A double-blind parallel evaluation of the efficacy and safety of a single dose of ketoprofen in cancer pain.
The analgesic effects of single oral doses of ketoprofen 100 and 300 mg, the combination of aspirin 650 mg plus codeine 60 mg, and placebo were compared under double-blind conditions in 160 hospitalized patients with cancer pain. At baseline and at 30 minutes and hourly for 6 hours after treatment, patients evaluated their pain intensity and pain relief. The 100 mg ketoprofen dose was significantly (P less than 0.05) superior to placebo for all 14 derived efficacy parameters; the 300 mg dose was significantly superior to placebo in all assessments except derived onset of relief. Aspirin plus codeine was significantly (P less than 0.05) superior to placebo for nine of the 14 assessments. No statistically significant differences were observed among active treatments for any of the 14 derived parameters. The number of patients with a "good" response was greatest in the ketoprofen 100 mg group (55%); the numbers of good responders in the aspirin plus codeine (37.5%) and the ketoprofen 300 mg (30%) groups were comparable. The three active treatment groups were not significantly different from each other for patient response. The numbers of patients requiring rescue analgesic were significantly (P less than 0.05) lower for both ketoprofen groups, but not for the aspirin plus codeine group, as compared with the placebo group. Twenty-three percent of the 160 patients reported adverse experiences, but there were no significant differences between the treatment groups in the number or type of experience. These results show that ketoprofen is as effective and well tolerated as aspirin plus codeine in relieving cancer pain.


International migration of unaccompanied minors: trends, health risks, and legal protection.
The global population of unaccompanied minors-children and adolescents younger than 18 years who migrate without their legal guardians-is increasing. However, as data are not systematically collected in any region, if collected at all, little is known about this diverse group of young people. Compared with adult migrants, unaccompanied minors are at greater risk of harm to their health and integrity because they do not have the protection provided by a family, which can affect their short-term and long-term health. This Review summarises evidence regarding the international migration and health of unaccompanied minors. Unaccompanied minors are entitled to protection that should follow their best interests as a primary consideration; however, detention, sometimes under the guise of protection, is a widespread practice. If these minors are provided with appropriate forms of protection, including health and psychosocial care, they can thrive and have good long-term outcomes. Instead, hostile immigration practices persist, which are not in the best interests of the child.


Cholesteryl ester transfer protein and hyperalphalipoproteinemia in Caucasians.
It is unclear whether cholesteryl ester transfer protein (CETP) contributes to high density lipoprotein cholesterol (HDL-C) levels in hyperalphalipoproteinemia (HALP) in Caucasians. Moreover, even less is known about the effects of hereditary CETP deficiency in non-Japanese. We studied 95 unrelated Caucasian individuals with HALP. No correlations between CETP concentration or activity and HDL-C were identified. Screening for CETP gene defects led to the identification of heterozygosity for a novel splice site mutation in one individual. Twenty-five heterozygotes for this mutation showed reduced CETP concentration (-40%) and activity (-50%) and a 35% increase of HDL-C compared with family controls. The heterozygotes presented with an isolated high HDL-C, whereas the remaining subjects exhibited a typical high HDL-C/low-triglyceride phenotype. The increase of HDL-C in the CETP-deficient heterozygotes was primarily attributable to increased high density lipoprotein containing apolipoprotein A-I and A-II (LpAI:AII) levels, contrasting with an increase in both high density lipoprotein containing apolipoprotein A-I only and LpAI:AII in the other group. This study suggests the absence of a relationship between CETP and HDL-C levels in Caucasians with HALP. The data furthermore indicate that genetic CETP deficiency is rare among Caucasians and that this disorder presents with a phenotype that is different from that of subjects with HALP who have no mutation in the CETP gene.


Patient-reported outcomes (PROs) in chronic urticaria.
Chronic urticaria is an itching skin disease which persists for more than 6 weeks. Chronic urticaria has great impact on the daily life of the patient, and the fluctuating nature of the symptoms complicates the monitoring and treatment of the disease. Currently, there are no reliable biomarkers to identify and measure disease activity in chronic spontaneous urticaria. Consequently, use of patient-reported outcomes (PROs) is crucial when evaluating and monitoring different aspects of chronic urticaria such as disease activity/severity, disease control, and quality of life. We present an overview of seven different PROs used in chronic urticaria and highlight their strengths, limitations, and use in clinical practice and research.


Engagement With Daily Testing Instead of Self-Isolating in Contacts of Confirmed Cases of SARS-CoV-2: A Qualitative Analysis.
Introduction: In December 2020 and January 2021 Public Health England (PHE) with NHS Test and Trace conducted a study to explore the feasibility and acceptability of daily testing as an alternative to self-isolation following close contact with a confirmed COVID-19 case. This qualitative paper aims to identify factors influencing uptake among those offered daily testing, and the subsequent impact on behaviour. Methods: We conducted in-depth interviews with 52 participants who had taken part in the feasibility study. Participants were asked about their experiences of daily testing or self-isolating, their reasons for choosing to test or isolate, and their behaviour during the study period. Data were analysed using inductive thematic analysis. Results: Results are presented under two main headings: (1) factors influencing acceptance of testing and (2) impact of test results. Participants appeared highly motivated to engage in behaviours that would protect others from the virus. Factors influencing the decision to accept testing included (1) needing to avoid self-isolation, (2) concerns about test sensitivity, and (3) perceived benefits of detecting infection. Participants who were taking tests reported: (1) positive consequences following confirmation of COVID status, (2) engaging in essential activities, (3) uncertainty, and (4) self-isolating whilst testing. Conclusions: This study has identified a range of factors that appear to influence the decision to engage in daily testing or to self-isolate following close contact with a positive case, many of which could be addressed by clear communications. Covid-19 infection rates and government restrictions influenced experiences, and so further research is needed to explore perceptions of daily testing and behaviour following close contact with a positive case among a wider range of individuals, in the context of lower rates of COVID-19, few government restrictions on general population behaviour and more widespread testing.


Global Estimates of Diabetic Retinopathy Prevalence and Progression in Pregnant Women With Preexisting Diabetes: A Systematic Review and Meta-analysis.
Diabetic retinopathy (DR) may be worsened by pregnancy in pregnant women with preexisting type 1 diabetes (T1D) or type 2 diabetes (T2D). Conflicting findings from previous studies have resulted in inconsistencies in guidelines regarding DR management in pregnancy. Global estimates of DR prevalence and progression in pregnancy are therefore required to provide clearer information about the overall true burden of DR in this population. To estimate the prevalence of DR and its progression rate in pregnant women with preexisting T1D or T2D diagnosed before pregnancy. For this systematic review and meta-analysis, conducted from November 27, 2018, to June 29, 2021, a systematic literature search was conducted in MEDLINE/Ovid, Embase/Ovid, and Scopus databases to identify English-language articles that were published from inception through October 2020. Observational studies that reported on DR and its changes in pregnant women with preexisting T1D and T2D. Two independent reviewers extracted relevant data from each included study. Data were pooled using a random-effects model with the Freeman-Tukey double arcsine transformation. This study followed the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines. Prevalence of any DR, proliferative DR (PDR), and DR progression rates. A total of 18 observational studies involving 1464 pregnant women with T1D and 262 pregnant women with T2D were included in the analysis. The pooled prevalence of any DR and PDR in early pregnancy was 52.3 (95% CI, 41.9-62.6) and 6.1 (95% CI, 3.1-9.8) per 100 pregnancies, respectively. The pooled progression rate per 100 pregnancies for new DR development was 15.0 (95% CI, 9.9-20.8), worsened nonproliferative DR was 31.0 (95% CI, 23.2-39.2), progression from nonproliferative DR to PDR was 6.3 (95% CI, 3.3-10.0), and worsened PDR was 37.0 (95% CI, 21.2-54.0). DR progression rates per 100 pregnancies were similar between the T1D and T2D groups, except for the development of new DR (T1D groups: 15.8; 95% CI, 10.5-21.9; T2D groups: 9.0; 95% CI, 4.9-14.8). A global trend toward a lower DR progression rate was observed after the 1989 St Vincent Declaration. Results of this systematic review and meta-analysis suggest that women with T1D and T2D had a similar risk of DR progression during pregnancy. Despite improvements in the management of diabetes and diabetes during pregnancy, DR prevalence and progression in pregnant women with diabetes remains higher than the nonpregnant population with diabetes, highlighting the need to improve DR management in pregnancy.


Maximum stimulation of insulin secretion in children with chemical diabetes and obesity.
The response of plasma insulin concentration to an oral glucose tolerance test (OGTT) and to the maximum stimulatory effect obtained with administration of glucose, glucagon and tolbutamide was studied in 24 siblings of diabetic children and in ten obese children. Five siblings of patients with diabetes sound to have chemical diabetes had hyperinsulinism during the OGTT. Serum insulin concentrations during the maximum stimulation of the beta cells in the children with chemical diabetes, although diminished at 15 minutes, were considered not significantly different from controls. Obese children had hyperinsulinism during the OGTT and the maximum stimulation of the beta cell. The data suggest that hyperinsulinism may precede or accompany carbohydrate intolerance in siblings of diabetic children.


Mediastinitis after percutaneous dilatational tracheostomy.
In our experience, PDT after total arch replacement, especially after dissection of neck vessels, should be approached with caution. A long skin incision that allows discharge to drain from the wound and a sufficiently long postoperative tracheostomy period to allow tissue healing in the neck are necessary for prevention of mediastinitis.


Measles epidemiology in Italy.
In preparation for a mass vaccination programme, the immune status with regard to measles was determined in over 8300 unvaccinated children aged 0-13 years, residing in eight Italian cities with different socioeconomic situations and geographical locations. The age corresponding to the 50% prevalence of immunes appeared to be intermediate (2.9-5.5 years) between that reported for industrialized (6-7 years) and developing countries (1-2 years). The 50% prevalence of natural immunity was reached at an earlier age in southern cities in which poorer socioeconomic and hygienic conditions prevailed; the earlier occurrence of measles in these areas was confirmed by a more detailed serological study of children in the first 24 months of life. For children aged 2-13 years, serological results showed that the history of measles reported by parents on questionnaires gave high positive predictive values (over 85%). Our seroepidemiological study shows that, on the basis of the ages of 25 and 75% prevalence of immunes, the target population for a mass immunization programme in Italy can be assumed to be aged from 12 months to 7 years. However, special attention should be given to the poorest areas, especially in southern Italy, where measles occurs earlier and can be particularly severe.


