Multiple factors predict physical performance in people with chronic liver disease.
The aim of this study was to assess whether physical performance correlates with metabolic and inflammatory measures in research subjects with chronic liver disease. This is a prospective, descriptive cohort study correlating performance on a 6-min walk test with cardiorespiratory variables, metabolic measures (glucose [GLU], C-peptide insulin, and lipids), liver enzymes (aspartate aminotransferase and alanine aminotransferase), and the proinflammatory cytokine interleukin-8 (IL-8). This study enrolled 51 subjects (18 women) with chronic liver disease: 41% (n = 21) with nonalcoholic fatty liver disease and 59% (n = 30) with hepatitis C virus. Age, resting heart rate, and fasting GLU correlated significantly with distance walked (P's < 0.05). First quartile "poor performers" (n = 14) and fourth quartile "high performers" (n = 14) showed differences in age, sex, fasting GLU, and IL-8 level (P's < 0.05). Combining the number of abnormal serum values (IL-8, C-peptide insulin, GLU, aspartate aminotransferase, alanine aminotransferase, high-density lipoprotein, triglyceride, and total cholesterol) did not correlate with distance walked (P > 0.90). However, in multiple regression analysis, a model that included sex, age, resting heart rate, IL-8 level, and fasting GLU level explained approximately 39% of the variance in the distance walked during the test. Older age, female sex, abnormal levels of the proinflammatory cytokine IL-8, abnormalities of GLU metabolism, and high resting heart rate are associated with poor physical performance in subjects with chronic liver disease. Poor physical performance is associated with physiologic, metabolic, and inflammatory abnormalities in subjects with nonalcoholic fatty liver disease and hepatitis C virus.


Overexpression of Hepatocyte Growth Factor mRNA Induced by Gene Transfer Attenuates Neointimal Hyperplasia After Balloon Injury.
Hepatic growth factor (HGF) has been widely used in studies on arterial remodeling after injury, and results turn out to be inconsistent. The changes of endogenous HGF expression after injury also remain controversial. This study clarified the role of exogenous human HGF (hHGF) gene transfer in neointimal hyperplasia and investigated the associated alterations of endogenous HGF and c-Met expressions under endothelial denudation with or without hHGF gene transfer using a balloon-injured rabbit aorta model. Sixty-one rabbits were randomly divided into normal controls, endothelial injury, endothelial injury with hHGF, or the control vector gene transfer groups. On weeks 1, 2, 4, and 8 after injury, neointimal hyperplasia and endothelialization were evaluated by the ratio of neointimal area to medial area (N/M ratio), CD31-positive staining, α-smooth muscle actin, and endothelial nitric oxide synthase expressions using histological analysis, immunohistochemistry staining, or real-time quantitative reverse transcriptase polymerase chain reaction. Endogenous rabbit HGF (rHGF) and c-Met expressions were detected with immunohistochemistry staining and quantitative reverse transcriptase polymerase chain reaction. It was found that expressions of endogeneous rHGF and c-Met in endothelial injury upregulated with peak levels on week 2 or week 4 after injury (p < 0.01). On week 1 after hHGF transfer, neointimal hyperplasia was significantly inhibited (p < 0.001), with decreased α-smooth muscle actin expression (p < 0.05) and improved endothelial cells regeneration and function (p < 0.01). More remarkable overexpression of endogenous rHGF and c-Met mRNAs were detected, and lowered positive staining of rHGF and c-Met was shown in the neointima (p < 0.05). These results demonstrated hHGF gene transfer induced further overexpression of endogenous rHGF and c-Met mRNAs but lowered immunoreactivities of rHGF and c-Met in the neointima, thus leading to significant attenuation of neointimal hyperplasia.


Studies on hepatic uptake of antigen. III. Studies of liver macrophage function in normal rats and following carbon tetrachloride administration.
A technique of pronase digestion followed by density gradient centrifugation was used to study the morphology and phagocytic function of isolated rat liver macrophages in the normal rat and at varying times after the in vivo administration of carbon tetrachloride. Administration of the hepatotoxin results in a transient fall in the number of isolated macrophages. This deficit is corrected by a rapid influx of mononuclear cells from elsewhere in the animal which quickly differentiate into liver macrophages. Despite changes in the morphology of isolated macrophages, no evidence was found to suggest in vitro functional impairment of these cells. In vivo studies of intrahepatic shunting showed that this became a significant phenomenon 6 hours after the administration of the hepatotoxin. The enhanced antibody response to sheep red cells which occurs after carbon tetrachloride administration appears to be due to a series of events in which the decrease in the number of liver macrophages is an early significant factor, while intrahepatic shunting is a major contributing factor at a later time.


Vitamin D Deficiency in Obsessive-Compulsive Disorder Patients with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections: A Case Control Study.
Previous studies have indicated that vitamin D deficiency is common in psychiatric patients, particularly in those with neuropsychiatric disorders such as autism and schizophrenia. Vitamin D is an important neurosteroid hormone and immunomodulatory agent that also has bone metabolic effects. There has been an increasing interest in immune-related neuropsychiatric symptoms that are triggered by group A beta-hemolytic streptococcal infections. In this study, we aimed to compare the serum levels of vitamin D between obsessive-compulsive disorder (OCD) patients with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and control subjects. Thirty-three OCD patients with PANDAS and 20 healthy controls were enrolled in the study. Serum 25-hydroxyvitamin D (25-(OH) D), calcium, phosphorus, alkaline phosphatase, and parathormone levels of the two groups were compared. Serum 25-(OH) D levels of <15 ng/mL were classified as vitamin D deficiency. The children's Yale-Brown Obsessive Compulsive Scale (YBOCS) and Clinical Global Impression (CGI) were used to assess the severity of OCD symptoms. There was no significant difference in serum 25-(OH) D levels between the patient and control groups. However, vitamin D deficiency was significantly more frequent in the patient group than in the control group (48.5% vs. 20.0%; p=0.038). Moreover, OCD patients with vitamin D deficiency had higher rates of comorbid ADHD than those without vitamin D deficiency (87.5% vs. 52.6%; p=0.027). While serum phosphorus levels were negatively correlated with age as well as alkaline phosphatase and ASO levels, they were positively correlated with the YBOCS total score and global severity score. Serum parathormone levels were positively correlated with the YBOCS total score, compulsion score, obsession score, and global severity score. This study supports the hypothesis that an association between vitamin D metabolism and PANDAS-related OCD exists. We suggest that biochemical parameters predicting metabolic bone diseases are more common in PANDAS patients. There is a need for prospective studies to show a clear association between PANDAS and bone metabolic turnover based on autoimmune mechanisms.


[Application of Polysomnography in Common Neurodegenerative Diseases].
At present, the etiology and pathogenesis of most neurodegenerative diseases are still not fully understood, which poses challenges for the prevention, diagnosis, and treatment of these diseases. Sleep disorders are one of the common chief complaints of neurodegenerative diseases. When patients suffer from comorbid sleep disorder and neurodegenerative diseases, the severity of their condition increases, the quality of their life drops further, and the difficulty of treatment increases. A large number of studies have been conducted to monitor the sleep of patients with neurodegenerative diseases, and it has been found that there are significant changes in their polysomnography (PSG) results compared to those of healthy control populations. In addition, there are also significant differences between the PSG findings of patients with different neurodegenerative diseases and the differences are closely associated with the pathogenesis and development of the disease. Herein, we discussed the characteristics of the sleep structure of patients with Parkinson's disease, Alzheimer's disease, Huntington's disease, and dementia with Lewy bodies and provided a brief review of the sleep disorders and the PSG characteristics of these patients. The paper will help improve the understanding of the pathogenesis and pathological changes of neurodegenerative diseases, clarify the relationship between sleep disorders and these diseases, improve clinicians' further understanding of these diseases, and provide a basis for future research.


Leptospira Immunoglobulin-Like Protein B Interacts with the 20th Exon of Human Tropoelastin Contributing to Leptospiral Adhesion to Human Lung Cells.
Leptospira immunoglobulin-like protein B (LigB), a surface adhesin, is capable of mediating the attachment of pathogenic leptospira to the host through interaction with various components of the extracellular matrix (ECM). Human tropoelastin (HTE), the building block of elastin, confers resilience and elasticity to lung, and other tissues. Previously identified Ig-like domains of LigB, including LigB4 and LigB12, bind to HTE, which is likely to promote Leptospira adhesion to lung tissue. However, the molecular mechanism that mediates the LigB-HTE interaction is unclear. In this study, the LigB-binding site on HTE was further pinpointed to a N-terminal region of the 20th exon of HTE (HTE20N). Alanine mutants of basic and aromatic residues on HTE20N significantly reduced binding to the LigB. Additionally, HTE-binding site was narrowed down to the first β-sheet of LigB12. On this binding surface, residues F1054, D1061, A1065, and D1066 were critical for the association with HTE. Most importantly, the recombinant HTE truncates could diminish the binding of LigB to human lung fibroblasts (WI-38) by 68%, and could block the association of LigA-expressing L. biflexa to lung cells by 61%. These findings should expand our understanding of leptospiral pathogenesis, particularly in pulmonary manifestations of leptospirosis.


Architectonic mapping of somatosensory areas involved in skilled forelimb movements and tool use.
Cebus monkeys stand out from other New World monkeys by their ability to perform fine hand movements, and by their spontaneous use of tools in the wild. Those behaviors rely on the integration of somatosensory information, which occurs in different areas of the parietal cortex. Although a few studies have examined and parceled the somatosensory areas of the cebus monkey, mainly using electrophysiological criteria, very little is known about its anatomical organization. In this study we used SMI-32 immunohistochemistry, myelin, and Nissl stains to characterize the architecture of the parietal cortical areas of cebus monkeys. Seven cortical areas were identified between the precentral gyrus and the anterior bank of the intraparietal sulcus. Except for areas 3a and 3b, distinction between different somatosensory areas was more evident in myelin-stained sections and SMI-32 immunohistochemistry than in Nissl stain, especially for area 2 and subdivisions of area 5. Our results show that cebus monkeys have a relatively complex somatosensory cortex, similar to that of macaques and humans. This suggests that, during primate evolution, the emergence of new somatosensory areas underpinned complex manual behaviors in most Old World simians and in the New World cebus monkey. J. Comp. Neurol. 524:1399-1423, 2016. © 2015 Wiley Periodicals, Inc.


