Soluble endothelial adhesion molecules during paediatric cardiovascular surgery with or without cardiopulmonary bypass.
Paediatric cardiovascular surgery with or without cardiopulmonary bypass induces a complex pattern of pro- and anti-inflammatory responses. It is suspected that they may contribute to changes on the vascular endothelium. The endothelial response to cardiosurgical trauma and cardiopulmonary bypass, especially in children, has yet to be well established. We studied 29 children undergoing cardiovascular surgery with cardiopulmonary bypass, comparing them with 21 not undergoing bypass. The groups did not differ significantly with respect to age, sex, weight and preoperative parameters. Blood samples were drawn 24 h before surgery, after onset of anaesthesia, after onset of cardiopulmonary bypass and after rewarming in those undergoing bypass, or immediately after surgery in the control group, 4 h and 2 days after surgery, at discharge, and months after surgery during out-patient follow-up. Serum levels of soluble E-selectin, P-selectin and P-selectin glycoprotein ligand-1 were measured by enzyme-linked immunoassay. Paediatric cardiovascular surgery leads perioperatively to the significant decreases of the serum levels of soluble P- and E-selectin, as well as of soluble P-selectin glycoprotein ligand-1 (all p < 0.05). The time course, and all concentrations, of these molecules were not significantly different with and without bypass. The decreases, however, were more pronounced with cardiopulmonary bypass. Preoperative baseline values were reached months after surgery. Endothelial activation of release of adhesion molecules is reduced during paediatric cardiovascular surgery. Endothelial activity is more perturbed with cardiopulmonary bypass and for a long time after surgery.


How many pins? A case report of a girl who swallowed more than 50 straight pins in a suicide attempt.
A 14-year-old girl was admitted after attempting suicide by swallowing over 50 pins. On admission, she complained of abdominal pain. A flat abdominal X-ray revealed numerous needle-like objects in the large intestine. After a period of observation we were able to diagnose her as suffering from a major depressive episode with psychotic features, post-traumatic stress disorder, physical abuse, neglect and inhalant abuse. Medically, the pins were spontaneously evacuated with her stools without any intervention. The mode of the suicide attempt was an important clue to raise suspicion of a psychotic episode. Two issues are discussed: 1) A "psychiatric" issue: the way in which an attempt is made should be considered as a factor not just for the evaluation of the suicidal risk, but also for the psychopathology. This case demonstrates that a bizarre attempt should raise the suspicion of a psychotic disorder. 2) A "general medical" issue: our experience with this patient was in accordance with common medical expectant management for patients who have swallowed multiple sharp objects once they have reached the large intestine. We conclude: 1) In the preliminary psychiatric evaluation, more emphasis should be placed on how bizarre the means of the suicide attempt as a possible sign of a psychotic psychopathology. 2) Treatment for adolescents who swallow numerous sharp objects should consist of expectant management once those objects reach the large intestine.


Epstein-Barr Virus: From the Detection of Sequence Polymorphisms to the Recognition of Viral Types.
The Epstein-Barr virus is etiologically linked with the development of benign and malignant diseases, characterized by their diversity and a heterogeneous geographic distribution across the world. The virus possesses a 170-kb-large genome that encodes for multiple proteins and non-coding RNAs. Early on there have been numerous attempts to link particular diseases with particular EBV strains, or at least with viral genetic polymorphisms. This has given rise to a wealth of information whose value has been difficult to evaluate for at least four reasons. First, most studies have looked only at one particular gene and missed the global picture. Second, they usually have not studied sufficient numbers of diseased and control cases to reach robust statistical significance. Third, the functional significance of most polymorphisms has remained unclear, although there are exceptions such as the 30-bp deletion in LMP1. Fourth, different biological properties of the virus do not necessarily equate with a different pathogenicity. This was best illustrated by the type 1 and type 2 viruses that markedly differ in terms of their transformation abilities, yet do not seem to cause different diseases. Reciprocally, environmental and genetic factors in the host are likely to influence the outcome of infections with the same virus type. However, with recent developments in recombinant virus technology and in the availability of high throughput sequencing, the tide is now turning. The availability of 23 complete or nearly complete genomes has led to the recognition of viral subtypes, some of which possess nearly identical genotypes. Furthermore, there is growing evidence that some genetic polymorphisms among EBV strains markedly influence the biological and clinical behavior of the virus. Some virus strains are endowed with biological properties that explain crucial clinical features of patients with EBV-associated diseases. Although we now have a better overview of the genetic diversity within EBV genomes, it has also become clear that defining phenotypic traits evinced by cells infected by different viruses usually result from the combination of multiple polymorphisms that will be difficult to identify in their entirety. However, the steadily increasing number of sequenced EBV genomes and cloned EBV BACS from diseased and healthy patients will facilitate the identification of the key polymorphisms that condition the biological and clinical behavior of the viruses. This will allow the development of preventative and therapeutic approaches against highly pathogenic viral strains.


[A registry of registries and cohorts: recommendations for metadata and policies].
Registries and cohort studies play a central role in patient-oriented medical research, in particular in health services research. In order to increase the transparency about ongoing registries and cohort studies in Germany, and to promote communication and cooperation between the drivers in the field a so-called register portal should be established. Metadata are characteristics that are used to describe registries and cohort studies in the register portal. A limited set of characteristics, the core set, should correctly describe the projects on the one hand while reducing workload for data capture and data administration on the other hand. The core set consists of 26 data elements that had been defined in a Delphi-consensus process involving experts from the working group registries of the German Network for Health Services Research (DNVF) and the working group IT infrastructure and quality management of the Technology, Methods, and Infrastructure for Networked Medical Research (TMF). Transparent policies are required to guarantee traceability and reliability of the portal's services. Six so-called top-level-tasks and 37 use cases were defined in an interim report so far. The metadata have been agreed upon by most of the member associations of the DNVF. Metadata and rules of procedures are the starting point for the practical implementation of the register portal in the next future.


Growth, crystal structure, Hirshfeld surface, optical, piezoelectric, dielectric and mechanical properties of bis(L-asparaginium hydrogensquarate) single crystal.
Molecular organic single crystals of bis(L-asparaginium hydrogensquarate) monohydrate [BASQ; (C8H10N2O7)2·H2O] have been grown by solution technique. Crystallographic information was investigated by single-crystal X-ray diffraction (SCXRD) analysis. Hirshfeld surface and fingerprint plot studies were performed to understand the intermolecular interactions of the BASQ crystal in graphical representation. Functional group identification was studied with FT-IR (Fourier transform-IR) spectroscopy. The positions of proton and carbon atoms in the BASQ compound were analyzed using NMR spectroscopy. High transparency and a wide band gap of 3.49 eV were observed in the linear optical study by UV-vis-NIR spectroscopy. Intense and broad photoluminescence emissions at room temperature were observed in blue and blue-green regions. The frontier molecular orbitals of the BASQ molecule were obtained by the DFT/B3LYP method employing 6-311G** as the basis set. The dielectric study was carried out with temperature at various frequency ranges. The piezoelectric charge coefficient (d33) value of BASQ crystal was found to be 2 pC/N, which leads to its application in energy harvesting, mechanical sensors and actuators applications. In the non-linear optical study, the BASQ crystal showed promising SHG conversion efficiency. Mechanical properties of the BASQ crystal were studied experimentally by Vicker's microhardness technique, which revealed that the grown crystal belonged to the softer category. BASQ crystal void estimation reveals the mechanical strength and porosity of the material.


Developing a comprehensive, community-based asthma education and training program.
The Community Asthma Prevention Program (CAPP) is a comprehensive, community-based asthma education and training program focused on the prevention of asthma exacerbations in the pediatric/adolescent population. Details of starting a community-based education program are described. The asthma class series is taught for 5 hours, delivered in 1-hour sessions once each week. Programs are held in schools, daycare centers, churches, and community centers. Classes are conducted simultaneously in separate rooms with parents being taught by a health educator and children taught by a peer educator. To date, 774 parents and 570 children have completed the community classes. The retention rate of participants who complete the 5-week program is 80%. The train-the-trainer model is used for training community members such as parents, teens, school nurses, daycare providers, and foster care workers to provide the community with many members who are trained in asthma education. Strategies used to obtain support and promote program visibility and use in the targeted community are presented.


Peretinoin, an Acyclic Retinoid, Inhibits Hepatitis B Virus Replication by Suppressing Sphingosine Metabolic Pathway In Vitro.
Hepatocellular carcinoma (HCC) frequently develops from hepatitis C virus (HCV) and hepatitis B virus (HBV) infection. We previously reported that peretinoin, an acyclic retinoid, inhibits HCV replication. This study aimed to examine the influence of peretinoin on the HBV lifecycle. HBV-DNA and covalently closed circular DNA (cccDNA) were evaluated by a qPCR method in HepG2.2.15 cells. Peretinoin significantly reduced the levels of intracellular HBV-DNA, nuclear cccDNA, and HBV transcript at a concentration that did not induce cytotoxicity. Conversely, other retinoids, such as 9-cis, 13-cis retinoic acid (RA), and all-trans-retinoic acid (ATRA), had no effect or rather increased HBV replication. Mechanistically, although peretinoin increased the expression of HBV-related transcription factors, as observed for other retinoids, peretinoin enhanced the binding of histone deacetylase 1 (HDAC1) to cccDNA in the nucleus and negatively regulated HBV transcription. Moreover, peretinoin significantly inhibited the expression of SPHK1, a potential inhibitor of HDAC activity, and might be involved in hepatic inflammation, fibrosis, and HCC. SPHK1 overexpression in cells cancelled the inhibition of HBV replication induced by peretinoin. This indicates that peretinoin activates HDAC1 and thereby suppresses HBV replication by inhibiting the sphingosine metabolic pathway. Therefore, peretinoin may be a novel therapeutic agent for HBV replication and chemoprevention against HCC.


Fortuitous Diagnosis of Preexisting Neuropathy During Ultrasound-Guided Regional Anesthesia Performance: A Case Report.
Ultrasound-guided regional anesthesia requires the anesthesia provider to interpret new information. This article reports on the case of a 38-year-old man scheduled for a fifth metacarpal fracture repair. Ultrasound nerve examination revealed abnormal pathology of the axillary brachial plexus consisting of an increased volume of the terminal nerves of the brachial plexus. Ultrasound scanning initiated the subsequent diagnosis of multifocal motor neuropathy. Regional anesthesia was abandoned in favor of general anesthesia. Ultrasonography training needs to be expanded in the coming years to include awareness of the abnormal pathology, as it might impact the choice of anesthetic procedure and patient outcome.