Cryo-electron microscopy and single molecule fluorescent microscopy detect CD4 receptor induced HIV size expansion prior to cell entry.
Viruses are often thought to have static structure, and they only remodel after the viruses have entered target cells. Here, we detected a size expansion of virus particles prior to viral entry using cryo-electron microscopy (cryo-EM) and single molecule fluorescence imaging. HIV expanded both under cell-free conditions with soluble receptor CD4 (sCD4) targeting the CD4 binding site on the HIV-1 envelope protein (Env) and when HIV binds to receptor on cellular membrane. We have shown that the HIV Env is needed to facilitate receptor induced virus size expansions, showing that the 'lynchpin' for size expansion is highly specific. We demonstrate that the size expansion required maturation of HIV and an internal capsid core with wild type stability, suggesting that different HIV compartments are linked and are involved in remodelling. Our work reveals a previously unknown event in HIV entry, and we propose that this pre-entry priming process enables HIV particles to facilitate the subsequent steps in infection.


Implementation of Simulation: A Contemporary Strategy to Enhance Clinical Skills of Undergraduate Students in Mental Health Nursing.
Simulation is an innovative teaching strategy that supports student centered learning. It improves therapeutic communication skills with clients. Additionally, it enhances critical thinking, problem solving, and confidence among students, in a non-threatening and safe environment, without posing a risk to actual patients. This paper describes the process of application of simulation for undergraduate nursing students enrolled in a mental health nursing course. The project aimed to determine the significance of simulation to improve the communication skills and confidence level, and to decrease the anxiety of undergraduate nursing students, prior to attending mental health clinical. The Experiential Learning (ELT), by Kolb in 1984, was chosen as a framework for the simulation strategy. The simulation experience was a stepwise process that comprised a briefing session with students to explain them the process and purpose of the simulation activity, followed by a two-day simulation experience. The experience comprised students' interaction with Simulated Patients (SP), who had been prepared to manifest symptoms of depression, mania, and schizophrenia. The later part of the experience was a debriefing session, in which students were provided an opportunity for self-reflection and for thinking a way forward, to enhance their clinical competency, using their video recording. The students' evaluation regarding the simulation experience was positive and they suggested that it be integrated in the mental health nursing course.


Influence of maternal factors and mode of induction on labour outcomes: a pragmatic retrospective cohort study.
Since recent research indicates that other modalities are at a minimum non-inferior to the NICE-recommended hormonal agent prostaglandin E2 (PGE2), a retrospective cohort study was conducted on 1971 consecutively induced singleton pregnancies. Multinominal regression analysis showed that the odds ratio (OR) for vaginal delivery with balloon-mediated labour induction (84% vaginal deliveries; OR 1.6; 95% CI 0.7-3.5) is similar to the PGE2 agents propess (81%; OR 1.2; 95% CI 0.68-1.98) and prostin (79%; OR 0.99; 95% CI 0.55-1.79) when using a triple multi-agent induction as a reference. On the other hand, combining the propess and prostin (60% vaginal deliveries; OR 0.45; 95% CI 0.21-0.96) and attempting quadruple combinations of the induction modalities (56%; OR 0.37; 95% CI 0.16-0.85) yields significantly poorer outcomes. However, compared to the known factors associated with increased caesarean section rates, such as an increased maternal age, nulliparous pregnancies and a history of caesarean section, the differential impact of different induction modalities appear less pronounced. Impact statement What is already known on this subject? Recent published data from controlled clinical trials have shown that other labour-inducing agents, including balloon catheters, are as effective as prostaglandin E2 (PGE2) in achieving a vaginal delivery. What do the results of this study add? The data from this pragmatic retrospective cohort study supports the findings of others that the use of a balloon is as effective as PGE2. It also demonstrates that regular clinical practice can differ from an experimental environment, with patients receiving multiple induction modalities in a daily practice. Both the combination of different PGE2 medications and a quadruple labour induction approach are associated with poorer results, as measured by the vaginal delivery rate. The data presented here also confirms that a nulliparous status, a maternal age and a history of caesarean section are associated with reduced odds of achieving a vaginal delivery. What are the implications of these findings for clinical practice and/or further research? The body of evidence showing favourable results with a balloon induction is growing. Furthermore, there are limits to the effectiveness of combining the different induction modalities. Maternal and perinatal factors associated with a risk of caesarean section further complicate labour induction management.


Development of the New Kibou® Equipment for Continuous Renal Replacement Therapy from Scratch to the Final Configuration.
A new technology has recently appeared in the area of extracorporeal therapies for critically ill patients with acute kidney injury. The International Renal Research Institute of Vicenza was involved from the beginning in the development of a new continuous renal replacement therapy (CRRT) equipment with peculiar characteristics. We report the overall experience from design of the new machine to its in vitro and in vivo testing. Kibou® (Asahi Kasei Kuraray Medical Co., Ltd., Tokyo, Japan) is a new multifunctional machine designed for delivering RRT. Kibou® carries out many features of the fourth generation CRRT machines including the possibility of a dynamic prescription and reduction of nursing workload. We describe our first experience with this new device, focusing on several usability and performance parameters. A specific in vitro protocol was designed to analyze the various characteristics and accuracy of performance of the machine. Furthermore, a preliminary in vivo alpha trial with 12 CRRT sessions was performed to test, characterize and evaluate the machine in terms of usability, flexibility and reliability. The in vitro evaluation confirmed an adequate design and a good usability of the machine with accurate delivery of prescribed parameters. No adverse events were observed during the in vivo test that confirmed usability and safety together with accuracy of treatment delivery in different modalities. In general, the machine was rated by physicians and nurses involved in the evaluation as practical and easy to use, although a specific training is required to familiarize with the equipment. A large-scale multicenter beta trial is required to confirm the results reported in this preliminary evaluation in terms of safety, accuracy and performance of Kibou®.


A longitudinal study comparing mutans streptococci and lactobacilli colonisation in dentate children aged 6 to 24 months.
This longitudinal study aimed to investigate variables associated with colonisation of mutans streptococci (MS) compared with lactobacilli (LB) colonisation in a cohort of children (n = 214) from the time of first tooth eruption at approximately 6 months until 24 months of age. Repeated plaque and salivary samples were collected from the same infants at 6, 12, 18 and 24 months and assayed for MS and LB using a microbiological culture kit. Children having both MS and LB increased from 4% at 6 months to 13% at 12 and 18 months to 20% at 24 months (p = 0.004). LB presence at 6 months was correlated with MS presence at 12, 18 and 24 months (r = 0.21 to r = 0.46, p = 0.02), while MS presence at 6 months correlated with LB presence at all other times (r = 0.19 to r = 0.31, p = 0.03). At 6 and 12 months, the key variables for MS colonisation included unrestored dental cavities in the mother (p = 0.03), mother not persisting with toothbrushing (p = 0.001) and bottle taken to bed at night (p = 0.033), while the only significant variable for LB colonisation was natural birth (p = 0.01). At 24 months, the significant variables for MS colonisation were condiments added to pacifier (p = 0.022) and child being uncooperative for toothbrushing (p = 0.025), while the significant variables for LB colonisation were pregnancy problems (p = 0.028) and child being uncooperative for toothbrushing (p = 0.013). The ages 6-12 months thus represent a time period when key variables may be controlled to reduce MS and LB colonisation.


[Inflammatory bowel disease and quality of life: psychopathological variants.]
Purpose of the study was to analyze the quality of life and psychiatric symptomatology in patients suffering from Inflammatory Bowel Diseases. In this study were enrolled 108 patients: 67 cases (Ulcerative Colitis in 39 patients, Crohn's Disease in 28 cases) and 41 controls (patients suffering from Irritable Bowel Syndrome). Patients were subjected to Self-Report Symptom Inventory-Revised (SCL-90-R) to analyze general psychiatric symptomatology; Hamilton Depression Rating Scale (HAM-D) to analyze depressive symptomatology; Short Form-36 (SF-36) to evaluate the quality of life. Patients suffering from Inflammatory Bowel Disease have major limitations in phisical activities; they complain about daily activities; they consider their general health as the most poor and destined to deteriorate further in time. Patients suffering from Ulcerative Colitis have greater impairment if compared with Crohn's disease patients. Patients suffering with inflammatory bowel disease have a significant impairment in several areas of life quality and a psychiatric symptomatology that shows emotional - psycological discomfort due to the underlying disease.


Magnitude of microelectrode refinement in pallidotomy and thalamotomy.
The relative accuracy of starting point algorithms in microelectrode-guided stereotactic pallidotomy and thalamotomy was evaluated using postoperative magnetic resonance imaging (MRI) data. Multiplanar reformations were performed to align postoperative MRI in anterior-posterior, dorsal-ventral and mediolateral planes. Three-dimensional distance and direction from the pallidal and thalamic stereotactic starting points to the respective radiofrequency lesions were measured. Similar magnitude of microelectrode refinement in pallidotomy and thalamotomy suggested similar accuracy of algorithms used to set the stereotactic starting point. Fewer microelectrode-recording tracts were required to identify optimal lesioning sites in thalamotomy compared to pallidotomy. Lesions were consistently localized anterior and superior to the starting point and a refined starting point algorithm may reduce the number of microelectrode recording tracts.


Presence of circulating immune complexes in patients with chronic lymphocytic leukaemia. Correlations between clinical and immunological features.
The presence of circulating immune complexes (CIC) was evaluated in 60 untreated patients with chronic lymphocytic leukaemia with the polyethylene-glycol precipitation assay. The mean values of optical density (OD) in patients' sera was 0.161 +/- 0.121 compared with control values of 0.082 +/- 0.045 (P less than 0.001). Sera of 16 patients gave OD values higher than 0.172 (mean of controls plus 2 SD) and were considered positive for the presence of CIC. Using the new staging proposed by Binet for CLL we did not find any correlation between presence of CIC and stage of the disease. On the contrary, it was possible to correlate the presence of CIC with the stability of the disease: CIC were found in only 2 of the 22 patients (9.1%) with progressive disease but in 10 of the 30 patients (33.3%) with stable disease (P less than 0.05). CIC were present in 12 of the 38 patients in whom the only surface immunoglobulins present were IgM, but in only 1 of the 14 patients in whom both IgM and IgD were contemporaneously present on the lymphocyte surface. No correlations were found between levels of serum immunoglobulins and presence of CIC.


