Cardiac resynchronization therapy and its potential proarrhythmic effect.
Cardiac resynchronization therapy (CRT) has become an established adjunctive treatment to optimal pharmacologic therapy in patients with advanced chronic heart failure (CHF), diminished left ventricular (LV) function and intraventricular conduction delay. Although CRT has been shown to improve ventricular hemodynamics, quality of life and exercise capacity, there is some evidence that it may rarely potentiate ventricular arrhythmias. As CRT is considered for an expanded population of CHF patients, and left-sided pacing is considered as an option for pacemaker-indicated patients (potentially without defibrillator backup), the effect of these pacing modalities on the incidence of ventricular tachyarrhythmia must be systematically studied and mechanistically understood. Strategies to prospectively predict the proarrhythmic potential of LV epicardial pacing need to be developed, and therapy accordingly individualized. This review attempts to summarize the current information on proarrhythmia in resynchronization therapy.


[The technic of argon laser trabeculoplasty and its results].
Argon laser trabeculoplasty (ALT) was performed on 130 eyes with primary open-angle glaucoma or capsular glaucoma. Three different methods of ALT were employed to determine if the methods itself affects the incidence of immediate postoperative rises in intraocular pressure (IOP). Thirty-five eyes received 100 burns over 360 degrees of the posterior trabecular meshwork; these were categorized as Group 1. Group 2 comprised 77 eyes given 50 burns over 180 degrees of the posterior meshwork. Group 3 consisted of 18 eyes treated with 50 burns over 180 degrees of the anterior trabecular meshwork. The duration of each burn was 0.2 s in Group 1 and 0.1 s in Groups 2 and 3. The power of each burn ranged from 700 to 1000 mW in each group. Immediate postlaser IOP rise was defined as a pressure elevation exceeding prelaser value by 5 mmHg or more. In Group 1 the incidence of IOP rise was 82%; it was 58% after the first session in Group 2, but only 22% in Group 3. A sustained, marked pressure rise was most frequently observed in Group 1 as compared with the other two groups. Other complications, including sustained iritis, peripheral anterior synechiae and hyphema, were seen most frequently in Group 1 and least frequently in Group 3. Successful control of IOP, defined as an IOP of less than 20 mmHg, was achieved in 37% in Group 1, 70% in Group 2 and 56% in Group 3. The follow-up period ranged from 1.5 to 52 months.(ABSTRACT TRUNCATED AT 250 WORDS)


Allergy to soft cannula of insulin pump in diabetic patient.
Insulin pump is a relatively good choice for diabetic patients who require multiple daily injections with wide fluctuations of blood glucose. Patients using insulin pump therapy and still having uncontrolled blood glucose levels for various factors: insulin pump not working properly, insulin instability, insulin autoantibody, insulin allergy, etc. We described a 46-year-old woman with type 2 diabetes and progressive hyperglycemia after switching multiple daily insulin injections to insulin pump, due to allergy to soft cannula of insulin pump.


Association analysis of norepinephrine transporter polymorphisms and methylphenidate response in ADHD patients.
Methylphenidate (MPH) is the most frequently prescribed drug in Attention Deficit Hyperactivity Disorder (ADHD). Hitherto mostly the dopamine transporter gene has been studied in MPH-response and only a few studies analyzed the norepinephrine transporter (NET, SLC6A2) gene, although MPH is a potent inhibitor of both dopamine and norepinephrine transporters. We aimed to analyze this monoamine transporter gene in relation to ADHD per se and MPH-response in particular to gain further knowledge in ADHD pharmacogenetics using a Caucasian sample. Six single nucleotide polymorphisms (rs28386840, rs2242446, rs3785143, rs3785157, rs5569, rs7194256 SNP) were studied across the NET gene in 163 ADHD children (age: 9.3±2.6; 86.5% male) using ADHD-RS hyperactivity-impulsivity and inattention scales. For case-control analysis 486 control subjects were also genotyped. At the MPH-response analysis responders had minimum 25% decrease of ADHD-RS total score after 2months of treatment, and chi-square test compared 90 responders and 32 non-responders, whereas ANOVA was used to assess symptom improvement after the first month among the 122 ADHD patients. The classical case-control analysis did not yield any association with ADHD diagnosis, which was supported by meta-analysis conducted on the available genetic data (combining previously published and the present studies). On the other hand, the intronic rs3785143 showed nominal association with inattention symptoms (p=0.01). The haplotype analysis supported this association, and indicated the importance of the first haploblock encompassing the intronic and 2 promoter SNPs. With MPH-response only the promoter rs28386840 showed nominal association: Those with at least one T-allele were overrepresented in the responder group (42% vs 19%, p=0.08), and they had better improvement on the hyperactivity-impulsivity scale compared to the AA genotype (p=0.04). Although none of our single SNP findings remained significant after correcting for multiple testing, our results from the MPH-response analysis indicate the potential importance of promoter variants in the NET gene.


Value-based procurement: Canada's healthcare imperative.
Value-based healthcare models are being adopted globally to maximize value for patients. Given that procurement is at the heart of purchasing value, value-based procurement goes hand in hand with value-based healthcare. Shifting procurement's traditional focus on short-term cost savings to a more holistic objective that includes health system performance and patient outcomes, giving preference to longer-term cost efficiencies, and working with suppliers to identify opportunities to develop more innovative products and services, is proving successful in leading jurisdictions. This article presents an overview of value within healthcare systems and how healthcare value-based procurement is being implemented across various jurisdictions.


Selective inhibition by betamethasone of allergen-induced release of SRS-A from human lung.
Passively sensitized human lung, when incubated with the appropriate allergen, released histamine and slow-reacting substance (SRS-A). Betamethasone sodium phosphate (5-100 microgram/ml), preincubated with the lung overnight, suppressed, in a dose-related manner, the release of SRS-A without having an effect on the release of histamine. Preincubation for only 1 h produced little effect on the release of SRS-A or of histamine. These results may help to explain some of the beneficial effects of glucocorticoids in allergic asthma.


Salivary Biomarker Responses to Two Final Matches in Women's Professional Football.
The aim of this study was to examine the link between salivary concentrations of cortisol, testosterone, immunoglobulin A (IgA) and the rate of perceived exertion (RPE) as a measure of internal load after two final matches played 3 days apart by professional women football players. Saliva samples were taken before and after the two matches (M1, M2). RPE was used to monitor the exercise intensity after each match. Testosterone concentrations increased after each match (M1: +42%, p = 0.002; M2: +50%, p < 0.001) while cortisol increased only after M1 (+116%, p < 0.001). The testosterone-to-cortisol ratio decreased only after M1 (-32.4%, p < 0.001). IgA concentration did not change after any match. Testosterone concentrations were correlated with IgA concentrations after each match (M1: R = 0.59, p = 0.008; M2: R=0.51, p = 0.02). RPE was correlated with cortisol concentrations after M1 (R = 0.57; p = 0.01), but not after M2 (R = 0.38; p = 0.07). All these results suggest that salivary cortisol and testosterone concentrations increase especially after the first match of a final, without affecting IgA levels. We speculate that increased testosterone concentration in women after football matches may play a protecting role against immune suppression usually observed after intense exercise. Key pointsIn our sample space, IgA concentrations did not change for teams even, before and after separated match. Suggesting that salivary IgA determinations after physical activities remain under debate.Testosterone concentrations were the only one hormone showing a consequent increase in both matches after physical activity carrying.The T/C ratio decrease only after M1 according with a higher cortisol level reach after M1 get-together, suggesting a differential impact over anxiety-associated team performance. So M2 play gives a more stable psychological state.


Staged percutaneous coronary intervention followed by minimally invasive mitral valve surgery versus combined coronary artery bypass graft and mitral valve surgery for two-vessel coronary artery disease and moderate to severe ischemic mitral regurgitation.
The optimal treatment for concomitant two-vessel coronary artery disease (CAD) and moderate to severe ischemic mitral regurgitation (IMR) remains unclear. We compared the results of a staged percutaneous coronary intervention followed by minimally invasive mitral valve surgery (PCI+MIVS) versus combined coronary artery bypass graft and mitral valve surgery (CABG+MVS) in this population. All consecutive patients with two-vessel CAD and moderate to severe IMR, who underwent PCI+MIVS or CABG+MVS at our institution between February 2009 and April 2014, were retrospectively evaluated. There were nine patients identified who underwent PCI+MIVS, and 15 who underwent CABG+MVS, with a mean age of 71±7, and 70±7 years, respectively (P=0.86). The remaining baseline characteristics were similar between both groups, with the exception of a higher prevalence of pre-operative clopidogrel administration (78% versus 27%, P=0.03) and left anterior descending plus left circumflex CAD (78% versus 27%, P=0.03), in those who underwent PCI+MIVS. The PCI+MIVS approach was associated with decreased mean cardiopulmonary bypass (111±41 versus 167±49 min, P=0.01) and aortic cross-clamp (79±32 versus 129±35 min, P=0.003) times, and less median number of intraoperative packed red blood transfusions {2 [interquartile range (IQR), 0-2] versus 3 units (IQR, 1-4), P=0.05}, when compared with CABG+MVS. The rate of mitral valve repair, postoperative complications, 30-day mortality, and 1-year survival did not differ between the surgical approaches. PCI+MIVS for two-vessel CAD and moderate to severe IMR is feasible, and associated with satisfactory outcomes, as compared with CABG+MVS.


Does Pseudomonas aeruginosa colonization influence morbidity and mortality in the intensive care unit patient? Experience from an outbreak caused by contaminated oral swabs.
Contaminated oral swabs caused a nationwide monoclonal Pseudomonas aeruginosa outbreak involving 27 Norwegian hospitals. The aim of the study was to study the consequences on mortality and morbidity of the introduction of this P. aeruginosa strain to intensive care unit (ICU) patients. Forty-four out of 96 patients admitted to the general ICU of Akershus University Hospital during the outbreak, ventilated for more than 24 h and with at least one microbiological sample, were included and followed until death or hospital discharge. All isolated P. aeruginosa strains were genotyped. Demographic data, admission diagnosis, Simplified Acute Physiology Score II (SAPS II), Sequential Organ Failure Assessment (SOFA) score, comorbidities, and antibiotics used in the first week were recorded. The outbreak strain was found in 18 patients (41%) of whom seven became infected. Median time to the first positive culture was 4 days. These 18 patients spent a significantly longer time on mechanical ventilation (P =0.03) and had a significantly higher hospital mortality, 55.5% vs. 19.2% (P =0.03), than non-colonized patients. The number of patients with severe underlying disease was significantly higher (P =0.01) and the decline in SOFA score was significantly slower in the pseudomonas group (P =0.02). Irrespective of colonization status, patients with severe underlying disease had a significantly higher mortality (58%) than those without (16%) (P =0.009). Use of contaminated oral swabs led to a high rate of early airways colonization. Patients with severe underlying disease were more likely to become colonized, but whether colonization has any influence on hospital mortality requires further study.