[Postoperative refraction and anterior chamber depth after complicated cataract operation with vitreous loss and transscleral posterior chamber lens fixation].
The accuracy of preoperative biometry was tested in patients with transscleral suture fixation of the posterior chamber lens. Postoperative refraction and anterior chamber depth of 34 eyes that had been subjected to complicated cataract extraction with vitreous loss were compared with those in 17 fellow-eyes in which uncomplicated cataract extraction had been performed. The anterior chamber depth was significantly deeper after transscleral suture fixation of the posterior chamber lens (mean 0.59 mm, P < 0.05). The refraction differed by +0.68 D between transscleral suture fixation and the control group. We recommend that +0.5 D should be added to the calculated intraocular lens power if transscleral suture fixation becomes necessary during cataract extraction.


Changes in spastic muscle tone increase in patients with spinal cord injury using functional electrical stimulation and passive leg movements.
Comparison of cycling interventions to reduce spastic muscle tone increase in patients with spinal cord injury. Neuroprosthetic outpatient clinic in a university hospital. Five patients with spinal cord injury took part in a crossover study in which the lower limbs (1) were stimulated by functional neuromuscular electrical stimulation (FES) to induce leg cycling movements and (2) were passively moved by an ergometer machine. Patients sat in a comfortable chair fastened to the ergometer while FES was done to induce leg cycling (active session). During the passive leg movement session the ergometer moved their legs for the same period of time at the same velocity and frequency. The change in spastic muscle tone increase before and after each training session was tested with the modified Ashworth Scale and the pendulum test of spasticity (relaxation index and peak velocity). The averaged data of the relaxation index increased after FES by about 68%. Compared with the slight increase after the passive movement training of 12%, this is statistically significant (P = 0.01). Peak velocity increased after FES by around 50%, while it was nearly unchanged after the passive intervention (1%); this is also significant (P = 0.01). This was similar with the peak velocity and the modified Ashworth Scale. The study presents further interesting aspects of the usefulness of FES in patients with spinal cord injury to reduce spastic muscle tone.


Spirituality and quality of life in women with breast cancer: The role of hope and educational attainment.
This study investigated relationships among spirituality, hope, and overall quality of life in Muslim women with breast cancer in Malaysia. A cross-sectional descriptive design with a convenience sample of 145 Malay patients was used. The mediating role of hope in the relationship between spirituality and quality of life as well as the moderating effect of education level on the spirituality hope link were examined. Participants with higher self-reported spirituality reported more hope (b = 6.345, p < 0.001) and higher levels of quality of life (b = 1.065, p < 0.001). Higher educational attainment weakened relationships between spirituality and hope (b = -1.460, p < 0.001). The role of advanced education in contributing to lessened hope in relation to spirituality emphasizes the importance of skilled and personalized spiritual counseling in the respective socio-cultural religious context.


Mapping cerebral atrophic trajectory from amnestic mild cognitive impairment to Alzheimer's disease.
Alzheimer's disease (AD) patients suffer progressive cerebral atrophy before dementia onset. However, the region-specific atrophic processes and the influences of age and apolipoprotein E (APOE) on atrophic trajectory are still unclear. By mapping the region-specific nonlinear atrophic trajectory of whole cerebrum from amnestic mild cognitive impairment (aMCI) to AD based on longitudinal structural magnetic resonance imaging data from Alzheimer's disease Neuroimaging Initiative (ADNI) database, we unraveled a quadratic accelerated atrophic trajectory of 68 cerebral regions from aMCI to AD, especially in the superior temporal pole, caudate, and hippocampus. Besides, interaction analyses demonstrated that APOE ε4 carriers had faster atrophic rates than noncarriers in 8 regions, including the caudate, hippocampus, insula, etc.; younger patients progressed faster than older patients in 32 regions, especially for the superior temporal pole, hippocampus, and superior temporal gyrus; and 15 regions demonstrated complex interaction among age, APOE, and disease progression, including the caudate, hippocampus, etc. (P < 0.05/68, Bonferroni correction). Finally, Cox proportional hazards regression model based on the identified region-specific biomarkers could effectively predict the time to AD conversion within 10 years. In summary, cerebral atrophic trajectory mapping could help a comprehensive understanding of AD development and offer potential biomarkers for predicting AD conversion.


* Efficacy of a Self-Assembling Peptide Hydrogel, SPG-178-Gel, for Bone Regeneration and Three-Dimensional Osteogenic Induction of Dental Pulp Stem Cells.
The aim of this study was to assess the efficacy of a self-assembling peptide hydrogel as a scaffold for bone regeneration. We used a neutral and injectable self-assembling peptide hydrogel, SPG-178-Gel. Bone defects (5 mm in diameter) in rat calvarial bones were filled with a mixture of alpha-modified Eagle's medium and peptide hydrogel. Three weeks after surgery, soft X-ray and microcomputed tomography (micro-CT) images of the gel-treated bones showed new bone formations in the periphery and in central areas of the defects. Next, we evaluated the three-dimensional osteogenic induction of dental pulp stem cells (DPSCs), a type of mesenchymal stem cell, in SPG-178-Gel. We first confirmed that the osteogenic differentiation of DPSCs was significantly promoted by osteogenic induction medium containing recombinant human bone morphogenetic protein-4 (rhBMP-4) in a two-dimensional cell culture. Then, we verified DPSC proliferation and osteogenic differentiation in a three-dimensional cell culture using SPG-178-Gel. The gene expression levels of osteopontin, osteocalcin, and collagen type I were significantly increased when DPSCs were cultured in SPG-178-Gel with the osteogenic induction medium. Micro-CT observations showed the formation of widespread calcium deposition. In conclusion, SPG-178-Gel was adequately effective as a scaffold and can be a suitable tool for bone formation in vivo and in vitro. These findings suggest that the self-assembling peptide hydrogel, SPG-178-Gel, could be a promising tool for bone tissue engineering.


Early atherosclerosis and cardiac autonomic responses to mental stress: a population-based study of the moderating influence of impaired endothelial function.
Acute mental stress may contribute to the cardiovascular disease progression via autonomic nervous system controlled negative effects on the endothelium. The joint effects of stress-induced sympathetic or parasympathetic activity and endothelial function on atherosclerosis development have not been investigated. The present study aims to examine the interactive effect of acute mental stress-induced cardiac reactivity/recovery and endothelial function on the prevalence of carotid atherosclerosis. Participants were 81 healthy young adults aged 24-39 years. Preclinical atherosclerosis was assessed by carotid intima-media thickness (IMT) and endothelial function was measured as flow-mediated dilatation (FMD) using ultrasound techniques. We also measured heart rate, respiratory sinus arrhythmia (RSA), and pre-ejection period (PEP) in response to the mental arithmetic and speech tasks. We found a significant interaction of FMD and cardiac RSA recovery for IMT (p = 0.037), and a significant interaction of FMD and PEP recovery for IMT (p = 0.006). Among participants with low FMD, slower PEP recovery was related to higher IMT. Among individuals with high FMD, slow RSA recovery predicted higher IMT. No significant interactions of FMD and cardiac reactivity for IMT were found. Cardiac recovery plays a role in atherosclerosis development in persons with high and low FMD. The role of sympathetically mediated cardiac activity seems to be more important in those with impaired FMD, and parasympathetically mediated in those with relatively high FMD. The development of endothelial dysfunction may be one possible mechanism linking slow cardiac recovery and atherosclerosis via autonomic nervous system mediated effect.


[Bursitis iliopectinea].
PURPOSE OF THE STUDY To present clinical and radiographic findings of iliopectineal bursitis and draw attention to some related etiopathogenetic factors. MATERIAL AND METHODS Six patients followed up between 2005 and 2007 were evaluated. They included four women and two men (average age, 58 years; range, 35 to 80 years) who presented with a tender mass in the hip region (four right and two left sides). Each patient underwent an examination involving a clinical check-up, imaging methods (CT, MR, angio-CT) and standard laboratory tests. RESULTS Iliopectineal bursitis clinically manifested as a tender mass in the groin and hip region in five patients; in one it was pulsating. The sixth case was asymptomatic. In three patients iliopectineal bursitis was found in association with steroid therapy and subsequent avascular necrosis of the femoral head and chronic synovitis. It followed tularemia with hip joint involvement in one patient, salmonella arthritis in one, and kidney transplant rejection in one. Also, iliopectineal bursitis was diagnosed in a patient with rheumatoid arthritis treated with steroids, but without femoral head avascular necrosis, and was incidentally found in another patient examined for digestive problems. Of the six cases of swollen bursa detected by the imaging methods used, five were found to communicate with the hip joint cavity, with four being so large that the bursa extended into the retroperitoneum. Two patients underwent excision or resection of the bursa; in addition, one of them had revitalizing graft surgery for femoral head necrosis. The patient with salmonella arthritis had to undergo a Girdlestone procedure. One patient was treated by draining of the bursa and, after inflammation resolved, total hip replacement surgery was carried out during which the iliopectineal bursa was removed. The patient with rheumatoid arthritis was treated by bursa draining and refused further surgical therapy (total hip replacement). DISCUSSION In our group of six patients, bursitis was symptomatic in five and was associated with chronic hip synovitis accompanying femoral head necrosis following steroid therapy or inflamation, either non-specific or arthitic. Bursitis was asymptomatic in one patient and was diagnosed only incidentally on CT examination done for another reason. The communication between the bursa and the hip joint cavity, found on CT scans and magnetic resonance images, was a radiographic factor important for differential diagnosis. The underlying disease of the hip joint plays a key role in the etiopathogenesis of iliopectineal bursitis. Therefore, surgical treatment should be comprehensible and, in addition to bursa resection or excision, should also include treatment of the affected joint (alloplasty, femoral head resection or revitalization). CONCLUSION Iliopectineal bursitis is associated with chronic hip synovitis present in degenerative, infectious or rheumatic joint diseases. When a lump is diagnosed in the inguinal or hip region, iliopectineal bursitis should always be considered in addition to conditions such as abscess, cyst, hernia, pseudoaneurysm, lymphocele, etc. The finding of communication beteen the bursa and hip joint cavity, made on CT scans or magnetic resonance images, is a radiographic factor important in terms of differential diagnosis. The surgical treatment of iliopectineal bursitis includes excision or resection of the bursa and therapy for the hip joint (alloplasty, femoral head resection or revitalization).


