Reversed Robin Hood syndrome in acute ischemic stroke patients.
Recurrent hemodynamic and neurological changes with persisting arterial occlusions may be attributable to cerebral blood flow steal from ischemic to nonaffected brain. Transcranial Doppler monitoring with voluntary breath-holding and serial NIH Stroke Scale (NIHSS) scores were obtained in patients with acute middle cerebral artery or internal carotid artery occlusions. The steal phenomenon was detected as transient, spontaneous, or vasodilatory stimuli-induced velocity reductions in affected arteries at the time of velocity increase in normal vessels. The steal magnitude (%) was calculated as [(MFVm-MFVb)/MFVb]x100, where m=minimum and b=baseline mean flow velocities (MFV) during the 15- to 30-second period of a total 30 second of breath-holding. Six patients had steal phenomenon on transcranial Doppler (53 to 73 years, NIHSS 4 to 15 points). Steal magnitude ranged from -15.0% to -43.2%. All patients also had recurrent neurological worsening (>2 points increase in NIHSS scores) at stable blood pressure. In 3 of 5 patients receiving noninvasive ventilatory correction for snoring/sleep apnea, no further velocity or NIHSS score changes were noted. Our descriptive study suggests possibility to detect and quantify the cerebral steal phenomenon in real-time. If the steal is confirmed as the cause of neurological worsening, reversed Robin Hood syndrome may identify a target group for testing blood pressure augmentation and noninvasive ventilatory correction in stroke patients.


Pronator Quadratus to Extensor Carpi Radialis Brevis Nerve Transfer in C5-C7 or C5-C8 Brachial Plexus Injuries for Independent Wrist Extension.
Background Patients with lesions affecting C7 and C8 roots (in addition to C56) demonstrate loss of independent wrist dorsiflexion in addition to loss of shoulder abduction and elbow flexion. Traditionally, this deficit has been addressed using tendon transfers after useful function at the shoulder and elbow has been restored by primary nerve surgery. Confidence with nerve transfer techniques has prompted attempts to replace this method by incorporating procedures for wrist dorsiflexion in the primary operation itself. Aim The objective of this study was to report the results of pronator quadratus motor branch transfers to the extensor carpi radialis brevis motor branch to reconstruct wrist extension in C5-C8 root lesions of the brachial plexus. Patients and Methods Twenty-three patients, average age 30 years, with C5-8 root injuries underwent operations an average of 4.7 months after their accident. Extrinsic extension of the fingers and thumb was weak or absent in two cases while the remaining 18 patients could open their hand actively. The patients lacked independent wrist extension when they were examined with the fingers flexed as the compensatory action of the extrinsic finger extensors was removed. The average follow-up was 21 months postoperative with the minimal follow-up period was at least 12 months. Results Successful reinnervations of the extensor carpi radialis brevis (ECRB) were demonstrated in all patients. In 17 patients, wrist extension scored M4, and in 3 patients it scored M3. Conclusions The pronator quadratus (PQ) to ECRB nerve transfer in C5-C7 or C5-C8 brachial plexus injuries for independent wrist extension reconstruction gives consistently good results with minimal donor morbidity.


Osler revisited: an unusual cause of inversion of the diaphragm.
Osler described depression of the left hemidiaphragm and left lobe of the liver as a physical finding in some patients with pericardial effusion. Inversion of the left hemidiaphragm associated with a large pericardial effusion is an unusual, previously unreported complication. It may be a contributory factor in the production of unexplained dyspnea in some patients.


Persistent ectopic pregnancy following laparoscopic linear salpingostomy.
As the surgical approach for ectopic pregnancies evolves from radical to conservative procedures, the potential hazard of persistent ectopic pregnancy has become increasingly pertinent. From September 1, 1986 to August 31, 1989, 11 women with persistent ectopic pregnancy after laparoscopic salpingostomy were diagnosed and treated at Yale-New Haven Hospital. Persistent ectopic pregnancy was suspected in nine cases because of symptoms and in two because of plateauing beta-hCG titers. Ten of 11 patients underwent repeat surgery. Eight had partial or complete salpingectomy of the involved ipsilateral tube, two had repeat salpingostomies, and one was treated with methotrexate. When the 11 women with persistent ectopic pregnancies were compared with 70 patients treated successfully by laparoscopic salpingostomy using multivariate stepwise logistic regression, smaller size of the ectopic (P less than .01) and fewer days of amenorrhea (P less than .05) predicted persistent ectopic pregnancy after laparoscopic salpingostomy. Based upon our experience, we believe that earlier-treated ectopic pregnancies (ie, fewer than 42 days of amenorrhea) and/or smaller ectopics (ie, 2.0 cm or less in diameter) require treatment with particular caution and close postoperative surveillance.


Co-ordination chemistry of amino pendant arm derivatives of 1,4,7-triazacyclononane.
The binding properties of 1,4,7-triazacyclononane ([9]aneN3) to metal cations can be adapted through sequential functionalisation of the secondary amines with aminoethyl or aminopropyl pendant arms to generate ligands with increasing numbers of donor atoms. The new amino functionalised pendant arm derivative of 1,4,7-triazacyclononane ([9]aneN3), L1, has been synthesised and its salt [H2L1]Cl2 characterised by X-ray diffraction. The protonation constants of the ligands L1-L4 having one, two or three aminoethyl or three aminopropyl pendant arms, respectively, on the [9]aneN3 framework, and the thermodynamic stabilities of their mononuclear complexes with CuII and ZnII have been investigated by potentiometric measurements in aqueous solutions. In order to discern the protonation sites of ligands L1-L4, 1H NMR spectroscopic studies were performed in D2O as a function of pH. While the stability constants of the CuII complexes increase on going from L1 to L2 and then decrease on going from L2 to L3 and L4, those for ZnII complexes increase from L1 to L3 and then decrease for L4. The X-ray crystal structures of the complexes [Cu(L1)(Br)]Br, [Zn(L1)(NO3)]NO3, [Cu(L2)](ClO4)2, [Ni(L2)(MeCN)](BF4)2, [Zn(L4)](BF4)2.MeCN and [Mn(L4)](NO3)2.1/2H2O have been determined. In both [Cu(L1)(Br)]Br and [Zn(L1)(NO3)]NO3 the metal ion is five co-ordinate and bound by four N-donors of the macrocyclic ligand and by one of the two counter-anions. The crystal structures of [Cu(L2)](ClO4)2 and [Ni(L2)(MeCN)](BF4)2 show the metal centre in slightly distorted square-based pyramidal and octahedral geometry, respectively, with a MeCN molecule completing the co-ordination sphere around NiII in the latter. In both [Zn(L4)](BF4)2.MeCN and [Mn(L4)](NO3)2.1/2H2O the metal ion is bound by all six N-donors of the macrocyclic ligand in a distorted octahedral geometry. Interestingly, and in agreement with the solution studies and with the marked preference of CuII to assume a square-based pyramidal geometry with these types of ligands, the reaction of L4 with one equivalent of Cu(BF4)2.4H2O in MeOH at room temperature yields a square-based pyramidal five co-ordinate CuII complex [Cu(L6)](BF4)2 where one of the three propylamino pendant arms of the starting ligand has been cleaved to give L6.