The addition of calcitriol or its synthetic analog EB1089 to lapatinib and neratinib treatment inhibits cell growth and promotes apoptosis in breast cancer cells.
In breast cancer the use of small molecule inhibitors of tyrosine kinase activity of the ERBB family members improves survival thus represents a valuable therapeutic strategy. The addition of calcitriol, the most active metabolite of vitamin D, or some of its analogs, to conventional anticancer drugs, including tyrosine kinase inhibitors (TKIs), has shown an increased effect on the inhibition of cancer cell growth. In this work, we have evaluated the effects and the mechanism of action of the combination of calcitriol or its analog EB1089 with lapatinib or neratinib on EGFR and/or HER2 positive breast cancer cell lines. Lapatinib, neratinib, calcitriol and EB1089 inhibited breast cancer cell proliferation in a concentration-dependent manner. Addition of calcitriol or EB1089 to TKIs treatment induced more effective inhibiting effect on cell growth and AKT and MAPK phosphorylation than all compounds alone. The combined treatments incremented also the expression of active caspase 3 and induced cell death in two and three-dimensional cell culture and significantly inhibited anchorage-independent colony formation. Our results suggest that the addition of calcitriol or its analog EB1089 to conventional targeted therapies, including lapatinib or neratinib might be of benefit to patients with breast cancer, particularly those with an EGFR and/or HER2 positive phenotype.


Use of non-steroidal anti-inflammatory drugs, aspirin and the risk of depression: The "Seguimiento Universidad de Navarra (SUN)" cohort.
The potential effect of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) to prevent depression remains largely unknown, in spite of the implication of inflammation in depression. This study aimed to investigate whether the habitual intake of aspirin and other NSAIDs was prospectively associated with a reduction in the observed incidence of depression. A dynamic cohort including 22,564 Spanish university graduates (mean age: 37 years) initially free of depression was followed during an average of 8.7 years. Exposure to NSAIDs was assessed with specific repeated questionnaires throughout follow-up, starting in the 2-year follow-up questionnaire. Incident cases of depression were defined as either a new validated medical diagnosis of depression or reporting the initiation of habitual use of antidepressants. We identified 772 incident cases of depression. Regular intake of aspirin and other NSAIDs was not associated with depression risk. Only in secondary sensitivity analyses using a definition of the outcome with higher specificity (a validated medical diagnosis of depression), an inverse association of aspirin with depression was found [HR (95%CI): 0.20 (0.04-0.87)]. However, these results were non-significant after adjustment for multiple testing. A possible underestimation of incident depression and a limited ability to detect all possible residual confounding. Regular use of NSAIDs was not associated with the incidence of depression. Further longitudinal controlled studies are necessary to clarify a potential role of aspirin use in depression risk.


Assessing the thrombotic risk of patients with essential thrombocythemia in the genomic era.
The molecular characterization of myeloproliferative neoplasms, including essential thrombocythemia (ET), has enabled deeper understanding of their pathogenesis. A driver lesion, namely, Janus kinase (JAK)2V617F, calreticulin (CALR) or myeloproliferative leukemia (MPL) gene mutation can be identified in the vast majority of patients. Each of these mutations is associated with distinct clinical features and may modulate the patients' clinical course, risk of complications, including vascular events, and survival. JAK2V617F appears to be a risk-modifying mutation and has been shown to increase the likelihood of thrombotic events in patients with ET across studies. As such, it has been included in prognostic models and its presence may influence treatment decisions. The association of CALR and MPL mutations with the incidence of vascular events has been less clear. Even more limited information is available on the contribution of additional non-driver lesions to the thrombotic risk. In this review we discuss the available evidence on the role of recurrent mutations in the risk of thrombotic complications in patients with ET and how these mutations weigh into modern prognostic scores.


[Data science in large cohort studies].
Large cohort study gained its popularity in biomedical research and demonstrated its application in exploring disease etiology and pathogenesis, improving the prognosis of disease, as well as reducing the burden of diseases. Data science is an interdisciplinary field that uses scientific methods from computer science and statistics to extract insights or knowledge from data in a specific domain. The results from the combination of the two would provide new evidence for developing the strategies and measures on disease prevention and control. This review included a brief introduction of data science, descriptions on characteristics of large cohort data according to the development of the study design, and application of data science at each stage of a large cohort study, as well as prospected the application of data science in the future large cohort studies.


Direct construction of a chromosome-specific NotI linking library from flow-sorted chromosomes.
A linking library consists of genomic DNA fragments which contain a specific rare restriction enzyme site; such clones are very useful as probes in pulsed field gel electrophoresis and in mapping and cloning large regions of DNA. However, identifying those linking clones which map to a certain chromosomal region can be laborious. Therefore, we have developed a straightforward procedure for constructing a linking library directly from flow-sorted chromosomes. As a test of the approach, a NotI linking library was constructed from the chromosome 17 fraction of a flow-sort of human chromosomes, using only 70 ng of DNA. Thirteen of sixteen linking clones were mapped to chromosome 17, suggesting that the library is highly enriched for this chromosome. This method should be generally applicable to other chromosomes and enzymes as well.


A novel calcium signalling response in the breast cancer cell line MDA-468.
In the human breast carcinoma cell line MDA-468 addition of epidermal growth factor (EGF) is growth inhibitory. Calcium signalling was investigated in this cell line using the calcium sensitive fluorescent probe Indo-1. Addition of EGF to MDA-468 cells resulted in a novel biphasic calcium response. In the first phase of the response EGF raised calcium to levels significantly above basal. This was followed by a prolonged fall in calcium to levels significantly lower than original basal levels. The G-protein activator aluminum fluoride (AlF), stimulated a rise in calcium which was not proceeded by a fall below basal levels. Conversely addition of PMA, an activator of protein kinase C (PKC), induced a fall in calcium from basal without a prior increase. Down regulation of PKC eliminated the response to PMA, however the biphasic nature of the EGF response was maintained. Pretreatment of the cells with pertussis toxin did not alter the response to EGF nor to AlF. We conclude that in the MDA-468 cell in which EGF is growth inhibitory: 1) EGF results in a biphasic calcium response which ultimately leads to reduction below baseline levels, 2) a rise in calcium itself is not sufficient to account for the subsequent fall below basal levels, 3) G-proteins may be involved in the initial phase of the EGF response, 4) activation of PKC can also reduce intracellular calcium, however the response to EGF is not dependent on this pathway.


DNA microarray gene expression analysis of human vascular endothelial cells exposed to arsenite.
DNA microarray was used to monitor the transcriptional response of human brain microvascular endothelial cells (HBMEC) and human coronary artery endothelial cells (HCAEC) to sodium arsenite (iAs(III)). iAs(III) enhanced the expression of 10 and 6 genes, and reduced the expression of 45 and 20 genes in HBMEC and HCAEC, respectively. Among the 64 genes whose expression was changed in some way, HBMEC and HCAEC had 5 up-regulated and 12 down-regulated genes in common.


A Study of the Compressive Behavior of Recycled Rubber Concrete Reinforced with Hybrid Fibers.
With the development of the automotive industry, a large amount of waste rubber is produced every year. The application and development of recycled rubber concrete (RRC) can effectively reduce 'black pollution' caused by waste rubber. However, the addition of recycled rubber particles can lead to a decrease in the compressive behavior of concrete. Previous research has demonstrated that by preventing crack growth, fiber addition can increase the strength and ductility of concrete. In this work, a total of 28 RRC mixes are designed, and the compressive behavior of RRC reinforced by steel fibers (SFs) and glass fibers (GFs) is investigated. The workability of fresh RRC can be negatively impacted by an increase in both fiber contents, with the GF content having a more notable effect. With the addition of fibers, the maximum increase rates for the compressive strength, elastic modulus, strain at peak stress, and compressive toughness were 27%, 8%, 45%, and 152%, respectively. A constitutive model is concurrently put forward to forecast the stress-strain curves of RRC with various fiber contents. These findings indicate that the maximum improvement in compressive behavior is achieved when the GF content was 0.4% and the SF content was 1.2%. The proposed constitutive model can be used to predict the stress-strain curve of hybrid fiber-reinforced recycled rubber concrete (HFRRRC).


[Transference Focused Psychotherapy for Borderline-Adolescents in a Day Clinic Treatment Program].
Transference Focused Psychotherapy for Borderline-Adolescents in a Day Clinic Treatment Program This paper focuses on the concept of transference focused psychotherapy (TFP) modified for juvenile borderline patients. Adolescents with borderline developmental personality disorder (bpd) have an essential deficit in their personality structure that leads to oscillations in their self-esteem and in a "split" perception of the world. They suffer from a variety of symptoms and severe impairments on their own and their families' quality of life. Their fragmented perception of themselves and others make relationships almost unbearable for them. Relationships are mostly marked by severe anxiety of resentment and rejection. For these patients this causes intolerable trouble at school where every day conflicts take place. Self-mutilation and suicidal thoughts often seem the only way out. By now, there is an agreement that an early specialized assessment and treatment is necessary in order to stop the typical consequences of their self-mutilative and dysfunctional behavior. Still, in contrast to adult age, empirical evidence is missing which proves the effectiveness of treating adolescent borderline patients. In this paper we present a research project on the effectiveness of transference focused psychotherapy with adolescent borderline patients (TFP-A) in a day clinic setting, combining TFP with group skills training as known from dialectic behavior therapy (DBT). Furthermore, we give first results on analyzing the effectiveness of our day clinic treatment program based on TFP-A, focusing on improving core symptoms such as affective problems, aggressive behavior against self and others and interpersonal problems.


