The quality of assessment visits in community nursing.
The aim of this study was the measurement of the quality of assessment visits of community nurses in The Netherlands. Process criteria were derived for the quality of the assessment visits from the quality standards of community nursing care established by Appelman et al. Over a period of 8 weeks, a representative sample of 108 community nurses and 49 community nursing auxiliaries at 47 different locations paid a total number of 433 assessment visits. The nursing activities were recorded for each visit. The results suggested that most assessment visits (88%) were paid by community nurses. During the assessment visits, community nurses more often paid attention to questions and expectations of the patient than nursing auxiliaries did. Furthermore, the quality of taking case histories in the actual practice of assessment appeared to be high in general. However, nearly half of the nurses did not enquire whether the patient received care from other health care professionals. The drafting of the care plan was, on average, of a lesser quality. In particular, the re-assessment of patients was not systematically planned.


Design, synthesis, and biological evaluation of novel Tri- and tetrasubstituted imidazoles as highly potent and specific ATP-mimetic inhibitors of p38 MAP kinase: focus on optimized interactions with the enzyme's surface-exposed front region.
The synthesis, biological testing, and SAR of novel 2,4,5- and 1,2,4,5-substituted 2-thioimidazoles are described. Amino, oxy, or thioxy substituents at the 2-position of the pyridinyl moiety were evaluated for their contributions to inhibitor potency and selectivity against p38 mitogen activated protein kinase (p38 MAPK) as well as for the ability to minimize cytochrome P450 (CYP450) inhibition. Incorporation of polar substituted (cyclo)aliphatic amino substituents (e.g., tetrahydropyranylamino), which positively interacted with the surface-exposed front region (hydrophobic region II) of the enzyme led to the identification of extremely potent p38 MAPK inhibitors with p38 IC 50 values in the low nanomolar range. Approximately 90 pyridinylimidazole-based compounds with a range of potencies against p38alpha MAP kinase were further investigated for their ability to inhibit the release of tumor necrosis factor-alpha (TNFalpha) and/or interleukin-1beta (IL-1beta) from human whole blood. Some of the most promising drug candidates underwent selectivity profiling against a panel of 17 different kinases besides p38alpha and/or were tested for their interaction potential toward a number of metabolically relevant CYP450 isozymes.


Ameliorative effect of naringin against doxorubicin-induced acute cardiac toxicity in rats.
Doxorubicin (Dox) is one of the most active chemotherapeutic agents used to treat various types of cancers. Its clinical utility is compromised due to fatal cardiac toxicity characterized by an irreversible cardiomyopathy. This study evaluates the cardioprotective potential of naringin (NR) against Dox-induced acute cardiac toxicity in rats. Male Wistar rats were randomly divided into five groups. NR (50 and 100 mg/kg) was administered intraperitoneally (i.p.) daily from 0 to 14 d. Doxorubicin (15 mg/kg, i.p.) was given as a single dose on the 10th day. On the 14th day, all animals were sacrificed and oxidative stress parameters that include malondialdehyde (MDA), glutathione (GSH) level, superoxide dismutase (SOD), catalase (CAT) activities, and all mitochondrial complexes (I-IV) activities were evaluated along with histopathological studies of the heart. Doxorubicin-induced cardiotoxicity was confirmed by increased (p < 0.05) MDA, decreased (p < 0.05) GSH levels, SOD, and CAT activities, mitochondrial complexes (I-IV) activities in the heart tissue. NR (100 mg/kg) showed cardioprotection as evident from significant decreased MDA (p < 0.001) level, raised (p < 0.001) GSH level, SOD and CAT activities and increased mitochondrial complexes I (p < 0.01), II (p < 0.001), III (p < 0.001), and IV (p < 0.05) activities. Further, Dox-induced cardiotoxicity was confirmed by histopathological studies. These obtained results indicated the protective role of NR against Dox-induced cardiac toxicity in rats. NR can be used in combination with Dox due to its high cardioprotective effect against Dox-induced cardiomyopathy.


[Hormonal, radiation and combined therapy of locally advanced prostatic cancer (T3NXM0)].
The analysis is presented of combined treatment of locally advanced prostatic cancer (LAPC), stage T3NXM0, in 158 LAPC patients treated in 1998-2002. The patients were divided into four groups: group 1 (n=72) received hormones in parallel with radiation, group 2 (n=52) received only hormones, group 3 (n=27) received radiotherapy after failure of long-term (1 year and more) hormone therapy, group 4 (n=7) was given teleradiotherapy only. 3-year recurrence-free survival in patients with LAPC showed advantage of the combined treatment (82 +/- 0.1%) vs hormone (56 +/- 0.1%) or radiation (69.3 +/- 0.1%) therapy alone. It provides a high local control over the primary tumor and an increase of survival, prolongs distant metastases free period, improves the patients' quality of life and their adaptation.


Nutrition through the life-span. Part 1: preconception, pregnancy and infancy.
Good nutrition throughout the life-span is fundamental if infants are to grow into healthy adults with subsequent progression through to old age. However, with an alarming increase in both the rates of obesity and malnutrition, it would seem prudent to suggest that infants, children and adults are not achieving an adequate nutritional status. This article is part one of a two-part series which aims to educate nurses by giving some guidelines on how such individuals may achieve a healthy nutritional status right through from preconception, pregnancy, infancy and childhood, through to adulthood and old age. It should always be remembered that although nurses are in a prime position to identify and treat malnutrition, it is not just a nursing responsibility. Safe and effective nutritional care can only be delivered if all those involved in the care of the patient - dieticians, nutritionists, doctors and pharmacists - are working together.


A strategy for redesigning the medical record for quality assurance.
The medical record should be viewed as an instrument to facilitate and demonstrate the achievement of explicit health care goals. Current systems do not accomplish this. Our examination of the traditional record suggests that modifications of the record should be based on the principles of information system design theory. Necessary modifications include changes which prompt the monitoring of the outcome parameters of a patient's illness, encourage the analysis of the patient's outcome, and facilitate adaptive (corrective) actions. We have termed those data elements which describe the achievement of patient-specific, problem-specific objectives as the "minimum care assurance data set." To designers of computerized medical information systems, this approach provides a rationale for selecting which data to place in computer storage from the myriad of detail in the traditional paper record.


Hepatorenal syndrome.
The hepatorenal syndrome is a severe and common complication of patients with advanced cirrhosis and ascites. It is characterised not only by renal failure but also by marked alterations in systemic haemodynamics. Renal failure is due to a marked hypoperfusion of the kidney secondary to renal vasoconstriction. Although the pathogenesis of hepatorenal syndrome is not completely understood, it is thought to be the extreme manifestation of the underfilling of the arterial circulation secondary to an arterial vasodilation, located mainly in the splanchnic circulation. Recently, a revised definition and diagnostic criteria of hepatorenal syndrome have been proposed. The prognosis of patients with hepatorenal syndrome is very poor. Liver transplantation is the only effective treatment but it is not applicable in most cases due to short survival. New therapies developed during the last years, such as the use of systemic vasoconstrictors or transjugular intra-hepatic portosystemic shunts appear to be promising, but prospective investigations are needed to delineate their real usefulness.


Approximate Bayesian Bootstrap procedures to estimate multilevel treatment effects in observational studies with application to type 2 diabetes treatment regimens.
Randomized clinical trials are considered as the gold standard for estimating causal effects. Nevertheless, in studies that are aimed at examining adverse effects of interventions, randomized trials are often impractical because of ethical and financial considerations. In observational studies, matching on the generalized propensity scores was proposed as a possible solution to estimate the treatment effects of multiple interventions. However, the derivation of point and interval estimates for these matching procedures can become complex with non-continuous or censored outcomes. We propose a novel Approximate Bayesian Bootstrap algorithm that results in statistically valid point and interval estimates of the treatment effects with categorical outcomes. The procedure relies on the estimated generalized propensity scores and multiply imputes the unobserved potential outcomes for each unit. In addition, we describe a corresponding interpretable sensitivity analysis to examine the unconfoundedness assumption. We apply this approach to examine the cardiovascular safety of common, real-world anti-diabetic treatment regimens for type 2 diabetes mellitus in a large observational database.


[Study on the mechanism of tumor regression by adoptive immunochemotherapy in mice].
The mechanism of tumor regression by adoptive immunochemotherapy has been unknown. We examined tumor infiltrating lymphocytes (TILs) and cytokines, using immunohistochemical staining and the histo in situ hybridization (HISH) technique, on Meth A tumor in regression of BALB/c mice. In addition, we examined cytokine activity in the serum of mice with a tumor in regression. The result of immunohistochemical staining showed that the number of Thy-1+ cells, Lyt-1+ cells, OKIa1+ cells all increased in the tumors in regression compared to those in the tumors in non-regression. However, there were no these TILs in the necrotic part of tumor. This result suggested that TILs released substances which might include cytokines. A small number of each cytokine mRNA was observed, using HISH with cytokine DNA probes. TNF-alpha, and -beta mRNA were observed in both he tumors in regression and non-regression; while, IFN-beta and -gamma mRNA were observed only in the tumor in regression. TNF-alpha activity in the serum of tumor in regression group was higher than that of he tumor in non-regression group. IFN activity in the serum of the tumor in regression group started increasing after adoptive immunochemotherapy. These results show that cytokines as well as TILs have important roles in tumor regression.


Approach-avoidance motivation in personality: approach and avoidance temperaments and goals.
The present research examined the role of approach and avoidance motivation in models of personality. Specifically, it examined the hypothesis that approach and avoidance temperaments represent the foundation of several basic dimensions espoused in the trait adjective, affective disposition, and motivational system approaches to personality. Factor analytic support for the hypothesis was obtained in Studies 1, 2, and 6; measures of extraversion, positive emotionality, and behavioral activation system loaded together on 1 factor (Approach Temperament) and measures of neuroticism, negative emotionality, and behavioral inhibition system loaded on another factor (Avoidance Temperament). This 2-factor structure was shown to be independent of response biases. In Studies 3-7, approach and avoidance temperaments were shown to be systematically linked to achievement goals (both nomothetic and idiographic). The findings are discussed in terms of an integrative approach to personality.


Lafora disease: a quantitative morphological and biochemical study of the cerebral cortex.
Morphological and biochemical studies were performed on a brain biopsy from a patient with typical Lafora disease. Qualitative morphological investigation of the cortex showed that the Lafora bodies were most abundant in layers III and V of the cerebral cortex. They were exclusively located in the neurons and their processes. Quantitative morphological investigation of the cerebral cortex revealed abnormalities of the pyramidal cells of layers III and V. The neurons were often slightly atrophic. There was a reduction in the number of dendrites, in maximal dendritic length, and in the number of spines on the apical dendrites and on the side branches. Because of the biochemical study of the pyruvate metabolism of the gray and white matter of the cortex did not show abnormalities, a mitochondrial dysfunction is not likely.