Preterm labor: the role of amnionitis.
This prospective study represents an attempt to find a link between subclinical intra-amniotic infection and preterm singleton labor in 27 asymptomatic patients with intact membranes. Liquor amnii was obtained by transabdominal amniocentesis and cultured for anaerobic and aerobic bacteria and mycoplasmas. None of these cultures was positive. The value of gas-liquid chromatographic determination of volatile and non-volatile acids in liquor amnii could not be determined because amniotic infections did not occur in the population under study.


Characterization of malignant pancreatic cystic lesions in the background of chronic pancreatitis.
Cystic lesions of the pancreas in association with chronic pancreatitis are a diagnostic and therapeutic challenge. The aim of the study was to study clinical and radiological features that may differentiate between benign and malignant cystic lesions of the pancreas and examine the indications for surgery in these patients. Retrospective case note study. Patients with concomitant cystic lesions of the pancreas and chronic pancreatitis stated in radiology reports between 1995 and 2005. Thirty-one patients were identified with alcohol-related chronic pancreatitis with a median age of 53 years (range: 27-82 years). Eight patients (26%) had deranged liver function tests and four (13%) presented a raised CA 19.9. Radiological features of cystic lesions of the pancreas included median cyst size of 3 cm (range: 0.8-10 cm), solitary cyst in 28 patients (90%) and multi-loculated in 3 patients (10%). Dilatation of the main pancreatic duct was seen in seven cases (23%). Overall, 12 patients (39%) underwent surgery, 13 patients (42%) were managed with radiological follow-up, five patients (16%) were managed conservatively and one patient (3%) was treated with chemotherapy for advanced malignancy. Overall, three cases (10%) of this series had malignant cystic lesions of the pancreas. Malignant cystic lesions of the pancreas are associated with deranged liver function tests, elevated CA 19.9, and are larger solitary cysts on imaging. The differentiation between benign and malignant cystic lesions of the pancreas remains a diagnostic challenge, although malignant cysts tend to be solitary and larger. The high prevalence of malignancy merits an aggressive approach to follow-up and early surgical intervention.


Mixed and nonvaccine high risk HPV types are associated with higher mortality in Black women with cervical cancer.
We studied the incidence of HPV genotypes in mostly Black women with cervical carcinoma and correlated histopathologic tumor characteristics, immune markers and clinical data with survival. Disease-free survival (DFS) and overall survival (OS) were recorded for 60 months post-diagnosis. Fifty four of the 60 (90%) patients were Black and 36 (60%) were < 55 years of age. Of the 40 patients with typeable HPV genotypes, 10 (25%) had 16/18 HPV genotypes, 30 (75%) had one of the non-16/18 HPV genotypes, and 20 (50%) had one of the 7 genotypes (35, 39, 51, 53, 56, 59 and 68) that are not included in the nonavalent vaccine. Mixed HPV infections (≥ 2 types) were found in 11/40 (27.5%) patients. Patients infected with non-16/18 genotypes, including the most common genotype, HPV 35, had significantly shorter DFS and OS. PD-L1 (p = 0.003), MMR expression (p = 0.01), clinical stage (p = 0.048), histologic grade (p = 0.015) and mixed HPV infection (p = 0.026) were independent predictors of DFS. A remarkably high proportion of cervical cancer cells in our patients expressed PD-L1 which opens the possibility of the use of immune checkpoint inhibitors to treat these cancers. Exclusion of the common HPV genotypes from the vaccine exacerbates mortality from cervical cancer in underserved Black patients.


Does Vitamin Supplementation Play a Role in Chronic Kidney Disease?
Although the role of vitamins in the human body is proven, guidelines for patients with chronic kidney disease (CKD) remain unclear. This narrative review summarizes the findings of 98 studies of CKD and the effects of vitamin D, B, C, A, E, and K supplementation on patients on dialysis for CKD, with the aim of summarizing the existing guidelines. The findings are promising, showing the potential effectiveness of vitamin supplementation with, for example, vitamins B, D, or C. However, recommendations are still ambiguous, especially in the case of vitamins A and K, due to the potential toxicity associated with higher doses for patients. Continued research is needed to rigorously evaluate the effectiveness and carefully consider the potential risks of some vitamin supplementation for patients with CKD.


Role of outer ring carboxylates of the rat skeletal muscle sodium channel pore in proton block.
Voltage-gated Na+ current is reduced by acid solution. Protons reduce peak Na+ conductance by lowering single channel conductance and shift the voltage range of gating by neutralizing surface charges. Structure-function studies identify six carboxyls and a lysine in the channel's outer vestibule. We examined the roles of the superficial ring of carboxyls in acid block of Na(v)1.4 (the rat skeletal muscle Na+ channel isoform) by measuring the effects of their neutralization or their substitution by lysine on sensitivity to acid solutions, using the two-micropipette voltage clamp in Xenopus oocytes. Alteration of the outer ring of carboxylates had little effect on the voltage for half-activation of Na+ current, as if they are distant from the channels' voltage sensors. The mutations did not abolish proton block; rather, they all shifted the pK(a) (-log of the dissociation constant) in the acid direction. Effects of neutralization on pK(a) were not identical for different mutations, with E758Q > D1241A > D1532N > E403Q. E758K showed double the effect of E758Q, and the other lysine mutations all produced larger effects than the neutralizing mutations. Calculation of the electrostatic potential produced by these carboxylates using a pore model showed that the pK(a) values of carboxylates of Glu-403, Glu-758, and Asp-1532 are shifted to values similar to the experimentally measured pK(a). Calculations also predict the experimentally observed changes in pK(a) that result from mutational neutralization or introduction of a positive charge. We propose that proton block results from partial protonation of these outer ring carboxylates and that all of the carboxylates contribute to a composite Na+ site.


Targeting the DENV NS2B-NS3 protease with active antiviral phytocompounds: structure-based virtual screening, molecular docking and molecular dynamics simulation studies.
Dengue fever has been a global health concern. Mitigation is a challenging problem due to non-availability of workable treatments. The most difficult objective is to design a perfect anti-dengue agent capable of inhibiting infections caused by all four serotypes. Various tactics have been employed in the past to discover dengue antivirals, including screening of chemical compounds against dengue virus enzymes. The objective of the current study is to investigate phytocompounds as anti-dengue remedies that target the non-structural 2B and non-structural 3 protease (NS2B-NS3pro), a possible therapeutic target for dengue fever. Initially, 300 + antiviral phytocompounds were collected from Duke's phytochemical and ethnobotanical database and 30 phytocompounds with anti-dengue properties were identified from previously reported studies, which were virtually screened against NS2B-NS3pro using molecular docking and toxicity evaluation. The top five most screened ligands were naringin, hesperidin, gossypol, maslinic acid and rhodiolin with binding affinities of - 8.7 kcal/mol, - 8.5 kcal/mol, - 8.5 kcal/mol, - 8.5 kcal/mol and - 8.1 kcal/mol, respectively. The finest docked compounds complexed with NS2B-NS3pro were subjected for molecular dynamics (MD) simulations and binding free energy estimations through molecular mechanics generalized born surface area-based calculations. The results of the study are intriguing in the context of computer-aided screening and the binding affinities of the phytocompounds, proposing maslinic acid (MAS) as a potent bioactive antiviral for the development of phytocompound-based anti-dengue agent.


Survival and prognostic factors in resected N2 non-small cell lung cancer: a study of 140 cases. Leuven Lung Cancer Group.
The selection of stage IIIA N2 non-small cell lung cancer patients for primary surgical treatment remains controversial. One hundred forty patients with resected non-small cell lung cancer who eventually proved to have pathologic N2 disease were studied with a univariate and multivariate analysis of prognostic factors. Nineteen patients had a positive mediastinoscopy; the others had a preoperative N0 or N1 stage. Complete resection rate was 80.7%. Five-year survival was 20.8% (95% confidence interval, 17.2% to 24.4%), 32.2% in mediastinoscopy-negative patients. In the univariate analysis, clinical N stage at mediastinoscopy, complete resection, performance status, T stage, number of metastatic levels in adenocarcinoma, and nodal capsule rupture were important factors. In a multivariate model, survival was worse in case of higher T stage (relative risk = 1.43), lower performance status (relative risk = 1.37), involvement of more than one node level (relative risk = 1.68), nonsquamous histology (relative risk = 1.29) and clinical N2 stage (relative risk = 1.43). Long-term survival was unlikely when lactic dehydrogenase or carcinoembryonic antigen levels were elevated. In clinical N0 or N1 cancer, complete resection resulted in reasonable survival prospects. In patients with N2 disease discovered at mediastinoscopy, surgical treatment was only worthwhile in case of minimal N2. Several unfavorable prognostic factors could be identified in the univariate analysis and confirmed in a multivariate Cox model.


Methodological issues in treatment research for anxiety disorders in youth.
This article identifies and addresses three methodological domains relevant to the treatment of anxiety disorders in youth: (a) procedural matters, (b) the assessment of anxious distress, and (c) the analysis of treatment-produced change. Procedural topics include the need to manualize treatment, have diversity among participants and comparability of the duration of treatment and control conditions, and control for medication status. Multiple-method measurement issues include child and parent reports, observations, and structured interviewing. Our examination of change issues considers comorbidity, analyzing the intent-to-treat sample, treatment "spillover," and clinical as well as statistical significance. Problems are identified and potential ameliorative strategies are offered.


Paclitaxel dimers assembling nanomedicines for treatment of cervix carcinoma.
Poor water solubility and adverse side effects pose a challenge for clinical application of paclitaxel (PTX). In this work, a series of PTX dimers are synthesized by coupling two PTX molecules with dicarboxylic acids. As-synthesized PTX dimers form stable nanoparticles in aqueous solution without using any surfactants or adjuvants, and the solubility of PTX in water increases by 2500-fold compared to that of free PTX. These nanoparticles with high content of PTX are internalized by cancer cells and exhibit comparable cytotoxicity with Taxol. Furthermore, when the PTX dimers are incorporated into methoxypoly(ethylene glycol)2K-block-poly(d, l-lactide)2K (PEG-PDLLA) micelles, the loading content of PTX dimers is as high as 85wt%. The formed nanoparticles possess the high stability in biological conditions. Both in vitro and in vivo experiments show that these (PTX dimer)/PEG-PDLLA formulations possess effective cellular uptake and potent cytotoxicity, and exhibit reduced systemic toxicity and enhanced antitumor efficacy towards human cervical tumor. We believe these PTX dimers-based nanoparticles would be an alternative formulation for PTX, and such drug dimer assembling behaviors could be extended to other therapeutic agents.


