[Increased threshold for detection of phase differences in pattern-induced color flicker fusion in patients with glaucoma].
Pattern-induced flicker-colors are subjective colors produced by rotating disks with black-and-white arcs. Changing the direction of rotation results in a different color. Small variations in the temporal sequence (phase differences) of the black-and-white pattern cause the colors to vary and can be perceived as color differences. We investigated the thresholds for such phase differences in healthy (n = 11) and in glaucomatous (n = 19) eyes. Acuity and color vision were tested and in patients static visual field perimetry (Octopus G1) was carried out. The disks used for producing the pattern-induced flicker-colors were viewed from a distance of 2 m and had a luminance of 35 cd/m2. The phase difference thresholds were determined using a double staircase procedure. In glaucomatous eyes the thresholds were significantly higher (33.9 +/- 4.8 for clockwise rotation) than in normal eyes (18.2 +/- 1.4), p < 0.005 and this was the case for anticlockwise as well as clockwise rotation. The difference between the two groups remained significant (p < 0.025) when the data for glaucomatous eyes was corrected for acuity losses. In the glaucomatous eyes the increase in phase difference threshold was correlated with raised visual field MD (r = 0.87 for clockwise rotation). The higher thresholds in glaucomatous eyes point to a loss in blue-yellow-sensitive, parvocellular retinal ganglion cells, which play an important part in the perception of pattern-induced flicker-colors. Pattern-induced flicker-colors are a new method for the clinical investigation of retinal function in the center of the visual field and have the advantage that fixation is unnecessary and the yellow filter properties of the refractive media and the macula are of no importance.


Progression of voice and speech impairment in the course of Parkinson's disease: a longitudinal study.
Impairment of voice and speech occurs in the majority of patients in the course of Parkinson's disease (PD). The aim of the current study was to survey the changes of voice and speech performance in the individual patients over time. 80 patients with PD and 60 healthy speakers were tested and retested after at least 12 months (average time interval: 32.5 months). Participants had to read a given text which was digitally recorded as a source for the perceptual and acoustic analysis. Stage of the disease and global motor impairment were rated according to the accepted scales. As a result, abnormalities of voice and speech were already present in mildly affected patients and there were significant deteriorations of quality of voice and articulatory velocity and precision between baseline and followup examination which showed no correlation with the time interval between the visits. Summarized, voice, and speech performance were found to further deteriorate in the individual patient in the course of time although global motor impairment was widely stable which might be a hint for nondopaminergic mechanisms of progression of dysarthrophonia. Further investigations are warranted to get a better insight into the dynamics of the progression of voice and speech impairment in PD as a precondition for the development of therapeutic approaches.


Radiofrequency ablation (Rafaelo Procedure) for the treatment of hemorrhoids: a case series in the United Kingdom.
Hemorrhoidal disease remains a common condition that can have a significant effect on a patient's quality of life. Various methods have been introduced over the years; however, their overall success rates remain low. Although the traditional Milligan Morgan technique is effective, the associated pain level prevents it from being an attractive form of treatment. This study was devised to assess the safety and efficacy associated with a novel minimally invasive approach, radiofrequency ablation (RFA). Forty-two patients underwent RFA at a single center, by 1 of 2 surgeons. This was performed under local anesthetic and sedation. Outcomes including postoperative pain levels, recurrence rates, and patient satisfaction scores were recorded and analyzed using medians and interquartile ranges. The median postoperative pain score was 2.5/10 (interquartile range [IQR], 0-4.5) and the overall patient satisfaction score was 9 out of 10 (IQR, 6.5-10). Recurrence rates (6-12 months following the procedure) were low at 12% and all patients reported milder symptoms at recurrence. There were no serious adverse complications. The results from this case series supports other limited data in concluding that RFA is a safe and effective method in the treatment of hemorrhoids and patients report a high level of satisfaction following.


Results of subxiphoid pericardiostomy in pericardial effusion.
37 patients with pericardial effusions were managed by early subxiphoid pericardiostomy under local anaesthesia in most cases (31/37). The aetiology was pyogenic infection in 21, tuberculosis in 7, trauma in 3, cardiomyopathy in one. It was unclear in five patients. The effusion recurred in two patients (one with pyogenic, the other with traumatic pericarditis). An infant with pyogenic pericarditis developed pericardial constriction. The mortality, mainly due to associated infections or diseases, was related to aetiology: 0% for tuberculosis and trauma, 19% (4/21) for pyogenic infections, 80% (4/5) for unclear causes. Overall results were good in 28 patients. Subxiphoid pericardiostomy is a simple and safe procedure which allows a quick differential diagnosis and drainage of pericardial effusions.


[Characteristics of the joint involvement in fibrodysplasia ossificans progressiva and follow up].
Objective: To summarize the clinical data of 15 patients with fibrodysplasia ossificans progressiva (FOP), follow up and analyze the characteristics of the joint involvement in FOP. Method: From May 2005 to December 2016, fifteen FOP cases had been diagnosed in the Children's Hospital Capital Institute of Pediatrics. All medical records and follow-up data were collected and a retrospective analysis was made on the joint involvement in FOP. Pearson correlation analysis was used for data, P<0.05 for the difference was statistically significant. Result: There were 8 males and 7 females in 15 cases. The age of onset was 2(1-6)years. The age at diagnosis was 6 (4-9) years. All cases had hallux valgus deformity and bone mass formation. Twelve cases had joints involvement on enrollment into this study: 8 cervical vertebra, 7 shoulder joint, 5 hip joint, 4 elbow joint, 3 wrist joint, 2 temporomandibular joint, 2 lumbar vertebra. The age of diagnosis and duration of disease were positively correlated with the number of the involved joints (r=0.523, 0.628; P=0.045, 0.012); mild changes were found in joint imaging. Thirteen cases received telephone follow-up, the average duration of follow-up was 6(3-7)years, no change in 11 cases, disease progress in 2 cases. Conclusion: Joint involvement is a common complication of FOP, especially the cervical vertebra.Multiple joints involvement, dominant functional impairment, and mild imaging changes are the characteristics of joint lesions caused by FOP.The number of involved joints gradually increases with increase of age of the patients and the prolonged course of the disease.


Heard or Understood? Neural Tracking of Language Features in a Comprehensible Story, an Incomprehensible Story and a Word List.
Speech comprehension is a complex neural process on which relies on activation and integration of multiple brain regions. In the current study, we evaluated whether speech comprehension can be investigated by neural tracking. Neural tracking is the phenomenon in which the brain responses time-lock to the rhythm of specific features in continuous speech. These features can be acoustic, i.e., acoustic tracking, or derived from the content of the speech using language properties, i.e., language tracking. We evaluated whether neural tracking of speech differs between a comprehensible story, an incomprehensible story, and a word list. We evaluated the neural responses to speech of 19 participants (six men). No significant difference regarding acoustic tracking was found. However, significant language tracking was only found for the comprehensible story. The most prominent effect was visible to word surprisal, a language feature at the word level. The neural response to word surprisal showed a prominent negativity between 300 and 400 ms, similar to the N400 in evoked response paradigms. This N400 was significantly more negative when the story was comprehended, i.e., when words could be integrated in the context of previous words. These results show that language tracking can capture the effect of speech comprehension.


Rescuers' characteristics associated with the correct chest compression during cardiopulmonary resuscitation.
To analyse the caregivers' physical, anthropometrical and educational characteristics associated with adequate chest compression and full chest recoil during cardiopulmonary resuscitation (CPR). An observational prospective research study was conducted. Emergency and critical care health professionals and students performed two minutes of chest compressions on a dummy. Depth and residual leaning after the compressions were assessed and their association with several variables (physical, anthropometrical, and educational) was analysed using logistic regression models. Two hundred thirty-eight volunteers participated. Previous experience of the rescuer in less than six CPRs (OR: 3.03; CI 95%: 1.2-7.63) was related to a higher probability of not achieving an adequate depth of compressions. Greater height (OR: .93; 95% CI: .87-.99) and grip strength (OR: .94; 95% CI: .89-.99) were associated with correct performance of chest compression. We did not find any characteristic related to chest recoil. The caregiver's previous experience with CPR was the strongest factor associated with adequate performance of chest compressions. To a lesser extent, the professional's height and upper body muscle strength also have an influence. No factors associated with the adequacy of full chest recoil were identified.


Endogenous oncornaviral DNA sequences: evidence for two classes of viral DNA sequences in guinea pig cells.
The nature of the endogenous viral DNA sequences in guinea pig cells was studied by hybridization. A segment of the viral RNA (r-VRNA) hybridizing to abundant (or reiterated) DNA sequences (R-VDNA) was isolated by recycling to a Cot of 300. The hybridization of the recycled VRNA, as well as the total VRNA, was followed by determining their kinetics and by Wetmur-Davidson analysis. The kinetics of hybridization of total VRNA were complex, did not follow a second-order kinetics, and revealed two slopes by Wetmur-Davidson analysis. The recycled RNA, on the other hand, had a second-order reaction rate expected of the hybridization between a single species of RNA and DNA sequences and yielded a single straight line in a Wetmur-Davidson plot. The Cot1/2 and slope of the recycled r-VRNA was almost identical to that of the abundant VDNA sequences obtained from the hybridization data of the total VRNA. Guinea pig 28S rRNA with or without recycling was used in monitoring hybridization rate. The kinetics of hybridization of 28S RNA followed a second-order reaction and produced a single straight line by Wetmur-Davidson plot, with a second-order reassociation rate constant of 9.6 x 10(-3) liters/mol-s, a Cot1/2 of 104 mol-s/liter, and reiteration frequency of 146. There was no difference in the kinetics of hybridization of 28S RNA before and after recycling. These experiments showed that guinea pig cells contain two classes of VDNA sequences. (i) R-VDNA sequences with a second-order reassociation rate constant of 8.2 x 10(-4) liters/mol-s, a Cot1/2 of 1,219 mol-s/liter, and a reiteration frequency of 12 represent 37.5% of the viral genome. (ii) Unique VDNA sequences with a second-order reassociation rate constant of 1.2 x 10(-4) liters/mol-s, a Cot1/2 of 7,692 mol-s/liter, and a reiteration frequency of 2 represent 62.5% of the viral genome.