Effect of Uncaria tomentosa Extract on Apoptosis Triggered by Oxaliplatin Exposure on HT29 Cells.
Background/Aim. The use of herbal products as a supplement to minimize the effects of chemotherapy for cancer treatment requires further attention with respect to the activity and toxicity of chemotherapy. Uncaria tomentosa extract, which contains oxindole alkaloids, is one of these herbal products. The objective of this study was to evaluate whether Uncaria tomentosa extract modulates apoptosis induced by chemotherapy exposure. Materials and Methods. Colorectal adenocarcinoma cells (HT29 cells) were grown in the presence of oxaliplatin and/or Uncaria tomentosa extract. Results. The hydroalcoholic extract of Uncaria tomentosa enhanced chemotherapy-induced apoptosis, with an increase in the percentage of Annexin positive cells, an increase in caspase activities, and an increase of DNA fragments in culture of the neoplastic cells. Moreover, antioxidant activity may be related to apoptosis. Conclusion. Uncaria tomentosa extract has a role for cancer patients as a complementary therapy. Further studies evaluating these beneficial effects with other chemotherapy drugs are recommended.


Early life trauma and sensitivity to current life stressors in individuals with and without cocaine dependence.
This study investigated the link between exposure to early life trauma, sensitivity to current daily stressors, and cocaine dependence. Individuals with (n = 105) or without (n = 53) cocaine dependence completed the Early Trauma Inventory and the Daily Hassles Scale. In comparison to controls, cocaine-dependent individuals reported almost twice as many daily hassles and perceived those hassles more negatively (p < .001). For participants with cocaine dependence, a significant relationship between exposure to early life trauma and negative perception of current daily hassles was observed (p < .01), whereas no such relationship was observed for participants without cocaine dependence. Adverse childhood events may lead to an altered view of the environment that contributes to increased irritability with daily life events among cocaine-dependent individuals.


A new approach to fabricate the Mn(ii)-based magnetic refrigerant through incorporation of a diamagnetic {LiO4} spacer.
A new 3D MOF [MnLi2(ip)2(H2O)2] (1) with a 1D heterometallic inorganic Mn(ii)-Li(i) chain is reported. With the assistance of diamagnetic {LiO4} connectors, which separate the paramagnetic Mn(ii) ions and act as magnetic spacers, very weak magnetic interactions were obtained. Remarkably, 1 showed a significant magnetocaloric effect (MCE) with a large entropy change value of 30.4 J kg-1 K-1 for ΔH = 8 T at 2 K.


The effect of psychological and educational counselling in reducing anxiety in nursing students.
A quasi-experimental pre-, post-test, follow-up and control group design was used to investigate the effect of psychological and educational counselling in reducing anxiety in nursing students. The research study used methodological triangulation, involving the use of structured data collection techniques such as standardized questionnaires and semi-structured focus groups. Focus groups were used to provide greater insight regarding the student's opinions. The sample consisted of 100 second- and fourth-year baccalaureate nursing students from the Faculty of Nursing at Shiraz University of Medical Sciences, Iran. They were randomly assigned to either an experimental group (n = 50) or a control group (n = 50). The experimental group received a 12-week intervention programme. Quantitative analysis of data was undertaken using t-test and analysis of variance for repeated measures to test differences between and within groups. The results indicated that from pre- to post-test there was no statistically significant reduction in anxiety between groups, but there was a statistically significant reduction in anxiety after one semester (in the follow-up). Student self-esteem was increased significantly from pre- to post-test. This increase was statistically significant and remained the same in follow-up. A statistically significant difference was seen in the student grade point average from pre-test to follow-up in the experimental group but not for the control group. The implementation of an intervention programme reduced their anxiety, increased their self-esteem and improved their grade point average over time.


Histochemistry and ultrastructure of gastric submucosal vasculature in portal hypertensive rats.
We studied histochemical and ultrastructural characteristics of the gastric submucosal blood vessels in portal hypertensive (PHT) rats. PHT was induced by two-stage ligation of the portal vein. Control rats were sham operated (SO). On the fifth day after surgery portal vein blood pressure was measured and rats were killed under nembutal anesthaesia. Gastric specimens were obtained for histological, histochemical and ultrastructural assessment. PHT rats showed thickening and increased cellularity of submucosal vessels including increase in number and size of endothelial cells. All these mesenchymal cells were vimentin-positive. Thickening of vascular wall in submucosal vessels was also observed ultrastructurally together with prominent elaboration of luminal surface of endothelial cells. These changes were not observed in SO rats. All changes in PHT rats reflect vasculopathic involvement of gastric wall in portal hypertension.


Clinical and economic impact of infliximab one-hour infusion protocol in patients with inflammatory bowel diseases: A multicenter study.
To assess the impact of short infliximab (IFX) infusion on hospital resource utilization and costs. All inflammatory bowel diseases (IBD) patients who received IFX 1 h infusion from March 2007 to September 2014 in eight centers from Southern Italy were included in the analysis. Demographic, clinical and infusion related data were collected. The potential benefits related to the short infusion protocol were assessed both in terms of time saving and increased infusion unit capacity. In addition, indirect patient-related cost savings were evaluated. One hundred and twenty-five patients were recruited (64 with ulcerative colitis and 61 with Crohn's disease). Median duration of disease was of 53 mo and mean age of pts at diagnosis was of 34 years (SD: ± 13). Adverse infusion reactions were reported in less than 4% both before and after short infusion. The total number of infusions across the selected centers was of 2501 (30.5% short infusions). In the analyzed cohort, 1143 h were saved (762 in the infusion and 381 in observation phases) through the rapid IFX infusion protocol. This time saving (-15% compared to the standard protocol in infusion phase) represents, from the hospital perspective, an opportunity to optimize infusion unit capacity by allocating the saved time in alternative cost-effective treatments. This is the case of opportunity cost that represents the value of forgone benefit which could be obtained from a resource in its next-best alternative use. Hence, an extra hour of infusion in the case of standard 2-h IFX represents a loss in opportunity to provide other cost effective services. The analysis showed that the short infusion increased the infusion units capacity up to 50% on days when the IFX infusions were scheduled (infusion phase). Furthermore, the analysis showed that the short IFX infusion protocol leads to time savings also in the post-infusion phase (observation) leading to a time saving of 10% on average among the analyzed centers. Finally, the short infusion protocol has been demonstrated to lead to indirect cost savings of €138/patient (average -€17.300 on the whole cohort). A short IFX infusion protocol can be considered time and cost saving in comparison to the standard infusion protocol both from the hospital's perspective, as it contributes to increase infusion units capacity, and the patients' perspective, as it reduces indirect costs and the impact of treatment on everyday life and work productivity.


Effect of nanoparticles on the interfacial properties of liquid/liquid and liquid/air surface layers.
An investigation is reported on the interfacial properties of nanometric colloidal silica dispersions in the presence of a cationic surfactant. These properties are the result of different phenomena such as the particle attachment at the interface and the surfactant adsorption at the liquid and at the particle interfaces. Since the latter strongly influences the hydrophobicity/lipophilicity of the particle, i.e., the particle affinity for the fluid interfacial environment, all those phenomena are closely correlated. The equilibrium and dynamic interfacial tensions of the liquid/air and liquid/oil interfaces have been measured as a function of the surfactant and particle concentration. The interfacial rheology of the same systems has been also investigated by measuring the dilational viscoelasticity as a function of the area perturbation frequency. These results are then crossed with the values of the surfactant adsorption on the silica particles, indirectly estimated through experiments based on the centrifugation of the dispersions. In this way it has been possible to point out the mechanisms determining the observed kinetic and equilibrium features. In particular, an important role in the mixed particle-surfactant layer reorganization is played by the Brownian transport of particles from the bulk to the interface and by the surfactant redistribution between the particle and fluid interface.


Correlation of mismatch repair deficiency with clinicopathological features and programmed death-ligand 1 expression in thyroid carcinoma.
Mutations in DNA mismatch repair (MMR) genes associated with thyroid carcinoma (TC) have rarely been reported, especially in East Asian populations. We examined tumor tissue from a cohort of 241 patients diagnosed with TC between 2008 and 2020. MMR proteins were detected using tissue microarray-based immunohistochemistry in order to identify MMR-protein-deficient (MMR-D) and MMR-protein-intact (MMR-I) tumors. We retrospectively summarized the clinicopathologic characteristics of patients with MMR-D TC, measured the expression of PD-L1, and recorded overall survival (OS) and other clinical outcomes. In our cohort, there were 18 (7.5%) MMR-D (MLH1, MSH2, MSH6, and PMS2) patients, including 12 with papillary TC (PTC) (6.7%), 2 with poorly differentiated TC (PDTC) (4.7%), and 4 with anaplastic TC (ATC) (22.2%). Half of them (9/18) showed a specific deletion in MSH6, and 6 of them also carried variants in the MSH6 and PMS2 gene. Survival was significantly better in patients with MMR-D ATC than in those with MMR-I tumors (p = 0.033). Four of the 18 MMR-D patients (22%) were found to be PD-L1 positive. Their OS was much shorter than that of PD-L1-negative patients. MMR-D and PD-L1 positivity appear to be associated with clinicopathological characteristics and prognosis in TC. The results indicate that MMR status may have important prognostic significance in TC. Therefore, immune checkpoint inhibitors that target the PD-1/PD-L1 pathway may be a treatment option for TCs.


Endoscopic retrograde cholangiopancretography in modified double tracks anastomosis with anastomotic stenosis.
A 63-year-old man presented at our hospital with right upper abdomen pain and fever for 4 d. The patient's magnetic resonance cholangiopancreatography revealed dilated common bile duct and choledocholithiasis. In his past history, he received proximal gastrectomy and modified double tracks anastomosis. Endoscopic retrograde cholangiopancretography in modified double tracks anastomosis, especially accompanied with anastomotic stenosis, has been rarely reported. In the present case, the duodenoscope was successfully introduced over the guidewire and the stone taken out using a basket. The patient had good palliation of his symptoms after removal of the stone.


The complete mitochondrial genome of Xiangdong black goat (Capra hircus).
Xiangdong black goat (Capra hircus) is a native breed of Hunan province in China. It is the first time that the complete mitochondrial genome sequence of Xiangdong black goat is reported in this work, which is determined through the PCR-based method. The total length of the mitognome is 16,641 bp, which contains 2 ribosomal RNA genes, 22 tRNA genes, 13 PCGs and 1 conntrol region (D-loop region). The total base composition of Lantang pig mitochondrial genome is 33.53% A, 13.12% G, 27.25% T and 26.09% C, in the order A > T > C > G. The complete mitochondrial genome of Xiangdong black goat provides an important data in genetic mechanism and the evolution genomes.


