Phytochemical Constituents from the Seeds of Capsella bursa-pastoris and Their Antioxidant Activities.
Phytochemical investigation of 70% EtOH extract of the seeds of Capsella bursa-pastoris led to the isolation of a new cyclobutane organic acid (1), and fourteen known compounds, including two organosulfur compounds (2, 3), two quinonoids (4, 5), five flavonoids (6-10), three sterols (11-13) and two other types (14, 15). The structures of the compounds were elucidated by extensive spectroscopic analyses as well as comparison of their spectroscopic data with those reported in the literature. The antioxidant capacities of all compounds and extractive fractions were evaluated by the 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical-scavenging test and ferric reducing antioxidant power (FRAP) assay. Then the antioxidative substances were evaluated for their neuroprotective effects against H2O2-induced HT22 cell injury. The results indicated the strong scavenging ability to free radical of the extractive fractions and compounds 1-3, 8-10 and 13, and the ferric reducing antioxidant power of the extractive fractions and compounds 1-3, 8 and 10, which were close to or higher than that of the positive control trolox. The EtOAc fraction, n-BuOH fraction, and compounds 1, 3 and 8 can protect HT-22 cells from oxidative damage.


Review of the existing maximum residue levels for cypermethrins according to Article 12 of Regulation (EC) No 396/2005.
According to Article 12 of Regulation (EC) No 396/2005, EFSA has reviewed the maximum residue levels (MRLs) currently established at European level for the group of pesticide active substances cypermethrins. To assess the occurrence of cypermethrin, alpha-cypermethrin, zeta-cypermethrin, beta-cypermethrin residues in plants, processed commodities, rotational crops and livestock, EFSA considered the conclusions derived in the framework of Regulation (EC) No 1107/2009, the MRLs established by the Codex Alimentarius Commission (codex maximum residue limits; CXLs) for cypermethrin, alpha-cypermethrin and zeta-cypermethrin as well as the European authorisations and import tolerances reported by Member States and the UK (including the supporting residues data) for cypermethrin and zeta-cypermethrin. The toxicological profile of zeta-cypermethrin was also assessed. Based on the assessment of the available data, MRL proposals were derived, and a consumer risk assessment was carried out. Some information required by the regulatory framework was missing and a possible chronic/acute risk to consumer was identified. Hence, the consumer risk assessment is considered indicative only, all MRL proposals derived by EFSA still require further consideration by risk managers and measures for reduction of the consumer exposure should also be considered.


[Perspectives and plans to improve the prognosis of cervical cancer].
The cervical cancer has already attained high survival rate and there is a little room to improve the prognosis. The examination of recurred patients reveals that the recurrence was often found in the cervix, parametrium, pelvic wall, and distant organs. More intensive treatment to such part may be of beneficial to reduce recurrence. Post operative radiation to the pelvis for high risk patients seemed to improve the survival rate, although some authors failed to show its merit. Radiation to the para-aortic lymph node is matter of controversial. Chemotherapy is now expected to play an important role to control or prevent distant metastasis. Considering these facts, improvement of prognosis of the cervical cancer will be expected by 1. early detection by mass screening and 2. centralization the treatment facilities in order to do the individualized and multidisciplinary treatment.


Patellar Height after High Tibial Osteotomy of the Distal Tibial Tuberosity: A Retrospective Study of Age Stratification.
To explore the effect of age stratification on patellar height after single-plane high tibial osteotomy of the distal tibial tuberosity (DTT-HTO). A retrospective analysis was performed on 110 knee joints undergoing DTT-HTO. Patients were divided into three groups according to age: under 60 years old, 28 cases; 60 to 70 years old, 61 cases; and over 70 years old, 21 cases. All patients were followed up for no less than 12 months, and at each follow-up, short-leg radiographs and whole-leg radiographs were taken. The values of the Caton-Deschamps index (CDI) and Blackburne-Peel index (BPI) of single-short-leg radiographs and the femoral-tibial angle (FTA) and weight-bearing line ratio (WBLR) of whole-leg radiographs were measured before and at the last follow-up. The Lysholm score before and at the last follow-up and the visual analogue scale (VAS) score before and 3 days after surgery and at the last follow-up were calculated. The frequency of classification of the normal-height patella, patella alta, and patella baja before and after surgery was recorded. There were no significant differences in CDI and BPI preoperatively or postoperatively among the three groups (P > 0.05), and there were no statistically significant differences in FTA and WBLR. There were no significant differences in CDI, BPI, FTA, or WBLR between the three groups before and after the operation (P > 0.05). The Lysholm score increased from 48.84 ± 10.10 before surgery to 91.96 ± 3.082 after surgery (P < 0.05); the VAS score decreased from 8.23 ± 0.99 before surgery to 1.93 ± 0.953 at 3 days after surgery and 1.07 ± 0.53 at the last follow-up (P < 0.01). No significant difference was observed in the incidence of each patellar height classification between the three groups preoperatively and postoperatively. Patellar height is not influenced by DTT-HTO. The age of patients is not a limiting factor for the selection of this surgical procedure. Without affecting the height of the patella, DTT-HTO can effectively reduce pain in the knee joint, restore the function of the knee joint, and delay the progression of patellar arthritis.


Classification and classification criteria for vasculitis: achievements, limitations and prospects.
The classification of diseases reveals the relationships between conditions that are linked in some way. Such classification has been a challenge for vasculitis because of the heterogeneous and protean nature of the illnesses. Classification criteria are critical to homogenize patient populations with vasculitis who are included in basic and clinical research studies. The most recent advance in vasculitis classification has been the revised 2012 Chapel Hill Consensus Conference (CHCC) nomenclature of vasculitis that, although mainly focusing on nomenclature, also included classification elements. Whereas still maintaining the caliber of the predominantly involved vessels as the main categorization criterion for primary systemic vasculitis, the 2012 CHCC nomenclature introduced a new category--variable-vessel vasculitis--to include Behçet's disease and Cogan's syndrome in the vasculitis spectrum. Another important feature was the expansion of the classification to secondary vasculitis and single-organ vasculitis. Similarly, classification criteria for several vasculitis entities have been altered and new criteria published, namely for Behçet's disease and cryoglobulinemic vasculitis. The classification of vasculitis continues to be amended to account for advances in the general understanding of the nature of vasculitis and our ability to diagnose them. The relevance of the prevailing classification system, relying on affected vessel size as the primary discriminator of vasculitis entities, is still questionable for clinical practice. Clinically sound, widely accepted classification criteria are available for most vasculitis entities, although some areas remain ill-defined: polyarteritis nodosa, microscopic polyangiitis and adult immunoglobulin A vasculitis (Henoch-Schönlein).


[Surgical management of the spinal metastases].
Seventy per cent of patients with cancer have evidence of metastases and spinal involvement may occur in up to 50 %. Pain is the most frequent symptom and it occurs in 90 % of the patients. It exist three different type of spinal pain : inflammatory, radicular and mechanical pain. Pain could be related to a neurological compromise and treatment becomes urgent. Steroids are introduced even if surgery is indicated. The Spinal Instability Neoplastic Score is a useful tool in order to determine instability in spinal metastases. Early recognition of instability could allow to minimal invasive surgery and even vertebroplasty. Tokuhashi score facilitates patient's selection during the decision-making process to the multidisciplinary team.


Evolution of cooperative imitators in social networks.
Many evolutionary game models for network reciprocity are based on an imitation dynamics, yet how semirational imitators prevail has seldom been explained. Here we use a model to investigate the coevolutionary dynamics of cooperation and partnership adjustment in a polygenic population of semirational imitators and rational payoff maximizers. A rational individual chooses a strategy best responding to its neighbors when updating strategy and switches to a new partner who can bring it the maximal payoff from all candidates when adjusting the partnership. In contrast, a semirational individual imitates its neighbor's strategy directly and adjusts its partnership based upon a simple reputation rule. Individual-based simulations show that cooperation cannot evolve in a population of all best responders even if they can switch their partners to somebody who can reward them best in game playing. However, when imitators exist, a stable community that consists of cooperative imitators emerges. Further, we show that a birth-death selection mechanism can eliminate all best responders, cultivating a social regime of all cooperative imitators. Compared with parallel simulations that assume fixed networks, cooperative imitators are evolutionarily favored, provided they are able to adjust their partners.


Highly sensitiveT1-T2dual-mode MRI probe based on ultra-small gadolinium oxide-decorated iron oxide nanocrystals.
Single-mode magnetic resonance imaging (MRI) contrast agents (CAs) in clinical settings are easily disturbed by calcification, bleeding, and adipose signals, which result in inaccurate diagnoses. In this study, we developed a highly efficientT1-T2dual-mode MRI CA using an ultra-small gadolinium oxide-decorated magnetic iron oxide nanocrystal (GMIO). The gadolinium element could effectively alter the magnetic properties of the GMIO from soft-ferromagnetism to superparamagnetism. In addition, when the Gd/Fe ratio was 15% (designated as GMIO-2), the GMIO-2 possessed the best superparamagnetism and highest magnetism. Subsequently,T1andT2values of GMIO-2 were measured through a series of turbo spin-echo images and then multi-spin echo sequence, respectively. Based on this,T1andT2relaxivities of GMIO-2 were calculated and were the highest (r1: 1.306 m M-1s-1andr2: 234.5 m M-1s-1) when compared to other groups. The cytotoxicity of GMIO-2 was negligible under a wide range of dosages, thus exhibiting excellent cell biocompatibility. Moreover, GMIO-2 could quickly diffuse into cells, leading to its effective accumulation. The systemic delivery of GMIO-2 resulted in an excellentT1-T2dual-mode MRI contrast effect in kidneys, which is expected to improve the diagnosis of kidney lesions. Therefore, this work provides a promising candidate for the development of aT1-T2dual-mode MRI CA.


A competition model of the chemostat with an external inhibitor.
A competition model of the chemostat with an external inhibitor is considered. This inhibitor is lethal to one competitor and results in the decrease of growth rate of this competitor. The existence and stability of the extinction equilibria are discussed by using Liapunov function. The necessary and sufficient condition guaranteeing the existence of the interior equilibrium is given. It is found by numerical simulation that the system may be globally stable or have a stable limit cycle if the interior equilibrium exists.