Disseminated nocardiosis caused by Nocardia farcinica in a patient with colon cancer: A case report and literature review.
Nocardiosis is an uncommon and potentially life-threatening infection that usually affects immunocompromised hosts. No clinical guidelines have been established for managing this rare disease, and the optimal treatment modality remains unclear. Nocardia farcinica, a relatively infrequent pathogen of nocardiosis, causes a clinically aggressive infection. In addition to our patient data, our search of the literature for patients who presented with empyema caused by N. farcinica will provide fundamental information for optimal treatment modalities. A 64-year-old man was diagnosed with empyema, 4 days following surgery for sigmoid colon cancer. Brain lesions were evaluated only after N. farcinica was isolated and identified as the causative pathogen through repeated culture tests. N. farcinica was isolated from the pleural effusion and confirmed as the pathogen through 16S rRNA sequencing. The patient was successfully treated with tube thoracotomy, neurosurgical evacuation, and a combination of trimethoprim/sulfamethoxazole plus imipenem. Long-term antibiotic therapy was required to prevent recurrence. Pyothorax showed a good clinical response to antimicrobial therapy and drainage of pleural effusion, whereas brain abscess did not respond to medical therapy and required surgery. The patient eventually recovered and continued chemotherapy as treatment for sigmoid colon cancer. Although extremely rare, this report demonstrates the importance of considering Nocardia infection as the differential diagnosis in immunocompromised patients who present with empyema. In particular, because of the N. farcinica infection's tendency to spread and the resistance of the organism to antibiotics, aggressive evaluation of metastatic lesions and standardized support from microbiological laboratories are important. Surgery may be required in some patients with brain abscesses to improve the chance of survival.


Possible relationship between antimanic effect and activity of zotepine to 5HT1 receptor.
Zotepine (ZTP), synthesized by Fujisawa Pharmaceutical Co., Ltd. for possible use as an antipsychotic drug, clinically features a very rapid and potent antimanic effect. To elucidate the psychopharmacological mechanisms of zotepine, we have attempted to measure the potency of ZTP compared with other neuroleptic drugs in competing for binding sites in the brain associated with dopamine, serotonin (5-HT1, 5-HT2), noradrenaline (NA) and acetylcholine. Zotepine was found to have the most potent activity to the 5HT1 receptor among the test drugs. Chlorpromazine and thioridazine, which belong to phenothiazines and clinically have less potent antimanic effect, shared ZTP's potent activity to the NA receptor, while they were less potent than ZTP in activity to the 5HT1 receptor. These results show that the activity of the drugs to the 5HT1 receptor may be associated with the antimanic effect.


ATP Synthesis by Oxidative Phosphorylation.
The F1F0-ATP synthase (EC 188.8.131.52) is a remarkable enzyme that functions as a rotary motor. It is found in the inner membranes of Escherichia coli and is responsible for the synthesis of ATP in response to an electrochemical proton gradient. Under some conditions, the enzyme functions reversibly and uses the energy of ATP hydrolysis to generate the gradient. The ATP synthase is composed of eight different polypeptide subunits in a stoichiometry of α3β3γδεab2c10. Traditionally they were divided into two physically separable units: an F1 that catalyzes ATP hydrolysis (α3β3γδε) and a membrane-bound F0 sector that transports protons (ab2c10). In terms of rotary function, the subunits can be divided into rotor subunits (γεc10) and stator subunits (α3β3δab2). The stator subunits include six nucleotide binding sites, three catalytic and three noncatalytic, formed primarily by the β and α subunits, respectively. The stator also includes a peripheral stalk composed of δ and b subunits, and part of the proton channel in subunit a. Among the rotor subunits, the c subunits form a ring in the membrane, and interact with subunit a to form the proton channel. Subunits γ and ε bind to the c-ring subunits, and also communicate with the catalytic sites through interactions with α and β subunits. The eight subunits are expressed from a single operon, and posttranscriptional processing and translational regulation ensure that the polypeptides are made at the proper stoichiometry. Recent studies, including those of other species, have elucidated many structural and rotary properties of this enzyme.


Anticancer effects of β-elemene with hyperthermia in lung cancer cells.
β-elemene is a novel, plant-derived anticancer drug, which has been used to target multiple solid tumor types. Hyperthermia is an adjuvant therapeutic modality to treat cancer. However, the underlying mechanisms associated with the efficacy of these two treatments are largely unknown. The aim of the present study was to evaluate the effects of β-elemene combined with hyperthermia in lung cancer cell lines. An MTT assay was used to determine cell viability. The cell cycle and apoptosis were analyzed using flow cytometry. The morphology of cells during apoptosis was determined using a transmission electron microscope. The expression levels of P21, survivin, caspase-9, B-cell lymphoma 2 (Bcl-2) and Bcl-2-like protein 4 (Bax) mRNA were detected using quantitative polymerase chain reaction. β-elemene with hyperthermia treatment significantly inhibited the viability and increased the apoptosis rate of A549 cells compared with β-elemene treatment alone (P<0.01), and significantly decreased the proportion of cells in S phase compared with the control (P<0.01). Morphological observation using transmission electron microscopy indicated cross-sectional features of apoptosis: Chromatin condensation, reduced integrity of the plasma membrane, increased cellular granularity, nuclear collapse and the formation of apoptotic bodies. β-elemene with hyperthermia treatment significantly promoted P21 and Bax mRNA expression (P<0.01) and significantly decreased caspase-9, Bcl-2 and survivin mRNA expression (P<0.01) in A549 cells. In conclusion, β-elemene with hyperthermia has a significant inhibitory effect on A549 cells. This occurs through reducing S phase and inducing apoptosis, via an increase in P21 and Bax expression and a decrease in caspase-9, Bcl-2 and survivin expression.


The use of a decision tree based on the rabies diagnosis scenario, to assist the implementation of alternatives to laboratory animals.
Brazilian federal legislation makes the use of alternatives mandatory, when there are validated methods to replace the use of laboratory animals. The objective of this paper is to introduce a novel decision tree (DT)-based approach, which can be used to assist the replacement of laboratory animal procedures in Brazil. This project is based on a previous analysis of the rabies diagnosis scenario, in which we identified certain barriers that hinder replacement, such as: a) the perceived higher costs of alternative methods; b) the availability of staff qualified in these methods; c) resistance to change by laboratory staff; d) regulatory obstacles, including incompatibilities between the Federal Environmental Crimes Act and specific norms and working practices relating to the use of laboratory animals; and e) the lack of government incentives. The DT represents a highly promising means to overcome these reported barriers to the replacement of laboratory animal use in Brazil. It provides guidance to address the main obstacles, and, followed step-by-step, would lead to the implementation of validated alternative methods (VAMs), or their development when such alternatives do not exist. The DT appears suitable for application to laboratory animal use scenarios where alternative methods already exist, such as in the case of rabies diagnosis, and could contribute to increase compliance with the Three Rs principles in science and with the current legal requirements in Brazil.


Cortisol and glucose tolerance in normal pregnancy.
The possible correlations between the increase in cortisol levels and the decrease in glucose tolerance and changes in insulin and glucagon secretion in normal pregnancy were studied in 17 normal pregnant women. Total and free plasma cortisol concentrations and urinary cortisol excretion rate were measured monthly from week 12 and the results were related to the changes in glucose tolerance in early, mid, and late pregnancy and finally compared to postpartum findings. In early pregnancy, total and free plasma cortisol concentrations and the urinary cortisol excretion rate were already higher than postpartum and the levels increased further throughout gestation, reaching maximum levels at term. Glucose tolerance deteriorated during pregnancy. When the increases during pregnancy in total and free plasma cortisol concentrations and urinary cortisol excretion rates on the one hand and the deterioration of glucose tolerance on the other hand were related, significant positive correlations were obtained (r-values between 0.55 and 0.63, p less than 0.05). No correlation was found between the increase in cortisol levels or excretion rates and the changes in the insulin and glucagon responses to glucose in pregnancy. It is concluded that the elevation of cortisol levels in pregnancy might possibly be associated with the diabetogenicity of pregnancy.


Air and dielectric bands photonic crystal microringresonator for refractive index sensing.
We present the experimental and numerical analysis of a microring resonator with an integrated one-dimensional photonic crystal fabricated on a silicon-on-insulator platform and show its applicability in bulk refractive index sensing. The photonic crystal is formed by periodically patterned, partially etched cylindrical perforations, whose induced photonic bandgap is narrower than the range of measurable wavelengths (1520-1620 nm). Of particular interest is that the microring operates in both air and dielectric bands, and the sensitivities of the resonances on both edges of the bandgap were investigated. We showed that a higher field localization inside the volume of the perforations for the air band mode leads to an increase in sensitivity.


Diagnosis Disclosure and Peer-to-Peer Information Seeking Among COVID-19-Infected Social Media Users: Survey of US-Based Adults.
Research examining online health communities suggests that individuals affected by chronic health conditions can obtain valuable information and social support through participation in peer-to-peer web-based information exchanges, including information sharing and seeking behaviors. The risks and rewards of these same behaviors in the case of acute illnesses, such as COVID-19, are less well understood, though there is reason to believe that individuals with COVID-19 and other acute illnesses may accrue similar benefits. This study examines the propensity of American adults to disclose and discuss their COVID-19 diagnosis and symptoms on social media while actively infected with the SARS-CoV-2 virus, as well as to engage in peer-to-peer information seeking in order to better understand the illness that they are experiencing. Additionally, this study seeks to identify the motivations for these behaviors as well as their subsequent impacts on perceived social connectedness and health anxiety in patients with COVID-19. We conducted a representative survey of 2500 US-based adults using a sample purchased through an industry-leading market research provider. Participants were selected through a stratified quota sampling approach to ensure a representative sample of the US population. Balanced quotas were determined (by region of the country) for gender, age, race, ethnicity, and political affiliation. Responses were analyzed from 946 participants who reported having an active social media account and testing positive for COVID-19 at least once since the start of the pandemic. The results show that only a small portion of social media users (166/946, 18%) chose to disclose and discuss their COVID-19 diagnosis while infected with the virus. However, among those who did, an overwhelming majority (206/251, 82%) said that doing so helped them feel more connected and supported while infected with the virus. A larger percentage of the 946 respondents (n=319, 34%) engaged in peer-to-peer information seeking while infected with COVID-19. Among those who did, a large majority (301/319, 94%) said that doing so was "helpful," but more than one-third (115/319, 36%) said that reading about other people's experiences made them "more worried" about having COVID-19, while 33% (108/319) said that it made them "less worried." Illness severity and political affiliation were significant predictors of both information sharing and seeking. The findings suggest that the benefits (and risks) associated with online health communities are germane to patients with acute illnesses such as COVID-19. It is recommended that public health officials and health care providers take a proactive approach to cultivating professionally moderated forums supporting peer-to-peer engagement during future outbreaks of COVID-19 and other acute illnesses in order to improve patient outcomes and promote social support and connectedness among infected patients.