Spastic diplegia as a complication of interferon Alfa-2a treatment of hemangiomas of infancy.
We report the development of spastic diplegia in infants during the course of interferon Alfa-2a (IFN) therapy for potentially life-endangering hemangiomas. Five infants who displayed diplegia were selected from a group of 26 infants treated with IFN. Diplegia persisted in three infants, and in the remaining two significant recovery occurred after IFN was discontinued. Magnetic resonance imaging showed no significant brain or spinal abnormalities except minor to moderate delayed myelination in two patients. Myelination was normal on subsequent radiographic examination in all five patients. We conclude that IFN can adversely affect the immature central nervous system and produce spastic diplegia, which is potentially reversible. We recommend careful clinical assessment of neurodevelopmental status during IFN therapy.


Shared identity is key to effective communication.
The ability to communicate with others is one of the most important human social functions, yet communication is not always investigated from a social perspective. This research examined the role that shared social identity plays in communication effectiveness using a minimal group paradigm. In two experiments, participants constructed a model using instructions that were said to be created by an ingroup or an outgroup member. Participants made models of objectively better quality when working from communications ostensibly created by an ingroup member (Experiments 1 and 2). However, this effect was attenuated when participants were made aware of a shared superordinate identity that included both the ingroup and the outgroup (Experiment 2). These findings point to the importance of shared social identity for effective communication and provide novel insights into the social psychology of communication.


Immunohistochemical demonstration of peptidylarginine deiminase in human sweat glands.
Human skin is known to contain protein-bound citrulline. This is the product of enzymatic deimination of arginine residues catalyzed by peptidylarginine deiminase. We probed frozen sections of human skin with a rabbit antiserum raised to rat skeletal muscle peptidylarginine deiminase using the avidin-biotin-peroxidase complex technique. This led us to interesting findings. No staining was observed in epidermis, inner root sheaths of hair follicles, sebaceous glands, and hair erector muscle. However, we noticed specific staining of the cytoplasm of secretory and myoepithelial cells of both eccrine and apocrine sweat glands. The procedure also stained neoplastic cells present in specimens dissected from extramammary Paget's disease. The data mean that peptidylarginine deiminase may be used as a new marker in the classification of skin neoplasms showing sweat gland differentiation. Possible localization of multiple types of peptidylarginine deiminases in human skin is discussed.


Microbubble Size and Dose Effects on Pharmacokinetics.
Optimization of contrast-enhanced imaging and focused ultrasound therapy requires a comprehensive understanding of in vivo microbubble (MB) pharmacokinetics. Prior studies have focused pharmacokinetic analysis on indirect techniques, such as ultrasound imaging of the blood pool and gas chromatography of exhaled gases. The goal of this work was to measure the MB concentration directly in blood and correlate the pharmacokinetic parameters with the MB size and dose. MB volume dose (MVD) was chosen to combine the size distribution and number into a single-dose parameter. Different MB sizes (2, 3, and 5 μm diameter) at 5-40 μL/kg MVD were intravenously injected. Blood samples were withdrawn at different times (1-10 min) and analyzed by image processing. We found that for an MVD threshold < 40 μL/kg for 2 and 3 μm and <10 μL/kg for 5 μm, MB clearance followed first-order kinetics. When matching MVD, MBs of different sizes had comparable half-lives, indicating that gas dissolution and elimination by the lungs are the primary mechanisms for elimination. Above the MVD threshold, MB clearance followed biexponential kinetics, suggesting a second elimination mechanism mediated by organ retention, possibly in the lung, liver, and spleen. In conclusion, we present the first direct MB pharmacokinetic study, demonstrate the utility of MVD as a unified dose metric, and provide insights into the mechanisms of MB clearance from circulation.


Solar ultraviolet radiation exposure in workers with outdoor occupations: a systematic review and call to action.
Chronic solar ultraviolet radiation (sUVR) exposure leads to an increased incidence of non-melanoma skin cancer (NMSC) development, particularly when accumulated over decades. Workers in certain industries, such as construction, agriculture, postal workers, and the military, are at higher risk due to cumulative sUVR exposure in their line of work. By assessing the relationship between sUVR exposure in outdoor workers and their skin cancer risk and defining methods of prevention, clinicians can offer focused sun protection counseling to this unique population. PubMed was used to perform a literature review to address the following research questions: 1. How is ultraviolet radiation measured? 2. What is the modern utility of the ultraviolet index in modifying sun protection behaviors in outdoor industry workers? 3. What is the risk of non-melanoma skin cancer development in individuals working in outdoor occupations? 4. What is the prevalence of skin cancer among outdoor workers? 5. Is the number of nevi and solar lentigines elevated among individuals employed in outdoor occupations? The literature suggests that individuals in outdoor occupations are exposed to UV levels that often surpass safety limits for occupational UVR exposure, increasing their risk of developing skin cancer and precursor and pigmented lesions. Individuals in high-risk occupations experience significantly higher levels of sUVR exposure than their indoor worker counterparts, increasing their risk of malignant cutaneous transformation. Accordingly, these individuals must be counseled on effective solar protection methods, and employers should advocate for actionable change.


Recognition of objects displayed with incomplete sets of discrete boundary dots.
Most extant theories of shape perception assume or assert that various contour attributes, and in particular, the orientation, curvature and linear extent of the contours provide essential object recognition cues. The present study examined this proposal using discrete dots that marked locations on the outer boundary of namable objects, providing shape-patterns similar to silhouettes. For each shape, the display initially provided only a sampling of the total number of dots in the boundary, and the number of dots was periodically increased until the participant named the object. There were three treatment conditions in which the initial display as well as the periodic increments consisted of continuous arrays (strings) of dots, randomly positioned dots, or evenly spaced dots. Analysis showed objects were recognized with the fewest percentage of dots with the evenly spaced condition, and participants needed the greatest percentage with the contiguous array condition. In many cases objects could be identified when very few evenly spaced dots were shown, thereby providing large spacing between the dots. It seems unlikely that known neural mechanisms could extract contour attributes, e.g., orientation, curvature, and linear extent, from such sparse stimulus patterns, which provides a challenge to the proposition that these are essential shape cues.


Pathways to psychological wellbeing for patients with bladder cancer and their partners-in-care.
The goal of the current analyses was to describe pathways through which Psychological Wellbeing might be better understood for clinical participants with bladder cancer and their partners. This was achieved by applying Roy's Adaptation Model that provides a framework with which to understand responses to challenging circumstances that has proved useful in the study of a range of chronic conditions. The sample comprised 119 patients with a diagnosis of bladder cancer, and 103 supportive partners. Participants completed a self-report questionnaire comprising the Bladder Cancer Index, Mini-Mental Adjustment to Cancer Scale, Psychosocial Adjustment to Illness Scale, and sociodemographic details. For each sample, structural equation modelling was used to determine goodness of fit, guided by Roy's Adaptation Model. For patients, increasing age and disease duration, the negative appraisal of health care, perceived poor functioning and elevated burden of disease provided pathways to Psychological Wellbeing. For partners, increasing age, being male, a negative health care experience, and perceived burden of disease were significant. However, for both groups a positive evaluation of family and social support was the key indicator of lower Psychological Wellbeing. The models presented describe a suite of issues that could inform a nursing model of care to enhance the experience of living with bladder cancer for both patients and their supportive partners.


Immunohistochemical detection of bcl-2 and p53 proteins and apoptosis in soft tissue sarcoma: their correlations with prognosis.
Information on prognostic factors is essential to establish appropriate therapeutic modalities for soft tissue sarcoma (STS). To evaluate the biological nature and prognostic factors of STS, p53 and bcl-2 expression was immunohistochemically studied on paraffin-embedded sections from 70 patients with STS in the extremities and trunk. In addition, the degree of apoptosis was examined by in situ end-labeling. Histologic diagnoses in these cases were malignant fibrous histiocytoma in 29 cases, liposarcoma in 11, synovial sarcoma in 11, leiomyosarcoma in 5, malignant neurogenic tumor in 5, and others in 9. Tumor cells in 31 of 70 cases (44%) showed positive nuclear staining for p53 protein. There was no correlation between p53 expression and tumor size, histologic grade, argyrophilic nucleolar organizer region (AgNOR) count, cellularity and extent of neerosis. Expression of p53 did not correlate with survival of patients. Tumor cells in 24 of 56 cases (43%) were positive for bcl-2 protein expression. The frequency of bcl-2 expression in the tumor cells showed a direct proportion to tumor size (> or = 10 vs. < 10 cm) but inverse proportion to AgNOR counts and cellularity. The 5-year survival rate in patients with bcl-2-positive tumors (87%) was more favorable than in those with bcl-2-negative tumors (53%; p < 0.05). The frequency of apoptosis in low-grade STS was significantly higher than that in the intermediate and high-grade STS (p < 0.001). Extent of necrosis, a well-known prognostic indicator in STS, was not correlated with the frequency of apoptosis. Multivariate analysis showed that cellularity, bcl-2 and AgNOR counts were independent prognostic factors in patients with STS. The current study revealed that STS with a higher expression of bcl-2 had lower proliferative activity and larger size than those without. Immunohistochemical detection of bcl-2 is useful for predicting prognosis in patients with STS.


A Secure Technique for Microvascular Anastomosis in Arteries with Intimal Dissection: Intimal Sleeve Fold-Over Technique.
Intimal dissection can cause an irregular internal surface with intimal flaps and subendothelial collagen exposure. This has been associated with a high risk of thrombosis. Trimming the artery to a healthy level is routinely recommended to avoid intimal dissection. However, this method is limited when there is inadequate vascular length to work with. We dealt with an artery exhibiting severe intimal dissection by using a new suture technique: the intimal sleeve fold-over technique. Severe arterial intimal dissections were observed in 9 (6.9%) of 130 arterial microvascular anastomoses in free flap reconstruction for oral cancer patients from January 2013 to December 2013. We used this technique in 6 of the 9 patients. All 6 patients were discharged as scheduled without perioperative problems and complications during follow-ups. The mean diameters of the recipient and pedicle arteries with intimal dissection were 2.13 and 2.20 mm. The mean time for performing sleeve fold-over procedure of on each artery was 5.1 minutes. A secure intima-to-intima contact can be achieved using this technique. This technique can provide an alternative method to intimal dissection when the length of the artery is limited.