[Characteristics of urinary tract infection in kidney transplant recipients and non-recipient patients].
To compare the characteristics of urinary tract infection (UTI) between kidney transplant recipients and non-recipient patients. Forty-nine kidney transplant recipients with UTI (69 episodes) and 401 non-recipient patients with UTI (443 episodes) admitted in Nanfang Hospital from January 2003 to August 2014 were enrolled in the study. The characteristics of UTI were compared between two groups. In both groups of UTI, female patients comprised a greater proportion (63.3% and 58.6%) and Escherichia coli was the most common pathogen isolated (37.7% and 34.1%). However, the infection rate of Klebsiella pneumonia in recipients was higher than that in non-recipients (11.6% vs 3.2%, P= 0.001), while the infection rate of Candida albicans was lower (1.5% vs 11.3%, P=0.008) than that in non-recipients. Recipients were likely to develop antibiotic resistance and with a higher recurrence rate than non-recipient patients (38.8% vs 16.7%, P<0.001). Compared to non-recipient UTI patients, the symptoms of urinary irritation in recipient UTI patients were more common. There was higher percentage of neutrophil granulocyte (72.65% ± 1.90% vs 68.59% ± 0.73%, P=0.048), lower proportion of lymphocytes (17.73% ± 1.27% vs 21.28% ± 0.61%, P=0.037), and less platelets [(187.64 ± 10.84) × 10(9)/L vs (240.76 ± 5.26) × 10(9)/L, P<0.01] in recipients than in non-recipient UTI patients. These results indicate that the characteristics of UTI in kidney transplantation recipients and non-recipients patients are different.


Sensorimotor adaptation of speech I: Compensation and adaptation.
When motor actions (e.g., reaching with your hand) adapt to altered sensory feedback (e.g., viewing a shifted image of your hand through a prism), the phenomenon is called sensorimotor adaptation (SA). In the study reported here, SA was observed in speech. In two 2-hour experiments (adaptation and control), participants whispered a variety of CVC words. For those words containing the vowel /E/, participants heard auditory feedback of their whispering. A DSP-based vocoder processed the participants' auditory feedback in real time, allowing the formant frequencies of participants' auditory speech feedback to be shifted. In the adaptation experiment, formants were shifted along one edge of the vowel triangle. For half the participants, formants were shifted so participants heard /a/ when they produced /E/; for the other half, the shift made participants hear /i/ when they produced /E/. During the adaptation experiment, participants altered their production of /E/ to compensate for the altered feedback, and these production changes were retained when participants whispered with auditory feedback blocked by masking noise. In a control experiment, in which the formants were not shifted, participants' production changes were small and inconsistent. Participants exhibited a range of adaptations in response to the altered feedback, with some participants adapting almost completely, and other participants showing very little or no adaptation.


Animal models of vascularized nerve grafts: a systematic review.
The aim of this review is to present and compare the various animal models of vascularized nerve grafts described in the literature as well as to summarize preclinical evidence for superior functional results compared to non-vascularized free nerve grafts. We also will present the state of the art on prefabricated vascularized nerve grafts. A systematic literature review on vascularized nerve graft models was conducted via the retrieval with the PubMed database on March 30, 2019. Data on the animal, nerve, and vascularization model, the recipient bed, the evaluation time points and methods, and the results of the study results were extracted and analyzed from selected articles. The rat sciatic nerve was the most popular model for vascularized nerve grafts, followed by the rabbit; however, rabbit models allow for longer nerve grafts, which are suitable for translational evaluation, and produced more cautious results on the superiority of vascularized nerve grafts. Compared to free nerve grafts, vascularized nerve grafts have better early but similar long-term results, especially in an avascular bed. There are few studies on avascular receiving beds and prefabricated nerve grafts. The clinical translation potential of available animal models is limited, and current experimental knowledge cannot fully support that the differences between vascularized nerve grafts and free nerve grafts yield a clinical advantage that justifies the complexity of the procedure.


Characteristics of frequent emergency department users with type 2 diabetes mellitus in Korea.
Frequent emergency department (ED) visitors are medically vulnerable individuals. We identified the characteristics of "frequent ED users" among Korean patients with type 2 diabetes mellitus. We used the Health Insurance Review and Assessment Service National Patient Sample, which is a nationally representative sample. Patients (n = 109,412) with type 2 diabetes mellitus as a primary or secondary diagnosis at one of their visits were included. Individuals were classified into three groups according to the number of ED visits: frequent (≥4 visits), occasional (<4 visits) and non-users of the ED. The characteristics of the patients that distinguished frequent users from the other groups were investigated. Frequent ED users were mainly men (P < 0.001), with longer treatment duration (P < 0.001), more frequent comorbidities (cardiovascular and chronic kidney disease) and primary diagnosis made by surgery (P = 0.0028). They had higher mortality (P = 0.0085), longer hospitalization duration (P < 0.001), higher costs per visit (P < 0.001) and more often required medical protection (P < 0.001). These patients were treated more frequently with sulfonylurea, insulin, meglitinide and alpha-glucosidase inhibitors (P < 0.05). The present findings suggest that frequent users of the ED with type 2 diabetes mellitus have serious health conditions, a poor socioeconomic situation and tend to take some medicines (sulfonylurea, etc.), which often are associated with hypoglycemia. Attention should be given to therapy, and to patients with renal and cardiovascular diseases to decrease the dependency of these patients on the ED.


Resourcefulness in African American and Caucasian American Caregivers of Persons With Dementia: Associations With Perceived Burden, Depression, Anxiety, Positive Cognitions, and Psychological Well-Being.
Providing care to persons with dementia can have negative effects on caregivers' physical and psychological well-being. This secondary analysis explored relationships among perceived burden, depression, anxiety, resourcefulness, and psychological well-being in 28 African American (AA) and 45 Caucasian American (CA) caregivers of persons with dementia. Descriptive, cross-sectional design was used to examine the hypothesized relationships in a sample of 73 caregivers. CAs reported greater burden (t=-3.68, p<.001), more anxiety (t=-2.66, p<.01), depression (t=-2.21, p<.05), and hostility (t=-2.30, p<.05) than AAs. AAs reported higher scores than CAs on resourcefulness, positive cognitions, and psychological well-being. The study findings provided directions for the development of resourcefulness interventions to enhance the psychological well-being among dementia caregivers.


X-ray diagnostics of imploding plasmas from planar wire arrays composed of Cu and few tracer Al wires on the 1MA pulsed power generator at UNR.
Tracer aluminum alloyed wires (Al5056) are used to provide additional information for x-ray diagnostics of implosions of Cu planar wire arrays (PWAs). Specifically, the analysis of combined PWA experiments using the extensive set of x-ray diagnostics is presented. In these experiments, which were conducted at the 1MA pulsed power generator at University of Nevada, Reno, the Z-pinch load consisted of several (eight) Cu alloyed (main material) and one to two Al alloyed (tracer) wires mounted in a single plane row or double parallel plane rows, single planar wire array (SPWA) or double planar wire array (DPWA), respectively. The analysis of x-ray spatially resolved spectra from the main material indicates the increase in the electron temperature T(e) near the cathode. In general, the axial gradients in T(e) are more pronounced for SPWA than for DPWA due to the more "columnlike" plasma formation for SPWA compared to "hot-spot-like" plasma formation for DPWA. In addition, x-ray spectra from tracer wires are studied, and estimated plasma parameters are compared with those from the main material. It is observed that the x-ray K-shell Al spectra manifest more opacity features for the case of SPWA with about 18% of Al mass (to the total load mass) compared to the case of DPWA with about 11% of Al mass. The analysis of time-gated spectra shows that the relative intensity of the most intense K-shell Al line, small before the x-ray burst, increases with time and peaks close to the maximum of the sub-keV signal.


STEM Lab on a Kitchen Table: An Investigation of Remote Student-Driven Problem-Based Research.
In 2020, the COVID-19 pandemic affected formal and informal education programs in the USA. The pandemic had a devastating impact on programs that required a dedicated physical space and in-person laboratory research. The distinguishing feature of New Hampshire Academy of Science (NHAS) programs is the participation of secondary school students in STEM research projects that emulate university-level research. Moving to a remote format presented various challenges. In this case study, we describe and discuss our experiences transforming a summer STEM research program for secondary school students from on-site and in-person to a remote platform, providing details of the planning phase, the logistics of maintaining the quality of the students' research, and the results of internal and external evaluations. Of the 33 students who participated, 32 completed all central elements of the program, and 25 went further and submitted summary papers and presented their research at the remote annual meeting of the American Association for the Advancement of Science. External evaluation found that students saw their work as similar to that of professional scientists, and perceived themselves to have gained proficiency in the use of scientific techniques and instrumentation. Students expressed they missed elements of in-person lab work including social interactions.


Bufalin, a component in Chansu, inhibits proliferation and invasion of hepatocellular carcinoma cells.
Hepatocellular carcinoma (HCC) is a common and aggressive cancer, and the treatment options are limited for patients with advanced HCC. Bufalin, the major digoxin-like component of the traditional Chinese medicine Chansu, exhibits significant anti-tumor activities in many tumor cell lines. In the present study, we investigated the effect of bufalin on the inhibition of an AKT-related signaling pathway, and examined the relationship between regulatory proteins and anti-tumor effects in hepatoma cells. Proliferation, wound healing, transwell-migration/invasion and adhesion assays were performed in HCCLM3 and HepG2 cell lines. The protein levels of pAKT, AKT, pGSK3β, GSK3β, pβ-catenin, β-catenin, E-cadherin, MMP-9, and MMP-2 were measured by western blot analysis. E-Cadherin and β-catenin expression levels were also evaluated by immunofluorescence. Bufalin inhibited hepatoma cell proliferation, migration, invasion and adhesion. In addition, treatment with bufalin significantly decreased the levels of pAKT, pGSK3β, MMP-9, and MMP-2, while increasing the levels of GSK3β and E-cadherin and suppressing the nuclear translocation of β-catenin. Bufalin is a potential anti-HCC therapeutic candidate through its inhibition of the AKT/GSK3β/β-catenin/E-cadherin signaling pathway. Further studies with bufalin are warranted in patients with HCC, especially those with the disease at advanced stages.


Managing Depression Among Homeless Mothers: Pilot Testing an Adapted Collaborative Care Intervention.
Although depression is common among homeless mothers, little progress has been made in testing treatment strategies for this group. We describe pilot test results of an adapted collaborative care model for homeless mothers with depression. We conducted a pilot intervention study of mothers screening positive for depression in 2 randomly selected shelter-based primary care clinics in New York over 18 months in 2010-2012. Study participants completed a psychosocial, health, and mental health assessment at baseline, 3 months, and 6 months. One-third of women screened positive for depression (123 of 328 women). Sixty-seven women (63.2% of the eligible sample) enrolled in the intervention. At 6 months, compared to usual-care women, intervention group women were more likely to be receiving depression treatment (40.0% vs 5.9%, P = .01) and antidepressant medication (73.3% vs 5.9%, P = .001, respectively) and had more primary care physician and care manager visits at both 3 months (74.3% vs 53.3%, P = .009 and 91.4% vs 26.7%, P < .001, respectively) and 6 months (46.7% vs 23.5%, P = .003 and 70% vs 17.7%, P = .001, respectively). More women in the intervention group compared to usual-care women reported ≥ 50% improvement in depression symptoms at 6 months (30% vs 5.9%, P = .07). This pilot study found that implementing an adapted collaborative care intervention was feasible in a shelter-based primary care clinic and had promising results that require further testing. ClinicalTrials.gov identifier: NCT02723058.


