Antidiabetic effects of Corni Fructus extract in streptozotocin-induced diabetic rats.
Diabetes is the leading cause of end-stage renal failure. The present study was undertaken to characterize the effects of Corni Fructus on diabetic nephropathy in streptozotocin-induced diabetic rats and their mechanisms. Streptozotocin-diabetic rats were orally administrated with Corni Fructus at a dose of 100, 200 or 400 mg/kg body mass for 40 days. Corni Fructus-treated diabetic rats showed significant decreases of blood glucose, urinary protein levels and water consumption. Corni Fructus also reduced serum total cholesterol, total triglyceride and low-density lipoprotein cholesterol levels, and showed a tendency of enhancing high-density lipoprotein cholesterol level. Levels of serum albumin and creatinine in diabetic rats were also significantly reduced by Corni Fructus administration at a dose of 200 and 400 mg/kg body mass compared with non-treated diabetic rats. Corni Fructus increased catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidose (GSH-px) activities in the kidneys of diabetic rats. Furthermore, Corni Fructus treatment enhanced renal peroxisome proliferator-activated receptor-γ (PPARγ) expression in diabetic rats. These results demonstrated that Corni Fructus may have the potential to protect the animals from diabetic nephropathy by amelioration of oxidative stress and stimulation of PPARγ expression.


Empirical verification of a theoretical model derived from the Roy adaptation model: findings from five studies.
This article presents a theoretical model derived from the Roy adaptation model and the findings of an empirical verification of this model from five studies. Four groups of subjects were included in the studies: informal caregivers of demented relatives at home, informal caregivers of psychiatrically ill relatives at home, professional caregivers of elderly institutionalized patients, and aged spouses in the community. In at least three studies, a number of theoretical propositions derived from the Roy adaptation model were supported using LISREL VIII, thus adding credence to some tenets of Roy's model. Particularly, the focal stimulus of perceived stress, the contextual stimulus of conflicts in the exchange of social support, and one component of the coping mechanisms (the passive/avoidance coping strategies) were positively linked directly or indirectly with psychological distress, which is an indicator of adaptation in the self-concept mode. Given their importance, these elements should be considered in the development of a middle-range theory of psychological adaptation derived from the Roy adaptation model.


The atypical 'hippocampal' glutamate receptor coupled to phospholipase D that controls stretch-sensitivity in primary mechanosensory nerve endings is homomeric purely metabotropic GluK2.
A metabotropic glutamate receptor coupled to phospholipase D (PLD-mGluR) was discovered in the hippocampus over three decades ago. Its pharmacology and direct linkage to PLD activation are well established and indicate it is a highly atypical glutamate receptor. A receptor with the same pharmacology is present in spindle primary sensory terminals where its blockade can totally abolish, and its activation can double, the normal stretch-evoked firing. We report here the first identification of this PLD-mGluR protein, by capitalizing on its expression in primary mechanosensory terminals, developing an enriched source, pharmacological profiling to identify an optimal ligand, and then functionalizing it as a molecular tool. Evidence from immunofluorescence, western and far-western blotting indicates PLD-mGluR is homomeric GluK2, since GluK2 is the only glutamate receptor protein/receptor subunit present in spindle mechanosensory terminals. Its expression was also found in the lanceolate palisade ending of hair follicle, also known to contain the PLD-mGluR. Finally, in a mouse model with ionotropic function ablated in the GluK2 subunit, spindle glutamatergic responses were still present, confirming it acts purely metabotropically. We conclude the PLD-mGluR is a homomeric GluK2 kainate receptor signalling purely metabotropically and it is common to other, perhaps all, primary mechanosensory endings. NEW FINDINGS: What is the central question of this study? The metabotropic glutamate receptor coupled to phospholipase D (PLD-mGluR) is a glutamate receptor previously only characterized pharmacologically but essential for maintaining stretch responsiveness in muscle spindle mechanosensory primary endings: what is the PLD-mGluR protein? What is the main finding and its importance? PLD-mGluR was identified as a homomeric GluK2 receptor signalling metabotropically. This identifies PLD-mGluR 30 years after its discovery. This is important because: PLD-mGluR is essential for muscle spindle stretch sensitivity; it is the first native kainate receptor shown to signal solely metabotropically; and, as it is the only GluR expressed in spindle mechanosensory endings, muscle spindles make a good functional assay of the native receptor.


[Characteristics of caloric value and nutrient content of four garden tree species].
In this study, the caloric value, nutrient content, and ash content in the stem, leaf, and root of four garden tree species Prunus mume Meiren, P. serrulata, Magnolia denudata and M. grandiflora were determined to explore the distribution characteristics of caloric value in different tree organs at different development stages, and related affecting factors. The results showed that the gross caloric value (GCV) and ash free caloric value (AFCV) in different organs of the tree species ranged from 17.02 to 21.93 kJ g(-1) and from 18.42 to 22.57 kJ g(-1), respectively. Leaf and fine root had relatively higher GCV and AFCV than stem, and AFCV had a decreasing trend with the development of stem and root. P. mume Meiren and P. serrulata had higher GCV and AFCV than M. grandiflora and M. denudate. Both GCV and AFCV of fine root were significantly correlated with its nutrient and ash contents (P <0.01). With the development of root, the correlations of GCV and AFCV with organic carbon content declined gradually, while the GCV of different organs had the strongest correlation with total nitrogen content.


Bloodstream form Trypanosoma brucei do not require mRPN1 for gRNA processing.
Mitochondrial RNA processing in the kinetoplastid parasite Trypanosoma brucei involves numerous specialized catalytic activities that are incompletely understood. The mitochondrial genome consists of maxicircles that primarily encode rRNAs and mRNAs, and minicircles that encode a diverse array of guide RNAs (gRNAs). RNA editing uses these gRNAs as templates to recode mRNAs by insertion and deletion of uridine (U) residues. While the multiprotein complex that catalyzes RNA editing has been extensively studied, other players involved in mitochondrial RNA processing have remained enigmatic. The proteins required for processing mitochondrial polycistronic transcripts into mature species was essentially unknown until an RNase III endonuclease, called mRPN1, was reported to be involved in gRNA processing in procyclic form parasites. In this work, we examine the role of mRPN1 in gRNA processing in bloodstream form parasites, and show that complete elimination of mRPN1 by gene knockout does not alter gRNA maturation. These results indicate that another enzyme must be involved in gRNA processing.


Modeling source-source and source-filter acoustic interaction in birdsong.
We present a simple model for birdsong production in Oscine songbirds that allows us to study the acoustic interaction between their two sound sources, as well as the acoustic coupling between sources and vocal tract. This model allows us to study complex phenomena in which the traditionally assumed source-filter separation hypothesis does not hold. We make testable hypotheses about the source of complexity in the song of some birds.


[Methods for the evaluation of bone regeneration during distraction osteogenesis].
During limb lengthening gradual reconstruction of bone tissue in distraction gap requires constant, systematic control and evaluation. This process is depicted descriptively and subjectively. Changes happening during osteogenesis are dynamic, they can stop, slow down or accelerate, and regenerate may be of various shape and form. In this work different methods of bone regenerate evaluation are presented. They may be divided on two basic groups. First group contains methods with X-radiation, and the second - without X-rays. Examinations that evaluate arising bone regenerate may be also divided on descriptive examinations and quantitative. Despite that different methods are used for distraction osteogenesis course estimation, classic radiological examination remains the basic one. The rest of them are most often supplementary examinations, useful in selected stages of treatment, for e.g. ultrasonography in first stage of regenerate arising. So it seems, that future is in quantitative regenerate evaluation using radiographs. Classic X-ray picture made in reproducible and repeatable conditions may be subjected to digital, quantitative image analysis, and acquired results enables for more precise and more balanced evaluation of new bone formation in distraction osteogenesis.


Influence of sex, menstrual cycle, and hormonal contraceptives on egocentric navigation with or without landmarks.
This study examines the influence of sex, menstrual cycle, hormonal contraceptives (HC) and sex hormone levels in following egocentric navigation instructions with or without landmarks. Estradiol seem to bias the reference frame for navigation during estrous cycle of female rats. However, previous studies in humans found no differences in overall navigation between women in their early follicular and mid-luteal menstrual cycle phases, whose performance was worse than that of men. Our study hypothesis was that the performance of women would be improved during the peri-ovulatory phase and would remain the same during placebo and active phases of HC users. The study included 21 men, 62 women with natural menstrual cycle (21 during early follicular phase, 20 during peri-ovulatory phase, and 21 during mid-luteal phase), and 38 women that were receiving HC (13 during placebo phase and 25 during active phase). The men outperformed the women with a natural menstrual cycle when following egocentric instructions without landmarks. However, the women's performance varied according to the phase of their menstrual cycle, differing from men during early follicular and mid-luteal phases but not during the peri-ovulatory phase. The use of HC also improved the performance of women to the extent that the difference with men disappeared. No differences were observed between HC-placebo and HC-active user groups during egocentric navigation without landmarks and among all groups during egocentric navigation with landmarks. Analysis of salivary hormones showed that testosterone levels were higher in men and that estradiol levels in women were higher during peri-ovulatory and mid-luteal phases and also in HC users. Progesterone levels were higher in women during the mid-luteal phase. These results appear compatible with beneficial effect of testosterone and estradiol on egocentric navigation without landmarks and with a block of this effect produced by progesterone.


