are recommended as first-line therapy. If the treatment goals cannot be achieved through non-pharmacological measures, drug therapy should be added. Of the available lipid-lowering agents, HMG CoA reductase inhibitors (statins) are the clear choice to decrease LDL-cholesterol levels. However the favourable effects of statins on high-density lipoprotein (HDL)-cholesterol and triglyceride levels are more modest, and statins are not known to decrease lipoprotein (a) [Lp(a)] levels. Estrogen or hormone replacement therapy (ERT/HRT) and nicotinic acid improve LDL- and HDL-cholesterol levels and also decrease Lp(a) levels. However, ERT/HRT is no longer recommended as first-line therapy for decreasing CHD risk. Nicotinic acid is particularly useful for decreasing triglyceride levels (as are fibrates) and raising HDL-cholesterol levels. Bile-acid sequestrants reduce LDL-cholesterol and slightly increase HDL-cholesterol levels. Both bile acid sequestrants and ERT/HRT tend to raise triglyceride levels, therefore they should be used cautiously in women with hypertriglyceridaemia. Treatment should be individualised for each patient. It is important to evaluate the primary form of dyslipidaemia, other CHD risk factors, comorbidities, and the extent of lipid improvement needed in order to reach treatment goals. The effects of each type of therapy and potential adverse effects should also be considered.


Wherefore art thou, homeo(stasis)? Functional diversity in homeostatic synaptic plasticity.
Homeostatic plasticity has emerged as a fundamental regulatory principle that strives to maintain neuronal activity within optimal ranges by altering diverse aspects of neuronal function. Adaptation to network activity is often viewed as an essential negative feedback restraint that prevents runaway excitation or inhibition. However, the precise importance of these homeostatic functions is often theoretical rather than empirically derived. Moreover, a remarkable multiplicity of homeostatic adaptations has been observed. To clarify these issues, it may prove useful to ask: why do homeostatic mechanisms exist, what advantages do these adaptive responses confer on a given cell population, and why are there so many seemingly divergent effects? Here, we approach these questions by applying the principles of control theory to homeostatic synaptic plasticity of mammalian neurons and suggest that the varied responses observed may represent distinct functional classes of control mechanisms directed toward disparate physiological goals.


Clinical experiences with human parathyroid hormone 1-34.
Human parathyroid hormone (PTH) 1-34 was given to nine normal subjects and to 10 patients with hypoparathyroidism. There were no side effects associated with the protocol employed. In normal subjects, five statistically significant changes occurred during the period of observation: plasma cyclic adenosine monophosphate (cAMP) rose by a factor of 3 (at 30 min), nephrogenous cyclic AMP rose approximately 40-fold (at 60 min), urinary phosphate rose by a factor of 2 (at 120 min), urine calcium levels fell by 50% between 60 and 120 min, and plasma prolactin rose by a factor of 1.4 (at 60 min). The cAMP responses were significantly blunted in five patients with chronic hypocalcemia, chronic hyperphosphatemia, and detectable serum immunoreactive PTH levels. On the basis of this test these patients were designated as suffering from pseudohypoparathyroidism. The acute phosphaturic and hypocalciuric responses were apparently intact in these five individuals. Human PTH 1-34 is likely to replace bovine material in the delineation of syndromes associated with PTH resistance.


The effect of exercise training on human hypertension: a review.
Numerous sources of information in both the medical and exercise physiology areas state that exercise training lowers blood pressure at rest and during submaximal exercise in normotensive and hypertensive individuals. Based on these statements, the medical community is currently recommending regular exercise as a non-pharmacological therapy for reducing blood pressure in hypertensive patients. The purpose of this review was to assess the existing literature in this area to determine whether a basis exists for this recommendation. Our findings indicate that most of the studies reviewed reported modest reductions in blood pressure (means less than or equal to 10 mmHg) at rest and during submaximal exercise after training. However, even the modest reductions in blood pressure reported in these studies must be interpreted with caution because of numerous methodological shortcomings and inadequate study design, most notably the omission of non-exercising hypertensive control groups. Therefore, the evidence available at the present time is inadequate to recommend exercise training as a non-pharmacological therapy in hypertension.