Very hot tea drinking increases esophageal squamous cell carcinoma risk in a high-risk area of China: a population-based case-control study.
Previous studies on the association between green tea drinking and esophageal squamous cell carcinoma (ESCC) risk show inconsistent results. We conducted a large population-based case-control study from 2010 to 2013 in a high-risk area of China, in which 1,355 ESCC cases and 1,962 controls were recruited. Information on lifelong tea drinking was collected via face-to-face interviews using an electronic structured questionnaire. ORs with 95% CIs were estimated using unconditional logistic regression models. Most tea drinkers were males and consumed exclusively green tea. After adjustment for potential confounders, among men the OR of ever green tea drinking for ESCC risk was 1.52 (95% CI: 1.24-1.85), compared with never tea drinking. The excess risk increased monotonically with earlier age at starting, longer duration, more intensity, and accumulation of tea drinking. The OR of drinking very hot green tea for ESCC risk was 2.15 (95% CI: 1.52-3.05), compared with never drinking tea. For accumulation of tea drinking and the risk of ESCC, a non-linear relationship was observed. Before the accumulation of tea drinking reached 5 L/day*years, drinking tea showed a mild protective effect; then the ORs sharply increased to around 2.0 from 5 L/day*years to 25 L/day*years, and leveled off thereafter. The non-linear relationship was further modified by tea temperature. The joint effect of tea drinking and alcohol consumption on ESCC risk was also significant (P=0.019). Very hot tea drinking significantly increases the risk of ESCC among Chinese men, which is particularly evident among alcohol drinkers.


Prognostic significance of oestrogen receptor alpha (ERalpha) and beta (ERbeta), progesterone receptor A (PR-A) and B (PR-B) in endometrial carcinomas.
The expression of the classic steroid receptors ERalpha and PR-A has been correlated with stage, histological grade and survival in endometrial cancer. Endometrial cancer samples (293) were immunohistochemically analysed with monoclonal antibodies against the four steroid receptors. The loss of ERalpha, PR-A and PR-B resulted in a poorer survival in endometrial cancer patients, while ERbeta expression did not demonstrate any correlations with several analysed clinicopathological characteristics and did not affect survival. Additionally, multivariate survival analysis demonstrated that PR-B was a significant independent prognostic factor for cause-specific survival. In contrast, although ERalpha and PR-A showed a significant association between different endometrial histological subtypes and grading, both receptors were not independent factors with survival in endometrial carcinoma patients. Therefore, the PR-B immunostaining might be used as an easy, simple and highly efficient marker to identify high-risk patients and may aid in the selection of patients for a more aggressive adjuvant therapy.


Cellular responses to interferon-gamma.
Interferons are cytokines that play a complex and central role in the resistance of mammalian hosts to pathogens. Type I interferon (IFN-alpha and IFN-beta) is secreted by virus-infected cells. Immune, type II, or gamma-interferon (IFN-gamma) is secreted by thymus-derived (T) cells under certain conditions of activation and by natural killer (NK) cells. Although originally defined as an agent with direct antiviral activity, the properties of IFN-gamma include regulation of several aspects of the immune response, stimulation of bactericidal activity of phagocytes, stimulation of antigen presentation through class I and class II major histocompatibility complex (MHC) molecules, orchestration of leukocyte-endothelium interactions, effects on cell proliferation and apoptosis, as well as the stimulation and repression of a variety of genes whose functional significance remains obscure. The implementation of such a variety of effects by a single cytokine is achieved by complex patterns of cell-specific gene regulation: Several IFN-gamma-regulated genes are themselves components of transcription factors. The IFN-gamma response is itself regulated by interaction with responses to other cytokines including IFN-alpha/beta, TNF-alpha, and IL-4. Over 200 genes are now known to be regulated by IFN-gamma and they are listed in a World Wide Web document that accompanies this review. However, much of the cellular response to IFN-gamma can be described in terms of a set of integrated molecular programs underlying well-defined physiological systems, for example the induction of efficient antigen processing for MHC-mediated antigen presentation, which play clearly defined roles in pathogen resistance. A promising approach to the complexity of the IFN-gamma response is to extend the analysis of the less understood IFN-gamma-regulated genes in terms of molecular programs functional in pathogen resistance.