Beneficial influence of fungal metabolite nigerloxin on diabetes-induced oxidative stress in experimental rats.
Oxidative stress plays a key role in the progression of diabetes and its complications. In this study, the beneficial influence of the fungal metabolite nigerloxin, a new aldose reductase inhibitor and a free-radical scavenger, was investigated on oxidative stress in streptozotocin-induced diabetic rats. Groups of diabetic rats were orally administered nigerloxin for 30 days at a dose of 25 and 100 mg·(kg body mass)(-1)·day(-1). Diabetic rats showed significantly increased lipid peroxide levels in blood and liver, which was accompanied by lowered concentrations of antioxidant molecules and activities of antioxidant enzymes in blood and liver. Administration of nigerloxin for 30 days at a daily dose of 100 mg∙(kg body mass)(-1) to diabetic rats significantly decreased plasma and liver lipid peroxides, elevated the nonenzymatic antioxidants ascorbic acid, reduced glutathione, and total thiols, and elevated the activities of antioxidant enzymes in blood and liver. Nigerloxin showed a tendency to counter lipid abnormalities in diabetic animals, while fasting glucose and body mass were unaffected by nigerloxin treatment. Thus, this animal study has indicated the beneficial influence of nigerloxin on oxidative stress associated with diabetes that may have an implication in delaying or ameliorating the secondary complications.


Prognostic role of incidental pleural effusion diagnosed during echocardiographic evaluation.
The purpose of this study was to determine the long-term prognostic implications of incidental pleural effusion (PE) detected during echocardiographic examination and its relationship with concomitant diseases. The study hypothesis is to test whether incidental pleural PE detected during echocardiographic examination be used as a prognostic marker. The study was performed by evaluating patient records (N = 251) in whom PE was incidentally detected during echocardiographic examination in a tertiary hospital between 1999 and 2012. The patients were classified into 4 major groups according to the concomitant primary disease: malignancy, and cardiovascular, renal, and pulmonary diseases. The total survival time was obtained from hospital records for patients who died during the hospital stay and social security institution records for patients with out-of-hospital death. One-year and 5-year life expectancies of PE cases concomitant with different disorders were as follows; heart failure (n = 151), 81% and 70%; malignancies (n = 45), 53% and 44%; pulmonary diseases (n = 37), 89% and 78%; renal diseases (n = 18), 100% and 83%; respectively. PE associated with heart failure, renal disease, and pulmonary disease had similar (P > 0.05 for all) and favorable outcomes compared to PE associated with malignancies (P < 0.001). The prognosis of incidental PE was the worst in patients with concomitant malignancies; however, PE associated with nonmalignant diseases including heart failure, pulmonary disease, and renal disease have similar and favorable outcomes.


Relationship between obesity-related parameters and chronic kidney disease in middle-aged and elderly populations in Taiwan: A community-based study.
Globally, obesity is a major health problem and can markedly increase the risk of various diseases, including type 2 diabetes mellitus, hypertension (HTN), dyslipidemia, and chronic kidney disease (CKD). The association of obesity-related parameters, such as lipid parameters and their ratio, with CKD in clinical settings is not well understood. This study aimed to investigate the association of obesity-related parameters with CKD in the middle-aged and elderly population in Taiwan. This cross-sectional, community-based study recruited 400 participants (141 males and 259 females) aged 50 years or over from a community health promotion project at the Linkou Chang Gung Memorial Hospital (Guishan District, Taoyuan City) in 2014. Each participant completed a questionnaire including personal information and medical history during a face-to-face interview. Laboratory data were obtained from blood and urine sampling. The data were analyzed using t-test, chi-square test, Pearson's correlation test, multivariate logistic regression, and receiver operating characteristic (ROC) analysis. A total of 81 participants were identified as having CKD [estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 or urine albumin/creatinine ratio ≥30 mg/g], and their mean triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio was 3.37 ± 2.72. The mean TG/HDL-C ratio of the 319 participants without CKD was 2.35 ± 1.66. After adjusting for age, TG/HDL-C was significantly positively correlated with blood pressure, body mass index, waist circumference, and fasting plasma glucose but not low-density lipoprotein cholesterol. There was a negative correlation between TG/HDL-C and eGFR. Multiple logistic regression model analysis showed that TG/HDL-C was still significantly associated with CKD (OR: 1.17, 95% CI: 1.01-1.36, p = 0.04) after adjusting for multiple covariates. The cut-off point of TG/HDL-C as a predictor of CKD was 2.54 with an area under the ROC curve of 0.61 (95% CI: 0.53-0.68). There was a significant positive correlation between TG/HDL-C and several cardiovascular disease risk factors, including obesity indices. The TG/HDL-C ratio was significantly associated with the risk of CKD and demonstrated predictive ability for CKD in the middle-aged and elderly population. Further studies on its application in clinical settings are warranted.


Features of brain magnetic resonance imaging diffusion-weighted images of aortogenic embolic stroke.
The features of acute aortogenic embolic stroke on magnetic resonance diffusion-weighted imaging (DWI) have not been fully elucidated, so we compared patients with acute aortogenic embolic stroke and those with acute cardioembolic stroke. This study included 40 consecutive patients with acute aortogenic embolic stroke, and 40 age- and sex-matched patients with acute cardioembolic stroke. The diagnosis of aortogenic embolic stroke was made when patients met 5 criteria: (1)acute neurologic event lasting >24h; (2) positive signals on DWI; (3) atherosclerotic lesions ≥3.5-mm thick at the aortic arch on transesophageal echocardiography; (4) neuroradiologic features suggesting embolic stroke, such as lesions involving the brain cortex or the re-opening phenomenon of previously occluded vessels on Magnetic Resonance Angiography (MRA); and (5) absence of other embolic sources, including heart disease and carotid stenosis. The number, site, and maximal diameter of the infarct lesions on DWI were compared between the aortogenic and cardiogenic groups. The aortogenic patients more frequently had ≥3 lesions (25.0% vs. 2.5%, P<0.01), lesions with a maximal diameter <30mm (77.5% vs. 20.0%, P< 0.001), and vertebrobasilar system lesions (55.0% vs. 10.0%, P< 0.001) than the cardiogenic patients. Acute aortogenic embolic stroke is characterized by multiple (≥3) and small lesions, and involvement of the vertebrobasilar system.


Pregnancy outcomes after ultrasound-guided high-intensity focused ultrasound (USgHIFU) for conservative treatment of uterine fibroids: experience of a single institution.
To assess the impact of ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation for uterine fibroids on fertility. A retrospective observational study was conducted of 560 reproductive-age women with symptomatic uterine fibroids who underwent USgHIFU therapy at Mútua Terrassa University Hospital, Spain, between February 2008 and February 2018. We analyzed pregnancy outcomes including time to conception, pregnancy approach, gestational age, delivery mode, neonatal outcomes and complications during pregnancy and delivery. After USgHIFU treatment, 71 pregnancies were obtained in 55 patients. Of these, 58 (82%) cases were natural pregnancies and 13 (18%) were in vitro fertilization (IVF) pregnancies. The median time to conception was 12 (range 1-72) months. There were 43 (61%) successful deliveries, including a twin gestation, 22 (31%) spontaneous abortions and 6 (8%) therapeutic abortions. The rate of full-term deliveries was 91% (39/43) and the remaining 9% (4/43) were preterm deliveries. Of the 44 live births, 25 (57%) were born vaginally and 19 (43%) by cesarean section. The complications reported included 3 women with retained placenta (7%), 2 with placenta previa (5%) and 1 with severe preeclampsia (2%). The mean birth weight was 3.1 (range: 1.4-4.3) kg, and except for a baby born with a tetralogy of Fallot, all newborns developed well without complications during postpartum and breastfeeding. Patients undergoing USgHIFU treatment of uterine fibroids can achieve full-term pregnancies with few intrapartum or postpartum complications. More studies are required to compare fertility and perinatal outcomes between patients who underwent or not USgHIFU.


Reduced baroreflex control of heart period after bed rest is normalized by acute plasma volume restoration.
Adaptation to spaceflight or head-down-tilt bed rest leads to hypovolemia and an apparent abnormality of baroreflex regulation of cardiac period. In a previous study, we demonstrated that both chronic (2 wk) head-down-tilt bed rest and acute induced hypovolemia led to similar impairments in spontaneous baroreflex control of cardiac period, suggesting that a reduction in plasma volume may be responsible for this abnormality after bed rest. Therefore we hypothesized that this reduced "baroreflex function" could be restored by intravenous volume infusion equivalent to the reduction in plasma volume after bed rest. Six healthy subjects underwent 2 wk of -6 degrees head-down bed rest. Beat-by-beat arterial blood pressure and ECG were recorded during 6 min of spontaneous respiration and fixed-rate breathing (0.2 Hz), and transfer function analysis between systolic blood pressure and R-R interval was performed. Plasma volume was measured with Evans blue dye, and cardiac filling pressures were directly measured (Swan-Ganz catheter). After bed rest, studies were repeated before and after plasma volume restoration, with which both plasma volume and left ventricular end-diastolic pressure were restored to pre-bed rest levels by intravenous dextran40 infusion (288 +/- 31 ml). Transfer function gain in the high-frequency range, used as an index of vagally mediated arterial-cardiac baroreflex function, decreased significantly (13.4 +/- 3.1 to 8.1 +/- 2.9 ms/mmHg, P < 0.05) after bed rest. However, reduced transfer function gain was normalized to the pre-bed rest level (12.2 +/- 3.6 ms/mmHg) after precise plasma volume restoration. This result confirms that reductions in plasma volume, rather than a unique autonomic nervous system adaptation to bed rest, are largely responsible for the observed changes in spontaneous arterial-cardiac baroreflex function after bed rest.