Effects of alinidine, a novel bradycardic agent, on heart rate and blood pressure in man.
The effects of the oral administration of alinidine (ST567) were studied on heart rate and blood pressure in healthy subjects in the supine and standing positions and on an exercise tachycardia. Exercise tachycardia was reduced by the three doses (20, 40 and 80 mg) of alinidine, and supine and standing heart rate by 80 mg alinidine. The maximum reductions in heart rate occurred at 1 to 2 h but were still present at 6 h. Systolic and diastolic pressure in the supine and standing positions was significantly reduced by alinidine, 80 mg. A comparison of the effects of placebo, alinidine (80 mg), propranolol, (40 mg), and clonidine (0.1 mg) showed that the effects of alinidine on heart rate and blood pressure in the supine and standing positions and after exercise were similar to those of propranolol; clonidine had little effect on these parameters. Alinidine, 40 and 80 mg, had no effect on an isoprenaline tachycardia, which was competitively antagonised by propranolol, 40 mg. The oral administration of alinidine, 40 mg once daily and 40 mg twice daily, for 8 days reduced heart rate in supine and standing positions and on exercise tachycardia with small reductions in systolic and diastolic pressure. The effect of the twice-daily regimen was greater. Some subjects had a dry mouth after alinidine, and 8-9 h after 80 mg all subjects felt drowsy an sleepy. Tiredness was reported during the first 2 days of the chronic-dosing study. One subject had a visual disturbance after 40 mg. These studies show that alinidine reduces heart rate in man without blocking Beta-adrenoceptors. This is a novel pharmacological action warranting further investigation.U


FORM AND HABIT IN SPECIES OF MALLEUS (INCLUDING THE "HAMMER OYSTERS") WITH COMPARATIVE OBSERVATIONS ON ISOGNOMON ISOGNOMON.
1. Study of the structure and mode of life of Malleus regula provides the basis for consideration of the "hammer" species, M. malleus and M. albus. 2. M. regula occurs byssally attached, vertically disposed on rocky substrates associated with mud and is widely distributed in the tropical Indo-Pacific. 3. The distal two-thirds of the elongated shell is exclusively prismatic. By means of special pallial retractors the mantle lobes can be withdrawn within the nacreous region. 4. The massive opisthodetic ligament has a short secondary extension of fusion layer. 5. A promyal chamber on the right side proximal to the adductor increases water flow into the exhalant chamber. 6. The long filibranch ctenidia provide a vertically extended food-collecting surface. 7. The foot is concerned with planting of the massive byssus which emerges through a notch in the right valve but on the under ( i.e., dorsal) surface. There is also a unique and very long accessory foot, ventrally grooved, everywhere ciliated and in constant writhing activity due to blood pressure and intrinsic muscle. Moving freely throughout the lower mantle cavity it can only be concerned with cleansing. 8. Pseudofaeces are ejected from the distal tip of the mantle cavity. 9. M. malleus, the black hammer shell, occurs vertically embedded in coarse sand or sandy gravel. Byssus threads are attached to fragments within the substrate. The great anterior and posterior elongations of the hinge line (also exclusively prismatic) are separated by the byssal notch (now affecting both valves). 10. Shells are usually excessively irregular due to the great exposure to damage and the almost unlimited powers of rapid repair by the three pallial extensions. 11. M. albus, the white hammer shell, is stouter and inhabits muddy sand. During growth it loses the byssus with reduction of the foot and byssal retractors and closure of the byssal notch. The accessory foot is not affected. The animal becomes anchored in the substrate exclusively by the anterior and posterior extensions of the shell. 12. Description of the typically rounded Isognomon ephippium leads to that of the elongated I. isognomon which occupies precisely the same habitat as M. regula. 13. It lacks the pallial retractors, promyal chamber and accessory foot of Malleus, the nacreous region is more extended distally and the ligament is multivincular (the formation of which is discussed), producing some posterior, but never any anterior, extension of the hinge line. 14. A remarkably dense mixed bed of M. regula and I. isognomon in Darvel Bay, Sabah (Borneo), is described. Different spawning periods, by preventing competition during settlement, may account for this complete intermixing of sympatric species, which, however, are generalized herbivores where numbers are not limited by food supply. 15. From a basic epifaunal habit (Pteria, Isognomon, M. regula), members of the Pteriacea have become adapted for infaunal life within sponges (Vulsella, Crenatula) or within soft substrates ( M. malleus, M. alba and the Pinnidae). 16. There is final discussion about elongation in monomyarians, i.e., in the genus Malleus and in I. isognomon.


Tunable Kondo effect in a double quantum dot coupled to ferromagnetic contacts.
We investigate the effects induced by ferromagnetic contacts attached to a serial double quantum dot. Spin polarization generates effective magnetic fields and suppresses the Kondo effect in each dot. The superexchange interaction J(AFM), tuned by the interdot tunneling rate t, can be used to compensate the effective fields and restore the Kondo resonance when the contact polarizations are aligned. As a consequence, the direction of the spin conductance can be controlled and even reversed using electrostatic gates alone. Our results demonstrate a new approach for controlling spin-dependent transport in carbon nanotube double dot devices.


[Distribution of ABO and Rhesus phenotypes and genes in the population of Kursk region].
The distributions of AB0 and Rhesus phenotypes and the corresponding genes in the population of Kursk oblast were studied. Based on these data, genetic differentiation of rural populations with respect to the d gene frequency was revealed. The differentiation was determined by the differences in the genetic and demographic structure of these rural populations. The frequency of homozygotes for the recessive gene d and the incidence of malformations affecting the children's viability increased with an increase in the inbreeding level of a population. Genetic distances between the population of Kursk oblast and other populations were estimated.


Morphologic and immunocytochemical study of young dogs with diabetes mellitus associated with pancreatic islet hypoplasia.
In 11 dogs (7 males, 4 females; 10 purebred, 1 mixed breed), diagnosed as having diabetes mellitus before the age of 6 months, the pancreas was evaluated histologically; in 6, the pancreas also was examined by use of electron microscopy and/or immunocytochemical methods. Each dog was placed in 1 of 3 groups (A through C) on the basis of pancreatic histopathologic findings: Group A (n = 3)--no recognizable islets, but the pancreas in 2 dogs contained scattered endocrine cells detectable by use of immunoperoxidase staining or electron microscopy; Group B (n = 4)--no recognizable islets, but the pancreas had severe vacuolation of ducts and acini, as well as acinar atrophy; Group C (n = 4)--scant shrunken islets; 1 pancreas had reduced numbers of recognizable islets, hydropic beta-cell vacuolation attributable to glycogen deposition, and islet and nonislet endocrine cells in expected proportions. Insulitis was not observed in any pancreas, although scattered lymphocytes were seen in the pancreatic interstitial fibrous tissue of 3 dogs. Histologic pancreatic lesions in these young dogs were distinct from those of type-I (insulin-dependent) diabetes mellitus in human beings, as well as from those of diabetes mellitus in aged dogs, but were similar to those described in other young diabetic dogs. This uncommon syndrome is distinct from commonly recognized canine diabetes mellitus, on the basis of age of onset, predisposition for purebred dogs, lack of predisposing endocrinopathies or obesity, and pancreatic histologic features. The cause(s) is unknown, but is related to pancreatic endocrine hypoplasia and not to insulitis or to exocrine pancreatic inflammation. The term pancreatic islet hypoplasia is chosen as best describing this disorder.


CRISPR/Cas12a-based approaches for efficient and accurate detection of Phytophthora ramorum.
Phytophthora ramorum is a quarantine pathogen that causes leaf blight and shoot dieback of the crown, bark cankers and death on a number of both ornamental and forest trees, especially in North America and northern Europe, where it has produced severe outbreaks. Symptoms caused by P. ramorum can be confused with those by other Phytophthora and fungal species. Early and accurate detection of the causal pathogen P. ramorum is crucial for effective prevention and control of Sudden Oak Death. In this study, we developed a P. ramorum detection technique based on a combination of recombinase polymerase amplification (RPA) with CRISPR/Cas12a technology (termed RPACRISPR/ Cas12a). This novel method can be utilized for the molecular identification of P. ramorum under UV light and readout coming from fluorophores, and can specifically detect P. ramorum at DNA concentrations as low as 100 pg within 25 min at 37°C. We have developed a simple, rapid, sensitive, unaided-eye visualization, RPA CRISPR/Cas12a-based detection system for the molecular identification of P. ramorum that does not require technical expertise or expensive ancillary equipment. And this system is sensitive for both standard laboratory samples and samples from the field.


Topographic map reorganization in cat area 17 after early monocular retinal lesions.
Neither discrete peripheral retinal lesions nor the normal optic disk produces obvious holes in one's percept of the world because the visual brain appears to perceptually "fill in" these blind spots. Where in the visual brain or how this filling in occurs is not well understood. A prevailing hypothesis states that topographic map of visual cortex reorganizes after retinal lesions, which "sews up" the hole in the topographic map representing the deprived area of cortex (cortical scotoma) and may lead to perceptual filling in. Since the map reorganization does not typically occur unless retinotopically matched lesions are made in both eyes, we investigated the conditions in which monocular retinal lesions can induce comparable map reorganization. We found that following monocular retinal lesions, deprived neurons in cat area 17 can acquire new receptive fields if the lesion occurred relatively early in life (8 weeks of age) and the lesioned cats experienced a substantial period of recovery (>3 years). Quantitative determination of the monocular and binocular response properties of reactivated units indicated that responses to the lesioned eye for such neurons were remarkably robust, and that the receptive-field properties for the two eyes were generally similar. Moreover, excitatory or inhibitory binocular interactions were found in the majority of experimental units when the two eyes were activated together. These results are consistent with the hypothesis that map reorganization after monocular retinal lesions require experience-dependent plasticity and may be involved in the perceptual filling in of blind spots due to retinal lesions early in life.


Bacillus cereus-type polyhydroxyalkanoate biosynthetic gene cluster contains R-specific enoyl-CoA hydratase gene.
Bacillus cereus and Bacillus megaterium both accumulate polyhydroxyalkanoate (PHA) but their PHA biosynthetic gene (pha) clusters that code for proteins involved in PHA biosynthesis are different. Namely, a gene encoding MaoC-like protein exists in the B. cereus-type pha cluster but not in the B. megaterium-type pha cluster. MaoC-like protein has an R-specific enoyl-CoA hydratase (R-hydratase) activity and is referred to as PhaJ when involved in PHA metabolism. In this study, the pha cluster of B. cereus YB-4 was characterized in terms of PhaJ's function. In an in vitro assay, PhaJ from B. cereus YB-4 (PhaJYB4) exhibited hydration activity toward crotonyl-CoA. In an in vivo assay using Escherichia coli as a host for PHA accumulation, the recombinant strain expressing PhaJYB4 and PHA synthase led to increased PHA accumulation, suggesting that PhaJYB4 functioned as a monomer supplier. The monomer composition of the accumulated PHA reflected the substrate specificity of PhaJYB4, which appeared to prefer short chain-length substrates. The pha cluster from B. cereus YB-4 functioned to accumulate PHA in E. coli; however, it did not function when the phaJYB4 gene was deleted. The B. cereus-type pha cluster represents a new example of a pha cluster that contains the gene encoding PhaJ.