Long-term cryopreservation of dental stem cells.
Cryopreservation is a procedure of a long-term storage of cells and/or tissues at a temperature that prevents cell divisions and metabolic processes. Due to ability to self-renewal and differentiation into more specialised cells, stem cells may be helpful in repairing of other damaged organs or tissues. Cryopreservation allows the frozen genetic material to maintain its biological properties for a long time. Therefore, there is a real chance for some samples to be used in the future therapy of the pathological conditions that at present remain incurable because of the current state of knowledge. The purpose of this review is to describe the modern methods of extraction, preservation, and storage of dental stem cells at low temperatures in particular procedure of collecting and transporting tissues intended for freezing, precise characteristics of stem cells of dentary origin and methods of their isolation using Enzymatic Digestion and Spontaneous Outgrowth. In the paper are also presented technical details of the protocols of rapid rate freezing, controlled rate milling and freezing in a magnetic field (magnetic freezing) which provides precise information about procedures of thawing cells and unfavourable effect of negative temperature on the biological properties of stem cells. Dental tissues may constitute a rich source of stem cells. The inexpensive, simple and quick procedure of their extraction is minimally invasive and does not pose a threat to the donor's organism. Transferring autologous cells within the same organism does not present a potential risk of transplant rejection and thereof does not raise ethical controversies. Laboratory procedures including cell preparation, its characteristics and genetic features, basics on the process of freezing, thawing, as well as quality control essentials have been also outlined.


Species of Proteocephalus Weinland, 1858 (Cestoda: Proteocephalidae) from cyprinid fishes in North America.
A taxonomic study of Proteocephalus species parasitizing cyprinid fishes in North America, namely Proteocephalus ptychocheilus Faust, 1920 and Proteocephalus cobraeformis Haderlie, 1953, has demonstrated their conspecificity with Proteocephalus torulosus (Batsch, 1786), a common parasite of cypriniform fishes (Cyprinidae and Cobitidae) in the Palaearctic Region. Proteocephalus ptychocheilus and P. cobraeformis are considered junior synonyms of P. torulosus.


[[Research Progress in Escape Mutations of the Human Immunodeficiency Virus under Pressure of HLA-Restricted Cytotoxic T Lymphocytes].
Human immunodeficiency virus type 1 (HIV-1)-specific cytotoxic T lymphocytes (CTLs) play a critical role in the control of HIV-1 infection and replication. HIV-1 evades CTL mediated pressure through viral escape mutations within targeted CTLs epitopes or flanking regions, but this process is usually associated with a viral fitness cost. The mutated epitopes may weaken the level of the original CTL responses, however, the immune system holds potential to mount denovo responses towards those newly emerged epitopes. This article briefly summarizes recent research progress regarding the competition between HIV-1's escape mutations and host CTL responses.


Role and Significance of Markers of Inflammation in the Asthmatic Disease.
Asthma is characterized by airway inflammation which can be reversible. Investigation the importance of eosinophils, ECP and IL-5 in asthmatics versus patients with obstructive bronchitis and healthy subjects. We investigated the values before and after the treatment in asthmatics. We studied 77 subjects divided in three groups as follows: 1) asthma patients; 2) patients with obstructive bronchitis and 3) control group of healthy subjects. In all the subjects there were determined: Total number of eosinophils (Eo), eosinophilic cationic protein (ECP), Interleukin 5 (IL-5) and allergy tests. The total number of eosinophils was significantly increased in the group of asthma patients versus second and third group. We found that the presence of ECP demonstrate an ongoing inflammation, with or without clinical symptoms of asthma patients. There was significant difference between the values of ECP of asthma patients versus second and third group. Our results have shown that IL-5 was significantly increased versus second group and controls (p < 0.01). We also found the decrease of the values of inflammatory markers after the treatment with corticosteroids. Eosinophils, ECP and IL-5 could be useful markers for selecting allergic patients and could be the monitors of treatment effects.


Association of healthy child-rearing practices and children's receipt of care in patient-centered medical homes.
Efforts to improve the quality of care for children have focused on the patient-centered medical home (PCMH), defined by the National Committee for Quality Assurance (NCQA). Little research has focused on caregivers' role in choosing physicians for children. This study aims to determine whether healthy caregiving behaviors and specific behaviors are associated with children's receipt of PCMH care. Using data from the 2016-2017 National Survey of Children's Health, which includes information on child-rearing behaviors, we estimated logistic regressions, controlling for children's and caregivers' characteristics, to quantify possible associations. We found that each additional healthy child-rearing practice followed increased a child's chance of receiving PCMH care by 4.5% (p < 0.001). Being breastfed (children aged 0-5 years), sharing ideas with their caregiver (children aged 6-17 years), their caregiver ensuring homework is finished (children aged 6-17 years), and having TV time monitored (all ages), each increased the likelihood of PCMH use. These findings show that caregiving behavior is independently associated with locus of care. Future research is warranted as educating caregivers about healthy child-rearing may lead them to seek higher quality care for their children. Also, evaluating the effect of behaviors on health outcomes associated with PCMH would be valuable.


Pancolonic chromoendoscopy with indigo carmine versus standard colonoscopy for detection of neoplastic lesions: a randomised two-centre trial.
Colonoscopy is the accepted gold standard for detecting colorectal adenomas, but the miss rate, especially for small and flat lesions, remains unacceptably high. The aim of this study was to determine whether enhanced mucosal contrast using pancolonic chromoendoscopy (PCC) allows higher rates of adenoma detection. In a prospective, randomised two-centre trial, PCC (with 0.4% indigo carmine spraying during continuous extubation) was compared with standard colonoscopy (control group) in consecutive patients attending for routine colonoscopy. The histopathology of the lesions detected was confirmed by evaluating the endoscopic resection or biopsy specimens. A total of 1008 patients were included (496 in the PCC group, 512 in the control group). The patients' demographic characteristics and indications for colonoscopy were similar in the two groups. The proportion of patients with at least one adenoma was significantly higher in the PCC group (46.2%) than in the control group (36.3%; p = 0.002). Chromoendoscopy increased the overall detection rate for adenomas (0.95 vs 0.66 per patient), flat adenomas (0.56 vs 0.28 per patient) and serrated lesions (1.19 vs 0.49 per patient) (p < 0.001). There was a non-significant trend towards increased detection of advanced adenomas (103 vs 81; p = 0.067). Mean extubation times were slightly but significantly longer in the PCC group in comparison with the control group (11.6 ± 3.36 min vs 10.1 ± 2.03 min; p < 0.001). Pancolonic chromoendoscopy markedly enhances adenoma detection rates in an average-risk population and is practicable enough for routine application.