Suppression of osteogenic differentiation in mesenchymal stem cells from patients with ossification of the posterior longitudinal ligament by a histamine-2-receptor antagonist.
Mesenchymal stem cells (MSCs) in ossification of the posterior longitudinal ligament (OPLL) patients have a high propensity toward osteogenesis. Histamine receptor H2 (H2R) antagonists (H2 blockers) like famotidine decrease ossification in patients, by an unclear mechanism. To confirm that MSCs express H2R and to clarify how H2 blockers suppress osteogenic differentiation, we used spinal-ligament MSCs from patients with OPLL or with cervical spondylotic myelopathy (CSM) (control). The MSCs were treated with 10, 30, or 100nM famotidine for 7 or 21 days. Flow cytometry revealed that cells from both groups expressed MSC surface markers CD44, CD90, and CD105 (> 97.5%) but not CD34 or CD45 (< 2.5%). Immunoblotting showed that the MSCs from both groups expressed H2R, but those from OPLL patients expressed it at higher levels. Real-time qPCR indicated the H2R expression was significantly suppressed by 30nM famotidine for 7 days or by 30 or 100nM for 21 days. However, histidine decarboxylase, a key enzyme in histamine production, did not change significantly after famotidine addition. Famotidine treatment at 100nM for 21 days significantly suppressed mRNA expression of the osteogenic markers osteocalcin (OCN), bone morphogenetic protein 2 (BMP2), and runt-related transcription factor 2 (RUNX2) only in OPLL-derived MSCs. Immunoblots showed that famotidine suppressed BMP2 and OCN in the OPLL group and H2R and RUNX2 in both groups. These results suggest famotidine inhibits osteogenic differentiation in OPLL-derived MSCs by acting as an H2R antagonist, but also by decreasing H2R expression, and support the clinical use of famotidine to treat OPLL.


[A mathematical model of determining the knee joint injury].
A mathematical model of determining the injury of human knee joint was established by using structural dynamics method. The results showvered the corresponding shearing displacement and bending angle of the knee joint on the occasion of ligament avulsion, and the shearing force and bending moment which caused tibial condylar fractures under purest shearing and bending condition. The calculated results consisted with the experimental results greatly, suggesting that using mathematical method to determine the injury is feasible and this kind of method can do good to lots of subjects, such as pedestrian protection, athletic medicine and rehabilitation engineering.


Conjugate treatment with high concentration normobaric oxygen and hyaluronic acid for vaginal atrophy: a prospective study.
Vulvovaginal atrophy is a condition closely related to low circulating estrogen levels, with post-menopause being the main cause. However, patients of childbearing age may also present with these symptoms due to treatments that reduce estrogen production. Local estrogen therapy is the causal treatment of local symptoms, but it is not always accepted and is often abandoned by patients. In recent years, alternative therapies have been proposed: fractional CO2 laser or the conjugate treatment with normobaric oxygen and hyaluronic acid, the latter being the subject of this study. The study aimed to evaluate the effectiveness of conjugate topical treatment with normobaric oxygen and hyaluronic acid. 50 patients were evaluated and treated with 5 applications of 15 minutes each, every 15 days, with Caressflow®. All patients presented at least one of the symptoms related to vulvovaginal atrophy: dryness, burning, and dyspareunia. In all cases, vulvoscopy, colposcopy, and cervicovaginal cytology were performed. The patients were interviewed with an analogic scale (VAS) concerning the severity of symptoms before and after the treatment. Colposcopy and PAP-smear were assessed by mean of Vaginal Health Index Score (VHI) at baseline and at the end of the treatment. All patients completed the treatment scheme and presented with a significant improvement in subjective symptoms. The colposcopy and PAP-smear performed 10 days after the end of the last treatment showed a significant improvement in the appearance and elasticity of the vaginal epithelium and the cytological picture, which showed, in the sample taken after treatment, hyaluronic acid vesicles within the cell cytoplasm. This study corroborates the data presented in the latest published papers on the effectiveness of treatment with normobaric O2 and hyaluronic acid on vaginal atrophy. Efficacy has been confirmed both in terms of subjective symptoms reported by the patients and objective improvement at colposcopy and PAP-smear cytology.


Additives for Efficient Biodegradable Antifouling Paints.
The evolution of regulations concerning biocidal products aims to increase protection of the environment (e.g., EU Regulation No 528/2012) and requires the development of new non-toxic anti-fouling (AF) systems. The development of these formulations implies the use of ingredients (polymers, active substances, additives) that are devoid of toxicity towards marine environments. In this context, the use of erodable antifouling paints based on biodegradable polymer and authorized biocides responds to this problem. However, the efficiency of paints could be improved by the use of specific additives. For this purpose, three additives acting as surface modifiers were studied (Tween 80, Span 85 and PEG-silane). Their effects on parameters involved in antifouling efficiency as hydrophobicity, hydration and copper release were studied. Results showed that the addition of 3% of additives modulated hydrophobicity and hydration without an increase of copper release and significantly reduced microfouling development. Efficient paints based on biodegradable polymer and with no organic biocide could be obtained by mixing copper thiocyanate and additives.


Revision of the eastern Pacific species of Gobulus (Perciformes: Gobiidae), with description of a new species.
Gobulus birdsongi is described as a new species from the Pacific coast of Panama. The two other known species of Gobulus from the eastern Pacific, Gobulus crescentalis and G. hancocki are redescribed. Gobulus birdsongi differs from other species in the genus in having more numerous second dorsal and anal rays. Gobulus hancocki differs from G. crescentalis in having a much smaller eye. The genus is distinctive in having reversed countershading, with the ventral surface of the body darker than the dorsal surface.


Pancreatic secretory trypsin inhibitor as a marker for early detection of rejection in canine pancreas allotransplantation.
Serum pancreatic secretory trypsin inhibitor (PSTI)* was measured in the course of canine segmental pancreas allotransplantation without immunosuppression. Serum PSTI concentrations showed two distinct elevations: the first elevation was on the first day and the onset of the second elevation was the sixth day after operation. The first postoperative elevation of the serum PSTI level is thought to be related to the operative procedures, because the first elevation was observed after both autotransplantation and allotransplantation, and biopsies of the autograft and allograft at the first day after the operations showed nonspecific neutrophilic infiltration and no perivascular lymphoid infiltrates. The second postoperative elevation of the serum PSTI level is thought to reflect a rejection process because this elevation was not seen after autotransplantation, and biopsies of allografts at the sixth day after the operation showed typical perivascular lymphoid infiltrates and cellular rejection of the exocrine tissue. In addition, the onset of the second elevation of serum PSTI level preceded by about three days the onset of the elevation of blood sugar at the ninth day after the operation. The results suggest that serum PSTI can be used as a marker for diagnosis of early pancreatic allograft rejection.


Opioid Prescribing to US Children and Young Adults in 2019.
Recent national data are lacking on the prevalence, safety, and prescribers of opioid prescriptions dispensed to children and young adults aged 0 to 21 years. We identified opioid prescriptions dispensed to children and young adults in 2019 in the IQVIA Longitudinal Prescription Database, which captures 92% of US pharmacies. We calculated the proportion of all US children and young adults with ≥1 dispensed opioid prescription in 2019. We calculated performance on 6 metrics of high-risk prescribing and the proportion of prescriptions written by each specialty. Of all prescriptions and those classified as high risk by ≥1 metric, we calculated the proportion written by high-volume prescribers with prescription counts at the ≥95th percentile. Analyses included 4 027 701 prescriptions. In 2019, 3.5% of US children and young adults had ≥1 dispensed opioid prescription. Of prescriptions for opioid-naive patients, 41.8% and 3.8% exceeded a 3-day and 7-day supply, respectively. Of prescriptions for young children, 8.4% and 7.7% were for codeine and tramadol. Of prescriptions for adolescents and young adults, 11.5% had daily dosages of ≥50 morphine milligram equivalents; 4.6% had benzodiazepine overlap. Overall, 45.6% of prescriptions were high risk by ≥1 metric. Dentists and surgeons wrote 61.4% of prescriptions. High-volume prescribers wrote 53.3% of prescriptions and 53.1% of high-risk prescriptions. Almost half of pediatric opioid prescriptions are high risk. To reduce high-risk prescribing, initiatives targeting high-volume prescribers may be warranted. However, broad-based initiatives are also needed to address the large share of high-risk prescribing attributable to other prescribers.


Tracking patient radiation exposure: challenges to integrating nuclear medicine with other modalities.
The cumulative radiation exposure to the patient from multiple radiological procedures can place some individuals at significantly increased risk for stochastic effects and tissue reactions. Approaches, such as those in the International Atomic Energy Agency's Smart Card program, have been developed to track cumulative radiation exposures to individuals. These strategies often rely on the availability of structured dose reports, typically found in the DICOM header. Dosimetry information is currently readily available for many individual x-ray-based procedures. Nuclear medicine, of which nuclear cardiology constitutes the majority of the radiation burden in the US, currently lags behind x-ray-based procedures with respect to reporting of radiation dosimetric information. This article discusses qualitative differences between nuclear medicine and x-ray-based procedures, including differences in the radiation source and measurement of its strength, the impact of biokinetics on dosimetry, and the capability of current scanners to record dosimetry information. These differences create challenges in applying, monitoring, and reporting strategies used in x-ray-based procedures to nuclear medicine, and integrating dosimetry information across modalities. A concerted effort by the medical imaging community, dosimetry specialists, and manufacturers of imaging equipment is required to develop strategies to improve the reporting of radiation dosimetry data in nuclear medicine. Some ideas on how to address this issue are suggested.


Changes in sexual risk behavior in the Mombasa cohort: 1993-2007.
The Mombasa Cohort is an open cohort study following HIV-seronegative women reporting transactional sex. Established in 1993, the cohort provides regular HIV counseling and testing at monthly visits. Over time, HIV acquisition risk has declined steadily in this cohort. To evaluate whether this decline may reflect changes in sexual risk behavior, we investigated trends in condom use and partner numbers among women who participated in the Mombasa Cohort between 1993 and 2007. Multinomial logistic regression and generalized estimating equations were used to evaluate the association of calendar time and follow-up time with key risk behaviors, after adjustment for potential confounding factors. At enrollment visits by 1,844 women, the adjusted probability of never using condoms decreased over time, from 34.2% to 18.9%. Over 23,911 follow-up visits, the adjusted probabilities of reporting >2 partners decreased from 9.9% to 4.9% and inconsistent condom use decreased from 7.9% to 5.3% after ≥12 cohort visits. Important predictors of risk behavior were work venue, charging low fees for sex, and substance abuse. Women with a later sexual debut had less risky behavior. Although sexual risk has declined among women participating in the Mombasa Cohort, HIV acquisition continues to occur and interventions to promote and reinforce safer sex are clearly needed.


