Some dream mechanisms in Finnegans Wake.
This paper does not purport to offer a psychoanalytic reading of Finnegans Wake, but rather to demonstrate how, in recreating the mechanisms of the dream, Joyce's masterpiece offers to psychoanalysis a uniquely rich opportunity to explore the shadowy play of the dream in the permanence of a work of art. In particular, the manner in which Finnegans Wake tells its story through the distortions of dream narrative while bodying forth its protagonists in the substitutions of dream-identity are explored, with the help of certain Freudian and Lacanian concepts of unconscious structure.


A System-Level Self-Calibration Method for Installation Errors in A Dual-Axis Rotational Inertial Navigation System.
In a dual-axis rotational inertial navigation system (RINS), there are two kinds of installation errors, nonorthogonal installation errors of inertial sensors, and installation errors between the inertial measurement unit (IMU) and rotation axes. Traditionally, these two errors are not considered simultaneously. Thus, they are calibrated separately by different estimation algorithms and rotation schemes. In this paper, a system-level self-calibration method for installation errors of a dual-axis RINS is proposed. Based on the Kalman filter, the measurement model is reestablished to ensure that all installation errors can be estimated together. First, the relationship between the initial attitude and subsequent attitude of IMU during rotation is used as a constraint to estimate nonorthogonal installation errors of accelerometers, and installation errors between the IMU and rotation axes. Then, the angular rate of the rotation mechanism is used as a reference to estimate nonorthogonal installation errors of the gyros. The rotation scheme of the IMU is designed to make all installation errors observable, and the observability of the system is analyzed based on the piecewise constant system method. Simulation and laboratory experiment results suggest that installation errors can be effectively estimated by the proposed method, thereby avoiding the complex separating process.


Paclitaxel has moderate activity in squamous cervix cancer. A Gynecologic Oncology Group study.
Taxol (paclitaxel; Bristol-Myers Squibb, Princeton, NJ) is a new antineoplastic drug with broad-spectrum activity in solid tumors, including epithelial ovarian cancer, head and neck cancer, esophageal cancer, breast cancer, bladder cancer, and lung cancer. Its unique mechanism of action, polymerization of tubulin monomers, has stimulated both clinical and preclinical research on this agent. As limited drug supplies became more plentiful, a phase II trial of Taxol was initiated in patients with advanced squamous cervix cancer who had received no prior chemotherapy. In this trial, 30 assessable patients were initially entered onto the study and four partial responses were seen. Further accrual of 22 assessable patients was then accomplished to define better the response rate with smaller confidence intervals. The starting dose of Taxol was 170 mg/m2 (135 mg/m2 for patients with prior pelvic radiation) given as a 24-hour continuous intravenous infusion with courses repeated every 3 weeks. Dose escalations to 200 mg/m2 and deescalations to 110 mg/m2 were allowed based on adverse effects. The final response rate was 17% (two complete responses and seven partial responses). The primary and dose-limiting toxicity was neutropenia. The response rate makes Taxol a drug with sufficient activity to explore it in combination with other agents with similar activity.


Training and certification in endobronchial ultrasound-guided transbronchial needle aspiration.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) plays a key role in the staging of lung cancer, which is crucial for allocation to surgical treatment. EBUS-TBNA is a complicated procedure and simulation-based training is helpful in the first part of the long learning curve prior to performing the procedure on actual patients. New trainees should follow a structured training programme consisting of training on simulators to proficiency as assessed with a validated test followed by supervised practice on patients. The simulation-based training is superior to the traditional apprenticeship model and is recommended in the newest guidelines. EBUS-TBNA and oesophageal ultrasound-guided fine needle aspiration (EUS-FNA or EUS-B-FNA) are complementary to each other and the combined techniques are superior to either technique alone. It is logical to learn and to perform the two techniques in combination, however, for lung cancer staging solely EBUS-TBNA simulators exist, but hopefully in the future simulation-based training in EUS will be possible.


Acellular dermal matrix and bone cement sandwich technique for chest wall reconstruction.
The authors performed rigid reconstruction using the sandwich technique for full-thickness chest wall defects by using two layers of acellular dermal matrix and bone cement. We assessed six patients who underwent chest wall reconstruction. Reconstruction was performed by sandwiching bone cement between two layers of acellular dermal matrix. In all patients, there was no defect of the overlying soft tissue, and primary closure was performed for external wounds. The average follow-up period was 4 years (range, 2-8 years). No major complications were noted. The sandwich technique can serve as an efficient and safe option for chest wall reconstruction.


Stapling of the botulinum type A protease to growth factors and neuropeptides allows selective targeting of neuroendocrine cells.
Precise cellular targeting of macromolecular cargos has important biotechnological and medical implications. Using a recently established 'protein stapling' method, we linked the proteolytic domain of botulinum neurotoxin type A (BoNT/A) to a selection of ligands to target neuroendocrine tumor cells. The botulinum proteolytic domain was chosen because of its well-known potency to block the release of neurotransmitters and hormones. Among nine tested stapled ligands, the epidermal growth factor was able to deliver the botulinum enzyme into pheochromocytoma PC12 and insulinoma Min6 cells; ciliary neurotrophic factor was effective on neuroblastoma SH-SY5Y and Neuro2A cells, whereas corticotropin-releasing hormone was active on pituitary AtT-20 cells and the two neuroblastoma cell lines. In neuronal cultures, the epidermal growth factor- and ciliary neurotrophic factor-directed botulinum enzyme targeted distinct subsets of neurons whereas the whole native neurotoxin targeted the cortical neurons indiscriminately. At nanomolar concentrations, the retargeted botulinum molecules were able to inhibit stimulated release of hormones from tested cell lines suggesting their application for treatments of neuroendocrine disorders.


Autophagy in kidney health and disease.
Autophagy is emerging as an important pathway in many biological processes and diseases. This review summarizes the current progress on the role of autophagy in renal physiology and pathology. Studies from renal cells in culture, human kidney tissues, and experimental animal models implicate that autophagy regulates many critical aspects of normal and disease conditions in the kidney, such as diabetic nephropathy and other glomerular diseases, tubular injuries, kidney development and aging, cancer, and genetic diseases associated with the kidney. The importance of autophagy in the kidney has just started to be elucidated. How the process of autophagy is altered in the pathogenesis of kidney diseases and how this alteration is beneficial or detrimental to kidney functions still need to be fully understood. Investigations that uncover the precise mechanism and regulation of autophagy in various kidney diseases may lead to new strategies for therapeutic modulation.


Anxiety and depression with neurogenesis defects in exchange protein directly activated by cAMP 2-deficient mice are ameliorated by a selective serotonin reuptake inhibitor, Prozac.
Intracellular cAMP and serotonin are important modulators of anxiety and depression. Fluoxetine, a selective serotonin reuptake inhibitor (SSRI) also known as Prozac, is widely used against depression, potentially by activating cAMP response element-binding protein (CREB) and increasing brain-derived neurotrophic factor (BDNF) through protein kinase A (PKA). However, the role of Epac1 and Epac2 (Rap guanine nucleotide exchange factors, RAPGEF3 and RAPGEF4, respectively) as potential downstream targets of SSRI/cAMP in mood regulations is not yet clear. Here, we investigated the phenotypes of Epac1 (Epac1(-/-)) or Epac2 (Epac2(-/-)) knockout mice by comparing them with their wild-type counterparts. Surprisingly, Epac2(-/-) mice exhibited a wide range of mood disorders, including anxiety and depression with learning and memory deficits in contextual and cued fear-conditioning tests without affecting Epac1 expression or PKA activity. Interestingly, rs17746510, one of the three single-nucleotide polymorphisms (SNPs) in RAPGEF4 associated with cognitive decline in Chinese Alzheimer's disease (AD) patients, was significantly correlated with apathy and mood disturbance, whereas no significant association was observed between RAPGEF3 SNPs and the risk of AD or neuropsychiatric inventory scores. To further determine the detailed role of Epac2 in SSRI/serotonin/cAMP-involved mood disorders, we treated Epac2(-/-) mice with a SSRI, Prozac. The alteration in open field behavior and impaired hippocampal cell proliferation in Epac2(-/-) mice were alleviated by Prozac. Taken together, Epac2 gene polymorphism is a putative risk factor for mood disorders in AD patients in part by affecting the hippocampal neurogenesis.


Determinants of extinction in fragmented plant populations: Crepis sancta (Asteraceae) in urban environments.
Local populations are subject to recurrent extinctions, and small populations are particularly prone to extinction. Both demographic (stochasticity and the Allee effect) and genetic factors (drift load and inbreeding depression) potentially affect extinction. In fragmented populations, regular dispersal may boost population sizes (demographic rescue effect) or/and reduce the local inbreeding level and genetic drift (genetic rescue effect), which can affect extinction risks. We studied extinction processes in highly fragmented populations of the common species Crepis sancta (Asteraceae) in urban habitats exhibiting a rapid turnover of patches. A four-year demographic monitoring survey and microsatellite genotyping of individuals allowed us to study the determinants of extinction. We documented a low genetic structure and an absence of inbreeding (estimated by multilocus heterozygosity), which suggest that genetic factors were not a major cause of patch extinction. On the contrary, local population size was the main factor in extinction, whereas connectivity was shown to decrease patch extinction, which we interpreted as a demographic rescue effect that was likely due to better pollination services for reproduction. This coupling of demographic and genetic tools highlighted the importance of dispersal in local patch extinctions of small fragmented populations connected by gene flow.


[A rare case of huge triple-negative of accessory breast cancer enlarged during the course of chemotherapy].
A 38-year-old premenopausal woman with a right axillary mass was told that she had an atheroma. The mass enlarged. An infectious atheroma was suspected, and incision and drainage were performed. A mass 4 cm in diameter was palpated in the right axillary region. Ultrasonography showed a mass 6 cm in diameter, and magnetic resonance imaging revealed a hypervascular mass at the same site. Stage IIIB triple-negative of accessory breast cancer (T4bN1M0) was diagnosed. The patient received four courses of FEC 100 (5-fluorouracil, epirubicin, and cyclophosphamide) as preoperative chemotherapy, but progressive disease was diagnosed, and the regimen was switched to weekly paclitaxel. The tumor became ulcerated and friable, and the hemoglobin level fell to 6 g/dL. Emergency surgery was thus performed. Postoperatively, the patient received six courses of chemotherapy with paclitaxel plus gemcitabine. Accessory breast cancer is extremely rare, but should be borne in mind when an axillary mass is encountered. In our patient, progressive disease had developed during the preoperative chemotherapy for accessory breast cancer. Although treatment was switched to a different regimen, bleeding was detected, and the patient underwent a semi-emergency surgery.