Vaccination against bovine herpes mammillitis virus infections in guinea pigs.
Bovine herpes mammillitis virus or bovine herpesvirus type 2 (BHV-2) causes ulcerative lesions on the teats and udders of infected cows. Since no commercial vaccine is available for this disease, we investigated certain experimental BHV-2 vaccines against this virus in infected guinea pigs. Vaginally infected guinea pigs get severe, self-limiting vaginal infections characterized by erythema and swelling and the production of measurable vaginal virus titers. Two vaccine approaches were investigated: vaccination with wild-type (WT) virus by the subcutaneous route, and vaccination either subcutaneously or intravaginally with a thymidine kinase (TK) deficient (TK-) virus. The TK- strain was prepared by passage of BHV-2 in the presence of the potent TK-dependent antiviral agent 1-(2'-deoxy-2'-fluoro-beta-D-arabinofuranosyl)-5-methyluracil (FMAU). The antiviral activity of FMAU against the virus in plaque reduction assays changed from 0.05 to 2 microM at the same time that the TK activity of the mutant virus decrease to 7% of WT virus TK activity. Subcutaneous vaccination of guinea pigs with WT and TK- viruses did not induce vaginal infection. Primary vaginal infection (vaccination) with the TK- virus led to greatly reduced lesion severity compared to vaginal infection with the WT virus. However, the amount of vaginal virus titers recovered during these primary infections was similar for both TK- and WT viruses, indicating that both viruses had equal infecting potential. Thirty days after vaccination the animals were re-infected intravaginally with WT virus. The vaccinated animals showed dramatically reduced lesion severity and low recoverable virus titers compared to age-matched nonvaccinated animals.(ABSTRACT TRUNCATED AT 250 WORDS)


Intraocular projections from the pterygopalatine ganglion in the cat.
The intraocular projection of the cat pterygopalatine (sphenopalatine) ganglion was examined by using retrograde axoplasmic transport techniques in order to investigate the possibility of the involvement of the facial nerve in ocular parasympathetic innervation. Following an injection of horseradish peroxidase (HRP) or wheat germ agglutinin-HRP into the eye, retrogradely labeled cells were observed in the ipsilateral pterygopalatine ganglion, principally in the caudal part. By dissection of silver-impregnated, acetylcholinesterase- and cholinesterase-stained orbital preparations, it was determined that two different nerve pathways link the pterygopalatine ganglion and the eye. One took a retrograde course to join the retro-orbital plexus and then traveled forward accompanying the ciliary artery, the long ciliary nerve, the short ciliary nerve, and/or the optic nerve sheath. The other entered the orbit directly, fused with the ethmoidal nerve or the infratrochlear nerve in a retrograde fashion, and then turned forward along the long ciliary nerve to enter the eye. All these nerves arose from the caudal part of the ganglion. These results are discussed in relation to recent biochemical and histochemical data demonstrating the involvement of the facial nerve in the control of ocular blood flow and intraocular pressure.


Does Timing Matter?: Timing and Outcomes Among Early Unplanned PICU Transfers.
Many institutions track early ICU transfers (transfer from an inpatient floor to an ICU within 24 hours of admission) as a marker of quality of emergency department (ED) care. There are limited data evaluating whether patient characteristics or clinical outcomes differ on the basis of timing of ICU transfer within this 24-hour window. We conducted a retrospective cohort study examining all patients ≤21 years old admitted to an inpatient pediatric floor from the ED and subsequently transferred to an ICU within 24 hours of hospitalization. Patient characteristics and clinical outcomes were compared on the basis of timing (0-6 hours, 6-12 hours, 12-24 hours) of ICU transfer. Outcomes assessed included receipt of critical intervention, timing of intervention with respect to transfer, type of intervention received, hospital and ICU length of stay, and mortality at 72 hours and during hospitalization. A total of 841 patients were transferred to an ICU within 24 hours from admission to a pediatric ward from the ED; 266 patients (32%) transferred within 6 hours of admission, 269 patients (32%) transferred between 6 and 12 hours, and 306 patients (36%) transferred between 12 and 24 hours. Patient characteristics did not materially differ on the basis of timing of ICU transfer, nor did clinical outcomes. Among children transferred to an ICU within 24 hours of hospitalization, patient characteristics and clinical outcomes did not materially differ based on the timing of transfer relative to admission from the ED.


[Soft tissue injuries of the shoulder joint].
In contrast to rare occurrence of blood vessel and nerve injuries the frequency of tendinous lesions of the shoulder is high. The clinical diagnosis of the ruptured tendon of the M. biceps brachii is obvious. On the other hand only arthrography or arthroscopy can verify the diagnosis of a ruptured supraspinatus tendon. The best access for tenosuture and tenoplasty of the latter is the transacromeal method.


Giant papillary conjunctivitis in connection with corneoscleral supramid (nylon) suture knots.
A material consisting of 27 patients had corneoscleral wound closure by 8-0 polyamide (supramid, nylon) sutures after intracapsular cataract extraction and intraocular lens implantation. A few months after surgery 16 patients had developed giant papillary conjunctivitis of the upper tarsus of the operated eye, associated with itching and blurring. The earlier stages of the condition, as described by other authors, could be defined in the remaining 11 patients. Cytologic tests - pipette samples of tear fluid and tarsal conjunctival scrapings - demonstrated eosinophil leucocytes and neutrophilia in most of the giant papillary conjunctivitis cases. The conjunctival scraping proved the more sensitive test for detection of eosinophils, the pipette test being mainly an indicator of inflammatory reaction. The condition seems to be allergic with an element of mechanical irritation. The use of polyamide sutures of the 8-0 size is not recommended.


Recent progress in autophagic lysosome reformation.
Autophagic lysosome reformation (ALR) is the terminal step of autophagy and is essential for maintaining lysosome homeostasis during autophagy. During ALR, tubules are extruded from autolysosomes, and small vesicles named proto-lysosomes, which are composed of lysosomal membrane components, are generated from these tubules. Eventually, proto-lysosomes mature into functional lysosomes. In this review, we will summarize recent progress in understanding the regulation, mechanisms and physiological functions of ALR.


A Semantic Parsing Pipeline for Context-Dependent Question Answering over Temporally Structured Data.
We propose a new setting for question answering in which users can query the system using both natural language and direct interactions within a graphical user interface that displays multiple time series associated with an entity of interest. The user interacts with the interface in order to understand the entity's state and behavior, entailing sequences of actions and questions whose answers may depend on previous factual or navigational interactions. We describe a pipeline implementation where spoken questions are first transcribed into text which is then semantically parsed into logical forms that can be used to automatically extract the answer from the underlying database. The speech recognition module is implemented by adapting a pre-trained LSTM-based architecture to the user's speech, whereas for the semantic parsing component we introduce an LSTM-based encoder-decoder architecture that models context dependency through copying mechanisms and multiple levels of attention over inputs and previous outputs. When evaluated separately, with and without data augmentation, both models are shown to substantially outperform several strong baselines. Furthermore, the full pipeline evaluation shows only a small degradation in semantic parsing accuracy, demonstrating that the semantic parser is robust to mistakes in the speech recognition output. The new question answering paradigm proposed in this paper has the potential to improve the presentation and navigation of the large amounts of sensor data and life events that are generated in many areas of medicine.


Association of the medical therapy with beta-blockers or inhibitors of renin-angiotensin system with clinical outcomes in patients with mildly reduced left ventricular ejection fraction after acute myocardial infarction.
In the era of the initial optimal interventional and medical therapy for acute myocardial infarction (AMI), a number of patients with mildly reduced left ventricular ejection fraction (EF) (41%-49%) have been increasing. This observational study aimed to investigate the association between the medical therapy with oral beta-blockers or inhibitors of renin-angiotensin system (RAS) and 2-year clinical outcomes in patients with mildly reduced EF after AMI. Among patients enrolled in the Korea Acute Myocardial Infarction Registry-National Institute of Health, propensity-score matched patients who survived the initial attack and had mildly reduced EF were selected according to beta-blocker or RAS inhibitor therapy at discharge. Beta-blocker therapy at discharge was associated with lower 2-year major adverse cardiac events which was a composite of cardiac death, myocardial infarction, revascularization and re-hospitalization due to heart failure (8.7 vs 12.8/100 patient-years; hazard ratio [HR] 0.68; 95% confidence interval [CI] 0.50-0.93; P = .015), and no significant interaction between EF ≤ 45% and > 45% was observed (Pinteraction = 0.354). This association was mainly driven by lower myocardial infarction in patients with beta-blockers (HR 0.50; 95% CI 0.26-0.95; P = .035). Inhibitors of RAS at discharge were associated with lower re-hospitalization due to heart failure (1.8 vs 3.5/100 patient-years; HR 0.53; 95% CI 0.33-0.86; P = .010) without a significant interaction between EF ≤ 45% and > 45% (Pinteraction = 0.333). In patients with mildly reduced EF after AMI, the medical therapy with beta-blockers or RAS inhibitors at discharge was associated with better 2-year clinical outcomes.


MLPA-Based Analysis of Copy Number Variation in Plant Populations.
Copy number variants (CNVs) are intraspecies duplications/deletions of large DNA segments (>1 kb). A growing number of reports highlight the functional and evolutionary impact of CNV in plants, increasing the need for appropriate tools that enable locus-specific CNV genotyping on a population scale. Multiplex ligation-dependent probe amplification (MLPA) is considered a gold standard in genotyping CNV in humans. Consequently, numerous commercial MLPA assays for CNV-related human diseases have been created. We routinely genotype complex multiallelic CNVs in human and plant genomes using the modified MLPA procedure based on fully synthesized oligonucleotide probes (90-200 nt), which greatly simplifies the design process and allows for the development of custom assays. Here, we present a step-by-step protocol for gene-specific MLPA probe design, multiplexed assay setup and data analysis in a copy number genotyping experiment in plants. As a case study, we present the results of a custom assay designed to genotype the copy number status of 12 protein coding genes in a population of 80 Arabidopsis accessions. The genes were pre-selected based on whole genome sequencing data and are localized in the genomic regions that display different levels of population-scale variation (non-variable, biallelic, or multiallelic, as well as CNVs overlapping whole genes or their fragments). The presented approach is suitable for population-scale validation of the CNV regions inferred from whole genome sequencing data analysis and for focused analysis of selected genes of interest. It can also be very easily adopted for any plant species, following optimization of the template amount and design of the appropriate control probes, according to the general guidelines presented in this paper.


[Clinical study of renal cell carcinoma in dialysis patients: a single center experience].
Because of a higher incidence in dialysis patients, regular screening for renal cell carcinoma (RCC) is considered beneficial in this population. RCC is associated with a high incidence of acquired cystic disease of the kidney (ACDK), and it has been suggested that these conditions are related. This study was designed to examine the efficacy of RCC screening for dialysis patients and the relationship between RCC and ACDK. This study enrolled 624 dialysis patients treated between August 2005 and June 2011 at our hospital. Screening for RCC was performed by annual abdominal ultrasonography. Factors analyzed were as follows: RCC morbidity, incidence, diagnostic method, and survival rate; and the RCC and ACDK comorbidity rate. RCC was diagnosed in 12 patients. RCC morbidity and incidence rates were 2.08% and 0.33%, respectively. Diagnosis of RCC was made by abdominal ultrasonography screening (N = 7, group A), abdominal ultrasonography or computed tomography for other disease (N = 2, group B) or detailed examination after appearance of symptoms (N = 3, group C). With the exception of one death from other disease, all group A and group B patients survived the follow-up period. In contrast, all group C patients died of RCC within 6 months of diagnosis; only one of these patients underwent RCC screening. The RCC/ACDK comorbidity rate was 91.7% (p = 0.0026). Results indicate that regular screening of dialysis patients for RCC is beneficial. RCC was associated with a high incidence of ACDK, indicating that there is a relationship between these two diseases.