Morphological changes in the implantation zone of Prolen and Esfil reticular endoprostheses.
Comparative histological and electron microscopic study of tissues in the zone of implantation of polypropylene endoprostheses Prolen and Esfil was carried out in mice. Implantation of a reticular endoprosthesis Esfil was associated with a more pronounced infiltration with neutrophilic granulocytes, macrophages, and lymphocytes. Both nets were characterized by pronounced integration in the adjacent tissues in the implantation zone and can be recommended for clinical use.


A Mouse Model for Ocular Surface Staphylococcus aureus Infection.
Creation of an appropriate animal model that accurately reflects the disease and host immune response to bacterial infection in humans is a major challenge in ocular-surface infection research. For decades, mice have been the ideal small animal model for ocular-surface infection research because of the availability and relatively low cost of various genetic backgrounds, targeted defects, and immunologic reagents. By employing different combinations of mouse and bacterial strains, murine infection models can be used to explore a complete picture of bacterial infection and innate immunity of the ocular surface. A murine model of Staphylococcus aureus infection under normal ocular circumstances is presented here as a convenient and tractable model system in which to study mammalian host responses to pathogens. © 2017 by John Wiley & Sons, Inc.


Riociguat versus sildenafil on hypoxic pulmonary vasoconstriction and ventilation/perfusion matching.
Current treatment with vasodilators for pulmonary hypertension associated with respiratory diseases is limited by their inhibitory effect on hypoxic pulmonary vasoconstriction (HPV) and uncoupling effects on ventilation-perfusion (V'/Q'). Hypoxia is also a well-known modulator of the nitric oxide (NO) pathway, and may therefore differentially affect the responses to phosphodiesterase 5 (PDE5) inhibitors and soluble guanylyl cyclase (sGC) stimulators. So far, the effects of the sGC stimulator riociguat on HPV have been poorly characterized. Contraction was recorded in pulmonary arteries (PA) in a wire myograph. Anesthetized rats were catheterized to record PA pressure. Ventilation and perfusion were analyzed by micro-CT-SPECT images in rats with pulmonary fibrosis induced by bleomycin. The PDE5 inhibitor sildenafil and the sGC stimulator riociguat similarly inhibited HPV in vitro and in vivo. Riociguat was more effective as vasodilator in isolated rat and human PA than sildenafil. Riociguat was ≈3-fold more potent under hypoxic conditions and it markedly inhibited HPV in vivo at a dose that barely affected the thromboxane A2 (TXA2) mimetic U46619-induced pressor responses. Pulmonary fibrosis was associated with V'/Q' uncoupling and riociguat did not affect the V'/Q' ratio. PDE5 inhibitors and sGC stimulators show a different vasodilator profile. Riociguat was highly effective and potentiated by hypoxia in rat and human PA. In vivo, riociguat preferentially inhibited hypoxic than non-hypoxic vasoconstriction. However, it did not worsen V'/Q' coupling in a rat model of pulmonary fibrosis.


The Endocannabinoid Metabolite Prostaglandin E2 (PGE2)-Glycerol Inhibits Human Neutrophil Functions: Involvement of Its Hydrolysis into PGE2 and EP Receptors.
The endocannabinoids 2-arachidonoyl-glycerol and N-arachidonoyl-ethanolamine mediate an array of pro- and anti-inflammatory effects. These effects are related, in part, to their metabolism by eicosanoid biosynthetic enzymes. For example, N-arachidonoyl-ethanolamine and 2-arachidonoyl-glycerol can be metabolized by cyclooxygenase-2 into PG-ethanolamide (PG-EA) and PG-glycerol (PG-G), respectively. Although PGE2 is a recognized suppressor of neutrophil functions, the impact of cyclooxygenase-derived endocannabinoids such as PGE2-EA or PGE2-G on neutrophils is unknown. This study's aim was to define the effects of these mediators on neutrophil functions and the underlying cellular mechanisms involved. We show that PGE2-G, but not PGE2-EA, inhibits leukotriene B4 biosynthesis, superoxide production, migration, and antimicrobial peptide release. The effects of PGE2-G were prevented by EP1/EP2 receptor antagonist AH-6809 but not the EP4 antagonist ONO-AE2-227. The effects of PGE2-G required its hydrolysis into PGE2, were not observed with the non-hydrolyzable PGE2-serinol amide, and were completely prevented by methyl-arachidonoyl-fluorophosphate and palmostatin B, and partially prevented by JZL184 and WWL113. Although we could detect six of the documented PG-G hydrolases in neutrophils by quantitative PCR, only ABHD12 and ABHD16A were detected by immunoblot. Our pharmacological data, combined with our protein expression data, did not allow us to pinpoint one PGE2-G lipase, and rather support the involvement of an uncharacterized lipase and/or of multiple hydrolases. In conclusion, we show that PGE2-G inhibits human neutrophil functions through its hydrolysis into PGE2, and by activating the EP2 receptor. This also indicates that neutrophils could regulate inflammation by altering the balance between PG-G and PG levels in vivo.


Aggregation of alpha-synuclein in Lewy bodies of sporadic Parkinson's disease and dementia with Lewy bodies.
Lewy bodies (LBs) are hallmark lesions of degenerating neurons in the brains of patients with Parkinson's disease (PD) and dementia with Lewy bodies (DLB). Recently, a point mutation in the gene encoding the presynaptic alpha-synuclein protein was identified in some autosomal-dominantly inherited familial PD pedigrees, and light microscopic studies demonstrated alpha-synuclein immunoreactivity in LBs of sporadic PD and DLB. To characterize alpha-synuclein in LBs, we raised monoclonal antibodies (MAbs) to LBs purified from DLB brains and obtained a MAb specific for alpha-synuclein that intensely labeled LBs. Light and electron microscopic immunocytochemical studies performed with this MAb as well as other antibodies to alpha-and beta-synuclein showed that alpha-synuclein, but not beta-synuclein, is a component of LBs in sporadic PD and DLB. Western blot analyses of highly purified LBs from DLB brains showed that full-length as well as partially truncated and insoluble aggregates of alpha-synuclein are deposited in LBs. Thus, these data strongly implicate alpha-synuclein in the formation of LBs and the selective degeneration of neurons in sporadic PD and DLB.


A patient with a resistant major depression disorder treated with deep brain stimulation in the inferior thalamic peduncle.
The present report explored the effect of electrical stimulation on the inferior thalamic peduncle in a patient with resistant major depression disorder (MDD). This report refers to a 49-year-old woman with a history of recurrent episodes of major depression for 20 years (12 episodes and 2 hospitalizations), fulfilling Diagnostic and Statistical Manual of Mental Disorders, 4th edition, revised, criteria for MDD; in addition, the patient met criteria for borderline personality disorder and bulimia. Her longest episode of depression with suicidal ideation began 5 years before surgery. The patient's symptom array responded poorly to different combinations of antidepressants, cognitive therapy, and electroconvulsive therapy, which induced improvement only for short periods of time. Immediately before surgery, her Global Assessment of Functioning score was 20 and her Hamilton Depression Scale score ranged from 33 to 42. The patient was proposed for surgery for MDD. The patient had bilateral eight-contact electrodes stereotactically implanted for stimulation of areas at and around the inferior thalamic peduncle. Electrode position was corroborated by unilateral electrical stimulation searching for recruiting responses and regional direct current shifts in the electroencephalogram. Recording electrodes were replaced by tetrapolar electrodes for deep brain stimulation and connected to an internalized stimulation system for continuous bipolar stimulation at 130 Hz, 0.45 milliseconds, 2.5 V. Bimonthly follow-up included psychiatric and neuropsychological evaluations performed over the course of 24 months. After 8 months of ON stimulation, the patient entered a double-blind protocol with stimulators turned OFF. Improvement of depression measured by the Hamilton Depression Scale score was evident after initial placement of electrodes without electrical stimulation. Depression relapsed partially at the end of the first week. Electrical stimulation further improved depression, normalizing depression scores and neuropsychological performance. Patient depression scores ranked between 2 and 8 during 8 months of ON stimulation without antidepressant medication. After stimulation was turned OFF, spontaneous fluctuations in patient symptoms reflected by Hamilton Depression Scale and Global Assessment of Functioning scores were documented; these fluctuations disappeared after stimulation was turned on by Month 20. Complicated patients with comorbid conditions are common referrals to psychosurgery services. In this report, we present promising results of electrical stimulation of the inferior thalamic peduncle to treat recurrent unipolar depression in a patient with MDD and borderline personality disorder who responded poorly to treatment.


Tailored Self-Assembled Ferroelectric Polymer Nanostructures with Tunable Response.
A facile ferroelectric nanostructures preparation method is developed based on the self-assembly of poly(2-vinylpyridine)-b-poly(vinylidene fluoride-co-trifluoroethylene)-b-poly(2-vinylpyridine) triblock copolymers (P2VP-b-P(VDF-TrFE)-b-P2VP), and the effect of morphological characteristics of the block copolymers on the ferroelectric response has been investigated for the first time. By simple adjustment of the ratio between the blocks, lamellar, cylindrical, and spherical morphologies are obtained in the melt and preserved upon crystallization of P(VDF-TrFE). However, at high P(VDF-TrFE) content, crystallization becomes dominant and drives the self-assembly of block copolymers. The crystallization study of the block copolymers reveals the preservation of the high degree of crystallinity inside the confined nanodomains as well as the reduction of the crystalline size and the Curie transition temperature with the confinement level. Only a small difference in the coercive field and the shape of the hysteresis loop is observed for block copolymers with a lamellar morphology produced either by crystallization-driven self-assembly or by confinement inside preformed lamellar domains. In contrast, delayed spontaneous polarization or the absence of dipole switching is demonstrated for the confinement of ferroelectric crystals inside both isolated cylindrical and spherical domains, exemplifying the influence of dimensionality on the critical size for ferroelectric order.