[Complications associated with inguinal hernia repairs at the Patient Insurance Centre in 2003 to 2007].
The aim was to elucidate the prevalence of complications associated with adults' inguinal hernia repairs in Finland. We reviewed the notices of patient injury associated with inguinal hernia repairs, as reported in 2003 to 2007 to the Patient Insurance Centre. We analyzed the associated causes, compensations, and compensation criteria. The numbers and types of hernia operations performed during the same period in the whole country were retrieved from the notification register. A total of 55,000 hernia operations were carried out during this period, resulting in 250 notices of patient injury. Of these, 92 resulted in compensation. Besides severe pain, serious complications from inguinal hernia repairs seem to be rare.


Acceptability of male circumcision as a tool for preventing HIV infection in a highly infected community in South Africa.
Because a growing body of evidence suggests that male circumcision (MC) is associated with a reduced risk of HIV infection in Africa, it is being considered as a potential prevention tool to reduce the spread of infection. Its feasibility must therefore be assessed. A community-based cross-sectional study was conducted among a random sample of 482 men aged 19-29 years and 302 women aged 14-25 years, all living in the Westonaria district, South Africa. The prevalence of HIV infection was 11% among the men and 30% among the women. Trained personnel administered standardized questionnaires. Two-thirds of the 108 circumcised men (CM) were circumcised during a traditional ceremony and one-third in a clinical setting; the latter reported less pain and adverse outcomes. More than 70% of the non-circumcised men (NCM) stated that they would want to be circumcised if MC were proved to protect against sexually transmitted diseases (STD). Twenty-nine per cent of the CM and 22% of the NCM believed that MC protects against HIV and other STD. Moreover, 30% and 18%, respectively, believed that CM could safely have sex with multiple partners. Multivariate analysis showed that CM were more likely to report many lifetime partners. Although the level of MC in the area is relatively low, it is perceived positively. A significant proportion of the CM felt protected by their circumcision, a feeling unfortunately translated into unsafe practices. Our results strongly suggest that interventions including MC should carefully address the false sense of security that it may provide.


Corneal Ectasia and Hydrops in Ocular Hypotony: The Corneal Crease.
To report the association of chronic ocular hypotony with the development of progressive corneal ectasia and hydrops. Retrospective case series. Three patients with ocular hypotony were referred for corneal evaluation and found to have ectasia and acute corneal hydrops in their hypotonous eye(s). Clinically, the globes were easily deformable with either external digital palpation and/or simple blinking. All 3 patients had a history of chronic iridocyclitis, including one with juvenile idiopathic arthritis. In each case, the area of thinning was narrow and arcuate in configuration, distinctive from other ectatic disorders. Also uncharacteristically, the acute hydrops resolved rapidly within 2 to 3 weeks without surgical intervention. In 1 case, severe thinning with perforation occurred requiring urgent penetrating keratoplasty. This case series demonstrates a unique clinical entity in which corneal ectasia and hydrops developed in the setting of ocular hypotony and easily deformable corneas, in a pattern unlike previously described forms of ectasia. Acute hydrops, even with associated corneal perforation, demonstrated a short and self-limited course. Corneal ectasia and irregular astigmatism should be suspected as a cause of unexplained visual loss in the ever-increasing number of patients with chronic, stable ocular hypotony. Further study is warranted to determine the pathophysiology of corneal ectasia in this setting, which may include mechanical and inflammatory factors.


Reactive lymphoid hyperplasia of the liver mimicking hepatocellular carcinoma: incidental finding of two cases.
Reactive lymphoid hyperplasia is a rare disease that forms a mass-like lesion and is characterized by the proliferation of non-neoplastic, polyclonal lymphocytes forming follicles. We recently encountered 2 cases of reactive lymphoid hyperplasia of liver, both of which were asymptomatic and mimicked hepatocellular carcinoma by various imaging modalities. Based on the clinical impression of hepatocellular carcinoma, surgical resections were performed. Microscopic findings revealed that both lesions consisted of an aggregation of lymphocytes consisting of predominantly B-cells, with multiple lymphoid follicles positive for CD10 and negative for bcl-2, consistent with the diagnosis of reactive lymphoid hyperplasia. Polyclonality of both lesions was further confirmed by B cell receptor gene rearrangement study. The incidence of reactive lymphoid hyperplasia in the liver is exceedingly rare, and it is difficult to differentiate such lesions from hepatic malignancies based upon clinical grounds. The clinicopathological findings and literature review of this report may be helpful to improve the clinical decision-making.


Structural features of cell death in atherosclerotic lesions affecting long-term aortocoronary saphenous vein bypass grafts.
Aortocoronary saphenous vein bypass grafts fail because of structural pathologies (thrombosis, intimal hyperplasia and atherosclerosis) within the 'arterialized' vein leading to graft stenosis. This study examined structural characteristics of atherosclerotic alterations in long-term aortocoronary artery saphenous vein bypass grafts with particular attention to the features of cell death in atherosclerotic lesions. Stenotic vein grafts were obtained from 10 patients at redo coronary artery bypass grafting operations. All the grafts were affected by histological abnormalities, with eight out of ten grafts showing evidence of atherosclerotic alterations in the intimal hyperplastic layer. Areas containing foam cells were examined by electron microscopy. Cells with cytoplasmic lipid accumulations were characterized by varying degrees of chromatin condensation, fragmentation or dispersion, by focal areas of oedema and vacuolisation of their cytoplasm, and by plasmalemmal destruction. Some lipid-filled cells exhibiting signs of destruction contained myofilaments and basal membrane fragments, allowing them to be identified as smooth muscle cells. Macrophage foam cells were found to have undergone similar destruction. No cells showing nuclear degeneration were observed to have intact cytoplasmic organelles. Neither were apoptotic bodies identified, but necrotic remnants were frequently seen. The results suggest that cell death in atherosclerotic lesions affecting aortocoronary artery saphenous vein bypass grafts occurs through oncosis rather than by apoptosis.


Salvage Treatment for Invasive Aspergillosis and Mucormycosis: Challenges, Recommendations and Future Considerations.
Invasive mold diseases are devastating systemic infections which demand meticulous care in selection, dosing, and therapy monitoring of antifungal drugs. Various circumstances regarding PK/PD properties of the applied drug, resistance/tolerance of the causative pathogen or host intolerability can lead to failure of the initial antifungal therapy. This necessitates treatment adaption in the sense of switching antifungal drug class or potentially adding another drug for a combination therapy approach. In the current state of drastically limited options of antifungal drug classes adaption of therapy remains challenging. Current guidelines provide restricted recommendations only and emphasize individual approaches. However, novel antifungals, incorporating innovative mechanisms of action, show promising results in late stage clinical development. These will expand options for salvage therapy in the future potentially as monotherapy or in combination with conventional or other novel antifungals. We outline current recommendations for salvage therapy including PK/PD considerations as well as elucidate possible future treatment options for invasive aspergillosis and mucormycosis.


[Transvesical prostatectomy for benign prostatic hyperplasia--a 364 cases analysis].
During a 16 year period from January 1972 to December 1988, transvesical prostatectomies were performed on 364 patients with benign prostatic hyperplasia in the Department of Urology, Kaohsiung Medical College Hospital. The average operational procedure time was 116.1 minutes and the average amount of tissue resected was 38.3 grams. The most common complications were wound infections (6.8%), stress incontinence (1.92%), urethral stricture (4.12%) and impotence (0.27%). In this series, epididymitis and/or orchitis was noted in 4.3% of those who underwent vasectomies and 1.8% of those who did not; thus, epididymitis cannot be prevented by a prophylactic vasectomy. There was one postoperative death (mortality rate-0.27%). The present study found that 6.86% of the transvesical prostatectomy patients will require longer hospitalization and greater amounts of antibiotics due to post-operative wound infection; therefore the use of transvesical prostatectomy will decline and only be recommended for fit patients with others genitourinary diseases such as bladder diverticulum or giant bladder calculus.


Coordinate regulation of glycan degradation and polysaccharide capsule biosynthesis by a prominent human gut symbiont.
Bacteria in the distal human gut have evolved diverse abilities to metabolize complex glycans, including the capacity to degrade these compounds as nutrients and to assemble their component sugars into new polymers such as extracellular capsules. The human gut bacterium Bacteroides thetaiotaomicron is well endowed with the ability to metabolize both host- and diet-derived glycans. Its genome contains 88 different polysaccharide utilization loci (PULs) for complex glycan catabolism and eight different gene clusters for capsular polysaccharide biosynthesis. Here, we investigate one of the prominent mechanisms by which this gut symbiont regulates many PULs involved in host mucin O-glycan degradation; namely, transcriptional regulation via the concerted interactions of cell-envelope-localized TonB-dependent transporters, extra-cytoplasmic function sigma factors and anti-sigma factors, which participate together in a regulatory pathway termed trans-envelope signaling. Unexpectedly, we found that several different trans-envelope signaling switches involved in PUL-mediated O-glycan degradation also modulate capsular polysaccharide synthesis. A novel regulatory pathway, which is dependent on expression of O-glycan-targeting outer membrane proteins, governs this coordinated regulation of glycan catabolism and capsule synthesis. This latter finding provides a new link in the dynamic interplay between complex glycan metabolism, microbial physiology, and host responses that occurs during colonization of the gut.


The interpersonal-psychological theory of suicide and the role of psychological pain during the COVID-19 pandemic: A network analysis.
Among the most investigated theories explaining suicidal behavior there are the interpersonal-psychological theory of suicide (IPTS) by Thomas E. Joiner and the one focused on the construct of psychological pain (or psychache, or mental pain). Since it remains unclear whether these two different theories correlate with each other in the explanation of suicidal risk, we used a network analysis approach to investigate the complex interplay between both IPTS and psychological pain theories and history of suicidal planning and/or suicide attempt (SP/SA). A sample of 1,586 university students from various Italian universities was recruited between April 24th, 2020 and February 23rd, 2021, hence during the COVID-19 pandemic. To be included subjects should have been university students and aged between 18 and 35 years old. Within a network that included the core factors from both models (IPTS and psychological pain), higher fearlessness about death (Acquired Capability for Suicide Scale-Fearlessness About Death, ACSS-FAD) and higher psychological pain (Psychache Scale) were the variables most strongly associated with history of SP/SA. Considering a large number of variables, history of SP/SA was explained in particular by fearlessness about death and psychological pain in university students. Hence these aspects should be targeted in the treatment for suicide prevention.