Transferrin phenotype and level of carbohydrate-deficient transferrin in healthy individuals.
Elevated concentrations of carbohydrate-deficient components of transferrin (CDT) in serum may be used as a sensitive and specific marker of regular, high alcohol consumption. When determined by a new, simplified assay, CDT values are nearly normally distributed in low- or non-alcohol-consuming control populations. The importance of transferrin phenotype for this normal variation was analyzed in 100 healthy, European men and women with no or negligible alcohol intake. No significant relation was found between phenotype and CDT value in this population. The three rare B-variants found had low CDT levels, and one subject, examined outside the study, with a rare D-variant indicated that D-variants may result in false-positive CDT values. Moreover, women tended to have somewhat higher values than men, in whom CDT levels were weakly correlated with age. Other as yet undefined biological factors are clearly responsible for the major part of the normal variation of CDT values in nonalcoholic individuals.


Double-layered TiO2-SiO2 nanostructured films with self-cleaning and antireflective properties.
Dual function of self-cleaning and antireflection can be created in double-layered TiO2-SiO2 nanostructured films. The film were prepared by (1) layer-by-layer deposition of multilayered SiO2 nanoparticles with polydiallyldimethylammonium (PDDA) cations, (2) layer-by-layer deposition of multilayered titanate nanosheets with polications on PDDA/SiO2 multilayer films, and (3) burning out the polymer and converting titanate nanosheets into TiO2 by hearing at 500 degrees C. The as-prepared films, consisting of a porous SiO2 bottom layer and a dense TiO2 top layer, improved the transmittance of glass or quartz substrates, as demonstrated by transmission spectra collected at normal incidence. The photocatalytic properties of the films were studied by the change of the water contact angle together with the decay of the IR absorption of the hydrocarbon chain of octadecylphosphonic-acid-modified films under 2.6 mW cm-2 UV illumination. Both the antireflective and the photocatalytic properties of the films were dependent on the number of PDDA/nanosheet bilayers deposited. however, excellent surface wettability of the films for water was obtained, independent of the preparation conditions. The experimental findings are discussed in terms of the special structure of the double-layered nanostructured film.


Analysis of fatty acid steryl esters in tetraploid and hexaploid wheats: identification and comparison between chromatographic methods.
Fatty acid steryl esters (FASE) in whole meal of 14 genotypes of tetraploid wheats (Triticum dicocconand T. durum) and 17 genotypes of hexaploid wheats (T. spelta and T. aestivum) were analyzed using different chromatographic strategies. By both GC-FID and HPLC-ELSD, tetraploid wheats are lacking two major peaks. The amounts of FASE, calculated on the basis of the GC-FID analysis, were double in hexaploid species as compared to tetraploids (40 and 20 mg/100 g db, respectively). HPLC with ESI-MS detection enabled the identification of FASE by the characteristic fragmentations and ion-adducts of each molecule. The distribution of steryl residues was not different between the wheat species: the main class of steryl derivatives found was the beta-sitosteryl derivatives, followed by campesteryl derivatives with small amounts of stigmasteryl esters. The esterified fatty acids explain the difference between the hexaploid and tetraploid wheats. In particular, small amounts of campesteryl and beta-sitosteryl, while no trace of stigmasteryl palmitates, were found in T. durum or its hulled ancestor T. dicoccon. Steryl oleates were not detectable in T. aestivum or its hulled ancestor T. spelta, which is consistent with the filogenesis of tetraploid and hexaploid species. Both chromatographic techniques (GC and HPLC) showed that FASE are useful to discriminate between hexaploid and tetraploid wheats from both qualitative and quantitative points of view.


Bacterial lipopolysaccharide induces expression of ABCA1 but not ABCG1 via an LXR-independent pathway.
Two ATP-binding cassette transporter proteins, ABCA1 and ABCG1, may mediate an active efflux of cellular cholesterol and phospholipids. They are ubiquitously expressed and are subject to regulation by cholesterol loading or by treatment with agents that activate the nuclear hormone receptor LXR. Earlier studies in both primates and non-primates reported that treatment with endotoxin (bacterial lipopolysaccharide, LPS) reduces plasma levels of HDL cholesterol. To determine if such HDL reduction correlates with a change in ABCA1 or ABCG1 expression, their expressions were measured in THP-1 monocytes and mice treated with LPS. LPS treatment leads to a rapid, dose-dependent increase of ABCA1 but not ABCG1 mRNA expression. Analysis of mouse livers showed that LPS treatment decreases expression of CYP7A, another target gene of LXR. When THP-1 cells were transfected with the ABCA1 promoter construct (-928 to +101 bp), promoter activity was significantly increased by treatment of 22(R)-hydroxycholesterol but not by LPS. Together, these studies show that LPS regulates ABCA1 expression through an LXR-independent mechanism. Further studies showed that treatment with Rhodobacter sphaeroiders LPS, an LPS antagonist, or PD169316, a specific p38 MAP kinase inhibitor, prevented the induction of ABCA1 by LPS. Therefore, this suggests that both transport of LPS from the plasma membrane to an intracellular site and activation of p38 MAP kinase are involved in the LPS-mediated induction of ABCA1.


[Peripheral blood albumin level in significantly correlated with the severity of atherosclerosis in hypertensive patients].
To investigate the relationship between peripheral blood albumin (Hb) level and the severity of arteriosclerosis in hypertensive patients. This retrospective analysis was conducted among 419 randomly selected patients with hypertension. The pulse wave velocity (ba-PWV) of the bilateral limbs was measured using an arteriosclerosis tester. According to the ba-PWV value (the higher value of the two sides), the hypertensive patients were divided into 4 groups, namely normal arterial group [S0 group, ba-PWV < 1400 cm/s; 49 cases (11.7%)], mild arteriosclerosis group [S1 group, ba-PWV of 1400-1800 cm/s; 190 cases (45.3%)], moderate arteriosclerosis group [S2 group, ba-PWV of 1800-2000 cm/s); 69 cases (16.5%)], and severe arteriosclerosis group [S3 group, ba-PWV > 2 000 cm/s; 111 cases (26.5 %)]. The clinical data of the patients were collected and multivariate logistic regression was used to analyze the risk factors of arteriosclerosis. The patients' age, obesity, albumin, alanine aminotransferase (ALT), total bile acid, adenosine deaminase, urea nitrogen, serum creatinine, cystatin C, low-density lipoprotein, red blood cells, hemoglobin (Hb), fibrinogen, and FT3 all differed significantly between S0 group and the 3 arteriosclerosis groups (P < 0.05). Multivariate logistic regression analysis revealed that in hypertensive patients, age was an independent risk factor for severe arteriosclerosis (OR=1.094, 95% CI: 1.052-1.137, P < 0.05) and moderate arteriosclerosis (OR= 1.081, 95% CI: 1.039-1.125, P < 0.05); Hb was an independent risk factor for new-onset severe arteriosclerosis (OR= 1.025, 95% CI: 1.003-1.045, P < 0.05) and moderate arteriosclerosis (OR=1.035, 95% CI: 1.008-1.056, P < 0.05), and an increase of Hb levels by 1 standard deviation was associated with a doubled risk in hypertensive patients. Peripheral Hb level is significantly correlated with the severity of arteriosclerosis and may serve as a new predictor for arteriosclerosis in hypertensive patients.


Effects of beta-carotene and vitamin A on oval cell proliferation and connexin 43 expression during hepatic differentiation in the rat(1).
The effects of beta-carotene and vitamin A administrations were evaluated in an in vivo model of hepatic cell differentiation. For this purpose, male Wistar rats received beta-carotene (70 mg/kg of body weight), vitamin A (10 mg/kg of body weight) or corn oil (control group), by gavage and at every other day during the entire experimental period. After 4 consecutive weeks of treatment, the animals were submitted to the AAF/PH model of hepatic cell differentiation (6 x 20 mg of AAF [2-acetylaminofluorene]/kg of body weight and partial hepatectomy) and killed on different days following the surgery (until day 16 after hepatectomy). Liver samples were collected for determination of beta-carotene, retinol and retinyl palmitate concentrations, for histopathological (hematoxilin-eosin) examination, for immunohistochemical detection of glutathione S-transferase, as well as for the evaluation of connexin 43 (a structural protein of gap junctions of oval cells) expression by northern blot analysis. Compared to controls, the oval cell proliferation peaks (observed by histopathological examination and immunohistochemistry) and connexin 43 expression peaks, were postponed to later days after hepatectomy, in a similar way in beta-carotene and vitamin A treated animals. Compared to the other experimental groups, the vitamin A treated group showed an increase in connexin 43 expression. It was concluded that beta-carotene and vitamin A modulated oval cell proliferation and connexin 43 expression, delaying both events. These findings suggest that beta-carotene and vitamin A can modulate the hepatic differentiation process in vivo.


Hyperprolactinaemia abolishes sensitivity of stria terminalis neurones to testosterone.
Hyperprolactinaemia was induced in castrated, testosterone-treated male rats using ectopic pituitary grafts under the kidney capsules. After 6 weeks the absolute refractory period of stria terminalis neurones in these animals did not differ significantly from long-term castrated rats (mean = 1.72 vs 1.69 ms) in spite of the presence of normal testosterone concentrations. Gonadally intact animals, and sham-operated castrated animals treated with testosterone, showed by comparison the characteristic significantly shorter absolute refractory period normally associated with testosterone stimulation (mean = 1.15 and 1.08 ms respectively). These results provide the first demonstration that hyperprolactinaemia can abolish central sensitivity to testosterone.


Effects of phytate on mineral bioavailability in mice.
Phytic acid (inositolhexaphosphoric acid) constitutes 1-3% by weight of all plant seeds and is present in numerous food commodities. Excessive dietary intake of phytate is thought to suppress the bioavailability of important polycations, such as Fe3+ and Zn2+, through the formation of insoluble metal phytate complexes. However, multiple factors may affect intestinal mineral absorption, and direct interference by phytate is still controversial. Therefore, we decided to investigate the chemical interactions between phytate and Fe3+, Zn2+ and Ca2+ in vitro and to measure the uptake of 59Fe3+ and 45Ca2+ administered to mice by intraduodenal instillation and by gavage, respectively. The results demonstrate that: 1) di- and trivalent cations studied form soluble complexes with phytate at high phytate-to-metal ratios, independent of pH and 2) phytic acid has no substantial effect on the absorption of either Ca2+ or Fe3+. These results may prompt reevaluation of the supposedly adverse effects of dietary phytate on the bioavailability of metallophytate complexes.