[Effectiveness of methods of isolating specific class-G rabbit antibodies for the immunoenzyme determination of human placental alkaline phosphatase].
Four different chromatographic methods of IgG isolation from rabbit antisera to placental alkaline phosphatase (HPAP) have been compared. The antibodies were obtained by ion-exchange chromatography and affinity chromatography on protein-A-sepharose, on the sepharose with immobilized antigen. IgG samples were characterized by the content of specific antibodies to HPAP and checked in enzyme immunoassay (EIA). IgG purified on immobilized antigen were found to be the optimal both from the point of view of the specific antibodies content and EIA sensitivity, but satisfactory results could be also obtained with ion-exchange and protein-A-chromatography purified IgG. The last two isolation methods are simpler and provide 3-10 ng/ml sensitivity of HPAP detection, which is lower, as compared with the test employing affinity antibodies (1 ng/ml), but allows the detection of HPAP in serum samples.


Cognition, reserve, and amyloid deposition in normal aging.
To determine whether amyloid deposition is associated with impaired neuropsychological (NP) performance and whether cognitive reserve (CR) modifies this association. In 66 normal elderly controls and 17 patients with Alzheimer disease (AD), we related brain retention of Pittsburgh Compound B (PiB) to NP performance and evaluated the impact of CR using education and American National Adult Reading Test intelligence quotient as proposed proxies. We found in the combined sample of subjects that PiB retention in the precuneus was inversely related to NP performance, especially in tests of memory function, but also in tests of working memory, semantic processing, language, and visuospatial perception. CR significantly modified the relationship, such that at progressively higher levels of CR, increased amyloid deposition was less or not at all associated with poorer neuropsychological performance. In a subsample of normal controls, both the main effect of amyloid deposition of worse memory performance and the interaction with CR were replicated using a particularly challenging memory test. Amyloid deposition is associated with lower cognitive performance both in AD patients and in the normal elderly, but the association is modified by CR, suggesting that CR may be protective against amyloid-related cognitive impairment.


Influence of drug therapy on survival following acute myocardial infarction.
The treatment of the patient with acute myocardial infarction remains a complex field of endeavour. Undoubtedly thrombolytic therapy, if instituted sufficiently early, holds considerable promise for the immediate prevention of myocardial necrosis. Alone, however, without further endeavours to remove the offending obstruction that precipitated clot formation in the coronary arteries, the procedure is only temporarily palliative. The long-term results of thrombolysis plus coronary angioplasty or bypass surgery are awaited but are unlikely to be universally successful or universally applicable. Moreover for the foreseeable future it is probable that the majority of patients will continue to present with established myocardial infarction. The prognosis of these patients is dominated by the presence or absence of left ventricular failure complicating the acute event. In those without such a sinister complication the evidence available suggests that early treatment with beta-blocking drugs or nitrates may enhance their prognosis although the most that can be expected is that the chances of survival will be improved in only one patient for every 150 treated. Moreover it is impossible to predict the patient who will benefit from such treatment and the improvement in length of life-span that this single beneficiary may expect. The major mortality risk of acute myocardial infarction resides in patients who have lost a substantial amount of muscle which has resulted in pump failure of the left ventricle. Both the short-term and long-term mortality rates in these patients is high. A range of drugs exist with which it is possible to ameliorate the hemodynamic evidence of left ventricular failure.(ABSTRACT TRUNCATED AT 250 WORDS)


Comparison of source apportionments of fine particulate matter at two San Jose speciation trends network sites.
In this study, the chemical composition of fine particulate matter samples collected at U.S. Environmental Protection Agency Speciation Trends Network sites in San Jose, CA, from February 2000 to February 2005 were analyzed. A San Jose site was initially established at 4th Street and then subsequently moved to Jackson Street in mid-2002. These sites are approximately 1 km apart. There were no known major changes in the nature of the sources in the area over this period. The study used positive matrix factorization model to extract the source profiles and their mass contributions and to compare the results for the congruence of the source apportionments between these two nearby sites. In the case of the 4th Street site, the average mass was apportioned to wood combustion (32.1 +/- 2.5%), secondary nitrate (22.3 +/- 2%), secondary sulfate (10.7 +/- 0.6%), fresh sea salt (7.7 +/- 0.9%), gasoline vehicles (7.3 +/- 0.5%), aged sea salt (6.8 +/- 0.4%), road dust (6.7 +/- 0.7%), diesel emissions (3.9 +/- 0.3%), and a Ni-related industrial source (2.5 +/- 0.4%). At the Jackson Street site, the average mass was apportioned to wood combustion (33.6 +/- 2.6%), secondary nitrate (20.3 +/- 1.9%), secondary sulfate (13.9 +/- 0.9%), aged sea salt (12.4 +/- 0.7%), gasoline vehicle (8.3 +/- 0.6%), fresh sea salt (5.3 +/- 0.5%), diesel emission (3.2 +/- 0.3%), road dust (1.9 +/- 0.1%), and Ni-related industrial source (1.3 +/- 0.1%). Conditional probability function analysis was used to help identify local sources. These results suggested that moving the sampling site a short distance had little effect on the nature of the resolved source types although some differences in their quantitative impacts were obtained in the positive matrix factorization analyses.


Listeria monocytogenes: antibiotic resistance in food production.
Listeria monocytogenes is an opportunistic human pathogen that causes listeriosis, a disease that mainly affects the immunocompromised, the elderly, infants, and pregnant women. Listeriosis has become increasingly common in the last 25 years since the first foodborne outbreak was noted. Treatment for listeriosis currently consists primarily of supportive therapy in conjunction with the use of intravenous antibiotics. Antibiotics have been commercially available for over 60 years for treatment of a myriad of clinical diseases. Bacteria resistant to antibiotics have been developing over this same period. This review seeks to elucidate the extent of antibiotic resistance in L. monocytogenes, the possible transmission mechanisms, and contributing factors to distribution of antibiotic resistance among Listeria species, and possible control strategies.


Attentional Profiles and White Matter Correlates in Attention-Deficit/Hyperactivity Disorder Predominantly Inattentive Type.
Attention-deficit/hyperactivity disorder (ADHD) is a widely studied neurodevelopmental disorder. It is a highly heterogeneous condition, encompassing different types of expression. The predominantly inattentive type is the most prevalent and the most stable over the lifetime, yet it is the least-studied presentation. To increase understanding of its cognitive profile, 29 children with attention-deficit/hyperactivity disorder of predominantly inattentive type (ADHD-I) and 29 matched controls, aged 7-15 years, had their attentional abilities assessed through the Conners' continuous performance test. Diffusion tensor imaging data were collected for all of the participants using a 3.0-T MRI system. Fractional anisotropy (FA) values were obtained for 20 fiber tracts, and brain-behavior correlations were calculated for 42 of the children. The ADHD-I children differed significantly from the typically developing (TD) children with respect to attentional measures, such as the ability to maintain response-time consistency throughout the task (Hit RT SE and Variability), vigilance (Hit RT ISI and Hit RT ISI SE), processing speed (Hit RT), selective attention (Omissions), sustained attention (Hit RT Block Change), error profile (Response Style), and inhibitory control (Perseverations). Evidence of significant differences between the ADHD-I and the TD participants was not found with respect to the mean FA values in the fiber tracts analyzed. Moderate and strong correlations between performance on the attention indicators and the tract-average FA values were found for the ADHD-I group. Our results contribute to a better characterization of the attentional profile of ADHD-I individuals and suggest that in children and adolescents with ADHD-I, attentional performance is mainly associated with the white matter structure of the long associative fibers that connect anterior-posterior brain areas.


Risk factors for extended disruption of family function after severe injury to a child.
To identify risk factors for long-lasting disruption of family function following pediatric trauma that can be measured at the time of trauma. Prospective, exploratory study. Personal interviews were conducted at the time of admission and 6 months and 1 year after discharge. Level I regional pediatric trauma centre. One hundred and five families (86% of those eligible) with a child admitted to hospital for severe trauma with an Abbreviated Injury Scale (AIS) score of 4 or higher or with two or more injuries in different body parts and AIS scores of 2 or higher were recruited; 13 families were lost to follow-up at 6 months or 1 year, so their data were not included in the analyses. Family function status (normal or abnormal compared with function before the injury), demographic characteristics of the parents and child, injury severity, presence of maternal psychologic disorder, presence of child behaviour abnormality and functional status of the child. At 6 months and at 1 year 41 families (45%) and 21 families (23%) respectively reported that their family lives had not returned to normal. The relative odds for disruption of family life were about five times higher (95% confidence limits [CL] 1.4 and 19.7) and four times higher (95% CL 1.1 and 14.0) for single-parent families than for families with married parents living together at 6 months and 1 year respectively. The presence of maternal psychologic disorders at admission and increased age of the injured child were also significantly associated with extended disruption of family function. Injury severity and functional status at discharge were not good predictors of family function. Severe injury to a child places a heavy strain on normal family function. In particular, single parents and parents experiencing mental or emotional problems at the acute stage of the injury need help in coping with their reactions to the trauma and may benefit from individual or group counseling.


High titres of IgM-bound circulating immune complexes and erythrocytic oxidative damage are indicators of dengue severity.
Global incidence of dengue has drastically increased in the last few years. Despite the global morbidity and mortality associated with dengue infection, mechanisms of immune control and viral pathogenesis are poorly explored. Pancytopenias, along with increased oxidative stress, are salient clinical findings in severe dengue patients. Previously, we demonstrated significant differences of circulating immune complexes (CICs) among severe and non-severe dengue patients. Accordingly, here we sought to determine the contributory role of affinity-purified antibody-bound CICs in dengue severity. To characterize intracellular oxidative stress induced by antibody-bound CICs, 5-(and-6)-chloromethyl-2'-7'-dichlorodihydrofluorescein diacetate (DCFDA) was measured by flow cytometry. At the same time, CICs sensitized healthy red blood cells (RBC) and patients' RBC morphology was determined by scanning electron microscopy and flow cytometry analysis. Erythrophagocytosis and ferritin levels were further determined in severe and non-severe dengue patients. Our results showed that the severe patients had high titres of immunoglobulin (Ig)M-bound CICs (P < 0·0001) in their sera, increased intracellular oxidative stress (P < 0·0001), high ferritin levels (P < 0·0001), altered morphology of RBC and finally enhanced erythrophagocytosis. This study shows for the first time that RBC morphology is altered in severe dengue patients. Taken together, this study suggests that the enhanced IgM-bound CICs could contribute to the increased oxidative stress and act directly on RBC destruction of severe dengue patients, and is an important pathophysiological determinant. Hence, IgM-bound CICs can serve as an important laboratory parameter to monitor dengue infection progression.