Evaluation of VP22 spread in tissue culture.
We compare methods of detection of intercellular transport of the herpes simplex virus protein VP22 and of a green fluorescent protein (GFP)-VP22 fusion protein. Spread of both proteins was observed by immunofluorescence (IF) using organic fixatives. Spread of both proteins was also detected by IF after paraformaldehyde (PFA) fixation and detergent permeabilization, albeit at reduced levels. However, while spread of GFP-VP22 was observed by examining intrinsic GFP fluorescence after methanol fixation, little spread was observed after PFA fixation, suggesting that the levels of the fusion protein in recipient cells were below the detection limits of intrinsic-fluorescence or that PFA fixation quenches the fluorescence of GFP-VP22. We further considered whether elution of VP22 from methanol-fixed cells and postfixation binding to surrounding cells contributed to the increased detection of spread observed after methanol fixation. The results show that while this could occur, it appeared to be a minor effect not accounting for the observed VP22 cell-to-cell spread in culture.


Local linear regression for function learning: an analysis based on sample discrepancy.
Local linear regression models, a kind of nonparametric structures that locally perform a linear estimation of the target function, are analyzed in the context of empirical risk minimization (ERM) for function learning. The analysis is carried out with emphasis on geometric properties of the available data. In particular, the discrepancy of the observation points used both to build the local regression models and compute the empirical risk is considered. This allows to treat indifferently the case in which the samples come from a random external source and the one in which the input space can be freely explored. Both consistency of the ERM procedure and approximating capabilities of the estimator are analyzed, proving conditions to ensure convergence. Since the theoretical analysis shows that the estimation improves as the discrepancy of the observation points becomes smaller, low-discrepancy sequences, a family of sampling methods commonly employed for efficient numerical integration, are also analyzed. Simulation results involving two different examples of function learning are provided.


[Effect of birth weight on neonatal and maternal morbidity in expectant management of post-term pregnancy].
In the retrospective study to evaluate whether the number of newborns over 4000 grams weight is greater under expectative management of post-term pregnancy and explain its influence on perinatal and maternal morbidity and mortality. Retrospective study. Gynaecology and Obstetric Clinic, Medical Faculty, Masaryk University, Brno. Two groups were compared. Group I includes 1906 women, who delivered in the year 1996 under the active management of the post-term pregnancy with induction of labour in the 41st week. Group II includes 2008 parturients who delivered under the expectative management of the post-term pregnancy with induction of labour at the end of 42nd week. Perinatal mortality, brachial plexus injuries, clavicle fractures, Caesarean section rate for cephalopelvic dysproportion and injuries in mothers were evaluated. Students T test and chi square test were used for statistical purposes. In the group with expectative management of the post-term pregnancy there was significantly higher number of newborns over 4000 grams. Perinatal mortality and morbidity did not differ between the two groups. There is no difference in maternal morbidity as well. Our results of expectative management in post-term pregnancies with newborns over 4000 grams did not confirm our worries about higher morbidity both in newborns and mothers. There is no need to consider the expectative management of the post-term pregnancies to be dangerous.


MRI-based Decision Making of Implant Removal in Deep Wound Infection After Instrumented Lumbar Fusion.
A retrospective study. The aim of the study was to review the treatment of deep wound infection after posterior instrumented lumbar fusion, and thereby to optimize the decision-making process of implant removal or retention on the basis of magnetic resonance imaging (MRI) assessment. Biofilm formed on the surface of the spinal implant prevents infiltration of antibiotics and makes the infection treatment more complicated. The decision of implant removal, if necessary, should be made appropriately, but the problem is a lack of consensus for implant removal or retention. A total of 1445 consecutive patients who underwent posterior instrumented lumbar fusion were reviewed retrospectively. There were 23 deep wound infections (1.6%) requiring surgical treatment. MR images were used to evaluate the presence or absence of osteomyelitis of the instrumented vertebra and intervertebral abscess. Six patients in the negative MRI group (n=7) were successfully treated by a single salvage surgery without implant removal; fusion occurred in 86% of the patients. However, in the positive MRI group (n=13), 4 patients required implant removal at the initial surgery and 5 patients eventually warranted implant removal after an average of 2.4 additional operations. Notably, 3 of the 4 patients who kept the implants ended up with a loss of fixation stability attributed to screw loosening with a progressive destruction of the instrumented vertebra. Therefore, the fusion rate was only 23% for the MRI-positive patients. Furthermore, making a wrong decision regarding implant removal increased the number of salvage surgeries and frequently resulted in progressive bone destruction and pseudarthrosis. Once vertebral osteomyelitis and/or intervertebral abscess were evident in MR images, all the hardware should be removed. Failure to adhere to this recommendation resulted in multiple additional failed operations, and ultimately pseudarthrosis with further bony destruction.


Permanent Visual Impairment due to Delayed Diagnosis of Shunt Malfunction in Case of Lack of Typical Features of Increased Intracranial Pressure and Unchanged Ventricular Size.
We present the clinical features, imaging, and management of 5 cases of visual impairment as the primary manifestation ventriculoperitoneal (V-P) shunt malfunction. We retrospectively reviewed the medical records of 126 patients of V-P shunt malfunction in Shanghai Children's Medical Center between 2015 and 2020. Medical records including all hospital admissions were reviewed and follow-up data were collected. Five children (3.97%) had visual impairment as the primary manifestation of V-P shunt malfunction, with a mild or no headache. Four broken distal shunt catheters and one proximal catheter blockage were confirmed intraoperatively and cured by surgery. None of the patients had a definite improvement in ophthalmic examinations after 4-52 months of follow-up. Visual impairment as the primary manifestation of V-P shunt malfunction was uncommon and could be easily missed or misdiagnosed as the only problem for lack of typical features of increased intracranial pressure and unchanged ventricular size. Earlier definitive diagnosis and surgical intervention could prevent a further development of the visual loss caused by V-P shunt malfunction.


Phlebography as the gold standard in thromboprophylactic studies? A multicenter interobserver variation study.
In 241 patients with total hip arthroplasty and entering a study on thrombosis prophylaxis, phlebography was adequately performed in 451 legs 7 to 11 days after surgery. The phlebograms were primary evaluated by 4 independent observers, and finally a consensus of the images in which disagreement primarily occurred was obtained. The diagnosis of thrombosis in the 4 primary observations varied between 65% and 83% (mean 70%) and the agreement on a negative diagnosis between 97% and 99% (mean 98%). Taking into account agreement by chance, kappa-values varied from 0.60 to 0.83 when the 6 different pairs of observations were compared. When comparing the primary evaluations with the final consensus, agreements on positive diagnosis varied between 70% and 90% (mean 80%) and on negative diagnosis between 97% and 99% (mean 98%). Kappa-values varied from 0.68 to 0.90. The factor of uncertainty in evaluation of phlebography may have to be considered when studies on postsurgical thromboprophylaxis are planned.


Pleiotropic regulation of central carbohydrate metabolism in Escherichia coli via the gene csrA.
The carbon storage regulator gene csrA has been shown previously to dramatically affect the biosynthesis of intracellular glycogen in Escherichia coli through its negative control of the expression of two glycogen biosynthetic operons and the gluconeogenic gene pckA (Romeo, T., Gong, M., Liu, M. Y., and Brun-Zinkernagel, A. M. (1993) J. Bacteriol. 175, 4744-4755). Examination of the effects of csrA on several enzymes, genes, and metabolites of central carbohydrate metabolism now establishes a more extensive role for csrA in directing intracellular carbon flux. Phosphoglucomutase and the gluconeogenic enzymes fructose-1,6-bisphosphatase and phosphoenolpyruvate synthetase were found to be under the negative control of csrA, and these enzyme activities were maximal during the early stationary phase of growth. The enzymes glucose-6-phosphate isomerase, triose-phosphate isomerase, and enolase were positively regulated by csrA. Thus, csrA exerts reciprocal effects on glycolysis versus gluconeogenesis and glycogen biosynthesis. The glycolytic isozymes pyruvate kinase F and A (encoded by pykF and pykA, respectively) and phosphofructokinase I and II (pfkA and pfkB, respectively) exhibited differential regulation via csrA. Since the individual members of these isozyme pairs are allosterically regulated by different cellular metabolites, csrA is also capable of fine-tuning the allosteric regulation of glycolysis. In contrast, the expression of genes of the pentose phosphate pathway was weakly or negligibly affected by csrA.


[Visceral pain in acute abdomen].
Visceral pain is caused by either distension or contraction of the visceral muscular wall or obstruction of hollow gastrointestinal organs. Unlike the somatic pain due to peritonitis, visceral pain is diffuse, epigastric, periumbilical and is often accompanied by nausea, vomiting and restlessness. We demonstrate the significance of visceral pain in the differential diagnosis of the acute abdomen presenting five cases of appendicitis and cholecystitis. A correct early diagnosis of the acute abdomen while signs of local peritonitis are still absent (appendicitis in atypical location, recurrent acute appendicitis, spontaneous reopening of an occlusion) is facilitated by the awareness for the characteristics and symptoms of visceral pain, and therefore careful taking of the patient's history. A history lacking visceral pain on the other hand represents an important clue for the diagnosis of other conditions (gynecological, diverticulititis, etc.) with acute pelvic peritonitis.