The Nurse's Role in Supporting Patients and Family in Sharing Personal Accounts of Traumatic Events: A Personal Experience.
Life-changing events unfold quickly as trauma nurses provide care for patients during the most vulnerable time of their lives. Nurses also bear the weight of simultaneously caring and providing emotional support for the families of trauma victims. Trauma nurses have a profound responsibility to assist patients and families through this process, as well as having a unique opportunity to encourage families to share their personal stories and experiences. On occasion, some high-profile traumas make their way to the local news and inquiries from the media soon follow. The public has an interest in stories related to trauma and a fascination in the reactions of individuals immediately impacted. These stories have value to the public, as they create opportunities for others to learn, examine personal values and social norms, develop new perspectives, and reflect on the fragility and meaning of life. Personal accounts of traumatic life events can be shared privately or publicly, and nurses should be prepared to provide effective interventions and, on occasion, support families faced with weighing the potential risks and benefits of sharing their story with the media.


[Influencing Factors for Hydrochemistry and δ13CDIC of Karst Springs].
To gain more knowledge on the change of karst spring and its influencing factors, the hydrochemistry and δ13CDIC of Baishuwan spring, Lanhuagou spring and Hougou spring were monitored in rainy season (from June 2014 to October 2014) and contrasted with the results obtained in dry season. The results showed that more carbonate rock was dissolved and less CO2 was consumed in rainy season. And for Lanhuagou spring and Hougou spring, the CO2 consumption was less than the production. Compared to other months in rainy season, the least carbonate rock dissolution and the most CO2 consumption were observed in July 2014. Influenced by hydrodynamic condition, carbonate rock dissolved by HNO3 and H2SO4 increased while that dissolved by H2CO3 decreased during the rainy season. The δ13CDIC increased due to the HNO3 and H2SO4 dissolution of carbonate rock and the dehydration of HCO3-. Therefore, δ13CDIC correlated negatively to HCO3- concentration and positively to NO3- + SO(4)2- concentration. It was indicated that the hydrochemistry and δ13CDIC of karst springs were affected by the HNO3, H2SO4 and hydrodynamic condition.


Association Between Multimodality Neck Treatment and Work and Leisure Impairment: A Disease-Specific Measure to Assess Both Impairment and Rehabilitation After Neck Dissection.
This study describes the effect of adjuvant treatment on shoulder-related quality of life, leisure activities, and employment for patients undergoing neck dissection for head and neck cancer. To explore the association between treatment outcome and shoulder-related on critical daily life functions such as employment and recreation. Cross-sectional study of patients with head and neck cancer at a tertiary care hospital. Level V–sparing selective neck dissection or modified radical neck dissection sparing the accessory nerve, with or without radiation therapy and/or chemotherapy. Patients completed the Neck Dissection Impairment Index (NDII), with scores ranging from 0 to 100 and higher scores indicating better shoulder functioning and shoulder-related quality of life, and underwent objective testing with the Constant-Murley Shoulder Function Test (Constant test) at least 12 months after the completion of all adjuvant treatment. Additional outcome measures related to physical therapy, pain medication use, leisure activity, and employment status. We evaluated 167 patients who underwent 121 selective neck dissections and 46 modified radical neck dissections. The median (range) NDII score was 90 (10-100). Patients with modified radical neck dissection reported lower scores than those with selective neck dissection (85 [10-100] vs. 92 [30-100]; P = .01). Multivariable analysis showed that advanced-stage disease (mean, 77 [range, 25-100] vs. 87 [18-100]; P = .006), radiation therapy (80 [10-100] vs. 88 [50-100]; P = .03), and chemotherapy (77 [30-100] vs. 83 [18-100]; P = .002) were associated with greater shoulder impairment. The NDII and Constant test were well correlated (0.64; P < .001). Change in leisure activity was correlated with greater impairment (median [range] NDII score, 90 [18-100] for patients with no change vs. 53 [10-100] for patients with change, P = .005; Constant score, 85 [12-100] vs. 68 [10-88], P = .004). Patients who remained employed or resumed working had higher median (range) NDII scores (94 [10-100] and 88 [75-100], respectively) than those who limited or stopped working (70 [10-100]), which also correlates with greater shoulder impairment (P < .001). More aggressive treatment, either in the form of increased surgical dissection, radiation therapy, or chemotherapy, was associated with worse shoulder function and quality of life. The degree of impairment perceived by the patient and measured in objective testing was correlated with leisure activity and employment status. These findings may stimulate further investigation related to optimizing quality of life following neck dissection.


Learning and feedback from the Danish patient safety incident reporting system can be improved.
The perceived usefulness of incident reporting systems is an important motivational factor for reporting. The usefulness may be facilitated by well-established feedback mechanisms and by learning processes. The aim of this study was to investigate how feedback mechanisms and learning processes were implemented at four Danish hospital units all located in one of the five Danish regions. Based on the concepts of feedback and learning from incident processes, a questionnaire was developed and distributed to 335 patient safety representatives from 200 departments at four Danish hospital units in one of the five Danish regions. The study showed that external reporters were rarely contacted for dialogue, grouped front-line staff were sparsely involved in the learning process, few evaluated the effectiveness of implemented interventions and personal factors were frequently perceived as a primary contributory factor to these incidents. In contrast, the patient safety representatives perceived their competencies as sufficient for the job, internal reporters were often contacted for dialogue, evaluation was widely used and management supported the work with incident reports. The results of the study identified several shortcomings in the implementation of learning processes and feedback mechanisms. The apparent existence of a person-focused approach stands out as an element of notice. The insufficient implementation we observed indicates that there is room for improvement in the efforts made to maximise learning from incidents in the investigated population. not relevant. not relevant.


Occupational Farm Work Activities Influence Workers' Indoor Home Microbiome.
Farm work entails a heterogeneous mixture of exposures that vary considerably across farms and farmers. Farm work is associated with various health outcomes, both adverse and beneficial. One mechanism by which farming exposures can impact health is through the microbiome, including the indoor built environment microbiome. It is unknown how individual occupational exposures shape the microbial composition in workers' homes. We investigated associations between farm work activities, including specific tasks and pesticide use, and the indoor microbiome in the homes of 468 male farmers. Participants were licensed pesticide applicators, mostly farmers, enrolled in the Agricultural Lung Health Study from 2008-2011. Vacuumed dust from participants' bedrooms underwent whole-genome shotgun sequencing for indoor microbiome assessment. Using questionnaire data, we evaluated 6 farm work tasks (processing of either hay, silage, animal feed, fertilizer, or soy/grains, and cleaning grain bins) and 19 pesticide ingredients currently used in the past year, plus 7 persistent banned pesticide ingredients ever used. All 6 work tasks were associated with increased within-sample microbial diversity, with a positive dose-response for the sum of tasks (p=0.001). All tasks were associated with altered overall microbial compositions (weighted UniFrac p=0.001) and with higher abundance of specific microbes, including soil-based microbes such as Haloterrigena. Among the 19 pesticides, only current use of glyphosate and past use of lindane were associated with increased within-sample diversity (p=0.02-0.04). Ten currently used pesticides and all 7 banned pesticides were associated with altered microbial composition (p=0.001-0.04). Six pesticides were associated with differential abundance of certain microbes. Specific farm activities and exposures can impact the dust microbiome inside homes. Our work suggests that occupational farm exposures could impact the health of workers and their families through modifying the indoor environment, specifically the microbial composition of house dust, offering possible future intervention targets.


[The differential diagnosis of the types of trauma caused by wheeled tractors].
Examinations of 23 corpses and study of 282 expert conclusions concerning the deaths of subjects aged 6 to 78 dead because of wheeled tractor injuries under agricultural conditions helped detect the specific characteristic signs of tractor injury types. Mathematical method of analysis of the characteristic features' quantitative parameters permitted the author to find statistically reliable criteria for differential diagnosis of the types of injuries inflicted by wheeled tractors. The possibility of correct conclusions of an expert using this method is at least 95%.


Eosinophils bind rhinovirus and activate virus-specific T cells.
Episodes of virus-induced exacerbations of asthma are accompanied by increased eosinophils (EOS) in respiratory secretions and evidence of EOS degranulation. Although rhinoviruses (RV) are the viruses most often implicated in exacerbations of asthma in both children and adults, little is known about the immune response to this group of viruses and, in particular, EOS-RV interactions. To define such interactions, we incubated human rhinovirus type 16 (RV16), a serotype using ICAM-1 as a receptor, with EOS purified from PBMC, and measured EOS-RV binding, EOS-mediated Ag presentation and T cell activation, and EOS cell surface marker expression and superoxide production. Significant RV16 binding occurred to EOS that were pretreated with granulocyte-macrophage CSF, and this binding was inhibited by anti-ICAM-1 mAb. EOS also presented viral Ags to RV16-specific T cells, causing T cell proliferation and secretion of IFN-gamma. RV16 induced a significant shift from CD18dim to CD18bright, but did not affect EOS expression of CD54, CD69, or HLA-DR. Finally, RV16 did not induce superoxide production from peripheral blood EOS. These findings suggest that RV16 also binds to airway EOS, which resemble granulocyte-macrophage CSF-treated blood EOS in terms of high expression of ICAM-1. Furthermore, our findings suggest that EOS could participate in RV-induced immune responses through Ag presentation and T cell activation. By activating RV-specific T cells, EOS may play an important role in the initiation of antiviral T cell responses, and these effects could also contribute to enhanced airway inflammation and increased asthma symptoms in susceptible individuals.