Picture archiving and communication systems (PACS) for radiological images: state of the art.
Implementation of a Picture Archiving and Communication System (PACS) is a system integration task and requires the knowledge of multidisciplinary fields. This paper reviews current PACS development with emphasis on radiological images. The following topics are covered: methods of image acquisition, image compression, storage, display, communication, and image database structure. Methods of implementation of PACS in a clinical environment as well as current operational PACS in hospitals are reviewed. A survey of private industry participating in PACS research and development are also given.


Trastuzumab and vinorelbine as first-line therapy for HER2-overexpressing metastatic breast cancer: multicenter phase II and pharmacokinetic study in Japan.
Tolerability and response rate to weekly combination chemotherapy with trastuzumab and vinorelbine in Japanese women with HER2-overexpressing breast cancer not previously receiving either therapy were assessed. Tumor response was evaluated every 4 weeks and adverse events were graded. A total of 23 patients from six participating centers in Japan were enrolled. Median dose intensity of vinorelbine was 16.9 mg/m2/week and response rate was 73% (complete response+partial response); complete response=9%, partial response=64%, and progressive disease=5%. Time to progression was 361 days, with 75.0% of liver metastases and 60% of lung metastases responding to this treatment. The most common adverse events were leukocytopenia and neutropenia (96%); however, hematologic toxicity associated with vinorelbine was manageable by adjusting the dose. No pharmacokinetic differences for vinorelbine were found between single administration and combination with trastuzumab. This combination therapy produced high response rates and good tolerability, indicating a promising role in first-line chemotherapy for HER2-overexpressing metastatic breast cancer in Japan.


Equine Infectious Anemia Virus (EIAV): what has HIV's country cousin got to tell us?
Equine Infectious Anemia Virus (EIAV) is a lentivirus, of the Retrovirus family, with an almost worldwide distribution, infecting equids. It causes a persistent infection characterized by recurring febrile episodes associating viremia, fever, thrombocytopenia, and wasting symptoms. The disease is experimentally reproducible by inoculation of Shetland ponies or horses with EIAV pathogenic strains. Among lentiviruses, EIAV is unique in that, despite a rapid virus replication and antigenic variation, most animals progress from a chronic stage characterized by recurring peaks of viremia and fever to an asymptomatic stage of infection. The inapparent carriers remain infective for life, as demonstrated by experimental transfer of blood to naive animals. The understanding of the correlates of this immune control is of great interest in defining vaccine strategies. Research on EIAV, this "country cousin" of HIV (Human Immunodeficiency Virus), over the last five decades has produced some interesting results on natural immunological control of lentivirus replication and disease and on the nature and role of virus variation in persistence and pathogenesis. These studies are of interest in the context of HIV and efforts to develop a vaccine. This review will focus on some of the most recent results.


Delusional Infestation: State of the Art.
Patients with a delusional infestation (DI) have an overwhelming conviction that they are being infested with (non) pathogens without any medical proof. The patients need a systematic psychiatric and dermatological evaluation to assess any possible underlying cause that could be treated. Because they avoid psychiatrists, a close collaboration of dermatologists and psychiatrists, who examine the patient together, seems to be a promising solution. It helps to start a trustful doctor-patient relationship and motivates the patient for psychiatric treatment. We here review diagnostic criteria, classification of symptoms, pathophysiology and treatment options of DI. Antipsychotic medication is the treatment of choice when any other underlying cause or disorder is excluded. Further research is needed to assess the pathophysiology, and other treatment options for patients with DI.


Isotopic discrimination of stable isotopes of nitrogen (δ15N) and carbon (δ13C) in a host-specific holocephalan tapeworm.
During the past decade, parasites have been considered important components of their ecosystems since they can modify food-web structures and functioning. One constraint to the inclusion of parasites in food-web models is the scarcity of available information on their feeding habits and host-parasite relationships. The stable isotope approach is suggested as a useful methodology to determine the trophic position and feeding habits of parasites. However, the isotopic approach is limited by the lack of information on the isotopic discrimination (ID) values of parasites, which is pivotal to avoiding the biased interpretation of isotopic results. In the present study we aimed to provide the first ID values of δ(15)N and δ(13)C between the gyrocotylidean tapeworm Gyrocotyle urna and its definitive host, the holocephalan Chimaera monstrosa. We also test the effect of host body size (body length and body mass) and sex of the host on the ID values. Finally, we illustrate how the trophic relationships of the fish host C. monstrosa and the tapeworm G. urna could vary relative to ID values. Similar to other studies with parasites, the ID values of the parasite-host system were negative for both isotopic values of N (Δδ(15)N = - 3.33 ± 0.63‰) and C (Δδ(13)C = - 1.32 ± 0.65‰), independent of the sex and size of the host. By comparing the specific ID obtained here with ID from other studies, we illustrate the importance of using specific ID in parasite-host systems to avoid potential errors in the interpretation of the results when surrogate values from similar systems or organisms are used.


Membrane damage and incorporation of Escherichia coli components into Bdellovibrio bacteriovorus.
Cytoplasmic membrane of E. coli is degraded within 20 min following infection with Bdellovibrio. 50% of cellular 42-K is lost during the first 10 min. The cytoplasmic membrane, 20 min after infection, centrifugated on a sucrose gradient produces a wide band containing the main enzyme activities (succinic dehydrogenase and lactic dehydrogenase) bound to the membrane. The incorporation into Bdellovibrio of labelled host cell constituents during intracellular growth has been studied at successive intervals during the development cycle in diluted nutrient broth (about 3 hrs). The cells were broken in a Sorvall-Ribi cell fractionator and the Bdellovibrios separated by centrifugation on sucrose gradient. Polysaccharides, proteins and lipids of Bdellovibrio derive from the utilization of components of the host cells and not from the utilization of the components present in the medium. The incorporation of precursors into polysaccharides and proteins shows the same exponential pattern.


Clinical development of 17-allylamino, 17-demethoxygeldanamycin.
17-allylamino, 17-demethoxygeldanamycin (17AAG; NSC 330507) is the first modulator of heat shock protein 90 (Hsp90) to enter clinical trials. Hsp90 serves a chaperone role to properly fold and deliver client proteins to appropriate intracellular locations. Interest in Hsp90 modulators for the experimental therapeutics of cancer has arisen based on pre-clinical evaluations suggesting that Hsp90 client proteins regulate signaling pathways critical to the molecular economy of many types of tumors, including oncogene signaling, cyclin-dependent kinase activation, steroid hormone receptors, and mediators of invasion and metastasis. Thus, Hsp90-directed agents could affect molecules upon which tumors depend for their proliferation and survival. Initial clinical studies have therefore sought to incorporate assessment of these endpoints into initial clinical evaluations. Three schedules of administration have been supported for initial evaluation in Phase I studies sponsored by the National Cancer Institute (NCI) or supported by NCI and sponsored by Cancer Research UK. In the daily times five schedule, a recommended Phase II dose (RPTD) of 40 mg/m(2) has been reached, while once weekly or three of four weekly schedules are defining RPTDs of 295 and 308 mg/m(2). Toxicity is tolerable and appears dominated by hepatic, gastrointestinal, and constitutional symptoms. Concentrations of drug at peak of ~1700-3000 nM are concordant with concentrations predictive of useful outcomes in pre-clinical model systems. Evidence of modulation of Hsp90 partner molecules has been obtained in both surrogate and some tumor compartments. These very early results encourage additional clinical evaluations of 17AAG and related molecules.


[Erectile dysfunction, physiologic approach, diagnosis and therapy].
Erectile dysfunction is defined as the consistent or recurrent inability to obtain and/or maintain a penile erection sufficient for sexual activity. Erection is a vascular phenomenon under a psychoneurological control and situated in an hormonal environment. A variety of treatment options are available to the clinician including medical, psychological and surgical treatments. The choice of therapy should be based on careful matching of the patient's needs and preferences with the available treatment options.


Abundant presolar grains and primordial organics preserved in carbon-rich exogenous clasts in asteroid Ryugu.
Preliminary analyses of asteroid Ryugu samples show kinship to aqueously altered CI (Ivuna-type) chondrites, suggesting similar origins. We report identification of C-rich, particularly primitive clasts in Ryugu samples that contain preserved presolar silicate grains and exceptional abundances of presolar SiC and isotopically anomalous organic matter. The high presolar silicate abundance (104 ppm) indicates that the clast escaped extensive alteration. The 5 to 10 times higher abundances of presolar SiC (~235 ppm), N-rich organic matter, organics with N isotopic anomalies (1.2%), and organics with C isotopic anomalies (0.2%) in the primitive clasts compared to bulk Ryugu suggest that the clasts formed in a unique part of the protoplanetary disk enriched in presolar materials. These clasts likely represent previously unsampled outer solar system material that accreted onto Ryugu after aqueous alteration ceased, consistent with Ryugu's rubble pile origin.


Dyslipidaemia as a risk factor in the occurrence of stroke in Nigeria: prevalence and patterns.
Stroke is a major public health problem worldwide. Hypertension, diabetes mellitus, dyslipidaemia and smoking are some of the common modifiable risk factors in the occurrence of stroke. Therefore, this study was designed to assess the prevalence and patterns of dyslipidaemia among individuals with acute stroke. This is a retrospective descriptive cross-sectional study, carried out in the Departments of Medicine at the LAUTECH Teaching hospital, Ogbomoso and General Hospital, Orile-Agege, Lagos, South-West, Nigeria, over a 18-month period between September 2012 and February 2014. One hundred and six (106) patients with acute stroke confirmed with computed tomography (CT) brain scan were recruited. Clinical features, risk factors, lipid profiles and stroke patterns were identified. Mean age was significantly higher in ischaemic stroke compared to haemorrhagic (64.08±10.87 Vs, 56.21±12.38years, p=0.001). There was slight male preponderance in both stroke types (1.3:1). Out of 106 patients, 65 (61.3%) had ischaemic stroke, 38 (35.8%) intracerebral haemorrhage and 3 (2.9%) with subarachnoid haemorrhage. Dyslipidaemia is the most frequent risk factor (85.9%), followed by hypertension (66.0%) and diabetes mellitus (15.1%). Dyslipidaemia was significantly higher in the ischaemic stroke compared to haemorrhagic. Reduced HDL-cholesterol is the most prevalent fraction of lipid abnormalities (74.5%). Dyslipidaemia, particularly low HDL-C, was the most frequent risk factor in our patients with stroke. Hence, prevention of dyslipidaemia as well as other risk factors is key to reducing the burden of stroke in our country.