Menstrual Morbidities, Menstrual Hygiene, Cultural Practices during Menstruation, and WASH Practices at Schools in Adolescent Girls of North Karnataka, India: A Cross-Sectional Prospective Study.
Issues of menstrual morbidities, menstrual hygiene, and cultural practices are rarely discussed by adolescents. The burden of menstruation and cultural practices which the adolescent girls have to face has been less quantified. This study aims to assess the issues related to menstruation in school girls. A cross-sectional prospective study was conducted on 1016 school-going adolescent girls in January 2020. A questionnaire in English and in Kannada was distributed to girls of class 8-12 of ages between 10 and 19 years. 70.5% of the girls attained menarche by 12 to 14.9 years, 37.2% of the girls had their periods every 28-34 days, and 12.2% of the girls said they have heavy periods. 61.95% of the girls had dysmenorrheal, and 9.7% of the girls said that they required medications for the pain. 70.7% of the girls were using commercial sanitary napkins, 12.7% were using cloth, and 15.3% were using both. 55.5% of the girls who were using cloth as an absorbent were not drying the cloth in sunlight. 57.1% of the girls were washing their genitals more than 2 times a day. 93.8% were having bath during menses and 87.2% were using soap along with water. 37.7% of the girls disposed their pads by burning them, 50.8% of then disposed them in the dust bin, and 4.9% of them buried them. 8.6% of the girls said that they remained completely absent from school during periods. 17.85% said that they remained absent for a day. 53.4% of the respondents said that they have difficulty in concentrating at school. 76.1% said that they had adequate water and sanitation facilities at school. 22.3% said that there was adequate facility to change their pads at school. 73.2% said that they could get a spare pad at school. 43.3% of the girls said they avoided cultural functions during their periods, and 38.5% said that they avoided religious ceremonies and practices during their periods. 8.7% of the girls were made to sit outside the house during their periods. The girls from rural areas had poorer hygienic habits, in comparison to the urban girls. Cultural restrictions such as sitting outside the house during menstruation and restricting play were more in the rural girls than the urban girls. Menstrual morbidities, menstrual hygiene management, and cultural beliefs all play a role in school absenteeism in adolescent girls. Improvement of facilities at school and conducting awareness programs can help adolescent girls to attend schools.


Urinary concentration and dilution in the aging kidney.
Aged people and rats have a reduced ability to maximally concentrate their urine. Many of the key transport proteins that contribute to urine concentrating ability are reduced in the medulla of aged rats. The reductions in the abundances of water, sodium, and urea transport proteins, and their reduced response to water restriction, contributes to the reduced ability of aged rats to concentrate their urine and conserve water. If similar mechanisms occur in human kidneys, it would provide a molecular explanation for the reduced concentrating ability in aging and may provide opportunities for novel therapeutic approaches to improve urine concentrating ability.


A new hypothesis about neuronal degeneration appeared after a rat model of menopause.
Estrogen is suggested to be one of the most important regulators of neuronal function, including neuronal proliferation, survival and plasticity. There is a broad consensus that the loss of ovarian hormones is associated with neurodegeneration in the hippocampus that leads to cognitive impairment. A total of 8 female rats which were subjected to bilateral ovariectomy were included in this study. After ovariectomy, the rats were housed for 123 days in a standard laboratory. At the end of the 123 days, the rats were euthanized and the brain sections were investigated by conventional light microscopic and electron microscopic techniques. The regular structure of almost all axon extensions was lost. The majority of these extensions had a sawtooth-like appearance in longitudinal section profiles. Especially in transfer section profiles of myelinated axons, some morphological changes were shown which may be matched up with light microscopic findings. Deficiency of estrogen will initially affect microtubule organization. When this organization breaks down, it will physically cause the distribution of the normal structure of axonal plasmalemma. This in turn will lead to the distribution of physical organizations of estrogen and other different types of receptors which are placed in both the membrane and microtubules in the axon.


[Fatal bleeding complications caused by Evans syndrome (autoimmune thrombocytopenia and hemolytic anemia) and type II autoimmune hepatitis in a 56-year-old patient].
Autoimmune hepatitis is a rare form of hepatitis of nonviral origin. Two main subentities have been described. The classical lupoid hepatitis (type I) is characterized by hypergammaglobulinemia and the presence of lupus erythematosus cells due to antinuclear antibodies. Autoimmune hepatitis type II, which is associated with antiliver/kidney microsomal antibodies type 1 (LKM 1) shows a more aggressive clinical course than autoimmune hepatitis type I and is frequently (41% of cases) associated with other immunologic diseases. In the present study we report a case of autoimmune hepatitis Type II, associated with autoimmune thrombocytopenia and hemolytic anemia, in a 56-year-old patient. The patient's death was caused by a fatal association of a failing coagulation system due to liver dysfunction and a severe autoimmune thrombocytopenia. The aggressive course of the thrombocytopenia even after splenectomy demonstrated that the splenic enlargement due to the portal hypertension was only a minor factor in the destruction of the thrombocytes. Interestingly, some findings of this case such as the advanced age, the presence of anti-smooth muscle antibodies and HLA-DR4 are usually associated with autoimmune hepatitis type I. The findings of this case indicate that concomitant autoimmune diseases can worsen the prognosis of autoimmune hepatitis. Prednisolone and azathioprine might not be sufficient to treat aggressive forms of autoimmune hepatitis. Immunosuppressive regimens administered to recipients after organ transplantation might be used as a therapy of autoimmune hepatitis in multicenter clinical trials.


How the Medicare Part D drug benefit changed the distribution of out-of-pocket pharmacy spending among older beneficiaries.
To examine the impact of the Medicare drug benefit (Part D) on the distribution of out-of-pocket pharmacy spending among older adults. We used a pre-post-with-comparison-group design to compare four groups of beneficiaries continuously enrolled in a Medicare Advantage plan between 2004 and 2007: three intervention groups with no or limited (quarterly caps of $150 or $350) prior coverage that obtained Part D benefits in 2006 and a comparison group with stable drug coverage from 2004 to 2007. The comparison group's out-of-pocket drug spending was stable throughout 2004-2007, whereas Part D reduced out-of-pocket spending 13.4% among those without prior coverage (95% confidence interval [CI] -17.1% to -9.1%) and 15.9% among those with $150 quarterly caps (95% CI -19.1% to -12.8%) relative to the comparison group. Individuals in the top decile of drug spending paid a greater share of their costs out-of-pocket than others in the top 5 deciles. Although Part D reduced out-of-pocket expenditures for older adults, those with the highest drug spending still pay a substantial share of their drug costs out-of-pocket. Thus, the Part D benefit does not achieve a primary purpose of insurance-to offer the greatest financial protection to those at the highest risk.


[Mortality from cancer, arsenic, and nitrates in drinking water and cropland in ArgentinaMortalidade por câncer, arsênio e nitratos na água para consumo humano e em áreas semeadas na Argentina].
Cancer mortality in the central region of Argentina is among the highest in the country. Two possible environmental factors could explain this situation: agricultural activity and drinking water quality. The objective of the study is to evaluate the interaction between these variables. This is a retrospective ecological study. Total cropland over 10-year periods as well as the percentage of the population exposed to high levels of arsenic and nitrates in drinking water were analyzed and compared to total mortality rates (TMR) and organ-specific mortality rates (SMR); the Spearman's rank correlation coefficient was then calculated. Positive and significant correlations were found between the first two 10-year periods of total cropland and the first 10-year period of TMR, as well as correlations with lung, pancreatic, and colon cancers in men and colon cancer in women. Elevated arsenic levels are associated with TMR in both sexes across all 10-year periods but are specifically associated with lung cancer in men. No significant correlation was found with nitrates. The association between total cropland and TMR/SMR is stronger with proximity over time, with greater impact from the oldest crops. The association between TMR and consumption of water containing arsenic, as well as the association with lung SMR in men and colon SMR in women, show that exposure over time is essential to understanding regional epidemiological conditions. The synergy between these variables should be explored.


Progressive multifocal leukoencephalopathy, a review and an extended report of five patients with different immune compromised states.
Progressive multifocal leukoencephalopathy (PML) is an opportunistic infection of the brain caused by the JC-virus. Both a decreased cellular or humoral immune response can increase the susceptibility for JC-virus induced PML. Not only HIV infected people are at risk, a wide range of otherwise immune compromised patients are a potential target for this virus. This report of five PML patients shows the importance of a clinician's familiarity with this disease and it's presenting symptoms. The presenting symptoms of PML can sometimes mimic worsening of the underlying disease. Although different therapeutic strategies have been tried, the outcomes remain very poor. In this series, treatment with cidofovir appears not to be effective in treating PML, neither in HIV positive nor HIV negative patients. Experimental therapy with leflunomide, after tapering of the immunosuppressive medication, did change the natural course of PML in one patient.


Carrier ampholyte-free free-flow isoelectric focusing for separation of protein.
Free-flow isoelectric focusing (FFIEF) has the merits of mild separation conditions, high recovery and resolution, but suffers from the issues of ampholytes interference and high cost due to expensive carrier ampholytes. In this paper, a home-made carrier ampholyte-free FFIEF system was constructed via orientated migration of H+ and OH- provided by electrode solutions. When applying an electric field, a linear pH gradient from pH 4 to 9 (R2 = 0.994) was automatically formed by the electromigration of protons and hydroxyl ions in the separation chamber. The carrier ampholyte-free FFIEF system not only avoids interference of ampholyte to detection but also guarantees high separation resolution by establishing stable pH gradient. The separation selectivity was conveniently adjusted by controlling operating voltage and optimizing the composition, concentration and flow rate of the carrier buffer. The constructed system was applied to separation of proteins in egg white, followed by MADLI-TOF-MS identification. Three major proteins, ovomucoid, ovalbumin and ovotransferrin, were successfully separated according to their pI values with 15 mmol/L Tris-acetic acid (pH = 6.5) as carrier buffer at a flow rate of 12.9 mL/min.


Recruitment and funding for clinical pharmacy residency and fellowship programs.
A survey was conducted to determine if a shortage exists of graduates interested in residency and fellowship training, and whether program preceptors experience difficulty maintaining funding. Questionnaires were mailed to 195 preceptors listed in the American College of Clinical Pharmacy Directory of Residencies and Fellowships, and responses from 143 (73%) were compiled. Average numbers of applicants interviewed per available position were 3.1, 3.3, and 2.6 for general clinical residency, specialized residency, and fellowship positions, respectively. Approximately 20% of specialty residency and fellowship positions were reported to be unfilled, and 70% of preceptors of these programs expressed the opinion that a shortage of interested graduates exists. Difficulty maintaining funding was most frequently reported by fellowship preceptors (54%), and several sources of funding were required to maintain such programs.