Ocular Pharmacology for Scleritis: Review of Treatment and a Practical Perspective.
Scleritis is defined as an infectious or noninfectious inflammation of the sclera that can be broadly categorized according to anatomic location (ie, anterior or posterior) and whether the process is necrotizing or non-necrotizing. Treatment for scleritis is dictated by the etiology of the inflammation, with infectious forms requiring treatment of the inciting agent and noninfectious forms requiring treatment of the underlying inflammation with immunosuppression. Pharmacotherapy for noninfectious scleritis can be classified according to delivery route (eg, local or systemic) and mechanism of action (eg, biologic or nonbiologic). This review will briefly summarize the classification scheme for scleritis before reviewing in depth both systemic and local pharmacotherapies that can be used to effectively treat an eye afflicted by either infectious or noninfectious scleritis. Traditional anti-inflammatory agents such as nonsteroidal anti-inflammatory drugs, steroids, and immunomodulatory therapy will be discussed, as well as newer biologic therapies such as antitumor necrosis factor alpha and anti-CD20 agents.


Large-Scale Fabrication of Photonic Nanojet Array via Template-Assisted Self-Assembly.
A large-scale homogenized photonic nanojet array with defined pattern and spacing facilitates practical applications in super-resolution imaging, subwavelength-resolution nanopatterning, nano objects trapping and detection technology. In this paper, we present the fabrication of a large-scale photonic nanojet array via the template-assisted self-assembly (TASA) approach. Templates of two-dimensional (2D) large-scale microwell array with defined pattern and spacing are fabricated. Melamine microspheres with excellent size uniformity are utilized to pattern on the template. It is found that microwells can be filled at a yield up to 95%. These arrayed microspheres on the template serve as microlenses and can be excited to generate large-scale photonic nanojets. The uniformly-sized melamine spheres are beneficial for the generation of a homogenized photonic nanojet array. The intensity of the photonic nanojets in water is as high as ~2 fold the background light signal. Our work shows a simple, robust, and fast means for the fabrication of a large-scale homogenized photonic nanojet array.


Fluorescent in situ hybridization analysis of cervical smears. A pilot study of 20 cases.
The Papanicolaou smear has been established as a useful cytological screening tool that has greatly contributed to the reduction of cervical cancer related mortalities. This test, however, cannot reveal underlying genetic damage, i.e., numerical and structural chromosomal abnormalities that may predispose an individual to a future potentially life-threatening cervical neoplasm. An assay that has the ability to detect genetic abnormalities in interphase cervical mucosal cells will be a useful complement to the Papanicolaou smear on cytological preparations. The present project explores such a possibility using the technique of fluorescent in situ hybridization (FISH). The chromosome 8 specific alpha-satellite probe is initially used because of our past experience in the validation of this probe in various cancers. The applicability of this assay, however, is not restricted to the use of this particular probe. Data on our initial pilot study of 20 cases revealed that such an interphase FISH assay is indeed feasible as a potential future screening tool for cervical cancer.


Preeclampsia: recent insights.
Preeclampsia is a pregnancy complication with serious consequences for mother and infant. The disorder is diagnosed by gestational hypertension and proteinuria but is far more than pregnancy induced hypertension. Preeclampsia is proposed to occur in 2 stages. Stage 1 reduced placental perfusion is postulated as the root cause and to lead to the maternal syndrome, Stage 2. Why perfusion is reduced, how this translates to a maternal disease in some but not all women and what is the linkage of the 2 stages are topics of intense study. In the last decade such studies have provided valuable insights into pathophysiology that now guide ongoing clinical trials.


Effects of the magnesium and chloride ions and shikimate on the structure of shikimate kinase from Mycobacterium tuberculosis.
Bacteria, fungi and plants can convert carbohydrate and phosphoenolpyruvate into chorismate, which is the precursor of various aromatic compounds. The seven enzymes of the shikimate pathway are responsible for this conversion. Shikimate kinase (SK) is the fifth enzyme in this pathway and converts shikimate to shikimate-3-phosphate. In this work, the conformational changes that occur on binding of shikimate, magnesium and chloride ions to SK from Mycobacterium tuberculosis (MtSK) are described. It was observed that both ions and shikimate influence the conformation of residues of the active site of MtSK. Magnesium influences the conformation of the shikimate hydroxyl groups and the position of the side chains of some of the residues of the active site. Chloride seems to influence the affinity of ADP and its position in the active site and the opening length of the LID domain. Shikimate binding causes a closing of the LID domain and also seems to influence the crystallographic packing of SK. The results shown here could be useful for understanding the catalytic mechanism of SK and the role of ions in the activity of this protein.


Optimizing range of motion in cruciate-retaining mobile-bearing tka: experience with 2000 cases.
We describe experience with 2000 cruciate-retaining Sigma RP total knee arthroplasties performed between September 2000 to January 2006. All procedures were performed with a midvastus arthrotomy, medioposterior release, and posterior condylar clean-out technique. This implant design uses a congruent polyethylene bearing to diminish contact stress while allowing rotation between the polyethylene bearing surface and tibial tray. Of the 2000 knees, 1596 had follow-up data at one year. Seven hundred-twenty-seven had an average flexion of 123 degrees, 692 had an average Knee Society Score of 94, and 672 had an average function score of 86.


Complete mitochondrial genome of the freshwater sculpin Cottus koreanus (Scorpaeniformes, Cottidae).
The complete mitochondrial genome was sequenced from the freshwater sculpin Cottus koreanus. The genome sequence was 16,560 bp in size, and the gene order and contents were identical with those of previously reported fish mitochondrial genomes. Of 13 protein-coding genes (PCGs), 3 genes (CO2, ND4, Cytb) had incomplete stop codons. The base composition of C. koreanus mitogenome showed anti-G bias (13.94% and 12.73%) on the second and third positions of PCGs, respectively.


The DNA architectural protein HMGB1 displays two distinct modes of action that promote enhanceosome assembly.
HMGB1 (also called HMG-1) is a DNA-bending protein that augments the affinity of diverse regulatory proteins for their DNA sites. Previous studies have argued for a specific interaction between HMGB1 and target proteins, which leads to cooperative binding of the complex to DNA. Here we propose a different model that emerged from studying how HMGB1 stimulates enhanceosome formation by the Epstein-Barr viral activator Rta on a target gene, BHLF-1. HMGB1 stimulates binding of individual Rta dimers to multiple sites in the enhancer. DNase I and hydroxyl radical footprinting, electrophoretic mobility shift assays, and immobilized template assays failed to reveal stable binding of HMGB1 within the complex. Furthermore, mutational analysis failed to identify a specific HMGB1 target sequence. The effect of HMGB1 on Rta could be reproduced by individual HMG domains, yeast HMO1, or bacterial HU. These results, combined with the effects of single-amino-acid substitutions within the DNA-binding surface of HMGB1 domain A, argue for a mechanism whereby DNA-binding and bending by HMGB1 stimulate Rta-DNA complex formation in the absence of direct interaction with Rta or a specific HMGB1 target sequence. The data contrast with our analysis of HMGB1 action on another BHLF-1 regulatory protein called ZEBRA. We discuss the two distinct modes of HMGB1 action on a single regulatory region and propose how HMGB1 can function in diverse contexts.


Exploring Supports and Barriers to Physical Activity in Catholic Priests.
Although physical activity has been examined in many different populations, little is known about the physical activity of religious leaders. Religious leaders have considerable demands on their time and energy resulting in fewer opportunities for self-care, including participating in regular physical activity. The purpose of our study was to better understand the role of physical activity in Roman Catholic priests and in particular, the supports and barriers they face. We conducted one-on-one semi-structured interviews with eight priests regarding their perceived motivators and impediments to physical activity. Following a socioecological framework, we noted two common themes from the priests' interviews regarding their lived experiences. Our first theme included intra-individual characteristics such as personal factors including personality, knowledge, attitudes, and beliefs regarding physical activity. Our second theme contained extra-individual factors such as environmental influences including community involvement, accessible resources, and weather determinants. Both themes reflected supports and barriers to the priests' physical activity. Overall, our results indicated that although Roman Catholic priests experience unique barriers to physical activity related to their social identity, similar to other men of the same age, they are also affected by common factors that support or prohibit engagement in physical activity. The priests shared that health benefits and being physically active with others were their main supports, while busy work schedules, lack of knowledge, and poor health were barriers to their physical activity participation. These results suggest physical activity programming should be considered as part of seminary education, in particular, as a method of proactively taking care of physical and mental health so priests can manage the persistent and consistent demands made upon them. Further, once working as priests, physical activity programs should involve individualized approaches that include personal interests, and available resources while recognizing personal, social, and environmental barriers.


Altered expression, but small contribution, of the histone demethylase KDM6A in obstructive uropathy in mice.
Epigenetic processes have emerged as important modulators of kidney health and disease. Here, we studied the role of KDM6A (a histone demethylase that escapes X-chromosome inactivation) in kidney tubule epithelial cells. We initially observed an increase in tubule cell Kdm6a mRNA in male mice with unilateral ureteral obstruction (UUO). However, tubule cell knockout of KDM6A had relatively minor consequences, characterized by a small reduction in apoptosis, increase in inflammation and downregulation of the peroxisome proliferator-activated receptor (PPAR) signaling pathway. In proximal tubule lineage HK-2 cells, KDM6A knockdown decreased PPARγ coactivator-1α (PGC-1α) protein levels and mRNA levels of the encoding gene, PPARGC1A. Tubule cell Kdm6a mRNA levels were approximately 2-fold higher in female mice than in male mice, both under sham and UUO conditions. However, kidney fibrosis after UUO was similar in both sexes. The findings demonstrate Kdm6a to be a dynamically regulated gene in the kidney tubule, varying in expression levels by sex and in response to injury. Despite the context-dependent variation in Kdm6a expression, knockout of tubule cell KDM6A has subtle (albeit non-negligible) effects in the adult kidney, at least in males.