Biblical authority and the not-so strange silence of Scripture about abortion.
Biblical authority is definitive for many Protestants in matters of faith and practice. The question this essay addresses is the deafening silence of this Scriptural authority on the controversial issue of abortion, especially because Christian scholars have argued vehemently against this practice. In particular, Michael Gorman's recent article 'Why is the New Testament silent about abortion?' raises many substantive issues with implications for the very meaning of authority, faith, and the life of the community. It is contended that elective abortion poses significant substantive issues with which a woman, or couple, must struggle, and that it is inappropriate (perhaps unfaithful) to make such a profound decision according to unfeeling or out-modeled patriarchal rules.


Reversible switching of a supramolecular morphology driven by an amphiphilic bistable [2]rotaxane.
An acid/base responsive amphiphilic [2]rotaxane switch containing a hydrophilic macrocycle component and a hydrophobic terminal bulky group was prepared and characterized. The morphology of the supramolecular assemblies formed by the rotaxanes could be switched between spherical vesicles and worm-like micelles using acid/base stimuli, as confirmed by transmission electron microscopy (TEM).


Modification of indium tin oxide with dendrimer-encapsulated nanoparticles to provide enhanced stable electrochemiluminescence of Ru(bpy)3(2+)/tripropylamine while preserving optical transparency of indium tin oxide for sensitive electrochemiluminescence-based analyses.
Here, we report highly enhanced stable electrogenerated chemiluminescence (ECL) of Ru(bpy)3(2+) (bpy = 2,2'-bipyridyl) with tripropylamine (TPrA) coreactant on indium tin oxide (ITO) electrodes modified with amine-terminated dendrimers encapsulating catalytic nanoparticles while maintaining optical transparency of ITO and feasibility of the modified ITOs to sensitive ECL-based assays. As model systems, we prepared Pt and Au dendrimer-encapsulated nanoparticles (DENs) using amine-terminated sixth-generation poly(amido amine) dendrimers and subsequently immobilized the DENs onto ITO surfaces via electrooxidative grafting of the terminal amines of dendrimers to the surfaces. The resulting DEN-modified ITOs preserved good optical transparency of ITO and exhibited highly catalyzed electrochemical oxidation of Ru(bpy)3(2+)/TPrA, leading to significantly increased ECL emission. Especially, the Pt DEN-modified ITO electrode provides negligible transmittance drop, i.e., only ∼1.99% over the entire visible region, and exhibited not only much enhanced (i.e., ∼213-fold increase compared to ECL obtained from bare ITO) but also stable ECL emission under consecutive potential scans from 0.00 to 1.10 V for 10 cycles, which allowed ∼329 times more sensitive ECL-based analysis of nicotine using the Pt DEN-modified ITO compared with the use of bare ITO.


Adherence of platelets to human endothelial cells infected by Rickettsia rickettsii.
Rickettsia rickettsii, the etiologic agent of Rocky Mountain spotted fever, causes widespread vasculitis due to extensive injury of endothelial cells lining small blood vessels. Injury to these cells can lead to denudation of the endothelial lining and exposure of the thrombogenic subendothelium. Modification of the cell surface, either through minor trauma or as a result of altered cell surface biochemistry, could induce changes reflected in increased platelet reactivity. Because membrane modification is likely when R. rickettsii enters endothelial cells, the possibility that infection by this organism caused increased reactivity of platelets with the endothelial cell surface was examined. A fourfold increase in adherence of platelets to cultured endothelial cells from the human umbilical vein infected by R. rickettsii compared with uninfected cells was found. These studies suggest that the adherence of platelets to the surface of Rickettsia-infected endothelial cells can contribute to reduction in the number of circulating platelets in blood during human infection.


Tumor microenvironment: driving forces and potential therapeutic targets for breast cancer metastasis.
Distant metastasis to specific target organs is responsible for over 90% of breast cancer-related deaths, but the underlying molecular mechanism is unclear. Mounting evidence suggests that the interplay between breast cancer cells and the target organ microenvironment is the key determinant of organ-specific metastasis of this lethal disease. Here, we highlight new findings and concepts concerning the emerging role of the tumor microenvironment in breast cancer metastasis; we also discuss potential therapeutic intervention strategies aimed at targeting components of the tumor microenvironment.


Delay in Diagnosis of Autoimmune Polyendocrine Syndrome Type 2 as a Consequence of Misinterpretation of Gastrointestinal Symptoms.
Type 2 autoimmune polyendocrine syndrome (APS-2) is characterized by the presence of at least two of three endocrinopathies: Addison's disease, autoimmune thyroiditis, and diabetes type 1. The prevalence of APS-2 is estimated to be 1 : 1000 to 1 : 20.000 in the general population. Diagnosis of APS-2 often is delayed due to its rarity and wide spectrum of clinical symptoms. Case Presentation. A 27-year-old presented with a 6-month history of abdominal pain, vomiting, diarrhea, weakness, fatigue, and 15 kg of weight loss. The patient was diagnosed with Crohn's disease in a local hospital and referred to our institution because of treatment failure. Colonoscopy performed in this hospital identified irregular mucosal erosions in terminal ileum, and the microscopy of biopsy specimens demonstrated nonspecific inflammation. On physical examination, the patient appeared cachectic. Blood pressure was 90/60 mmHg. Laboratory results were significant for severe hyponatremia and mild hyperkalemia. Morning cortisol was low, and adrenocorticotropic hormone (ACTH) concentration was high. An ACTH stimulation test did not present any increase in serum cortisol, which confirmed primary adrenal insufficiency. Antithyroid peroxidase antibody (anti-TPO) as well as both anti-21-hydroxylase antibodies and antiglutamic acid decarboxylase antibodies (GAD65) were positive. So, the diagnosis of APS-2 was made, and the replacement doses of hydrocortisone and fludrocortisone has brought a rapid improvement in all clinical symptoms; colonoscopy showed normal. The case presented herein highlights rapidly progressive nature of untreated APS-2 and that the diagnosis of APS-2 may be challenging.


Heideggerian phenomenology: an approach to understanding family caring for an older relative.
Recent research has found that family caregivers do not discuss their caregiving in terms of tasks but instead describe their care as shaped by concerns, commitments and goals. The purpose of this paper is to challenge the ways in which nurses approach the family caregiving process and to explore possibilities for evolving nursing knowledge by questioning existing practice in the light of developing insight into the ways in which being a family caregiver is meaningful. A critique of the philosophical orientations of rationalism and empiricism provides a platform to discuss the merits of a Heideggerian phenomenological approach in assisting nurses to better understand family caring experience. Such critique serves to support the notion of displacing the traditional scientific view as the prime means of disclosing truth, acknowledging alternative ways of knowing.


Resveratrol pretreatment protects neurons from oxygen-glucose deprivation/reoxygenation and ischemic injury through inhibiting ferroptosis.
Ferroptosis, a newly discovered iron-dependent cell death, is involved in brain ischemia-reperfusion injury. Iron scavengers or ferroptosis inhibitors could reduce infarct volume and improve neurological function in mice. Resveratrol has neuroprotective and neurorestorative effects. However, it is unclear whether resveratrol can play a neuroprotective role via inhibiting ferroptosis. Our study showed that resveratrol pretreatment had a similar effect with ferrostatin‑1, which inhibited neuronal ferroptosis-related changes, such as iron overload, damages of oxidation-reduction system, and destruction of mitochondrial structure, after oxygen-glucose deprivation/reoxygenation (OGD/R) and application of ferroptosis inducers. In addition, middle cerebral artery occlusion/reperfusion (MCAO/R) injury in vivo also induced ferroptosis, and resveratrol pretreatment could inhibit ferroptosis and reduce degenerative neurons, cerebral ischemic damage and infarction volume. Our results are the first to indicate that resveratrol pretreatment might inhibit ferroptosis induced by OGD/R and ferroptosis inducers in neurons, and MCAO/R in rats.


In vitro effects of calcium phosphate biomaterials on fibroblastic cell behavior.
The effect of synthetic granular hydroxyapatite (HAP) on cultured fibroblastic cells (L929, human bone and gingiva cells) was studied. Phagocytosis of HAP particles and resulting morphological cell changes were demonstrated by microscopic examinations. Cell counts and [3H]thymidine uptake indicated significant increases in cell proliferation and DNA synthesis. These results could account for some of the alterations of the fibroblast behavior induced by changes in intracellular levels of calcium ions released from the material.


Polyglycolic acid sheet application to prevent esophageal stricture after endoscopic submucosal dissection for esophageal squamous cell carcinoma.
Esophageal stricture following endoscopic submucosal dissection (ESD) can be a serious complication in patients with large mucosal defects. This preliminary study examined the efficacy of using a polyglycolic acid (PGA) sheet with fibrin glue for the prevention of esophageal stricture after ESD. A total of 15 patients were enrolled. After resection, PGA sheets were placed over the surgical wound. The size of the mucosal defect was estimated by dividing the circumference of the esophagus into 12 parts of equal size. The occurrence of esophageal stricture at 6 weeks, along with the proportion of patients who had PGA sheet remaining in place 1 week and 2 weeks after ESD, and the occurrence of adverse events were investigated. The size of mucosal defects in the 15 patients were 7/12 (n = 4), 8 /12 (n = 5), 9/12 (n = 4), 10/12 (n = 1) and 11/12 (n = 1). Esophageal stricture occurred in 1/13 patients (7.7 %; two patients were not included in the analysis because they had required surgical resection during the follow-up period). The PGA sheet remained at 1 week after ESD in 13/15 patients (86.7 %) and at 2 weeks after ESD in 6/15 patients (40 %). No adverse events were observed. PGA sheets may have the potential to prevent esophageal stricture.


Factors linking perceived discrimination and weight bias internalization to body appreciation and eating pathology: A moderated mediation analysis of self-compassion and psychological distress.
Stigma and recurrent discriminatory experiences can lead to distress and internalization of biases. Self-compassion is a widely-recognized resilience factor that may decrease the impact of discrimination on psychological well-being. Research highlights the potential utility of self-compassion in counteracting the harmful effects of discrimination, reducing psychological distress, and preventing the development of eating disorders. The current study examined the roles of self-compassion and psychological distress in perceived discrimination, internalized weight bias, body image, and eating pathology. Participants (N=694) living in the United States completed an online battery of measures assessing perceived discrimination, weight bias internalization, self-compassion, psychological distress, body appreciation, and eating pathology. Self-compassion was associated negatively with perceived discrimination, weight-bias internalization, psychological distress, and eating pathology and was associated positively with body appreciation. Moderated mediation analyses examined whether psychological distress statistically mediated the relationship between perceived discrimination (Model 1) or weight bias internalization (Model 2) on body appreciation, as well as between perceived discrimination (Model 3) or weight bias internalization (Model 4) on eating psychopathology. For all models, self-compassion was explored as a moderator of indirect and direct effects. Results revealed how psychological distress mediated the link between perceived discrimination and body appreciation/eating psychopathology, as well as between weight bias internalization and body appreciation, but not eating psychopathology. For weight bias internalization models only, the statistical links between psychological distress in relation to body appreciation/eating psychopathology were stronger for those with lower self-compassion. Self-compassion may promote more effective coping and outcomes for individuals who are subject to societal stigma.