Prevalence, incidence burden, and clinical impact of healthcare-associated infections and antimicrobial resistance: a national prevalent cohort study in acute care hospitals in Greece.
Assessing the overall burden of healthcare-associated infections (HAIs) is challenging, but imperative in evaluating the cost-effectiveness of infection control programs. This study aimed to estimate the point prevalence and annual incidence of HAIs in Greece and assess the excess length of stay (LOS) and mortality attributable to HAIs, overall and for main infection sites and tracer antimicrobial resistance (AMR) phenotypes and pathogens. This prevalent cohort study used a nationally representative cross-section of 8,247 inpatients in 37 acute care hospitals to record active HAIs of all types at baseline and overall LOS and in-hospital mortality up to 90 days following hospital admission. HAI incidence was estimated using prevalence-to-incidence conversion methods. Excess mortality and LOS were assessed by Cox regression and multistate models correcting for confounding and time-dependent biases. HAIs were encountered with daily prevalence of 9.1% (95% confidence interval [CI] 7.8%-10.6%). The estimated annual HAI incidence was 5.2% (95% CI 4.4%-5.3%), corresponding to approximately 121,000 (95% CI 103,500-123,700) affected patients each year in the country. Ninety-day mortality risk was increased by 80% in patients with HAI compared to those without HAI (adjusted hazard ratio 1.8; 95% CI 1.3-2.6). Lower respiratory tract infections, bloodstream infections, and multiple concurrent HAIs doubled the risk of death, whereas surgical site and urinary tract infections were not associated with increased mortality. AMR had significant impact on the daily risk of 90-day mortality, which was increased by 90%-110% in patients infected by carbapenem-resistant gram-negative pathogens. HAIs increased LOS for an average of 4.3 (95% CI 2.4-6.2) additional days. Mean excess LOS exceeded 20 days in infections caused by major carbapenem-resistant gram-negative pathogens. HAIs, alongside with increasing AMR, pose significant burden to the hospital system. Burden estimates obtained in this study will be valuable in future evaluations of infection prevention programs.


Repeat whole-blood and plateletpheresis donors:unreported deferrable risks, reactive screening tests, andresponse to incentive programs.
Evaluating plateletpheresis (PPH) and repeat community whole-blood (RWB) donors' responses to donation incentive programs is essential for developing effective donor retention programs. Using data from a 1998 anonymous questionnaire sent to 92,581 US blood donors, the prevalence of unreported deferrable risks, screening test reactivity, and response to incentives were compared in RWB and PPH donors by the use of weighted chi-square tests and logistic regression analyses. From 52,650 respondents, 38,884 RWB and 2,028 PPH donors were identified. Levels of screening test reactivity (1%) and unreported deferrable risks (UDRs, 2-3%) were similar in RWB and PPH donors. RWB and PPH donors were strongly encouraged or discouraged by similar incentives. Of the incentives that would encourage a higher proportion of UDR-free RWB donors to return, cholesterol screening and earning a blood credit appealed to >50 percent. Similar results were obtained for cholesterol screening in PPH donors. Community service or education credits, premarital screening, and cash had limited appeal for PPH and RWB donors, respectively, and would be more likely to differentially encourage donors with a UDR to return. Incentives that were associated with the greatest donor appeal and that minimized the potential recruitment of more risky donors were identified.


Choosing and using contraception: toward a theory of women's contraceptive self-care.
Thirty women of varying ethnicity and socioeconomic status, who were actively seeking to avoid pregnancy, were interviewed concerning their lifetime experience with contraceptive use. The resulting description, Women's Contraceptive Self-Care, was divided into four processes: the central process, Choosing and Using Contraception, and three contextual processes. Forestalling Pregnancy was defined as using contraceptive methods or behaviors to prevent or delay childbearing. Assigning the Burden of Contraceptive Responsibility was defined as assuming responsibility for contraception or shifting that responsibility to a partner. Negotiating with Those who Control Contraception was defined as maneuvering among individuals and agencies that permit or hinder access to contraceptive methods and behaviors. Each process is comprised of thematic clusters and/or themes that are defined and illustrated.


[Biplane transesophageal echocardiography. Experience with 130 outpatients].
To analyse the utility of transesophageal echocardiography (TEE) as a complementary technique to transthoracic echocardiographic (TTE) comparing results and additional informations. One hundred and thirty consecutive outpatients (66 male) submitted to TEE, with age ranging from 12 to 84 years were studied. Patients were grouped according to the main indication: evaluation of prosthetic valves, 21 patients; cardiac source of emboli, 43; diseases of the aorta, 17; infective endocarditis, 14; congenital heart diseases, 14 and other abnormalities in 21 patients. TEE provided additional and important information in all groups. Perivalvular leakage was observed in 42.1% of patients with prosthetic valves. Vegetations were detected in 45.5% of the suspected cases of endocarditis (missed by TTE). Dissection of aorta was diagnosed in 35.2% of patients with suspected disease and atrial septal defect was successfully recognized in 80% of the cases. No complications were observed. TEE is a safe and usefull complementary non-invasive diagnostic tool in the assessment of structures such as left atrium, left atrial appendage, thoracic aorta, prosthetic valves and in the investigation of infective endocarditis.


Activation of junB by PKC and PKA signal transduction through a novel cis-acting element.
The product of the junB gene, a gene homologous to the proto-oncogene c-jun, is a component of transcription factor AP-1. JunB expression is modulated by a wide variety of extracellular stimuli, such as serum, growth factors, phorbol esters (TPA) and activators of protein kinase A (PKA). In order to study the molecular basis of this complex regulation, we have cloned the mouse junB gene from a genomic testis library, and characterized the junB promoter. Here we show that the junB promoter is activated by serum, TPA, and activated PKA. Sequences located between -91 and -44 are necessary for induction. These sequences contain a CAAT box, a G-C rich region and a previously undescribed inverted repeat (IR). The IR element can mediate induction by TPA and PKA when coupled to a heterologous promoter, and specifically binds a protein of 110 kD.


Diabetes Mellitus as Hub for Tuberculosis Infection: A Snapshot.
Tuberculosis (TB) still remains the thorn in the flesh of efficient therapeutics affecting one-third of global population annually. There are several factors that enhance the susceptibility to TB infections including malnutrition, smoking, and immunocompromised conditions such as AIDS. In the recent years, growing body of evidence has gained considerable prominence which suggests that Diabetes Mellitus (DM) is individual risk factor leading to complicated TB infections. In this article the authors have attempted to summarize the link of type 2 DM with TB, the mechanistic action of how DM sensitizes for developing the active TB infection from the latent infection, and problems faced during treatment followed by possible preventive measures. We have tried to give account of the alterations that occurred in DM making a person more prone to develop TB.


Structure and mechanism of L-fucose isomerase from Escherichia coli.
The three-dimensional structure of L-fucose isomerase from Escherichia coli has been determined by X-ray crystallography at 2.5 A resolution. This ketol isomerase converts the aldose L-fucose into the corresponding ketose L-fuculose using Mn2+ as a cofactor. Being a hexamer with 64,976 Da per subunit, L-fucose isomerase is the largest structurally known ketol isomerase. The enzyme shows neither sequence nor structural similarity with other ketol isomerases. The hexamer obeys D3 symmetry and forms the crystallographic asymmetric unit. The strict and favorably oriented local symmetry allowed for a computational phase extension from 7.3 A to 2.5 A resolution. The structure was solved with an L-fucitol molecule bound to the catalytic center such that the hydroxyl groups at positions 1 and 2 are ligands of the manganese ion. Most likely, L-fucitol mimics a bound L-fucose molecule in its open chain form. The protein environment suggests strongly that the reaction belongs to the ene-diol type.


Preparing to receive patients with trauma.
Appropriate preparation could prevent up to 70% of trauma-related deaths in hospital. In this article, a military trauma team discusses the infrastructure required to receive patients with major trauma. It explains who should be in a trauma team and the tools needed to ensure efficient communication between team members. Roles for nurses are explored under the following headings: control of environmental factors; pain management; prevention of pressure ulcers; and the care of patients' relatives. The reception of mass casualties is also considered.


Photosynthetic Enhancement, Lifespan Extension, and Leaf Area Enlargement in Flag Leaves Increased the Yield of Transgenic Rice Plants Overproducing Rubisco Under Sufficient N Fertilization.
Improvement in photosynthesis is one of the most promising approaches to increase grain yields. Transgenic rice plants overproducing Rubisco by 30% (RBCS-sense rice plants) showed up to 28% increase in grain yields under sufficient nitrogen (N) fertilization using an isolated experimental paddy field (Yoon et al. in Nat Food 1:134-139, 2020). The plant N contents above-ground sections and Rubisco contents of the flag leaves were higher in the RBCS-sense plants than in the wild-type rice plants during the ripening period, which may be reasons for the increased yields. However, some imprecise points were left in the previous research, such as contributions of photosynthesis of leaves below the flag leaves to the yield, and maintenance duration of high photosynthesis of RBCS-sense rice plants during ripening periods. In this research, the photosynthetic capacity and canopy architecture were analyzed to explore factors for the increased yields of RBCS-sense rice plants. It was found that N had already been preferentially distributed into the flag leaves at the early ripening stage, contributing to maintaining higher Rubisco content levels in the enlarged flag leaves and extending the lifespan of the flag leaves of RBCS-sense rice plants throughout ripening periods under sufficient N fertilization. The higher amounts of Rubisco also improved the photosynthetic activity in the flag leaves throughout the ripening period. Although the enlarged flag leaves of the RBCS-sense rice plants occupied large spatial areas of the uppermost layer in the canopy, no significant prevention of light penetration to leaves below the flag leaves was observed. Additionally, since the CO2 assimilation rates of lower leaves between wild-type and RBCS-sense rice plants were the same at the early ripening stage, the lower leaves did not contribute to an increase in yields of the RBCS-sense rice plants. We concluded that improvements in the photosynthetic capacity by higher leaf N and Rubisco contents, enlarged leaf area and extended lifespan of flag leaves led to an increase in grain yields of RBCS-sense rice plants grown under sufficient N fertilization.


Evaluation of anti-influenza efficiency of polyclonal IgG antibodies specific to the ectodomain of M2 protein of influenza A virus by passive immunization of mice.
We attempted to quantify the protective potential of polyclonal IgG antibodies specific to the ectodomain of M2 protein (eM2) of influenza A virus (IAV) against lethal influenza infection of mice. For this purpose, eM2 conjugated with keyhole limpet hemocyanin (KLH) or KLH alone were administered with Freund's adjuvant intraperitoneally (i.p.) to BALB/c mice. IgG antibodies specific to the KLH-eM2 conjugate (anti-KLH-eM2 IgGs) and KLH (anti-KLH IgGs), respectively, were purified from ascitic fluids. Analysis of the preparation of anti-KLH-eM2 IgGs by ELISA revealed that it contained about 25% of anti-eM2 IgGs and 75% of anti-KLH IgGs. Taking into account this finding mice were passively immunized by intravenous route with 320, 160, 80, and 40 µg of anti-eM2 IgGs per mouse, respectively, while 320 µg of anti-KLH IgGs were used in control. Following subsequent infection with 3 LD50 IAV the survival of mice was determined. An absolute protection (100% survival) was obtained with 320 µg of anti-eM2 IgGs, and a relatively strong significant protection (~80% survival, p = 0.024) with 160 µg. The amount 160 µg of IgGs represents approx. 100 µg IgGs per 1 ml of blood.