Modified renal morcellation for renal cell carcinoma: laboratory experience and early clinical application.
To present our modified technique to expedite the entrapment and morcellation process. Standard renal morcellation is typically performed using a 12-mm incision, with the specimen entrapped within a durable LapSac. Because the LapSac does not have a deployment mechanism, its application is technically demanding and time consuming. The recent elimination of the electrical morcellator has also made the morcellation process time consuming and tedious. Using an in vitro porcine kidney morcellation model, we compared traditional morcellation (n = 10) with our modified morcellation technique (n = 10). The modified morcellation technique incorporated an EndoCatch entrapment sac and used standard manual morcellation through a 3-cm incision. The 3-cm incision allowed for extracorporeal morcellation, because the specimen could be seen through the abdominal wall defect. Subsequently, we performed 11 laparoscopic radical/total nephrectomies for renal masses using the modified morcellation technique through a 3-cm incision. In this in vitro model, renal specimen morcellation with the standard technique required a mean of 9.4 minutes (16.5 g/min) and modified morcellation required 3.24 minutes (51.24 g/min; P <0.0001). The mean fragment size with standard and modified morcellation was 1.47 and 4.46 g, respectively (P <0.0001). EndoCatch entrapment sack integrity was confirmed in all 10 cases (100%). Clinically, 12 patients underwent modified morcellation of radical nephrectomy specimens. All specimens were renal cell carcinoma, with a mean specimen weight of 724 g. The mean entrapment time was 2 minutes, 40 seconds, and the mean morcellation time was 11 minutes. EndoCatch entrapment sack integrity was confirmed in all cases. At a mean follow-up of 8 months, no trocar site or local recurrences have developed. Preliminary laboratory and clinical data have demonstrated that the modified morcellation technique is safe and expeditious. The larger fragments that result from the modified technique may facilitate tumor staging. The technique must be performed with great care to prevent sack perforation. Prospective randomized comparison of the modified and standard morcellation techniques and long-term follow-up are required before routine application of this technique.


Synthesis and biological activity studies of 1,3,4-thiadiazolo[2,3-c]-as-triazines.
Several new 1,3,4-thiadiazolo[2,3-c]-as-triazines were synthesized by the reaction of 6-substituted-4-amino-3-mercapto-1,3,4-triazon-5 (4H)-ones with appropriate aromatic and heterocyclic carboxylic acids in the presence of phosphorus oxychloride. The structures of the newly synthesized compounds were established on the basis of analytical, IR, NMR and mass spectral data. Some selected compounds from this series were subjected to both antimicrobial and pharmacological studies.


Reduced urinary corin levels in patients with chronic kidney disease.
Corin is a cardiac protease that regulates BP (blood pressure) by activating natriuretic peptides. Recent animal studies identified corin expression in the kidney where it may regulate renal function. In the present study, we tested the hypothesis that corin may be present in human urine and that urinary corin levels may be altered in patients with kidney disease. We obtained urine and kidney tissue samples from normal individuals and CKD (chronic kidney disease) patients. Using ELISA, we detected corin protein in human urine. In normal individuals, urinary corin levels did not correlate with that of plasma, indicating that urinary corin is probably of kidney origin. Compared with normal controls, CKD patients had markedly reduced urinary corin levels and this reduction correlated with disease severity. By immunostaining, human corin protein was identified on the epithelial cell surface in renal tubules. The renal corin mRNA and protein levels were significantly lower in CKD patients than non-CKD controls. The results indicate that renal tubular corin may be shed into urine and that urinary and renal corin levels were reduced in CKD patients. These data suggest that reduced corin levels in the kidney may reflect the underlying pathology in CKD.


Implementing dimer metadynamics using gromacs.
We develop a Gromacs implementation of dimer metadynamics (DM) (JCTC 13, 425 [2017]) for enhanced sampling through artificial delocalization effects. This implementation is based entirely on a Plumed collective variable developed for this purpose, the fine tuning of Gromacs input parameters, modified forcefields and custom nonbonded interactions. We demonstrate this implementation on alanine dipeptide in vacuum and in water, and on the 12-residue alanine polypeptide in water and compare the results with a standard multiple-replica technique such as parallel tempering. In all the considered cases, this comparison is consistent and the results with DM are smoother and require shorter simulations, thus proving the consistency and effectiveness of this Gromacs implementation. © 2018 Wiley Periodicals, Inc.


Cloning and high-level expression of a chloroperoxidase gene from Pseudomonas pyrrocinia in Escherichia coli.
A chloroperoxidase gene from Pseudomonas pyrrocinia was cloned into Escherichia coli using the cosmid vector pJB8. The gene coding for the chloroperoxidase could be localized to a 1.5 kb fragment of DNA which was subcloned into the high-copy-number plasmid pUC18. In one subclone increased halogenating activity could be found which was 570-fold greater than in P. pyrrocinia. The halogenating enzyme was identified as the chloroperoxidase by SDS-polyacrylamide gel electrophoresis.


Epidemiology of antituberculosis drug resistance in Saudi Arabia: findings of the first national survey.
The real magnitude of antituberculosis (anti-TB) drug resistance in Saudi Arabia is still unknown because the available data are based on retrospective laboratory studies that were limited to hospitals or cities. A representative national survey was therefore conducted to investigate the levels and patterns of anti-TB drug resistance and explore risk factors. Between August 2009 and July 2010, all culture-positive TB patients diagnosed in any of the tuberculosis reference laboratories of the country were enrolled. Isolates obtained from each patient were tested for susceptibility to first-line anti-TB drugs by the automated Bactec MGIT 960 method. Of the 2,235 patients enrolled, 75 cases (3.4%) were lost due to culture contamination and 256 (11.5%) yielded nontuberculous mycobacteria (NTM). Finally, 1,904 patients (85.2% of those enrolled) had available drug susceptibility testing results. Monoresistance to streptomycin (8.1%; 95% confidence interval [CI], 7.2 to 9.1), isoniazid (5.4%; 95% CI, 4.7 to 6.2), rifampin (1%; 95% CI, 0.7 to 1.3) and ethambutol (0.8%; 95% CI, 0.5 to 1.2) were observed. Multidrug-resistant TB (MDR-TB) was found in 1.8% (95% CI, 1.4 to 2.4) and 15.9% (95% CI, 15.4 to 16.5) of new and previously treated TB cases, respectively. A treatment history of active TB, being foreign-born, having pulmonary TB, and living in the Western part of the country were the strongest independent predictors of MDR-TB. Results from the first representative national anti-TB drug resistance survey in Saudi Arabia suggest that the proportion of MDR-TB is relatively low, though there is a higher primary drug resistance. A strengthened continuous surveillance system to monitor trends over time and second-line anti-TB drug resistance as well as implementation of innovative control measures, particularly among immigrants, is warranted.


HIV/STIs risks between migrant MSM and local MSM: a cross-sectional comparison study in China.
Background. Internal migration plays a significant role in China's HIV epidemic. However, few studies have directly compared migrant men who have sex with men (MSM) with local MSM with regard to HIV/sexually transmitted infections (STIs) risks. Methods. We conducted a study in Guangzhou, China, with the aim of understanding the differences in HIV/STIs risks between migrant MSM and local MSM. A cross-sectional study was conducted among 273 migrant MSM and 249 local MSM in Guangzhou, China. Their behavioral and serologic data on HIV/syphilis were collected and compared between the two groups. A multivariate logistic regression was used to estimate the associations between HIV/STIs risks and migratory status. Results. Migrant MSM, compared to local MSM, have higher odds of reporting unprotected anal intercourse (UAI) (OR = 1.4; 95% CI [0.9-2.0]) and having multiple homosexual partners (OR = 1.2; 95% CI [0.8-1.8]). A lower rate of condom use at homosexual debut was reported in migrant MSM than in local MSM (OR = 0.7; 95% CI [0.5-0.9]). Migrant MSM have less odds of reporting HIV/STIs testing in the previous 6 months relative to local MSM (OR = 0.5; 95% CI [0.4-0.8]). In addition, migrant MSM demonstrated a lower level of HIV knowledge than local MSM (OR = 0.4; 95% CI [0.2-0.8]). Conclusion. Migrant MSM are more likely to engage in sexual risk behaviors, report a lower level of HIV knowledge and have less access to HIV/STIs testing. Further comprehensive interventions targeting migrant MSM are urged.


Adults' judgments of fictional story quality.
Narratives are commonly used for research and clinical purposes, but the ecological validity of our analyses needs verification. Do our macrostructural and microstructural narrative analysis methods give us an accurate picture of what would generally be considered "story quality"? We addressed this question by using 39 untrained adult judges who were presented with sets of brief stories, each set constructed to vary on a single story aspect (story grammar elements, story grammar structural pattern, referring expressions, or connectives). Judges ranked the stories in each set from best to worst. Results indicate that judges were generally sensitive to story features commonly used in narrative analyses, including characters' thoughts and feelings, goal-directedness, adequacy of referent introductions, and connectedness of clauses. However, they failed to make distinctions between stories that differed in types of connectives or referring expressions and had mixed reactions to description in stories.


MITOCHONDRIAL DNA PHYLOGENIES FOR THE DROSOPHILA OBSCURA GROUP.
Species belonging to the obscura group of the genus Drosophila have long held a central position in evolutionary studies, especially in experimental population genetics. Despite the considerable amount of accumulated knowledge, many of the phylogenetic relationships of the species in the group remain unclear. Here we present DNA sequence data for the mitochondrial gene cytochrome oxidase I (COI) for 13 species native to both the Old and New Worlds. We combine these data with seven other mitochondrial gene sequences from previous studies, for a total of over 3 kb per species. Strongly supported conclusions include: (1) the two North American subgroups, pseudoobscura and affinis, are each monophyletic; and (2) among Eurasian species two unambiguous clades are identified, one containing D. tristis, D. ambigua, and D. obscura and the other containing D. guanche, D. subobscura, and D. madeirensis. Constructing firm hypotheses connecting these four major clades is problematic with all datasets. Major ambiguities are the number of invasions giving rise to the North American obscura species and the relationships among the Eurasian species. The inadequacy of the mtDNA data to resolve these ambiguities does not reside in lack of changes; the transversions-only parsimony tree has 283 informative characters. Rather, the problems are likely intrinsic to the history of the group: while radiating in temperate Eurasia, North America was colonized once or twice, followed by one or two radiations in the New World.