Characterization of phenolic compounds from lingonberry (Vaccinium vitis-idaea).
Phenolic compounds from the lingonberry (Vaccinium vitis-idaea) were identified using LC-TOFMS, LC-MS/MS, and NMR experiments. The compounds were extracted from the plant material using methanol in an ultrasonicator and further isolated and purified using solid-phase extraction and preparative liquid chromatographic techniques. A total of 28 phenolic compounds were at least tentatively identified, including flavonols, anthocyanidins, catechins and their glycosides, and different caffeoyl and ferulic acid conjugates. This is apparently the first report of coumaroyl-hexose-hydroxyphenol, caffeoyl-hexose-hydroxyphenol, coumaroyl-hexose-hydroxyphenol, quercetin-3-O-alpha-arabinofuranoside, kaempferol-pentoside, and kaempferol-deoxyhexoside in the plant, and the flavonol acylglycosides quercetin-3-O-[4' '-(3-hydroxy-3-methylglutaroyl)]-alpha-rhamnose and kaempferol-3-O-[4' '-(3-hydroxy-3-methylglutaroyl)]-alpha-rhamnose are presented here for the first time ever. In addition, more detailed structure in comparison to earlier reports is described for some compounds previously known to exist in lingonberry.


Transcriptomic analysis of staphylococcal sRNAs: insights into species-specific adaption and the evolution of pathogenesis.
Next-generation sequencing technologies have dramatically increased the rate at which new genomes are sequenced. Accordingly, automated annotation programs have become adept at identifying and annotating protein coding regions, as well as common and conserved RNAs. Additionally, RNAseq techniques have advanced our ability to identify and annotate regulatory RNAs (sRNAs), which remain significantly understudied. Recently, our group catalogued and annotated all previously known and newly identified sRNAs in several Staphylococcus aureus strains. These complete annotation files now serve as tools to compare the sRNA content of S. aureus with other bacterial strains to investigate the conservation of their sRNomes. Accordingly, in this study we performed RNAseq on two staphylococcal species, Staphylococcus epidermidis and Staphylococcus carnosus, identifying 118 and 89 sRNAs in these organisms, respectively. The sRNA contents of all three species were then compared to elucidate their common and species-specific sRNA content, identifying a core set of between 53 and 36 sRNAs encoded in each organism. In addition, we determined that S. aureus has the largest set of unique sRNAs (137) while S. epidermidishas the fewest (25). Finally, we identify a highly conserved sequence and structural motif differentially represented within, yet common to, both S. aureus and S. epidermidis. Collectively, in this study, we uncover the sRNome common to three staphylococcal species, shedding light on sRNAs that are likely to be involved in basic physiological processes common to the genus. More significantly, we have identified species-specific sRNAs that are likely to influence the individual lifestyle and behaviour of these diverse staphylococcal strains.


Successful multimodality therapy of recurrent multifocal juvenile granulosa cell tumor of the ovary.
Juvenile granulosa cell tumor (JGCT) of the ovary, a rare pediatric cancer, carries a very poor prognosis in advanced and recurrent cases. A 10-year-old girl with stage IA JGCT, initially treated with resection only, presented with extensive unresectable multifocal pelvic recurrence. She underwent surgery, chemotherapy (cisplatin/paclitaxel alternating with cisplatin/cyclophosphamide/etoposide/bleomycin), myeloablative chemotherapy (carboplatin/etoposide/melphalan) with autologous bone marrow transplant, and pelvic radiation. She tolerated therapy well and is in complete remission 69 months after her recurrence.


Delta-volume radiomics of induction chemotherapy to predict outcome of subsequent chemoradiotherapy for locally advanced hypopharyngeal cancer.
Induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) is recommended for larynx-preserving treatment of locally advanced hypopharyngeal cancer (LAHC). However, the conventional evaluation of response is not robust enough to predict the outcome of subsequent treatments. This study aimed to develop an imaging biomarker using changes in radiomic features in invasive tumor front (ITF) by IC to predict treatment outcome of subsequent CCRT in LAHC. From 2006 to 2018, 59 computed tomography (CT) scan images before and after IC in patients with LAHC were used to contour the gross tumor volumes (GTVs). A total of 48 delta-volume radiomics features were acquired from the absolute spatial difference of GTVs (delta-GTV) before and after IC, conceptually representing a consistent portion of ITF. Least absolute shrinkage and selection operator regression (LASSO) was used to select features for establishing the model generating radiomic score (R score). A model including 5 radiomic features from delta-GTV to predict better progression-free survival (PFS) of patients receiving subsequent CCRT was established. The R score was validated with all datasets (area under the curve 0.77). Low R score (<-0.16) was associated with improved PFS (p < 0.05). The established radiomic model for ITF from radiomic features of delta-GTV after IC might be a potential imaging biomarker for predicting clinical outcome of subsequent CCRT in LAHC.


The Mutual Assistance Programme of the IUATLD. Development, contribution and significance.
The Mutual Assistance Programme of the IUATLD is aimed at trying to compensate for the neglect into which tuberculosis had fallen from the part of governments, teaching institutions and international agencies, and represents an innovative approach to promote solidarity between governments and voluntary organizations of low tuberculosis prevalence countries and those of high prevalence countries. The main objective has been to develop a system of delivery of treatment and diagnosis of tuberculosis that would be efficacious even under the difficult conditions of high prevalence of tuberculosis, low resources and/or socio-political disturbances. The system turned out not only to be efficacious in terms of cure rates and epidemiological impact but also to be efficient in terms of cost/benefit. The National Tuberculosis Programme's approach includes the application of short-course chemotherapy, the regular provision of drugs and products, a system of registers, forms and periodic reports, the assessment of the yield of case-finding and, most important of all, the analysis of the therapeutic results in successive cohorts of patients. Cure rates repeatedly reach around 85% in new cases and approximately 80% in retreatment cases, nationwide, in the countries where such programmes have been successively implemented. Each national programme has an important role of training and of capacity building. While serving the populations, the national programmes also provide the framework for relatively inexpensive operational research and, finally, the careful collection of data represents a basis--unique of its kind in the world--for the study of the clinical and epidemiological relationships between tuberculosis and HIV. The method has been endorsed by the WHO and has the support of the World Bank, the United Nations Development Plan and the main government Agencies for Development Cooperation. It is part of the new Global Strategy against Tuberculosis which is presently being developed under the WHO TB Unit. The other aspects of Mutual Assistance concern courses, consultation to programmes not directly sponsored by the IUATLD and publications.


Screening and quantitative confirmatory method for the analysis of glucocorticoids in bovine milk using liquid chromatography-tandem mass spectrometry.
An LC/MS/MS method was developed and validated for the simultaneous identification, confirmation, and quantification of 12 glucocorticoids in bovine milk. The method was validated in accordance with the criteria defined in Commission Decision 2002/657/EC. The developed method can detect and confirm the presence of dexamethasone, betamethasone, prednisolone, flumethasone, 6alpha-methylprednisolone, fluorometholone, triamcinolone acetonide, prednisone, cortisone, hydrocortisone, clobetasol propionate, and clobetasol butyrate in bovine milk. Milk samples are extracted with acetonitrile; sodium chloride is subsequently added to aid partition of the milk and acetonitrile mixture. The acetonitrile extract is then subjected to liquid-liquid purification by the addition of hexane. The purified extract is evaporated to dryness and reconstituted in a water-acetonitrile mixture, and determination is carried out by LC/MS/MS. The method permits analysis of up to 30 samples in 1 day.


On the Z1-dependence of electronic stopping in TiN.
We present a thorough experimental study of electronic stopping of H, He, B, N, Ne and Al ions in TiN with the aim to learn about the energy loss mechanisms of slow ions. The energy loss was measured by means of time-of-flight medium-energy ion scattering. Thin films of TiN on silicon with a δ-layer of W at the TiN/Si interface were used as targets. We compare our results to non-linear density functional theory calculations, examining electron-hole pair excitations by screened ions in a free electron gas in the static limit, with a density equivalent to the expected value for TiN. These calculations predict oscillations in the electronic stopping power for increasing atomic number Z1 of the projectile. An increasing discrepancy between our experimental results and predictions by theory for increasing Z1 was observed. This observation can be attributed to contributions from energy loss channels different from electron-hole pair excitation in binary Coulomb collisions.


Absence of microbiota (germ-free conditions) accelerates the atherosclerosis in ApoE-deficient mice fed standard low cholesterol diet.
The aim of our work was to determine the influence of intestinal bacteria on the development of atherosclerotic lesions using apolipoprotein E (ApoE)-deficient knockout mice. The experiments were performed on ApoE-/--deficient mouse strain C57BL/6, bred under germ-free (GF) conditions for two generations or under conventional conditions with defined microflora (CV). The mice were fed a standard low cholesterol diet or cholesterol-rich diet for 3-4 months. We studied the development of advanced lesions in the thoracic and abdominal aorta by histological, morphometric and immunohistological methods. Conventionally reared ApoE-/- mice (containing no pathogenic intestinal microbiota) and fed a standard low cholesterol diet in contrast to a high cholesterol diet did not develop atherosclerotic aortic plaques. In contrast, ApoE-/- mice reared under germfree conditions for 2 generations and fed a low cholesterol diet exhibited atherosclerotic plaques in the aorta. Characteristic lipid deposition with foam cells and macrophages was found in their arterial walls. In contrast to the absence of atherosclerotic plaques in conventionally reared ApoE-deficient mice, germ-free ApoE-/- mice consuming the same low cholesterol standard diet developed atherosclerotic plaques in the aorta. Differences in atherosclerotic plaques between GF and CV ApoE-/- mice are not so apparent when mice are fed a high cholesterol diet. Our findings thus document the protective effect of microbiota (commensal bacteria) on atherosclerosis development.