The cwp66 Gene Affects Cell Adhesion, Stress Tolerance, and Antibiotic Resistance in Clostridioides difficile.
Clostridioides difficile is a Gram-positive, spore-forming anaerobic bacteria that is one of the leading causes of antibiotic-associated diarrhea. The cell wall protein 66 gene (cwp66) encodes a cell wall protein, which is the second major cell surface antigen of C. difficile. Although immunological approaches, such as antibodies and purified recombinant proteins, have been implemented to study the role of Cwp66 in cell adhesion, no deletion mutant of the cwp66 gene has yet been characterized. We constructed a cwp66 gene deletion mutant using Clustered Regularly Interspaced Short Palindromic Repeats Cpf1 (CRISPR-Cpf1) system. The phenotypic and transcriptomic changes of the Δcwp66 mutant compared with the wild-type (WT) strain were studied. The deletion of the cwp66 gene led to the decrease of cell adhesive capacity, cell motility, and stresses tolerance (to Triton X-100, acidic environment, and oxidative stress). Interestingly, the Δcwp66 mutant is more sensitive than the WT strain to clindamycin, ampicillin, and erythromycin but more resistant than the latter to vancomycin and metronidazole. Moreover, mannitol utilization capability in the Δcwp66 mutant was lost. Comparative transcriptomic analyses indicated that (i) 22.90-fold upregulation of cwpV gene and unable to express gpr gene were prominent in the Δcwp66 mutant; (ii) the cwp66 gene was involved in vancomycin resistance of C. difficile by influencing the expression of d-Alanine-d-Alanine ligase; and (iii) the mannose/fructose/sorbose IIC and IID components were upregulated in Δcwp66 mutant. The present work deepens our understanding of the contribution of the cwp66 gene to cell adhesion, stress tolerance, antibiotic resistance, and mannitol transportation of C. difficile. IMPORTANCE The cell wall protein 66 gene (cwp66) encodes a cell wall protein, which is the second major cell surface antigen of C. difficile. Although immunological approaches, such as antibodies and purified recombinant proteins, have been implemented to study the role of Cwp66 in cell adhesion, no deletion mutant of the cwp66 gene has yet been characterized. The current study provides direct evidence that the cwp66 gene serves as a major adhesion in C. difficile, and also suggested that deletion of the cwp66 gene led to the decrease of cell adhesive capacity, cell motility, and stresses tolerance (to Triton X-100, acidic environment, and oxidative stress). Interestingly, the antibiotic resistance and carbon source utilization profiles of the Δcwp66 mutant were significantly changed. These phenotypes were detrimental to the survival and pathogenesis of C. difficile in the human gut and may shed light on preventing C. difficile infection.


Physical analysis of the COR region: a cluster of six genes in Saccharomyces cerevisiae.
Six genes, CYC1, UTR1, UTR3, OSM1, tRNAGly, and RAD7, have been localized within an 8-kilobase region on chromosome X of the yeast Saccharomyces cerevisiae. The physical structures and the transcripts of these genes were identified by analyzing a normal strain and six deletion mutants by genomic blotting, transcriptional analysis, and gene disruption procedures. The well-studied CYC1 gene encodes iso-1-cytochrome c; the tRNAGly gene encodes a tRNA; deletion of OSM1 and RAD7 causes sensitivity to hypertonic medium and UV irradiation, respectively. There were no observable phenotypes in strains having deletions of the UTR1, UTR3, and tRNAGly gene. The high density of transcripts, with little or almost no intragenic regions, indicates that the chromosomal organization of S. cerevisiae resembles the chromosomal organization of procaryotes rather than higher eucaryotes.


The Ross procedure is the optimal solution for young adults with unrepairable aortic valve disease.
While aortic valve repair remains the ideal intervention to restore normal valvular function, the optimal aortic valve substitute for patients with a non-repairable aortic valve remains an ongoing subject for debate. In particular, younger patients with a non-repairable valve represent a unique challenge because of their active lifestyle and long life expectancy, which carries a higher cumulative risk of prosthesis-related complications. The Ross procedure, unlike prosthetic or homograft aortic valve replacement (AVR), provides an expected survival equivalent to that of the age and gender-matched general population. Contemporary data has shown that the Ross procedure can be performed safely in centers with expertise, and is associated with improved valvular durability, hemodynamics and quality of life.


Patient-specific orthotopic glioblastoma xenograft models recapitulate the histopathology and biology of human glioblastomas in situ.
Frequent discrepancies between preclinical and clinical results of anticancer agents demand a reliable translational platform that can precisely recapitulate the biology of human cancers. Another critical unmet need is the ability to predict therapeutic responses for individual patients. Toward this goal, we have established a library of orthotopic glioblastoma (GBM) xenograft models using surgical samples of GBM patients. These patient-specific GBM xenograft tumors recapitulate histopathological properties and maintain genomic characteristics of parental GBMs in situ. Furthermore, in vivo irradiation, chemotherapy, and targeted therapy of these xenograft tumors mimic the treatment response of parental GBMs. We also found that establishment of orthotopic xenograft models portends poor prognosis of GBM patients and identified the gene signatures and pathways signatures associated with the clinical aggressiveness of GBMs. Together, the patient-specific orthotopic GBM xenograft library represent the preclinically and clinically valuable "patient tumor's phenocopy" that represents molecular and functional heterogeneity of GBMs.


Rounding Probabilistic Expectations in Surveys.
Rounding is the familiar practice of reporting one value whenever a real number lies in an interval. Uncertainty about the extent of rounding is common when researchers analyze survey responses to numerical questions. The prevalent practice has been to take numerical responses at face value, even though many may in fact be rounded. This paper studies the rounding of responses to survey questions that ask persons to state the percent-chance that some future event will occur. We analyze data from the Health and Retirement Study and find strong evidence of rounding, the extent of rounding differing across respondents. We propose use of a person's response pattern across different questions to infer his rounding practice, the result being interpretation of reported numerical values as interval data. We then bring to bear recent developments on statistical analysis of interval data to characterize the potential consequences of rounding for empirical research. Finally, we propose enrichment of surveys by probing to learn the extent and reasons for rounding.


Direct and indirect costs of end-stage renal disease patients in the first and second years after initiation of nocturnal home haemodialysis, hospital haemodialysis and peritoneal dialysis.
To estimate the direct and indirect costs of end-stage renal disease (ESRD) patients in the first and second years of initiating peritoneal dialysis (PD), hospital-based haemodialysis (HD) and nocturnal home HD. A cost analysis was performed to estimate the annual costs of PD, hospital-based HD and nocturnal home HD for ESRD patients from both the health service provider's and societal perspectives. Empirical data on healthcare resource use, patients' out-of-pocket costs, time spent on transportation and dialysis by ESRD patients and time spent by caregivers were analysed. All costs were expressed in Hong Kong year 2017 dollars. Analysis was based on 402 ESRD patients on maintenance dialysis (PD: 189; hospital-based HD: 170; and nocturnal home HD: 43). From the perspective of the healthcare provider, hospital-based HD had the highest total annual direct medical costs in the initial year (mean ± SD) (hospital-based HD = $400 057 ± 62 822; PD = $118 467 ± 15 559; nocturnal home HD = $223 358 ± 18 055; P < 0.001) and second year (hospital-based HD = $360 924 ± 63 014; PD = $80 796 ± 15 820; nocturnal home HD = $87 028 ± 9059; P < 0.001). From the societal perspective, hospital-based HD had the highest total annual costs in the initial year (hospital-based HD = $452 151 ± 73 327; PD = $189 191 ± 61 735; nocturnal home HD = $242 038 ± 28 281; P < 0.001) and second year (hospital-based HD = $413 017 ± 73 501; PD = $151 520 ± 60 353; nocturnal home HD = $105 708 ± 23 853; P < 0.001). This study quantified the economic burden of ESRD patients, and assessed the annual healthcare and societal costs in the initial and second years of PD, hospital-based HD and nocturnal home HD in Hong Kong. From both perspectives, PD is cost-saving relative to hospital-based HD and nocturnal home HD, except that nocturnal home HD has the lowest cost in the second year of treatment from the societal perspective. Results from this cost analysis facilitate economic evaluation in Hong Kong for health services and management targeted at ESRD patients.


Simple renal cysts are associated with increased arterial stiffness in a Taiwanese population.
Arterial stiffness has been found to be a predictive risk factor for cardiovascular disease. Simple renal cysts are associated with prehypertension, hypertension, diabetes, and increased serum creatinine, which are risk factors of cardiovascular events. The aim of this work was to clarify the association between simple renal cysts and arterial stiffness defined by the brachial and ankle pulse wave velocity (baPWV). Subjects with and without simple renal cysts had right baPWV values of 1522.8 ± 357.5 cm/s and 1344.2 ± 268.8 cm/s, respectively (p < 0.001). Based on multiple linear regression analysis, the presence of simple renal cysts was associated with increased baPWV values (p < 0.001). Both the size and the number of simple renal cysts were positively associated with an increased baPWV value. Subjects with a cyst size ≥2 cm (p < 0.001) and a cyst number ≥2 (p < 0.01) had higher baPWV values than those without SRCs. Simple renal cysts are associated with increased arterial stiffness.


Learning to live with childhood cancer: a literature review of the parental perspective.
This article presents an analysis of literature on paternal and maternal development and resilience through the experience of having a child diagnosed, treated, and possibly die from cancer. The methods and analysis of findings from research conducted in this area are assessed, as are the data's relevance and implications for practice. The review required an in-depth search of relevant health-care databases using appropriate search terms. Findings were then culled and analysed based on the inclusion and exclusion criteria, and two papers were deemed appropriate for selection. Four contrasting themes emerged from each article. It was generally acknowledged that mothers and fathers enduring such an experience stated that changes occurred in their lives. The mothers felt a need to become tougher for their child and family, and the fathers recognized a need to focus quickly on what needed to be done to treat their child's illness. However, analytically the differences in each paper are vast. The research was conducted in Japan and the United States, where contrasting cultural and societal beliefs and influences are apparent, therefore inadvertently affecting the research findings. Furthermore, a gap in research in this area has been detected, and much more research specifically focused on this subject is required if the children's nurse is to provide evidence-based holistic care in this area on a continual basis.


Absence of regulator of G-protein signaling 4 does not protect against dopamine neuron dysfunction and injury in the mouse 6-hydroxydopamine lesion model of Parkinson's disease.
Regulator of G-protein signaling 4 (RGS4), a member of the RGS family of proteins that inactivate G-proteins, has gained interest as a potential drug target for neurological disorders, such as epilepsy and Parkinson's disease (PD). In the case of PD, the main current options for alleviating motor symptoms are dopamine replacement therapies, which have limitations because of side effects and reduced effectiveness over the long term. Research on new nondopaminergic PD drug targets has indicated that inhibition of RGS4 could be an effective adjuvant treatment option. The effectiveness of RGS4 inhibition for an array of PD-linked functional and structural neuroprotection end points has not yet been demonstrated. Here, we use the 6-hydroxydopamine (6-OHDA) lesioning model of the nigrostriatal pathway in mice to address this question. We observe, using a battery of behavioral and pathological measures, that mice deficient for RGS4 are not protected from 6-OHDA-induced injury and show enhanced susceptibility in some measures of motor function. Our results suggest that inhibition of RGS4 as a nondopaminergic target for PD should be approached with caution.