Zidovudine concentration in brain extracellular fluid measured by microdialysis: steady-state and transient results in rhesus monkey.
We measured zidovudine concentrations in blood, muscle, and brain extracellular fluid (ECF) by microdialysis and in serum ultrafiltrate and cerebrospinal fluid (CSF) samples during a continuous intravenous infusion (15 mg/kg/h) and after bolus dosing (50-80 mg/kg over 15 min) in nonhuman primates to determine whether CSF drug penetration is a valid surrogate for blood-brain barrier penetration. Recovery was estimated in vivo by zero net flux for the continuous infusion and retrodialysis for the bolus dosing. In vivo recovery was tissue-dependent and was lower in brain than in blood or muscle. Mean (+/-S.D.) steady-state blood, muscle, and brain zidovudine concentrations by microdialysis were 112 +/- 63.8, 105 +/- 51.1, and 13.8 +/- 10.4 microM, respectively; and steady-state serum ultrafiltrate and CSF concentrations were 81.2 +/- 40.2 and 14.1 +/- 8.0 microM, respectively. Brain ECF penetration (microdialysis brain/blood ratio) and CSF penetration (standard sampling CSF/serum ratio) at steady state were 0.13 +/- 0.06 and 0.17 +/- 0.02, respectively. With bolus dosing the mean (+/-S.D.) zidovudine area under concentration-time curve (AUC) normalized to a dose of 80 mg/kg was 577 +/- 103 microM. h in blood, 528 +/- 202 microM. h in muscle, and 108 +/- 74 microM. h in brain (brain/blood ratio of 0.18 +/- 0.10) by microdialysis. Serum ultrafiltrate AUC was 446 +/- 72 microM. h and the CSF AUC was 123 +/- 4.7 microM. h (CSF/serum ratio of 0.28 +/- 0.06). In conclusion, recovery was tissue-dependent. CSF and brain ECF zidovudine concentrations were comparable at steady state, and the corresponding AUCs were comparable after bolus injection. Thus, zidovudine penetration in brain ECF and CSF in nonhuman primates is limited to a similar extent, presumably by active transport, as in other species.


PhyloBot: A Web Portal for Automated Phylogenetics, Ancestral Sequence Reconstruction, and Exploration of Mutational Trajectories.
The method of phylogenetic ancestral sequence reconstruction is a powerful approach for studying evolutionary relationships among protein sequence, structure, and function. In particular, this approach allows investigators to (1) reconstruct and "resurrect" (that is, synthesize in vivo or in vitro) extinct proteins to study how they differ from modern proteins, (2) identify key amino acid changes that, over evolutionary timescales, have altered the function of the protein, and (3) order historical events in the evolution of protein function. Widespread use of this approach has been slow among molecular biologists, in part because the methods require significant computational expertise. Here we present PhyloBot, a web-based software tool that makes ancestral sequence reconstruction easy. Designed for non-experts, it integrates all the necessary software into a single user interface. Additionally, PhyloBot provides interactive tools to explore evolutionary trajectories between ancestors, enabling the rapid generation of hypotheses that can be tested using genetic or biochemical approaches. Early versions of this software were used in previous studies to discover genetic mechanisms underlying the functions of diverse protein families, including V-ATPase ion pumps, DNA-binding transcription regulators, and serine/threonine protein kinases. PhyloBot runs in a web browser, and is available at the following URL: http://www.phylobot.com. The software is implemented in Python using the Django web framework, and runs on elastic cloud computing resources from Amazon Web Services. Users can create and submit jobs on our free server (at the URL listed above), or use our open-source code to launch their own PhyloBot server.


The effect of transfixation pins on the biomechanical properties of angled acrylic connecting bars.
With acrylic external-fixation frames for fracture repair the acrylic columns can be contoured to allow greater versatility in the placement of transfixation pins, thus minimizing damage to the surrounding soft tissue and making mandibular and transarticular fixation easier. However, contouring affects the stiffness and ultimate strength of the construct under axial compression. In this study, polymethylmethacrylate columns 21 mm in diameter angled at 0°, 30°, 45°, 60°, or 90° with clamps were constructed. For each angulation group, pins 3.2-mm long were placed in 6 columns, 2 pins at each end, 1.5 cm from each other, and 6 columns had no pins. Each column was allowed to polymerize for a minimum of 10 min, then was placed in a biomechanical-testing machine, the load cell at the bottom end of the column and the actuator on top, with a preload of 10 to 12 N to prevent slippage. The columns underwent axial loading at a rate of 8 mm/s until catastrophic failure occurred. Data on force and deformation were collected every 0.025 s. Both stiffness and ultimate strength of the column decreased significantly (P < 0.01), up to 77% and 70%, respectively, with each increase of angulation. The columns with pins were significantly less stiff (P < 0.05) than those without pins at angulations of 45° and 60°. However, the columns with pins did not show significant differences in ultimate strength from the columns without pins at any of the angulations. The point of failure was always at the angle of the column, demonstrating that in axial compression the weakest point is not the pin-acrylic interface when pins are eccentrically located within the column.


[Long-term results (≥ 10 years) after bariatric surgery : review of the literature.]
Bariatric and metabolic surgery (BMS) is currently the cornerstone of treatment for severe obesity. It produces significant and lasting weight loss in the vast majority of cases, which depends on the procedure performed, in any case much greater than that observed with non-surgical treatments. This weight loss along with direct metabolic effects of BMS, result in a substantial and lasting improvement in many obesity-related comorbidities, notably metabolic ones, sometimes with complete remission. This leads to a reduction in cardiovascular risk and mortality. Any BMS must be carried out by a multidisciplinary team, which will ensure lifelong follow-up in order to optimize results and prevent complications, including micronutrient deficiencies, by adequate supplementations.


Microtubule-associated protein 1 light chain 3 interacts with and contributes to growth inhibiting effect of PML.
Previously we reported that the expression of promyelocytic leukemia (PML)-retinoic acid receptor alpha (RARα) fusion gene, which is caused by specific translocation (15;17) in acute promyelocytic leukemia, can enhance constitutive autophagic activity in leukemic and nonleukemic cells, and PML overexpression can sequestrate part of microtubule-associated protein light chain 3 (LC3) protein in PML nuclear bodies, suggesting that LC3 protein also distributes into nuclei although it is currently thought to function primarily in the cytoplasm, the site of autophagosomal formation. However, its potential significance of nucleoplasmic localizations remains greatly elusive. Here we demonstrate that PML interacts with LC3 in a cell type-independent manner as assessed by Co-IP assay and co-localization observation. Overexpressed PML significantly coprecipitates with endogenous and nuclear LC3 protein. Furthermore, a fraction of endogenous PML protein is found to be co-localized with LC3 protein under steady state condition, which is further enhanced by IFNα induction, indicating that PML up-regulation potentiates this interaction. Additionally, DsRed-PML associates with EGFP-LC3 during telophase and G1 phase but not in metaphase and anaphase. Two potential LC3-interacting region (LIR) motifs in PML are required for interaction of PML with LC3 while this association is independent of autophagic activity. Finally, we show that interaction between PML and LC3 contributes to cell growth inhibition function of PML. Considering that PML is an important tumor suppressor, we propose that nuclear portion of LC3 protein may associate with PML to control cell growth for prevention and inhibition of cancer occurrence and development.


Theory for spectral broadening of narrowband signals in the atmosphere and experiment with an acoustic source onboard an unmanned aerial vehicle.
Narrowband acoustic signals propagating through inhomogeneous moving media, such as atmospheric turbulence, exhibit spectral broadening. This phenomenon has been previously studied with regard to acoustic remote sensing of the atmosphere with sodars and tonal noise of turbofan aircraft engines. In this paper, spectral broadening is studied for line-of-sight sound propagation in a turbulent atmosphere. The averaged power spectral density of a narrowband signal is calculated from a Fourier transform of the temporal mutual coherence function of the sound field. Spectral broadening is characterized by the width of the spectral density. The spectral width is calculated for the Kolmogorov spectra of temperature and wind velocity fluctuations for both horizontal and slanted propagation in the atmosphere. In the latter case, the height-dependence of the wind speed and turbulence parameters is addressed. The spectral width is studied numerically for different meteorological regimes of the atmospheric boundary layer characterized by the friction velocity and the surface sensible heat flux. Theoretical results are compared to experimental data for propagation from an acoustic multi-tone source onboard an unmanned aerial vehicle to a microphone array located on the ground.


Temperature shock proteins in plants.
Plant tissue generally responds rapidly to sudden increases in temperature by curtailing or abolishing normal protein synthesis and producing new polypeptides known as heat shock proteins (HSP). Some of the methods used for monitoring the expression of heat shock genes are described, and the characteristics of the heat shock response in higher plants are discussed with special reference to tropical cereals. The possible role for heat shock proteins in conferring thermo-tolerance upon plant tissue is considered. The behaviour of plant tissue subjected to temperature decreases has been much less intensively studied, and varies greatly according to species and the nature of the cold treatment. No homology has yet been detected between the heat shock and the cold shock response in any plant system. Cold-induced changes in gene expression observed in a wide range of plant species are discussed with particular reference to parallel changes in cold-hardiness. Marked contrasts have been observed between the response of temperate grasses and that of tropical cereals to cold treatment, and these are discussed in relation to growth and survival at suboptimal temperatures.


Atypical protein kinase C isoforms differentially regulate directional keratinocyte migration during wound healing.
The epidermis possesses regenerative properties that become apparent only after wounding. Atypical protein kinase C (aPKC) isoforms aPKCζ and aPKCλ form a ternary complex with Par3 and Par6, and play crucial roles in establishing and maintaining epithelial cell polarity. The epidermal loss of aPKCλ results in progressive depletion of hair follicle stem cells. However, it is unclear whether aPKCs have equivalent activities in epidermal regeneration. To clarify functional differences between aPKCζ and aPKCλ in cutaneous wound healing. We compared cutaneous wound healing processes in vivo using mutant mice with genetic deletion of each aPKC isoform. We also analyzed functional differences between aPKCζ and aPKCλ in cell proliferation, directional cell migration, and formation of microtubules in vitro using primary keratinocytes established from each mutant mouse. Wound healing was significantly retarded in epidermis-specific aPKCλ knockout mice. In aPKCλ-deleted keratinocytes, the correct orientation of cell protrusions toward the wound was disrupted through the destabilization of Par6β. The elongation of stabilized β-tubulin was also deteriorated in aPKCλ-deleted keratinocytes, leading to defects in cell spreading. Conversely, wound healing and directional cell migration in aPKCζ-deleted mice were comparable to those in their control littermates. aPKCs are not functionally equivalent; aPKCλ, but not aPKCζ, plays a primary role in cutaneous wound healing.


The nurse's first visit. 1918.
Home visiting was an important component of the Public Health Nurse's (PHN) role in the early twentieth century. In this reprint, originally published in 1918 and reprinted in 1926, Edna Foley discusses the significance of the first visit the PHN makes to a family. Critical themes in the paper include the importance of first impressions, communication and observation skills, obtaining the statistical data needed by the agency and collaboration with other community social service agencies. Many of the themes and strategies discussed by Foley are cogent to PHNs and visiting nurses in the contemporary health care arena.