A Correlational Study of Spiritual Well-being and Depression in the Adult Cancer Patient.
Depression in adult cancer patients has been widely studied, along with spiritual effects of traumatic events and even spiritual growth after a diagnosis of cancer. There has been limited research determining a direct correlation between spiritual well-being and depression in adult cancer patients. The purpose of this research study was to examine the relationship between spiritual well-being and depression in adult cancer patients. This was a descriptive correlational study using 59 patients older than 18 years from an outpatient cancer center. The researchers hypothesized that patients with a low spiritual well-being score would be more likely to have a high depressive symptom score, thus providing support for a correlation between cancer patient's spiritual well-being and risk of depression. Implications of this study lead to evidence for better screening processes for cancer patients regarding spiritual well-being.


Learning lessons from the paediatric critical care response to the SARS-CoV-2 pandemic in England and Wales: a qualitative study.
To explore the experiences of clinical leads in paediatric critical care units (PCCUs) in England and Wales during the reorganisation of services in the initial surge of the SARS-CoV-2 pandemic and to learn lessons for future surges and service planning. A qualitative study design using semistructured interviews via virtual conferencing was conducted with consultant clinical leads and lead nurses covering 21 PCCUs. Interviews were conducted over a period of 2 weeks, 2 months after the initial SARS-CoV-2 surge. Interview notes underwent thematic analysis. Thematic analysis revealed six themes: leadership, management and planning; communication; workforce development and training; innovation; workforce experience; and infection prevention and control. Leadership was facilitated through clinician-led local autonomy for decision-making and services were better delivered when the workforce was empowered to be flexible in their response. Communication was preferred through collaborative management structures. Further lessons include recognising workforce competencies in surge preparations, the use of virtual technology in facilitating training and meetings, the importance of supporting the well-being of the workforce and the secondary consequences of personal protective equipment use. During the 2020 SARS-CoV-2 pandemic, an agile response to a rapidly changing situation was enabled through effective clinical leadership and an adaptive workforce. Open systems of communication across senior clinical and management teams facilitated service planning. Support for all members of the workforce through implementation of appropriate and innovative education and well-being solutions was vital in sustaining resilience. This learning supports planning for future surge capacity across paediatric critical care locally and nationally.


A Novel Ultrasonic Method for Liquid Level Measurement Based on the Balance of Echo Energy.
This study presents a novel method for determining the liquid level from the outside of a sealed container, which is based on the balance of echo energy received by two receiving sensors. The proposed method uses one transmitting transducer and two receiving sensors that are encapsulated in a coupling plane and arranged by certain rules. The calculation and comparison of echo energy are grounded on the difference ultrasonic impedance between gas and liquid media. First, by analyzing the propagation and attenuation characteristics of ultrasonic waves in a solid, an acoustic model for calculating the echo energy is established and simulated in MATLAB. Second, the proposed method is evaluated through a series of experiments. The difference and ratio of echo energy received by two receiving sensors are calculated and compared under two different coupling conditions. Two kinds of the sensors that are arranged by different rules are selected for measuring the liquid level, and the measurement are analyzed and discussed in detail. Finally, the experimental results indicate that the proposed method can meet the proposed accuracy requirements and can effectively solve the problems caused by some poor coupling conditions.


[Generalized saturnine paralysis. Discovery of a double congenital disease: glucose-6-phosphate dehydrogenase deficiency (new variant) and distal tubular acidosis].
A case of severe lead poisoning with haemolytic anemia, extensive polyneuropathy and arterial hypertension is reported in a patient for whom G-6-P-D deficiency and renal tubular acidosis were discovered. Both traits were present in his family. Incomplete regression of paralysis and persistant biological abnormalities after chelating treatment were demonstrative of heavy saturnine load even though the toxic exposure was brief. The role of the two deficiencies in the mechanism of intoxication is discussed: facilitation of haemolysis by enzymopathy and bone lead redistribution resulting from osteolysis probably due to the tubulopathy. The authors emphasize the fact that thorough and serial biological investigation is essential in the discovery of factors which may precipitate lead poisoning, as well as in the determination of follow-up criteria of efficient toxic epuration with sufficient delay. Typing of the enzyme has led to the identification of a new variant of glucose-6-phosphate dehydrogenase deficiency.


A cell-to-cell mediated interaction involving monocytes and non-T/CD16+ natural killer (NK) cells is required for histamine H2-receptor-mediated NK-cell activation.
Histamine (10(-4) to 10(-7) M) augmented natural killer cell cytotoxicity (NKCC) of human CD16+, non-T lymphocytes in vitro against the NK-sensitive target cells K562 erythroleukaemic, Molt-4 lymphoma, Chang liver cells and against Epstein-Barr virus (EBV)-transformed, NK-insensitive Daudi B-lymphoblastoid target cells by a mechanism of action involving a prostaglandin- and interleukin 1 (IL-1)-independent accessory function of monocytes. No evidence for the production of intermediary, NK-enhancing cytokines by histamine was obtained, indicating a cell-to-cell mediated interaction between monocytes and NK cells as a plausible mechanism of action for the NK-augmenting effect. Monocytes recovered by countercurrent centrifugal elutriation (CCE), but not monocytes recovered by adherence, reconstituted the effect of histamine when added to non-adherent NK cells. The development of NKCC in response to histamine was time-dependent with (i) an induction phase, dependent on the presence of accessory monocytes and ongoing histamine H2-receptor activation (half-maximal response required approximately 30 min treatment of large granular lymphocyte (LGL)-enriched lymphocytes and monocytes with histamine), and (ii) an effector phase, independent of the presence of monocytes or histamine receptor activation. Histamine-activated mononuclear cells (MNC) continued to exert augmented cytotoxicity for at least 8 h after removal of histamine and monocytes. In several experiments, histamine-activated NK-effector cells killed greater than 90% of the target cells at low baseline NKCC. We suggest that histamine may have a role in non-specific tumour defence by regulating an earlier unrecognized interplay between monocytes and NK cells.


Strong coupling of excitons and electric/magnetic toroidal dipole modes in perovskite metasurfaces.
Effective manipulation of the interactions between light and matter is crucial for the advancement of various high-performance optoelectronic devices. It is noted that the toroidal dipole resonance refers to an electromagnetic excitation that exists beyond the conventional understanding of electric and magnetic multipoles, which shows great potential for enhancing light-matter interactions. In this work, we investigate the strong coupling properties of electric toroidal dipole (ETD) and magnetic toroidal dipole (MTD) with excitons in (PEA)2PbI4 perovskite metasurfaces. The nanostructure consists of two identical nanobars on a SiO2 substrate, which support ETD and MTD responses. The strong coupling between ETD/MTD modes and perovskite excitons is achieved when adjusting oscillator strength f0, which can be charactered by the clearly anti-crossing behavior appeared in the transmission spectra. The Rabi splitting can be readily tuned by controlling f0. When f0 increases to 1.0, their Rabi splitting values reach as high as 371 meV and 300 meV, respectively. The proposed strong coupling between excitons and ETD/MTDs paves the way for large-scale, low-cost integrated polaritonic devices operating at room temperature.


Nurses' experiences of restraint and seclusion use in short-stay acute old age psychiatry inpatient units: a qualitative study.
Restraint and seclusion are often ineffective and can affect patients adversely. In this study, we explored nurses' experiences of restraint and seclusion in short-stay acute old age psychiatry inpatient units and how these experiences underpin resistance to eliminating these practices. Qualitative interviews were conducted with nurses in three old age psychiatry units in Melbourne, Australia. The results provide one overarching theme, lack of accessible alternatives to restraint and seclusion, indicating that nurses believe there are no effective, accessible alternatives to these practices. Three related themes contribute to this perception. First, an adverse interpersonal environment contributes to restraint and seclusion, which relates to undesirable consequences of poor staff-to-patient relationships. Second, an unfavourable physical environment contributes to aggression and restraint and seclusion use. Third, the practice environment influences the adoption of restraint and seclusion. The findings contribute to the limited evidence about nurses' experiences of these practices in short-stay old age psychiatry, and how account needs to be taken of these experiences and contextual influences when introducing measures to address these practices. Policies addressing these measures need to be accompanied by wide-ranging initiatives to deal with aggression, including providing appropriate education and support and addressing ethical and workplace cultural issues surrounding these practices.


Isolation, transplantation, and functional studies of adult porcine islets of Langerhans.
Transplantation of islets of Langerhans is a possible treatment for type-I diabetes mellitus. However, there is a shortage of donors for such transplantations and the pig may be an alternative source of donor organs. The aims of the study reported here were to establish a method for adult porcine islet isolation that was based on enzymatic digestion using Liberase PI in a semiautomatic set-up, and to evaluate the in vitro and in vivo function of isolated islets. After overnight culture, isolated islets, from five of seven batches, had poor insulin response to an in vitro glucose challenge that was only partially increased by additional challenge with arginine. More than 50% of DNA and 90% of the insulin content was lost during a one-week culture period. With some batch-to-batch variation, in 15 of 25 cases, 4,000 to 7,000 porcine islets cured streptozotocin diabetic nude mice within three weeks following transplantation. In conclusion, it is possible to isolate viable islets from adult pigs, using a semiautomatic set-up. With batch-to-batch variation, the islets are able to revert diabetes mellitus when transplanted to diabetic nude mice.


Siamang gibbons exceed the saccular threshold: intensity of the song of Hylobates syndactylus.
Measurements are reported of the intensity of the siamang gibbon loud call obtained from the vocal bouts of three family groups at Twycross Zoo, UK. Across 25 samples the maximum intensity ranged from 95 to 113 dB SPL (linear frequency-weighting and fast time-weighting) and exhibited three frequency modes of 250-315 Hz, 630-800 Hz and 1.2-1.6 kHz. The lowest frequency mode, which may correspond to the "boom" sound produced by resonance of the siamang inflated vocal sac, had a mean maximum intensity of 99 dB SPL. These values, which are in excess of the saccular acoustic threshold of about 90 dB at 300 Hz for air conducted sound, suggest that primate loud calls recruit a primitive mode of acoustic sensitivity furnished by the sacculus. Thus reproductive vocal behavior of primates may be influenced by a primitive acoustical reward pathway inherited from a common ancestor with anamniotes. In humans such a pathway could explain the compulsion for exposure to loud music.