Validation of musculoskeletal ultrasound to assess and quantify muscle glycogen content. A novel approach.
Glycogen storage is essential for exercise performance. The ability to assess muscle glycogen levels should be an important advantage for performance. However, skeletal muscle glycogen assessment has only been available and validated through muscle biopsy. We have developed a new methodology using high-frequency ultrasound to assess skeletal muscle glycogen content in a rapid, portable, and noninvasive way using MuscleSound (MuscleSound, LCC, Denver, CO) technology. To validate the utilization of high-frequency musculoskeletal ultrasound for muscle glycogen assessment and correlate it with histochemical glycogen quantification through muscle biopsy. Twenty-two male competitive cyclists (categories: Pro, 1-4; average height, 183.7 ± 4.9 cm; average weight, 76.8 ± 7.8 kg) performed a steady-state test on a cyclergometer for 90 minutes at a moderate to high exercise intensity, eliciting a carbohydrate oxidation of 2-3 g·min⁻¹ and a blood lactate concentration of 2 to 3 mM. Pre- and post-exercise glycogen content from rectus femoris muscle was measured using histochemical analysis through muscle biopsy and through high-frequency ultrasound scans using MuscleSound technology. Correlations between muscle biopsy glycogen histochemical quantification (mmol·kg⁻¹) and high-frequency ultrasound methodology through MuscleSound technology were r = 0.93 (P < 0.0001) pre-exercise and r = 0.94 (P < 0.0001) post-exercise. The correlation between muscle biopsy glycogen quantification and high-frequency ultrasound methodology for the change in glycogen from pre- and post-exercise was r = 0.81 (P < 0.0001). These results demonstrate that skeletal muscle glycogen can be measured quickly and noninvasively through high-frequency ultrasound using MuscleSound technology.


Behavioral benefits of maternal swimming are counteracted by neonatal hypoxia-ischemia in the offspring.
Hypoxia-ischemia (HI) represents one of the most common causes of neonatal encephalopathy. The central nervous system injury comprises several mechanisms, including inflammatory, excitotoxicity, and redox homeostasis unbalance leading to cell death and cognitive impairment. Exercise during pregnancy is a potential therapeutic tool due to benefits offered to mother and fetus. Swimming during pregnancy elicits a strong metabolic programming in the offspring's brain, evidenced by increased antioxidant enzymes, mitochondrial biogenesis, and neurogenesis. This article aims to evaluate whether the benefits of maternal exercise are able to prevent behavioral brain injury caused by neonatal HI. Female adult Wistar rats swam before and during pregnancy (30min/day, 5 days/week, 4 weeks). At 7(th) day after birth, the offspring was submitted to HI protocol and, in adulthood (60(th) day), it performed the behavioral tests. It was observed an increase in motor activity in the open field test in HI-rats, which was not prevented by maternal exercise. The rats subjected to maternal swimming presented an improved long-term memory in the object recognition task, which was totally reversed by neonatal HI encephalopathy. BDNF brain levels were not altered; suggesting that HI or maternal exercise effects were BDNF-independent. In summary, our data suggest a beneficial long-term effect of maternal swimming, despite not being robust enough to protect from HI injury.


[Homocysteine and diabetes].
The authors present the current knowledge on the role of hyperhomocysteinemia in developing of vascular changes, especially in diabetes. A high serum homocysteine concentration is a new independent risk factor in the development of arteriosclerosis and cardiovascular diseases. The role of the hyperhomocysteinemia in diabetes has not been explained yet. Probably hyperhomocysteinemia affects the clinical course, metabolic control and possible complications of diabetes mainly by its influence on the development of macro- and microangiopathy.


Etiology and pharmacologic management of noninfectious diarrhea in HIV-infected individuals in the highly active antiretroviral therapy era.
Diarrhea remains a common problem for patients with human immunodeficiency virus (HIV) infection despite highly active antiretroviral therapies (HAART) and can negatively affect patient quality of life and lead to discontinuation or switching of HAART regimens. In the era of HAART, diarrhea from opportunistic infections is uncommon, and HIV-associated diarrhea often has noninfectious causes, including HAART-related adverse events and HIV enteropathy. Diarrhea associated with HAART is typically caused by protease inhibitors (eg, ritonavir), which may damage the intestinal epithelial barrier (leaky-flux diarrhea) and/or alter chloride ion secretion (secretory diarrhea). HIV enteropathy may result from direct effects of HIV on gastrointestinal tract cells and on the gastrointestinal immune system and gut-associated lymphoid tissue, which may be active sites of HIV infection and ongoing inflammation and mucosal damage. New therapies targeting the pathogenic mechanisms of noninfectious diarrheas are needed.


Tempicol-2 (4-hydroxy-4-(2-picolyl)-2,2,6,6-tetramethylpiperidine-1-oxyl), a stable free radical, is a novel member of nitroxide class of antioxidants and anticancer agents.
As a part of our studies on the chemical, biochemical and pharmacological characteristics of the newly synthesized antioxidants, nitroxide derivatives, we designed a novel nitroxide, named Tempicol-2. Its capacity to act as antioxidant of potential pharmacological application was tested in three model systems: xanthine/xanthine oxidase, iron- and ascorbate Fenton reaction(s) and gamma-radiolysis. The antioxidant properties of Tempicol-2 as a function of concentration were compared with those previously characterized nitroxide derivatives Tempace and Rutoxyl which we had synthesized. The possibility of one-electron reduction of the novel substance by ascorbic acid was also examined and compared. The ability of Tempicol-2 to act as anticancer agent in vivo was also investigated in pharmacologic tests. The administration of Tempicol-2 to rats bearing 3 day-old Yoshida Sarcoma (promotion phase) led to both growth inhibition and the induction of apoptotic cells(s) death, comparable to the effects of Tempace and Rutoxyl under the same experimental conditions. Our results confirmed the suggested involvement of free radicals in the pathogenesis of model. Yoshida Sarcoma, thus indicating that anticancer activity of the investigated nitroxides may indirectly involve an antioxidant mechanism. The results reported here are encouraging as we find a limited correlation between the molecular redox properties, structure of nitroxides and their antitumor action. Tempicol-2, similarly to Tempace and Rutoxyl, is a promising antioxidant which can induce apoptosis, thus providing the basis for further investigations of the concentration and phase-dependent effects and the exact mechanisms of nitroxide(s) apoptotic action using cell line(s) model.


Fine mapping by composite genome-wide association analysis.
Genome-wide association (GWA) studies play a key role in current genetics research, unravelling genomic regions linked to phenotypic traits of interest in multiple species. Nevertheless, the extent of linkage disequilibrium (LD) may provide confounding results when significant genetic markers span along several contiguous cM. In this study, we have adapted the composite interval mapping approach to the GWA framework (composite GWA), in order to evaluate the impact of including competing (possibly linked) genetic markers when testing for the additive allelic effect inherent to a given genetic marker. We tested model performance on simulated data sets under different scenarios (i.e., qualitative trait loci effects, LD between genetic markers and width of the genomic region involved in the analysis). Our results showed that the genomic region had a small impact on the number of competing single nucleotide polymorphisms (SNPs) as well as on the precision of the composite GWA analysis. A similar conclusion was derived from the preferable range of LD between the tested SNP and competing SNPs, although moderate-to-high LD seemed to attenuate the loss of statistical power. The composite GWA improved specificity and reduced the number of significant genetic markers. The composite GWA model contributes a novel point of view for GWA analyses where testing circumscribed to the genomic region flanking each SNP (delimited by the nearest competing SNPs) and conditioning on linked markers increases the precision to locate causal mutations, but possibly at the expense of power.


Plasmacytoid T cells. Immunohistochemical evidence for their monocyte/macrophage origin.
To elucidate the lineage of plasmacytoid T cells, their immunophenotype was studied in reactive lymph nodes with a broad panel of monoclonal antibodies. Plasmacytoid T cells expressed several myelomonocytic markers, and almost all markers highly selective for macrophages. They lacked granulocyte-associated and B or T lymphocyte-associated antigens. These results provide strong evidence that plasmacytoid T cells are of monocyte lineage.


Racial differences in the use of adjuvant chemotherapy for breast cancer in a large urban integrated health system.
Background. Racial differences in breast cancer survival may be in part due to variation in patterns of care. To better understand factors influencing survival disparities, we evaluated patterns of receipt of adjuvant chemotherapy among 2,234 women with invasive, nonmetastatic breast cancer treated at the Henry Ford Health System (HFHS) from 1996 through 2005. Methods. Sociodemographic and clinical information were obtained from linked datasets from the HFHS, Metropolitan Detroit Cancer Surveillance Systems, and U.S. Census. Comorbidity was measured using the Charlson comorbidity index (CCI), and economic deprivation was categorized using a neighborhood deprivation index. Results. African American (AA) women were more likely than whites to have advanced tumors with more aggressive clinical features, to have more comorbidity and to be socioeconomically deprived. While in the unadjusted model, AAs were more likely to receive chemotherapy (odds ratio (OR) 1.22, 95% confidence interval (CI) 1.02-1.46) and to have a delay in receipt of chemotherapy beyond 60 days (OR 1.68, 95% CI, 1.26-1.48), after multivariable adjustment there were no racial differences in receipt (odds ratio (OR) 1.02, 95% confidence interval (CI) 0.73-1.43), or timing of chemotherapy (OR 1.18, 95 CI, 0.8-1.74). Conclusions. Societal factors and not race appear to have an impact on treatment delay among African American women with early breast cancer.


The meaning of diabetes. Significance for holistic nursing practice.
Recent research has raised questions about the validity and relevance of health practitioners' perspectives of diabetes and diabetes care. This article describes a qualitative research study that was undertaken to illuminate an insider's perspective of how Type I diabetes is meaningfully experienced. The results of this study reveal that although people with diabetes share a common disease, the meaning of that disease in people's lives is unique and varied. To provide holistic care, nurses must assist people in discovering and articulating the meaning of diabetes in their lives as well as acknowledging and attending to the significant elements within their experiences.