Psychiatric and Neurocognitive Evaluation Focused on Frontal Lobe Functions in Rolandic Epilepsy.
In this study, we aimed to assess the behavioral problems, psychiatric disorders and neurocognitive functions focusing on frontal lobe functions in children with rolandic epilepsy (RE) and compare them with a control group. 31 children with RE, aged between 8 and 13,5 years were compared with a control group matched for age, sex and socioeconomic status. Behavioral problems were assessed by the Child Behavior Checklist (CBCL) and psychiatric diagnoses were established by using the Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version. The Wechsler Intelligence Scale for Children-Revised (WISC-R), Wisconsin Card Sorting Test (WCST) and the Stroop Color and Word Test (SCWT) were applied in both groups of children. The RE group presented more psychiatric disorders than the control group. Verbal and total IQ scores in the RE group were lower than in the control group. Although the groups did not differ from each other in WCST scores, children with RE displayed lower performance in SCWT. The RE group had a higher externalizing score and higher total scores in CBCL. It was concluded that RE did not affect basic frontal lobe functions significantly, had negative effects on attention and IQ performance and increased behavioral problems and psychiatric disorders.


Cephalotaxine esters: antileukemic advance or therapeutic failure?
Clinical trials conducted in the People's Republic of China and the United States of the antileukemic efficacy of the cephalotaxine esters are reviewed. Harrington has been incorporated into combination regimens for the treatment of newly diagnosed acute nonlymphocytic leukemia (ANLL) in China, and activity with cephalotaxine esters has also been noted in chronic myelogenous leukemia. While the investigational agent homoharringtonine has shown some activity in the United States in ANLL, investigator interest in the United States has waned because of toxicity and inconvenient schedules. The Chinese trials have used different schedules than have U.S. studies and have been associated with less toxicity. These trials provide new information that may lead to further investigations of the cephalotaxine esters in the United States.


Hsp90 inhibitor as a sensitizer of cancer cells to different therapies (review).
Hsp90 is a molecular chaperone that maintains the structural and functional integrity of various client proteins involved in signaling and many other functions of cancer cells. The natural inhibitors, ansamycins influence the Hsp90 chaperone function by preventing its binding to client proteins and resulting in their proteasomal degradation. N- and C-terminal inhibitors of Hsp90 and their analogues are widely tested as potential anticancer agents in vitro, in vivo as well as in clinical trials. It seems that Hsp90 competitive inhibitors target different tumor types at nanomolar concentrations and might have therapeutic benefit. On the contrary, some Hsp90 inhibitors increased toxicity and resistance of cancer cells induced by heat shock response, and through the interaction of survival signals, that occured as side effects of treatments, could be very effectively limited via combination of therapies. The aim of our review was to collect the data from experimental and clinical trials where Hsp90 inhibitor was combined with other therapies in order to prevent resistance as well as to potentiate the cytotoxic and/or antiproliferative effects.


New phorbol ester derivatives as potent anti-HIV agents.
Tigliane esters show many biological activities, including anti-HIV-1 activity. Our aim in this study was to establish structure-anti-HIV activity relationships for four series of tigliane-type diterpenoids. We synthesized and evaluated 29 new phorbol ester derivatives for anti-HIV activity and for cytotoxicity against human tumor cell lines. Among them, three derivatives, two phorbol-13-monoesters (5d and 5e) and a phorbol-12,13-diester (6a), showed significant anti-HIV activity. We found that better anti-HIV activity was often associated with a shorter acyl ester at C-13. Particularly, compounds with a phenyl ring in the ester side chain exhibited excellent anti-HIV activity and had good safety indexes. Due to its significant anti-HIV potency with a high selectivity index, phorbol-12,13-dicinnamoate (6a) was chosen as the potential candidate for further preclinical trials.


Factors associated with preterm birth: from logistic regression to structural equation modeling.
This study proposed the application of structural equation modeling (SEM) to investigate variables associated with preterm birth based on a theoretical model analyzed previously by hierarchical logistic regression. The data came from a population-based case-control observational study of hospital births to mothers residing in Londrina, Paraná State, Brazil (June 2006 to March 2007). For the SEM, the study considered the association between socioeconomic characteristics and psychosocial aspects pertaining to reproductive history, work and physical activity, complications during the pregnancy, and fetal characteristics. It also considered the relationship between these associations and the outcome preterm birth mediated by adequacy of prenatal care. The weighted least square mean and variance adjusted estimator (WLSMV) was used for categorical data and robust maximum likelihood (MLR) for odds ratios. Three latent variables were created: socioeconomic vulnerability, family vulnerability, and unwanted pregnancy. The effect of socioeconomic and family vulnerability and unwanted pregnancy on prematurity occurred indirectly through inadequacy of prenatal care. The proposed methodology allowed using constructs, verifying the role of mediation by inadequacy of prenatal care, and identifying the variables' direct and indirect effects on the outcome preterm birth.


Multimicronutrient supplementation for undernourished pregnant women and the birth size of their offspring: a double-blind, randomized, placebo-controlled trial.
To evaluate the effect of multimicronutrient supplementation for undernourished pregnant women on the birth size of their offspring, incidence of low-birth-weight infants (<2500 g), and early neonatal morbidity. Randomized, double-blind, placebo-controlled trial. Tertiary care hospital. Two hundred pregnant women (of 13 465 approached) with a body mass index (calculated as weight in kilograms divided by the square of height in meters) of less than 18.5 and/or a hemoglobin level of 7 to 9 g/dL were enrolled at 24 to 32 weeks of gestation. One hundred forty-six neonates (73.0%) were available for analysis of birth size and 170 (85.0%) for analysis of morbidity in the 7 days after delivery. Intervention The micronutrient supplementation group (n = 99) received a multimicronutrient supplement containing 29 vitamins and minerals once a day, from enrollment until delivery (median duration, 58 days; interquartile range, 37-77 days; compliance, 87%). The comparison group (n = 101) received placebo for 52 (15-66) days, with 85% compliance. All subjects also received supplements of iron (given in the form of ferrous sulfate, containing 60 mg of elemental iron), 60 mg/d, and folic acid, 500 mug/d. Birth weight, length, midarm circumference, incidence of low birth weight, and early neonatal morbidity. Infants in the micronutrient group were heavier by 98 g (95% confidence interval [CI], -16 to 213 g) and measured 0.80 cm (95% CI, 0.03-1.57 cm) longer and 0.20 cm (95% CI, 0.04-0.36 cm) larger in midarm circumference compared with the placebo group. Incidence of low birth weight declined from 43.1% to 16.2% with multimicronutrient supplementation a (a 70% decrease; relative risk, 0.30; 95% CI, 0.13-0.71; P=.006), and that of early neonatal morbidity declined from 28.0% to 14.8% (a 58% decrease; relative risk, 0.42; 95% CI, 0.19-0.94; P=.04). Compared with iron and folic acid supplementation, the administration of multimicronutrients to undernourished pregnant women may reduce the incidence of low birth weight and early neonatal morbidity.