EUFEMED London Conference 2017: Exploratory Medicines Development: Innovation and Risk Management.
The first formal conference of the EUropean Federation for Exploratory MEdicines Development (EUFEMED) held in London was the result of a collaborative effort of its founding associations: the Association for Applied Human Pharmacology (AGAH; Germany), the Association for Human Pharmacology in the Pharmaceutical Industry (AHPPI; UK), the Belgian Association of Phase-I Units (BAPU; Belgium), and Club Phase-I (France). The conference focused on innovation and risk management in early clinical drug development. Among other innovations, immunotherapy in oncology and inflammatory diseases were discussed as well as the importance of adaptive trial designs in early clinical drug development. Consideration was given to assessing and mitigating risk in early clinical drug development, and included a preconference workshop. Different measures to minimize risks in healthy volunteers and patients in first-in-human trials were discussed in addition to the importance of non-clinical data, the need for reliable biomarkers, improved communication on adverse events (AEs) and well-trained study sites with ready access to intensive care units and clinical specialists. The need for a European-wide system for prevention of over-volunteering was also discussed. The conference provided opportunity to discuss these developments and concerns and the changing regulatory environment with stakeholders from academia, industry, and regulatory agencies including the European Medicines Agency (EMA). Presentations given by invited speakers are published on http://www.eufemed.eu/london-conference-2017/.


Observations of the microcirculatory bed in rat mesocecum using differential interference constrast microscopy in vivo and electron microscopy.
The microvascular bed of the rat mesocecum has been examined in vivo using differential interference (Nomarski) optics and subsequently by electron microscopy. The preferential channel, from terminal arteriole to collecting venule, has been examined. In the terminal arteriolar segment the endothelial layer is covered by a continuous layer of smooth muscle cells which, in turn, are surrounded by adventitia. In the metarteriolar segment the periendothelial cells still resemble smooth muscle cells but the tunica media is discontinuous. In the distal segment periendothelial cells are more scattered and have the appearance of pericytes. There appears to be a continuous transition of the periendothelial cell layer from terminal arteriole to distal segment. Nerve endings were seeen in both the terminal arteriolar and metarteriolar segments. During contraction smooth muscle cells, oriented circumferentially, shorten and thicken. Endothelial cells appear anchored by myoendothelial junctions. Endothelial cells have filaments which show increased banding during vasoconstriction, suggesting that such cells may contract. Capillary offshoots leave the preferential channel, usually at right angles. Smooth muscle cells are oriented to form a sphincter and there are many myoendothelial junctions at the branch point. Within a short distance the capillary branch loses its periendothelial coat.


An Introductory Qualitative Exploration of Medical Student Perceptions of Professionalism at One Medical University.
Professionalism as a competency in medical education has been defined in multiple ways. Irby and Hamstra offered three frameworks of professionalism in medical education. This study examines medical students' definitions of professionalism to assess whether they align with these frameworks. We administered an open-ended questionnaire to 92 medical students at a single university in the United States. We conducted thematic coding of responses and calculated code frequencies. The response rate was 54%. There were no observable differences between the responses of students in clinical versus preclinical training phases. The majority of comments (84%) reflected aspects of multiple frameworks from Irby and Hamstra and three emergent themes were identified. Most respondents (96%) cited aspects of the behavior-based framework. Most students' (66%) responses also aligned with the virtue-based framework. Emergent themes were "hierarchical nature of medicine," "academic environment/hidden curriculum," and "service and advocacy." "Service and advocacy" can be viewed as contexts for Irby and Hamstra's identity formation framework, but references did not align with the full definition. Our findings suggest that students view professionalism through multiple frameworks and indicate a predominance of the behavior-based framework. Experiences with organizational culture and values may be important in students' definitions of professionalism.


Minimum Lateral Bone Coverage Required for Securing Fixation of Cementless Acetabular Components in Hip Dysplasia.
Objectives. To determine the minimum lateral bone coverage required for securing stable fixation of the porous-coated acetabular components (cups) in hip dysplasia. Methods. In total, 215 primary total hip arthroplasties in 199 patients were reviewed. The average follow-up period was 49 months (range: 24-77 months). The lateral bone coverage of the cups was assessed by determining the cup center-edge (cup-CE) angle and the bone coverage index (BCI) from anteroposterior pelvic radiographs. Further, cup fixation was determined using the modified DeLee and Charnley classification system. Results. All cups were judged to show stable fixation by bone ingrowth. The cup-CE angle was less than 0° in 7 hips (3.3%) and the minimum cup-CE angle was -9.2° (BCI: 48.8%). Thin radiolucent lines were observed in 5 hips (2.3%), which were not associated with decreased lateral bone coverage. Loosening, osteolysis, dislocation, or revision was not observed in any of the cases during the follow-up period. Conclusion. A cup-CE angle greater than -10° (BCI > 50%) was acceptable for stable bony fixation of the cup. Considering possible errors in manual implantation, we recommend that the cup position be planned such that the cup-CE angle is greater than 0° (BCI > 60%).


HAX1 deficiency causes autosomal recessive severe congenital neutropenia (Kostmann disease).
Autosomal recessive severe congenital neutropenia (SCN) constitutes a primary immunodeficiency syndrome associated with increased apoptosis in myeloid cells, yet the underlying genetic defect remains unknown. Using a positional cloning approach and candidate gene evaluation, we identified a recurrent homozygous germline mutation in HAX1 in three pedigrees. After further molecular screening of individuals with SCN, we identified 19 additional affected individuals with homozygous HAX1 mutations, including three belonging to the original pedigree described by Kostmann. HAX1 encodes the mitochondrial protein HAX1, which has been assigned functions in signal transduction and cytoskeletal control. Here, we show that HAX1 is critical for maintaining the inner mitochondrial membrane potential and protecting against apoptosis in myeloid cells. Our findings suggest that HAX1 is a major regulator of myeloid homeostasis and underline the significance of genetic control of apoptosis in neutrophil development.


QUANTITATIVE GENETICS AND THE EVOLUTION OF REACTION NORMS.
We extend methods of quantitative genetics to studies of the evolution of reaction norms defined over continuous environments. Our models consider both spatial variation (hard and soft selection) and temporal variation (within a generation and between generations). These different forms of environmental variation can produce different evolutionary trajectories even when they favor the same optimal reaction norm. When genetic constraints limit the types of evolutionary changes available to a reaction norm, different forms of environmental variation can also produce different evolutionary equilibria. The methods and models presented here provide a framework in which empiricists may determine whether a reaction norm is optimal and, if it is not, to evaluate hypotheses for why it is not.


Effect of pH and fatty acid chain length on the interaction of myelin basic protein with phosphatidylglycerol.
The basic protein of myelin binds electrostatically to acidic lipids but has several hydrophobic segments which may penetrate into the lipid bilayer. Calorimetric and spin-label evidence suggests that below the phase transition temperature, Tc, several phase states occur in the complex of phosphatidylglycerol with basic protein, possibly due to differences in the degree of penetration of the protein and/or interdigitation of the lipid acyl chains. One of these states is a metastable state which starts to melt 10 degrees C below the Tc of the pure lipid and then refreezes, with release of heat, into a stable state. The stable state melts near the Tc of the pure lipid but restricts the motion of fatty acid spin-labeled near the terminal methyl much more than does the pure lipid. The relationship between the rate of conversion to the stable state and the degree of penetration of the protein at varying pH, in the range 4--8, and the lipid acyl chain length, in the range 14 to 18 carbons, was investigated. Altering the pH in this range affects protonation of the histidines of the protein but has no effect on the lipid at pH 4 and above. The rate of conversion of the sample to both the metastable state and the stable state decreased with increase in pH for phosphatidylglycerol with all lipid chain lengths. It also decreased with decreasing chain length at constant pH. This suggested that the lipid could refreeze into the stable state more readily if a smaller proportion of the total bilayer thickness was occupied by the hydrophobic segments of the protein. The consistency of these results with the concept of penetration of portions of the protein partway into the bilayer lends support to this hypothesis.


Disparities in sport participation of transgender women: a systematic and scoping review protocol.
Transgender women experience disparities in sport participation that are exacerbated by policies from sport organisations and legislation in the USA regulating the participation of transgender women in the category that best aligns with their gender identity. Both transgender and cisgender women are affected by these policies because sport organisations do not have a clear understanding of the effects of gender-affirming hormone therapy on transgender women and the unfair advantage they may have over cisgender women athletes. This article describes a review protocol to understand disparities in sport participation of transgender women. A systematic and scoping review is being conducted. Studies are included if they explore disparities in sport participation (ie, participation rates, real and/or perceived barriers to participation) of transgender women of any age. A search strategy has been developed for PubMed, EMBASE, Web of Science, Cochrane Library and CINAHL. Relevant grey literature will also be scanned. The planned search dates are July and August 2023. This review does not directly involve human subjects, so ethical approval is not required. Findings from the systematic review will be disseminated via publications in peer-reviewed journals and conferences.


The chest radiograph: anatomic considerations.
This article discusses the routine posteroanterior and lateral radiographs of the chest, utilizing an anatomic approach. Topics covered include lobar collapse, pulmonary fissures, mediastinal anatomy, and pericardial effusion.


Dosing the Coast: Leaking Sewage Infrastructure Delivers Large Annual Doses and Dynamic Mixtures of Pharmaceuticals to Urban Rivers.
Pharmaceuticals are commonly detected at low concentrations in surface waters, where they disrupt biological and ecological processes. Despite their ubiquity, the annual mass of pharmaceuticals exported from watersheds is rarely quantified. We used liquid chromatography-mass spectroscopy to screen for 92 pharmaceuticals in weekly samples from an urban stream network in Baltimore, MD, USA, that lacks wastewater treatment effluents. Across the network, we detected 37 unique compounds, with higher concentrations and more compounds in streams with higher population densities. We also used concentrations and stream discharge to calculate annual pharmaceutical loads at the watershed outlet, which range from less than 1 kg to ∼15 kg and are equivalent to tens of thousands of human doses. By calculating annual watershed mass balances for eight compounds, we show that ∼0.05 to ∼42% of the pharmaceuticals consumed by humans in this watershed are released to surface waters, with the importance of different pathways (leaking sewage vs treated wastewater effluent) differing among compounds. These results demonstrate the importance of developing, maintaining, and improving sewage infrastructure to protect water resources from pharmaceutical contamination.


Nucleic acid-based analyses of non-group A rotaviruses.
Simple genome profile studies on polyacrylamide gels allow all non-group A rotaviruses isolated so far to be recognized by the absence of the tight triplet (7-9) of RNA segments seen in all group A viruses. However, reliance solely on genome profile studies for rotavirus grouping can be misleading and, for virus group definition, additional corroborating nucleic acid and serological studies are essential. Terminal fingerprint analysis was the first generation of nucleic acid-based assays that allowed discrimination between the various rotavirus groups. By means of this technique the clear definition of five rotavirus groups (A-E), correlating exactly with those found by a serological assay, has been possible, with preliminary evidence for at least two additional groups. The technical sophistication of fingerprinting techniques prevents their widespread use in epidemiological studies; the development of a second generation of nucleic acid-based assays is therefore under way. These employ molecularly cloned cDNA probes to the genomes of non-group A viruses which can be widely distributed for use in 'dot-blot' screening of faecal samples and, if expressed as protein in Escherichia coli, should provide a ready source of viral antigen for use in surveying viral prevalence through the screening of serum antibody levels.