Classical cardiovascular risk factors in Trinidadian patients with type 2 diabetes mellitus are not influenced by the level of plasma glycaemia.
The aim of this study is to assess the plasma glycaemia of patients attending the diabetes mellitus outpatients' clinics in Trinidad and to determine how different plasma glycaemia would affect cardiovascular disease (CVD) risk factors. One hundred and ninety-one patients (64 males, 127 females, mean age 56.6 +/- 0.8 yr) with Type 2 diabetes mellitus (mean duration 9.2 +/- 0.6 yr) attending diabetes mellitus clinics from January to April 2000 participated in the study. Anthropometric indices (weight, height, waist and hip circumferences) and blood pressure were measured and overnight fasting blood samples were collected for glycated haemoglobin (HbA1c), glucose, lipids (triglyceride, total cholesterol, LDL-cholesterol, HDL-cholesterol) and creatinine determinations. The patients were categorized into Group 1 ('well controlled'; HbA1c < 7.0%) and Group 2 ('poorly controlled'; HbA1c > 7.0%). Although the majority (85%) of patients were poorly controlled', there were no significant differences in the age, duration of diabetes mellitus, body mass index and waist/hip ratios between the two groups of patients (p > 0.05). Similarly, the blood pressure and lipid (total cholesterol, HDL-cholesterol, LDL-cholesterol) levels did not differ between the two groups (p > 0.05) although triglyceride (1.4 +/- 0.1 vs. 2.2 +/- 0.1 mmol/L) levels were higher in patients in Group 2 compared with Group 1 (p < 0.05). Multiple linear regression analysis indicates that the levels of blood pressure, lipid and anthropometric parameters were not significantly dependent on the plasma glycaemia of the patients (p > 0.05). Analysis of the data has shown that the majority of patients with Type 2 diabetes mellitus attending primary care clinics in Trinidad had poor glycaemic control. The poorly controlled patients had similar levels of CVD risk factors to 'well controlled' patients although the former were potentially at greater risk of progressing to cardiovascular disorder than 'well controlled' patients.


Structure and chromosomal assignment of the human cathepsin K gene.
Cathepsin K is a recently identified lysosomal cysteine proteinase that is the major protease responsible for bone resorption and remodeling. Mutations in this gene cause the sclerosing osteochondrodysplasia pycnodysostosis. To assess its evolutionary relatedness to other cysteine proteases and to facilitate mutation identification in patients with pycnodysostosis, a genomic clone, 74e16, containing the cathepsin K gene was isolated from a human PAC library, and the cathepsin K genomic structure was determined. The cathepsin K gene contained eight exons and spanned approximately 9 kb. The transcription initiation site, determined by primer extension analysis, was 169 nucleotides upstream from the translation initiation site. The 5'-flanking region lacked a TATA box but contained two AP1 sites. Comparison of genomic and cDNA sequences suggested that this flanking sequence may be the major promoter in osteoclasts and macrophages. Cathepsin K was mapped to chromosome 1q21 by fluorescence in situ hybridization and found to reside within 150 kb of an evolutionarily related cysteine protease, cathepsin S. These findings expand our understanding of the papain family lysosomal cysteine proteases and should facilitate mutation analysis in pycnodysostosis.


miR-23a-3p Regulates Runx2 to Inhibit the Proliferation and Metastasis of Oral Squamous Cell Carcinoma.
To investigate the effects of microRNA-23a (miR-23a-3p) and Runx2 on malignant progression of oral cancer cells and their possible molecular mechanisms. Fluorescence quantitative PCR (qPCR) was used to detect the expression of miR-23a-3p and Runx2 in human oral squamous cell carcinoma tissues and paracancerous tissues. The dual luciferase reporter assay was used to evaluate the targeted regulation of miR-23a-3p on Runx2. A subcutaneous xenograft model was established to investigate the tumor-suppressive effect of miR-23a-3p. Cells were transfected with miR-23a-3p mimics and negative control NC. CCK-8 assay, EDU assay, Transwell assay, and clone formation assay were used to detect malignant evolution of cells. Western blotting was used to detect the expression of Runx2, PTEN, and PI3K/Akt. The cells were simultaneously transfected with miR-23a-3p mimics and Runx2 to detect the malignant evolution of cells. The expression of miR-23a-3p was downregulated in oral squamous cell carcinoma tissues, while the expression of Runx2 was upregulated. Overexpression of miR-23a-3p or inhibition of Runx2 inhibited the malignant progression of oral squamous cell carcinoma CAL-27 and TSCCA. Overexpression of miR-23a-3p inhibits the growth of oral cancer tumors. miR-23a-3p inhibits the PTEN/PI3K/Akt signaling pathway through Runx2. Overexpression of Runx2 reverses the tumor-suppressive effect of miR-23a-3p. miR-23a-3p can inhibit the PI3K/Akt signaling pathway by targeting Runx2 and inhibit the malignant evolution of oral cancer.


Short-limbed dwarfism and ocular defects in the Samoyed dog.
A syndrome of short-limbed dwarfism and ocular defects was found in Samoyed dogs. The most prominent abnormalities were small stature and valgus deformity of the carpi. Radiographic evidence of retarded growth at the distal ulnar physis was apparent by 12 weeks of age. Ocular defects included cataracts and retinal detachment. Family studies and limited breeding experiments were consistent with an autosomal recessive mode of inheritance.


The current status of intensity-modulated radiation therapy in the treatment of nasopharyngeal carcinoma.
Radiation therapy is the mainstay of treatment in nasopharyngeal carcinoma, alone or in combination with chemotherapy. In the early stage, it can be managed by radiotherapy alone. For locally advanced-stage disease, several meta-analyses have demonstrated the role of concurrent chemoradiotherapy. Conventional radiation therapy results in significant side effects, particular xerostomia, leading to poor quality of life. With the maturity of intensity-modulated radiation therapy in the recent 10 years, more and more evidences have shown the advantages of intensity-modulated radiation therapy over conventional radiation therapy, regarding the local-regional control, survival rate and quality of life. This article reviews the utilization of intensity-modulated radiation therapy in the management of nasopharyngeal carcinoma with respect to its technical advantages, clinical outcome, critical organ sparing and quality of life, and the dilemma in target delineation. In particular, an issue of treatment-related dysphagia will also be discussed.


Overexpression of Rice Rab7 Gene Improves Drought and Heat Tolerance and Increases Grain Yield in Rice (Oryza sativa L.).
Rab family proteins play a crucial role in plant developmental processes and tolerance to environmental stresses. The current study investigated whether rice Rab7 (OsRab7) overexpression could improve rice tolerance to drought and heat stress conditions. The OsRab7 gene was cloned and transformed into rice plants. The survival rate, relative water content, chlorophyll content, gas-exchange characteristics, soluble protein content, soluble sugar content, proline content, and activities of antioxidant enzymes (CAT, SOD, APX, POD) of the transgenic rice lines were significantly higher than that of the wild-type. In contrast, the levels of hydrogen peroxide, electrolyte leakage, and malondialdehyde of the transgenic lines were significantly reduced when compared to wild-type. Furthermore, the expression of four genes encoding reactive oxygen species (ROS)-scavenging enzymes (OsCATA, OsCATB, OsAPX2, OsSOD-Cu/Zn) and eight genes conferring abiotic stress tolerance (OsLEA3, OsRD29A, OsSNAC1, OsSNAC2, OsDREB2A, OsDREB2B, OsRAB16A, OsRAB16C) was significantly up-regulated in the transformed rice lines as compared to their expression in wild-type. OsRab7 overexpression also increased grain yield in rice. Taken together, the current study indicates that the OsRab7 gene improves grain yield and enhances drought and heat tolerance in transgenic rice by modulating osmolytes, antioxidants and abiotic stress-responsive genes expression. Therefore, OsRab7 gene could be exploited as a promising candidate for improving rice grain yield and stress tolerance.


Plant Polyphenols Attenuate DSS-induced Ulcerative Colitis in Mice via Antioxidation, Anti-inflammation and Microbiota Regulation.
The pathogenesis of ulcerative colitis (UC) is associated with inflammation, oxidative stress, and gut microbiota imbalance. Although most researchers have demonstrated the antioxidant bioactivity of the phenolic compounds in plants, their UC-curing ability and underlying mechanisms still need to be further and adequately explored. Herein, we studied the antioxidation-structure relationship of several common polyphenols in plants including gallic acid, proanthocyanidin, ellagic acid, and tannic acid. Furthermore, the in vivo effects of the plant polyphenols on C57BL/6 mice with dextran-sulfate-sodium-induced UC were evaluated and the action mechanisms were explored. Moreover, the interplay of several mechanisms was determined. The higher the number of phenolic hydroxyl groups, the stronger the antioxidant activity. All polyphenols markedly ameliorated the symptoms and pathological progression of UC in mice. Furthermore, inflammatory cytokine levels were decreased and the intestinal barrier was repaired. The process was regulated by the antioxidant-signaling pathway of nuclear-erythroid 2-related factor 2. Moreover, the diversity of the intestinal microbiota, Firmicutes-to-Bacteroides ratio, and relative abundance of beneficial bacteria were increased. An interplay was observed between microbiota regulation and oxidative stress, immunity, and inflammatory response. Furthermore, intestinal barrier repair was found to be correlated with inflammatory responses. Our study results can form a basis for comprehensively developing plant-polyphenol-related medicinal products.


[A new simple scoring system to determine the timing and efficacy of entecavir therapy in hepatitis B-related acute-on-chronic liver failure].
Objective: To determine the timing and efficacy of entecavir (ETV) therapy in hepatitis B-related acute-on-chronic liver failure (HBV-ACLF) using a new simple scoring system. Methods: A total of 212 patients with HBV-ACLF were treated with ETV 0.5 mg daily besides the routine treatment. The severity of illness was scored by the HBV-ACLF prognostic scoring system. Hepatic failure severity scores, hepatitis B virus DNA (HBV DNA) load, and length of hospital stay were recorded at the time of initiation of treatment, and the time of survival to hospital discharge/end of life. Results: Patiens were divided into four groups by the admission severity scores according to the percentile table: low score group (score≤ 4), medium-low score group (score: 5-7), medium-high score group (score: 8-11), and high score group (score ≥12). As the scores increased, the mortality rate increased. There were significant differences among different groups (χ(2)=310.662, P<0.001). There were significant difference of the admission and discharge/death severity scores in the low score group (P=0.003). There were significant differences of the comparison of HBV DNA load at admission and death/discharge using ETV in low-, medium-low, and medium-high score groups (P<0.001). There were no significant differences of HBV DNA load at admission and death/discharge using ETV for dead and survival patients in the medium-low, and medium-high score groups. Conclusions: The efficacy of ETV in the rescue treatment of HBV-ACLF is related to the severity of ACLF when starting medication. The HBV-ACLF prognostic scoring system can clearly determine the timing and efficacy of ETV treatment of HBV-ACLF.