In vivo assessment of lipid peroxidation in experimental edematous and necrotizing rat pancreatitis.
Lipid peroxidation, which may be involved in the pathogenesis of acute pancreatitis, is usually assessed in vitro or indirectly using antioxidants or free radical scavengers. We assessed lipid peroxidation in an in vivo model by measuring ethane exhalation in two models of acute pancreatitis. Edematous acute pancreatitis was induced by a supramaximal intraperitoneal injection of cerulein. Necrotizing acute pancreatitis was induced by retrograde infusion of sodium taurocholate into the pancreaticobiliary duct. Rats were placed in closed chambers and ethane exhalation was measured in aliquots. Ethane exhalation was significantly increased (p < 0.002) in cerulein (n = 12)- but not in taurocholate (n = 6)-induced pancreatitis compared to controls (n = 12 and 6, respectively). Our results suggest that free radicals may play a role in the pathogenesis of edematous pancreatitis but do not play an important role in the progression to necrotizing pancreatitis.


Lnk deficiency partially mitigates hematopoietic stem cell aging.
Upon aging, the number of hematopoietic stem cells (HSCs) in the bone marrow increases while their repopulation potential declines. Moreover, aged HSCs exhibit lineage bias in reconstitution experiments with an inclination toward myeloid at the expense of lymphoid potential. The adaptor protein Lnk is an important negative regulator of HSC homeostasis, as Lnk deficiency is associated with a 10-fold increase in HSC numbers in young mice. However, the age-related increase in functional HSC numbers found in wild-type HSCs was not observed in Lnk-deficient animals. Importantly, HSCs from aged Lnk null mice possess greatly enhanced self-renewal capacity and diminished exhaustion, as evidenced by serial transplant experiments. In addition, Lnk deficiency ameliorates the aging-associated lineage bias. Transcriptome analysis revealed that WT and Lnk-deficient HSCs share many aging-related changes in gene expression patterns. Nonetheless, Lnk null HSCs displayed altered expression of components in select signaling pathways with potential involvement in HSC self-renewal and aging. Taken together, these results suggest that loss of Lnk partially mitigates age-related HSC alterations.


Incidence, Bacterial Profile and Predictors of Surgical Site Infection After Cesarean Section in Ethiopia, A Prospective Cohort Study.
Surgical site infections (SSI) after cesarean section are common in Ethiopia and result in maternal morbidity, mortality, hospitalization, and medical costs. This study aimed to determine the incidence, bacterial profile, and associated factors of surgical site infection after cesarean section (CS) in public and private referral hospitals. A prospective observational cohort study was conducted on 741 pregnant women who underwent CS from July to September 2022. Women who had CS were followed up for at least 30 days. Infected wound specimens from those who had SSIs were collected and bacteriologically analyzed. The data were analyzed with SPSS version 25. The logistic regression model assessed the relationship between the independent variable and the outcome with 95% confidence interval. The incidence of post-cesarean surgical site infection was 11.6% (95% Cl: 9.4, 13.6). Staphylococcus aureus was the most common bacteria in CS wounds 10 (21.2%). Two to three antenatal care visits (ANC) (AOR: 3.11, 95% CI: 1.69, 5.75), delayed antenatal booking (AOR: 6.99, 95% CI: 2.09, 23.32), membrane rupture (AOR: 2.10, 95% CI: 1.04, 4.24), multiple vaginal examinations (AOR = 4.21, 95% CI: 1.35, 6.92) and public hospitals (AOR: 11.1, 95% CI: 1.48, 45, 14) were associated with increased risk of SSI after CS, in contrary shorter hospital stays (AOR = 0.37, 95% CI: 0.15, 0.91) and transversal incisions (AOR = 0.38, 95% CI: 0.15, 0.91) were associated with lower risk SSI after CS. The incidence of SSI after CS was high. Delayed antenatal booking, two to three antenatal visits, multiple vaginal exams, membrane rupture, vertical incision, longer postoperative hospital stays, and procedures in public hospitals were associated with increased risk of SSI after CS. Therefore, intervention programs should focus on post-discharge surveillance and identification of risk to reduce and prevent SSI after CS rate.


Tricuspid regurgitation in screening for trisomies 21, 18 and 13 and Turner syndrome at 11+0 to 13+6 weeks of gestation.
To investigate the performance of first-trimester screening for aneuploidies by including assessment of tricuspid blood flow in the combined test of maternal age, fetal nuchal translucency (NT) thickness, fetal heart rate (FHR) and serum free beta-human chorionic gonadotropin (beta-hCG) and pregnancy-associated plasma protein A (PAPP-A). Screening by the combined test was performed in singleton pregnancies, including 19 614 with chromosomally normal fetuses or the delivery of a phenotypically normal baby (euploid group), 122 with trisomy 21, 36 with trisomy 18, 20 with trisomy 13 and eight with Turner syndrome. In all cases tricuspid flow was assessed to determine if there was tricuspid regurgitation. We examined the performance of two screening strategies: firstly, assessment of tricuspid flow in all patients and secondly, first-stage screening using the combined test in all patients followed by second-stage assessment of tricuspid flow only in those with an intermediate risk of 1 in 51 to 1 in 1000 after the first stage. Tricuspid regurgitation was observed in 0.9% of the euploid fetuses and 55.7%, 33.3% and 30% of the fetuses with trisomies 21, 18 and 13, respectively, and in 37.5% of those with Turner syndrome. In a screening policy based on maternal age, fetal NT, FHR, serum free beta-hCG and PAPP-A, for a fixed false positive rate of 3% the standardized detection rates were 91% for trisomy 21 and 100% for trisomy 18, trisomy 13 and Turner syndrome. Assessment of tricuspid flow in all pregnancies would increase the detection rate of trisomy 21 to 96%, and the detection rates of trisomy 18, trisomy 13 and Turner syndrome would be 92%, 100% and 100%, respectively. The same detection rates were achieved with the two-stage strategy-in which it was necessary to assess tricuspid flow in only 15% of the total population-at a false positive rate of 2.4%. Assessment of tricuspid flow improves the performance of first-trimester screening for trisomy 21.


Variable response of post-Mohs surgery telangiectasias to KTP laser: A case report.
A common but under-recognized complication of Mohs micrographic surgery is the development of surgical site telangiectasias after repair. Treatment with pulsed dye laser has shown good results in treating periscar telangiectasias, while treatment with KTP laser has never been studied for this complication. We report the findings in six patients with persistent telangiectasias post-Mohs micrographic surgery and their response to treatment with KTP laser. After one treatment with KTP laser, the severity of telangiectasias, scar erythema, and patient and physician-rated improvement were recorded. Response to KTP laser was variable. However, this case series suggests that KTP laser may have the potential to improve the appearance of periscar telangiectasia after Mohs micrographic surgery.


Direct cloning of the unknown flanking DNA fragments from a large insert without restriction mapping.
A simple technique for direct cloning of the target DNA fragments from a large insert according to its adjacent known sequence is described here. In this new subcloning method, a large DNA insert is digested and ligated with a linearized plasmid vector to construct a subclone library that is subjected to screening. The bacterial clones in this library are individually picked, grown in a 96-well plate, and then pooled across the rows or columns. Target clones are obtained from the ordered separate pools by PCR-screening with a set of primers, one specific for the adjacent known sequence and the other serving as "anchor primer" specific for the vector sequence. This direct subcloning procedure was efficiently demonstrated by cloning a specific DNA region from a large insert within 2 days without mapping the starting DNA or isolating the digested DNA fragment.


Antero-posterior activity changes in the superficial masseter muscle after exposure to experimental pain.
The aim of this randomized, controlled, double-blind study was to examine how the activation pattern of the masseter muscle changes during natural function when experimental pain is induced in a discrete anterior area of the muscle. In 20 subjects, three bipolar surface electrodes and three intramuscular fine-wire electrodes (antero-posterior mapping) were simultaneously attached above and in the right masseter muscle to record the electromyographic (EMG) activity during unilateral chewing before and after infusion of a 0.9% isotonic and 5% hypertonic saline bolus in the anterior area of the muscle. The activity of the contralateral masseter muscle was registered by surface electrodes. In addition, the development of pain intensity was quantitatively measured with a numerical rating scale (NRS). While both saline concentrations caused pain, the hypertonic solution evoked stronger pain. The experiments also provided evidence of a significant although differential activity reduction of the ipsilateral masseter muscle in the antero-posterior direction. The activity reduction decreased with increasing distance from the location of the infusion. The results support the idea that the strategy of differential activation protects the injured muscle while simultaneously maintaining optimal function.


Exploring Two-Dimensional Materials toward the Next-Generation Circuits: From Monomer Design to Assembly Control.
Two-dimensional (2D) materials have attracted tremendous research interest since the breakthrough of graphene. Their unique optical, electronic, and mechanical properties hold great potential for harnessing them as key components in novel applications for electronics and optoelectronics. Their atomic thickness and exposed huge surface even make them highly designable and manipulable, leading to the extensive application potentials. What's more, after acquiring the qualification for being the candidate for next-generation devices, the assembly of 2D materials monomers into mass or ordered structure is also of great importance, which will determine their ultimate industrialization. By designing the monomers and regulating their assembling behavior, the exploration of 2D materials toward the next-generation circuits can be spectacularly achieved. In this review, we will first overview the emerging 2D materials and then offer a clear guideline of varied physical and chemical strategies for tuning their properties. Furthermore, assembly strategies of 2D materials will also be included. Finally, challenges and outlooks in this promising field are featured on the basis of its current progress.


Management of Temporomandibular Joint Ankylosis With Dentofacial Deformities in Children.
This retrospective study described the authors' experience in the treatment of temporomandibular joint (TMJ) ankylosis with dentofacial deformities in 18 pediatric patients during a 4-year period. These patients underwent different types of arthroplasty with condylar reconstruction, simultaneously with treatment of dentofacial deformities. Re-ankylosis was confirmed if maximal incisal opening (MIO) was <20 mm. Clinical outcomes were evaluated in terms of oral function, radiography, and medical photography. Patients were followed up for a mean time of 24.8 months. No infections, re-ankylosis, or permanent facial nerve damage were found during the hospitalization or follow-up period. All patients achieved significant improvements in MIO and oral function. The dentofacial deformities in most patients were improved to varying degrees. The results provided more useful information for the management of the pediatric patients with TMJ ankylosis and secondary dentofacial deformities. Early treatment and close follow-up play an important role in the management of these patients.