Spectrally-resolved internal quantum efficiency and carrier dynamics of semipolar [Formula: see text] core-shell triangular nanostripe GaN/InGaN LEDs.
We investigate the spectrally resolved internal quantum efficiency (IQE) and carrier dynamics in semipolar [Formula: see text] core-shell triangular nanostripe light-emitting diodes (TLEDs) using temperature-dependent photoluminescence (TDPL) and time-resolved photoluminescence (TRPL) at various excitation energy densities. Using electroluminescence, photoluminescence, and cathodoluminescence measurements, we verify the origins of the broad emission spectra from the nanostructures and confirm that localized regions of high-indium-content InGaN exist along the apex of the nanostructures. Spectrally resolved IQE measurements are then performed, with the spectra integrated from 400-450 nm and 450-500 nm to obtain the IQE of the QWs mainly near the sidewalls and apex of the TLEDs, respectively. TDPL and TRPL are used to decouple the radiative and non-radiative carrier lifetimes for different regions of the emission spectra. We observe that the IQE is higher for the spectral region between 450 nm and 500 nm compared to the IQE between 400 and 450 nm. This result is in contrast to the typical observation that the IQE of planar GaN-based LEDs is lower for longer wavelengths (i.e., higher indium contents). We also observe a longer non-radiative recombination lifetime for the longer wavelength portion of the spectrum. Several explanations are proposed for the improved IQE and longer non-radiative lifetime observed near the apex of the nanostructures. The results show that nanostructures may be leveraged to design more efficient green LEDs, potentially addressing a long-standing challenge in GaN-based materials.


Cultivating Country Doctors: Preparing Learners for Rural Life and Community Leadership.
Rural health disparities are growing, and medical schools and residency programs need new approaches to encourage learners to enter and stay in rural practice. Top correlates of rural practice are rural upbringing and rurally located training, yet preparation for rural practice plays a role. The authors sought to explore how selected programs develop learners' competencies associated with rural placement and retention: rural life, community engagement, and community leadership. Qualitative, semistructured phone interviews (n=20) were conducted with faculty of medical schools or family medicine residencies across the United States, Canada, Australia, and South Africa in which success in training rural practitioners was identified in the literature or by leaders of the National Rural Health Association's Rural Medical Educators Group. Participants included 18 physician program directors, one nonphysician program administrator, and one PhD researcher who had studied rural preparation. Interview transcripts were read twice using an inductive process: first to identify themes, and then to identify specific strategies and quotes to exemplify each theme. Participants' recommendations for rural preparation were: (1) Be intentional about strategies to prepare learners for rural practice; (2) Identify and cultivate rural interest; (3) Develop confidence and competence to meet rural community needs; (4) Teach skills in negotiating dual relationships, leading, and improving community health; and (5) Fully engage rural host communities throughout the training process. Medical schools and residencies may increase the likelihood of producing rural physicians by implementing these experts' strategies. Educators may select strategies that mesh with the structure and location of their training program.


Application of Holistic Nursing in Uremic Patients with Hematodialysis Related Malnutrition.
We aimed to observe the effect of holistic nursing on patients undergoing hematodialysis for uremia who simultaneously were suffering from moderate to severe malnutrition. Eighty patients with uremia on maintenance hematodialysis with malnutrition between June 2014 and June 2015 from Yantaishan Hospital, Yantai, Shandong, China were included and equally and randomly were divided into the control group (n=43) and observation group (n=43). Routine nursing was used in the control group while holistic nursing was used in observation group (before, during and after dialysis) and the clinical effects in the two groups were compared after 3 months. At follow-up visits, serum creatinine and urea nitrogen levels of the patients in the two groups were decreased, whereas hemoglobin and albumin levels were increased. In addition, these improvements were greater in the observation group and the differences were statistically significant (P<0.05). Furthermore, during follow-up visits, MQSGA and MIS scores of the two groups were lower and the scores of the observation group were lower than those in the control group were, and the differences were statistically significant (P<0.05). Holistic nursing is able to improve significantly malnutrition in patients with uremia on hematodialysis.


Evaluation and treatment of mood and anxiety disorders in opioid-dependent patients.
Mood and anxiety disorders are common and treatable but may cause considerable morbidity if left untreated. This is especially so in opioid-dependent individuals, for whom diagnosis is difficult and rehabilitation easily compromised. Clinicians need guidelines to distinguish the patient with an independent mood or anxiety disorder from the more common anxious or depressed addict who is withdrawing, intoxicated or reacting to a life crisis. This article reviews the current knowledge of diagnosis, clinical presentation, and prevalence of mood and anxiety disorders common among opioid-dependent patients. It attempts to identify features of a patient's history that distinguish truly independent disorders and proceeds to a discussion of treatment approaches for this subgroup.


Overexpression of the WOX gene STENOFOLIA improves biomass yield and sugar release in transgenic grasses and display altered cytokinin homeostasis.
Lignocellulosic biomass can be a significant source of renewable clean energy with continued improvement in biomass yield and bioconversion strategies. In higher plants, the leaf blade is the central energy convertor where solar energy and CO2 are assimilated to make the building blocks for biomass production. Here we report that introducing the leaf blade development regulator STENOFOLIA (STF), a WOX family transcription factor, into the biofuel crop switchgrass, significantly improves both biomass yield and sugar release. We found that STF overexpressing switchgrass plants produced approximately 2-fold more dry biomass and release approximately 1.8-fold more solubilized sugars without pretreatment compared to controls. The biomass increase was attributed mainly to increased leaf width and stem thickness, which was also consistent in STF transgenic rice and Brachypodium, and appeared to be caused by enhanced cell proliferation. STF directly binds to multiple regions in the promoters of some cytokinin oxidase/dehydrogenase (CKX) genes and represses their expression in all three transgenic grasses. This repression was accompanied by a significant increase in active cytokinin content in transgenic rice leaves, suggesting that the increase in biomass productivity and sugar release could at least in part be associated with improved cytokinin levels caused by repression of cytokinin degrading enzymes. Our study provides a new tool for improving biomass feedstock yield in bioenergy crops, and uncovers a novel mechanistic insight in the function of STF, which may also apply to other repressive WOX genes that are master regulators of several key plant developmental programs.


A Novel Use of the Erector Spinae Block in the Austere Environment.
A 25 year-old male presented with penetrating chest trauma to a split forward surgical team located in an austere setting. Due to limited resources and a minimal monitoring in-transit a regional anesthetic was placed for pain control. This is the first description of an Erector Spinae Block utilized in a far forward combat setting.


Unlocking the Potential of Arginine Deprivation Therapy: Recent Breakthroughs and Promising Future for Cancer Treatment.
Arginine is a semi-essential amino acid that supports protein synthesis to maintain cellular functions. Recent studies suggest that arginine also promotes wound healing, cell division, ammonia metabolism, immune system regulation, and hormone biosynthesis-all of which are critical for tumor growth. These discoveries, coupled with the understanding of cancer cell metabolic reprogramming, have led to renewed interest in arginine deprivation as a new anticancer therapy. Several arginine deprivation strategies have been developed and entered clinical trials. The main principle behind these therapies is that arginine auxotrophic tumors rely on external arginine sources for growth because they carry reduced key arginine-synthesizing enzymes such as argininosuccinate synthase 1 (ASS1) in the intracellular arginine cycle. To obtain anticancer effects, modified arginine-degrading enzymes, such as PEGylated recombinant human arginase 1 (rhArg1-PEG) and arginine deiminase (ADI-PEG 20), have been developed and shown to be safe and effective in clinical trials. They have been tried as a monotherapy or in combination with other existing therapies. This review discusses recent advances in arginine deprivation therapy, including the molecular basis of extracellular arginine degradation leading to tumor cell death, and how this approach could be a valuable addition to the current anticancer arsenal.


GENETIC VARIATION IN CACTOPHILIC DROSOPHILA FOR OVIPOSITION ON NATURAL YEAST SUBSTRATES.
Theory predicts that environmental heterogeneity in space or in time can maintain genetic polymorphism. Stable polymorphisms are expected to be more readily maintained if there are genotype specific habitat preferences. Genotype specific preferences for oviposition sites in Drosophila could be a major factor promoting habitat selection, and thus the maintenance of genetic variation. This hypothesis is being tested using the cactophilic species, D. buzzatii and D. aldrichi, where available evidence indicates a potential for such habitat selection, the habitats (oviposition sites) being yeast species found in the natural environment of these flies (cactus rots). Genetic variation for oviposition preferences was tested using isofemale lines-for D. buzzatii, a total of 60 lines from seven localities widely distributed through the species range in Australia, and for D. aldrichi, 21 lines from three of these localities. Females were given a choice of five yeast species as oviposition sites. Genetic variation for oviposition preferences on these natural substrates was demonstrated. There was significant variation among isofemale lines within populations in their patterns of preferences for oviposition on the five yeast species. However, analyses of preferences for each yeast species separately showed that the genetic variation for preferences relates to only three of the five species. Heritabilities of individual female preferences for these three species were low, ranging up to 9%. Little geographic differentiation was apparent among populations, most likely due to similar selection regimes within each population. Within populations, this kind of habitat selection could act to maintain polymorphisms, both at loci determining the habitat preferences and at other loci in linkage disequilibrium with them.


A survey of physician experience and treatment satisfaction prescribing once-weekly semaglutide injections for patients with type 2 diabetes in Canada.
We assessed physicians' experiences of prescribing once-weekly (OW) semaglutide to patients with type 2 diabetes (T2D) in Canada. Physicians who had prescribed OW semaglutide to ≥2 patients with T2D in the past 12 months and had been doing so for ≥3 months were surveyed during 1-17 October 2018. Prescribing reasons, treatment satisfaction and reasons for discontinuation were assessed. Of the 50 participants, 72% and 54% were prescribed OW semaglutide due to its superior glycemic control and effect on weight, respectively. Most physicians were more satisfied with injection frequency (62%), effect on weight (60%), achieving HbA1c target (54%) and therapy simplicity (50%) with OW semaglutide versus other glucagon-like peptide-1 receptor agonists. Treatment discontinuations in 13% of OW semaglutide-treated patients were reported by physicians, primarily due to gastrointestinal symptoms (70%). The survey suggests that physicians are satisfied with the OW semaglutide clinical effects. Video Abstract: http://links.lww.com/CAEN/A34.