Probable Factors Associated with Response to Mesenchymal Stem Cell Therapy in Stroke Patients: A Post Hoc Analysis of the STARTING-2 Trial.
The aim of this study was to identify factors associated with improved motor function of the lower extremities in response to mesenchymal stem cell (MSC) therapy in patients with ischemic stroke. This study was a post hoc analysis of data from a prospective, open-label, randomized controlled trial of MSC therapy for patients with ischemic stroke patients associated with severe middle cerebral artery territory (STARTING-2 trial). Lower limb motor function was scored based on the lower limb of Fugl-Meyer assessment (FMA-LL) score before MSC therapy and at 3 months after stroke. All FMA-LL changes greater than or equal to six points were considered clinically significant. Univariate and multivariate binary logistic regression models were used to determine possible predictors of clinically significant lower limb motor response to MSC therapy. Twelve (33%) of the thirty-six patients receiving MSC therapy reached a minimal clinically important difference (MCID) of FMA-LL. The two independent factors with the greatest impact on response to MSC therapy for achieving an MCID in FMA-LL score were: (1) the time from stroke onset to MSC therapy, and (2) age (p < 0.05). In addition, obese stroke patients responded better to MSC therapy than stroke patients with normal weight. In conclusion, this post hoc analysis might suggest the need for recruiting stroke patients at younger and early after stroke onset in future clinical trials of MSC therapy for stroke.


[Public participation and empowerment in Health Promotion].
A new model for Health Promotion was proposed by WHO in 1986. The purpose of this paper is to review public participation and empowerment in Health Promotion by reviewing case reports and original papers. The main results can be divided into two categories, public participation, and empowerment, The main results are as follows; 1) Health promotion involves the population as a whole in their everyday lives, rather than focusing on people who are sick or at risk for specific diseases. 2) The use of participatory and empowering approaches in the evaluation process has the potential to strengthen the public's capacity for organizational learning and improve their own health status. 3) It is possible to improve health conditions by using empowerment interventions: 1. The need to adopt an ecological approach that simultaneously addresses empowerment. 2. Policy-makers need to take a longer-term approach to empowerment interventions, including proper longitudinal studies to enhance the evidence base for such interventions. 4) Satisfaction is central to the delivery of health and human services. The most critical factor in service delivery is providing quality care and user merit. 5) In developing people-oriented health technologies, priority should be given to the availability of lay resources and to indigenously developed health practices. 6) Empowerment is the most important idea within health promotion. It is often a difficult concept for health professionals to grasp since most have been trained to consider health care providers as experts and the patient as a recipient of this expertise. 7) Health care specialists can contribute considerably to the development of a collaborative, family-oriented approach in the development of self care. The possibilities for such an undertaking depend on the establishment of working relationships at two interfaces: between the health care specialist and his/her client families. A framework for developing these relationships is proposed: involvement, collaboration, and empowerment. 8) The individual should also be given a greater opportunity to actively participate in the design and planning health care services. 9) In the Health Promotion program, it is important to provide a working and living environment in which respect for each other's humanity can be shared.


The combined effect of serum cystatin C and dyslipidemia on hypertension in a large health check-up population in China.
OBJECTIVE: Some studies have reported that both serum cystatin C (Cys C) and dyslipidemia are independently associated with hypertension. However, the combined effect of the two factors is still unknown. The present study was aimed at investigating the effect of Cys C combined with dyslipidemia on hypertension in a large health check-up population in China. METHODS: A total of 203 233 health check-up subjects from January 2011 to July 2016 were recruited into this cross-sectional study. A multivariate logistic regression model was used to evaluate the combined effect of Cys C and dyslipidemia on hypertension.RESULTS: In univariate analysis, Cys C, high-density lipoprotein cholesterol, low-density lipoprotein, total cholesterol, and triglycerides were independently correlated with hypertension (p < 0.001). A concentration-dependent combined effect of serum Cys C and dyslipidemia on hypertension was observed in multivariate regression analysis. When compared with Cys C of <0.82 mg/L, the risk of hypertension in Cys C of <0.82 mg/L with dyslipidemia, Cys C of 0.82-0.94 mg/L with dyslipidemia, Cys C of 0.94-1.08 mg/L with dyslipidemia, and Cys C of ≥1.08 mg/L with dyslipidemia was increased 1.946 (95% confidence interval [CI]: 1.827-2.074), 1.973 (95% CI: 1.864-2.088), 2.047 (95% CI: 1.941-2.158), and 2.038 (95% CI: 1.937-2.143) folds, respectively, after adjustment.CONCLUSION: There was an association between hypertension and the combined effect of Cys C with dyslipidemia.


[Demonstration of abnormalities of myocardial mitochondrial oxygenation in cardiac graft rejection].
Abnormalities of myocardial metabolism during acute rejection may be due to ischemia to primary metabolic changes related to rejection. An experimental study of heterotopic cardiac transplantation in the rat was undertaken to study myocardial mitochondrial oxidation during acute rejection. The receivers were Lewis rats and the donors Fischer (FL: allograft) or Lewis (LL: isograft) rats. The oxygen consumption of the mitochondria (VO2m) isolated from the transplanted and native hearts was measured by oxygraphy six days after transplantation. Using maleate and glutamate substrates, the VO2m of transplanted hearts was significantly lower than that of native hearts in the two groups of rats (FL, p less than 0.01; LL, p less than 0.01). In addition, the VO2m of FL allograft transplanted hearts was significantly lower than in the LL rats (30 +/- 9 vs 100 +/- 15 nanoatoms of oxygen/min.mg/prot, p less than 0.01) as was the VO2m of the native hearts (FL: 106 +/- 23 vs LL: 164 +/- 26, p less than 0.02). The respiratory control ratio (RCR) was significantly lower in the transplanted than in the native hearts in both the FL and LL groups (p less than 0.05 and p less than 0.01 respectively). The comparison of the RCR in the two groups (FL vs LL) showed no significant difference for transplanted or native hearts. Electron microscopy of transplanted (rejected or not) and native hearts showed no morphological abnormality of the mitochondria. The lower VO2m of the allograft group indicates a disturbance in the mitochondrial respiratory pathway during acute rejection.(ABSTRACT TRUNCATED AT 250 WORDS)


β2 -adrenergic receptor Thr164IIe polymorphism, blood pressure and ischaemic heart disease in 66 750 individuals.
The β(2) -adrenergic receptor (ADRB2) is located on smooth muscle cells and is an important regulator of smooth muscle tone. The Thr164Ile polymorphism (rs1800888) in the ADRB2 gene is rare but has profound functional consequences on receptor function and could cause lifelong elevated smooth muscle tone. We tested the hypothesis that Thr164Ile is associated with increased blood pressure, increased frequency of hypertension and increased risk of cardiovascular disease (CVD). A total of 66 750 individuals from two large Danish general population studies were genotyped, and 1943 Thr164Ile heterozygotes and 16 homozygotes were identified. Thr164Ile genotype was associated with increased systolic and diastolic blood pressure in women (trend: P = 0.04 and 0.02): systolic and diastolic blood pressure increased by 5% and 2%, respectively, in female homozygotes compared with female noncarriers. All female Thr164Ile homozygotes had hypertension compared with 58% of female heterozygotes and 54% of female noncarriers (chi-square: P = 0.001). Female Thr164Ile homozygotes and heterozygotes had odds ratios for ischaemic heart disease (IHD) of 2.93 (0.56-15.5) and 1.28 (1.03-1.61), respectively, compared with female noncarriers (trend: P = 0.007). These differences were not observed in men. Furthermore, Gly16Arg (rs1042713) and Gln27Glu (rs1042714) in the ADRB2 gene were not associated with blood pressure, hypertension or CVD either in the population overall or in women and men separately. ADRB2 Thr164Ile is associated with increased blood pressure, increased frequency of hypertension and increased risk of IHD amongst women in the general population. These findings, particularly for homozygotes, are novel.


Cerclage Wire Fixation for Fracture-Dislocations of the Proximal Interphalangeal Joint.
Proximal interphalangeal (PIP) joint fracture dislocations are challenging injuries to treat. Multiple and varied treatments have been proposed. We present the use of cerclage wiring as a helpful technique in these challenging scenarios. The technique has the benefit of securing fracture fragments from the volar or dorsal base of middle phalanges or a comminuted fracture involving the entire articular surface. We report on the use of cerclage wires in eight patients (average: 43 years of age). Three patients had volar base fractures, three dorsal base fractures, and two impacted fractures involving the entire articular surface. All fractures healed, and average postoperative PIP active flexion motion arc was 21° to 95° (functional arc of 74°). We believe cerclage wire fixation is an effective and reproducible method to treat intra-articular fractures of middle phalanges, especially comminuted fractures involving the entire articular surface, and should be available to hand surgeons treating these difficult injuries.


Chromosomal damage induced by vanadium oxides in human peripheral lymphocytes.
Fly ash, the inorganic residue resulting from the combustion of some fuels, may almost exclusively contain vanadium oxides, compounds which exert potential toxic effects on a wide variety of in vitro and in vivo biological systems. Because information related to the oxidation state responsible for inducing genotoxic effects is controversial, the aim of the present study was to evaluate the effects of three vanadium salts in vitro. Human peripheral lymphocyte cultures were exposed to 1, 2, 4, or 8 microg/mL of vanadium(III) trioxide, vanadium(IV) tetraoxide, or vanadium(V) pentoxide (V(2)O(3), V(2)O(4), or V(2)O(5), respectively). These cultures were then screened for structural chromosomal aberrations, and mitotic index (MI) measurements were made. Cytogenetic evaluations showed that only V(2)O(4) increased the percentage of aberrant cells (without gaps) and chromosome damage (including and excluding gaps), while all compounds led to a decrease in the MI. These results demonstrate that vanadium(III), vanadium(IV), and vanadium(V) are all capable of inducing cytotoxicity, but only oxidation state IV induces clastogenic effects.