Impacts of Ship Emissions on Air Quality in Southern China: Opportunistic Insights from the Abrupt Emission Changes in Early 2020.
In early 2020, two unique events perturbed ship emissions of pollutants around Southern China, proffering insights into the impacts of ship emissions on regional air quality: the decline of ship activities due to COVID-19 and the global enforcement of low-sulfur (<0.5%) fuel oil for ships. In January and February 2020, estimated ship emissions of NOx, SO2, and primary PM2.5 over Southern China dropped by 19, 71, and 58%, respectively, relative to the same period in 2019. The decline of ship NOx emissions was mostly over the coastal waters and inland waterways of Southern China due to reduced ship activities. The decline of ship SO2 and primary PM2.5 emissions was most pronounced outside the Chinese Domestic Emission Control Area due to the switch to low-sulfur fuel oil there. Ship emission reductions in early 2020 drove 16 to 18% decreases in surface NO2 levels but 3.8 to 4.9% increases in surface ozone over Southern China. We estimated that ship emissions contributed 40% of surface NO2 concentrations over Guangdong in winter. Our results indicated that future abatements of ship emissions should be implemented synergistically with reductions of land-borne anthropogenic emissions of nonmethane volatile organic compounds to effectively alleviate regional ozone pollution.


Surgical reconstruction in tetraplegia.
The authors reviewed their 10 years of combined experience in the surgical reconstruction of the upper extremities in 170 quadriplegic patients from two spinal cord treatment centers. The authors' current recommendations regarding patient selection are presented, refinements in previously published surgical techniques are defined, and the principles of postoperative care are discussed.


Selection of the method to appraise and compare health systems using risk stratification: the ASSEHS approach.
To face the challenge of active and healthy ageing, European Health Systems and services should move towards proactive, anticipatory and integrated care. The comparison of methods to combine results across studies and to determine an overall effect was undertaken by the EU project ASSEHS (Activation of Stratification Strategies and Results of the interventions on frail patients of Healthcare Services, EU project (No. 2013 12 04). The questions raised in ASSEHS are broad and involve a complex body of literature. Thus, systematic reviews are not appropriate. The most appropriate method appears to be scoping studies. In this paper, an updated method of scoping studies has been used to determine the questions needed to appraise the health systems and services for frailty in the ageing population. Three objectives were set (i) to detect a relevant number of risk stratification tools for frailty and identify the best-in-class, (ii) to understand the feasibility of introducing stratification tools and identify the difficulties of the process and (iii) to find evidence on the impact of risk stratification in Health Services. This novel approach may provide greater clarity about scoping study methodology and help enhance the methodological rigor with which authors undertake and report scoping studies.


Nosocomial infection surveillance and control policies.
In the majority of countries costs for health care are increasing and strategies to reduce adverse events in medical treatment have an increasing importance. Nosocomial infection remains the most common type of complication affecting hospitalized patients. As preventive strategies have indeed become more important they now have to show not only that they are effective in reducing nosocomial infections but also that they are cost effective. This paper investigates the contribution made by articles published in the last year to the development of nosocomial-infection surveillance and control policies. At least 15 randomized controlled studies and six meta-analyses investigating various infection-control policies were published last year. They did not lead to any changes in present guidelines, but rather endorsed existing recommendations. At least nine studies were found reporting a substantial reduction in nosocomial infections by the introduction of quality management principles under routine working conditions. Furthermore there were a lot of studies published which focused on optimizing surveillance measures and investigating the use of reference data for reducing infection rates. Only seven studies estimating the burden of disease were found in the literature of the past year. The predominant opinion voiced in the studies was that in many medical institutions some 30% or more of nosocomial infections could be prevented.


Triol-Ligand Modification and Structural Transformation of Anderson-Evans Oxomolybdates via Modulating Oxidation State of Co-Heteroatom.
Various covalent decorations and structural transformations of a series of R-C(CH2OH)3 triol ligands on CoII/CoIII-centered Anderson-Evans polyoxomolybdates were studied in aqueous and/or organic solution. Single-crystal X-ray structural analysis demonstrated that four manners, including (1) double-sided χ/χ-isomer and (2) double-sided δ/χ-isomer with CoII central heteroatom, and (3) single-sided δ-isomer and (4) double-sided δ/δ-isomer with CoIII central heteroatom, appeared on the decoration of the mother polyanion [CoII/III(OH)6Mo6O18]4-/3-. Through careful manipulation of the reaction conditions, a gradual oxidation process from CoII to CoIII was disclosed to happen in air, and accompanying that process, the CoII-centered double-sided δ/χ-isomer that formed in the initial stage transformed into a CoIII-centered double-sided δ/δ-isomer. When the electron-withdrawing group -NO2 substituted triol ligand was used to replace CH3C(CH2OH)3, the oxidation process accelerated spontaneously. A further investigation showed that this oxidation process can be blocked by acid. While the triol ligands' decoration on Anderson-Evans polyoxometalates (POMs) took place along with the oxidation of the central heteroatom, that codecoration of other components was also accomplished. In the presence of excess acetic acid, an unprecedented single-sided δ-isomer with an acetate ligand covalently attaching on the other side by replacing one μ3-O atom was obtained in aqueous solution. The reaction of the mother cluster [(n-C4H9)4N]3[Co(OH)6Mo6O18] and triol ligands in methanol resulted in a codecoration of methanol with the double-sided δ/δ-isomer, which has never been reported in B-type Anderson-Evans POMs. The obtained results revealed that the oxidation state of the heteroatom has a significant impact on the triol ligand decoration styles, such as the χ/χ- or δ/χ-isomer for the divalent heteroatom and the δ- or δ/δ-isomer for the trivalent heteroatom.


Palliative sedation: not just normal medical practice. Ethical reflections on the Royal Dutch Medical Association's guideline on palliative sedation.
The main premise of the Royal Dutch Medical Association's (RDMA) guideline on palliative sedation is that palliative sedation, contrary to euthanasia, is normal medical practice. Although we do not deny the ethical distinctions between euthanasia and palliative sedation, we will critically analyse the guideline's argumentation strategy with which euthanasia is demarcated from palliative sedation. First, we will analyse the guideline's main premise, which entails that palliative sedation is normal medical treatment. After this, we will critically discuss three crucial propositions of the guideline that are used to support this premise: (1) the patient's life expectancy should not exceed 2 weeks; (2) the aim of the physician should be to relieve suffering and (3) expert consultation is optional. We will conclude that, if inherent problematic aspects of palliative sedation are taken seriously, palliative sedation is less normal than it is now depicted in the guideline.


Helicobacter cinaedi knee infection after arthroscopy in an immunocompetent patient.
An otherwise healthy 36-year-old man was hospitalised due to a traumatic tear of the meniscus in the left knee. An arthroscopy was performed and his meniscus was partially resected. Thirty days later, he was rehospitalised with arthritis in the left knee and cellulitis on the left tibia. Helicobacter cinaedi was isolated from the synovial fluid, which was incubated in a BACTEC Paediatric bottle. The patient was treated with oral rifampicin and moxifloxacin for 6 weeks with good clinical response without relapse. The source of the infection was not found. The case emphasises the importance of incubating the synovial fluid in a rich medium such as a BACTEC Peds Plus/F bottle. Physicians and microbiologists should be aware of H. cinaedi as a human pathogen causing a range of disease manifestations, including infective arthritis and cellulitis, particularly if symptoms evolve in the weeks following a surgical procedure.


An accelerated method for the detection of extended-spectrum beta-lactamases in urinary isolates of Escherichia coli and Klebsiella pneumoniae.
We prospectively studied an accelerated phenotypic method by incorporating the double disk synergy test in the standard Kirby-Bauer disk diffusion susceptibility testing, to evaluate a protocol for the rapid detection of extended-spectrum beta-lactamases (ESBL) in urinary isolates of Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae). All ESBL-positive isolates were confirmed by the standard Clinical Laboratory Standards Institute (CLSI) confirmatory disk diffusion method. Between November 2004 and December 2005, a total of 6988 urine specimens were analyzed of which, 776 (11%) showed significant growth. They included E. coli in 577 cases (74%) and K. pneumoniae in 199 (25.6%). Of these, 63 E. coli (8%) and 15 K. pneumoniae (7.5%) were positive for ESBL by the accelerated and CLSI methods. Compared to the standard CLSI method, the accelerated method reduced the ESBL detection time from two days to one day. We conclude that the accelerated ESBL detection technique used by us in this study is a reliable and rapid method for detecting ESBL in urinary isolates of E. coli and K. pneumoniae.


Self-assembly of Au-Ag alloy nanoparticles by thermal annealing.
Hemispherical Au-Ag alloy nanoparticles were prepared on 2-inch Si wafer by thermal annealing Au-Ag alloy thin film in protective ambient. The nanoparticles were evenly distributed on the substrate surface. The diameter of the nanoparticles is dependent of the deposition duration of the Au-Ag alloy thin film, and also the separation between the nanoparticles. The minimum and maximum diameters of the nanoparticles obtained so far are about 5 nm and 160 nm, respectively. Experimental evidences indicated that the formation of the hemispherical nanoparticles is due to the surface tensile stressing induced by the lattice expansion.


Infiltration of a Unique CD8+CD274+ Cell Subgroup in Hepatocellular Carcinoma is Associated with Poor Clinical Outcomes.
Immune checkpoint (IC) inhibitor-related immunotherapies have attracted considerable attention in hepatocellular carcinoma (HCC). High IC expression and high tumor infiltrating lymphocyte levels are the current indicators of sensitivity to IC inhibitors. Thus, it is imperative to apply precision medicine strategies for patient selection. Six independent HCC cohorts were used for analysis at the single-cell and tissue levels. Multiplex immunofluorescence and immunochemistry staining assays were used to validate our results. A series of methodologies were used for immune-related evaluations. Herein, we uncovered a unique CD8+CD274+ cell subpopulation that is associated with tumor progression and poor survival in HCC at the single-cell level. We assessed this subset at the tissue level and found that the prognostic significance of CD274 is dependent on CD8A expression in HCC. Subsequently, we identified a unique high-risk subpopulation that showed high CD8A expression coupled with intense CD274 expression in multiple HCC cohorts. CD8AHighCD274High* subgroup was correlated with malignant indexes and remained an independent prognostic factor when considering the influence of these indexes. Molecular characteristic analyses showed that the CD8AHighCD274High* subgroup harbored more mutations, had higher immune response activity and presented enrichment of cancer-related biological processes. Moreover, this high-risk subpopulation in HCC was characterized by high immune cell infiltration, low tumor purity, and enrichment of cancer-related signatures. Finally, cases with this phenotype demonstrated higher immunomodulator and IC levels and greater sensitivity to IC inhibitors. Our findings illustrate that some HCC patients may have a poor prognosis despite high CD8+ T-cell infiltration. These patients would probably benefit from IC inhibitor-based combination treatment.