The relationship between type 2 diabetes and dementia.
The prevalence of type 2 diabetes and dementia are set to rise inexorably over the next 30-40 years. There are now substantial data to suggest that type 2 diabetes is associated with an increased risk of dementia. This is a narrative review using data from individual studies and review articles known to the authors. A Medline search was also undertaken and reference lists were reviewed to identify additional relevant studies. Type 2 diabetes is associated with an increased risk of both Alzheimer's and Vascular dementia, although the reality is that many affected individuals have mixed forms of dementia. The mechanisms underpinning this association remain to be clearly delineated. Type 2 diabetes is a complex disorder and so it is likely that multiple different, synergistic processes may interact to promote cognitive decrements. Recent data suggest that glucocorticoids excess and elevated inflammatory markers may also have a role in the aetiology of diabetes-related cognitive impairment. Large-scale, prospective epidemiological studies are now required to accurately delineate the pathogenesis of cognitive impairment in people with type 2 diabetes. These are underway and randomized trials of diabetes-specific interventions are also starting to include cognitive function as an outcome measure.


Spontaneous pneumothorax in adult Nigerians.
A 6-year study was carried out in our hospital practice to determine the prevalence of spontaneous pneumothorax. Thirty patients with 32 episodes of pneumothorax were diagnosed. Tuberculosis was encountered in 9(30%) patients while no specific cause was found in 12(40%) patients. This study indicates that spontaneous pneumothorax is uncommon in the Nigerian, while the tuberculosis aetiology may be a pointer to the overall high prevalence of the disease in the community.


A survey of aggressive behaviour among a population of persons with intellectual disability in Queensland.
A survey was conducted on aggressive behaviour within a population of 2412 persons with intellectual disability in Queensland, Australia. Two hundred and sixty-one individuals were identified who engaged in at least one form of aggressive behaviour, yielding an overall prevalence of 11%. The relative prevalence of aggressive behaviour was higher among institutionalized persons (35%) when compared to those living in group homes (17%) or other community-based facilities (3%). The aggressive behaviour sample included a higher percentage of males (64%). Most were described as functioning in the severe/profound (54%) or moderate (31%) range of intellectual disability with one-third having no intelligible speech. Two-thirds of the sample received medication for their challenging behaviour, while only one-third had behavioural programmes. Eighty per cent engaged in three or more forms of aggression. Many also displayed self-injury (34%) or property destruction (30%). Surveys of aggressive behaviour may prove useful for coordinating services.


Evidence of developmental alterations in cortical and subcortical regions of children with attention-deficit/hyperactivity disorder: a multivoxel in vivo phosphorus 31 spectroscopy study.
There is mounting evidence of neurodevelopmental alterations implicating the prefrontal cortex (PFC) and basal ganglia in children with attention-deficit/hyperactivity disorder (ADHD). The brain undergoes substantive structural and functional changes with a differential timing between brain regions during development from childhood to adolescence. In vivo phosphorus 31 magnetic resonance spectroscopy ((31)P MRS) is a noninvasive neuroimaging approach that is sensitive in assessing developmental changes of overproducing/pruning of synapses. To provide support for a developmental mechanism targeting a bottom-up dysfunction of the basal ganglia impairing the fine-tuning of prefrontal functions in ADHD. Cross-sectional study. Pittsburgh, Pennsylvania, and the surrounding areas. Thirty-one psychostimulant-naive children with ADHD (mean [SD] age, 8.1 [1.2] years; range, 6.1-10.0 years) and 36 healthy control subjects (mean [SD] age, 8.1 [1.3] years; range, 6.1-10.4 years). Membrane phospholipid (MPL) precursor levels (ie, phosphomonoesters that are anabolic metabolites of MPL) were assessed in the PFC and basal ganglia as well as in 4 other brain regions using in vivo (31)P MRS. Lower bilateral MPL precursor levels in the basal ganglia and higher MPL precursor levels in the inferior parietal region (primarily right side) were noted in the children with ADHD as compared with healthy control children. There was a group x age interaction in the PFC and inferior parietal region, with relatively older psychostimulant-naive children with ADHD showing significantly lower PFC and higher inferior parietal MPL precursor levels. No differences between groups were noted in the superior temporal, posterior white matter, or occipital regions. Though based on cross-sectional data, these results are suggestive of possible progressive, nonlinear, and sequential alterations implicating a bottom-up developmental dysfunction in parts of the cortico-striato-thalamo-cortical network in ADHD.


Alteration of inflammatory response by shock wave therapy leads to reduced calcification of decellularized aortic xenografts in mice†.
Tissue-engineered xenografts represent a promising treatment option in heart valve disease. However, inflammatory response leading to graft failure and incomplete in vitro repopulation with recipient cells remain challenging. Shock waves (SWs) were shown to modulate inflammation and to enhance re-epithelialization. We therefore aimed to investigate whether SWs could serve as a feasible adjunct to tissue engineering. Porcine aortic pieces were decellularized using sodium deoxycholate and sodium dodecylsulphate and implanted subcutaneously into C57BL/6 mice (n = 6 per group). The treatment (shock wave therapy, SWT) group received SWs (0.1 mJ/mm(2), 500 impulses, 5 Hz) for modulation of inflammatory response directly after implantation; control animals remained untreated (CTR). Grafts were harvested 72 h and 3 weeks after implantation and analysed for inflammatory cytokines, macrophage infiltration and polarization, osteoclastic activity and calcification. Transmission electron microscopy (TEM) was performed. Endothelial cells (ECs) were treated with SWs and analysed for macrophage regulatory cytokines. In an ex vivo experimental set-up, decellularized porcine aortic valve conduits were reseeded with ECs with and without SWT (0.1 mJ/mm(2), 300 impulses, 3 Hz), fibroblasts as well as peripheral blood mononuclear cells (all human) and tested in a pulsatile flow perfusion system for cell coverage. Treated ECs showed an increase of macrophage migration inhibitory factor and macrophage inflammatory protein 1β, whereas CD40 ligand and complement component C5/C5a were decreased. Subcutaneously implanted grafts showed increased mRNA levels of tumour necrosis factor α and interleukin 6 in the treatment group. Enhanced repopulation with recipient cells could be observed after SWT. Augmented macrophage infiltration and increased polarization towards M2 macrophages was observed in treated animals. Enhanced recruitment of osteoclastic cells in proximity to calcified tissue was found after SWT. Consequently, SWT resulted in decreased areas of calcification in treated animals. The reseeding experiment revealed that fibroblasts showed the best coverage compared with other cell types. Moreover, SW-treated ECs exhibited enhanced repopulation compared with untreated controls. SWs reduce the calcification of subcutaneously implanted decellularized xenografts via the modulation of the acute macrophage-mediated inflammatory response and improves the in vitro repopulation of decellularized grafts. It may therefore serve as a feasible adjunct to heart valve tissue engineering.


Retrospective review of cutaneous metastasis among 11,418 patients with solid malignancy: A tertiary cancer center experience.
Cutaneous metastasis (CM) occurs infrequently and usually presents during the later stages of cancer, and has a poor prognosis. Although there are insufficient current data, cancer treatment changes could have a positive impact on the outcome. This retrospective study aimed to review the pattern and prognosis of CM in patients with solid malignancy in a tertiary cancer center in Thailand.We reviewed the medical records of cancer patients diagnosed with CM between October 2009 and August 2015 at Chulabhorn Hospital, a tertiary cancer center in Thailand. Patients with primary skin cancer and hematological malignancies were excluded. We collected and analyzed data, including the time of cancer diagnosis and CM, type of cancer, clinical characteristics, and survival outcome.Of 11,418 patients, there were 33 (0.3%) were diagnosed with CM. Breast cancer was the most common primary cancer (12 cases, 36%). Skin nodules were commonly detected on the anterior chest wall. Also, 79% of CM patients had concomitant visceral metastasis. The median overall survival of those with CM was 9.21 months (95% confidence interval 4.75-83.38 months) regardless of presentation either at onset or disease recurrence (P = .083). However, the change of management was affected in 78% diagnosed with a later stage of CM. No statistical difference in survival was observed between breast cancer and non-breast cancer patients (8.79 vs 9.21 months, P = .613).Despite CM being a sign of poor prognosis, it may still be an indicator for changing cancer patients' treatment. Hence, early CM diagnosis and prompt novel therapy may positively affect outcomes for cancer patients.


Identfication of viral and bacterial etiologic agents of the pertussis-like syndrome in children under 5 years old hospitalized.
Acute respiratory infections (ARIs) represent an important cause of morbidity and mortality in children, remaining a major public health concern, especially affecting children under 5 years old from low-income countries. Unfortunately, information regarding their epidemiology is still limited in Peru. A secondary data analysis was performed from a previous cross-sectional study conducted in children with a probable diagnosis of Pertussis from January 2010 to July 2012. All samples were analyzed via Polymerase Chain Reaction (PCR) for the following etiologies: Influenza-A, Influenza-B, RSV-A, RSV-B, Adenovirus, Parainfluenza 1 virus, Parainfluenza 2 virus, Parainfluenza 3 virus, Mycoplasma pneumoniae and Chlamydia pneumoniae. A total of 288 patients were included. The most common pathogen isolated was Adenovirus (49%), followed by Bordetella pertussis (41%) from our previous investigation, the most prevelant microorganisms were Mycoplasma pneumonia (26%) and Influenza-B (19.8%). Coinfections were reported in 58% of samples and the most common association was found between B. pertussis and Adenovirus (12.2%). There was a high prevalence of Adenovirus, Mycoplasma pneumoniae and other etiologies in patients with a probable diagnosis of pertussis. Despite the presence of persistent cough lasting at least two weeks and other clinical characteristics highly suspicious of pertussis, secondary etiologies should be considered in children under 5 years-old in order to give a proper treatment.


Using demand analysis and system status management for predicting ED attendances and rostering.
It has been observed that emergency department (ED) attendances are not random events but rather have definite time patterns and trends that can be observed historically. To describe the time demand patterns at the ED and apply systems status management to tailor ED manpower demand. Observational study of all patients presenting to the ED at the Singapore General Hospital during a 3-year period was conducted. We also conducted a time series analysis to determine time norms regarding physician activity for various severities of patients. The yearly ED attendances increased from 113387 (2004) to 120764 (2005) and to 125773 (2006). There was a progressive increase in severity of cases, with priority 1 (most severe) increasing from 6.7% (2004) to 9.1% (2006) and priority 2 from 33.7% (2004) to 35.1% (2006). We noticed a definite time demand pattern, with seasonal peaks in June, weekly peaks on Mondays, and daily peaks at 11 to 12 am. These patterns were consistent during the period of the study. We designed a demand-based rostering tool that matched doctor-unit-hours to patient arrivals and severity. We also noted seasonal peaks corresponding to public holidays. We found definite and consistent patterns of patient demand and designed a rostering tool to match ED manpower demand.