Atypical chemokine receptor 3 induces colorectal tumorigenesis in mice by promoting β-arrestin-NOLC1-fibrillarin-dependent rRNA biogenesis.
Atypical chemokine receptor 3 (ACKR3) has emerged as a key player in various biological processes. Its atypical "intercepting receptor" properties have established ACKR3 as the major regulator in the pathophysiological processes in many diseases. In this study, we investigated the role of ACKR3 activation in promoting colorectal tumorigenesis. We showed that ACKR3 expression levels were significantly increased in human colon cancer tissues, and high levels of ACKR3 predicted the increased severity of cancer. In Villin-ACKR3 transgenic mice with a high expression level of CKR3 in their intestinal epithelial cells, administration of AOM/DSS induced more severe colorectal tumorigenesis than their WT littermates. Cancer cells of Villin-ACKR3 transgenic mice were characterised by the nuclear β-arrestin-1 (β-arr1)-activated perturbation of rRNA biogenesis. In HCT116 cells, cotreatment with CXCL12 and AMD3100 selectively activated ACKR3 and induced nuclear translocation of β-arr1, leading to an interaction of β-arr1 with nucleolar and coiled-body phosphoprotein 1 (NOLC1). NOLC1, as the phosphorylated protein, further interacted with fibrillarin, a conserved nucleolar methyltransferase responsible for ribosomal RNA methylation in the nucleolus, thereby increasing the methylation in histone H2A and promoting rRNA transcription in ribosome biogenesis. In conclusion, ACKR3 promotes colorectal tumorigenesis through the perturbation of rRNA biogenesis by the β-arr1-induced interaction of NOLC1 with fibrillarin.


[Suturing techniques for laparotomy wounds].
The author proposes a new method of suturing laparotomy wounds--extrafocal connection of wound margins with adaptive-repositive devices which permit to minimize damage and microcirculatory disorders of sutured tissues, and to reduce purulent complications rate from 30.6 to 11% (2.8 times) compared with routine method of tissues connection. The proposed method is recommended for patients with high risk of pyoinflammatory complications.


Effects of soy isoflavone supplementation on patients with diabetic nephropathy: a systematic review and meta-analysis of randomized controlled trials.
Diabetic nephropathy (DN) is a microvascular complication that is becoming a worldwide public health concern. The aim of this study was to assess the effects of dietary soy isoflavone intervention on renal function and metabolic syndrome markers in DN patients. Seven databases including Medline, the Cochrane Central Register of Controlled Trials, Science Direct, Web of Science, Embase, China National Knowledge Infrastructure, and WanFang were searched for controlled trials that assessed the effects of soy isoflavone treatment in DN patients. Finally, a total of 141 patients from 7 randomized controlled trials were included. The meta-analysis showed that dietary soy isoflavones significantly decreased 24-hour urine protein, C-reactive protein (CRP), blood urea nitrogen (BUN), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and fasting blood glucose (FBG) in DN patients. The standard mean difference was -2.58 (95% CI: -3.94, -1.22; P = 0.0002) for 24-hour urine protein, -0.67 (95% CI: -0.94, -0.41; P < 0.00001) for BUN, -6.16 (95% CI: -9.02, -3.31; P < 0.0001) for CRP, -0.58 (95% CI: -0.83, -0.33; P < 0.00001) for TC, -0.41 (95% CI: -0.66, -0.16; P < 0.00001) for TG, -0.68 (95% CI: -0.94, -0.42; P < 0.00001) for LDL-C, and -0.39 (95% CI: -0.68, -0.10; P = 0.008) for FBG. Therefore, soy isoflavones may ameliorate DN by significantly decreasing 24-hour urine protein, BUN, CRP, TC, TG, LDL-C, and FBG.