Molten Salt-Derived RuO2 Nanocrystals and Nanowires: Unveiling Correlations of Morphology, Microstructure, and Electrocatalytic Performance.
Ruthenium oxide (RuO2), due to its comparable binding energy with *H and cost-effectiveness against Pt, has emerged as a pivotal electrocatalyst for oxygen evolution reaction (OER). In the present study, RuO2 nanocrystals (NCs) and nanowires (NWs) were obtained by a molten salt process and the morphology, crystal structure, and local bonding features were examined by using electron microscopy and X-ray absorption spectroscopy. From the electrochemical measurement, both RuO2 NCs and NWs exhibit favorable stability and activity toward oxygen evolution reaction in an alkali medium, althought NCs exhibit higher activity, which is likely attributed to the larger surface area and the high local structural disorder. The theoretical calculation reveals that RuO2 NWs with a primary (110) orientation show a higher overpotential due to its d-band center's proximity to the Fermi level versus (101). The present work suggests that the molten salt process could be an efficient method for producing metal oxide catalysts with tailorable geometry and performances.


Teachers' perceptions of students with speech sound disorders: a quantitative and qualitative analysis.
This study examined 2nd-grade teachers' perceptions of the academic, social, and behavioral competence of students with speech sound disorders (SSDs). Forty-eight 2nd-grade teachers listened to 2 groups of sentences differing by intelligibility and pitch but spoken by a single 2nd grader. For each sentence group, teachers rated the speaker's academic, social, and behavioral competence using an adapted version of the Teacher Rating Scale of the Self-Perception Profile for Children (S. Harter, 1985) and completed 3 open-ended questions. The matched-guise design controlled for confounding speaker and stimuli variables that were inherent in prior studies. Statistically significant differences in teachers' expectations of children's academic, social, and behavioral performances were found between moderately intelligible and normal intelligibility speech. Teachers associated moderately intelligible low-pitched speech with more behavior problems than moderately intelligible high-pitched speech or either pitch with normal intelligibility. One third of the teachers reported that they could not accurately predict a child's school performance based on the child's speech skills, one third of the teachers causally related school difficulty to SSD, and one third of the teachers made no comment. Intelligibility and speaker pitch appear to be speech variables that influence teachers' perceptions of children's school performance.


Parallel-oriented fibrogenesis of a beta-sheet forming peptide on supported lipid bilayers.
Peptide self-assembly on substrates is currently an intensively studied topic that provides a promising strategy for fabrication of soft materials and is also important for revealing the surface chemistry of amyloidogenic proteins that aggregate on cell membranes. We investigated the fibrogenesis of a beta-sheet forming peptide Abeta(26-35) on supported lipid bilayers (SLBs) by in situ atomic force microscopy (AFM), circular dichroism (CD), and attenuated total reflectance Fourier transform infrared (ATR-FTIR) spectroscopy. The results show that the Abeta(26-35) nanofilaments' growth is oriented to a specific direction and formed a highly ordered, large-scale, parallel-oriented surface pattern on membranes. The parallel-oriented fibrogenesis of Abeta(26-35) was able to occur on different lipid membranes rather than on solid substrates. It implies that the parallel-oriented fibrogenesis was associated with the distinct properties of lipid membranes, such as the fluid nature of lipid molecules on membranes. The membrane fluidity may allow the peptide assemblies to float at the water-membrane interface and easily orient to an energetically favorable state. These results provide an insight into the surface chemistry of peptide self-assembly on lipid membranes and highlight a possible way to fabricate supramolecular architectures on the surface of soft materials.


Enhanced signal response in globally coupled networks of bistable oscillators: Effects of mean field density and signal shape.
This paper studies a set of globally coupled bistable oscillators, all subjected to the same weak periodic signal and identical coupling. The effect of mean field density (MFD) on global dynamics is analyzed. The oscillators switch from intra- to interwell motion as MFD increases, clearly demonstrating MFD-enhanced signal amplification. A maximum amplification also occurs at a moderate level of MFD, indicating that the response exhibits a nonmonotonic sensitivity to MFD. The MFD-enhanced response depends mainly on the signal intensity but not on the signal frequency or the network topology. The analytical investigation provides a simplified model to study the mechanism underlying this resonancelike behavior. It is shown that by modifying the bistability nature of the potential energy, the mean field density can promote well-to-well oscillations and larger amplitude motions. Finally, the robustness of this phenomenon to various signal waveforms is examined. It can therefore be used alternatively to efficiently amplify weak signals in practical situations with large network sizes.


The ovariectomized ewe: its contribution to controlled breeding.
The ovariectomized ewe has been used to establish principles and procedures which have proved invaluable in controlled breeding in entire animals. Bioassays in the ovariectomized ewe, the end-point of oestrous behaviour, have been used to identify potent and rapidly metabolized progestagens which were subsequently used to control the time of oestrus and ovulation in cyclic ewes effectively, and to induce oestrus and ovulation in anoestrous ewes. Steroid hormone treatment of the ovariectomized ewe has been used to study relationships between the ovary and the pituitary-hypothalamic axis, to examine transport of embryos within the female tract and to establish the steroid hormone requirements of early pregnancy.


Rivaroxaban: An Affordable and Effective Alternative in Cancer-Related Thrombosis?
Venous thromboembolic events (VTEs) are common and potentially fatal complications in cancer patients, and they are responsible for the second most common cause of death. Low molecular weight heparin (LMWH) is the gold-standard treatment, but the costs involved limit its use, especially in developing countries. Recently, the oral anticoagulant rivaroxaban, which directly inhibits factor Xa, was approved for VTE treatment. We conducted a retrospective analysis from January 2009 to February 2014 with patients who had cancer and VTE who were receiving rivaroxaban. We compared the efficacy, safety, and cost of rivaroxaban and low molecular weight heparin (LMWH) alone or followed by vitamin K antagonists. Forty-one patients were identified, with a median age of 62.5 years. The most frequent tumor histology was adenocarcinoma (78%), which was most often found in the colon (26.8%). Most participants had advanced disease and an implanted central venous catheter. Patients' VTE risk-assessment scores were low (12.5%), intermediate (50%), and high (35.5%). Pulmonary thromboembolism was reported in 41.4% of patients, but inferior limb thrombosis was reported only in 14.6%; 43.9% of patients received enoxaparin before starting rivaroxaban. Rivaroxaban was used for a median time of 5.5 months. Nonmajor bleeding was reported in 12.2% of patients, and rethrombosis was reported in 12.2%. In our study, rivaroxaban was as safe and effective as enoxaparin/vitamin K antagonists (P = .54 and P = .25, respectively) or LMWH (P = .46 and P = .29, respectively). Although our study was a retrospective analysis, our results suggest that in this cohort of oncologic patients, rivaroxaban was safe and effective. Its oral route and lower cost make it an attractive alternative to LMWH, improving management of patients with cancer in low-income countries. Additional studies are necessary to confirm our data.


Restoration of spermatogenesis by lentiviral gene transfer: offspring from infertile mice.
Disruption of spermatogenesis found in azoospermia and oligozoospermia is thought to be of primarily genetic origin. Sl/Sl(d) mutant mice offer a model system in which lack of transmembrane type c-kit ligand (KL2) expression on the somatic Sertoli cell surface results in disruption of spermatogenesis. We investigated the ability of adeno-, adeno-associated-, retro-, and lentiviral vectors to transduce Sertoli cells and found that transduction with either adeno- or lentiviral vectors led to reporter gene expression for more than 2 mo after testicular tubule injection. Because adenoviral vectors showed toxicity, lentiviral vectors were used to express the c-kit ligand in Sl/Sl(d) Sertoli cells. Restoration of spermatogenesis was observed in all recipient testes. Furthermore, the sperm collected from recipient testes were able to generate normal pups after intracytoplasmic sperm injection. None of the offspring carried the transgene, suggesting the inability of lentiviral vectors to infect spermatogenic cells in vivo. We propose that lentiviral vectors can be used for gene therapy of male infertility without the risk of germ-line transmission.


Effect of oral naloxone hydrochloride on gastrointestinal transit in premature infants treated with morphine.
Opioids are common drugs for pain treatment in preterm newborn infants, in spite of several adverse effects. Constipation is a frequent problem when opioids are used in both adults and neonates. Although several studies indicate that the oral administration of naloxone hydrochloride (NH) improves intestinal motility during opioid therapy, there is still a lack of evidence in newborns. The aim of this study was to assess the efficacy of NH against reduced intestinal motility during opioid treatment. A retrospective cohort study was performed. We analysed the medical records of fifteen infants (Group 1) treated with continuous morphine (MO) infusion and fourteen infants (Group 2) treated with both oral NH (3 microg/kg 4 times daily) and MO. There was no statistically significant difference in the total MO dose. Infants treated both with NH and MO had a tendency to improve their mean stool frequency/day. A statistically significant improvement was observed in the mean total food intake (mL/kg/day) of the infants treated with NH (p = 0.014). No difference in the mean food retention between the two groups was observed. Orally administrated NH seems to improve intestinal motility resulting in increased food intake/day and improved stool frequency/day in premature newborn infants treated with MO. Further studies are needed to corroborate these findings.


Arylcyanomethylenequinone Oximes: An Overview of Synthesis, Chemical Transformations, and Biological Activity.
Quinone methides are a class of biologically active compounds that can be used in medicine as antibacterial, antifungal, antiviral, antioxidant, and anti-inflammatory agents. In addition, quinone methides have the potential to be used as pesticides, dyes, and additives for rubber and plastics. In this paper, we discuss a subclass of quinone methides: methylenequinone oximes. Although the first representatives of the subgroup were synthesized in the distant past, they still need to be additionally studied, while their chemistry, biological properties, and perspective of practical applications require to be comprehensively summarised. Based on the analysis of the literature, it can be concluded that methylenequinone oximes exhibit a diversified profile of properties and outstanding potential as new drug candidates and reagents in organic synthesis, both of electrophilic and nucleophilic nature, worthy of wide-ranging further research.