A Zinc Oxide Nanoflower-Based Electrochemical Sensor for Trace Detection of Sunset Yellow.
Zinc oxide nanoflower (ZnONF) was synthesized by a simple process and was used to construct a highly sensitive electrochemical sensor for the detection of sunset yellow (SY). Due to the large surface area and high accumulation efficiency of ZnONF, the ZnONF-modified carbon paste electrode (ZnONF/CPE) showed a strong enhancement effect on the electrochemical oxidation of SY. The electrochemical behaviors of SY were investigated using voltammetry with the ZnONF-based sensor. The optimized parameters included the amount of ZnONF, the accumulation time, and the pH value. Under optimal conditions, the oxidation peak current was linearly proportional to SY concentration in the range of 0.50-10 μg/L and 10-70 μg/L, while the detection limit was 0.10 μg/L (signal-to-noise ratio = 3). The proposed method was used to determine the amount of SY in soft drinks with recoveries of 97.5%-103%, and the results were in good agreement with the results obtained by high-performance liquid chromatography.


Intensive immunosuppression and autologous stem cell transplantation for patients with severe rheumatoid arthritis: the Leiden experience.
Ten patients with active, destructive rheumatoid arthritis refractory to antirheumatic therapy enrolled in a study to evaluate the effects of intensive immunosuppression followed by autologous stem cell transplantation. Intensive immunosuppression was achieved with high dose cyclophosphamide as part of the mobilization (4 g/m2) and conditioning (200 mg/kg) regimen. The autologous stem cell products were enriched for CD34+ cells to minimize the chance of reinfusing autoreactive lymphocytes. Eight patients completed all consecutive treatment steps, one patient withdrew after mobilization because of improvement, one patient was taken off study because of pulmonary embolism. The treatment appeared feasible and safe, and marked sustained clinical improvement was observed in 6 patients, 2 of whom were previously unresponsive to tumor necrosis factor blocking therapy. In 5 patients disease modifying antirheumatic drugs were successfully withdrawn after transplantation. The treatment induced significant lymphopenia, with low levels of naive CD4+ T cells in particular, without clinical sequelae. Titers of rheumatoid factor dropped but did not normalize.


Benign familial chorea: an association with intellectual impairment.
Twenty-four members of a family with benign familial chorea underwent testing for evidence of intellectual impairment. Lower verbal intelligence was found in affected individuals compared to unaffected family members, as were deficits in verbal abstract concept formation. These results challenge the notion that benign familial chorea uniformly spares the intellect in all kindreds.


Substrate involvement in dioxygen bond dissociation catalysed by iron phthalocyanine supported on Ag(100).
Dioxygen adsorbs in the end-on configuration on-top of the Fe atoms of an iron phthalocyanine monolayer supported on Ag(100) and is partly cleaved at room temperature to produce O/FePc/Ag(100). Scanning tunnelling microscopy coupled to density functional theory calculations gives the first experimental evidence of the substrate involvement in the O2 bond dissociation.


Phase Separation of DNA-Encoded Artificial Cells Boosts Signal Amplification for Biosensing.
Life-like hierarchical architecture shows great potential for advancing intelligent biosensing, but modular expansion of its sensitivity and functionality remains a challenge. Drawing inspiration from intracellular liquid-liquid phase separation, we discovered that a DNA-encoded artificial cell with a liquid core (LAC) can enhance peroxidase-like activity of Hemin and its DNA G-quadruplex aptamer complex (DGAH) without substrate-selectivity, unlike its gelled core (GAC) counterpart. The LAC is easily engineered as an ultrasensitive biosensing system, benefiting from DNA's high programmability and unique signal amplification capability mediated by liquid-liquid phase separation. As proof of concept, its versatility was successfully demonstrated by coupling with two molecular recognition elements to monitor tumor-related microRNA and profile cancer cell phenotypes. This scalable design philosophy offers new insights into the design of next generation of artificial cells-based biosensors.


Safety precautions for bronchoscopic Nd-YAG laser surgery.
The application of the neodymium-yttrium aluminum garnet (Nd-YAG) laser in bronchoscopy originated in Europe in 1981 and is now widespread in the United States. Transmissible through flexible fiberoptic quartz fibers and an efficient coagulator of tissue, the Nd-YAG laser deeply penetrates tissue not readily predictable by the endoscopist. Dangers associated with the Nd-YAG laser include complications secondary to inadvertent exposure to normal tissues or structures, tracheobronchial accidents (perforation, hemorrhage, fire), and complications related to anesthetic technique (respiratory depression). Hypoxemia related to persistent hemorrhage, accumulation of secretions or debris or both, or anesthesia-induced respiratory depression is the common denominator of most intraoperative and postoperative complications. Careful selection of patients, intraoperative monitoring of ventilation and blood gases, and techniques of rigid bronchoscopy are stressed to avoid complications.


Two cases of suprachoroidal hemorrhage after implantation of an ex-press miniature glaucoma device and an intraocular lens.
Suprachoroidal hemorrhage is a rare complication of ophthalmic surgery in general and of glaucoma filtration procedures in particular. We present herein two cases of suprachoroidal hemorrhage in aphakic patients after simultaneous implantation of an Ex-Press miniature glaucoma device and an intraocular lens. Although a rare complication, we have now seen two cases develop in previously aphakic patients when we have attempted to place an Ex-Press miniature glaucoma device in conjunction with placement of a secondary intraocular lens. These two cases suggest that greater caution is warranted when attempting to surgically implant an express mini shut in the aphakic patient.


Novel assessment of leukocyte-rich platelet-rich plasma on functional and patient-reported outcomes in knee osteoarthritis: a pilot study.
Background: Leukocyte-rich platelet-rich plasma (LR-PRP) has demonstrated to be beneficial for patients with knee osteoarthritis (KOA); however, reliable objective end points to accurately assess its therapeutic effects is lacking. Aim: To investigate the efficacy of LR-PRP as assessed by functional and patient-reported outcomes at early time points (6 weeks). Materials & methods: We conducted a prospective cohort study in 12 patients with diagnosed KOA (Kellgren Lawrence score of II-III), who underwent a single ultrasound-guided LR-PRP injection. Results: There was significant improvement in timed up and go, pain and quality of life scales and balance parameters. There were nonsignificant improvements in range of motion and gait parameters. Conclusion: LR-PRP demonstrates efficacy in meaningful end points for functional and patient-reported outcomes at early time points in patients with KOA.


Ten Years toward Equity: Preliminary Results from a Follow-Up Case Study of Academic Computing Culture.
Just over 10 years ago, we conducted a culture study of the Computer Science Department at the flagship University of Illinois at Urbana-Champaign, one of the top five computing departments in the country. The study found that while the department placed an emphasis on research, it did so in a way that, in conjunction with a lack of communication and transparency, devalued teaching and mentoring, and negatively impacted the professional development, education, and sense of belonging of the students. As one part of a multi-phase case study spanning over a decade, this manuscript presents preliminary findings from our latest work at the university. We detail early comparisons between data gathered at the Department of Computer Science at the University of Illinois at Urbana-Champaign in 2005 and our most recent pilot case study, a follow-up research project completed in 2016. Though we have not yet completed the full data collection, we find it worthwhile to reflect on the pilot case study data we have collected thus far. Our data reveals improvements in the perceptions of undergraduate teaching quality and undergraduate peer mentoring networks. However, we also found evidence of continuing feelings of isolation, incidents of bias, policy opacity, and uneven policy implementation that are areas of concern, particularly with respect to historically underrepresented groups. We discuss these preliminary follow-up findings, offer research and methodological reflections, and share next steps for applied research that aims to create positive cultural change in computing.


The Dental Researcher's Guide to Data Analysis - Part 2.
It is important for dental researchers to have a general idea of the different types of data that can be collected from a study and the available statistical tools that can be used with such data. By knowing about what is available, researchers will have an informed idea of the types of studies that should be conducted, the data that should be collected, and the proper statistical methods for analyzing collected data. In the first part of this general overview of statistical methods, we walked through the various types of data that traditional statistical techniques, such as t tests and linear regression, can handle. In this second part, we explore more complex types of data that traditional statistical techniques are unable to handle. Specifically, we discuss longitudinal and time-to-event data because both occur frequently in dental studies and require special modeling techniques in order to analyze correctly. Using two different simulated dental datasets, the proper application of techniques such as repeated measures ANOVA, linear mixed modeling, generalized estimating equations, log-rank test, and Cox proportional hazards models are discussed and illustrated in depth.


A clinically useful anxiety outcome scale.
Standardized scales are increasingly being recommended to measure outcome when treating psychiatric disorders in routine clinical practice. If the standard of care is to change and scales are to be incorporated into clinical practice, then it will be necessary to develop measures that are feasible to use as well as have good psychometric properties. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we describe the reliability and validity of the Clinically Useful Anxiety Outcome Scale (CUXOS). The CUXOS was designed to be a brief (completed in less than 2 minutes), quickly scored (in less than 15 seconds), clinically useful measure that is reliable, valid, and sensitive to change. Nearly 1,000 psychiatric outpatients completed the CUXOS and were rated on clinician severity indices of depression, anxiety, and anger. A subset of patients completed other self-report symptom severity scales in order to examine discriminant and convergent validity, and a subset completed the CUXOS twice in order to examine test-retest reliability. Sensitivity to change was examined in patients with panic disorder and generalized anxiety disorder. On average, the CUXOS took less than 1.5 minutes to complete. The scale had high internal consistency and test-retest reliability, and was more highly correlated with other self-report measures of anxiety than with measures of depression, substance use problems, eating disorders, and anger. The CUXOS was more highly correlated with clinician severity ratings of anxiety than with depression and anger, and CUXOS scores were significantly higher in psychiatric outpatients with anxiety disorders than in patients with other psychiatric disorders. Finally, the CUXOS was a valid measure of symptom change. The results of this large validation study of the CUXOS show that it is a reliable and valid measure of anxiety that is feasible to incorporate into routine clinical practice.