A Case of Astasia-Abasia as Early Onset Conversion Disorder Triggered by Psychosocial Stress Factors.
Conversion disorder is defined as the loss or change of motor, sensory, and autonomic nervous system-related functions that cannot be explained completely with organic causes. The etiology of the disease may be explained by psychoanalytic theory, learning theory, sociocultural factors, and some traumatic life events besides genetic and neurobiological factors. The onset is usually between late childhood and early adulthood. The disorder occurs after a high rate of psychosocial stressors and the symptoms can vary. While astasia, as one of the possible complaints in conversion disorder, is defined as not being able to stand due to loss of motor power or sensory loss; abasia is identified as patients having no apparent motor problem but not being able to walk properly. Both conditions can be of organic as well as the psychogenic origin. In this paper, the clinical signs of a seven-year-old boy who was admitted to emergency service of Mersin University Faculty of Medicine with the complaints of astasia and abasia but was found to have conversion disorder is presented. The results of the medical examinations and the possible psychosocial stress factors behind these symptoms, as well as the treatment process of the case, were shared. With this report, we is aimed to draw attention to the importance of early diagnosis of the disorder, the necessity of an interdisciplinary approach in the treatment process, and the handling of psychosocial factors leading to somatic symptoms.


Molybdenum difluoride dioxide, MoO2F2.
MoO(2)F(2) is prepared by pyrolysis of (Na(+)H(2)O)(2) cis-MoO(2)F(4)(2-). A preliminary model of the structure is obtained from powder data: it has a triangular columnar structure with three fluorine bridges between the three molybdenum atoms and with oxygen bridges between the layers. (a = 1605, b = 384, c = 1395 pm, Pnma, Z = 12). The closest related structure is that of TiF(4), except that the orientation of the triangular columns is different.


Development of a pharmacokinetic model for chromium in the rat following subchronic exposure. I. The importance of incorporating long-term storage compartment.
A pharmacokinetic model of chromium depuration in the rat has been developed under subchronic exposure conditions. Rats were exposed to 100 ppm Cr(VI) in their drinking water for 6 weeks, followed by a 140-day period of depuration. Tissue concentrations of Cr at the end of the 6-week exposure period were greatest in the bone, spleen, and kidney, with lower concentrations present in the liver and blood. The overall kinetics of Cr depuration from the tissues were relatively slow, especially for the largest compartment which included bone. The results indicated that the half-life of Cr in bone exceeded 100 days. A three-compartment model was developed to fit the data. Liver, kidney, and spleen were grouped into a single compartment which was linked to a major storage compartment (i.e., bone, skin, hair, and muscle) via the blood. Using this model, the time to a 50% reduction of whole body Cr (i.e., loss of total Cr mass for the whole rat) was calculated to be about 80 days. The higher half-life for the storage compartment of 100 days is due to the relative weights of the compartments and the more rapid loss of Cr from the liver, kidney, and spleen compartment. The data suggest that Cr may be sequestered and release of Cr by the storage compartment over an extended period of time, thereby, may play an important role in maintaining elevated body burdens and tissue concentrations of Cr following long-term exposure to this toxic metal.


Targeting of human fibroblast growth factor receptor 2 by a novel specific nanobody.
Inhibition of FGFR2 signaling is promising in targeted therapy of FGFR2-related tumors. In this study, anti-FGFR2 nanobodies (Nbs) were isolated through screening of an immune camelid phage display library. Four rounds of biopanning were carried out with commercial human FGFR2 antigen and enrichment was assessed by ELISA and phage titration. The gene of Nb was sub-cloned into the expression vector, and the recombinant vector was transformed into Escherichia coli WK6 cells. The recombinant protein was purified using Ni-NTA affinity chromatography. The anti-FGFR2 Nb (C13) was characterized by SDS-PAGE, western blotting, competitive inhibition ELISA, flow cytometry, MTT, and migration assay. C13 Nb recognized FGFR2 with high specificity and no cross-reactivity was observed with other tested antigens. The affinity of C13 Nb was calculated to be 1.5 × 10-9 M. Results of cytotoxicity showed that C13 Nb (10 µg/ml) inhibited 85% of the proliferation of T-47D cells (p < 0.001). In addition, C13 inhibited the migration of 68% of T-47D toward the source of the growth factor (p < 0.01). The flow cytometry showed that C13 Nb bound to the surface of FGFR2+ cells, T-47D cell line (96%). Results indicate the potential of anti-FGFR2 Nb for targeted therapy of FGFR2-overexpressing tumors after complementary investigations.


Differential gene expression of Asian citrus psyllids infected with 'Ca. Liberibacter asiaticus' reveals hyper-susceptibility to invasion by instar fourth-fifth and teneral adult stages.
The bacterial pathogen Candidatus Liberibacter asiaticus (CLas) is the causal agent of citrus greening disease. This unusual plant pathogenic bacterium also infects its psyllid host, the Asian citrus psyllid (ACP). To investigate gene expression profiles with a focus on genes involved in infection and circulation within the psyllid host of CLas, RNA-seq libraries were constructed from CLas-infected and CLas-free ACP representing the five different developmental stages, namely, nymphal instars 1-2, 3, and 4-5, and teneral and mature adults. The Gbp paired-end reads (296) representing the transcriptional landscape of ACP across all life stages and the official gene set (OGSv3) were annotated based on the chromosomal-length v3 reference genome and used for de novo transcript discovery resulting in 25,410 genes with 124,177 isoforms. Differential expression analysis across all ACP developmental stages revealed instar-specific responses to CLas infection, with greater overall responses by nymphal instars, compared to mature adults. More genes were over-or under-expressed in the 4-5th nymphal instars and young (teneral) adults than in instars 1-3, or mature adults, indicating that late immature instars and young maturing adults were highly responsive to CLas infection. Genes identified with potential for direct or indirect involvement in the ACP-CLas circulative, propagative transmission pathway were predominantly responsive during early invasion and infection processes and included canonical cytoskeletal remodeling and endo-exocytosis pathway genes. Genes with predicted functions in defense, development, and immunity exhibited the greatest responsiveness to CLas infection. These results shed new light on ACP-CLas interactions essential for pathogenesis of the psyllid host, some that share striking similarities with effector protein-animal host mechanisms reported for other culturable and/or fastidious bacterial- or viral- host pathosystems.


Incidence of violence towards staff caring for the elderly.
A survey study concerning violence was conducted among staff (n=506) working with the elderly in residential settings and ordinary homes. The major aim of the study was to investigate the incidence of violence directed towards staff by elderly people living in residential settings. Furthermore, associations between the number of violent incidents and gender, age, year in service, year at present place of work, education of the staff, type of setting, the frequency and type of violence as well as the emotional reactions expressed by the staff should be examined. Forty percent of the staff was exposed to violence during the preceding year and 18% noted incidents of violence daily. A significantly larger proportion of staff working in nursing homes registered violence compared with those working in other types of settings. Physical violence was the most common (76%) type of violence. Powerlessness, sadness, anger and feelings of insufficiency were the most dominant feelings among staff facing by violent situations. Our results point to the necessity to further study caregivers' perception of patient violence and its impact on the quality of care.


Acute spontaneous cervical disc herniation causing rapidly progressive myelopathy in a patient with comorbid ossified posterior longitudinal ligament: Case report and literature review.
Ossification of the posterior longitudinal ligament (OPLL) and cervical disc herniation are commonly encountered neurosurgical conditions. Here we present an unusual case of nontraumatic rapidly progressive myelopathy due to cervical disc herniation with comorbid OPLL and conduct a literature review focusing on the frequency and management of disc herniations with OPLL. A 52-year-old healthy female presented with a 72-h history of rapid progression of dense quadriparesis with sensory deficits, with a precedent 4-week history of nontraumatic midline neck pain. Clinical examination revealed profound motor deficits below the C5 myotome. Spinal neuroimaging revealed OPLL (computed tomography [CT]) and a cervical disc herniation spanning from C4/5 to C5/6 with significant retrovertebral disease (magnetic resonance imaging [MRI]). Operative management involved an anterior cervical corpectomy and instrumented fusion, with removal of both the sequestered disc material and the locally compressive OPLL. The patient recovered full motor function and independent ambulation with no residual signs or symptoms of myelopathy at the time of discharge. This unique case of a spontaneous cervical disc herniation in the context of OPLL causing rapidly progressive myelopathy illustrates the complementarity of CT and MRI in diagnosing the underlying cause of a rapidly progressive neurologic deficit in the absence of antecedent trauma. Though the optimal surgical management of such pathology remains uncertain; in this case, the anterior approach was motivated by the significant retrovertebral ventrally compressive sequestrum, and provided for excellent neurologic outcome. This article also reviews the occurrence/management of such acute cervical discs with OPLL.


Lipid hydrogenation induces elevated 18:1-CoA desaturase activity in Candida lipolytica microsomes.
Microsomal membranes prepared from the mesophilic yeast Candida lipolytica grown at 10 degrees C were hydrogenated by the homogeneous Pd-catalyst, palladium di (sodium alizarine sulfonate) (Pd(QS)2). After hydrogenation to various levels, the microsomes were washed free of the Pd-complex and transferred to a reaction mixture (containing NADH, MgCl2, ATP, CoA and [14C]18:1-CoA) for assay of 18:1-CoA desaturase activity. Microviscosity alterations were also followed by measuring changes in DPH fluorescence polarization. Rapid catalytic hydrogenation of unsaturated fatty acids of the lipids occurred within 20-120 s, resulting in large increases in 16:0, 18:0 and 18:1 acids and decreases in 18:2 acid. In the range 7-20% 18:0 content, a pronounced increase in desaturase activity was observed, with a maximum of greater than 2-fold at a 18:0 content of 12%, followed by a decrease to the initial activity at 33% 18:0 content. These changes were well-correlated with changes in microviscosity, maximal desaturase activity occurring in the DPH fluorescence anisotropy range of 0.23-0.24; above and below this range, desaturase activities were close to the initial control values. It is suggested that the hydrogenation-induced increase in the formation of 18:2 from 18:1-CoA (proceeding partly through direct desaturation of PC) may be due to changes in conformation of the membrane-bound desaturase enzyme complex as a result of controlled rigidification of the surrounding lipids. The operation of such a self-regulating control mechanism would be consistent with a previously proposed model for microsomal desaturase action.