Liver transplantation for hepatocellular carcinoma.
Hepatitis B is endemic in many regions of Asia, including China, Korea and India. This results in a heavy burden of hepatocellular carcinoma (HCC) because hepatitis B virus is a major risk factor in the development of the disease. In addition, the incidence of hepatitis-C-related HCC is on the rise in the United States. HCC patients with poor liver function reserve are not suitable candidates for resection, and liver transplantation (LT) has emerged as the treatment of choice for small unresectable HCCs. To treat more HCC patients with LT, the standard patient selection criteria have been expanded at a number of centers. Careful and well-considered selection of patients is the key to success in LT for HCC. Although tumor size and tumor number are used to predict whether transplantation is likely to be successful, the weighting that should be attached these two parameters has not been determined. In addition to the size and number of lesions, the morphology of HCC is also predictive of its behavior. Well-circumscribed lesions, in general, are less aggressive than those with poorly defined borders. On the waiting list for LT, HCC patients compete with liver failure patients. It is essential that the criteria used for selecting HCC patients for LT should be easily applicable and fair to other transplant candidates. In the face of the scarcity of deceased-donor livers and the inevitable risks for living liver donors, a predictably low rate of recurrence of HCC after LT is mandatory.


Melbourne trial of adjuvant immunotherapy in operable large bowel cancer.
A controlled randomized clinical trial was undertaken to assess the ability of combined non-specific and specific immunotherapy to alter the disease-free interval and overall survival of patients with Stage B or C large bowel cancer. The immunotherapy consisted of a 2 year programme of vaccinations with BCG and neuraminidase-treated autologous tumour cells. Three hundred and one patients entered the trial. At 5 years of follow-up there is no evidence that this form of immunotherapy can alter either the disease-free interval or survival in this group of patients.


Cognitive diagnostic assessment of EFL learners' listening barriers through incorrect responses.
English as Foreign Language (EFL) learners' cognitive processes have been a research focus in listening assessment. Most studies use correct responses as data, but undervalue the rich information of the incorrect answers or options (in the case of multiple choice questions, MCQ). However, the MCQ distractors are often intentionally designed to reveal learners' problems or barriers. In order to diagnose the EFL learners' listening barriers through incorrect responses, Cognitive Diagnostic Models (CDMs) for bugs were adopted, hence the name Bug-CDMs. First, five EFL listening barrier attributes were identified and two Bug Q-matrices were developed to comparatively analyze the learner's responses with different Bug-CDMs. The results revealed that Bug-GDINA was the optimal model, and the most prevalent barriers were semantic understanding and vocabulary recognition. These barriers confirmed both compensatory and non-compensatory relationships in causing listening comprehension failures. The study proved the feasibility of Bug-GDINA in diagnosing listening barriers from the incorrect responses. Limitations and suggestions for further research were also proposed.


CYP2C19 genotype is a major factor contributing to the highly variable pharmacokinetics of voriconazole.
In vitro data on the metabolism of the antifungal voriconazole suggest that its pharmacokinetics might be influenced by the activity of CYP2C19, CYP2C9, and CYP3A. To elucidate the genetic influence of polymorphic enzymes on voriconazole metabolism, the authors pooled the pharmacokinetic data from 2 interaction studies in which 35 participants were enrolled according to their CYP2C19 genotype to receive a single 400-mg oral dose of voriconazole. Nine participants were homozygous for CYP2C19(*)1/(*)1, 8 heterozygous for (*)1/(*)17, 11 heterozygous for (*)1/(*)2, 2 heterozygous for (*)2/(*)17, 4 homozygous for (*)2/(*)2, and 1 with a double mutation CYP2C19(*)2/(*)2(*)17. Nine (heterozygous) individuals were carriers of the CYP2C9(*)2 or (*)3 variant alleles. Twenty-five participants did not express the CYP3A5 isozyme ((*)3/(*)3), whereas in 5 individuals, the (*)1/(*)3 combination was present (active enzyme). In addition, the CYP2D6 genotype and 2 variants of the drug transporter MDR1 (C3435T and G2677T) were determined. Multiple regression analysis of voriconazole apparent oral clearance revealed that 49% of its variance can be explained solely by the CYP2C19 polymorphism (P < .0001). Including the other polymorphisms into the regression model did not show any significant contribution. The number of variant CYP2C19 alleles therefore explains a substantial part of the wide variability of voriconazole pharmacokinetics, whereas the presence of functional CYP3A5 and the CYP2C9 genotype had no significant impact on voriconazole exposure. Some minor contribution results from the MDR1 C3435T genotype.