Advanced rural skills training: are recently qualified GPs using their procedural skills?
The number of GPs providing procedural services in rural areas is declining; however, few studies have investigated issues directly relevant to recently qualified doctors. Limited published data and anecdotal reports in Australia suggest that a large proportion of doctors leave rural procedural practice soon after training. This study aimed to: (1) describe where GPs practice in the 5 years after advanced rural skills training; (2) describe the proportion of doctors using their advanced skills; (3) measure doctors' ratings of the quality of support and how critical the year directly following training is in future career choices; and (4) measure the association between support and use of advanced skills. A cross-sectional, postal survey was undertaken of doctors who had completed advanced rural skills training in Queensland between 1995 and June 2009. Data were collected on a three-page, structured questionnaire. General practice colleges, the three Queensland regional training providers and one national training provider were approached in order to identify and mail questionnaires to eligible doctors. Descriptive statistics were prepared for practice history information, and attitudinal ratings. A χ(2) test was used to analyse the association between support and use of skills. Sixty-one completed questionnaires were returned resulting in an unadjusted response rate of 51.7%. Respondents had completed a range of training posts: obstetrics and gynaecology (37.7%), anaesthetics (18%), anaesthetics and obstetrics and gynaecology (11.5%) and Aboriginal and Torres Strait Islander health (11.5%). Thirty-nine respondents (63.9%) were using skills related to their advanced training at the time of the study. In the first 5 years after training, the percentage of doctors using their advanced rural skills decreased from 75.4% to 61.1%. The year directly following advanced training was rated as 'critical' or 'very critical' in their future career choices by 68.9% of respondents. However, ratings of the quality of support received in that year were varied, with 21.4% reporting 'very poor' support. There was a statistically significant association between ratings of support in the year directly following training and the use of skills 3 years after training (χ(2) = 8.715, df = 2, p = 0.013). This study has shown that while the majority of doctors are using skills related to their advanced rural skills training, there is room for improvement through training and career planning support, extending formal support mechanisms into the first year after training, improving opportunities to use advanced skills and improving systems to re-engage doctors into procedural practice.


Acid-sensing ion channel 3 (ASIC3) cell surface expression is modulated by PSD-95 within lipid rafts.
Acid-sensing ion channel 3 (ASIC3) is a H(+)-gated cation channel primarily found in sensory neurons, where it may function as a pH sensor in response to metabolic disturbances or painful conditions. We previously found that ASIC3 interacts with the postsynaptic density protein PSD-95 through its COOH terminus, which leads to a decrease in ASIC3 cell surface expression and H(+)-gated current. PSD-95 has been implicated in recruiting proteins to lipid rafts, which are membrane microdomains rich in cholesterol and sphingolipids that organize receptor/signaling complexes. We found ASIC3 and PSD-95 coimmunoprecipitated within detergent-resistant membrane fractions. When cells were exposed to methyl-beta-cyclodextrin to deplete membrane cholesterol and disrupt lipid rafts, PSD-95 localization to lipid raft fractions was abolished and no longer inhibited ASIC3 current. Likewise, mutation of two cysteine residues in PSD-95 that undergo palmitoylation (a lipid modification that targets PSD-95 to lipid rafts) prevented its inhibition of ASIC3 current and cell surface expression. In addition, we found that cell surface ASIC3 is enriched in the lipid raft fraction. These data suggest that PSD-95 and ASIC3 interact within lipid rafts and that this raft interaction is required for PSD-95 to modulate ASIC3.


[Czech linguistic validation of the Pelvic Organ Prolapse/ Urinary Incontinence Sexual Questionnaire - IUGA revised].
To produce a Czech version of a validated tool for sexual quality of life assessment among women with pelvic floor disorders; PISQ-IR (Pelvic organ prolapse/Incontinence Sexual Questionnaire - Internationally Revised). Original study. Department of Obstetrics and Gynecology, University Hospital and Faculty of Medicine, Charles University in Pilsen. The whole process of translation and linguistic validation of the questionnaire followed the protocol of the International Urogynecology Association developed for this purpose. The original translation was repeatedly discussed with patients with incontinence or prolapse in order to preserve the meaning and comprehensibility of the items. The resulting questionnaire was reversely translated into English by an independent translator and sent to IUGA translation working group for validation. The translation was finalized based on recommendations from the group. PISQ-IR is a self-administered questionnaire improved from the previous and short versions. It contains 20 questions, the first question determines whether section 1 for sexually inactive or section 2 for sexually active women is to be completed. The first section for sexually inactive women contains five questions with 12 items. The second section comprises of 14 questions with 22 items for sexually active women with a partner or 12 questions with 19 items for those without a partner. The questionnaire is evaluated separately for individual sub-scales. Compared to former PISQ-12, the PISQ-IR was improved to enable separate assessment of individual domains and its subscales, and to be useful also in non-sexually active women and women with anal incontinence. At the same time it can be also utilized in case of incompletely filled-in questionnaire. A certain disadvantage for clinical practice is its more complex evaluation. Linguistic validation of a PISQ-IR questionnaire was performed and the questionnaire is presented. We present a Czech translation of a validated tool for assessment of quality of sexual life in women with prolapse or urinary/anal incontinence. Psychometric evaluation remains yet to be performed.


The effect of surface treatment with a fractional carbon dioxide laser on shear bond strength of resin cement to a lithium disilicate-based ceramic.
This study investigated the impact of different surface treatments, including fractional carbon dioxide (CO2) laser on shear bond strength (SBS) of resin cement to lithium disilicate ceramic. In this in vitro study, 72 blocks of IPS e.max CAD ceramic were randomly divided into six groups in terms of treatment (n = 12). Group 1 underwent etching with 9.6% hydrofluoric (HF) acid, whereas group 2 was subjected to air abrasion with aluminum oxide particles. Groups 3 and 4 were treated with a fractional CO2 laser for 10 s using 10 W/14 mJ (group 3) or 20 W/10 mJ (group 4). In groups 5 and 6, the CO2 laser was applied similar to that in groups 3 and 4, respectively; then, the specimens were etched by HF acid. After silane application, luting cement was bonded to the specimens. The SBS was assessed with a universal testing machine, and the type of bond failure was determined. Data were analyzed by ANOVA, Duncan, and Fisher's exact tests. Surface conditioning with fractional CO2 laser alone resulted in significantly lower SBS than HF acid treatment (P < 0.05). Bond strengths of the specimens treated with a combination of laser irradiation and acid etching were significantly greater than all the other groups (P < 0.05). No significant difference was found in the distribution of failure modes among the groups (P = 0.337). The combination of fractional CO2 laser irradiation and HF acid etching could be recommended when extra retention is required for lithium disilicate-based restorations, whereas laser treatment alone cannot produce sufficient SBS.


In vitro studies on the antioxidant and growth stimulatory activities of a polyphenolic extract from Cudrania cochinchinensis used in the treatment of wounds in Vietnam.
The leaves of Cudrania cochinchinensis, a Vietnamese folk remedy, have been suggested as a beneficial agent for wound healing. Animal studies and clinical observations in Vietnam have shown positive wound healing activity. We studied the effects of a polyphenolic extract from the plant on the proliferation of cells in culture and their response to oxidative damage by hydrogen peroxide. Fibroblasts were incubated with different concentrations of the extract in 0.4% fetal calf serum, and proliferation was monitored by a colorimetric assay. Cell damage was induced by exposure to hydrogen peroxide 7 x 10(-5) mol/L for 3 hours. The same colorimetric assay was used to assess cell damage and the protective effect of the extract against oxidative damage. The extract at low concentrations (0.1 to 5 microg/ml) had a stimulatory effect on fibroblast growth. The effect was significant by 7 days after the addition of the extract and was strongest at a concentration of 1 microg/ml of extract (p< or = 0.01). The extract at concentrations of 5 or 50 microg/ml protected fibroblasts and endothelial cells against hydrogen peroxide-induced damage. Pretreatment with the extract or exposure to extract simultaneously with hydrogen peroxide gave only partial protection against oxidative damage, whereas a combination of the two treatments gave complete protection (p< or = 0.005). Stimulation of fibroblast proliferation and protection of cells against destruction by inflammatory mediators may be ways in which the polyphenolic substances from the plant, Cudrania cochinchinensis, contribute to wound healing.


A quantitative method for blood lipoproteins using cellulose acetate electrophoresis.
A rapid, inexpensive, and quantitative method is described for obtaining the levels of plasma very low, low, and high density lipoproteins using cellulose acetate electrophoresis and lipid assays without prior separation by ultracentrifuge or other techniques. It involves separation of the lipoproteins by cellulose acetate electrophoresis, followed by their identification with the ozone-Schiff reaction. The total lipoprotein concentration is estimated from the total plasma phospholipid, and the percentage of each component obtained by densitometric analysis of the stained electrophoretograms, using reflected light. For samples with a raised level of very low density lipoprotein, plasma triglyceride analysis is also required. The results obtained by the cellulose acetate electrophoresis method are in good agreement with those by the analytical ultracentrifuge and the preparative ultracentrifuge with refractometry. The theoretical assumptions on which the method is based have been shown to be valid.


Unzipping Mechanism of Free and Polyarginine-Conjugated DNA-PNA Duplexes, Preconfined Inside the α-Hemolysin Nanopore.
In this work, comparative studies on DNA-PNA and polyarginine-conjugated DNA-PNA duplexes unzipping inside the α-hemolysin nanopore (α-HL) are presented. We identified significant differences in the blockade currents, as the applied voltage across the nanopore facilitated the duplex capture inside the nanopore's vestibule against the constriction region, subsequent cDNA strand insertion inside the nanopore's β-barrel past the constriction site, its complete unzip from the duplex, and translocation. We observed that inside the voltage-biased nanopore, polyarginine-conjugated DNA-PNA duplexes dehybridize faster than their DNA-PNA counterparts and proposed a model to describe the duplex unzipping. This study identifies key particularities of DNA-PNA duplex unzipping as it takes place inside the nanopore and being preceded by entrapment in the vestibule domain of the α-HL. Our results are a crucial step toward understanding the nucleic acids duplexes unzipping kinetics variability, in confined, variable geometries.


Psychological sequelae of sterilization in women in Singapore.
The Chinese in Singapore erroneously believe that there is an association between sterilization and castration. This belief has led to deep-seated fears that sterilization may result in obesity, physical weakness, and impairment of sexual function. Beginning in 1969, Singapore authorities introduced increasingly stronger social policies to help reduce family size. Subsequently, there was a large increase in the number of tubal ligations. It was initially thought that this might result in a high incidence of psychological sequelae. A study of 150 women who had had culdoscopic ligations showed that 6.3 percent were dissatisfied at the end of 2 years. Women with fewer than 4 children and those with fewer than 2 sons tended to be more dissatisfied with sterilization.