Comparative analysis of hepatic miRNA levels in male marathon mice reveals a link between obesity and endurance exercise capacities.
Dummerstorf marathon mice (DUhTP) are characterized by increased accretion of peripheral body fat with fast mobilization in response to mild physical activity if running wheels were included in their home cages. The obese phenotype coincides with elevated hepatic lipogenesis if compared to unselected controls. We now asked, if microRNA (miRNA) species present in the liver may contribute to the obese phenotype of DUhTP mice and if miRNAs respond to mild physical activity in our mouse model. Total RNA was extracted from livers of sedentary or physically active marathon mice and controls and analyzed by array hybridization or real-time PCR using locked nucleic acid probes. Pathway analysis of altered miRNA concentrations identified fatty acid biosynthesis as the most important target for the effects of miRNAs in the liver. A miRNA signature consisting of miR-21, 27, 33, 122, and 143 was present at higher abundance (p < 0.01) in the liver of sedentary or active DUhTP mice indicating involvement of miRNAs with hepatic lipogenesis. Furthermore, in protein lysates from the liver of DUhTP mice, significantly reduced concentrations of total and phosphorylated AKT and lower levels of phosphorylated AMPK were found (p < 0.05). Our results indicate active involvement of miRNAs in the control of hepatic energy metabolism and discuss effects on signal transduction as a potentially direct effect of miR-143 in the liver of DUhTP mice.


[Instruments for intersubject processes: a research note].
An important problem of social research is the formation of aggregates in data sets which usually tend to bias the represented original first level data. In the empirical analysis of meaning of social interaction face-to-face the essential conditions of data construction should be with the decisions of the observed actors (and not with the " fiat " of the researcher). Especially for the micro-analysis of intersubjective processes in large samples by the means of questionnaire the use of four-dimensional scales is proposed; their graphic representation and multivariate analysis is described. In this way patterns of communication processes become open to research by questionnaire.


Advanced training in vascular surgery: how does it need to change?
Fellowship training in vascular surgery over the last several decades has typically involved 1 to 2 years of clinical training incorporating open surgical techniques, some noninvasive vascular diagnostic laboratory, outpatient and inpatient experiences, occasionally basic science research, and more recently training in endovascular procedures. In order to meet the projected increased need for vascular care in the future, vascular surgery training needs to undergo both structural and content modifications if the field is to stay at the forefront in caring for the patient with vascular disease. This article addresses these issues and potential solutions.


The rise and fall of cardiac rehabilitation in the United Kingdom since 1998.
Provision of cardiac rehabilitation is inadequate in all countries in which it has been measured. This study assesses the provision in the United Kingdom and the changes between 1998 and 2004. All UK cardiac rehabilitation programmes were surveyed annually. Figures for each year were up-rated to account for missing data and compared with national data for acute myocardial infarction, coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). The total numbers and percentage of eligible patients included were charted for 7 years. For centres giving figures, the total number treated rose from 29,890 in 1998 to 37,129 in 2004. The up-rated figures show that the percentage of eligible patients enrolled rose from 25.0% in 1998 to 31.5% in 1999 and has changed little since, falling from 31.3% in 2002 to 28.5% in 2004. About 25% of myocardial infarction patients, 75% of CABG patients and 20% of PCI patients joined cardiac rehabilitation programmes. The National Service Framework for Coronary Heart Disease set a target for 85% of myocardial infarct and coronary revascularization patients to be enrolled in rehabilitation programmes. Only one-third of this number is currently being enrolled and the percentage is falling.


Evidence-based management of tracheostomies in hospitalized patients.
There is little evidence-based literature on the management of tracheostomized patients. The existing data relate to the role of tracheostomy in specific disease states, the timing of tracheostomy, and comparison of open surgical to percutaneous tracheostomy. Tracheostomy protocols are under development. A recent series of 1,130 patients who underwent tracheostomy had a combined procedural, early, and late complication rate of approximately 4%, which is an improvement from the earlier complication rate. In the recent series, tracheal stenosis overtook hemorrhage as the leading complication, by 2 to 1. Tracheal stenosis accounted for nearly half of the complications. Half of the tracheal stenoses required surgical correction. All the patients who developed tracheal stenosis had endotracheal tubes for > 12 days before tracheostomy.


Reaction of dipeptidylpeptidase IV with substrate-analogous azapeptides.
The reaction of dipeptidyl peptidase IV (EC 126.96.36.199.) with azapeptide substrates containing azaalanine or azaproline in the P1-position was investigated. Accumulation of a fairly stable acyl-enzyme could be shown for ester substrates. Ala-AzaPro-pNA is a very poor substrate of DP IV and does not accumulate an acyl-enzyme. DP IV does not react with active-site titrants for trypsin-like serine proteases.


Comparison of nicorandil-induced relaxation, elevations of cyclic guanosine monophosphate and stimulation of guanylate cyclase with organic nitrate esters.
Nicorandil increases cyclic 3'5'-guanosine monophosphate (cGMP) in vascular smooth muscle. However, high concentrations are required to activate guanylate cyclase (GC). We examined the relationship between activation of GC, increases in cGMP and relaxation in canine mesenteric artery and vein, renal and coronary artery and thoracic aorta. Nicorandil (10-100 microM) relaxed in each of the blood vessels. Relaxation was associated with elevations of cGMP but independent of release of endothelium-derived relaxing factor, and inhibited by methylene blue and hemoglobin. The organic nitrate esters nitroglycerin, pentaerythritol tetranitrate, isosorbide dinitrate, 2-isosorbide mononitrate, and 5-isosorbide mononitrate each behaved in a similar manner. In each blood vessel pentaerythritol tetranitrate was the most potent and 5-isosorbide mononitrate the least potent relaxant and stimulant of cGMP. Each of the organic nitrate esters (1 microM to 1 mM) except nicorandil stimulated soluble GC activity in the presence of 10 mM cysteine. Nicorandil (EC50 38 mM) increased GC activity. Moreover, nicorandil (0.1 microM to 30 microM) did not inhibit cGMP phosphodiesterase. The EC50 for vascular relaxation was directly correlated with the EC50 for elevation of cGMP for each of the agonists in each blood vessel type. The EC50 for activation of GC was directly related to the reciprocal of the rate constant for nitric oxide formation for each of the organic nitrate esters. However, a direct correlation existed between the EC50 for activation of GC and the EC50 for 1) elevation of cGMP and 2) relaxation, for each of the organic nitrate esters except nicorandil. Thus, the high concentrations of nicorandil required to activate GC cannot account for the low concentrations required to elevate cGMP or relax smooth muscle. We postulate that nicorandil may interact with a membrane receptor or release a second messenger, distinct from nitric oxide or endothelium-derived relaxing factor, which then activates GC. This may represent a physiologic mechanism for regulation of GC activity in smooth muscle.


An investigation of the effect on 27-gauge needle tips following a single local anaesthetic injection.
One hundred and forty one, 27-gauge local anaesthetic needles were collected, each following a single injection of local anaesthetic using four commonly performed local anaesthetic injection techniques. The needles were examined for needle tip damage under the scanning electron microscope. Ten unused needles were used as controls. Bone was contacted in 75 (59%) instances and, of these, 73 (97.3%) showed needle tip deformity. Of the four techniques used, bone contact was commonest with the inferior alveolar nerve block, occurring in 88% of instances.


Local site differences in survival and parasitism of periwinkles (Littorina sitkana Philippi, 1846).
The periwinkle, Littorina sitkana, is found throughout the intertidal zone, often in isolated subpopulations. The majority of trematode parasites use snails as intermediate hosts, and decreased survivorship is often observed in snails infected with trematodes. Sampling L. sitkana from four sites in Barkley Sound, British Columbia, Canada, we test the effects of parasitic infection on snail survival using maximum likelihood and Bayesian approaches using the software MARK and WinBUGS. We found that survival of periwinkles and trematode community composition differed among sites, but survival and trematode prevalence were uncorrelated. WinBUGS performed better than MARK in two ways: (1) by allowing the use of information on known mortality, thus preventing survival overestimation; and (2) by giving more stable estimates while testing the effect of body size on snail survival. Our results suggest that snail survival depends heavily on local environmental factors that may vary greatly within a small geographical region. These findings are important because the majority of experimental studies on survival are done on snails from a single location.


Genetic and environmental risk factors for chronic kidney disease.
In order to change the current state of chronic kidney disease knowledge and therapeutics, a fundamental improvement in the understanding of genetic and environmental causes of chronic kidney disease is essential. This article first provides an overview of the existing knowledge gaps in our understanding of the genetic and environmental causes of chronic kidney disease, as well as their interactions. The second part of the article formulates goals that should be achieved in order to close these gaps, along with suggested timelines and stakeholders that are to be involved. A better understanding of genetic and environmental factors and their interactions that influence kidney function in healthy and diseased conditions can provide novel insights into renal physiology and pathophysiology and result in the identification of novel therapeutic or preventive targets to tackle the global public health care problem of chronic kidney disease.


General synthesis of sugar-derived azepane nitrones: precursors of azepane iminosugars.
A general and efficient method has been developed for the synthesis of sugar-derived azepane nitrones starting from aldohexoses, with an intramolecular condensation of aldehyde and hydroxylamine as the key step. Through this strategy, each aldohexose produced a pair of azepane nitrones, which are precursors of various azepane iminosugars.


Potential Lignocellulolytic Microfungi from Pineapple Plantation for Composting Inoculum Additive.
Pineapple plantations leave a lot of plant biomass after the planting season ends. The abundant residue of pineapple plants causes problems due to the high content of lignocellulose, which is difficult to decompose naturally. This study aimed to isolate and characterize lignocellulolytic microfungi isolates from pineapple plantations. The information of this study was used as data to prepare an inoculum for the induction of pineapple litter composting that was resistant to stress to pineapple plantation habitat. The results showed that there were 11 dominant lignocellulolytic microfungi isolates found from pineapple litter and plantation soil. Using selective media, the selection showed five cellulolytic (Bioggp 3, 6, 9, 11, and 12); five xylanolytic (Bioggp 3, 6, 8, 9, and 12); and two ligninolytic microfungi isolates (Bioggp 2 and 5). Bioggp 3, 6, 9, and 12 are cellulolytic and xylanolytic with Bioggp 3 showing the highest cellulolytic index (4.0) and xylanolytic index (4.20). Testing of ligninolytic microfungi showed that the Bioggp 5 isolate had a stronger lignin indicator (color intensity = 4.0 and zone ratio of 1.47) than the Bioggp 2 isolate. Bioggp 9 had the highest cellulolytic isolate spore productivity at 4.5 × 108 spores/mL with 93.3% spore viability, and Bioggp 3 had the highest xylanolytic isolate spore productivity at 2.5 × 109 spores/mL with 89.3% spore viability. Bioggp 2 had the highest ligninolytic isolate spore productivity at 1.8 × 109 spores/mL, but Bioggp 5 showed the highest spore viability at 98.0%.