Characterization of Key Aroma Compounds and Construction of Flavor Base Module of Chinese Sweet Oranges.
Sweet orange flavor, with its refreshing, joyful and attractive aroma, is favored by the majority of consumers all over the world. However, the industry terminology between flavorists for flavor evaluation is a bit vague and not intuitive for customers. Therefore, the study focused on analysis of sweet orange aroma and establishment of base module of orange flavor. The approach to the research involves screening key aroma compounds, identifying the attributes aroma and building base module of sweet orange. The notes of sweet orange flavor were determined by GC-O olfaction and sensory evaluation. 25 key aroma compounds with OAV ≥ 1 were screened and divided into eight notes: citrus, fruity, fresh, green, peely, woody, fatty, floral. Partial least squares regression (PLSR) was used to further verify the corresponding relationship between the volatile substances and notes. Terpenes, esters, aldehydes and alcohols compounds can provide these notes. Based on the notes, 8 base modules of sweet orange were built by selecting and matching aroma ingredients. Through this study, beginners could be trained according to the 8 notes of base modules and flavorists can engage in dialogue with different raw material sourcing teams or providers.


Low bone mineral density in Crohn's disease, but not in ulcerative colitis, at diagnosis.
The pathogenesis of low bone mineral density in patients with inflammatory bowel disease is unclear, and the relevance of secondary osteopenic influences is controversial. Our aim was to study bone mineral density in newly diagnosed patients. Bone mineral density and biochemical parameters of bone metabolism were measured in 15 patients with Crohn's disease and 15 patients with ulcerative colitis, all of whom were newly diagnosed. Lumbar and forearm bone mineral densities were measured by dual energy x-ray absorptiometry, and Z scores were obtained by comparison with age- and sex-matched normal values. Twenty-three patients had repeat measurements 1 year later, and 20 had received systemic steroids. At diagnosis, the mean Z score for patients with Crohn's disease (spine, -1.06 +/- 0.86; forearm, -1.04 +/- 0.86) was significantly lower than that for patients with ulcerative colitis (spine, -0.03 +/- 1.16; forearm, 0.11 +/- 1.24). Inflammatory activity, disease localization, body mass index, smoking habits, sex, physical activity, or biochemical parameters did not account for this difference. Spine and forearm Z scores were significantly correlated. Mean Z scores after 1 year were not significantly different from initial Z scores. At diagnosis, low bone mineralization is a feature of Crohn's disease but not ulcerative colitis. Treatment with corticosteroids did not result in further bone loss in 1 year.


Reexamining Healthcare Justice in the Light of Empirical Data.
This article discusses the notion of justice from a capabilities approach. We undertake an empirical analysis of the concepts of justice held by healthcare personnel, gleaned from a qualitative analysis of interviews on the subject of ethical dilemmas in everyday practice. The article states that Justice undoubtedly presents a work in progress, which implicates the link between justice as capability and human dignity. We empirically found a contrast between the views of justice based on the patient's own perceptions and those based on the perceptions of healthcare personnel. We establish the kind of actions, communication skills and justice required to build a stronger relationship between patients and healthcare professionals, which would improve prognosis, treatment efficiency and therapeutic adhesion.


Influence of dissolved gases and heat treatments on the oxidative degradation of polyunsaturated fatty acids enriched dairy beverage.
The combined effect of dissolved gas composition and heat treatment on the oxidative degradation of a dairy beverage enriched with 2% linseed oil was studied. The dairy beverage was saturated with air, nitrogen, or a nitrogen/hydrogen mixture (4% hydrogen) before pasteurization or sterilization. Saturation with either nitrogen or a nitrogen/hydrogen mixture decreased the dissolved oxygen concentration in dairy beverages (Delta = 7.7 ppm), and the presence of hydrogen significantly reduced the redox potential (Delta = 287 mV). Heat treatments also reduced the oxygen content and redox potential, sterilization being more effective than pasteurization. Both pasteurization and sterilization induced the oxidative degradation of the beverages. On average, the propanal concentration increased by a factor of 2.3 after pasteurization and by a factor of 6.2 after sterilization. However, during storage, sterilized beverages resisted light-induced oxidation better than unheated or pasteurized beverages. Furthermore, saturation with nitrogen or a nitrogen/hydrogen mixture significantly reduced oxidative degradation and provided some protection against color changes during storage.


Quantitative determination and distribution of the myotropic neuropeptide orcokinin in the nervous system of astacidean crustaceans.
For quantitative determinations of orcokinin, an indirect, noncompetitive sandwich ELISA was developed. This ELISA is highly specific for orcokinin and the detection limit is 1 fmol. In three astacidean species (Orconectes limosus, Homarus americanus, and Astacus astacus) orcokinin immunoreactivity (OK-IR) was measurable in all parts of the nervous system. Upon normalization to the protein content of the tissue (pmol/mg protein), concentrations were shown to be in the same range in all three species. The distribution of OK-IR in the nervous system is also very similar in the three species. In Orconectes limosus the following values were obtained (in pmol/mg protein): cerebral ganglion 215, optic ganglia in the eyestalk 38, subesophageal ganglion 182. The thoracic ganglia have lower concentrations (35-72) and the abdominal ganglia (AG) 1-5 even lower ones (11-17). In the AG 6 of Orconectes, from which the innervation of the hindgut arises, concentrations are approximately five times higher than in the other AG. In hindgut tissue, relatively high concentrations of 22 pmol/mg were measured, which is in agreement with the demonstrated function of orcokinin as a hindgut excitatory substance. Markedly elevated levels of orcokinin were observed in the AG 6 of Astacus, but not in Homarus. Orcokinin could also be measured consistently and reliably in the hemolymph, where its concentration is approximately 1 x 10(-11) M. These results show that orcokinin may be released into the hemolymph and may act as a hormone, in addition to its role as a locally acting neurotransmitter/modulator.


Ramadan and diabetes: What we see, learn and understand from continuous glucose monitoring.
Abstinence from eating and drinking from dawn to sunset characterizes the holy month of Ramadan. For the 50 million Muslims worldwide with diabetes who adhere to this religious fast, the practice results in marked changes in glucose homoeostasis. The sunset meal (Iftar) that breaks the fasting state is followed by exaggerated surges in blood glucose and sustained overnight hyperglycaemia in cases of nocturnal overfeeding. The predawn meal (Suhoor) frequently results in prolonged glucose decay over the daylight hours. These glycaemic disturbances are particularly marked in insulin-treated patients, in those with unsatisfactory diabetes control during the pre-Ramadan period and in patients who are poorly compliant with lifestyle recommendations. Whether such patients should be exempt from the Islamic fast remains an open debate, which might be partially resolved by long-term controlled studies using the technology of continuous glucose monitoring in large populations of patients with diabetes.


Implication of Nrf2 and ATF4 in differential induction of CHOP by proteasome inhibition in thyroid cancer cells.
Proteasome inhibition may cause endoplasmic reticulum (ER) stress, which has been reported to be implicated in the antitumoral effects of proteasome inhibitors. CCAAT/enhancer-binding protein homologous protein (CHOP) is induced by a variety of adverse physiological conditions including ER stress and is involved in apoptosis. We have reported that distinct induction of CHOP contributes to the responsiveness of thyroid cancer cells to proteasome inhibitors. However, the mechanism underlying differential induction of CHOP by proteasome inhibitors in thyroid cancer cells has not been well characterized. In the current study, we characterized that proteasome inhibition primarily activated the amino acid response element 1 (AARE1) on the CHOP promoter. We also demonstrated that although proteasome inhibition caused similar accumulation of activating transcription factor 4 (ATF4) in a panel of thyroid cancer cells, distinct amounts of ATF4 were recruited to the AARE1 element of CHOP promoter. In addition, we demonstrated that NF-E2-related factor 2 (Nrf2) was also implicated in the induction of CHOP by precluding the binding of ATF4 to the CHOP promoter. This study highlights the molecular mechanisms by which ATF4 and Nrf2 can control CHOP induction in thyroid cancer cells by proteasome inhibition.


Tropaeolum tuberosum (Mashua) reduces testicular function: effect of different treatment times.
Tropaeolum tuberosum Ruiz & Pavon, along with other several species, is an edible-tuber crop that grows in the Andean region. Folk medicine describes the use of mashua to reduce reproductive function in men. The present study aimed to evaluate the effect of mashua (1 g kg(-1)) on sperm production in rats during 7, 12, 21 and 42 days of treatment. The following parameters were assessed: reproductive organ weights, spermatid count and daily sperm production (DSP), sperm count in epididymis and sperm transit and serum testosterone levels. Freeze-dried extract of mashua had 3.7 g 100 g(-1) of benzyl glucosinolate. Mashua-treated rats showed a reduction in testicular spermatid number and DSP from day 12 to day 42; meanwhile, the effect of mashua was noted in epididymal sperm count after 12 and 42 days of treatment. In addition, epididymal sperm transit time was delayed at day 7 and it was accelerated on days 12 and 21 of treatment. No differences in serum testosterone levels were found between rats treated with vehicle and mashua after 42 days of treatment. Finally, mashua reduces testicular function after one spermatogenic cycle by reducing spermatid and sperm number, DSP and epididymal sperm transit time.


Two Case Reports on Thalamic and Basal Ganglia Involvement in Children with Dengue Fever.
There have been increasing numbers of case reports of dengue infection with unusual manifestations. Such unusual manifestations including acute liver failure and encephalopathy could be manifested even in the absence of significant plasma leakage. Further, severe organ involvement including nervous system involvement indicates severe dengue infection. However, neurological manifestations of dengue fever are rare. This is the first case report of dengue infection with thalamic and basal ganglia involvement in Sri Lanka.


Acquired optociliary shunt vessels in papilloedema.
Seven cases are presented in which prolonged papilloedema led to the development of acquired optociliary shunt vessels. These vessels may also be found with optic nerve tumours, particularly spheno-orbital meningiomas, optic nerve drusen, glaucoma, and after central retinal vein occlusion. Two patients had intracranial tumours, 4 benign intracranial hypertension, and one Crouzon's disease. Three had marked atrophic changes of the disc. The pathophysiology of the disc changes is discussed. The triad of long-standing poor vision, acquired optociliary shunts, and optic atrophy with blurred disc margins should not be regarded as specific for spheno-orbital meningioma.