Tuning the interactions of a magnetic colloidal suspension.
We present a versatile experimental system of magnetic charged nanospheres dispersed in water that belongs to both dipolar and electrostatic systems. In this system, the interactions can be continuously tuned by varying the ionic strength I. At low I, the potential is a strongly repulsive Yukawa potential that leads to a phase diagram similar to the one of repulsive spheres (fluid and solid phases). At high I, the potential is a globally attractive Lennard-Jones potential that leads to a phase diagram similar to the one of atomic systems (gas, liquid, fluid, and solid phases).


[Frequency of different sites of origin of the right gastric artery].
The aim of this study was to investigate the frequency of the different possibilities of the origin of the right gastric artery. The most frequent origin of the A. gastrica dextra was the A. hepatica propria (ca. 53%). Often the artery arised from the region where the A. hepatica communis divides into its branches (ca. 20%) or from the left hepatic branch (ca. 15%). In some cases (ca. 8%) it occurred as a branch of the A. gastroduodenalis and only in ca. 4% it arised from the A. hepatica communis. The findings concerning the frequency of the origin from the A. hepatica propria and from the A. hepatica communis are in accordance with the results obtained by some other authors. The observations concerning the frequency of the origin from some other arterial vessels (gastroduodenal artery, left and right hepatic branches and some other little branches) vary widely in the literature. As an incidental finding the observation of a truncus gastrolienalis and a truncus hepato- mesentericus has been made. Thereby the A. hepatica communis showed a flexuous course around the portal vein. In this connection the definition of the term "truncus hepato- mesentericus " is discussed.


Bedside ultrasonography for diagnosis of pneumothorax.
Ultrasonography (US) has found its way into the critical care and emergency settings for the evaluation of acute respiratory failure conditions in recent years. It is useful for the diagnosis of varieties of abnormalities involving pleura and lung such as pleural effusion, alveolar interstitial syndrome, and pneumothorax (PTX). In addition to its reproducibility and timeliness, US has high sensitivity and specificity for the diagnosis of these conditions. The most widely used method for bedside evaluation of PTX is chest X-ray (CXR). However, the diagnostic sensitivity of CXR in detecting PTX is limited especially in occult PTX and when the patient is assumed supine position. Computed tomography (CT) is the gold standard in the evaluation of PTX, but is limited by its high radiation exposure and safety concerns in transporting critically ill patients. In this paper we review current advances in PTX diagnosis using US.


CASK and Dlg form a PDZ protein complex at the mammalian neuromuscular junction.
Membrane-associated guanylate kinases (MAGUKs) are modular adapter proteins that serve as scaffolding molecules and anchor channels and receptors via their PDZ (PSD-95, Dlg, Zo-1) domains. Calcium, calmodulin-associated serine/threonine kinase (CASK) is a MAGUK that is critical at synapses in the central nervous system and at cell-cell junctions because of its interactions with channels, receptors, and structural proteins. We show via confocal microscopy that CASK and another MAGUK, Discs Large (Dlg), are present at the mammalian neuromuscular junction in skeletal muscle. Immunoprecipitation data from mouse muscle show that CASK associates with Dlg, providing evidence of a MAGUK protein complex at this synapse. These data indicate that CASK and Dlg may act as a scaffold for organizing receptors and channels at the postsynaptic membrane of the neuromuscular junction.


Epidemiological trend of pulmonary thromboembolism at a tertiary hospital in Korea.
Despite increasing interest in pulmonary thromboembolism (PTE), data on recent trends in PTE incidence are limited. This study evaluated the recent incidence rate of PTE. We performed a retrospective chart review of patients with PTE admitted to Chung-Ang University Hospital during the 10-year period from 2006 to 2015. Age-standardized incidence and mortality rates were calculated by the direct method per 100,000 populations. To analyze the trend of risk factor, we also calculated the proportions of cancer, major operation, and recent major fracture over that time. Total crude incidence rate of PTE per 100,000 was 229.36 and the age-sex adjusted standardized incidence rate was 151.28 (95% confidence interval [CI], 127.88 to 177.10). The incidence rate have been significantly increased 1.083 times annually from 2006 (105.96 per 100,000) to 2015 (320.02 per 100,000) (95% CI, 1.049 to 1.118; p < 0.001). These incidences also increased annually in age group of 35 to 54, 55 to 74, and ≥ 75 years, and in both males (odds ratio [OR], 1.071; 95% CI, 1.019 to 1.127; p = 0.007) and females (OR, 1.091; 95% CI, 1.047 to 1.136; p < 0.001). Cancer accounted for most of the increase from 20.0% at 2006 to 2007 to 42.8% at 2014 to 2015 (OR, 1.154; 95% CI, 1.074 to 1.240; p < 0.001), while the proportions of recent fracture and major operation remained constant. The incidence of pulmonary embolism has gradually increased over the 10 years. The increase of PTE incidence was mainly due to increased proportion of cancer patients.


Dynamical predictive power of the generalized Gibbs ensemble revealed in a second quench.
We show that a quenched and relaxed completely integrable system is hardly distinguishable from the corresponding generalized Gibbs ensemble in a dynamical sense. To be specific, the response of the quenched and relaxed system to a second quench can be accurately reproduced by using the generalized Gibbs ensemble as a substitute. Remarkably, as demonstrated with the transverse Ising model and the hard-core bosons in one dimension, not only the steady values but even the transient, relaxation dynamics of the physical variables can be accurately reproduced by using the generalized Gibbs ensemble as a pseudoinitial state. This result is an important complement to the previously established result that a quenched and relaxed system is hardly distinguishable from the generalized Gibbs ensemble in a static sense. The relevance of the generalized Gibbs ensemble in the nonequilibrium dynamics of completely integrable systems is then greatly strengthened.


Risk of latent tuberculosis in the cohort of patients with rheumatoid arthritis in Slovakia.
This study aims to determine the prevalence of latent tuberculosis infection (LTBI) in patients with moderate to severe rheumatoid arthritis (RA) who receive conventional and anti-cytokine therapy, to identify possible risk factors for tuberculosis (TB) and to evaluate the prophylactic treatment in positively screened patients. We conducted an observational, retrospective study in patients with RA, who underwent LTBI screening (chest X-ray, tuberculin skin test and interferon gamma release assay test - IGRA test). Out of 124 patients included, 7.25% of patients were diagnosed with LTBI during the treatment with conventional synthetic anti-rheumatic drugs in combination with glucocorticoids before initiation of anti-cytokine therapy. Another 21.77% were diagnosed during treatment with biologics or Janus kinase inhibitors. We confirmed the highest incidence of LTBI in TNF-treated group (66.66% LTBI positive patients), but also found positive screening in patients treated with other modalities. The mean LTBI detection time since the initiation of anti-cytokine therapy was 39.5 months (12-134 months). Active TB with clinical manifestation has occurred in one patient. Statistical analysis did not show an association between risk of LTBI and age, sex or treatment modality. The results of this study confirm the necessity of LTBI screening and long-term monitoring in RA patients treated with any kind of anti-cytokine therapy. The currently used national recommendations are sufficiently sensitive to identify TB in these patients. There remains a question of screening and prophylactic antituberculosis therapy in patients treated with conventional synthetic anti-rheumatic drugs in combination with glucocorticoids.


Improved extraction and purification of the hydrophobin HFBI.
Hydrophobins (HFBs) are a group of highly functional, low molecular weight proteins with the ability to self-assemble at hydrophobic-hydrophilic interfaces. The surface active, cysteine-rich proteins are found in filamentous fungi such as Trichoderma reesei. In the present study multiple extraction solvents and conditions were screened for the mycelium bound hydrophobin HFBI and the effects on the total amount of extracted proteins, HFBI recovery and HFBI gushing activity were investigated to gain a more thorough scientific insight on the extraction efficiency and selectivity. Results indicated the enhanced selectivity for HFBI extraction from the fungal biomass using 60% ethanol compared to solutions containing 1% sodium dodecyl sulphate (SDS). Complementing the higher selectivity, HFBI recovery was increased from 6.9 ± 0.6 mg HFBI (1% SDS) to 9.4 ± 0.4 mg HFBI per gram dry fungal biomass for extracts containing 60% ethanol. Furthermore, subsequent to HPLC purification, Cold Induced Phase Separation (CIPS) of acetonitrile-water systems was investigated at different pH levels. CIPS at pH 2.0 was found to effectively remove the majority of sorbicillinoid pigments from the purified HFBI fraction. The improved method resulted in a recovery of 85.4% of the extracted HFBI after final purification.


A New Risk Assessment Model for Hospital-Acquired Venous Thromboembolism in Critically Ill Children: A Report From the Children's Hospital-Acquired Thrombosis Consortium.
To create a risk model for hospital-acquired venous thromboembolism in critically ill children upon admission to an ICU. Case-control study. ICUs from eight children's hospitals throughout the United States. Critically ill children with hospital-acquired venous thromboembolism (cases) 0-21 years old and similar children without hospital-acquired venous thromboembolism (controls) from January 2012 to December 2016. Children with a recent cardiac surgery, asymptomatic venous thromboembolism, or a venous thromboembolism diagnosed before ICU admission were excluded. None. The multi-institutional Children's Hospital-Acquired Thrombosis registry was used to identify cases and controls. Multivariable logistic regression was used to determine the association between hospital-acquired venous thromboembolism and putative risk factors present at or within 24 hours of ICU admission to develop the final model. A total of 548 hospital-acquired venous thromboembolism cases (median age, 0.8 yr; interquartile range, 0.1-10.2) and 187 controls (median age, 2.4 yr; interquartile range, 0.2-8.3) were analyzed. In the multivariable model, recent central venous catheter placement (odds ratio, 4.4; 95% CI, 2.7-7.1), immobility (odds ratio 3.6, 95% CI, 2.1-6.2), congenital heart disease (odds ratio 2.9, 95% CI, 1.7-4.7), length of hospital stay prior to ICU admission greater than or equal to 3 days (odds ratio, 2.5; 95% CI, 1.1-5.6), and history of autoimmune/inflammatory condition or current infection (odds ratio, 2.1; 95% CI, 1.2-3.4) were each independently associated with hospital-acquired venous thromboembolism. The risk model had an area under the receiver operating characteristic curve of 0.79 (95% CI, 0.73-0.84). Using the multicenter Children's Hospital-Acquired Thrombosis registry, we identified five independent risk factors for hospital-acquired venous thromboembolism in critically ill children, deriving a new hospital-acquired venous thromboembolism risk assessment model. A prospective validation study is underway to define a high-risk group for risk-stratified interventional trials investigating the efficacy and safety of prophylactic anticoagulation in critically ill children.