Incidence of complications during flap creation in LASIK using the NIDEK MK-2000 microkeratome in 26,600 cases.
To evaluate the incidence of intraoperative complications using the NIDEK MK-2000 microkeratome during flap creation in LASIK. The incidence of intraoperative flap complications during LASIK using the NIDEK MK-2000 microkeratome was retrospectively studied in 26,600 procedures performed in 5 outpatient excimer laser surgery centers. A total of 65 (0.244%) complications were identified: 23 (0.086%) eyes had free caps, 13 (0.049%) eyes had an incomplete pass, 13 (0.049%) eyes had an epithelial defect, 11 (0.041%) eyes had buttonhole, and 5 (0.019%) eyes had irregular flap. The remaining 26,535 (99.756%) eyes had uneventful flap creation. Use of the NIDEK MK-2000 microkeratome resulted in a low incidence of intraoperative complications, making it a safe and reliable device for creating flaps during LASIK.


MANAGEMENT OF BILATERAL FEMORAL NECK FRACTURE IN A NONAGENARIAN PATIENT--CASE REPORT.
Simultaneous bilateral femoral neck fracture is rare injury. Cases with this type of fracture have been reported in the literature since the 1950s, following the introduction of electroconvulsive therapy which generates violent hip muscle contractions. In young patients' simultaneous bilateral femoral neck fracture results from high energy trauma (car accident or fall from height) in a normal bone. Pathological changes in bone structure occurring in chronic kidney disease, vitamin D deficiency, osteomalacia, osteoporosis, metabolic imbalances and administration of corticosteroids explain the occurrence of this particular type of fracture following low-energy trauma. We present the case of a 90-year-old female patient who suffered a simple fall from her own height resulting in a Garden IV bilateral femoral neck fracture. Our therapeutic option in this patient was bilateral uncemented bipolar hemiarthroplasty in a single session using a single tray of sterile surgical instruments and two sterile drapes. Postoperative outcome was very good, allowing the initiation of functional recovery on the first postoperative day. Uncemented hemiarthroplasty proved to be a good choice in such a patient in the associated diseases may trigger the risk of cardiovascular disturbances specific to bone cement implantation syndrome.


Interaction between cigarette smoke and mycoplasma infection: a murine model.
Cigarette smoke has a major impact on health issues worldwide. Although genetics certainly is a factor in the sensitivity to cigarette smoke, other lung environmental factors, such as infection, potentially could interact with cigarette smoke to induce inflammatory changes associated with various diseases. Four groups of BALB/c mice (smoking only; smoking + M. pneumoniae infection; mycoplasma only; saline control) were studied for eight weeks to determine the interactive outcomes of inflammation and structural changes in the smoking plus mycoplasma group. This group did have significantly higher amounts of neutrophil degranulation in the outer airway wall area (smooth muscle to alveolar attachments) (p = 0.03) and mRNA expression of matrix metalloproteinase-9 (p= 0.045). Although there was not a significant difference in alveolar tissue elastin between the groups, the smoking plus mycoplasma group had a level approximately 20% below the other groups. Even in this relatively short duration study, it appears that an infectious process can interact with cigarette smoke to produce a destructive type of inflammatory response (activated neutrophils and metalloproteinase-9) seen in the outer airway wall area.


Indirect Self-Destructive Behavior Among Elderly Patients in Nursing Homes: A Research Agenda.
Although suicide is rare in nursing homes, indirect self-destructive behaviors (ISDBs), such as the refusal to eat or take life-sustaining medications, are commonplace. For some, ISDB represents a cry for help, whereas in others it is a reasoned behavioral expression of legitimate preference for an earlier death. This article reports on the proceedings of a workshop held in May 1994 to discuss ISDB in long-term care settings. After a historical review, issues discussed by workshop participants are presented and a research agenda proposed. Future studies are advocated with regard to correlates for ISDB that are relevant to the patient and characteristic of the nursing home environment.


Everolimus in the management of metastatic neuroendocrine tumours.
Neuroendocrine tumours are increasing in incidence and cause a variety of symptoms. The mammalian target of rapamycin (mTOR) pathway plays a key role in neuroendocrine tumour (NET) pathogenesis, leading to increased lipid synthesis, protein synthesis and cellular growth. Upregulation of this pathway is noted in both hereditary and sporadic NETs. This understanding has led to investigations of mTOR inhibitors as therapy for metastatic NETs. After promising preclinical findings, everolimus, an mTOR inhibitor, was trialled in the RADIANT-1-4 studies on patients with advanced, well differentiated NETs. RADIANT-3 and RADIANT-4 established the efficacy of everolimus in improving progression-free survival (PFS) for metastatic NET of pancreatic, lung and gastrointestinal origin, leading to the US Food and Drug Administration (FDA) approval for its use in tumour control in those settings. Everolimus treatment is generally well tolerated; common adverse events include stomatitis, diarrhoea, rash and hyperglycaemia. Although discontinuation rates are low, many patients may require dose modification to successfully continue therapy. The combination of everolimus with somatostatin analogues (SSAs) (such as octreotide or pasireotide) or other targeted agents such as bevacizumab has not produced additional incremental benefit, and dual biologic therapy is not used widely. Ongoing trials are investigating everolimus compared with chemotherapy, optimal sequencing of therapy and combination of everolimus with radiotherapy. Future research should concentrate on identification of predictive biomarkers for benefit from mTOR therapy and include quality of life as a measure.


Women Veterans' Descriptions of Interactions With Civilian Health Care Providers: A Qualitative Inquiry.
Women veterans often obtain care for unique gender- and military-related health issues from civilian health care settings. There is a gap in the literature surrounding woman veterans' perspectives about the care they receive. The purpose of this study was to apply the Interaction Model of Client Health Behavior framework to study the patient-provider interaction described by women veterans. A qualitative descriptive methodology, using directed content analysis, was employed. Six themes were identified. Consistent screening, provider knowledge about service roles and experiences of women veterans, and familiarity with military-related health conditions support holistic care. Further research in this area is warranted.


Rotation rate and duration effects on the somatogyral illusion.
Aviation spatial disorientation mishaps remain a concern, especially due to their fatality rate. Some of the most insidious disorientations are due to vestibular stimuli in the absence of visual cues. A category of such disorientations are known as somatogyral illusions. To determine the effects of spin rate and duration on the perception of the somatogyral illusion, we examined the subjective response of pilots and non-pilots to rotation around the yaw axis in a flight simulator in a manner that would mimic two vestibular illusions found in flight: the washout of the semi-circular canals following sustained turns, and the illusory counter-rotation following return to straight and level flight. There were 29 subjects (14 pilots) who were seated blindfolded in a flight simulator which accelerated to constant plateau rotation rates of 20, 70, and 120 degrees x s(-1) and then decelerated to stationary; plateaus were 10, 20, or 40 s. Subjects reported 1) the time when the perception of rotation ceased (i.e., the subjective time until washout was reached); 2) the relative magnitude of the counter-rotation experienced; and 3) the time until the perception of counter-rotation ceased. Subjects also manipulated a slider to provide a continuous subjective measure of their experience of rotation. The two time measures increased with increases in both the duration and magnitude of the spin. The increase in perceived washout time with spin rate was non-linear (geometric). There was an interaction between spin duration and spin rate on the experience of illusory counter-rotation magnitude such that at low rates, spin duration had no effect, but its effect increased at faster rates. The time constant of adaptation of the semicircular canals was estimated to be 8.3 s. The effects were validated against a model of semicircular canal and cupola adaptation, which predicted the data with high accuracy. Pilots and non-pilots did not differ in their illusory experience.


Bone tissue amount related to upper incisors inclination.
To evaluate the amount of buccal and lingual supporting bone tissue of 60 upper central incisors and the relationship with their inclination. Thirty healthy adult patients with no previous orthodontic treatment were evaluated using cone-beam computed tomography. Cross-sectional views were analyzed to check the amount of the bone tissue on the cervical (cervical buccal thickness/CBT; lingual/CLT), middle (middle buccal thickness/MBT; lingual/MLT), and apical regions (apical buccal thickness/ABT; lingual/ALT). The Pearson correlation, linear regression, and analysis of variance tests were used (P < .05). The values of ABT of both teeth (11, right upper central incisor; 21, left upper central incisor) were significantly increased with the increase in the angle between the axis of the upper central incisor and the palatal plane (1/PP) (tooth 11 P = .034; tooth 21 P = .009), yet without a strong linear correlation. At the buccal and lingual surfaces, the mean apical supporting bone tissue was significantly greater than the other areas, and the middle region significantly greater than the cervical (P < .001). For both surfaces (buccal and lingual), the amount of bone tissue in the apical region was significantly higher than the middle and cervical regions, and the middle region was significantly higher than the cervical region. In relation to the upper central incisor's inclination, the higher the 1/PP the higher was ABT. However, the coefficient values for both teeth were low.


Association between gastrointestinal bleeding and 3-year mortality in patients with acute, first-ever ischemic stroke.
The influence of gastrointestinal bleeding on clinical presentation and outcomes of patients with acute ischemic stroke remains controversial. We investigate the effect of gastrointestinal bleeding on the outcomes of patients with acute, first-ever ischemic stroke. We enrolled 934 patients with acute, first-ever ischemic stroke and followed up them for 3years. Patients were divided into 2 groups according to the presence or absence of gastrointestinal bleeding during acute stroke stage. Clinical presentation, stroke risk factors, laboratory data, co-morbidities, and outcomes were recorded. Seventy-six (8.1%) patients had gastrointestinal bleeding at admission. The prevalence of old age, atrial fibrillation, and previous transient ischemic attack was higher in patients with gastrointestinal bleeding (P<0.001, P=0.038, and P=0.018, respectively). Total anterior circulation syndrome occurred more frequently among patients with gastrointestinal bleeding (P<0.001). The mean length of acute ward stay, initial impaired consciousness, and stroke in evolution were higher in patients with gastrointestinal bleeding (P<0.001, P<0.001, and P<0.001, respectively). The occurrence of pneumonia and dependent functional outcome were higher in patients with gastrointestinal bleeding (P<0.001 and P<0.001, respectively). A multivariate Cox regression analysis revealed that gastrointestinal bleeding is a significant risk factor for 3-year all-cause mortality (hazard ratio=2.76; 95% confidence interval=1.61-4.72; P<0.001). In conclusion, gastrointestinal bleeding is associated with increased risk of 3-year mortality in patients with acute, first-ever ischemic stroke. Prophylactic therapies for gastrointestinal bleeding might improve ischemic stroke outcome.