[Primary health care: reality or utopia in a developing country?].
Though it is 20 years since the acceptance, by member nations of WHO, of the concept of primary health care (PHC) as the best and cheapest means of achieving "Health for All in the Year 2000", most developing nations have made little or no progress toward its attainment. This is due, among other things, to a misconception of the meaning of PHC, by both developing and developed nations. While many developing nations see it as a new vertical programme, and therefore fail to integrate it into already existing ones, most developed nations take it, wrongly to mean that the developing nations should return to ancient, primitive medicine, which in earlier times led to high morbidity even in the developed nations. In the developing countries, there is still a disproportionately high concentration of resources in urban areas, and much more emphasis is still being placed on curative than on preventive measures. To achieve "Health for all in the Year 2000", therefore, a reorientation of both the developed and the developing nations is urgently needed.


Robotic Home-Based Rehabilitation Systems Design: From a Literature Review to a Conceptual Framework for Community-Based Remote Therapy During COVID-19 Pandemic.
During the COVID-19 pandemic, the higher susceptibility of post-stroke patients to infection calls for extra safety precautions. Despite the imposed restrictions, early neurorehabilitation cannot be postponed due to its paramount importance for improving motor and functional recovery chances. Utilizing accessible state-of-the-art technologies, home-based rehabilitation devices are proposed as a sustainable solution in the current crisis. In this paper, a comprehensive review on developed home-based rehabilitation technologies of the last 10 years (2011-2020), categorizing them into upper and lower limb devices and considering both commercialized and state-of-the-art realms. Mechatronic, control, and software aspects of the system are discussed to provide a classified roadmap for home-based systems development. Subsequently, a conceptual framework on the development of smart and intelligent community-based home rehabilitation systems based on novel mechatronic technologies is proposed. In this framework, each rehabilitation device acts as an agent in the network, using the internet of things (IoT) technologies, which facilitates learning from the recorded data of the other agents, as well as the tele-supervision of the treatment by an expert. The presented design paradigm based on the above-mentioned leading technologies could lead to the development of promising home rehabilitation systems, which encourage stroke survivors to engage in under-supervised or unsupervised therapeutic activities.


The fine line between harm reduction and harm production--development of a clinical policy on femoral (groin) injecting.
The femoral region ('groin') appears to be increasingly commonly used by injecting drug users in the UK. With the advent of Britain's first supervised prescribed injectable opioid treatment clinic, unprecedented decisions and judgements were required about the safe supervision of this practice, or whether to permit this behaviour on site at all. This paper reports the reasons for, and outcome of, development of a clinical policy on injecting into the deep femoral vein (groin injecting). A small in-depth audit of the complications of femoral injecting was undertaken in a supervised injecting clinic. All femoral injectors had had either local site-related medical complications or other health problems which could potentially be worsened by ongoing injection. This finding along with the personal and professional issues raised by staff for supervision of femoral injecting led to a revised policy focussing on achieving a shift towards lower-risk peripheral venous and intramuscular sites. While the clinic staff's training may be more compatible with professional duties of care by encouraging cessation of femoral injecting, this does not tell us what advice harm reduction workers in the field should offer groin injectors. More research is needed into this high-risk, controversial injecting practice.


The lateral dorsal cutaneous branch of the sural nerve: clinical importance of the surgical approach to proximal fifth metatarsal fracture fixation.
Fractures of the proximal fifth metatarsal are one of the most common forefoot injuries encountered by orthopaedic surgeons in sports medicine. The percutaneous surgical approach to Jones fracture fixation and corresponding anatomy has received little attention in the literature to date. To describe in detail the location of the lateral dorsal cutaneous nerve (LDCN) and its branches relative to the base of the fifth metatarsal and to the standard lateral approach. Descriptive laboratory study. Ten fresh-frozen cadaveric foot specimens were used for this study. Specimens were dissected at the lateral aspect of the foot over the proximal fifth metatarsal, and the LDCN and its branches were identified. The distance of the LDCN to the superior border of the peroneus brevis tendon (PBT) was measured relative to standard reference points in all specimens, and the presence of an anastomotic branch was noted. A set of vertical and horizontal reference lines were also constructed to determine whether the LDCN or its branches would be compromised by a standard lateral approach. The LDCN was superficial (ie, lateral) and inferior to the superior border of the PBT in all specimens and at all reference points. A bifurcation of the LDCN was present in 8 specimens, located an average of 18 mm posterior and 11 mm dorsal to the base of the fifth metatarsal. The dorsolateral branch and dorsomedial branch of the LDCN each intersected with the base of the fifth metatarsal horizontal line and vertical line, respectively, indicating potential compromise of the nerve with a standard lateral surgical approach. The standard lateral approach to the base of the fifth metatarsal carries a higher risk for surgical injury to the LDCN. A "high and inside" approach that remains superior to the superior border of the PBT is anatomically safe and may decrease the chance of intraoperative nerve injury and irritation postoperatively.


Expression and distribution of neuropeptides in the nervous system of the crab Carcinus maenas and their roles in environmental stress.
Environmental fluctuations, such as salinity, impose serious challenges to marine animal survival. Neuropeptides, signaling molecules involved in the regulation process, and the dynamic changes of their full complement in the stress response have yet to be investigated. Here, a MALDI-MS-based stable isotope labeling quantitation strategy was used to investigate the relationship between neuropeptide expression and adaptability of Carcinus maenas to various salinity levels, including high (60 parts per thousand [p.p.t.]) and low (0 p.p.t.) salinity, in both the crustacean pericardial organ (PO) and brain. Moreover, a high salinity stress time course study was conducted. MS imaging (MSI) of neuropeptide localization in C. maenas PO was also performed. As a result of salinity stress, multiple neuropeptide families exhibited changes in their relative abundances, including RFamides (e.g. APQGNFLRFamide), RYamides (e.g. SSFRVGGSRYamide), B-type allatostatins (AST-B; e.g. VPNDWAHFRGSWamide), and orcokinins (e.g. NFDEIDRSSFGFV). The MSI data revealed distribution differences in several neuropeptides (e.g. SGFYANRYamide) between color morphs, but salinity stress appeared to not have a major effect on the localization of the neuropeptides.


Mortality Rate Among Patients with Alcohol Use Disorder with Two or More Readmissions to the Hospital.
Alcohol use disorder is associated with high morbidity and mortality rates, leading to a significant burden worldwide. Increased hazardous alcohol consumption has been reported during the COVID-19 pandemic raising concerns for greater impact of this already prevalent serious medical condition. We conducted chart reviews and described demographic and clinical data for patients with two or more hospital readmissions from June 2020 to July 2021 and followed survival status through June 2022. We found a high mortality rate of 10.3%. Most patients had psychiatric conditions listed in the chart (n = 70, 80%). Only 34% (n = 24) of living patients and 6% (n = 1) of deceased patients were under psychiatric care. Rates of the utilization of medications for alcohol use disorder were low (n = 23, 26%). We found high mortality rates in patients with two or more hospital readmissions with low rates of utilization of medications for alcohol use disorder and psychiatric care, thus identifying areas of potential improvement.


Generalized 1/k-ensemble algorithm.
We generalize the 1/k-ensemble algorithm so that it can be used for both discrete and continuous systems, and show that the generalization is correct numerically and mathematically. We also compare the efficiencies of the generalized 1/k-ensemble algorithm and the generalized Wang-Landau algorithm through a neural network example. The numerical results favor to the generalized 1/k-ensemble algorithm.


A Randomized Controlled Trial of Nurse Coaching vs. Herbal Supplementation for Weight Reduction in Soldiers.
The number of overweight and obese service members has tripled since the beginning of Overseas Contingency Operations.1 Overwhelming evidence suggesting links between obesity and increased risk for conditions such as musculoskeletal injuries, type II diabetes, and cardiovascular disease,2 poses a threat to the strength and performance of our current and future fighting force. The purpose of the study was to test nurse health coaching (NHC) and/or herbal supplementation for weight reduction in Soldiers during a 12-week intervention. Body composition, biomarkers, adherence, and motivation were measured at three time points. The NHC provided a weekly scripted interaction. Change scores were compared across study groups using general linear models. Sample demographics (N = 435): mean age 30 ± 8.2 years, 73.4% men, predominantly white (70.1%) and non-Hispanic (80%), 71% married, and 91% enlisted. Results represent the 3 NHC groups compared to control group. Beneficial intervention effects were observed for heel bone mineral density (d = 0.3), 25-Hydroxyvitamin D (d = 0.43), and fasting blood sugar (d = -0.4), but were not significant following application of a 10% false discovery rate. There were no significant findings for any other comparisons. Weight loss proved difficult for all groups; there was no advantage of NHC over an herbal supplement as adjuncts to Army MOVE! for weight reduction. Highly motivated Soldiers were unable to sustain weight loss or body composition changes.


Uterine rupture after prior conservative management of placenta accreta.
There is little evidence for counseling patients who seek uterine conservation in the setting of placenta accreta. We report the case of a 37-year-old woman with retained placenta accreta after vaginal delivery. Attempts at transvaginal removal failed, and the placenta was removed through a fundal hysterotomy with bilateral uterine artery ligations performed to control blood loss. She conceived a second pregnancy 11 months later and sustained spontaneous fundal uterine rupture at 26.5 weeks of gestation with a recurrent accreta found at the rupture site. The newborn survived but has residual musculoskeletal morbidity and developmental delay at 1 year of age. Patients undergoing conservative treatment of placenta accreta in the setting of a fundal hysterotomy should be cautioned about recurrent accreta and uterine rupture.


Targeted chitosan-based bionanocomposites for controlled oral mucosal delivery of chlorhexidine.
The purpose of this study was to develop sustained release systems based on chitosan (CS) and montmorillonite (MMT) for chlorhexidine (CLX). Nanocomposites were prepared by ion-exchange. CLX systems were characterized by X-ray powder diffraction (XRD), thermal analysis (TGA), Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM) and X-ray fluorescence analysis (XRF). The mucoadhesion properties of CLX nanocomposites were evaluated by SEM. The release behavior of these systems was also studied by the dialysis technique. The antibacterial activity was investigated in vitro by the disk diffusion test. Results showed long-term sustained release of CLX from the hybrid carriers without initial burst release. The release profiles of CLX from the carriers suggested the diffusion through a swollen matrix and water filled pores as the controlled drug release mechanism. The CLX hybrid nanosystem containing the positively-charged chitosan exhibited good mucoadhesion properties maintaining the CLX antimicrobial properties.