Photoswitching of DNA Hybridization Using a Molecular Motor.
Reversible control over the functionality of biological systems via external triggers may be used in future medicine to reduce the need for invasive procedures. Additionally, externally regulated biomacromolecules are now considered as particularly attractive tools in nanoscience and the design of smart materials, due to their highly programmable nature and complex functionality. Incorporation of photoswitches into biomolecules, such as peptides, antibiotics, and nucleic acids, has generated exciting results in the past few years. Molecular motors offer the potential for new and more precise methods of photoregulation, due to their multistate switching cycle, unidirectionality of rotation, and helicity inversion during the rotational steps. Aided by computational studies, we designed and synthesized a photoswitchable DNA hairpin, in which a molecular motor serves as the bridgehead unit. After it was determined that motor function was not affected by the rigid arms of the linker, solid-phase synthesis was employed to incorporate the motor into an 8-base-pair self-complementary DNA strand. With the photoswitchable bridgehead in place, hairpin formation was unimpaired, while the motor part of this advanced biohybrid system retains excellent photochemical properties. Rotation of the motor generates large changes in structure, and as a consequence the duplex stability of the oligonucleotide could be regulated by UV light irradiation. Additionally, Molecular Dynamics computations were employed to rationalize the observed behavior of the motor-DNA hybrid. The results presented herein establish molecular motors as powerful multistate switches for application in biological environments.


Association of the risk of obstructive sleep apnoea with the severity of COVID-19.
Patients with coronavirus 2019 (COVID-19) and obstructive sleep apnoea (OSA) have a worse prognosis than COVID-19 patients without OSA. This study aimed to examine the relationship between OSA risk and the severity of COVID-19 in patients undiagnosed with OSA. Patients diagnosed with COVID-19 and hospitalized or admitted to a community hotel were recruited for the study after recovery during a clinic check-up visit 6-8 weeks after discharge. At this visit, they answered the Epworth Sleeping Scale (ESS) and Berlin questionnaire. Demographic and clinical details were collected from electronic medical records. OSA risk was observed in 37 of 119 included patients (31.1%). Patients with high OSA risk were male, significantly older, had a higher body mass index (BMI), and had higher rates of hypertension and snoring than patients with low OSA risk. Moreover, OSA risk was associated with COVID-19 severity; 48.6% of patients with high risk for OSA suffered from severe COVID-19 compared to 22% of patients with low risk for OSA (p = 0.007). The duration of hospitalization for patients with a high OSA risk was 10.97±9.43 days, while that for those with a low OSA risk was 4.71±6.86 days (p = 0.001). After adjusting for BMI, age, hypertension, and chronic disease, the odds ratio was 4.3 (95%CI, 1.2-16, p = 0.029). A high OSA risk was associated with severe COVID-19 and longer hospitalization. Thus, we recommend that the Berlin and ESS questionnaires be completed for every COVID-19-infected patient at hospitalization, especially in the presence of comorbidities.


[Psychotropic effects of Sino-Japanese traditional medicines].
Recently there are a number of clinical reports that Sino-Japanese traditional medicines have good effects on patients with anxiety and/or depression. To detect the clinical efficacy of those medicines, we have examined those effects on various behavioral changes induced by stress in experimental animals. Although it appears to be possible to demonstrate a part of the psychotropic effects of the medicines, their action mechanisms are far from being understood. An improving effect of Shimotsu-to on the spatial cognitive deficits induced by scopolamine in eight radial maze might be due to that of paeony root and to its major principle, paeoniflorin. However, it appears that pharmacological effects of Shimotsu-to, a traditional medicine, cannot be explained by those of an active principle of paeony root, paeoniflorin.


Conformation and orientation of a protein folding intermediate trapped by adsorption.
Although adsorption-induced conformational changes of proteins play an essential role during protein adsorption on interfaces, detailed information about these changes is lacking. To further the current understanding of protein adsorption, in this study, the orientation, conformation, and local stability of bovine alpha-lactalbumin (BLA) adsorbed on polystyrene nanospheres is characterized at the residue level by hydrogen/deuterium exchange and 2D NMR spectroscopy. Most of the adsorbed BLA molecules have conformational properties similar to BLA molecules in the acid-induced molten globule state (A state). A folding intermediate of BLA is thus induced and trapped by adsorption of the protein on the hydrophobic interface. Several residues, clustered on one side of the adsorbed folding intermediate of BLA, have altered amide proton exchange protection factors compared to those of the A state of BLA. This side preferentially interacts with the interface and includes residues in helix C, the calcium binding site, and part of the beta-domain. Local unfolding of this interacting part of the adsorbed protein seems to initiate the adsorption-induced unfolding of BLA. Adsorption-induced protein unfolding apparently resembles more the mechanical unfolding of a protein than the global unfolding of a protein as induced by denaturant, pH, or pressure. 2D macromolecular crowding prevented the minority of adsorbed BLA molecules, which arrived late at the interface, to unfold to the A state. Protein adsorption is a novel and challenging approach to probe features of the free energy landscapes accessible to unfolding proteins.


A technological and regulatory outlook on CRISPR crop editing.
Generating plants with increased yields while maintaining low production and maintenance costs is highly important since plants are the major food source for humans and animals, as well as important producers of chemicals, pharmaceuticals, and fuels. Gene editing approaches, particularly the CRISPR-Cas system, are the preferred methods for improving crops, enabling quick, robust, and accurate gene manipulation. Nevertheless, new breeds of genetically modified crops have initiated substantial debates concerning their biosafety, commercial use, and regulation. Here, we discuss the challenges facing genetic engineering of crops by CRISPR-cas, and highlight the pros and cons of using this tool.


Awarding Credit for Outcomes-Based Professional Development.
The American Nurses Credentialing Center is embarking on a pilot project designed to award credit to RNs for achievement of outcomes-based professional development activities, regardless of time spent in the endeavor. This article explores the value of this approach in the current health care environment. J Contin Educ Nurs. 2017;48(3):97-98.


Scales for hyperkinetic disorders: A systematic review.
Hyperkinetic movement disorders represent a heterogeneous group of disorders in which involuntary movements are the prevalent clinical symptoms. The five main categories of hyperkinetic disorders are tremor, dystonia, tics,myoclonus and drug-induced dyskinesia.The severity of hyperkinetic disorders is assessed by all clinicians when they examine a patient; quantifying the severity also provides a means of studying the natural history of a given disorder and the possible effect of new therapeutic interventions. This means that good rating instruments are required in both everyday practice and experimental settings. Unfortunately, the clinical evaluation of these disorders is complicated by the inherent nature and variability over time of involuntary movements. A number of scales have been proposed over the years to study the various hyperkinetic disorders. The aim of this review is to systematically identify all the clinical scales that have been proposed and to classify them according to the criteria developed by the Movement Disorder Society (MDS) task force for rating scales in Parkinson's disease.On the basis of this methodology, a scale may be defined as 'Recommended', 'Suggested' or 'Listed' in decreasing order of value.We found that, although numerous scales aimed at assessing hyperkinetic disorders have been published, their variability in terms of clinimetric properties, availability and effort required to administer them is high. In this evaluation, we identified scales defined as 'Recommended' for the assessment of all forms of hyperkinetic disorders. The situation highlighted by our analysis varies considerably, with several 'Recommended' scales being available for some conditions such as tics or dystonia, but only one being available for myoclonus. This gap needs to be filled by the scientific community through both the development of new clinical tools and there finement of existing ones.


Mixed Halide Perovskite Films by Vapor Anion Exchange for Spectrally Stable Blue Stimulated Emission.
Solution-processed all-inorganic CsPbX3 perovskites exhibit outstanding optoelectronic properties and are being considered as a promising optical gain medium, with impressive performance in the green and red region. However, the development of CsPbX3 for blue emission is still lagging far behind, owing to difficulties in thin films synthesis and spectral instability subject to light irradiation. Here, a facile vapor anion exchange (VAE) method that enables preparation of blue-emitting perovskite films with both excellent surface morphology and good photo-stability is reported. The mixed-Br/Cl quasi-2D perovskite films show spectrally stable pure blue emission (471 nm) under continuous-wave laser irradiation with power density as high as 81 W cm-2 . Furthermore, optically pumped blue amplified spontaneous emission (ASE) is realized based on the mixed-Br/Cl perovskite films. By changing the duration of VAE treatment, the ASE peak can be tuned from 537 nm down to 475 nm. This work not only presents a facile method to prepare high quality mixed halide Cs-based perovskite films, but also pave the way for further exploration of stable blue perovskite lasing.


Using micro-climates takes a cool head.
Simon Keel, product executive at air-conditioning equipment specialist Daikin UK, discusses climate control solutions for the hospital environment as a raft of environmental legislation, and the need to cut both costs and emissions, hit home.


Metastatic bronchial neuroendocrine tumor to the pineal gland: a unique manifestation of a rare disease.
Metastatic Neuroendocrine Tumor (NET) to the pineal gland is a unique manifestation previously unreported in the literature. We describe an unusual case of metastatic bronchial NET to the pineal gland in a 71-year-old male patient. His primary NET had been resected six years previously and there was no indication of the presence of disseminated metastatic disease at that time. Due to increased uptake by the pituitary gland on the post-operative 111Indium-pentetreotide scintigraphy (Octreoscan), an intra-sellar mass was diagnosed and excised using a transsphenoidal approach; histology revealed an unrelated non-functional pituitary macroadenoma. Four years later, a new mass appeared on MRI, involving the pineal gland, and was diagnosed on biopsy as a metastatic lesion from the original bronchial NET. Since this lesion was not accessible to surgery, it was treated successfully with radiosurgery. The case suggests that NETs should be considered in the differential diagnosis of pineal gland metastases and that radiosurgery may be an effective alternative in the treatment of these patients.


Risk factors of converting to laparotomy in laparoscopic appendectomy for acute appendicitis.
Laparoscopic appendectomy (LA) for acute appendicitis has several advantages over open appendectomy (OA). In cases of complicated appendicitis, LA is converted to OA at a constant rate, though converting appendectomy (CA) has several disadvantages. We retrospectively determined preoperative risk factors for failure of LA and subsequent conversion to OA. Consecutive cases of preoperative computed tomography (CT) and attempted LA were retrieved from our hospital database and grouped by procedure (LA versus CA). Patients with negative appendectomies (n = 28), opened appendectomy (n = 210), delayed interval appendectomy (n = 3), or who were <14 years of age were excluded. Average patient age, preoperative C-reactive protein (CRP) level, and diffuse peritonitis were significantly different between the groups. CT inflammation and occurrence of complicated appendicitis were significantly higher in CA than LA. Conversion to OA was mostly because of dense adhesions, diffuse peritonitis, and difficulties in excision of the appendix due to perforation or severe inflammation from surgical point of view. Postoperative complications were significantly lower in LA than CA, although the rate of intraoperative abscess was not different. Most patients with acute appendicitis can be successfully treated with LA. We identified the following significant risk factors of CA: CT inflammation grade 4 or 5; complicated appendicitis; higher preoperative CRP level; and diffuse peritonitis.