Mitochondrial Effects of Hydromethylthionine, Rivastigmine and Memantine in Tau-Transgenic Mice.
Tau protein aggregations are important contributors to the etiology of Alzheimer's disease (AD). Hydromethylthionine (HMT) is a potent inhibitor of tau aggregation in vitro and in vivo and is being developed as a possible anti-dementia medication. HMT was also shown to affect the cholinergic system and to interact with mitochondria. Here, we used tau-transgenic (L1 and L66) and wild-type NMRI mice that were treated with HMT, rivastigmine and memantine and with combinations thereof, for 2-4 weeks. We measured HMT concentrations in both brain homogenates and isolated mitochondria and concentrations of glucose, lactate and pyruvate in brain by microdialysis. In isolated brain mitochondria, we recorded oxygen consumption of mitochondrial complexes by respirometry. While rivastigmine and memantine lowered mitochondrial respiration, HMT did not affect respiration in wild-type animals and increased respiration in tau-transgenic L1 mice. Glucose and lactate levels were not affected by HMT administration. The presence of HMT in isolated mitochondria was established. In summary, traditional anti-dementia drugs impair mitochondrial function while HMT has no adverse effects on mitochondrial respiration in tau-transgenic mice. These results support the further development of HMT as an anti-dementia drug.


Musculoskeletal complaints, anxiety-depression symptoms, and neuroticism: A study of middle-aged twins.
Musculoskeletal (MS) complaints are reported commonly, but the extent to which such complaints reflect the severity of site-specific pathology or a more generalized susceptibility to feel pain/discomfort is uncertain. Both site-specific and more widespread MS conditions have been shown to be linked to anxiety and depression, but the nature of this relationship is poorly understood. In the present study the role of neuroticism as a shared risk factor that may possibly explain the co-occurrence between anxiety-depression and MS complaints was investigated. The sample consisted of 746 monozygotic and 770 dizygotic twins in the age group of 50-65 years (M = 57.11, SD = 4.5). Using Cholesky modeling, genetic and environmental influences on neuroticism, anxiety-depression and MS symptoms, and the associations among these phenotypes were determined. A single factor accounted for about 50% of the overall variance in MS symptom reporting. The best-fitting biometric model included sex-specific additive genetic and individual-specific environmental effects. All 3 phenotypes were strongly influenced by genetic factors, heritability (h2) = 0.41-0.56. Furthermore, while there was a considerable overlap in genetic risk factors among the 3 phenotypes, a substantial proportion of the genetic risk shared between MS complaints and anxiety-depression was independent of neuroticism. Evidence for a common underlying susceptibility to report MS symptoms, genetically linked to both neuroticism and anxiety-depression symptoms, was found. (PsycINFO Database Record


Unusual architecture of extensor digitorum muscle of hand in conjunction with accessory belly of extensor carpi radialis brevis: a clinico-anatomical insight.
The present article highlights an unusual combination of variations of the extensor digitorum and extensor carpi radialis brevis muscles in the dorsum of forearm and hand. The extensor carpi radialis brevis exhibited an accessory musculotendinous belly which inserted into the dorsal digital expansion of index finger. The extensor digitorum showed trifurcation into three distinct parts. Resultant multiple extensor tendon insertion pattern is reported upon highlighting the embryological basis and clinical importance. Knowledge of such anatomical variations adds upon the already existing information in literature and is also of profound interest to the clinician. Anatomical awareness of accessory multiple extensor tendons in the dorsum of hand is essential for successful management of extensor tendon injuries and graft transfer operations.


Optimization of a dual-energy contrast-enhanced technique for a photon-counting digital breast tomosynthesis system: II. An experimental validation.
Previously, the authors developed a dual-energy (DE) acquisition technique for a photon-counting digital breast tomosynthesis (DBT) imaging system. Low-energy (LE) and high-energy (HE) images are acquired in a single scan by covering alternate slits of a multislit prepatient collimator with Sn and Cu, respectively. A theoretical model was used to optimize the technique. In this article, an experimental validation of this technique is presented. Experiments were performed on a prototype DBT system. LE and HE projection images were acquired sequentially; either a Sn or a Cu filter was positioned in the filter holder at the exit window of the x-ray tube. Sn filters from 0.113 to 0.242 mm thick and Cu filters from 0.103 to 0.267 mm were used. The images were acquired with a W target at 49 kV. Tomographic images, hereafter referred to as DBT images, were reconstructed using a shift-and-add algorithm. DE-DBT images were obtained by weighted logarithmic subtraction of the LE and HE images. Weighting factors w(t) that optimally cancel breast tissues with two different glandularities were assessed for 20-80 mm thick phantoms with 0%, 50%, and 100% glandularity. The mean and standard deviation in the per-pixel signal intensity (SI) were calculated in the DBT images. These data were used to calculate signal-difference-to-noise ratios (SDNRs) between iodine enhanced and nonenhanced polymethyl methacrylate backgrounds. To illustrate the feasibility of the technique, DE-DBT images of a structured phantom containing iodine disks were assessed. The experimental results were compared against the values obtained from a theoretical model of the imaging system. The average difference between theoretical and experimental w(t) was found to range from 8% to 21%. Experimental w(t) values increase with phantom thickness and Cu thickness, depend somewhat on Sn thickness, and vary more as a function of breast composition in thick breasts than in thin breasts. Theoretical and experimental mean and standard deviation in the per-pixel SI differ by -7% to 10% and by -3% to 4%. Theoretical and experimental SDNR values differ, on average, by 1.5%. Iodine concentrations can be predicted from SDNR; the relationship can be accurately fit to a quadratic. In the images of the structured phantom, iodine concentrations of 1 mg/cm2 and larger are discernable. The strong agreement between experimental and theoretical results in this article indicates that the authors' computer model is accurate.


Cryopreservation and orthotopic transplantation of mouse ovaries: new approach in gamete banking.
Mouse half ovaries were cryopreserved and orthotopically transplanted into ovariectomized recipients genetically identical to ovary donors except for the coat color gene. Fertility was reestablished in 57% of the female recipients, which became pregnant in an average of 40 days after transplantation of frozen-thawed half ovaries. These experiments demonstrate that ovary cryopreservation can be a very useful option for banking mouse germplasm, or managing subfertile animal colonies, when embryo or sperm freezing cannot be used or is not cost effective.