Evolutionary triage governs fitness in driver and passenger mutations and suggests targeting never mutations.
Genetic and epigenetic changes in cancer cells are typically divided into 'drivers' and 'passengers'. Drug development strategies target driver mutations, but inter- and intratumoral heterogeneity usually results in emergence of resistance. Here we model intratumoral evolution in the context of a fecundity/survivorship trade-off. Simulations demonstrate that the fitness value of any genetic change is not fixed but dependent on evolutionary triage governed by initial cell properties, current selection forces and prior genotypic/phenotypic trajectories. We demonstrate that spatial variations in molecular properties of tumour cells are the result of changes in environmental selection forces such as blood flow. Simulated therapies targeting fitness-increasing (driver) mutations usually decrease the tumour burden but almost inevitably fail due to population heterogeneity. An alternative strategy targets gene mutations that are never observed. Because up or downregulation of these genes unconditionally reduces cellular fitness, they are eliminated by evolutionary triage but can be exploited for targeted therapy.


Phase and period responses of the circadian system of mice (Mus musculus) to light stimuli of different duration.
To understand entrainment of circadian systems to different photoperiods in nature, it is important to know the effects of single light pulses of different durations on the free-running system. The authors studied the phase and period responses of laboratory mice (C57BL6J//OlaHsd) to single light pulses of 7 different durations (1, 3, 4, 6, 9, 12, and 18 h) given once per 11 days in otherwise constant darkness. Light-pulse duration affected both amplitude and shape of the phase response curve. Nine-hour light pulses yielded the maximal amplitude PRC. As in other systems, the circadian period slightly lengthened following delays and shortened following advances. The authors aimed to understand how different parts of the light signal contribute to the eventual phase shift. When PRCs were plotted using the onset, midpoint, and end of the pulse as a phase reference, they corresponded best with each other when using the mid-pulse. Using a simple phase-only model, the authors explored the possibility that light affects oscillator velocity strongly in the 1st hour and at reduced strength in later hours of the pulse due to photoreceptor adaptation. They fitted models based on the 1-h PRC to the data for all light pulses. The best overall correspondence between PRCs was obtained when the effect of light during all hours after the first was reduced by a factor of 0.22 relative to the 1st hour. For the predicted PRCs, the light action centered on average at 38% of the light pulse. This is close to the reference phase yielding best correspondence at 36% of the pulses. The result is thus compatible with an initial major contribution of the onset of the light pulse followed by a reduced effect of light responsible for the differences between PRCs for different duration pulses. The authors suggest that the mid-pulse is a better phase reference than lights-on to plot and compare PRCs of different light-pulse durations.


A common anti-cardiolipin antibody idiotype in autoimmune disease: identification using a mouse monoclonal antibody directed against a naturally-occurring anti-phospholipid antibody.
We have recently produced a series of human monoclonal antibodies reacting with cardiolipin. One of these, H3, a polyspecific IgM/k derived from a normal individual, was used to raise mouse monoclonal antibody to its idiotype. Two anti-idiotypic antibodies, S2.9 (IgG2b) and S2.10 (IgM) were selected for their specific reaction with H3.S2.9 did not react with five other human monoclonal antibodies of IgM/k class despite the fact that these shared some antigen-binding characteristics with H3.S2.9 was able to block the binding of H3 to all of its cross-reactive antigens including cardiolipin, while S2.10 was not. S2.9 was equally efficient in blocking the binding of H3 to three of its cross-reactive antigens, cardiolipin, diphtheria and tetanus toxoids; greater than 90% inhibition could be achieved at an equimolar ratio of H3 to S2.9. The anti-idiotype S2.9 was used to demonstrate the presence of the H3 idiotype in serum. This idiotype was found in amounts greater than that seen in 42 normal individuals, in 30 of 36 patients with systemic lupus erythematosus (SLE), eight of 20 patients with rheumatoid arthritis (RA), 8 of 20 patients with Felty's syndrome as well as 10 of 23 patients with syphilis. Not one of nine patients with drug-induced lupus syndrome had abnormal levels. In patients with SLE and Felty's syndrome there was a good correlation between the amount of anti-cardiolipin antibodies and the amount of H3 idiotype (rs = 0.70 and 0.69 respectively). No such correlation was found in syphilitics or in patients with RA. In patients with SLE the H3 idiotype was present on IgM and IgG anti-cardiolipin antibodies. In 15 of 16 SLE sera with high levels of cardiolipin antibody, S2.9 blocked binding of serum antibodies to cardiolipin by 13-72%, with a mean value of 49%. One patient had a high level of anti-cardiolipin antibody which could not be blocked by S2.9. These results indicate that a mouse monoclonal antibody which reacts with an idiotope in the antigen-binding region of a naturally-occurring phospholipid antibody also defines a common idiotype of anti-cardiolipin antibodies in patients with autoimmune disease.


Inelastic Scattering of CO with He: Polarization Dependent Differential State-to-State Cross Sections.
A joint theoretical and experimental study of state-to-state rotationally inelastic polarization dependent differential cross sections (PDDCSs) for CO (v = 0, j = 0, 1, 2) molecules colliding with helium is reported for collision energies of 513 and 840 cm(-1). In a crossed molecular beam experiment, velocity map imaging (VMI) with state-selective detection by (2 + 1) and (1 + 1') resonance enhanced multiphoton ionization (REMPI) is used to probe rotational excitation of CO due to scattering. By taking account of the known fractions of the j = 0, 1, and 2 states of CO in the rotationally cold molecular beam (Trot ≈ 3 K), close-coupling theory based on high-quality ab initio potential energy surfaces for the CO-He interaction is used to simulate the differential cross sections for the mixed initial states. With polarization-sensitive 1 + 1' REMPI detection and a direct analysis procedure described by Suits et al. ( J. Phys, Chem. A 2015 , 119 , 5925 ), alignment moments are extracted from the images and the latter are compared with images simulated by theory using the calculated DCS and alignment moments. In general, good agreement of theory with the experimental results is found, indicating the reliability of the experiment in reproducing state-to-state differential and polarization-dependent differential cross sections.


Processing of XFEL Data.
The introduction of the X-ray laser to crystallography, and its impact on the types of crystallographic experiments being performed as described in the previous chapter, has meant that new data processing strategies had to be found. While some XFEL crystallography experiments approach the conventional methods quite closely, even those are not without special considerations relating to data processing. Serial femtosecond crystallography (SFX) introduces several additional problems, many of which have been solved recently, and there has been great progress towards resolving the remaining ones. Recent developments into the use of continuous scattering between the Bragg peaks will need even greater changes to the conventional data processing methods. This chapter describes the special characteristics of XFEL data and introduces the range of processing methods which are currently under development.


Effects of functional group changes in the EcoRV recognition site on the cleavage reaction catalyzed by the endonuclease.
Oligodeoxynucleotides have been prepared which contain changes in the functional group pattern present in the EcoRV recognition site d(GATATC). These modifications involve the deletion of specific functional groups or the reversal of the relative positions of functional groups within the canonical six base pair recognition site. The duplex stability of these modified oligodeoxynucleotides has been assessed by determining the thermodynamic parameters characterizing helix formation. Steady-state kinetic parameters have been used to characterize the interaction of the modified oligodeoxynucleotides with the EcoRV endonuclease. The enzyme is very sensitive to the deletion of either of the adenine amino or thymine methyl groups, or the reversal of the relative positions of the adenine amino group and thymine carboxy group which form an interstrand hydrogen bond in the major groove of the B-DNA helix. Conversely, deletion of the guanine amino group had only minimal effects upon the measured kinetic parameters. Deletion of the exocyclic amino group from the "inner" dA-dT base pair resulted in the fragment which interacted with the enzyme on the basis of observed inhibition experiments but was not cleaved. The results suggest that the endonuclease interacts with its recognition sequence via contacts in the major groove of the B-DNA helix and that both hydrogen bonding to the adenine amino groups and also hydrophobic interactions with the thymine methyl groups are involved.


Novel Borrelia Genotypes from Brazil Indicate a New Group of Borrelia spp. Associated with South American Bats.
The bacterial genus Borrelia comprises vector-borne spirochetes that have been classified into three major groups: the relapsing fever group (RFG), the Borrelia burgdorferi Johnson, Schmid, Hyde, Steigerwalt & Brenner sensu lato group (Bbsl), and the reptile-monotreme group (RMG). All three groups have been associated mainly with ticks and wild animals, especially rodents, birds, and reptiles. Here, we searched for Borrelia infection among 99 vampire bats [Desmodus rotundus (É. Geoffroy)] (Chiroptera: Phyllostomidae) from the Brazilian semiarid region. Through molecular investigation of bat internal organs, haplotypes of a potentially novel Borrelia organism were detected in 5% (5/99) of the bats. Borrelia DNA was detected in the liver, blood, spleen, kidney and brain, suggesting a systemic infection. Phylogenetic analyses inferred from partial sequences of the borrelial rrs and flaB genes indicated that the vampire bat-associated Borrelia sp. of this study form a monophyletic group with a newly reported Borrelia associated with a Colombia bat, distinct from the three main currently recognized groups of Borrelia spp., Bbsl, RFG, and RMG. These novel bat-associated Borrelia spp. from South America might have arisen through an independent event along the borrelial evolutionary history, since previous molecular reports of Borrelia organisms in bats or bat-associated ticks from Africa, Europe, and North America were all classified in the RFG.