Accurate Performance Analysis of Coded Large-Scale Multiuser MIMO Systems with MMSE Receivers.
In this paper, we estimate the uplink performance of large-scale multi-user multiple-input multiple-output (MIMO) networks. By applying minimum-mean-square-error (MMSE) detection, a novel statistical distribution of the signal-to-interference-plus-noise ratio (SINR) for any user is derived, for path loss, shadowing and Rayleigh fading. Suppose that the channel state information is perfectly known at the base station. Then, we derive the analytical expressions for the pairwise error probability (PEP) of the massive multiuser MMSE-MIMO systems, based on which we further obtain the upper bound of the bit error rate (BER). The analytical results are validated successfully through simulations for all cases.


Factors Associated With Testing for Hepatitis C Infections Among a Commercially Insured Population of Persons With HIV, United States 2008-2016.
Hepatitis C virus (HCV) infection is an important public health problem among people with HIV. People with HIV who are coinfected with HCV infection are at increased risk for cirrhosis, liver failure, and hepatitis C-related mortality; as such, national guidelines recommend that persons with HIV be tested for HCV infection. Data from the 2003-2017 IBM Watson Health MarketScan database were used for this study. We used diagnostic, procedural, and drug codes to identify patients with ≥1 inpatient or outpatient medical claim of HIV diagnosis. Patients with prior HIV or hepatitis C diagnoses were excluded. We calculated hepatitis C testing rates among newly diagnosed HIV-infected persons within 12 months of the initial HIV diagnosis date (January 1, 2008-December 31, 2016). We used Poisson regression to identify the factors associated with hepatitis C testing. Lastly, we assessed hepatitis C testing trends using the Cochran-Armitage test. The prevalence of testing for hepatitis C in newly identified persons with HIV (n = 46 277) was 50% within 12 months of the index HIV diagnosis. From 2008 to 2017, the testing rate increased by 13%. Significant predictors of hepatitis C testing were age, sex, and urbanicity. Women with HIV were less likely to have been tested compared with men (relative risk, 0.79; 95% CI, 0.77-0.81). Only 40% of patients between 50 and 59 years of age were tested for hepatitis C within 12 months of the index HIV diagnosis, while 56% of persons with HIV aged 20-29 years were tested for hepatitis C. Overall, 50% of newly diagnosed HIV patients were tested for hepatitis C within 12 months of HIV diagnosis. Although there were increases in hepatitis C testing rates over the study period, there were missed opportunities to detect HCV infection among people newly diagnosed with HIV.


Viability of 'Candidatus Liberibacter asiaticus' prolonged by addition of citrus juice to culture medium.
Huanglongbing, or citrus greening disease, is associated with infection by the phloem-limited bacterium 'Candidatus Liberibacter asiaticus'. Infection with 'Ca. L. asiaticus' is incurable; therefore, knowledge regarding 'Ca. L. asiaticus' biology and pathogenesis is essential to develop a treatment. However, 'Ca. L. asiaticus' cannot currently be successfully cultured, limiting its study. To gain insight into the conditions conducive for growth of 'Ca. L. asiaticus' in vitro, 'Ca. L. asiaticus' inoculum obtained from seed of fruit from infected pomelo trees (Citrus maxima 'Mato Buntan') was added to different media, and cell viability was monitored for up to 2 months using quantitative polymerase chain reaction in conjunction with ethidium monoazide. Media tested included one-third King's B (K), K with 50% juice from the infected fruit, K with 50% commercially available grapefruit juice, and 100% commercially available grapefruit juice. Results show that juice-containing media dramatically prolong viability compared with K in experiments reproduced during 2 years using different juice sources. Furthermore, biofilm formed at the air-liquid interface of juice cultures contained 'Ca. L. asiaticus' cells, though next-generation sequencing indicated that other bacterial genera were predominant. Chemical characterization of the media was conducted to discuss possible factors sustaining 'Ca. L. asiaticus' viability in vitro, which will contribute to future development of a culture medium for 'Ca. L. asiaticus'.


Study of the TIG Welding Process of Thin-Walled Components Made of 17-4 PH Steel in the Aspect of Weld Distortion Distribution.
This article presents the results of a study on the distribution of weld distortion in thin-walled components made of 17-4 PH steel, resulting from TIG (Tungsten Inert Gas) welding. Both manual and automatic welding processes were examined. Physical simulation of the automated welding process was conducted on a custom-built welding fixture. Analysis of weld distortion in thin-walled components made of 17-4 PH steel was based on the results of measurements of transverse shrinkage and displacement angle values. These measurements were taken on thin-walled parts before and after the welding process using a coordinate measuring machine (CMM). To determine the effect of manual and automated welding processes on the microstructure of the welded joint area, metallographic tests and hardness measurements were performed. The microstructure was analyzed using a scanning electron microscope (SEM). An analysis of the chemical composition of selected welded joint zones was also conducted. These tests were performed using an optical emission spectrometer (OES). According to the results, the use of automated welding and special fixtures for manufacturing thin-walled aircraft engine components made of 17-4 PH steel reduces the propensity of these components for distortion due to the effects of the thermal cycle of the welding process. This conclusion is supported by the results of the observation of the microstructure and analysis of the chemical composition of the various zones of the welded joint area.


Rapid screening of fatty acids using nanostructure-initiator mass spectrometry.
We present the application of nanostructure-initiator mass spectrometry (NIMS) as a fast and simple method for the analysis of plant and microbial fatty acids. NIMS allowed the direct detection of a broad range of saturated and unsaturated fatty acids in negative mode showing linearity over several orders of magnitude with a limit of detection at the femtomole level. Additionally, the fatty acid compositions of olive and soybean oil and the algal species Chlamydomonas reinhardtii could be determined both qualitatively and quantitatively with only minimal sample volumes and preparation steps. The unique properties of the NIMS surface allowed for an in situ sample cleanup step leading to a more than 10-fold increase of the signal-to-noise ratio. Our data provide the basis for rapid screening of plant and microbial oils and may aid in the development of biodiesel fuels.


The copying of upright and tilted squares by swazi children and adults.
Children aged 5-12, and adults from a rural area of Swaziland, along with urban based adults were assessed on their copying ability for a square orientated in two ways, squarely and obliquely; and under five different conditions. The children and rural adults experienced significant difficulties in copying the obliquely orientated shape, while the urban adults produced the shape without difficulty, although they all easily perceived the shapes and programmed the required movements. The results indicate that the process of planning the fine movements for drawing is learned, improves with age, and practice is necessary. Where planning is more complex, in the production and combination of oblique lines, it appears that the lack of practice in Swazi rural schools, and generally little requirement to use the skills, results in a delay of those particular drawing abilities.


The p49/TaqI Y-specific DNA haplotypes in Australian aborigines.
The TaqI/p49 Y-specific RFLPs were studied in 59 Australian aborigines. A new haplotype was found (not present in Caucasians and Africans, number XXV). In the revised genealogy of haplotypes, Australian haplotypes appear to occupy an intermediate position between African Pygmies and Papua haplotypic repartitions, while the most common Australian haplotypes (haplotype III, 25% of the subjects) is apparently derived from them.


Gender differences in the surgical treatment of lumbar disc herniation in elderly.
Outcome after lumbar disc herniation (LDH) surgery in middle-aged patient is usually reported to fulfill the criteria for successful outcome. It is also known that women in these years have an inferior outcome compared to men. This study evaluates whether the same gender differences exist in elderly. In the national Swedish register for spine surgery (SweSpine) we identified 1668 patients ≥65 years. 1250 of these patients had both pre- and 1-year postoperative data registered, 53 % males with mean age 70.6 ± 5.0 (mean ± SD) and 47 % females with mean age 71.3 ± 5.2. All were surgically treated due to LDH between 2000 and 2012. Before surgery both men and women had severe impairment, compared to normative data, in all patient-reported outcome measures (PROMs), with women having inferior status to men. Improvement by surgery was similar in both genders but neither of them reached normative values in quality of life as compared to normative age-matched individuals. As a consequence of this women 1 year after surgery had more back and leg pain, higher consumption of analgesics, greater impairment in walking distance and inferior scoring in virtually all registered PROMs compared to men (all p < 0.005). In spite of this women were as satisfied with the surgical outcome as the men. Elderly women with LDH surgery report inferior outcome compared to males, mainly as a result of being referred to surgery with an inferior status but are despite this as satisfied with outcome as the men.


Oesophageal hyperkeratosis: clinicopathological associations.
Oesophageal hyperkeratosis is rarely described. In contrast to hyperkeratosis of orolaryngeal mucosa, where its risk factors and association with squamous neoplasia are well-studied, the prevalence and clinicopathological features of oesophageal hyperkeratosis are unknown. We reviewed prospectively 1845 oesophageal biopsies and found hyperkeratosis in 37 (2.0%). Among 98 patients studied, hyperkeratosis occurred in two distinct settings: group 1 [within Barrett's oesophagus (BO)/adenocarcinoma, n = 61, 62%] and group 2 (outside BO/adenocarcinoma, n = 37, 38%). In contrast to group 1, hyperkeratosis in group 2 was more often multifocal (>3 foci in 51% versus 16%, P = 0.0001), involved mid-oesophagus (51% versus 2%, P < 0.0001), showed endoscopic leucoplakia (24% versus 3%, P = 0.003) and involved current/former alcohol users (51% versus 19%, P = 0.0012). Importantly, invasive squamous carcinoma and squamous dysplasia were seen only in group 2 (47% and 19% versus 0%, P < 0.0001). Further, 42% of group 2, but none of group 1, had benign or malignant squamous lesions of the oral cavity/larynx (P < 0.0001). Hyperkeratosis involves ~2% of oesophageal biopsies and can be divided into cases occurring within BO/adenocarcinoma and those occurring outside BO/adenocarcinoma. The former lack clinical significance, whereas the latter are associated frequently with oesophageal squamous neoplasia and squamous pathology of the head and neck region.