Risk Factors for Cognitive Impairment in Patients with Type 2 Diabetes.
To investigate the risk factors for cognitive impairment in Chinese type 2 diabetes mellitus (T2DM) patients of advanced age and to identify effective biomarkers of mild cognitive impairment (MCI) in these patients. Chinese T2DM patients (n = 120) aged 50-70 years were divided into groups with impaired (mild, moderate, and severe) and normal cognitive function based on Montreal Cognitive Assessment and Mini-Mental State Examination scores. Data regarding demographic characteristics, clinical features of diabetes, biochemical markers, and metabolomics were collected. Age, educational level, duration of diabetes, fasting blood glucose (FBG), HbA1c, total cholesterol (TC), triglyceride (TG), and 24-hour urine protein were significantly associated with cognitive impairment in T2DM patients of advanced age. The severity of fundus retinopathy and the incidence of macrovascular disease also differed significantly among the groups (P < 0.05). Metabolomics analysis suggested that increased levels of glutamate (Glu), phenylalanine (Phe), tyrosine (Tyr), proline (Pro), and homocysteine (Hcy) and a decreased level of glutamine (Gln) were significantly associated with cognitive impairment in the T2DM patients (P < 0.05). Receiver operating characteristic curve analysis demonstrated that Glu, Gln, Phe, and Pro levels were significant predictors of cognitive impairment in the T2DM patients. Age, educational level, duration of diabetes, and the levels of FBG, HbA1c, TC, TG, and 24-hour urine protein were considered as independent risk factors for cognitive impairment in older T2DM patients. Macrovascular and microvascular diseases also were closely associated with cognitive impairment in these patients. Together, Glu and Gln levels may represent a good predictive biomarker for the early diagnosis of cognitive impairment in T2DM patients.


Inhibition of endogenous reverse transcriptase antagonizes human tumor growth.
Undifferentiated cells and embryos express high levels of endogenous non-telomerase reverse transcriptase (RT) of retroposon/retroviral origin. We previously found that RT inhibitors modulate cell growth and differentiation in several cell lines. We have now sought to establish whether high levels of RT activity are directly linked to cell transformation. To address this possibility, we have employed two different approaches to inhibit RT activity in melanoma and prostate carcinoma cell lines: pharmacological inhibition by two characterized RT inhibitors, nevirapine and efavirenz, and downregulation of expression of RT-encoding LINE-1 elements by RNA interference (RNAi). Both treatments reduced proliferation, induced morphological differentiation and reprogrammed gene expression. These features are reversible upon discontinuation of the anti-RT treatment, suggesting that RT contributes to an epigenetic level of control. Most importantly, inhibition of RT activity in vivo antagonized tumor growth in animal experiments. Moreover, pretreatment with RT inhibitors attenuated the tumorigenic phenotype of prostate carcinoma cells inoculated in nude mice. Based on these data, the endogenous RT can be regarded as an epigenetic regulator of cell differentiation and proliferation and may represent a novel target in cancer therapy.


A novel water resistor divider with a coaxial low-voltage arm.
A new style high voltage resistor divider made of saline solution has been constructed and tested. A coaxial construction is used on the low-voltage arm, as the signal extraction electrode, which can increase the attenuation ratio of the divider. The time response of divider limited by the stray parameter also can be improved. Comparing the results of calibrated experiment with the commonly used equal size copper sulfate dividers, the new probe has nearly five times increase in the attenuation ratio. The time response of the new style divider in the dimension of 30 mm in diameter and 400 mm in length can reach to 1 ns.


Taxonomic revision of the Afrotropical species of Pachyanthidium Friese (Hymenoptera: Megachilidae: Anthidiini).
The Afrotropical species of Pachyanthidium Friese are revised. Sixteen species are recognized in four subgenera. One new species, Pachyanthidium (Trichanthidium) anoplos sp. n. is described; and one species, Pachyanthidium (Trichanthidium) cucullatum (Friese), is reinstated as a valid species. Four new synonymy are proposed: Pachyanthidium minutulum Pasteels =Pachyanthidium (Trichanthidiodes) semiluteum Pasteels syn. n.; Anthidium africanum Smith = P. (P.) bicolor (Lepeletier) syn. n.; Pachyanthidium cordatum swellemdamense Mavromoustakis = Pachyanthidium (P.) cordatum (Smith) syn. n. and Anthidium cordatum var. salamense Friese 1931 = Pachyanthidium (P.) salamense (Friese 1915) syn. n. Identification keys for the Afrotropical species are given.


Realization of Red Iridium-Based Ionic Transition Metal Complex Light-Emitting Electrochemical Cells (iTMC-LECs) by Interface-Induced Color Shift.
Red ionic iridium-based transition metal complex light-emitting electrochemical cells (iTMC-LECs) with emission centered at ca. 650 nm, maximum efficiency of 0.3%, maximum brightness above 650 cd m-2, and device lifetime well above 200 and 33 h at brightness levels of 10 and 210 cd m-2, respectively, are realized by the introduction of a p-type polymer interface to the standard design of [Ir(ppy)2(pbpy)]+[PF6]- (Hppy = 2-phenylpyridine, pbpy = 6-phenyl-2,2'-bipyridine) iTMC-LEC. The unexpected color shift from yellow to red is studied in detail with respect to operation conditions and material combination. The experimental data suggest that either exciplex formation or subordinate, usually suppressed optical transitions of the iTMC might become activated by the introduced interface, causing the pronounced red shift of the peak emission wavelength.