Reciprocal relationship between reactive oxygen species and cyclooxygenase-2 and vascular dysfunction in hypertension.
This study evaluates a possible relationship between reactive oxygen species (ROS) and cyclooxygenase (COX)-2-derived products in conductance and resistance arteries from hypertensive animals. Angiotensin II (Ang II)-infused mice or spontaneously hypertensive rats treated with the NAD(P)H Oxidase inhibitor apocynin, the mitochondrion-targeted SOD2 mimetic Mito-TEMPO, the superoxide dismutase analog tempol, or the COX-2 inhibitor Celecoxib were used. Apocynin, Mito-TEMPO, and Celecoxib treatments prevented Ang II-induced hypertension, the increased vasoconstrictor responses to phenylephrine, and the reduced acetylcholine relaxation. The NOX-2 inhibitor gp91ds-tat, the NOX-1 inhibitor ML171, catalase, and the COX-2 inhibitor NS398 abolished the ex vivo effect of Ang II-enhancing phenylephrine responses. Antioxidant treatments diminished the increased vascular COX-2 expression, prostanoid production, and/or participation of COX-derived contractile prostanoids and thromboxane A(2) receptor (TP) in phenylephrine responses, observed in arteries from hypertensive models. The treatment with the COX-2 inhibitor normalized the increased ROS production (O(2)·(-) and H(2)O(2)), NAD(P)H Oxidase expression (NOX-1, NOX-4, and p22phox) and activity, MnSOD expression, and the participation of ROS in vascular responses in both hypertensive models. Apocynin and Mito-TEMPO also normalized these parameters of oxidative stress. Apocynin, Mito-TEMPO, and Celecoxib improved the diminished nitric oxide (NO) production and the modulation by NO of phenylephrine responses in the Ang II model. This study provides mechanistic evidence of circuitous relationship between COX-2 products and ROS in hypertension. The excess of ROS from NAD(P)H Oxidase and/or mitochondria and the increased vascular COX-2/TP receptor axis act in concert to induce vascular dysfunction and hypertension.


CaMKII autophosphorylation but not downstream kinase activity is required for synaptic memory.
CaMKII plays a critical role in long-term potentiation (LTP), a well-established model for learning and memory through the enhancement of synaptic transmission. Biochemical studies indicate that CaMKII catalyzes a phosphotransferase (kinase) reaction of both itself (autophosphorylation) and of multiple downstream target proteins. However, whether either type of phosphorylation plays any role in the synaptic enhancing action of CaMKII remains hotly contested. We have designed a series of experiments to define the minimal requirements for the synaptic enhancement by CaMKII. We find that autophosphorylation of T286 and further binding of CaMKII to the GluN2B subunit are required both for initiating LTP and for its maintenance (synaptic memory). Once bound to the NMDA receptor, the synaptic action of CaMKII occurs in the absence of kinase activity. Thus, autophosphorylation, together with binding to the GluN2B subunit, are the only two requirements for CaMKII in synaptic memory.


Theoretical models in dentistry.
For the exchange between science and practice, a language that is as precise as possible is also required in dentisty. This language is necessarily based on our ideas about the relationships in reality. Since standardization is unavoidable, various methods have been developed in informatics as to how these models can be represented and made more precise. On this basis, it is possible to neutrally discuss the situations in which a given form of treatment is expedient or not. A step-by-step approach to standardization of dental language with the aid of meta models is shown by reference to examples. The medrapid.info service is presented as on approach to making medical and dental language more precise.


Exercise increases skin graft resistance to rejection.
Regular exercise reduces risk of various chronic diseases and can prevent the development and recurrence of cancer, making it a promising nonpharmacological modulator of disease. Yet the effect of regular exercise on solid organ transplant outcome remains uncertain. Using a model of voluntary wheel-running exercise and skin transplantation in mice, we hypothesized that exercise strengthens the alloimmune response, leading to an increased rate of rejection. Instead, we found that regular exercise in mice resulted in prolonged graft survival, with mean allograft survival time increasing by almost 50%. We observed this graft survival extension in exercised mice despite evidence of a slightly enhanced alloimmune response, comprised of increased proliferation of alloreactive CD4+ T cells, as well as increased interferon-γ production by these cells. Exercise was not associated with significant changes in numbers of conventional CD4+ or CD8+ T cells, NK cells, or Foxp3+ regulatory T cells. In conclusion, our study suggests that exercise increases skin graft resistance to a similar or slightly higher level of alloimmunity and supports regular exercise as an important beneficial pursuit for transplant recipients.


Correlation of knee strength to functional outcomes in Becker muscular dystrophy.
The correlation of strength with performance on functional outcomes has not been evaluated in Becker muscular dystrophy (BMD), yet the determination of proper outcome measures is critical to the success of upcoming trials designed to improve strength. Lower extremity strength and performance on functional outcome measures were tested in 25 ambulatory subjects with BMD. All subjects demonstrated marked knee extensor and flexor muscle weakness. Knee extensor strength was correlated with performance on the Berg Balance Scale and stair climbing. Knee flexor strength was highly correlated with performance on all functional outcomes, including timed walking distances. This profile differs from that previously reported in other neuromuscular diseases and demonstrates the importance of designing outcome measures for clinical trials in muscle disorders with considerations for the disease process, the mode, and the target of intervention. The findings emphasize that 1 set of outcomes is not appropriate for all neuromuscular diseases.


Synthesis and cytotoxic effect of a few N-heteroaryl enamino amides and dihydropyrimidinethiones on AGS and MCF-7 human cancer cell lines.
Cancer prevalence has increased in the last century posing psychological, social, and economic consequences. Chemotherapy uses chemical molecules to control cancer. New studies have shown that dihydropyrimidinethione (DHPMT) derivatives have the potential of being developed into anticancer agents. New derivatives of DHPMTs and a few acyclic bioisosters were synthesized via Biginelli reaction and assessed for their toxicity against gastric (AGS) and breast cancer (MCF-7) cell lines through MTT method. Chemical structures of all synthesized N-heteroaryl enamino amides and DHPMTs were confirmed by spectroscopic methods. Result of biological assessment exhibited that none of the tested agents was more cytotoxic than cis-platin against AGS and MCF-7 cell lines and compound 2b was the most cytotoxic agent against AGS (IC50 41.10 μM) and MCF-7 (IC50 75.69 μM). Cytotoxic data were mostly correlated with the number of H-bond donors within gastric and breast cancer cells. It was realized that DHPMTs were able to inhibit the growth of cancer cells much better than acyclic enamino amides and moreover; N-(4-methylbenzothiazol-2-yl) DHPMT derivative (2b) supposed possible interaction with a poor electron site of target due to the lipophilic nature of benzothiazole ring and also less electron rich nature than isoxazole. Similar scenario was observed with acyclic enamino amides in which incorporation of sulfur and nitrogen containing heterocycles doubled the cytotoxic effects. Results of the present contribution might assist in extending the scope of DHPMTs as privileged medicinal scaffolds.


Giant petrous carotid aneurysm: persistent epistaxis despite internal carotid artery ligation.
We report a rare case of giant petrous carotid aneurysm. Case report and a review of the literature regarding treatment options for such aneurysms. A 30-year-old man presented with epistaxis, headaches and visual disturbance. Definitive diagnosis was achieved by non-invasive imaging techniques, including magnetic resonance angiography and carotid angiography. Carotid angiography demonstrated a giant petrous carotid aneurysm effacing the petrous apex. The aneurysm was obliterated by internal carotid artery ligation, following successful tolerance of the balloon occlusion test. However, despite internal carotid artery ligation, this patient continued to have minor episodes of epistaxis. Some aneurysms are too large to be treated with endovascular occlusion techniques; in such cases, ligation of the parent vessel is indicated. However, our patient continued to experience persistent, mild epistaxis despite internal carotid artery ligation, as a result of the reperfusion phenomenon.


How do swimmers control their front crawl swimming velocity? Current knowledge and gaps from hydrodynamic perspectives.
The aim of this study was to review the literature on front crawl swimming biomechanics, focusing on propulsive and resistive forces at different swimming velocities. Recent studies show that the resistive force increases in proportion to the cube of the velocity, which implies that a proficient technique to miminise the resistive (and maximise the propulsive) force is particularly important in sprinters. To increase the velocity in races, swimmers increase their stroke frequency. However, experimental and simulation studies have revealed that there is a maximum frequency beyond which swimmers cannot further increase swimming velocity due to a change in the angle of attack of the hand that reduces its propulsive force. While the results of experimental and simulation studies are consistent regarding the effect of the arm actions on propulsion, the findings of investigations into the effect of the kicking motion are conflicting. Some studies have indicated a positive effect of kicking on propulsion at high swimming velocities while the others have yielded the opposite result. Therefore, this review contributes to knowledge of how the upper-limb propulsion can be optimised and indicates a need for further investigation to understand how the kicking action can be optimised in front crawl swimming.Abbreviations: C: Energy cost [kJ/m]; Ė: Metabolic power [W, kJ/s]; Fhand: Fluid resultant force exerted by the hand [N]; Ftotal: Total resultant force [N] (See Appendix A); Fnormal: The sum of the fluid forces acting on body segments toward directions perpendicular to the segmental long axis, which is proportional to the square of the segmental velocity. [N] (See Appendix A); Ftangent: The sum of the fluid forces acting on body segments along the direction parallel to the segmental long axis, which is proportional to the square of the segmental velocity. [N] (See Appendix A); Faddmass: The sum of the inertial force acting on the body segments due to the acceleration of a mass of water [N] (See Appendix A); Fbuoyant: The sum of the buoyant forces acting on the body segments [N] (See Appendix A); D: Fluid resistive force acting on a swimmer's body (active drag) [N]; T: Thrust (propulsive) force acting in the swimming direction in reaction to the swimmer's actions [N]; Thand: Thrust force produced in reaction to the actions of the hand [N]; Tupper_limb: Thrust force produced in reaction to the actions of the upper limbs [N]; Tlower_limb: Thrust force produced in reaction to the actions of the lower limbs [N]; Mbody: Whole-body mass of the swimmer [kg]; SF: Stroke frequency (stroke number per second) [Hz]; SL: Stroke length (distance travelled per stroke) [m]; v: Instantaneous centre of mass velocity of the swimmer [m/s]; V-: Mean of the instantaneous centre of mass velocities in the swimming direction over the period of the stroke cycle [m/s]; a: Centre of mass acceleration of the swimmer [m/s2]; V-hand: Mean of the instantaneous magnitudes of hand velocity over a period of time [m/s]; Ẇtot: Total mechanical power [W]; Ẇext: External mechanical power [W]; Ẇd: Drag power (mechanical power needed to overcome drag) [W, Nm/s]; α: Angle of attack of the palm plane with respect to the velocity vector of the hand [deg]; ηo: Overall efficiency [%]; ηp: Propelling efficiency [%]; MAD-system: Measuring Active Drag system; MRT method: Measuring Residual Thrust method.