Presenting Stage in Colon Cancer Is Associated with Insurance Status.
Colorectal cancer continues to be the third most common cause of cancer death in the United States. Access to health care is also a nationwide problem. The purpose of the current study is to see if insurance status is associated with stage of colon cancer at presentation. The tumor registry was queried for all patients with colon cancer from 2009 to 2014. Demographics, including insurance status was statistically analyzed to determine if an association existed between insurance status and stage of colon cancer at the time of presentation. There were 434 patients identified that underwent colonic resection during the study period; 224 were female and 210 were male. Of the 434 patients, 388 were insured and 46 were uninsured. When insurance status was compared with stage at diagnosis there was a statistically significant difference between the two groups. For patients that were uninsured, 13.01 per cent presented with stage I disease, 15.22 per cent with stage II disease, 34.78 per cent with stage III disease, and 36.96 with stage IV disease. For insured patients, 24.03 per cent present with stage I disease, 26.10 with stage II disease, 23.26 per cent with stage III disease, and 29.61 per cent with stage IV disease (P = 0.047). Access to health care continues to be a large problem and results in patients without insurance presenting with a high stage of disease.


Adoption of dental innovations: The case of a standardized dental diagnostic terminology.
Standardized dental diagnostic terminologies (SDDxTs) were introduced decades ago. Their use has been on the rise, accompanying the adoption of electronic health records (EHRs). One of the most broadly used terminologies is the Dental Diagnostic System (DDS). Our aim was to assess the adoption of SDDxTs by US dental schools by using the Rogers diffusion of innovations framework, focusing on the DDS. The authors electronically surveyed clinic deans in all US dental schools (n = 61) to determine use of an EHR and SDDxT, perceived barriers to adoption of an SDDxT, and the effect of implementing an SDDxT on clinical productivity. The response rate was 57%. Of the 35 responses, 91% reported using an EHR to document patient care, with 84% using axiUm; 41% used the DDS. Fifty-four percent of those who did not use an SDDxT had considered adopting the DDS, but 38% had not, citing barriers such as complexity and compatibility. Adoption of an SDDxT, particularly the DDS, is on the rise. Nevertheless, a large number of institutions are in the Rogers late majority and laggards categories with respect to adoption. Several factors may discourage adoption, including the inability to try out the terminology on a small scale, poor usability within the EHR, the fact that it would be a cultural shift in practice, and a perception of unclear benefits. However, the consolidation of the DDS and American Dental Association terminology efforts stands to encourage adoption. The successful adoption of dental innovation depends not only on the intrinsic merit of the innovation, as some useful innovations do not achieve widespread traction. As such, it is important for health care providers to understand how to disseminate their ideas in order to ensure traction and widespread adoption.


A one-pot preparation of 1,3-disubstituted azetidines.
A straightforward synthesis of 1,3-disubstituted azetidines has been accomplished via the alkylation of a primary amine with the bis-triflate of a 2-substituted-1,3-propanediol species. This transformation is carried out in one reaction vessel, and elimination of the alkylating reagent is generally not a major byproduct. The scope of this methodology has been investigated using a variety 2-substituted-1,3-propanediols and amine nucleophiles.


Cdk6 contributes to cytoskeletal stability in erythroid cells.
Mice lacking Cdk6 kinase activity suffer from mild anemia accompanied by elevated numbers of Ter119+ cells in the bone marrow. The animals show hardly any alterations in erythroid development, indicating that Cdk6 is not required for proliferation and maturation of erythroid cells. There is also no difference in stress erythropoiesis following hemolysis in vivo However, Cdk6-/- erythrocytes have a shortened lifespan and are more sensitive to mechanical stress in vitro, suggesting differences in cytoskeletal architecture. Erythroblasts contain both Cdk4 and Cdk6, while mature erythrocytes apparently lack Cdk4 and their Cdk6 is partly associated with the cytoskeleton. We used mass spectrometry to show that Cdk6 interacts with a number of proteins involved in cytoskeleton organization. Cdk6-/- erythroblasts show impaired F-actin formation and lower levels of gelsolin, which interacts with Cdk6. We also found that Cdk6 regulates the transcription of a panel of genes involved in actin (de-)polymerization. Cdk6-deficient cells are sensitive to drugs that interfere with the cytoskeleton, suggesting that our findings are relevant to the treatment of patients with anemia - and may be relevant to cancer patients treated with the new generation of CDK6 inhibitors.


Allogeneic blood stem cell transplantation after a reduced-intensity, preparative regimen: a pilot study in patients with refractory malignancies.
The immune-mediated graft-versus-tumor (GVT) effect plays a therapeutic role in the treatment of patients with hematologic malignancies who undergo allogeneic hematopoietic stem cell transplantation (HSCT). More recently, it was reported that a GVT effect also occurred in patients who underwent transplantation for metastatic renal carcinoma. The authors carried out a pilot trial of allogeneic transplantation after a reduced-intensity, preparative regimen in patients with refractory malignancies, including solid tumors. The objectives of the current study were to evaluate the feasibility of this approach in terms of toxicity and engraftment and to document evidence of GVT effects. Seventeen patients with Stage IV malignancies (7 patients with renal cell carcinoma, 3 patients with sarcoma, 2 patients with breast carcinoma, 2 patients with Hodgkin disease, 1 patient with ovarian carcinoma, 1 patient with melanoma, and 1 patient with both melanoma and renal cell carcinoma) that were not amenable to further conventional treatment were enrolled. The median patient age was 43 years (range, 10-60 years). The Eastern Cooperative Oncology Group performance status (PS) was 0-1 in 11 patients and 2-3 in 6 patients. Preparative treatment consisted of reduced-intensity chemotherapy with fludarabine (30 mg/m(2) per day for 4 consecutive days) and cyclophosphamide (30 mg/Kg per day for 2 consecutive days) prior to allogeneic HSCT from a human leukocyte antigen-identical sibling. The median number of CD34+ cells infused was 6.06 x 10(6)/kg (range, 1.5-14.0 x 10(6)/kg). Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporin-A and short-term methotrexate. Patients who had a PS of 2-3 prior to undergoing HSCT experienced Grade 4 hematologic toxicities and Grade > or = 3 organ toxicities and died of either treatment-related complications or disease progression within 100 days from transplantation. By contrast, 10 of 11 patients who had a PS of 0-1 prior to undergoing HSCT experienced only short-lasting, Grade < or = 3 neutropenia and thrombocytopenia and no organ toxicity; 1 of 10 patients died of graft failure on Day +29 after undergoing HSCT. By Day +90, 100% donor chimerism was documented in all patients with a past history of heavy chemotherapy, whereas mixed donor chimerism was observed in the 4 patients with a past history of only 1 line of chemotherapy and/or immunotherapy prior to entering the HSCT program. Grade 2-3 acute GVHD occurred in 5 patients. Among patients with a follow-up > 100 days, 2 complete responses and 3 transitory partial responses were recorded. With this conditioning regimen, full donor chimerism was achieved rapidly only in patients who had received previous intensive chemotherapy. In a proportion of patients with refractory malignancies, allogeneic transplantation resulted in tumor regression. This novel therapeutic strategy may provide little benefit in patients with poor PS and rapidly progressing disease.


Age-dependent down-regulation of hyperpolarization-activated cyclic nucleotide-gated channel 4 causes deterioration of canine sinoatrial node function.
The activity of pacemaker cells in the sinoatrial node (SAN) is an indicator of normal sinus rhythm. Clinical studies have revealed that the dysfunction of the SAN progressively increases with aging. In this study, we determined the changes in hyperpolarization-activated cyclic nucleotide-gated channel 4 (HCN4) expression and the relationship between aging and canine SAN dysfunction. The results of cardiac electrophysiological determination revealed that the intrinsic heart rate decreased from 168 ± 11 beats min-1 in young canines to 120 ± 9 beats min-1 in adults and to 88 ± 9 beats min-1 in aged canines. The sinus node recovery time (SNRT) increased from 412 ± 32 ms in young canines to 620 ± 56 ms in adults and to 838 ± 120 ms in aged canines. Corrected SNRT (CSNRT) increased from 55 ± 12 ms in young canines to 117 ± 27 ms in adults and to 171 ± 37 ms in aged canines. These results indicated that SAN function deteriorated with aging in the canine heart. However, histological staining illustrated that fibrosis was not significantly increased with aging in canine SAN. Real-time polymerase chain reaction indicated that the expression of HCN4 mRNA was downregulated in the elderly canine SAN. Similarly, we also verified that HCN4 protein expression within the SAN declined with aging via immunofluorescence staining and western blot analysis. Taken together, our data show that electrical remodeling, related to the down-regulation of HCN4, is responsible for the gradually increased incidence of SAN dysfunction with aging. Our results provide further evidence for explaining the mechanisms of age-related deterioration in the SAN.


P2Y12 Inhibitor Loading Time Before Elective PCI and the Prevention of Myocardial Necrosis.
There are dated and conflicting data about the optimal timing of initiation of P2Y12 inhibitors in elective percutaneous coronary intervention (PCI). Peri-PCI myocardial necrosis is associated with poor outcomes. We aimed to assess the impact of the P2Y12 inhibitor loading time on periprocedural myocardial necrosis in the population of the randomized Assessment of Loading With the P2Y12 Inhibitor Ticagrelor or Clopidogrel to Halt Ischemic Events in Patients Undergoing Elective Coronary Stenting (ALPHEUS) trial, which compared ticagrelor with clopidogrel in high-risk patients who received elective PCI. The ALPHEUS trial divided 1809 patients into quartiles of loading time. The ALPHEUS primary outcome was used (type 4 [a or b] myocardial infarction or major myocardial injury) as well as the main secondary outcome (type 4 [a or b] myocardial infarction or any type of myocardial injury). Patients in the first quartile group (Q1) presented higher rates of the primary outcome (P = 0.01). When compared with Q1, incidences of the primary outcome decreased in patients with longer loading times (adjusted odds ratio [adjOR], 0.70 [0.52.-0.95]; P = 0.02 for Q2; adjOR 0.65 [0.48-0.88]; P < 0.01 for Q3; adjOR 0.66 [0.49-0.89]; P < 0.01 for Q4). Concordant results were found for the main secondary outcome. There was no interaction with the study drug allocated by randomization (clopidogrel or ticagrelor). Bleeding complications (any bleeding ranging between 4.9% and 7.3% and only 1 major bleeding at 48 hours) and clinical ischemic events were rare and did not differ among groups. In elective PCI, administration of the oral P2Y12 inhibitor at the time of PCI could be associated with more frequent periprocedural myocardial necrosis than an earlier administration. The long-term clinical consequences remain unknown.