Stevens-Johnson Syndrome: A Case Study.
Physicians writing prescriptions for their patients must warn them about possible side effects. One such potential complication of drugs-including tetracycline-is Stevens-Johnson syndrome, a potentially fatal condition that manifests mainly on the skin and mucosal surfaces but also affects other vital organs. Many types of therapy have proved efficacious for treating the syndrome, but use of steroid agents for this purpose remains controversial. Care for patients with Stevens-Johnson syndrome consists of treating the presenting symptoms.


Emerging concepts of nucleolar assembly.
The nucleolus is a large nuclear domain and the site of ribosome biogenesis. It is also at the parting of the ways of several cellular processes, including cell cycle progression, gene silencing, and ribonucleoprotein complex formation. Consequently, a functional nucleolus is crucial for cell survival. Recent investigations of nucleolar assembly during the cell cycle and during embryogenesis have provided an integrated view of the dynamics of this process. Moreover, they have generated new ideas about cell cycle control of nucleolar assembly, the dynamics of the delivery of the RNA processing machinery, the formation of prenucleolar bodies, the role of precursor ribosomal RNAs in stabilizing the nucleolar machinery and the fact that nucleolar assembly is completed by cooperative interactions between chromosome territories. This has opened a new area of research into the dynamics of nuclear organization and the integration of nuclear functions.


Neon-20 depth-dose relations in water.
The dose from heavy ion beams has been calculated using a one-dimensional transport theory and evaluated for 670 MeV/ amu 20Ne beams in water. The result is presented so as to be applicable to arbitrary ions for which the necessary interaction data are known. The present evaluation is based on the Silberberg - Tsao fragmentation parameters augmented with light fragment production from intranuclear cascades, recently calculated nuclear absorption cross sections, and evaluated stopping power data. Comparison with recent experimental data obtained at the Lawrence Berkeley Laboratory reveals the need for more accurate fragmentation data.


Evaluation of two-way protein fluxes across the alveolo-capillary membrane by scintigraphy in rats: effect of lung inflation.
Pulmonary microvascular and alveolar epithelial permeability were evaluated in vivo by scintigraphic imaging during lung distension. A zone of alveolar flooding was made by instilling a solution containing 99mTc-albumin in a bronchus. Alveolar epithelial permeability was estimated from the rate at which this tracer left the lungs. Microvascular permeability was simultaneously estimated measuring the accumulation of (111)In-transferrin in lungs. Four levels of lung distension (corresponding to 15, 20, 25, and 30 cmH2O end-inspiratory airway pressure) were studied during mechanical ventilation. Computed tomography scans showed that the zone of alveolar flooding underwent the same distension as the contralateral lung during inflation with gas. Increasing lung tissue stretch by ventilation at high airway pressure immediately increased microvascular, but also alveolar epithelial, permeability to proteins. The same end-inspiratory pressure threshold (between 20 and 25 cmH2O) was observed for epithelial and endothelial permeability changes, which corresponded to a tidal volume between 13.7 +/- 4.69 and 22.2 +/- 2.12 ml/kg body wt. Whereas protein flux from plasma to alveolar space ((111)In-transferrin lung-to-heart ratio slope) was constant over 120 min, the rate at which 99mTc-albumin left air spaces decreased with time. This pattern can be explained by changes in alveolar permeability with time or by a compartment model including an intermediate interstitial space.


Oxidative metabolism of polymorphonuclear leukocytes in continuous ambulatory peritoneal dialysis.
To evaluate the oxidative metabolism of polymorphonuclear leukocytes (PMNL) in continuous ambulatory peritoneal dialysis (CAPD) patients compared with those of hemodialysis (HD) patients, chronic renal failure (CRF) patients not yet on dialysis, and healthy controls; and to discover factors contributing to the oxidative function in CAPD patients. Thirty-five CAPD, 22 HD, 11 CRF patients were assessed; all were free from infections at the time of examination. Thirty-one healthy volunteers served as controls. The oxidative metabolism was estimated by the production of superoxide anion, which was detected by luminol-dependent zymosan stimulated chemiluminescence (CL) with whole blood assessment. The volume of superoxide production equivalent to 1 mL of circulating blood (T-CL), that equivalent to 10(4) neutrophils (CL/N) and the velocity of superoxide production (V-CL), were measured as parameters for the oxidative function of PMNL. There were no differences in all CL parameters between CAPD and HD patients. T-CL and CL/N of dialysis patients were equal to controls but those of CRF patients were significantly decreased. V-CL of dialysis patients, as well as CRF patients, was smaller than that of controls but the difference was not significant. Among nutritional status, degree of anemia, dialytic efficacy and duration of dialysis in CAPD patients, only serum albumin concentration (Alb) correlated well to all CL parameters. Hypoalbuminemic patients (Alb < 3.6 g/dL, n = 20) had significantly decreased T-CL and CL/N compared to normoalbuminemic patients (Alb > or = 3.6 g/dL, n = 15), and decreased CL/N and V-CL compared to controls. No differences in CL parameters were observed between the patients with a history of peritonitis (n = 15) and without a history of peritonitis (n = 20). Oxidative metabolism of PMNL in CAPD patients was maintained with respect to superoxide productive volume, while the oxidative velocity was relatively impaired. Furthermore, it seems that albumin has a great influence on the oxidative metabolism of PMNL in CAPD patients.


Leadership in nursing and patient satisfaction in hospital context.
Objectives to know the quality of the leadership relationship from the perspective of a chief nurse and nurse, patient satisfaction, the relationship between the quality of the relationship perceived for both and patient satisfaction. Methods a quantitative, transverse and correlational approach. Non-probabilistic convenience sample consists of 15 chief nurses, 342 nurses, 273 patients. Data collected at the Central Lisbon Hospital Center, between January and March 2013, through the LMX-7, CLMX-7 and SUCEH21 scales. Statistical analysis was performed through SPSS ® Statistics 19. Results the chief nurse considers the quality of the leadership relationship good, the nurses consider it satisfactory, patients are considered to be satisfied with nursing care; there is a statistically significant correlation between the quality of the leadership relationship from the perspective of chief nurses and patient satisfaction, there is no statistically significant correlation between the quality of the leadership relationship in the nurse's perspective and satisfaction. Conclusion the chief nurse has a major role in patient satisfaction.


MRI of Traumatic Knee Dislocation: A Study to Evaluate Safety and Image Quality for Patients with Knee-Spanning Stabilization Devices.
This study evaluated safety and image quality of MRI exams performed for patients with traumatic knee dislocations in knee-spanning stabilization devices. It is an IRB-approved retrospective design with waived informed consent that included 63 patients with traumatic knee dislocation. 56 patients had metallic external fixators, and 7 patients had non-metallic knee immobilizers. 7 patients had bilateral dislocations yielding a total of 70 knee MRIs. 1.5 Tesla MRI exams were performed for all patients who were awake and alert at the time of imaging. All knee-spanning external fixators were considered "MR conditional" by the FDA. The electronic medical record was reviewed for notes from the technologist and nursing staff documenting any patient complaints or adverse events during the MRI exam as required by departmental protocol. Qualitative analysis of the six most frequently performed sequences were independently conducted by 2 musculoskeletal radiologists using a 5-point Likert scale. Overall image quality and select time intervals between the two groups were compared using an independent sample t test and the Mann-Whitney U test, respectively. No adverse events were reported for a 40-minute average estimated patient scan time with the stabilization devices in the MR gantry. Mean values of Likert scale scores were generated from two readers' data for comparison between the external fixation and the immobilizer groups. Most knee MRI exams with external fixators were within diagnostic quality despite artifacts (grade 3). MRI exams generally were of higher diagnostic quality in the immobilizer group than the external fixator group (p < 0.05). The external fixator models included DePuy Synthes, Smith and Nephew, Stryker Hoffman III, Zimmer FastFrame, and Zimmer XtraFix. MRI examinations in patients with external fixators for traumatic knee dislocations can be safely performed under certain conditions and provide diagnostic quality images.


Decision-making in anesthesiology: will artificial intelligence make intraoperative care safer?
This article explores the impact of recent applications of artificial intelligence on clinical anesthesiologists' decision-making. Naturalistic decision-making, a rich research field that aims to understand how cognitive work is accomplished in complex environments, provides insight into anesthesiologists' decision processes. Due to the complexity of clinical work and limits of human decision-making (e.g. fatigue, distraction, and cognitive biases), attention on the role of artificial intelligence to support anesthesiologists' decision-making has grown. Artificial intelligence, a computer's ability to perform human-like cognitive functions, is increasingly used in anesthesiology. Examples include aiding in the prediction of intraoperative hypotension and postoperative complications, as well as enhancing structure localization for regional and neuraxial anesthesia through artificial intelligence integration with ultrasound. To fully realize the benefits of artificial intelligence in anesthesiology, several important considerations must be addressed, including its usability and workflow integration, appropriate level of trust placed on artificial intelligence, its impact on decision-making, the potential de-skilling of practitioners, and issues of accountability. Further research is needed to enhance anesthesiologists' clinical decision-making in collaboration with artificial intelligence.


Surgical decompression for space-occupying cerebral infarction: outcomes at 3 years in the randomized HAMLET trial.
We assessed whether the effects of surgical decompression for space-occupying hemispheric infarction, observed at 1 year, are sustained at 3 years. Patients with space-occupying hemispheric infarction, who were enrolled in the Hemicraniectomy After Middle cerebral artery infarction with Life-threatening Edema Trial within 4 days after stroke onset, were followed up at 3 years. Outcome measures included functional outcome (modified Rankin Scale), death, quality of life, and place of residence. Poor functional outcome was defined as modified Rankin Scale >3. Of 64 included patients, 32 were randomized to decompressive surgery and 32 to best medical treatment. Just as at 1 year, surgery had no effect on the risk of poor functional outcome at 3 years (absolute risk reduction, 1%; 95% confidence interval, -21 to 22), but it reduced case fatality (absolute risk reduction, 37%; 95% confidence interval, 14-60). Sixteen surgically treated patients and 8 controls lived at home (absolute risk reduction, 27%; 95% confidence interval, 4-50). Quality of life improved between 1 and 3 years in patients treated with surgery. In patients with space-occupying hemispheric infarction, the effects of decompressive surgery on case fatality and functional outcome observed at 1 year are sustained at 3 years. http://www.controlled-trials.com. Unique identifier: ISRCTN94237756.