Meta-analysis of the prognostic and clinical value of serum 25-hydroxyvitamin D levels in previously untreated lymphoma.
Background: This meta-analysis explored the prognostic and clinical value of serum 25-hydroxyvitamin D, 25(OH)D, levels in previously untreated lymphoma. Materials & methods: PubMed, Web of Science, Embase and the Cochrane Central Register of Controlled Trials databases were searched for eligible studies. Summary effect estimates and 95% CIs were pooled using random-effects or fixed-effects models. Results: Twelve studies with 4139 patients were included. Low level of serum 25(OH)D was associated with inferior progression-free survival (hazard ratio [HR]: 2.06; 95% CI: 1.82-2.32) and overall survival (HR: 1.94; 95% CI: 1.71-2.19), advanced disease (odds ratio [OR]: 1.52; 95% CI: 1.09-2.13) and elevated lactate dehydrogenase (OR: 1.84; 95% CI: 1.08-3.15). Conclusions: Low level of serum 25(OH)D is a prognostic risk factor for newly diagnosed lymphoma.


Risk of Pediatric Cardiac Surgery Increased in Patients Undergoing Tracheal Surgery During the Same Hospitalization.
The impact of complex tracheal surgery (TS) on outcomes of children undergoing cardiac surgery has rarely been investigated in large national databases and could impact anticipated outcomes in those patients. The Pediatric Health Information System database was reviewed from January 1, 2005 to December 31, 2014, for pediatric (<18 years) patients undergoing select cardiac surgical procedures using International Classification of Disease-9 procedural coding. Patients were divided based upon having TS (excluding tracheostomy) during the same hospitalization. Patients with tracheal and cardiac surgeries (CHS + TS) were propensity matched in a 1 : 2 fashion to patients undergoing isolated cardiac surgeries without TS (CHS) based upon cardiac procedure(s), age at surgery, gender, and discharge year. Hospital mortality and other outcomes were compared between the 2 matched groups. The 283 CHS + TS patients were similar to the 566 CHS patients in gender, race, age, cardiac procedures, and presence of chromosomal abnormalities, all P > .05. Hospital mortality was 13.8% (n = 39) for CHS + TS and 5.8% (n = 33) for CHS patients with an unadjusted 2.58 hazard ratio of death (95% confidence interval: 1.59-4.20; P < .001). CHS + TS was also associated with a greater length of stay (63 days vs 12 days), a higher cost per hospitalization ($322 402 vs $80 273), and more readmissions (64.3% [n = 182] vs 41.8% [n = 243]), all P < .001. Patients undergoing cardiac and TS in the same hospitalization are at greater risk of in-hospital mortality than patients undergoing similar cardiac surgeries alone and incur higher resource utilization thereafter. The increased risk of mortality is currently underappreciated, but it is important to recognize when discussing expectations with families and providers.


Tumorigenicity test of 1,3- and 1,8-dinitropyrene in BALB/c mice.
1,3-Dinitropyrene (DNP) and 1,8-DNP (CAS: 42397-65-9) are very potent mutagens and induce a frameshift-type mutation in the Salmonella test system. Each compound was tested for tumorigenicity in BALB/c mice by sc inoculation of 0.05 mg of the compound once a week for 20 weeks. Tumors developed at the site of injection of 1,8-DNP in 6 of 15 mice up to 60 weeks after the first injection. The incidence of tumors was statistically significant at a P-value of less than .05 but not of less than .01. Therefore, the carcinogenicity of 1,8-DNP in BALB/c mice was concluded to be weaker than that of benzo[a]pyrene [(BP) CAS: 50-32-8], which induced a 100% tumor incidence when it was injected at the same dose as that of 1,8-DNP. No tumors occurred at the injection site in mice given 1,3-DNP. Most of the tumors induced by 1,8-DNP and BP showed histologic features characteristic of malignant fibrous histiocytoma.


Independent effect of cardiac rehabilitation on lipids in coronary artery disease.
We evaluate the effects cardiac rehabilitation (CR) participation independent of using lipid-altering agents (LAAs) on low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, total cholesterol, and triglyceride. Measurements included absolute and relative change in lipids and increases in percent of patients achieving goals. Analysis of 766 patients who participated in CR between 2000 and 2003 was performed. On enrollment to CR, all were being treated with an LAA defined as HIviG-CoA reductase inhibitors, bile acid sequestrant, fibrate, and niacin, hormone replacement therapy. Preenrollment and postenrollment lipids were obtained. Analysis was performed on 2 cohorts, participants enrolled on an LAA with no change in medication (n = 13) and participants enrolled on an LAA with a change in medications (n = 153). At completion of CR, 74.9% of patients on LAA at enrollment with no medication adjustments during the program were at Adult Treatment Panel III goal for low-density lipoprotein cholesterol compared with 68.5% at entry (P = .01), all other lipid parameters also significantly improved. Sixty-three percent who started CR on an LAA and had dose adjustment or an additional LAA added achieved low-density lipoprotein cholesterol goal compared with 43.1% at entry (P < .0001). Participation in CR significantly potentiates the lipid-improving effects of pharmacological therapy and independently contributed to the percent of patients achieving all lipid levels at Adult Treatment Panel III goal.


Development of rectangular airlift bubble column installed with support material for enhancement of nitrogen removal.
To enhance nitrogen removal during wastewater treatment using activated sludge, a rectangular airlift bubble column installed with support material is proposed. The flow characteristics and nitrogen removal performance were examined and compared with those of a column without support material. In the two columns, the riser was aerobic and the lower part of downcomer was anaerobic. The effects of operational conditions on the liquid circulation flow rate and liquid-phase volumetric mass transfer coefficient were examined. Using these flow characteristics, the distribution of dissolved oxygen (DO) concentration in the column was calculated. From the DO distribution, the anaerobic volume fraction in the column was estimated. The optimal anaerobic volume fraction for nitrogen removal was found to be approximately 50%. The column installed with support material showed higher nitrogen removal than the column without it.


Coronary Artery Aneurysms: A Review of the Epidemiology, Pathophysiology, Diagnosis, and Treatment.
Coronary artery aneurysms (CAAs) are uncommon and describe a localized dilatation of a coronary artery segment more than 1.5-fold compared with adjacent normal segments. The incidence of CAAs varies from 0.3 to 5.3%. Ever since the dawn of the interventional era, CAAs have been increasingly diagnosed on coronary angiography. Causative factors include atherosclerosis, Takayasu arteritis, congenital disorders, Kawasaki disease (KD), and percutaneous coronary intervention. The natural history of CAAs remains unclear; however, several recent studies have postulated the underlying molecular mechanisms of CAAs, and genome-wide association studies have revealed several genetic predispositions to CAA. Controversies persist regarding the management of CAAs, and emerging findings support the importance of an early diagnosis in patients predisposed to CAAs, such as in children with KD. This review aims to summarize the present knowledge of CAAs and collate the recent advances regarding the epidemiology, etiology, pathophysiology, diagnosis, and treatment of this disease.


The 5' untranslated regions of acetyl-coenzyme A carboxylase mRNA provide specific translational control in vitro.
Acetyl-coenzyme A carboxylase (ACC) catalyzes the rate-limiting step in the biosynthesis of long-chain fatty acids. Transcription of the single-copy ACC gene from two independent promoters, together with the differential splicing of the transcripts, gives rise to mature ACC mRNA having the same open reading frame (ORF), but exhibiting heterogeneity in their 5' untranslated region (5'-UTR). Class 1 ACC mRNA are transcribed from the inducible promoter 1 and their 5'-end leading sequences are provided by exon 1. Class 2 ACC mRNA are transcribed from the constitutively expressing promoter 2 and their leading sequences are derived from exon 2. In order to understand the role of different 5' UTR of ACC mRNA we have synthesized in vitro transcripts with defined ACC mRNA 5' UTR and examined their relative translational efficiencies in rabbit reticulocyte lysates. The major translation product of both forms of ACC mRNA was initiated at the first AUG of the ORF. Class 1 transcripts had a 6-9-fold better translational efficiency than class 2 transcripts, based on the quantity of major peptide produced by a given amount of transcript. The poor translational efficiency of class 2 transcripts can be improved by the removal of sequences contributed by exon 2, suggesting that they play an inhibitory role in the translation of class 2 types of ACC mRNA. In addition to their higher translational efficiency, the class 1 transcripts can also initiate translation at in-frame non-AUG codons, located in exon 1, i.e. upstream to the starting AUG of the common ACC mRNA ORF. This results in novel ACC peptides with extended N termini. These observations are consistent with the hypothesis that the 5' UTR heterogeneity in the ACC mRNA may be involved in post-transcriptional control, at the level of translation, of the ACC gene expression.


Accessibility and organizational settings for public supported family planning services.
This article reports on a survey of public supported family planning clinic users' travel time, appointment-delay time and waiting-room time. Comparisons of policy norms are made with three contraceptive organizational settings: hospitals, freestanding and community health clinics. The findings reveal freestanding and community health clinics were more accessible. This study suggests that despite the variety of public supported family planning clinics most were accessible to low-income women in western Pennsylvania.


Polymorphism of Segmented Grain Boundaries in Two-Dimensional Transition Metal Dichalcogenides.
Grain boundaries (GBs) are vital to crystal materials and their applications. Although GBs in bulk and two-dimensional materials have been extensively studied, the segmented GBs observed in transition metal dichalcogenide monolayers by a sequence of folded segments remain a mystery. We visualize the large-area distribution of the segmented GBs in MoSe2 monolayers and unravel their structural origin using ab initio calculations combined with high-resolution atomic characterizations. Unlike normal GBs in two-dimensional materials with commonly one type of dislocation cores, the segmented GBs consist of two basic elements-4|8 and 4|4|8 cores, whose alloying results in structural diversity and distinctly high stability due to relieved stress fields nearby. The defective polygons can uniquely migrate along the segmented GBs via the movement of single molybdenum atoms, unobtrusively endowing a given GB with variable appearances. Furthermore, the segmented GBs can achieve useful functionalities such as intrinsic magnetism and highly active electrocatalysis.