Fagerstrom test for nicotine dependence: reliability in a Turkish sample and factor analysis.
Fagerstom Test for Nicotine Dependence (FTND) has often been used as a measure of physical dependence on nicotine. In this study, we aimed to verify the usefulness of FTND and Heaviness of Smoking Index (HSI) in a sample of Turkish smokers and present relationship among interrelated items in our Turkish version of FTND by factor analysis. One hundred sixty nine smokers, 104 (61.5%) males, 65 (38.5%) females smoker were administered the Turkish translation of FTND. Fifty-two current smokers selected randomly from 169 were administered the questionnaire for test- retest reliability analysis. The Turkish version of FTND had moderate reliability (Cronbach alpha: 0.56). One FTND item (question 3: hate- most to give up) performed poorly on construct reliability tests. Factor 1 was loaded by questions 1 (first cigarette after awakening), 4 (number of cigarettes per day), 5 (smoking status during the first hours), 6 (smoking if ill), 2 (refrain from smoking in forbidden places) and factor 2 was separately loaded by question 3. Question 3 did not have significant correlation with the total score and the response to this question was significant between test and retest. The Turkish version of FTND may become a measuring tool in the assessment of smoking cessation programs. However, question 3 must be used attentively and preferably an explanation should be made to enable a clear understanding of the question to the Turkish smokers as they take the test.


The systemic angiogenic response during bone healing.
Angiogenesis is known to be a critical and closely regulated step during bone formation and fracture healing driven by a complex interaction of various cytokines. Delays in bone healing or even nonunion might therefore be associated with altered concentrations of specific angiogenic factors. These alterations might in turn be reflected by changes in serum concentrations. To determine physiological time courses of angiogenic cytokines during fracture healing as well as possible changes associated with failed consolidation, we prospectively collected serum samples from patients who had sustained surgical treatment for a long bone fracture. Fifteen patients without fracture healing 4 months after surgery (nonunion group) were matched to a collective of 15 patients with successful healing (union group). Serum concentrations of angiogenin (ANG), angiopoietin 2 (Ang-2), basic fibroblast growth factor (bFGF), platelet derived growth factor AB (PDGF-AB), pleiotrophin (PTN) and vascular endothelial growth factor (VEGF) were measured using enzyme linked immunosorbent assays over a period of 24 weeks. Compared to reference values of healthy uninjured controls serum concentrations of VEGF, bFGF and PDGF were increased in both groups. Peak concentrations of these cytokines were reached during early fracture healing. Serum concentrations of bFGF and PDGF-AB were significantly higher in the union group at 2 and 4 weeks after the injury when compared to the nonunion group. Serum concentrations of ANG and Ang-2 declined steadily from the first measurement in normal healing fractures, while no significant changes over time could be detected for serum concentrations of these factures in nonunion patients. PTN serum levels increased asymptotically over the entire investigation in timely fracture healing while no such increase could be detected during delayed healing. We conclude that fracture healing in human subjects is accompanied by distinct changes in systemic levels of specific angiogenic factors. Significant alterations of these physiologic changes in patients developing a fracture nonunion over time could be detected as early as 2 (bFGF) and 4 weeks (PDGF-AB) after initial trauma surgery.


Survival benefit of cardiopulmonary bypass support in bilateral lung transplantation for emphysema patients.
This study is designed to examine a possible association of cardiopulmonary bypass (CPB) support and outcome of lung transplantation in a well-balanced group of emphysema patients. We performed a retrospective analysis of 62 consecutive primary bilateral lung transplantations for emphysema. Risk factors for their possible association with patient survival were analyzed by multivariate logistic regression. The use of CPB support was associated with improved survival (odds ratio=0.25; P=0.038). The actuarial survival at 1 year was 97% for patients treated with CPB and 77% for patients treated without CPB support. In 28 patients (45%), 2 human leukocyte antigen (HLA)-DR mismatches between donor and recipient occurred, whereas 34 patients had 0 or 1 HLA-DR mismatches. The use of CPB support in the group with two HLA-DR mismatches was associated with improved survival (odds ratio=0.06; P=0.020). This association was not present in the group with 0 or 1 HLA-DR mismatches. These results demonstrate a significant survival benefit of CPB support during bilateral lung transplantation in emphysema patients. The difference in survival benefit of CPB support between the patients with 0 or 1 HLA-DR mismatches and the patients with 2 HLA-DR mismatches indicates that the immunosuppressive effect of CPB support might be responsible for this survival benefit. The underlying immunological mechanism might be important in the future treatment of organ transplantation.


Ovarian Sarcoma a Diagnostic Dilemma- A Case Report.
Primary sarcoma of the ovary is extremely rare. There are inadequate data in the literature regarding ovarian sarcoma in the pediatric age group. We report a case of an 8-year-old girl presenting with large abdominal mass and cachexia. Raised alpha-fetoprotein levels suggested germ cell tumor. Tru-cut biopsy histopathological report suggested a spindle cell tumor. The IHC staining suggested non rhabdomyosarcoma. As tumour was large and ovarian pediatric non rhabdomyosarcoma was not reported in the literature, we started on rhabdomyosarcoma neoadjuant regimen. Good response was noted for neoadjuvant chemotherapy, which was followed by complete surgical excision of the tumor and radiotherapy. At present, the overall outcome of the disease is dismal. Increased available data and gaining more evidence may help in improvising the treatment option.


The role of authoritarianism, perceived threat, and need for closure or structure in predicting post-9/11 attitudes and beliefs.
The authors examined relationships among authoritarianism, personal need for closure or structure, perceived threat, and post-9/11 attitudes and beliefs. Participants were 159 undergraduate students in the Southeastern United States. The authors collected data 1 week before the U.S.-led invasion of Iraq in March 2003. Correlation and regression analyses revealed that right-wing authoritarianism and social dominance orientation were significant predictors of support for restricting human rights during the U.S.-led War on Terror, support for U.S. President George W. Bush, and support for U.S. military involvement in Iraq. Right-wing authoritarianism and perceived threat emerged as the strongest predictors of the belief that Saddam Hussein supported terrorism.


Efficacy of phenylephrine-phenylpropanolamine in the treatment of rhinitis.
A double-blind placebo-controlled crossover study was done to evaluate the efficacy of an oral decongestant preparation in the treatment of rhinitis. The preparation consisted of 5 mg of phenylephrine hydrochloride, 45 mg of phenylpropanolamine hydrochloride, and 200 mg of guaifenesin (Rymed). Subjects were selected for participation in the study on the basis of history, physical examination, and immediate hypersensitivity skin testing. Fourteen of 20 subjects (P less than .05) observed a reduction in the severity of nasal symptoms while taking the drug. The mean symptom score of the 20 subjects while taking the drug was 31.344 and while taking placebo, 42.979. This is a statistically significant difference (P = .009717). Side effects were minimal. We concluded that the oral decongestant preparation used in this study is effective in controlling symptoms of rhinitis.


Tetrameres (Petrowimeres) striata in ducks.
Tetrameres (Petrowimeres) striata is an uncommon and incompletely described nematode from North American and Eurasian waterfowl. Specimens collected from mallards (Anas platyrhynchos) from the Playa Lakes Region (PLR) in western Texas (USA), the mottled duck (A. platyrhynchos fulvigula) in Florida (USA), the mallard in the Amur River Basin of eastern Russia and the blue-winged teal (Anas discors) from western Texas (USA) provide the basis for redescription of T. (P.) striata. This species is differentiated from the closely related T. (P.) zakharowi and T. (P.) galericulata by the size of the left spicule and the prominent cuff on the proximal end of the right spicule. In mallards from the PLR, one to several adult males and a single female occurred within distended mucosal glands or, more rarely, in cystic cavities in the submucosal tissue of the proventriculus; intensities ranged from one to seven nematodes per host (mean +/- SE = 2.9 +/- 0.8). Infected proventricular gland mucosae were compressed as a result of pressure atrophy by the large gravid females. In addition to nematodes, some lesions also contained necrotic debris with inflammatory cells and were surrounded by an intense inflammatory response of eosinophils, macrophages, lymphocytes, epithelioid cells and fibroblasts. Other lesions had little or no inflammatory response. Lesions in the submucosa were surrounded by a thin fibrous cyst with or without adjacent inflammatory cells.


[Anti-HBs persistence after revaccination with three doses of hepatitis B vaccine among non-responsive adults: a 4-year of follow-up study].
To explore anti-HBs persistence four years after revaccination with hepatitis B vaccine (HepB) among adults who were non-responsive to HepB primary immunization. A total of 24 237 healthy adults who had no history of hepatitis B infection and hepatitis B vaccination, resided in the local area for more than six months and aged 18-49 years were selected from 79 villages of Zhangqiu County, Shandong Province, China in 2009. Blood samples were obtained and hepatitis B surface antigen (HBsAg), antibody against hepatitis B surface antigen (anti-HBs) and antibody against hepatitis B core antigen (anti-HBc) were detected using ELISA method. A total of 11 590 persons who were negative for all of these indicators were divided into four groups by cluster sampling methods. Each group was vaccinated with one of the following four types of HepB at 0-1-6months schedule: 20 μg HepB derived in Saccharomyces cerevisiae (HepB-SC), 20 μg HepB derived in Chinese hamster ovary cell (HepB-CHO), 10 μg HepB-SC and 10 μg HepB derived in Hansenula polymorpha (HepB-HP). Blood samples were collected one month after the third dose of primary immunization and tested for anti-HBs using chemiluminescence microparticle immunoassay (CMIA). The non-responders were followed up and their basic information and the histories of hepatitis B infection, HepB vaccination, smoking and drinking were investigated. Then they were revaccinated with three doses of HepB with the same schedule as the primary immunization. Blood samples were collected from all of them one month (T1), two years and four years after revaccination and anti-HBs, anti-HBc and HBsAg were detected by CMIA. A total of 356 participants were followed up from 645 low-responders four years after revaccination, and the ratio was 55.2%. The risk factors associated with the positive rate and geometric mean concentration (GMC) of anti-HBs after four years of revaccination were analyzed using multivariate unconditional logistic regression model and multivariate linear regression model, respectively. Among 356 participants, 172 (48.3%) were males and 184 (51.7%) were females. The anti-HBs positive rate was 90.4% (322 cases) at T1 and was 55.9% (199 cases) four years after revaccination. The GMC of anti-HBs was 240.5 (95% CI: 186.4-310.4)mU/ml at T1 and decreased to 15.0 (95%CI: 12.2-18.5) mU/ml four years after revaccination. The average annual decreasing rate of GMC was 50.63% from one month after revaccination to four years after revaccination. The corresponding rate was 64.89% in the first two years, which was 2.12 times the rate in the latter two years (30.57%). When compared with those whose anti-HBs titer was less than 99 mU/ml at T1, the significantly higher anti-HBs four years after revaccination was observed in those whose anti-HBs titer at T1 was 100-999 mU/ml and those whose anti-HBs titer at T1 was ≥1 000 mU/ml. The OR (95%CI) was 7.14 (3.90-13.05) and 28.40 (13.16-61.30) respectively. When compared with those whose anti-HBs titer was ≤99 mU/ml at T1, the GMC of anti-HBs four years after revaccination was also significantly higher among those whose anti-HBs titer at T1 was 100-999 mU/ml and those whose anti-HBs titer at T1 was ≥1 000 mU/ml. The b (95%CI) was 1.66 (1.26-2.05) and 3.16 (2.72-3.60), respectively. The positive rate and GMC of anti-HBs decreased four years after revaccination among non-responsive adults, but still kept anti-HBs above protective level. The immunity durability after revaccination is mainly associated with anti-HBs titer one month after revaccination.