An ultrasensitive electrochemical biosensor for Pseudomonas aeruginosa assay based on a rolling circle amplification-assisted multipedal DNA walker.
Herein, we developed an ultrasensitive electrochemical biosensor for Pseudomonas aeruginosa detection based on a rolling circle amplification-assisted multipedal DNA walking strategy. The cascade signal amplification method can improve the sensitivity, showing promising applications in food security, environmental monitoring, and disease diagnosis.


[The IQ of heterozygotes for phenylketonuria (PKU). indication of a blood phenylalanine-independent action of the PKU mutant (author's transl)].
The IQ of parents of phenylketonuria-(PKU-)affected children is lower than that of parents with histidinemia-affected children (control group). The difference arises almost entirely from the verbal part of the Hamburg-Wechsler test. The IQ of the parents with histidinemia-affected children shows the same distribution as that of the normal population; heterozygosity for this condition does not appear to confer any intellectual advantage. In PKU patients treated at an early age and apparently adequately, a slight, but significant decrease in IQ becomes apparent between the ages of 6 and 8 years. This slight decrease also refers mainly to the verbal IQ. At 4 years of age all PKU patients are tested with Bühler-Hetzer, as well as the Kramer test. There is a significant difference between the results in favour of the Bühler-Hetzer test, which is much less verbal. Since heterozygotes for PKU never show elevated blood phenylalanine levels and, moreover, prenatal tyrosine deficiency, as argued by others, seems highly improbable, it is supposed that the PKU gene has a more direct influence on certain ganglion cells at least, with a consequent slight, but significant lowering of the verbal IQ in heterozygotes and satisfactorily-treated homozygotes for PKU. A slightly increased intracellular phenylalanine concentration in heterozygotes and apparently adequately-treated homozygotes need not to be reflected in raised blood levels and this could be an explanation for the observed IQ lowering. But it should not be overlooked that by far the greatest part of damage in PKU patients is caused by chronic phenylalanine poisoning which is well preventable by correct dietary treatment.


The histamine inhalation provocation test and its reproducibility.
The histamine inhalation provocation test (HIP) was followed during 5 weeks. This test was performed four (1 patient) or five times under standardized conditions in a group of 21 asthmatic patients. The HIP was performed with increasing concentrations of histamine phosphate produced by a 'Wiesbadener Doppelinhalator'. The HIP was called positive if there was a drop of 15% of the initial FEV1. 12 out of 21 patients (57%) showed a sufficient reproducibility. For the whole group of patients there hardly was a variability of the mean absolute concentration of histamine to produce a positive test, but individual patients showed a wide spread. Furthermore, the correlation between the initial value of the FEV1 and the bronchial response seemed to be highly significant (p less than 0.0001). It is concluded that the HIP is not always reproducible within a short period and that the hyperreactivity of the airways is correlated to the initial value of the FEV1.


Inside 'bed management': ethnographic insights from the vantage point of UK hospital nurses.
In the face of unprecedented financial and demographic challenges, optimising acute bed utilisation by the proactive management of patient flows is a pressing policy concern in high-income countries. Despite the growing literature on this topic, bed management has received scant sociological attention. Drawing on practice-based approaches, this article deploys ethnographic data to examine bed management from the perspective of UK hospital nurses. While the nursing contribution to bed management is recognised formally in their widespread employment in patient access and discharge liaison roles, nurses at all levels in the study site were enrolled in this organisational priority. Rather than the rational, centrally controlled processes promulgated by policymakers, bed management emerges as a predominantly distributed activity, described here as match-making. An example of micro-level rationing, for the most part, match-making was not informed by explicit criteria nor did it hinge on clearly identifiable decisions to grant or deny access. Rather it was embedded in the everyday practices and situated rationalities through which nurses accomplished the accommodations necessary to balance demand with resources.


Symmetry of the nose after presurgical nasoalveolar molding in infants with unilateral cleft lip and palate: a preliminary study.
To assess nostril symmetry and alveolar cleft width in infants with unilateral cleft lip and palate following presurgical nasoalveolar molding (NAM). Fifty-seven newborn patients underwent presurgical nasoalveolar molding. Magnified basal view facial photos were taken at four different times: initial visit (T1), before cheiloplasty (T2), 1 month after cheiloplasty (T3), and 1 year of age (T4). Direct measurements from the photos included: (1) nostril width on the affected and nonaffected side; (2) nostril height on the affected and nonaffected side; (3) columella-nasal base angle; and (4) width of the alveolar cleft. Nostril width and height data were used to calculate a ratio of affected to nonaffected side. Effects of nasal symmetry after presurgical nasoalveolar molding were compared between the affected and nonaffected side. The nostril width ratio was 1.7, 1.2, 1.0, and 1.2 for T1 to T4. The nostril height ratio was 0.5, 0.8, 1.0, and 0.9 for T1 to T4. The angle of the columella was 53.3 degrees , 69.9 degrees , 91.2 degrees , and 86.9 degrees for T1 to T4. The average alveolar cleft width was 8.2 mm at T1 and closed down to 2.4 mm before cheiloplasty (T2) in cases with complete cleft. Infants with presurgical nasoalveolar molding improved symmetry of the nose in width, height, and columella angle, as compared to their presurgical status. There was some relapse of nostril shape in width (10%), height (20%), and angle of columella (4.7%) at 1 year of age.


Order of statistical learning depends on perceptive uncertainty.
Statistical learning (SL) is an innate mechanism by which the brain automatically encodes the n-th order transition probability (TP) of a sequence and grasps the uncertainty of the TP distribution. Through SL, the brain predicts a subsequent event (e n+1 ) based on the preceding events (e n ) that have a length of "n". It is now known that uncertainty modulates prediction in top-down processing by the human predictive brain. However, the manner in which the human brain modulates the order of SL strategies based on the degree of uncertainty remains an open question. The present study examined how uncertainty modulates the neural effects of SL and whether differences in uncertainty alter the order of SL strategies. It used auditory sequences in which the uncertainty of sequential information is manipulated based on the conditional entropy. Three sequences with different TP ratios of 90:10, 80:20, and 67:33 were prepared as low-, intermediate, and high-uncertainty sequences, respectively (conditional entropy: 0.47, 0.72, and 0.92 bit, respectively). Neural responses were recorded when the participants listened to the three sequences. The results showed that stimuli with lower TPs elicited a stronger neural response than those with higher TPs, as demonstrated by a number of previous studies. Furthermore, we found that participants adopted higher-order SL strategies in the high uncertainty sequence. These results may indicate that the human brain has an ability to flexibly alter the order based on the uncertainty. This uncertainty may be an important factor that determines the order of SL strategies. Particularly, considering that a higher-order SL strategy mathematically allows the reduction of uncertainty in information, we assumed that the brain may take higher-order SL strategies when encountering high uncertain information in order to reduce the uncertainty. The present study may shed new light on understanding individual differences in SL performance across different uncertain situations.


Obstruction of the superior sagittal sinus caused by parasagittal meningiomas: the role of collateral venous pathways.
The authors present studies of eight patients who had obstruction of the superior sagittal sinus caused by parasagittal meningioma. The results indicate that meningeal veins and end-to-end anastomoses of the superficial veins of the cerebrum play important roles as collateral venous pathways. This assessment suggests that, in patients with obstruction of the superior sagittal sinus, venous phase angiography should be carefully interpreted before surgery is attempted for parasagittal meningiomas.


DNA strand transfer reactions catalyzed by vaccinia topoisomerase: hydrolysis and glycerololysis of the covalent protein-DNA intermediate.
Vaccinia topoisomerase forms a covalent protein-DNA intermediate at sites containing the sequence 5'-CCCTT. The T nucleotide is linked via a 3'-phosphodiester bond to Tyr-274 of the enzyme. Here, we report that the enzyme catalyzes hydrolysis of the covalent intermediate, resulting in formation of a 3'-phosphate-terminated DNA cleavage product. The hydrolysis reaction is pH-dependent (optimum pH = 9.5) and is slower, by a factor of 10(-5), than the rate of topoisomerase-catalyzed strand transfer to a 5'-OH terminated DNA acceptor strand. Mutants of vaccinia topoisomerase containing serine or threonine in lieu of the active site Tyr-274 form no detectable covalent intermediate and catalyze no detectable DNA hydrolysis. This suggests that hydrolysis occurs subsequent to formation of the covalent protein-DNA adduct and not via direct attack by water on DNA. Vaccinia topoisomerase also catalyzes glycerololysis of the covalent intermediate. The rate of glycerololysis is proportional to glycerol concentration and is optimal at pH 9.5.


Distribution of nerve growth factor, pro-nerve growth factor, and their receptors in human salivary glands.
Nerve growth factor (NGF) is a pluripotent mediator that is present in a range of human tissues. Nerve growth factor was originally considered important only in neuronal homeostasis and pathophysiology, but later it was also implicated in the pathophysiology of inflammation, epithelial differentiation, and wound healing. In this study, the distribution of nerve growth factor beta (NGF-β) and pro-NGF, and their receptors - tyrosine kinase A (TrkA) and p75(NTR) - was examined in human parotid, submandibular, sublingual, and labial salivary glands by immunohistochemistry. Intercalated, striated, and collecting-ducts in all gland types showed strong staining for pro-NGF but only weak cytoplasmic or sparse nuclear staining for NGF-β. Tyrosine kinase A was strongly expressed in the ducts of all gland types, whereas p75(NTR) expression was mainly confined to collecting ducts. In acini, no or only weak cytoplasmic staining was found for all markers, and some nuclei stained positive for NGF-β, pro-NGF, and TrkA. Western blotting of saliva showed secretion of several forms of pro-NGF, while no mature NGF-β was detected. Salivary pro-NGF may play a role in oral wound healing.


Transcriptome analysis of nodes and buds from high and low tillering switchgrass inbred lines.
In the last two decades switchgrass has received increasing attention as a promising bioenergy feedstock. Biomass is the principal trait for improvement in switchgrass breeding programs and tillering is an important component of biomass yield. Switchgrass inbred lines derived from a single parent showing vast variation in tiller number trait was used in this study. Axillary buds, which can develop into tillers, and node tissues, which give rise to axillary buds, were collected from high and low tillering inbred lines growing in field conditions. RNA from buds and nodes from the contrasting inbred lines were used for transcriptome profiling with switchgrass Affymetrix genechips. Nearly 7% of the probesets on the genechip exhibited significant differential expression in these lines. Real-time PCR analysis of 30 genes confirmed the differential expression patterns observed with genechips. Cluster analysis aided in identifying probesets unique to high or low tillering lines as well as those specific to buds or nodes of high tillering lines. Rice orthologs of the switchgrass genes were used for gene ontology (GO) analysis with AgriGO. Enrichment of genes associated with amino acid biosynthesis, lipid transport and vesicular transport were observed in low tillering lines. Enrichment of GOs for translation, RNA binding and gene expression in high tillering lines were indicative of active metabolism associated with rapid growth and development. Identification of different classes of transcription factor genes suggests that regulation of many genes determines the complex process of axillary bud initiation and development. Genes identified in this study will complement the current ongoing efforts in quantitative trait loci mapping of tillering in switchgrass.