Serum and urine amino acid patterns during the first month of life in small-for-date infants.
Prenatal nutrition is impaired in small-for-gestational-age infants. Serum amino acids may show some biochemical features related to the nutritional state of these children. We have carried out a study on serum and urine amino acids in 12 small-for-date infants (SFD) and 14 healthy newborns from birth to 1 month of life. SFD infants showed a high serum level of alanine and decreased concentrations of branched chain amino acids, aspartate, cystine and tryptophan at birth. The results are compatible with a protein malnutrition state. Levels of serum amino acids in SFD infants showed no differences in relation to normal infants after 1 month of rehabilitation with a diet consisting of an adapted milk formula.


Sleeping with an Android.
Sleep quality and duration are strong indicators of an individual's health and quality of lifebut they are difficult to track in everyday life. Mobile apps such as Sleep as Android leverage smartphone sensors to track sleep patterns and make recommendations to improve sleeping habits.


Can morbidity and mortality of SLE be improved?
Systemic lupus erythematosus (SLE) is the second most common autoimmune disorder (after thyroid disease) in women of childbearing age. Lupus is increasingly being recognized throughout the world's population. The incidence and prevalence of SLE varies among racial and ethnic groups. Lupus patient survival has significantly improved over the past five decades, but a three- to fivefold increased risk of death remains compared with the general population. As lupus patients survive longer, these individuals face a range of complications from the disease itself or consequent to its treatment. Emerging data from epidemiological studies underscore the importance of incorporating race and ethnicity in understanding the risk factors leading to the significant burden of mortality and morbidity associated with this disease. This chapter describes the epidemiology of lupus with a focus on racial and ethnic differences, reviews the mortality associated with the disease, discusses selected complications associated with morbidity related to the disease and highlights areas where we can improve mortality and morbidity.


Genetic polymorphisms in cell cycle regulatory genes CCND1 and CDK4 are associated with susceptibility to breast cancer.
This study was performed to screen cyclin D1 (CCND1) and cyclin dependent kinases (CDK4) genes in order to evaluate their association with breast carcinogenesis. The germline screening of these genes was carried out by combining polymerase chain reaction (PCR) and single-strand conformation polymorphism (SSCP), followed by DNA sequence analysis. A total of 400 individuals (200 breast cancer patients and 200 healthy controls) were recruited prospectively for this study. Sequence analyses of the coding region of CCND1 revealed 12 mutations. When analyzed, a significant association was found between CCND1 mutations and breast cancer. It was observed that a 6-fold increased breast cancer risk (odds ratio/OR=5.75, 95% confidence interval/CI=1.26-26.33) was associated with Cys7Tyr in breast cancer patients when compared with healthy controls. In addition, a 5-fold increased breast cancer risk was associated with Trp63Stop mutation (OR=5.44, 95% CI=1.82-16.23), 10861C>A (OR=4.84; 95% CI=1.60-14.58) and 7720insTT (OR=5.32, 95% CI=1.98-14.23) in breast cancer patients compared to healthy controls. Concerning CDK4 gene, 5 mutations were identified and a significant association was observed between CDK4 gene mutations and breast cancer. It was observed that a 6-fold increased risk of breast cancer (OR=5.71, 95% CI=0.29-4.65) was associated with 5693 T>A. In addition, a 5-fold increased risk of breast cancer (OR=5.05, 95% CI=2.17-11.78) was associated with 5732 G>A in breast cancer patients compared to controls. In this study, our results showed that CCND1 and CDK4 mutations are associated with an increased risk of breast cancer, and may serve as biomarkers for early diagnosis and detection of breast cancer.


Experiences of relatives caring for psychiatric patients in the Greater Accra Region of Ghana.
The study aimed at examining the lived experiences of relatives caring for family members with mental illness in Ghana. Interpretative Phenomenological Analysis (IPA) was adopted to explore caregivers' in-depth experiences. Fifteen caregivers were purposefully selected from four hospitals within the Greater Accra Region of Ghana, and they were engaged in face-to-face interview sessions through the semi-structured guided interviews. Interviews were transcribed into text formats and analysed using the IPA approach. Three superordinate themes and their respective sub-themes were identified. Theme 1: Being with the mentally ill (time consuming; financial burden; healer shopping); Theme 2: Psychosocial effect (stigmatization; stress and depression; changes in social/work life); Theme3: Coping resources (prayers/spirituality; psychological capital - ignoring, self-encouragement, acceptance, routinization; social/family support; reading). It was recommended that healthcare professionals ought to prepare family members for the emotional challenges by providing them with constant therapeutic service to help reduce their emotional strain associated with the burden of care. Public education should be intensified for people to understand the need for accepting people with mental illness in order to reduce the issue of stigmatization. Again, government should institute policies through its agencies (Ministry of Health, Ghana Health Service) to assist the caregivers in the discharge of responsibilities. This could take the form of reducing cost of drugs, and establishing community mental health care to provide immediate support.


Best practices: Best practices for improving engagement of clients in clinic care.
Mental health clinicians and program administrators must implement effective strategies for engaging and retaining clients in care. At a recent series of forums open to providers from clinics in New York City that was sponsored by the city and state public mental health authorities, high-performing providers described their client engagement strategies. In this column the effective strategies reported are summarized in four areas: the first session, staff training and expertise, productivity measures, and engaging families and support persons. The approaches should be of use to administrators to improve programs' ability to engage and retain clients in community-based clinic care.


Spin-dependent recombination between phosphorus donors in silicon and Si/SiO{2} interface states investigated with pulsed electrically detected electron double resonance.
We investigate the spin species relevant for the spin-dependent recombination used for the electrical readout of coherent spin manipulation in phosphorus-doped silicon. Via a multifrequency pump-probe experiment in pulsed electrically detected magnetic resonance, we demonstrate that the dominant spin-dependent recombination transition occurs between phosphorus donors and Si/SiO_{2} interface states. Combining pulses at different microwave frequencies allows us to selectively address the two spin subsystems participating in the recombination process and to coherently manipulate and detect the relative spin orientation of the two recombination partners.


Value-driven health care--pipe dream, placebo or prescription for excellence?
The Value-Driven Health Care initiative and the Executive Order (EO) that underpins it invert the cost/quality equation and proceed from the premise that improving quality first--in terms of both care and system management--will reduce costs and elevate value. Equally essential to the success of the initiative is transparency: access to information that will empower consumers to save on quality care. This article describes the four cornerstones of the EO and explains how they will translate into corporate action and value.


Effect of Colchicine on the Risk of Perioperative Acute Kidney Injury: Clinical Protocol of a Substudy of the Colchicine for the Prevention of Perioperative Atrial Fibrillation Randomized Clinical Trial.
Inflammation during and after surgery can lead to organ damage including acute kidney injury. Colchicine, an established inexpensive anti-inflammatory medication, may help to protect the organs from pro-inflammatory damage. This protocol describes a kidney substudy of the colchicine for the prevention of perioperative atrial fibrillation (COP-AF) study, which is testing the effect of colchicine versus placebo on the risk of atrial fibrillation and myocardial injury among patients undergoing thoracic surgery. Our kidney substudy of COP-AF will determine whether colchicine reduces the risk of perioperative acute kidney injury compared with a placebo. We will also examine whether colchicine has a larger absolute benefit in patients with pre-existing chronic kidney disease, the most prominent risk factor for acute kidney injury. Randomized, superiority clinical trial conducted in 40 centers in 11 countries from 2018 to 2023. Patients (~3200) aged 55 years and older having major thoracic surgery. Patients are randomized 1:1 to receive oral colchicine (0.5 mg tablet) or a matching placebo, given twice daily starting 2 to 4 hours before surgery for a total of 10 days. Patients, health care providers, data collectors, and outcome adjudicators will be blinded to the randomized treatment allocation. Serum creatinine concentrations will be measured before surgery and on postoperative days 1, 2, and 3 (or until hospital discharge). The primary outcome of the substudy is perioperative acute kidney injury, defined as an increase (from the prerandomization value) in serum creatinine concentration of either ≥26.5 μmol/L (≥0.3 mg/dL) within 48 hours of surgery or ≥50% within 7 days of surgery. The primary analysis (intention-to-treat) will examine the relative risk of acute kidney injury in patients allocated to receive colchicine versus placebo. We will repeat the primary analysis using alternative definitions of acute kidney injury and examine effect modification by pre-existing chronic kidney disease, defined as a prerandomization estimated glomerular filtration rate (eGFR) <60 mL/min per 1.73 m2. The substudy will be underpowered to detect small effects on more severe forms of acute kidney injury treated with dialysis. Substudy results will be reported in 2024. This substudy will estimate the effect of colchicine on the risk of perioperative acute kidney injury in older adults undergoing major thoracic surgery. NCT03310125.


Biosynthesis of bacterial menaquinones: the membrane-associated 1,4-dihydroxy-2-naphthoate octaprenyltransferase of Escherichia coli.
It has been postulated that 1,4-dihydroxy-2-naphthoic acid is the naphthalenic intermediate in the biosynthesis of menaquinone (vitamin K2) in Escherichia coli to which the octaprenyl side chain is attached to from demethylmenaquinone. In the present work the presence of enzyme, 1,4-dihydroxy-2-naphthoate octaprenyltransferase, which catalyzes the conversion of 1,4-dihydroxy-2-naphthoate to demethylmenaquinone was demonstrated in cell extracts of E. coli. Demethylmenaquinone-9 was formed when the naphthoate was incubated with cell extracts and the synthetic substrate, solanesyl pyrophosphate, in the presence of Triton X-100. Solanesyl monophosphate could not substitute for the pyrophosphate in the reaction. The prenylation of of 1,4-dihydroxy-2-naphthoate was also studied in a strain of E. coli which accumulates octaprenyl pyrophosphate, the natural precursor of the menaquinone side chain. The octaprenyltransferase was shown to be membrane bound and to require magnesium ions for optimal activity. A menA-mutant of E. coli was found to lack the octaprenyltransferase activity, suggesting that the menA gene is the structural gene for this enzyme. However, this strain had normal levels of 4-hydroxybenzoate octaprenyltransferase, the enzyme catalyzing the analogous prenylation reaction in ubiquinone biosynthesis, providing additional evidence that the two octaprenyltransferases are quite distinct.