Asymmetric mammographic findings based on the fourth edition of BI-RADS: types, evaluation, and management.
Asymmetric breast findings are frequently encountered at screening and diagnostic mammography. However, there has been some confusion about the applicable terminology for describing asymmetric breast findings. The fourth edition of the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) has incorporated changes in the lexicon for asymmetric breast findings to address such problems and improve the clinical utility of reporting. The fourth edition has replaced "asymmetric breast tissue" with "global asymmetry," "density seen in only a single projection" with "asymmetry," and "focal asymmetric density" with "focal asymmetry." Once an asymmetric finding is perceived, it should be determined whether it is due to a definite lesion. To interpret and manage asymmetric breast findings, additional imaging studies such as straight lateral views, rolled views, and spot compression views at mammography and ultrasonography or magnetic resonance imaging should be applied appropriately in a logical work flow, and the radiologist should be aware of the pitfalls and pearls of each technique and modality.


Attenuation and processing of RNA from the rplJL--rpoBC transcription unit of Escherichia coli.
Attenuation and processing of the mRNA from the ribosomal protein-RNA polymerase operon rplJL--rpoBC have been demonstrated by the analysis of nuclease SI-resistant RNA . DNA hybrids. These hybrids were formed between RNA produced in vivo and specific DNA restriction fragments which span the rplL--rpoB intercistronic region. The 3' end of the predominant attenuated RNA lies 69 nucleotides beyond the end of the rplL gene following sequence features that are similar to those of other known attenuators. The nonattenuated transcript is normally cleaved in the intercistronic region. However, in an RNase III mutant strain, the hybrids corresponding to the cleaved nonattenuated mRNAs disappear and the expected full-sized hybrid is seen. We have localized the cleavage to an area of possible secondary structure in the transcript approximately 200 nucleotides beyond the end of the rplL gene. This demontrates RNase III processing of Escherichia coli mRNA. The methods used in this study permit the examination of specific ends of large and complex polycistronic mRNAs. Such experiments should help in understanding how posttranscriptional events influence gene expression.


Musculoskeletal surgery in psoriatic arthritis.
To determine the probability that patients with psoriatic arthritis (PsA) will require musculoskeletal surgery. To identify factors predictive of surgery in patients with PsA. To determine the clinical outcome of patients with PsA who underwent surgery compared to patients who did not. The database of the Psoriatic Arthritis Clinic was searched to identify individuals who had undergone musculoskeletal surgery. Biological and clinical data such as erythrocyte sedimentation rate (ESR), rheumatoid factor, clinical pattern, nail changes, functional class, number of inflamed joints, and radiological damage, as well as health scores such as Arthritis Impact Measurement Scale 2 (AIMS-2), SF-36, and Health Assessment Questionnaire (HAQ) were available for these patients. Patients who had surgery were compared to those who did not. Out of 444 patients with confirmed PsA, 31 had musculoskeletal surgery (6.98%). This probability increased with the duration of PsA. Surgery patients had their first operation at an average of 13.9 years (range 1-46) after onset of joint disease. Age at onset of PsA, clinical pattern, constancy of clinical pattern over time, rheumatoid factor, functional class, symmetry, nail changes, and the time separating the onset of skin disease and the onset of joint disease were not significantly different at the 0.05 confidence level. Patients who had surgery had significantly more radiological damage (p < 0.001) and more actively inflamed joints (p < 0.02) at first assessment than patients who did not. AIMS2, SF-36, and HAQ scores at final review were not statistically different across both groups. In our patients the probability of having musculoskeletal surgery for PsA was 7%. It increased with disease duration. Patients had their first surgery after an average of 13 years. The number of actively inflamed joints and the extent of radiological damage at first assessment were highly predictive of subsequent surgery: patients with the highest numbers of severely affected joints, both clinically and radiologically, were more likely to have surgery. "Baseline characteristics" such as ESR, rheumatoid factor, functional class, clinical pattern, nail changes, and symmetry were not predictive of subsequent orthopedic surgery.