De novo autoimmune hepatitis subsequent to switching from type 2b to type 2a alpha-pegylated interferon treatment for recurrent hepatitis C after liver transplantation: report of a case.
Interferon (IFN), which is the only possible agent for recurrent hepatitis C after liver transplantation, may cause serious immune-related disorders. We report a case of de novo autoimmune hepatitis (AIH), which developed subsequent to switching from 2b pegylated interferon-α (peg-IFN) to 2a peg-IFN after living donor liver transplantation (LDLT). A 51-year-old man with hepatitis C-associated liver cirrhosis underwent LDLT. About 13 months after the initiation of antiviral therapy, in the form of type 2b peg-IFN with ribavirin, a negative serum hepatitis C virus (HCV)-RNA titer was confirmed. Thereafter, the 2b peg-IFN was switched to 2a peg-IFN, 3 months after which severe liver dysfunction developed, despite a constantly negative HCV-RNA. Liver biopsy showed portal and periportal inflammatory infiltrates including numerous plasma cells, indicating AIH. He was treated with steroid pulse treatment, followed by high-level immunosuppression maintenance, but eventually died of Pneumocystis pneumonitis 4 months after the diagnosis of de novo AIH.


Diffusion-weighted imaging for the cellularity assessment and matrix characterization of soft tissue tumour.
To evaluate whether apparent diffusion coefficient (ADC) of diffusion-weighted imaging (DWI) is able to investigate the histological features of soft tissue tumours. We reviewed MRIs of soft tissue tumours performed from 2012 to 2015 to calculate the average ADCs. We included 46 patients (27 male; mean age: 57 years, range 12-85 years) with histologically proven soft tissue tumours (10 benign, 2 intermediate 34 malignant) grouped into eight tumour type classes. An experienced pathologist assigned a semi-quantitative cellularity score (very high, high, medium and low) and tumour grading. The t test, ANOVA and linear regression were used to correlate ADC with clinicopathological data. Approximate receiver operating characteristic curves were created to predict possible uses of ADC to differentiate benign from malignant tumours. There was a significant difference (p < 0.01) in ADCs between these three groups excluding myxoid sarcomas. A significant difference was also evident between the tumour type classes (p < 0.001), grade II and III myxoid lesions (p < 0.05), tumour grading classes (p < 0.001) and cellularity scores classes (p < 0.001), with the lowest ADCs in the very high cellularity. While the linear regression analysis showed a significant relationship between ADC and tumour cellularity (r = 0.590, p ≤ 0.05) and grading (r = 0.437, p ≤ 0.05), no significant relationship was found with age, gender, tumour size and histological subtype. An optimal cut-off ADC value of 1.45 × 10-3 mm2/s with 76.8% accuracy was found to differentiate benign from malignant tumours. DWI may offer adjunctive information about soft tissue tumours, but its clinical role is still to be defined.


Single incision laparoscopic 90 % pancreatectomy for the treatment of persistent hyperinsulinemic hypoglycemia of infancy.
Single incision laparoscopic surgery as a surgical approach in treatment of pancreatic disease has recently been reported in adults. However, its application in persistent hyperinsulinemic hypoglycemia of infancy (PHHI) in children is limited. In this article, we report single incision laparoscopic 90 % pancreatectomy for the treatment of persistent hyperinsulinemic hypoglycemia of infancy. Between July 2011 and February 2015, the single incision laparoscopic 90 % pancreatectomy was performed in three children with PHHI. All patients underwent (18)F-FDOPA PET/CT before the surgeries. The scans showed diffuse physiologic (18)F-FDOPA activity in entire pancreas. All patients were followed up. The levels of blood sugar and insulin were recorded postoperatively. The time required for surgery was 120-230 min, and blood loss was minimal. The hospital stay was 6 days. The duration of postoperative abdominal drainage was 4-5 days. The levels of fasting blood glucose after surgery were higher than those before surgery (4.38-8.9 vs. 0.54-1.8 mmol/L). The levels of fasting insulin after surgery were lower than those before surgery (2.4-5.5 vs. 14-33.3 uU/ml). The duration of follow-up was 4-46 months. During follow-up, the levels of blood glucose and insulin were normal in three patients. There was no recurrence of hypoglycemia after operation in all patients. Single incision laparoscopic 90 % pancreatectomy for children with PHHI is feasible and safe in well-selected cases in the experienced centers.


Knowledge levels, attitudes, and awareness of nurses toward organ donation.
The aim of this study was to assess the knowledge, attitudes, and practices of nurses in Turkiye concerning organ donation. This survey-based, descriptive cross-sectional study was conducted from January 2020 to March 2020, recruiting 560 of 850 nurses currently working in a tertiary university hospital with a face-to-face interview technique. The questionnaire consisted of 35 questions evaluating sociodemographic features, organ donation knowledge level, attitude, and nurses' awareness. This study showed that only 6.5% of the nurses donated their organs. While 31.9% stated that they are willing to consider organ donation in the future, 41.3% were not decided about organ donation yet, and 27% rejected organ donation in any condition. Among the nurses who refused organ donation, 69.6% had no specific reason and 10.6% worried that their organs might be taken without proper diagnosis of brain death. About 10% denied organ donation for religious beliefs, and 5% were because of concerns about body integrity. Hesitation about procuring organs for commercial purposes was present in 7.2% of the nurses. Following a possible diagnosis of brain death of a relative, 33.8% of the nurses said that they would consent for organ donation to him/her, whereas 47.1% were not sure about this issue. Among the nurses, 76.6% agreed on a possible living-related organ donor for a close relative, 53.3% accepted receiving an organ from a close relative if required. Furthermore, this investigation showed that nurses who reported attending previous seminars, conferences, or training programs about organ donation have significantly better donation rates and stronger attitudes toward organ donation. Nurses who donated their organs are found to know better about brain death irreversibility, understand better the related national legal regulations for organ donation, and are more informed about the compatibility of organ donation with religious beliefs. This study showed that nurses have a relatively positive attitude toward donation and transplantation but are unwilling to bequeath their organs. This study underlines the indispensable contribution of nurses promoting organ donation and highlights the need for well-structured educational programs to enhance their role in organ donation and transplantation.


Hypoxemia associated with nimodipine in a patient with an aneurysmal subarachnoid hemorrhage.
A case of probable nimodipine-induced hypoxemia in a patient undergoing treatment for aneurysmal subarachnoid hemorrhage (SAH) is reported. A 62-year-old man hospitalized for SAH developed symptoms of respiratory distress on several occasions within days of initiation of nimodipine therapy (60 mg every four hours, with three doses withheld during intubation for intracranial surgery). Several hours after extubation (on hospital day 5), the patient had rapidly worsening tachypnea and declining arterial oxygen saturation (SPO2) despite increased oxygen delivery by mask, necessitating reintubation. When a nurse noted that the declines in SPO2 occurred soon after nimodipine administration, the patient's respiratory and hemodynamic functions were closely monitored after a single dose of nimodipine via nasogastic tube; the monitoring results supported the suspicion that nimodipine's vascular effects were a causal or contributory factor in the hypoxemia episodes. With subsequent fractionated dosing (30 mg every two hours), the patient completed the prescribed 21-day course of nimodipine therapy. Using the rating scale of Naranjo et al., this case was assigned a score of 7, indicating a probable pulmonary adverse reaction to nimodipine. As nimodipine is commonly used in cases of SAH to reduce delayed neurologic deficits due to persistent cerebral vasospasm, clinicians should be mindful of its potential hypoxemic effects in vulnerable patients. A patient with aneurysmal SAH developed hypoxemia associated with the administration of nimodipine. Hypoxemia is a known complication of treatment with other vasodilatory agents, particularly in patients who have concomitant pulmonary disease.


Effects of dyslipidaemia on monocyte production and function in cardiovascular disease.
Monocytes are heterogeneous effector cells involved in the maintenance and restoration of tissue integrity. Monocytes and macrophages are involved in cardiovascular disease progression, and are associated with the development of unstable atherosclerotic plaques. Hyperlipidaemia can accelerate cardiovascular disease progression. However, monocyte responses to hyperlipidaemia are poorly understood. In the past decade, accumulating data describe the relationship between the dynamic blood lipid environment and the heterogeneous circulating monocyte pool, which might have profound consequences for cardiovascular disease. In this Review, we explore the updated view of monocytes in cardiovascular disease and their relationship with macrophages in promoting the homeostatic and inflammatory responses related to atherosclerosis. We describe the different definitions of dyslipidaemia, highlight current theories on the ontogeny of monocyte heterogeneity, discuss how dyslipidaemia might alter monocyte production, and explore the mechanistic interface linking dyslipidaemia with monocyte effector functions, such as migration and the inflammatory response. Finally, we discuss the role of dietary and endogenous lipid species in mediating dyslipidaemic responses, and the role of these lipids in promoting the risk of cardiovascular disease through modulation of monocyte behaviour.


Disorders of calcium, phosphorus and magnesium metabolism.
Abnormalities of calcium, magnesium and phosphorus are common in hospitalized patients. Infrequently patients might present in the outpatient settings with non-specific symptoms that might be due to abnormalities of divalent cation (magnesium, calcium) or phosphorous metabolism. Several inherited disorders have been identified that result in renal or intestinal wasting of these elements. Physicians need to have a thorough understanding of the mechanism of calcium, magnesium and phosphorous metabolism and diagnoses disorders due to excess or deficiency of these elements. Prompt identification and treatment of the underlying disorders result in prevention of serious morbidity and mortality.


Incorporating Administrative Staff in Trans-Affirmative Care Training: A Cognitive-Behavioral Learning Approach.
Administrative staff play an integral role in providing trans-affirmative health care. However, few trans-affirmative education and training interventions have been developed for non-medical health care staff. In this short report, we describe the development and piloting of a trans-affirmative care training intervention designed expressly for administrative staff. Based on our piloting, we put forth recommendations for the inclusion of administrative staff in trans-affirming education and training in health care systems. We hope to stimulate further development and evaluation of our approach, as well as changes in policies, so as to create more inclusive, trans-affirming health care systems.