Patient and health care professional perspectives on using telehealth to deliver pulmonary rehabilitation.
The objective of this study was to identify the necessary features of pulmonary telerehabilitation (P-TR) from the perspectives of individuals living with chronic lung disease and health care professionals (HCPs) who deliver pulmonary rehabilitation (PR). Focus groups were carried out with patients ( n = 26) and HCPs ( n = 26) to elicit and explore their opinions about the critical elements of in-person PR and ideas for how these elements could be supported using technology. A questionnaire was used to assess technology use, PR experience, and general health status. Four key elements of PR were identified as critical to P-TR: the social aspect of PR; communicating with HCPs for education and support; using biosensors for monitoring and promoting self-knowledge; and the evolution of support with progress over time. A range of technology-enabled devices and programs were suggested as means to recreate aspects of these integral elements. Consultations with patients and HCPs suggest that users are interested in technology and want to ensure it recreates the important aspects of PR. Patients and HCPs identified similar key elements for P-TR. The opinions and suggestions of patients and HCPs should be the driving force of innovation if P-TR is to succeed in improving health outcomes.


Dual-Targeting of Tumor Cells and Tumor-Associated Macrophages by Palmitic Acid Modified Albumin Nanoparticles for Antitumor and Antimetastasis Therapy.
Tumor-associated macrophages (TAMs), the most abundant immune cells in the tumor microenvironment (TME), profoundly affect the occurrence and development of tumors. To overcome the common limitations of TAMs-targeted delivery systems, such as off-target toxicity, high cost, and transformation probability, we fabricated pirarubicin (THP)-loaded palmitic acid modified human serum albumin nanoparticles (THP-PSA NPs) for dual-targeting of tumor cells and TAMs via acidic secretory proteins rich in cysteine (SPARC) and scavenger receptor-A (SR-A), respectively. In vitro, the THP-PSA NPs exhibit stronger cytotoxicity against 4T1 and M2 macrophages compared with THP-loaded human serum albumin nanoparticles (THP-HSA NPs). In vivo, the infiltration of myeloid-derived suppressor cells (MDSCs) and the secretion of immunosuppressive cytokines significantly decrease after effective elimination of the TAMs through the THP-PSA NPs treatment; this is accompanied by an increase in the immunostimulatory cytokine expression level. Moreover, the antitumor and antimetastasis experimental results indicate that the tumor volumes in mice treated with the THP-PSA NPs are effectively controlled, resulting in an inhibition rate of 81.0% and almost no metastases in the lung tissues. Finally, in terms of biological safety, the THP-PSA NPs perform similar to THP-HSA NPs, causing no damage to the liver or kidney.


[Open minimally invasive parathyroid and thyroid surgery].
Open minimally invasive parathyroidectomy or thyroidectomy (small-incision technique) are frequently performed. Benefits and disadvantages of this approach are discussed in this review. Preoperative patients selection is mandatory and is also discussed.


Dopamine D(3) receptor as a new pharmacological target for the treatment of depression.
A substantial proportion of depressed patients do not respond to current antidepressant drug therapies. So far, antidepressant drugs have been developed based on the "monoaminergic hypothesis" of depression, which considers a synaptic deficiency in 5-hydroxytryptamine (5-HT; serotonin) or noradrenaline as main cause. More recently, the dopaminergic system has been implicated in the efficacy of some antidepressants, such as desipramine, amineptine, nomifensine. Dysfunction of dopaminergic neurotransmission within the mesolimbic system may contribute to anhedonia, loss of motivation and psychomotor retardation in severe depressive disorders. Dopamine D3 receptor subtype is located both pre- and postsynaptically in brain areas regulating motivation and reward-related behavior and has been implicated in depression-like behaviors. Activity of mesolimbic dopamine neurons in the reward circuit is a key determinant of behavioral susceptibility/resilience to chronic stress, which plays a central role in the pathogenesis of depression. Dopamine D3 receptor expression and function are both down-regulated in stress and depression, and these changes are reversed by antidepressant treatments, suggesting that enhanced dopaminergic neurotransmission mediated by dopamine D3 receptor participates in adaptive changes related to antidepressant activity. Of note, brain derived neurotrophic factor (BDNF) controls the expression of the dopamine D3 receptor in some brain areas and BDNF induction by antidepressant treatments is related to their behavioral activity. A number of experimental drugs in pre-clinical or clinical development, including aripiprazole and cariprazine, may act as antidepressants because of their partial agonist activity at dopamine D3 receptors. These preclinical and clinical data are discussed in the present review.


Morphologically Templated Growth of Aligned Spinel CoFe2 O4 Nanorods.
Uniaxially aligned CoFe2 O4 nanorods are obtained by coprecipitation of Co2+ , Fe2+ , and C2 O4 2- ions in a microemulsion solution, and subsequent high-temperature decomposition of CoFe2 (C2 O4 )3 . Each nanorod is made up of a "tectonic" assembly of CoFe2 O4 nanocrystals. Magnetization of such CoFe2 O4 materials may lead to their use in high-density magnetic recording media and high-performance electromagnetic and spintronic devices.


Dehydroepiandrosterone sulfate stimulates collagenase synthesis without affecting the rates of collagen and noncollagen protein syntheses by rabbit uterine cervical fibroblasts.
The effects of dehydroepiandrosterone 3-sulfate (DHAS) and 17 beta-estradiol (E2) on collagen and noncollagen protein syntheses by rabbit uterine cervical cells were studied, and their effects on latent collagenase synthesis were compared. DHAS (1 X 10(-6) M) stimulated the synthesis of latent collagenase and did not affect the cell number and [3H]thymidine incorporation into DNA, whereas E2 had no effect on collagenase synthesis. On the other hand, neither DHAS (1 X 10(-6) M) nor E2 (1 X 10(-10)-1 X 10(-6) M) showed effects on collagen and noncollagen protein syntheses. These results suggest that the stimulative effect of DHAS on cervical ripening is mediated mainly by the stimulation of collagen catabolism, and that E2 does not concern the changes in the concentration of collagen and noncollagen protein in uterine cervix of the rabbit during pregnancy at term.


[Differential diagnosis of an intracranial tumor and aneurysm of cerebral vessels. Diagnostic value of angiography and computer tomography].
On the basis of two patients with oversize aneurysms of the cerebral vessels , which in the preceding computer tomography had led to the diagnosis 'cerebral tumour' because of their localisation, size and enhancement tendency, the importance of cerebral angiography within modern diagnostics is discussed.


Role of angiotensin-converting enzyme inhibitors in early antihypertensive treatment in non-insulin dependent diabetes mellitus.
The effect of captopril monotherapy on blood pressure and metabolism was investigated in a placebo-controlled study in 30 non-insulin dependent (Type II) diabetic subjects during a 3-week observation period (run-in/drug; placebo/wash-out) on a metabolic ward. Captopril significantly reduced both systolic and diastolic blood pressure (154/90 +/- 5/2 vs. 144/86 +/- 4/3 mmHg) without major side effects. Mean run-in postprandial blood glucose concentrations were also reduced upon ACE-inhibition (9 a.m.: 12.7 +/- 0.4 vs. 11.1 +/- 0.4 mmol/l; 1 p.m.: 11.0 +/- 0.3 vs. 8.9 +/- 0.3 mmol/l; P less than 0.05), while blood kinin concentrations (40.0 +/- 2.5 pmol/l) were approximately doubled (108.8 +/- 23.5 pmol/l; P less than 0.05). Body mass index, fasting plasma insulin, serum electrolyte pattern, uric acid, white blood count, lipid profile as well as hepatic and renal function parameters remained unaltered throughout the observation period. The data are in line with recent experimental studies showing a beneficial metabolic effect of captopril in Type II diabetes. ACE inhibitors might therefore become first-line drugs in early antihypertensive intervention in Type II diabetic patients.


Phosphorus removal performance and speciation in virgin and modified argon oxygen decarburisation slag designed for wastewater treatment.
Argon oxygen decarburisation (AOD) slag may be used for phosphorus (P) removal, as its high pH and weatherable calcium (Ca) minerals provide sufficient Ca(2+) and OH(-) for calcium phosphate (Ca-PO4) precipitation. This study examined the P removal performance of AOD slag for use as wastewater treatment material. Batch experiments were carried out using both synthetic P solution and real wastewater, followed by chemical modelling and X-ray absorption near edge structure (XANES) spectroscopy. The influences of initial P concentration, slag dose and modification by polyethylene glycol (PEG), an effective agent for generation of porous materials, were investigated to determine the optimal conditions for P removal by AOD slag. It was found that virgin AOD slag removed 94.8% of P from a synthetic P solution in 4 h and 97.8% in 10 h. This high P removal was accompanied by a rapid increase in pH from 7.0 to 10.74. The maximum P removal capacity (PRC) from synthetic P solution ranged from 1.3 to 27.5 mg P g(-1). The optimal AOD dose for P removal from wastewater, determined in 8-h batch experiments, was 25 g L(-1). PEG modification increased the reaction rate and resulted in higher final pH, increasing PRC by 47.9%. Combined Visual MINTEQ and XANES analysis for detailed examination of P removal mechanisms revealed that the main P removal mechanism was precipitation of calcium phosphate. According to the XANES analysis, the main Ca-PO4 precipitate formed on virgin AOD slag under low initial P concentration and high pH was apatite, while brushite was the dominant product at high initial P concentration and low pH.