Transarterial Embolization With Complementary Surgical Ligation of Gastroduodenal Artery for Ruptured Pancreaticoduodenal Artery Aneurysm.
The association between pancreaticoduodenal artery aneurysm (PDAA) and local hemodynamic changes in pancreaticoduodenal arcades is well established. However, there are few case reports of PDAA associated with acute aortic dissection. In this article, we outline and discuss the case of a 61-year-old man diagnosed with a type A acute aortic dissection who underwent emergency surgery and developed sudden-onset severe abdominal pain and shock 10 days later. Contrast-enhanced computed tomography showed a ruptured PDAA with feeding vessels from the gastroduodenal and superior mesenteric arteries, with evidence that the celiac artery was diverged from a false lumen. Transarterial embolization via the superior mesenteric artery alone was not expected to achieve hemostasis, so we performed a hybrid procedure involving transarterial embolization cannulated from superior mesenteric artery with complementary surgical ligation of the gastroduodenal artery. The postoperative course was uneventful, and follow-up contrast-enhanced computed tomography showed no persistence of the aneurysm 8 days after the second operation. This case proposed that visceral arterial malperfusion due to acute aortic dissection can cause PDAA in the early postoperative period. Although previous reports suggest that endovascular treatment is preferable, it may not always be feasible. Since ruptured PDAAs are often not detected during surgery, surgical treatment can be overly invasive. Whereas, transarterial embolization with complementary clamping or ligation of the gastroduodenal artery for ruptured PDAA is less invasive and can control hemorrhage, especially when cannulation to the celiac artery is impossible. Notably, the technique did not cause organ ischemia, presumably because the small collateral vessels of the pancreaticoduodenal arcades permitted sufficient blood flow. If endovascular treatment is unable to achieve rapid hemostasis, this technique may be a useful option for ruptured PDAA.


Interdependent roles for hypoxia inducible factor and nuclear factor-kappaB in hypoxic inflammation.
Decreased oxygen availability (hypoxia) is a hallmark feature of the microenvironment in a number of chronic inflammatory conditions including arthritis and inflammatory bowel disease (IBD). Recent advances in our understanding of oxygen-dependent cell signalling have uncovered several mechanisms by which hypoxia impacts upon the development of inflammation through the coordinated expression of adaptive, inflammatory and apoptotic genes. Two central transcription factors involved in the regulation of this response are hypoxia inducible factor (HIF) and nuclear factor-kappaB (NF-kappaB) which display different degrees of sensitivity to activation during hypoxia. Furthermore, HIF and NF-kappaB demonstrate an intimate interdependence at several mechanistic levels. Recent studies indicate that these pathways may represent important new therapeutic targets in diseases characterized by hypoxic inflammation.


Lack of association between the interleukin 6 gene -174G>C polymorphism and colorectal cancer: evidence from a meta-analysis.
Interleukin 6 (IL6) is a pleiotropic cytokine involved in physiological processes and in a variety of human malignancies. It is thus a logical candidate for being a causative factor underlying colorectal cancer (CRC). The association between the IL6 -174G>C polymorphism and CRC has been widely evaluated; yet, there is a lack of agreement between studies on the role of this polymorphism in CRC. We performed a meta-analysis to evaluate this association signal. Articles published before May 10, 2012 were included in the meta-analysis. A total of 11 populations incorporating 6481 cases and 7935 controls were included in our analysis. A random-effect model was applied irrespective of between-study heterogeneity. Data and study quality were assessed in duplicate. Overall, the association of the -174G>C polymorphism with CRC was not significant in an allelic comparison model [odds ratio (OR) = 0.99; 95% confidence interval (95%CI) = 0.90-1.09; P = 0.827], a homozygote model (OR = 0.98; 95%CI = 0.83-1.15; P = 0.805), a dominant model (OR = 0.99; 95%CI = 0.87-1.13; P = 0.906), or a recessive model (OR = 0.97; 95%CI = 0.88-1.08; P = 0.610). Furthermore, the analyses of subgroups created based on common study design, genotyping methods, and ethnicity failed to find a significant association of this polymorphism with CRC. Therefore, our results collectively suggest that the IL6 -174G>C polymorphism might not be a potential candidate for CRC risk.