Letter to Editor: Support to the Spanish language, from Oral Medicine.
In the form of a letter to the director, the author provides linguistic comments related to Spanish. He draws attention to some often misused words and suggests some expressions that may improve the use of the Spanish language in scientific texts.


Primary pulmonary rhabdomyosarcoma in a child, with a review of literature.
A cyst in the left lower lobe of the lung was removed from a 15-month-old girl and showed evidence suggesting a preexistent congenital cystic adenomatoid malformation; in addition a rhabdomyosarcoma was identified. Primitive mesenchyme and mesenchymal elements also were seen. The origin of the rhabdomyosarcoma is discussed. The findings in the present case are compared with those of all childhood pulmonary rhabdomyosarcomas reported in the literature. This report of a child with a coexistent congenital adenomatoid malformation and a rhabdomyosarcoma is the third of its kind in the literature.


Chimera states and the interplay between initial conditions and non-local coupling.
Chimera states are complex spatio-temporal patterns that consist of coexisting domains of coherent and incoherent dynamics. We study chimera states in a network of non-locally coupled Stuart-Landau oscillators. We investigate the impact of initial conditions in combination with non-local coupling. Based on an analytical argument, we show how the coupling phase and the coupling strength are linked to the occurrence of chimera states, flipped profiles of the mean phase velocity, and the transition from a phase- to an amplitude-mediated chimera state.


Training needs for mid-level managers and immunisation coverage in Western Kenya.
To determine the current status of immunisation coverage in Western Kenya before intervention, to identify strengths and weaknesses of the existing programme in order to design educational interventions that could improve the services provided and find out the training needs of the mid-level managers of Kenya Expanded Programme of Immunisation. Cross-sectional descriptive study. All thirty nine districts in Rift Valley, Western and Nyanza provinces. Mid-level managers of Kenya Expanded Programme on Immunisation in the 39 districts and the provinces. These included Provincial Logisticians, Provincial Medical Officers of Health, District Medical Officers of Health, District Public Health Nurses, District Records and Health Information Officers, District Disease Surveillance Officers, and District Public Health Officers. Number of staff trained on EPI, coverage rates and perceived training needs of the mid-level managers. A total of eighty eight mid-level managers participated in the interviews. Most of these were District Public Health Nurses (40.9%) and District Health Information and Records Officers (23.9%). Only 49 (25%) of the District Health Management Team members had undergone training at the supervisory level. Eighteen districts (43.6%) had no member of the District Health Management Team that had ever been trained at the supervisory level. Using rates of Pentavalent 1 and measles coverage, Nyanza Province had the highest immunisation dropout rate (Pentavalent 1--measles) whereas Rift Valley Province had the lowest. The annual cumulative coverage for all the provinces by antigen was 80% for Pentavalent 1 and 2 and 60% for measles. The most requested need for inclusion in the training curriculum was maintenance of the cold chain equipment. Most of the members in the study area have not been trained on Expanded Programme on Immunisation and may be ill-equipped to manage the complicated programmes needed to maximise delivery of services. The immunisation coverage in this area is low while the dropout rates are high. We therefore recommend that all the mid-level managers of Expanded Programme on Immunisation in this area be trained comprehensively through the Merck Vaccine Network--Africa programme using the World Health Organisation approved mid-level managers course.


Endoscopic retreatment of Zenker's diverticulum using novel endoscopic scissors - The Clutch Cutter device.
Treatment of Zenker's diverticulum by flexible endoscopy consists of the myotomy of the cricopharyngeal muscle and is considered to be feasible, effective and safe. This report describes the novel use of a Clutch Cutter® device to perform flexible endoscopic retreatment of a symptomatic recurrence after previous treatment using a Needle knife in a 68 year old woman with symptoms of dysphagia for solids.


Tricuspid valve repair and pulmonary valve replacement in adults with repaired tetralogy of Fallot.
Pulmonary valve replacement (PVR) often is performed in adults with repaired tetralogy of Fallot (TOF). For patients who have tricuspid regurgitation (TR), tricuspid valve (TV) repair associated to PVR is still debated. We sought to evaluate perioperative factors related to TV repair when performed at the time of PVR in patients with repaired TOF. We retrospectively reviewed 104 patients with repaired TOF (or its equivalent) who underwent PVR (2002-2014). Mean age at initial complete correction and at PVR was 20.1 ± 17.2 months and 26.3 ± 9.5 years, respectively. Forty-one patients had significant preoperative TR: 24 were moderate (group M) and 17 were severe (group S). A total of 16 TV repair were performed (8 for each group). Moderate and severe tricuspid regurgitation observed in the first year following the initial complete repair were significantly associated with severe TR at PVR (P < .001). In group M patients, TR was improved regardless of TV repair, whereas, in group S, residual significant TR was reported in 7 patients who did not have TV repair. No cases were observed for patients who underwent concomitant TV repair (P = .002). Among these patients with residual significant TR, 2 needed a tricuspid valve replacement. The functional status (New York Heart Association classification) of group S patients was significantly improved by concomitant TV repair. In adults with repaired TOF, TV repair is a safe procedure when performed at the time of PVR. If, at mid-term follow-up, there is probably no benefit of TV repair when preoperative TR is moderate, TV repair may improve both tricuspid valve function and functional status of the patients in case of severe preoperative TR.


Phthalate release in leachate from municipal landfills of central Poland.
Phthalate diesters (PAEs) are used as plasticizer additives to polymer chains to make the material more flexible and malleable. PAEs are bonded physically, not chemically, to the polymeric matrix and can migrate to and leach from the product surface, posing a serious danger to the environment and human health. There have been a number of studies on PAE concentrations in landfill leachate conducted in the EU and around the world, though few in Poland. In the present study, the leachate of five municipal landfills was analyzed for the presence of PAEs. Raw leachate was sampled four times over the period of one year in 2015/16. It was the first large study on this subject in Poland. PAEs were detected in the leachate samples on all of the landfills, thereby indicating that PAEs are ubiquitous environmental contaminants. The following PAEs were detected in at least one sample: Di(2-ethylhexyl) phthalate (DEHP), Diethyl phthalate (DEP), Dimethyl phthalate (DMP), Di-n-butyl phthalate (DBP), Di-isobutylphthalate (DIBP). Out of all ten PAEs, DEHP was the most predominant, with concentrations up to 73.9 μg/L. DEHP was present in 65% of analyzed samples (in 100% of samples in spring, 80% in winter, and 40% in summer and autumn). In only 25% of all samples DEHP was below the acceptable UE limit for surface water (1.3 μg/L), while 75% was from 1.7 to 56 times higher than that value. On the two largest landfills DEHP concentrations were observed during samples from all four seasons, including on a landfill which has been remediated and closed for the last 5 years.


Active-site models for iron hydrogenases: reduction chemistry of dinuclear iron complexes.
Reduction of Fe2(mu-S2C3H6)(CO)6 (1) in tetrahydrofuran with 1 equiv of decamethylcobaltocene (Cp*2Co) affords a tetranuclear dianion 2. The IR spectra of samples of 2 in solution and in the solid state exhibit a band at 1736 cm(-1), suggestive of the presence of a bridging carbonyl (CO) ligand. X-ray crystallography confirms that the structure of 2 consists of two Fe2 units bridged by a propanedithiolate moiety formulated as [Fe2(mu-S2C3H6)(CO)5(SCH2CH2CH2-mu-S)Fe2(mu-CO)(CO)6](2-). One of the Fe2 units has a bridging CO ligand and six terminal CO ligands. The second subunit exhibits a bridging propanedithiolate moiety. One CO ligand has been replaced by a terminal thiolate ligand, replicating the basic architecture of Fe-only hydrogenases. The reduction reaction can be reversed by treatment of 2 with 2 equiv of [Cp2Fe][PF6], reforming complex 1 in near-quantitative yield. Complex 2 can also be oxidized by acids such as p-toluenesulfonic acid, regenerating complex 1 and forming H2.


A new redfin species, Pseudobarbus skeltoni (Cyprinidae, Teleostei), from the Cape Floristic Region, South Africa.
A new cyprinid species, Pseudobarbus skeltoni sp. nov, is described from material recently collected in the upper Riviersonderend River (a major tributary of the Breede River system) and the Krom River (a tributary of the Molenaars River in the upper Breede River) in the Cape Floristic Region of South Africa. The new species is readily distinguished from congeners, except P. burgi and P burchelli, by having two pairs of prominent oral barbels. Pseudobarbus skeltoni can be distinguished from P. burgi and P burchelli by the following combination of characters: distinctive terminal (vs. subterminal) mouth in adults; mouth inferior in sub-adults and young adults of P skeltoni but lower lips are unretracted (vs. retracted) and lack a distinct cartilaginous plate; snout prominent; more slender head (head depth 64.2% of HL, vs. 70.1% of HL in P. burchelli and 74.1% of HL in P. burgi); and a longer head relative to standard length (30.5 % vs. 26.8% in P. burchelli and 25.8% in P. burgi). The new species attains the largest size of any Pseudobarbus. The restricted distribution and the small remaining population sizes of P skeltoni indicate that this species is highly threatened and requires immediate conservation attention.


Numerical simulation of noninvasive blood pressure measurement.
In this paper, a simulation model based on the partially pressurized collapsible tube model for reproducing noninvasive blood pressure measurement is presented. The model consists of a collapsible tube, which models the pressurized part of the artery, rigid pipes connected to the collapsible tube, which model proximal and distal region far from the pressurized part, and the Windkessel model, which represents the capacitance and the resistance of the distal part of the circulation. The blood flow is simplified to a one-dimensional system. Collapse and expansion of the tube is represented by the change in the cross-sectional area of the tube considering the force balance acting on the tube membrane in the direction normal to the tube axis. They are solved using the Runge-Kutta method. This simple model can easily reproduce the oscillation of inner fluid and corresponding tube collapse typical for the Korotkoff sounds generated by the cuff pressure. The numerical result is compared with the experiment and shows good agreement.


[Georg Groddeck--father of psychosomatic medicine].
Life and work of Georg Groddeck (1866-1934), a nearly forgotten pioneer of psychosomatic medicine, are presented. Special emphasis is laid on the term "Es" and its impacts on putting forward psychoanalytic theories as well as the relationship to Sigmund Freud. The influence of Groddeck on the development of psychoanalysis and his friendship with Sándor Ferenczi are rendered prominent. Finally, the value of Groddeck's ideas for the future of psychosomatic medicine is discussed.