DNA polymerase III-dependent repair synthesis in response to bleomycin in toluene-treated Escherichia coli.
Bleomycin (BLM) is an antitumor drug which interacts with and damages DNA. We have reported a repair response dependent on DNA polymerase I in toluene-treated Escherichia coli. We report here that DNA polymerase III can also catalyze a repair response in toluene-treated E. coli following exposure to BLM. Polymerase III-mediated synthesis differs because it is ATP-dependent, whereas polymerase I-mediated repair synthesis is not. Polymerase III repair synthesis is independent of replicative synthesis, as demonstrated in a polA-, dnaBts strain, or use of Novobiocin to inhibit replication, and replication persists in the presence of repair synthesis. It appears that ATP-dependent repair synthesis in response to BLM is also present in polA+ strains. Repair synthesis does not require the uvrA gene product.


Global tree growth resilience to cold extremes following the Tambora volcanic eruption.
Although the global climate is warming, external forcing driven by explosive volcanic eruptions may still cause abrupt cooling. The 1809 and 1815 Tambora eruptions caused lasting cold extremes worldwide, providing a unique lens that allows us to investigate the magnitude of global forest resilience to and recovery from volcanic cooling. Here, we show that growth resilience inferred from tree-ring data was severely impacted by cooling in high latitudes and elevations: the average tree growth decreased substantially (up to 31.8%), especially in larch forests, and regional-scale probabilities of severe growth reduction (below -2σ) increased up to 1390%. The influence of the eruptions extended longer (beyond the year 1824) in mid- than in high-latitudes, presumably due to the combined impacts of cold and drought stress. As Tambora-size eruptions statistically occur every 200-400 years, assessing their influences on ecosystems can help humankind mitigate adverse impacts on natural resources through improved management, especially in high latitude and elevation regions.


Ectokinases as novel cancer markers and drug targets in cancer therapy.
While small-molecule kinase inhibitors became the most prominent anticancer drugs, novel combinatorial strategies need to be developed as the fight against cancer is not yet won. We review emerging literature showing that the release of several ectokinases is significantly upregulated in body fluids from cancer patients and that they leave behind their unique signatures on extracellular matrix (ECM) proteins. Our analysis of proteomic data reveals that fibronectin is heavily phosphorylated in cancer tissues particularly within its growth factor binding sites and on domains that regulate fibrillogenesis. We are thus making the case that cancer is not only a disease of cells but also of the ECM. Targeting extracellular kinases or the extracellular signatures they leave behind might thus create novel opportunities in cancer diagnosis as well as new avenues to interfere with cancer progression and malignancy.


Hair-cotton threads bezoar in two years child.
We report a case of 2 years old male child who presented with acute intestinal obstruction with palpable and mobile mass in the abdomen. He was diagnosed as a case of intestinal obstruction due to phytobezoar containing cotton threads. Surgical intervention is the treatment of choice for such conditions. Small bowel obstruction due to bezoar made of hair cotton threads is extremely rare. These cases are rarely reported in paediatric age group.


Potential uses of health promotion competencies.
Projects in Australia and internationally over the past two decades have sought to define and clarify competencies required to work in health promotion. It is now apparent that such competencies are very useful to health promotion practice. However, to date little attempt has been made to describe those uses. More than 200 health promotion practitioners throughout Australia were engaged in workshops to explore and define potential uses of health promotion competencies. The suggestions from these 10 workshops are summarised in eight categories of uses. Agreed health promotion competencies have potential to impact on recruitment, training, employment policy and health promotion practice.


Antecedents and Consequences of Therapeutic Communication in Iranian Nursing Students: A Qualitative Research.
In recent years, particular attention has been paid to nursing students' therapeutic communication (TC) with patients, due to a strong emphasis on patient-centered education in the Iranian healthcare reform. However, various studies have highlighted the poor communication of future nurses. Therefore, researchers have used qualitative methodology to shed light on the antecedents and consequences of nursing students' TC and promote it. We carried out a conventional content analysis using semistructured interviews with a purposefully selected sample of 18 participants, including nursing instructors, students, and patients in hospitals affiliated to Tehran University of Medical Sciences. "Communication readiness," "predisposing factors," and "continuity of care" were identified as the three major themes. "Communication readiness" consisted of "physical readiness," "academic readiness," and "developmental readiness." "Predisposing factors" included "contextual factors" and "educational condition." "Continuity of care" included "patient satisfaction" and "improving nursing student's motivation to communicate with patients." "Communication readiness" and "predisposing factors" constitute the antecedents of nursing student's TC with patients, and "continuity of care" is considered as its consequence. More attention needs to be paid by the regulators to TC instruction in both theoretical and clinical educational curriculum. Furthermore, all nurses must be informed about the importance of TC in promoting patient outcomes and quality of care.


Update: influenza activity - United States, September 28- December 6, 2014.
CDC collects, compiles, and analyzes data on influenza activity year-round in the United States (http://www.cdc.gov/flu/weekly/fluactivitysurv.htm). The influenza season generally begins in the fall and continues through the winter and spring months; however, the timing and severity of circulating influenza viruses can vary by geographic location and season. Influenza activity in the United States increased starting mid-October through December. This report summarizes U.S. influenza activity during September 28-December 6, 2014.


Early changes in L-arginine-nitric oxide metabolic pathways in response to the whole-body gamma irradiation of rats.
Nitric oxide (NO), a reactive radical, is formed in higher amounts from L-arginine by inducible NO synthase (iNOS) during early response to ionizing radiation presumably as a part of signal transduction pathways. This study investigated the changes in L-arginine-NO metabolic pathways within a 24-hour period after whole-body gamma irradiation of rats with the range of low to supra-lethal doses. Young adult female Wistar rats received either 0-50 Gy whole-body irradiation or an intraperitoneal injection of bacterial lipopolysaccharide (LPS, 10 mg/kg). Exhaled NO was monitored using chemiluminiscence, nitrite + nitrate (NO(x)) and L-arginine were assayed by high-performance liquid chromatography, and expression of iNOS was determined using Western blot. Irradiation resulted in a dose-dependent increase of plasma NO(x) to maximum levels which were 4-fold higher compared to controls (p < 0.001). The NO(x) levels increased less in the bronchoalveolar lavage fluid (BAL) (1.7-fold, p < 0.001) and liver homogenate (2.5-fold, p < 0.05), respectively, and were dose-independent. Exhaled NO, lung NO(x), plasma and BAL L-arginine, and the expression of iNOS in lung and liver tissues of irradiated rats and controls were similar. LPS caused a considerable increase (p < 0.001) in exhaled NO (61-fold), NO(x) levels (plasma 34-fold, BAL 6-fold, lung 5-fold, liver 4-fold), and in iNOS expression, respectively. In contrast to the LPS treatment of rats, the radiation-induced changes in L-arginine-NO metabolic pathways are modest, particularly in the airways and lungs. Noninvasive measurement of exhaled NO within a 24-h period following the exposure of rats to ionizing radiation has no value for biodosimetry.


Regionalization of coronary artery bypass surgery. Effects on access.
Coronary artery bypass surgery (CABS) has been regionalized in the province of Ontario since the introduction of the procedure in the 1970s. The authors examined the effect of regionalization on the age-adjusted surgery rates in the 38 counties of southern Ontario and found that county surgical rates were not related to whether the county had a referral center, bordered on a county with a referral center, or did not border on such a county (R2 = 0.019, P = 0.712). In addition, surgical rates were not related to the distance in miles to the nearest referral center (R2 = 0.019, P = 0.440). The authors also examined the relationship between the referral center providing care to the county and surgical rates and found a significant relationship between rates of surgery and referral center regardless of whether a strict rule (R2 = 0.741, P less than 0.0001), a majority rule (R2 = 0.514, P less than 0.0001), or a plurality rule (R2 = 0.497, P less than 0.0001) was used to assign counties to referral centers. The authors conclude that CABS rates are more related to the center serving the county than to the distance of the county from a referral center and discuss this finding in relation to access to care and its impact on costs and quality.


Analysis of BRCA1 and BRCA2 in breast and breast/ovarian cancer families shows population substructure in the Iberian peninsula.
An estimated 5-10% of all breast and ovarian cancers are due to an inherited predisposition, representing a rather large number of patients. In Spain 1/13-1/14 women will be diagnosed with breast cancer during their lifetime. Two major breast cancer genes, BRCA1 and BRCA2, have been identified. To date, several hundred pathogenic mutations in these two genes have been published or reported to the Breast Cancer Information Core, BIC database (http://www.nhgri.nih.gov/Intramural_research_Lab transfer/Bic/index.html). In the present study, 30 Spanish breast and breast/ovarian cancer families (29 from Galicia, NW Spain, and 1 from Catalonia, NE Spain) were screened for mutations in the BRCA1 and BRCA2 genes. The analysis of these genes was carried out by SSCP for shorter exons and direct sequencing in the case of longer ones. Mutations were found in 8 of the 30 families studied (26.66%). It is important to note that all mutations were detected within the BRCA1 gene: 330 A>G, 910_913delGTTC, 2121 C>T, 3958_3962delCTCAGinsAGGC, and 5530 T>A. The BRCA1 330 A>G mutation was found in four unrelated families and accounted for 50% of all identified mutations.


Effectiveness of a 12-week school-based educational preventive programme on weight and fasting blood glucose in "at-risk" adolescents of type 2 diabetes mellitus: Randomized controlled trial.
To assess the effectiveness of a 12-week school-based educational preventive programme for type 2 diabetes by change in weight and fasting blood glucose level in Jordanian adolescents. Sixteen percent of Jordanian adults have obesity-related type 2 diabetes and 5.6% of obese adolescents examined, however one-third unexamined. Rates in Arabic countries will double in 20 years, but this can be prevented and reversed by controlling obesity. A single-blinded randomized controlled trial was conducted in 2 unisex high schools in Irbid, Jordan, in 2012. Intervention and control participants, aged 12 to 18 years, were visibly overweight/obese. They were randomly allocated to the intervention (n = 205) or control (n = 196) groups. At-risk students were assessed before and after the 12-week intervention, for change in weight and fasting blood glucose level following preventive instruction and parent-supported changes. Mean age of participants was 15.3 years with equal percentages of both males (49.4%) and females. Post intervention, the intervention group, demonstrated statistically significant reductions: mean difference of 3.3 kg in weight (P < .000) and 1.36 mg/dL (0.075 mmol/L) in fasting blood glucose (P < .000). School-based early prevention intervention effectively reduced weight and fasting blood glucose in Jordanian at-risk adolescents.