A thermodynamic model of transcriptome formation.
The genome supplies information on both the quality and quantity of the transcriptome. However, as it remains unknown how a cell determines transcript levels from the genome sequences, despite comprehensive knowledge of the cellular components involved, the quantity information held by the genome cannot as yet be derived from nucleotide sequences. The model presented here explains on a thermodynamic basis how the components decode the genome to form and maintain the transcriptome. The model describes the level of a transcript as a pseudo-equilibrium between velocities of synthesis and degradation, both of which are controlled by sequence-specific interactions between protein factors and nucleic acids. Each of the transcript levels can be described by a single equation expressing a function of the activity concentrations of the protein factors. Quantitative information in the genome can thus be transformed into constants determined from the nucleotide sequences. Using this model, the transcriptome can be traced back to the protein factors and the state of chromosome packaging. The total description of transcript levels allows the model to be verified through comparison of derived hypotheses with comprehensive measurements of the transcriptome. The hypotheses thus derived in the present study are well supported by experimental microarray data, confirming the appropriateness of the model.


Dietary and other methyl-group availability factors and pancreatic cancer risk in a cohort of male smokers.
The authors examined prospectively whether dietary folate and other factors known to influence methyl-group availability were associated with the development of exocrine pancreatic cancer within the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study cohort. Of the 27,101 healthy male smokers aged 50--69 years who completed a self-administered dietary questionnaire at baseline, 157 developed pancreatic cancer during up to 13 years of follow-up from 1985 to 1997. Cox proportional hazards models were used to estimate the hazards ratios and 95% confidence intervals. The adjusted hazards ratio comparing the highest with the lowest quintile of dietary folate intake was 0.52 (95% confidence interval: 0.31, 0.87; p-trend = 0.05). Dietary methionine, alcohol intake, and smoking history did not modify this relation. No significant associations were observed between dietary methionine, vitamins B(6) and B(12), or alcohol intake and pancreatic cancer risk. Consistent with prior studies, this study shows that cigarette smoking was associated with an increased risk (highest compared with lowest quintile, cigarettes per day: hazards ratio = 1.82; 95% confidence interval: 1.10, 3.03; p-trend = 0.05). These results support the hypothesis that dietary folate intake is inversely associated with the risk of pancreatic cancer and confirm the risk associated with greater cigarette smoking.


Necrotizing soft tissue infection of the forearms in a patient using intravenous heroin: case report of advanced wound management improving dressing tolerance and expediting skin graft.
Necrotizing soft tissue infection (NSTI) is rare and characterized by rapid onset and spread of inflammation and necrosis. The infection starts within the fascia but can rapidly progress to include musculature, subcutaneous fat, and overlying skin. Its presentation is considered a surgical emergency. Persons who use intravenous or subcutaneous opioids are at higher risk of NSTIs. The purpose of this case report is to describe the positive clinical outcome after consulting with wound specialists and using a dressing regimen to expedite more rapid wound healing, shortened time to skin graft, and improved pain tolerance in a patient with a history of intravenous and subcutaneous heroin use. The patient presented with an NSTI that required extensive debridement of the bilateral upper extremities. The acute surgical wound service was consulted. A dressing regimen consisting of hypochlorous acid-preserved wound cleansing, followed by carboxymethylcellulose fiber with 1.2% ionic silver covered by hydrocellular foam to promote a moist healing environment, was used to facilitate granulation. Healthy granulation tissue was noted 6 days after debridement. The improved rate of granulation and the patient's tolerance to dressing changes secondary to decreased pain from these dressings significantly expedited the time to graft and wound healing. The patient underwent split-thickness skin grafting 10 days after debridement. There was 100% uptake of the grafts on postgraft day 8. The favorable clinical outcome suggests that early consultation with wound specialists and implementation of the dressing regimen were effective in this patient regarding improved pain control and healing. However, because the patient left against medical advice on hospital day 20, the clinical course could not be followed beyond the first few postoperative weeks.


TNF-alpha-induced chemokine production and apoptosis in human neural precursor cells.
Recent studies have shown that proinflammatory cytokines damage rodent neural precursor cells (NPCs), a source of self-renewing, multipotent cells that play an important role in the developing as well as adult brain. In this study, the effects of tumor necrosis factor alpha (TNF-alpha) on cytokine and chemokine production by human NPCs (>98% nestin- and >90% A2B5-positive), obtained from 6- to 8-week-old fetal brain specimens, were evaluated. NPCs stimulated with this proinflammatory cytokine were found to produce abundant amounts of the chemokines monocyte chemoattractant protein 1 (MCP-1)/CC chemokine ligand 2 (CCL2) and interferon-inducible protein 10 (IP-10)/CXC chemokine ligand 10 (CXCL10) in a time- and concentration-dependent manner. TNF-alpha treatment also induced NPC apoptosis. Receptors for TNF [TNFRI (p55) and TNFRII (p75)] mRNA were constitutively expressed on NPCs. However, only TNFRI was involved in TNF-alpha-induced chemokine production and apoptosis by NPCs, as anti-TNFRI but not anti-TNFRII antibodies blocked the stimulatory effect. TNF-alpha treatment induced p38 mitogen-activated protein kinase (MAPK) phosphorylation in NPCs, and SB202190, an inhibitor of p38 MAPK, blocked TNF-alpha-induced chemokine production. Thus, this study demonstrated that NPCs constitutively express receptors for TNF-alpha, which when activated, trigger via a p38 MAPK signaling pathway production of two chemokines, MCP-1/CCL2 and IP-10/CXCL10, which are involved in infectious and inflammatory diseases of the brain.


Changes in the Structure and Digestibility of Wrinkled Pea Starch with Malic Acid Treatment.
Resistant starch has gradually become a popular food component due to its beneficial physiological effects and heat resistance during processing. In this study, the structure, reaction mechanism, and digestibility of wrinkled pea starch with malic acid and heat⁻moisture treatment (HMT) are investigated. The degree of substitution (DS) of malate starch, HMT-malate starch, and malate-HMT starch was 0.164, 0.280, and 0.146, respectively. Malate starch remained in its complete particle form and pronounced birefringence was displayed. However, the malate-HMT starch sample was almost completely broken into pieces and lost the polarized cross. All modified starch samples had a decreased swelling power and a new peak at 1731⁻1741 cm-1 shown by FTIR. From the 13C CP/MAS NMR (Cross Polarizatio/Magic Angle Spinning Nuclear Magnetic Resonance) spectra, all the modified starches had extra peaks at 38.5 ppm and 172.8 ppm. After esterification treatment, the resistant starch (RS) and slowly digestible starch (SDS) content of starch samples increased dramatically. The higher content of RS and lower enzymatic hydrolysis rate of the malate starch could be used to produce low-calorie foods and have potential health benefits.


Further evidence for the presence of mitochondrially encoded subunits in cytochrome c oxidase of the trypanosomatid Crithidia fasciculata.
Mitochondrial mRNAs in trypanosomatids are edited by uridylate insertion and deletion. The respiratory chain complexes cytochrome c reductase, cytochrome c oxidase and F0F1-ATPase of the insect trypanosomatid Crithidia fasciculata have been isolated and analysed by peptide microsequencing, but so far, proteins encoded by edited (and unedited) mitochondrial mRNAs have not been found. In this paper, we provide evidence that the mitochondrial mRNAs encoding the three large subunits of cytochrome c oxidase are indeed translated. First, purified holo cytochrome c oxidase turned out to be cysteine-rich, in agreement with the high cysteine codon-content of the sequence of mitochondrial cox subunit mRNAs. Second, in mass spectrometry measurements of cytochrome c oxidase, a protein was detected with the predicted molecular weight of cytochrome c oxidase subunit 2. Finally, an antibody generated against a fusion protein produced in Escherichia coli from constructs containing a segment of cytochrome c oxidase subunit 2 cDNA, specifically recognised protein bands present in cytochrome c oxidase following SDS PAGE. However, these proteins were present in the high molecular weight region of the gel, suggesting that cytochrome c oxidase subunit 2 aggregates in the presence of SDS.


Topically applied antithrombotic agents offer a new therapeutic approach to the prevention of microvascular thrombosis.
In the quest to develop optimal antithrombotic therapies for reconstructive microsurgery, with concomitant minimization of patient risk for generalized hemorrhage, surgeons have been turning to localized intraarterial delivery of various agents. An extension of this direction is to design agents that bind specifically to the site of thrombogenesis and effectively inhibit or prevent the buildup of thrombotic components. Progress in this direction must make use of the latest developments in the molecular understanding of coagulation, platelet adhesion/aggregation, and fibrinolytic processes. This article reviews pertinent developments in the biochemical understanding of thrombosis and discusses current avenues of investigation in the development of topically applied agents that help prevent microvascular thrombotic occlusion.


A dose-ranging study of midazolam for postoperative sedation of patients: a randomized, double-blind, placebo-controlled trial.
To evaluate the dose range, efficacy, and safety of midazolam for induction of sedation of mechanically ventilated postoperative patients in the intensive care unit. A randomized, double-blind, placebo-controlled study. Thirteen intensive care units in Japan. We included 98 patients undergoing general surgery who were ASA physical status I-III. The following inclusion criteria were applied to the patients after surgery: under mechanical ventilation, sedation level 2 or 3 on the Ramsay Sedation Scale, and any pain level but 4 on the Pybus and Torda Pain Scale. Of the 98 patients initially enrolled in the study, 95 patients received one of the study medications: placebo (n = 24), 0.015 mg/kg midazolam (n = 21), 0.03 mg/kg midazolam (n = 26), or 0.06 mg/kg midazolam (n = 24). Level of sedation was assessed by using the Ramsay Sedation Scale before and 10 mins after medication. The proportions of patients with sedation level 4 or deeper after medication were 4.3%, 14.3%, 52.0%, and 90.9% in the placebo and the midazolam 0.015 mg/kg, 0.03 mg/kg, and 0.06 mg/kg groups, respectively. Safety was assessed by routine monitoring of body functions and monitoring for adverse events. Although midazolam dose-dependently reduced mean systolic arterial pressure, the changes in this variable were small; only one or two patients in each treatment group had decreases in systolic arterial pressure of >20%. No clear dose dependency was found for changes in other body functions measured in the intensive care unit. The proportion of patients who achieved a satisfactory level of sedation increased with an increasing dose of midazolam. Intravenous bolus injection of midazolam also dose-dependently reduced mean systolic arterial pressure. This study indicated that, balancing sedative efficacy and safety, from 0.03 to 0.06 mg/kg of midazolam provides relatively safe sedation in postoperative patients.