Extensive Cutaneous Botryomycosis With Subsequent Development of Nocardia-Positive Wound Cultures.
Botryomycosis is a rare, chronic granulomatous infection caused by a response to bacteria, most commonly Staphylococcus aureus. Cutaneous manifestations, such as subcutaneous nodules, nonhealing ulcers, or sinus tracks, typically occur following inoculation of bacteria after trauma. Drainage from the skin lesions may contain yellow grains resembling those seen in actinomycosis and nocardiosis. A 20-year-old Hispanic male presented over the course of several years with a chronic nonhealing left posterior scalp wound. A car hit the patient when he was 2 years old and injured the scalp in the location of the skin lesion. Multiple wound cultures grew methicillin-resistant Staphylococcus aureus (MRSA), and biopsies were consistent with botryomycosis. He was treated with multiple surgical debridements, skin grafts, and various courses of oral and intravenous antibiotics with slight improvement. One reason for poor response to therapy was noncompliance with long-term home antibiotics. The most recent tissue culture grew MRSA in addition to Nocardia mexicana, and he experienced improvement on linezolid and minocycline. Although it is important to exclude nocardiosis and actinomycosis when diagnosing botryomycosis, our patient was diagnosed with botryomycosis after multiple biopsies and positive MRSA cultures 2 years prior to 1 positive N mexicana culture. Our case is a unique presentation of botryomycosis in an individual who subsequently developed Nocardia-positive wound cultures.


Trauma, damage and pleasure: rethinking problematic drug use.
While the pleasures of drug use are sometimes acknowledged, they are normally limited to those who are socially privileged. The drug use of those who are impoverished and marginalised is linked instead to crime, social misery and addiction. Studying poverty in connection with drug use enriches our understanding of both poverty and drugs, but there are limitations to these connections, including their neglect of pleasure. This paper draws on 85 qualitative interviews with service providers and clients, conducted for a project entitled 'Comparing the role of takeaways in methadone maintenance treatment in New South Wales and Victoria'. Critical readings of psychoanalysis are used as a conceptual frame. Although pleasurable and problematic drug use are often thought to be mutually exclusive, pleasure is reported from both the effects of drugs such as heroin and methadone, and from the social worlds of methadone maintenance treatment. Attention to drug users' narratives of pleasure has the potential for new understandings of drug use and social disadvantage. Common distinctions between kinds of drug use, such as problematic and recreational, are less useful than is normally thought.


Use of Eflornithine (DFMO) in the Treatment of Early Alzheimer's Disease: A Compassionate Use, Single-Case Study.
Background: Recent genome-wide association screening (GWAS) studies have linked Alzheimer's disease (AD) neuropathology to gene networks that regulate immune function. Kan et al. recently reported that Arg1 (an anti-inflammatory gene that codes for arginase-1) is expressed in parts of the brain associated with amyloidosis prior to the onset of neuronal loss, suggesting that chronic brain arginine deprivation promotes AD-related neuropathology. They blocked arginine catabolism in their mouse AD model by administration of eflornithine (DFMO) to juvenile animals, effectively blocking the expression of AD-related amyloid pathology as the mice aged. We report results from a single-case study in which DFMO was administered, for the first time, in an attempt to slow progression of AD in a single woman with multi-domain, amnestic MCI who was unable to tolerate an acetylcholinesterase inhibitor. Methods: Patient C.S. is a 74-year old female with a 5-year history of cognitive decline who was placed on DFMO (500 mg b.i.d.) for 12 months, with amyloid PET scans (baseline and 12-months), APOE genotyping and neuropsychological exams at baseline, 3, 9, and 12 months. Results: C.S. suffered continued cognitive decline over 12 months, including progressive worsening of orientation, social functions and ability to engage in IADL's. She also showed progressive decline on measures of episodic memory and executive function. Florbetapir PET imaging yielded elevated total neocortical SUVr scores at both baseline (SUVr = 1.55) and at 12 months (SUVr = 1.69). Conclusions: We report a first attempt at using DFMO to slow AD progression. This 12-month single-case trial did not halt continued amyloidosis nor cognitive decline. Although this trial was predicated on data reported by Kan et al. (2015) showing that DFMO administered to juvenile AD-prone mice led to diminished amyloid aggregation, this attempt to treat an older mild AD patient may not be a fair test of Kan et al.'s model and results. A future trial might seek to block amyloidosis in young adults who are autosomal gene carriers for early onset AD, or perhaps in adults who are very clearly in the pre-clinical disease stage. Trial Registration: This trial was registered as a Compassionate Use IND #128888 with the United States Food and Drug Administration (FDA).


Impact of Increased Early Statin Administration on Ischemic Stroke Outcomes: A Multicenter Electronic Medical Record Intervention.
Statin administration early in ischemic stroke may influence outcomes. Our aim was to determine the clinical impact of increasing statin administration early in ischemic stroke hospitalization. This is a retrospective analysis of a multicenter electronic medical record (EMR) intervention to increase early statin administration in ischemic stroke across all 20 hospitals of an integrated healthcare delivery system. A stroke EMR order set was modified from an "opt-in" to "opt-out" mode of statin ordering. Outcomes were mortality by 90 days, discharge disposition, and increase in stroke severity. We examined the relationship between intervention and outcome using autoregressive integrated moving average (ARIMA) time-series modeling. The EMR intervention increased both overall in-hospital statin administration (from 87.2% to 90.7%, P<0.001) and early statin administration (from 16.9% to 26.3%, P<0.001). ARIMA models showed a small increase in the rate of survival (difference in probability [Pdiff]=0.02, P=0.016) and discharge to home or rehabilitation facility (Pdiff=0.04, P=0.034) associated with the intervention. The increase in statin administration <8 hours was associated with much larger increases in survival (Pdiff=0.17, P=0.033) and rate of discharge to home or rehabilitation (Pdiff=0.29, P=0.011), as well as a decreased rate of neurological deterioration in-hospital (Pdiff=-0.14, P=0.026). A simple EMR change increased early statin administration in ischemic stroke and was associated with improved clinical outcomes. This is, to our knowledge, the first EMR intervention study to show that a modification of an electronic order set resulted in improved clinical outcomes.


Comparison of cause distribution between elderly and non-elderly patients with chronic cough.
The causes of chronic cough in elderly patients have not been specifically investigated. Therefore, it remains to be determined whether chronic cough differs between elderly and non-elderly patients. To investigate the distribution of causes of chronic cough in elderly patients in comparison with etiologies of chronic cough observed in non-elderly patients. From 2,989 new patients presenting consecutively to the Department of Respiratory Medicine of the Tongji Hospital over a 1.5-year period, 287 patients with chronic cough were enrolled in the study. Patients aged > or =60 years were assigned to the elderly group. The elderly group comprised 104 patients and the non-elderly group the remaining 183 patients. The causes of cough were primarily evaluated according to a modification of Irwin's anatomic diagnostic protocol which included induced sputum cytology, verified by the specific therapy. Cough-variant asthma (34.6 vs. 41.5%) and upper airway cough syndrome (19.3 vs. 23.5%) were the most common causes of chronic cough both in the elderly and non-elderly groups. The distribution of causes and frequency were significantly different between elderly and non-elderly groups: angiotensin-converting enzyme inhibitor (ACEI)-induced cough (16.3 vs. 1.7%, chi(2) value = 22.12, p < 0.001) and gastroesophageal reflux disease (GERD; 10.6 vs. 3.7%, chi(2) value = 5.14, p = 0.02) were more common in the elderly group. A more frequent incidence of ACEI-induced cough and GERD is the distinctive feature in the cause distribution between elderly and non-elderly patients with chronic cough.


Bisabolane-type sesquiterpenoids and bacillibactin from the marine-derived fungus Aspergillus sydowii SCSIO 41041 and their enzyme inhibiting activity.
Twelve compounds, including eleven bisabolane-type sesquiterpenoids (1 - 11), and one bacillibactin (12) were identified from marine-derived fungus Aspergillus sydowii SCSIO 41041 isolated from Creseis acicula. The chemical structures were elucidated by the basis of spectroscopic evidences, including HRESIMS, NMR and optical rotation. Biologically, all compounds were evaluated for their acetyl cholin-esterase (AChE) enzyme, pancreatic lipase (PL) enzyme, neuraminidase (NA) and phosphodiesterase 4 (PDE4) inhibitory activities. Compound 12 displayed significant inhibitory activity against neuraminidase (NA) with an IC50 value of 24.0 μM, which was equivalent to the positive drug oseltamivir phosphate (IC50 value of 20.0 μM). And the NA inhibitory activity was confirmed by molecular docking analysis.


WHO collaborative breast feeding study. I. Organochlorine contaminants in individual samples of Swedish human milk, 1978--1979.
Individual samples of human milk collected in Uppsala at 3 months post-partum (18 samples) or 6 months post-partum (23 samples) were analysed for chlorinated insecticides and polychlorinated biphenyls (PCBs) by gas chromatography. The mean levels of the organochlorine compounds in the 3- and 6-month groups were similar. The mean content of DDE, the major metabolite of DDT, in all the samples was 54 micrograms/kg fresh weight (1.3 mg/kg on a fat basis) with a range of 8.4--220 micrograms/kg (0.49--3.0 mg/kg fat). The results confirm that the decline since 1967 in the levels of DDT and its metabolites in Swedish human milk reported by other authors is continuing. The levels of dieldrin and beta-hexachlorocyclohexane found are lower than those reported earlier in Sweden, whereas the levels of hexachlorobenzene are about the same. On the other hand, the levels of PCBs (mean 64 micrograms/kg, range 15--150 micrograms/kg, fresh weight, equivalent to 1.6 mg/kg, range 0.84--2.9 mg/kg, on a fat basis) are higher than those reported earlier in Swedish human milk. Although the calculated intake of the DDT complex (DDT + DDE + DDD) by some of the suckling infants exceeds the acceptable daily intake proposed by a FAO/WHO expert group, it does not constitute a reason for recommending any restrictions on breast feeding--for nutritional, immunological and other reasons it should be encouraged.