New method to remove tibial intramedullary nail through original suprapatellar incision: A case report.
Since 2006, introducing a tibial intramedullary nail via the suprapatellar approach has been established; however, nail removal must be carried out using classic infrapatellar access, which can lead to complications. Here, we report a new method to remove the intramedullary nail through the original suprapatellar incision. A 39-year-old man was hit by a vehicle in 2019. He was immobilized with a 10-mm × 330-mm tibial intramedullary nail via the suprapatellar approach due to left middle tibial fracture. Two years later, the patient requested for the implant to be removed. We used a new method to remove the tibial intramedullary nail through the original suprapatellar incision, and the operation went smoothly. This case report indicates that suprapatellar access can be used to remove the intramedullary nail via the original incision without infrapatellar access, thus avoiding surgical complications.


[The observation of engraftment of human umbilical cord blood-derived hematopoietic stem/progenitor cells in xenotransplanted NOD/SCID mouse model by intra-bone marrow injection].
To explore whether intra-bone marrow injection strategy could promote the engraftment of human umbilical cord blood derived hematopoietic stem/progenitor cells (HS/PC) in xenotransplanted NOD/SCID mouse model. Aliquots containing 1 x 10(3), 1 x 10(4), 0.5 x 10(5), 1 x 10(5) and 5 x 10(5) human umbilical cord blood (hUCB) CD34+ cells were transplanted into sublethally irradiated NOD/SCID mice via intra-venous (i.v.) and intra-bone marrow (iBM) injection. The homing and long-term engraftment capabilities of hUCB CD34+ cells from right tibia, right femur, left tibia, left femur and spleen were detected by PCR 24h after xenotransplantation and by FACS 8-week after xenotransplantation. Tissues of liver, spleen, lungs, or cells from peripheral blood, right tibia, right femur, left tibia and left femur 24 hours after xenotransplantation in iBM injecting 5 x 10(5) CD34+ cells recipients expressed human chromosome 17 specific alpha-satellite fragment. 8-week engraftment of human cells was observed and engraftment level indicated dose-dependent effect in injected bone (right tibia) as well as non-injected bones (including right femur, left tibia and left femur), spleen and peripheral blood in all iBM recipients. 8-week engraftment levels of human cells were (44.063 +/- 20.095)% and (45.881 +/- 22.316)% for i.v. and iBM groups respectively, when transplanted with 1 x 10(5) hUCB CD34+ cells, being no statistical difference (P >0.05). More superior 8-week engraftment levels of human cells were observed in iBM recipients [(54.019 +/- 31.338)%] than in i.v. recipients [(12.197 +/- 10.350)%] when transplanted with 1.0 x 10(4) CD34 cells (P<0.01). Human cell engraftment was observed in iBM but not in i.v. recipients when transplanted with 1.0 x 10(3) CD34+ cells, and was usually observed in non-injected bones. Intra-bone marrow strategy can efficiently increase the engraftment of umbilical cord blood derived hematopoietic stem/progenitor cells in xenotransplanted NOD/SCID mouse model.


A parallel side graft-frontage graft-technique for intercostal artery reimplantation during thoraco-abdominal aorta replacement.
In the conventional way of thoraco-abdominal aortic replacement, the intercostal arteries are reimplanted directly to the main aortic graft or by the interposition of branch grafts. To overcome the disadvantages of these techniques, we adopted a different technique using a parallel side graft. The good patency rate of reimplanted intercostal arteries achieved by this technique and its potential technical advantages can contribute to the improvement of the surgical outcome.


Precisional modulation of translaminar pressure gradients for ophthalmic diseases.
The translaminar pressure gradient (TLPG) refers to two forces at the lamina cribosa of the optic nerve: the anteriorly acting intracranial pressure (ICP), and posteriorly-acting intraocular pressure (IOP). It has been proposed that controlling the translaminar pressure gradient at regular intervals may preserve the optic nerve and slow the course of glaucoma. The precisional modulation of this TLPG is a recently introduced concept that may play a role in the treatment of ophthalmic diseases such as glaucoma. In this manuscript, we review the applications of pressurized goggles on ophthalmic diseases. We also elaborate upon current investigations in modulation of the TLPG including goggles and the multi-pressure dial goggle. We discuss future research directions for ophthalmic diseases including spaceflight associated neuro-ocular syndrome (SANS), a large physiological barrier to future long-duration spaceflight.


Energetic efficiency of infant formulae: a review.
Breast-fed and formula-fed infants differ in terms of nutrient intake, growth, and metabolic and endocrine responses. The energetic efficiency, i.e. the weight or length gain per 100 kcal of energy intake, of breast-fed infants is about 11% higher than the energetic efficiency of formula-fed infants. Only limited data is available on the influence of formula composition on the energetic efficiency of infant formulae. We conducted a review of controlled trials to identify the impact of the macronutrient composition of infant formulae on energetic efficiency. An electronic literature search was conducted in February 2014. Intervention trials that investigated the effect of an infant formula with a modified macronutrient composition and reported the weight, length, and nutritional intake of apparently healthy, term, fully formula-fed infants with a normal weight were included. Thirteen trials met the inclusion criteria. The results showed no effect of the total content of energy, carbohydrate, protein, or fat on energetic efficiency. In contrast, small increasing effects of higher glycemic carbohydrates on energetic efficiency were identified. Improved fat absorption via the use of palmitic acid at the sn-2 ester position of triacylglycerol increased the energetic efficiency by 11%. The quality of formula protein, specifically an increased whey-to-casein ratio, an increased α-lactalbumin content, or a higher tryptophan content increased the energetic efficiency by about 13%. We conclude that fat absorption and protein quality have the potential to modulate energetic efficiency and may contribute to the observed differences in growth and metabolism between breast-fed and formula-fed infants.


Enhancing osteogenic differentiation of MC3T3-E1 cells by immobilizing inorganic polyphosphate onto hyaluronic acid hydrogel.
In tissue engineering, precise control of cues in the microenvironment is essential to stimulate cells to undergo bioactivities such as proliferation, differentiation, and matrix production. However, current approaches are inefficient in providing nondepleting cues. In this study, we have developed a novel bioactive hydrogel (HAX-PolyP) capable of enhancing tissue growth by conjugating inorganic polyphosphate chains onto hyaluronic acid macromers. The immobilized polyphosphates provided constant osteoconductive stimulation to the embedded murine osteoblast precursor cells, resulting in up-regulation of osteogenic marker genes and enhanced levels of ALP activity. The osteoconductive activity was significantly higher when compared to those stimulated with free-floating polyphosphates. Even at very low concentrations, immobilization of polyphosphates onto the scaffold allowed sufficient signaling leading to more effective osteoconduction. These results demonstrate the potential of our novel material as an injectable bioactive scaffold, which can be clinically useful for developing bone grafts and bone regeneration applications.


Metabolic and inflammatory responses to the common sweetener stevioside and a glycemic challenge in horses with equine metabolic syndrome.
Extracts derived from the leaves of the stevia plant (stevioside) are commonly used as sweeteners for humans and horses. Stevioside appears to be safe for human consumption, including for individuals with insulin dysregulation. In the horse, the safety or metabolic effects of stevioside on normal animals or on those with metabolic dysfunction are unknown. Furthermore, the inflammatory response to a glycemic challenge or to stevioside in horses is not well defined. Therefore, the objective of this study was to measure the effects of stevioside and a glycemic challenge on insulin, glucose, and inflammatory responses in horses with a common metabolic dysfunction (equine metabolic syndrome or EMS) compared with non-EMS controls. To accomplish this, 15 horses were selected; 8 EMS and 7 age-matched controls. An oral sugar test was performed using Karo corn syrup (karo) or stevioside in a random crossover design. Horses were given 0.15 mL/kg body weight of karo or its equivalent grams of sugar in stevia dissolved in water. Blood samples were collected by jugular venipuncture before administration of either stevia or karo and at 60 and 240 min after administration. Serum was used for glucose and insulin determination and plasma for isolation of peripheral blood mononuclear cells (PBMCs) for inflammatory cytokine analysis via flow cytometry and reverse transcription PCR (RT-PCR). Stevia appeared to stimulate lower glycemic and insulinemic responses when compared to karo, in particular in EMS horses. EMS and control horses had inverse inflammatory responses to administration of either stevia or karo with EMS horses having a proinflammatory response (P ≤ 0.05). These data provide evidence as to why horses with EMS may be predisposed to developing laminitis, potentially as a result of an exaggerated inflammatory response to glycemic and insulinemic responses. Furthermore, the data provide new avenues for exploring mechanisms behind the syndrome, in particular when using a glycemic challenge.


Comparative Genomics of Clostridium difficile.
Clostridium difficile, a gram-positive spore-forming anaerobic bacterium, has rapidly emerged as the leading cause of nosocomial diarrhoea in hospitals. The availability of genome sequences in large numbers, mainly due to the use of next-generation sequencing methods, have undoubtedly shown their immense advantages in the determination of the C. difficile population structure. The implementation of fine-scale comparative genomic approaches have paved the way to global transmission and recurrence studies, but also more targeted studies such as the PaLoc or the CRISPR/Cas systems. In this chapter, we provide an overview of the recent and significant findings on C. difficile using comparative genomics studies with implication for the epidemiology, infection control and understanding of the evolution of C. difficile.


Association of patients with parkinsonism and epilepsy with EEG changes.
EEG is an important diagnostic method for epilepsies. EEG changes in patients with Parkinson's disease and epilepsy are not unknown or unexpected events. We investigated 250 Parkinson's disease patients. Epileptic seizures were recorded in 10 patients. Four patients had generalized tonic clonic seizures; 3 partial complex seizures, 2 of which with secondary generalization; while 3 patients had right-handed simple motor partial seizure. Clinical and neurophysiological investigations, neuroimagining techniques electroencephalographic investigations (EEG, EEG in sleep) were conducted. Our patients were well controlled with antiepileptic therapy.


Early postpartum separation and maternal attachment to twins.
A mother's attachment to her newborn twins was delayed due to a postpartal maternal illness. Attachment as affected by twin births and separation from the mother is reviewed. Nursing actions, designed to facilitate attachment, are described as encompassing the needs of the whole family. Use of these concepts in similar situations is discussed.