Differential protein expression during aging in ventricular myocardium of Fischer 344 x Brown Norway hybrid rats.
The aging heart undergoes well characterized structural changes associated with functional decline, though the underlying mechanisms are not understood. The aim of this study was to determine to what extent ventricular myocardial protein expression was altered with age and which proteins underwent protein nitration. Fischer 344 x Brown Norway F1 hybrid (FBN) rats of four age groups were used, 4, 12, 24, and 34 months. Differential protein expression was determined by 2-DE and proteins were identified by peptide mass fingerprinting. Altered protein nitration with age was assessed by immunoblotting. Over 1000 protein spots per sample were detected, and 255 were found to be differentially expressed when all aged groups were compared to young rats (4 months) (p0.05). A strong positive correlation between differential protein expression and increasing age (p=0.03, R(2)=0.997) indicated a progressive, rather than abrupt, change with age. Of 46 differentially expressed proteins identified, seventeen have roles in apoptosis, ten in hypertrophy, seven in fibrosis, and three in diastolic dysfunction, aging-associated processes previously reported in both human and FBN rat heart. Protein expression alterations detected here could have beneficial effects on cardiac function; thus, our data indicate a largely adaptive change in protein expression during aging. In contrast, differential protein nitration increased abruptly, rather than progressively, at 24 months of age. Altogether, the results suggest that differential myocardial protein expression occurs in a progressive manner during aging, and that a proteomic-based approach is an effective method for the identification of potential therapeutic targets to mitigate aging-related myocardial dysfunction.


Effect of Comprehensive Nursing on the Recovery of Gastrointestinal Function in Patients Undergoing Abdominal Operation.
The objective is to explore the effect of comprehensive nursing on the recovery of gastrointestinal function in patients undergoing an abdominal operation. Sixty patients undergoing abdominal surgery in our hospital from January 2019 to April 2021 were enrolled. The patients were arbitrarily assigned into control group and research group. The former group received routine nursing and the latter group received comprehensive nursing. Nursing satisfaction, gastrointestinal function, POMS-SF score, nutrition risk score, incidence of adverse reactions, and quality of life scores were compared. The nursing satisfaction of the research group was higher than that of the control group, and the difference between the groups was statistically significant (P < 0.05). In terms of gastrointestinal function, the anal exhaust time eating time defecation time and bowel sound recovery time in the research group were significantly lower than those in the control group, and the difference between the groups was statistically significant (P < 0.05). In terms of POMS-SF score, the scores of tension-anxiety, depression-depression, fatigue-dullness, anger-hostility, and confusion-confusion in the research group were lower than those in the control group, while the energy-vitality score was higher than that in the control group, and the difference between the groups was statistically significant (P < 0.05). There was no significant difference in nutritional risk score among patients before nursing (P > 0.05); after nursing, the nutritional risk score decreased. Compared between the two groups, the nutritional risk score of the research group was lower when compared to the control group at 3 days, 5 days, and 7 days after nursing, and the difference between the groups was statistically significant (P < 0.05). In terms of the incidence of adverse reactions, the incidence of adverse reactions such as incision effusion, incision infection, incision dehiscence, and anastomotic leakage in the research group was lower when compared to the control group, and the difference between the groups was statistically significant (P < 0.05). Regarding quality of life scores, before nursing, there exhibited no significant difference of patients (P > 0.05); after nursing, the quality of life scores of patients decreased. Compared with the two groups, the physical function, psychological function, social function, and healthy self-cognition scores of the research group were all lower compared to the control group, and the difference between the groups was statistically significant (P < 0.05). Abdominal surgery patients received comprehensive care, which improved their mental health, reduced anxiety and depression levels, relieved fatigue and dullness, improved energy and vitality, and enhanced their overall mood. Meanwhile, it can also promote the recovery of gastrointestinal function in patients and reduce the incidence of adverse reactions.


Antioxidant capacity and UPLC-PDA ESI-MS polyphenolic profile of Citrus aurantium extracts obtained by ultrasound assisted extraction.
This study aimed to evaluate different pre-treatments and solvent ratios on the total phenolic content and antioxidant activity of Citrus aurantium (sour orange) peel extracted by ultrasound. A two-factor (2 × 3) factorial design was implemented, with fresh and dry peels as pre-treatment conditions, and water (100%), 50% aqueous ethanol (v/v) and 96% aqueous ethanol (v/v) as the solvents. The phenolic compounds were identified and quantified by ultra-performance liquid chromatography-photodiode array and electrospray ionisation-mass spectrometry, respectively. The compounds were partially purified by advanced automated flash purification. The results indicated that the maximal phenolic content (40.95 ± 3.44 mg gallic acid equivalents/g dry weight) was obtained when fresh sour orange peels were extracted with 50% (v/v) aqueous ethanol while the maximal antioxidant activity (730.04 ± 28.60 μmol Trolox equivalents/g dry weight) was achieved from aqueous extraction of dry sour orange peels. Nine phenolic compounds were identified and quantified. Naringin and neohesperidin predominated in sour peel extracts, whereas, caffeic and chlorogenic acids were the least abundant. Evaluation of the antioxidant activity in the fractions suggested that this activity might be attributed to the synergistic effect of the nine phenolic compounds present in the crude extract. Accordingly, sour orange peel is a potential source of phenolic compounds with antioxidant activity.


A force field for guanidinium-based ionic liquids that utilizes the electron charge distribution of the actual liquid: a molecular simulation study.
We propose a new all-atom force field for guanidinium-based ionic liquids (GILs) which is based on the charge distribution in the actual liquid. It comprises all cations that can be built by attaching alkyl chains of variable length to an acyclic or cyclic guanidinium compound and that are paired with nitrate or perchlorate anions. We based the parametrization of the force field on liquid-phase charge distributions to improve the prediction of energetic and dynamic properties of GILs. The impact of electron charge transfer and polarization on various properties of GILs is systematically assessed. A significant average electron charge transfer between -0.12 and -0.06 e from anions to the central guanidinium group of the cations and a strong polarization of acyclic cations are observed by applying a combined quantum mechanical/molecular mechanical (QM/MM) approach. Molecular dynamics simulations of GILs are performed, utilizing the proposed force field. Derived structures approach the accuracy of QM/MM structures, and a previously reported crystal structure remains stable throughout the simulations. Mass densities are reproduced with a deviation of only 1.4% from experimental data. The calculated melting point of a GIL crystal deviates only 8% from the measured value. Self-diffusion coefficients of various GILs are reported, and a comparison with a diffusion coefficient derived from experimental data indicates that the values are within a reasonable range. We observe that the melting point of a GIL crystal was lowered up to 60 K and that diffusion coefficients are substantially increased by a factor of up to 3.5 upon consideration of charge transfer and polarization. The results demonstrate that liquid-phase partial charges are capable of improving the quality of ionic liquid force fields substantially and that their utilization led to a model that can be applied to predict structural, energetic, and dynamic properties of GILs.


Mosaic pattern of hepatocellular carcinoma: histologic basis for a characteristic CT appearance.
The mosaic pattern is a characteristic CT appearance for hepatocellular carcinoma (HCC). This study was designed to assess the tissue composition responsible for the CT mosaic pattern. Gross and whole-mount histologic sections of 10 HCC tumors from eight patients were prepared at identical levels as preoperative CT sections. CT features of the mosaic tumor pattern were spatially registered with the corresponding pathologic sections. CT of mosaic HCC demonstrated enhancing nodules (9/10), low attenuation areas (9/10), and internal septa (3/10). Spatial registration of CT and microscopic sections showed that enhancing tissue was viable tumor in nine of nine. Low attenuation areas were either necrotic (4/9) or of mixed tissue (5/9), including areas of necrosis, fibrosis, and hemorrhage. The variable tissue composition of HCC accounts for the mosaic CT pattern. In most patients, enhancing nodules indicate viable tumor cells, and low attenuation areas represent necrosis, fibrosis, or hemorrhage.


Educational outreach to improve emergency medical services systems of care for stroke in Montana.
To improve stroke knowledge, identification, and acute care among first responders (FRs) and emergency medical technicians (EMTs) through educational outreach and support. Beginning in 2006, the Montana Stroke Initiative implemented outreach to FRs and EMTs and emergency medical services (EMS) statewide. Cross-sectional telephone surveys of FRs and EMTs were used to evaluate changes in stroke knowledge and practice in 2006 (n = 988) and 2009 (n = 944), overall and in rural and urban counties. The respondents to the 2009 survey were more likely to report the availability of a stroke protocol in their service (69% vs. 61%, p = 0.001), training in the use of a stroke screening tool (62% vs. 42%, p < 0.001), use of a stroke screening tool (62% vs. 40%, p < 0.001), and an adequate level of knowledge about stroke (81% vs. 66%, p < 0.001) compared with the respondents to the 2006 survey. Significant improvements in each of these areas were achieved for both rural and urban FRs and EMTs. Educational outreach to FRs and EMTs was associated with marked improvement in selected components of the EMS system of stroke care.


Sub-ppb-Level Detection of Nitrogen Dioxide Based on High-Quality Black Phosphorus.
The development of gas sensors based on two-dimensional (2D) layered materials has received lots of focus attributing to their excellent gas sensitivity. Here, a black phosphorus (BP) gas sensor device is fabricated based on high-quality few-layered BP microribbons using a facile route. Although BP is well known to oxidize in ambient conditions, energy dispersive spectroscopy (EDS) mapping manifests that the few-layered BP microribbons undergo slight oxidation and contamination during the grinding process. It is interesting that the surface and side of BP microribbons have nanoscale thin films and step-like nanoscale thin films, respectively, owing to the in-plane slip of the few-layered BP microribbons in the process of grinding, which are different from the conventional BP bulk crystals. The layered BP microribbon gas sensor demonstrated a high response to low-concentration NO2 and a very low limit of detection (LOD) of 0.4 ppb of NO2 under N2 and air conditions, which is the lowest LOD for NO2 detection reported so far. The mechanisms for excellently sensitive detection of NO2 for the BP microribbons have been investigated by first-principles calculations combined with experiment results, revealing that the sensitization mechanisms of the BP microribbon sensor are abundant nanoscale thin films, an optimum bandgap range with optimal carrier concentration, a hierarchical homojunction structure, and strong adsorption energy to NO2. In addition, the BP microribbon sensor demonstrated high selectivity to NO2, a low LOD under a high relative humidity, and good repeatability. The reported results of the BP sensor may provide great promise for improving the performance of other 2D material-based gas sensors and may expand sensing applications.