A Case of Intraocular Lymphoma Diagnosed by Subretinal Fluid Biopsy.
Although intraocular lymphoma (IOL) mainly has have vitreous opacity and subretinal infiltration, its clinical symptoms are diverse. We report a case of IOL that mainly showed exudative retinal detachment in which analysis of IgH gene rearrangement (AIGHR) of the collected subretinal fluid sample was useful for diagnosis. A 77-year-old woman developed decreased left visual acuity for 1 month. She had been treated for dermatomyositis, diabetes mellitus, and right parotid tumor for 3 years. Visual acuity was 0.1 OD and counting fingers OS. Slit-lamp examination showed grade 4 (Emery-Little classification) nuclear cataract in both eyes and keratoprecipitates and tan vitreous opacity in the left eye. Fundoscopy details were unclear except for a vaguely observable optic nerve head due to yellow-brown vitreous opacity, which we judged as an old vitreous hemorrhage. Phacovitrectomy was performed and almost total retinal detachment was found, except for a part of the superior periphery. Since no retinal break was found and a wide range of thin membrane-like tissue was found on the surface of the retina, the surgeon suspected primary IOL and performed unplanned biopsy. The peripheral vitreous was collected as a sample, and then the subretinal fluid was collected through an intentional break to prevent mixing with other fluids. The subretinal strand was gently removed and collected. Cytology showed class III, the IL10/IL6 ratio was low, and AIGHR was positive. Postoperatively, fundus autofluorescence showed no abnormality, no leakage was observed on fluorescein and indocyanine green angiography, and the location of typical infiltration lesions under the retina was unclear. There were no positive findings on systemic examinations and a diagnosis of primary IOL was made. The main symptoms of this case were vitreous opacity and exudative retinal detachment, and AIGHR using subretinal fluid was useful for diagnosis.


Photohydration and photosolvolysis of biphenyl alkenes and alcohols via biphenyl quinone methide-type intermediates and diarylmethyl carbocations.
Evidence is presented for the photochemical generation of novel biphenyl quinone methide (BQM)-type intermediates on photolysis of hydroxybiphenyl alkenes 7 and 8 and hydroxybiphenyl alcohols 9 and 10. Mechanistic investigations utilizing product, fluorescence, and nanosecond laser flash photolysis (LFP) studies indicate two distinct pathways for the formation of these BQMs depending upon the functional groups of the progenitor. Formal excited-state intramolecular proton transfer (ESIPT) between the phenol and the alkene led to BQMs upon irradiation of the hydroxybiphenyl alkenes 7 and 8, while excited-state proton transfer (ESPT) to solvent followed by dehydroxylation was responsible for BQM formation from the hydroxybiphenyl alcohols 9 and 10. Photolysis of 7 and 8 in aqueous CH(3)CN gave photohydration products via attack of water on the respective BQMs, while photolysis of the analogous methyl ethers (of the phenolic moiety) gave only carbocation intermediates. Hydroxybiphenyl alcohols 9 and 10 yielded the corresponding photomethanolysis products in aqueous methanol, through attack of CH(3)OH on the respective BQMs. Although no evidence was found for BQM formation in LFP studies of 8 and 10, due to its suspected short lifetime, the respective diaryl carbocation (lambda(max) 420 nm, tau = 8.5 micros) has been observed upon irradiation of 8 in 2,2,2-trifluoroethanol. A BQM (lambda(max) 580 nm) was observed for 9 but not for 10, the latter having more complex chemistry on laser excitation, resulting in a transient that appears to mask any BQM absorption. Significant quenching of fluorescence from the hydroxybiphenyl alkenes at low water content implies that H(2)O is directly involved in reaction from the singlet excited state. The decrease in fluorescence intensity of 8 was found to depend on [H(2)O](3); however, the distance required for ESIPT in these systems is too large to be bridged by a water trimer. The nonlinear quenching has been attributed to deprotonation of the phenol by two water molecules, with concerted protonation at the alkene by another molecule of water. Fluorescence quenching of the hydroxybiphenyl alcohols required much higher water content, implying a different mechanism of reaction, consistent with the proposal of ESPT (to solvent water) followed by dehydroxylation.


Molecular basis of the D variant phenotypes DNU and DII allows localization of critical amino acids required for expression of Rh D epitopes epD3, 4 and 9 to the sixth external domain of the Rh D protein.
The discovery of Rh partial D variant red cells by discrepant reactions with different monoclonal anti-D has demonstrated the range of Rh D epitopes that have arisen due to alterations in Rh D protein structure. There are two current classification systems, one which uses a nine epitope model (epD1-epD9) whereas a more recent model proposes 30 different epitopes. We describe here the molecular basis of two D variants which lack epD4 and epD9 namely the DNU and D(II) phenotypes. These would have both been originally classified as D(II) phenotype individuals, but we have revealed subtle differences in the serological profile of these erythrocytes. Such a differential reactivity and determination of the molecular bases of these phenotypes allows us to predict critical amino acids for epD3, epD4 and epD9 expression. The DNU phenotype arises from a single point mutation in the RHD gene resulting in a single amino acid change (Gly353Arg). Sequence analysis of exon 7 of the RHD gene derived from the D(II) propositus indicates that there is a single point mutation in this exon resulting in a single amino acid change (Ala354Asp). It is likely that this point mutation gives rise to the D(II) phenotype. Both mutations result in the change to Rh D-specific residues. Our results indicate that the following amino acids are crucial for epD3a (Asp350), epD3b (Asp350 + Gly353), epD4a (Gly353 + Ala354), epD4b (Ala354), epD9a (Asp350 + Gly353 + Ala354) and epD9b (Asp350 + Ala354) expression. All of these amino acids reside on the predicted sixth external domain of the Rh D protein, so it is possible that epD3, 4 and 9 are continuous epitopes.


Naïve helper T cells with high CD5 expression have increased calcium signaling.
The adaptive immune response is orchestrated by T helper cells and their function is dependent upon interactions between the T cell receptor (TCR), peptide MHC (pMHC) and co-receptors. TCR-pMHC interactions initiate calcium signaling cascades which determine T cell activation, survival, proliferation and differentiation. CD5 is a co-receptor that plays an important role in regulating T cell signaling and fate during thymocyte education. CD5 surface expression on mature single positive thymocytes correlates with the TCR signal strength for positive selecting self-ligands. CD5 also plays a role in T cell function after thymic development is complete. Peripheral T cells with higher CD5 expression respond better to foreign antigen than those with lower CD5 expression and CD5-high T cells are enriched in memory populations. In our study, we examined the role of CD5 expression and calcium signaling in the primary response of T cells using two Listeria monocytogenes specific T helper cells (LLO118 and LLO56). These T cells recognize the same immunodominant epitope (LLO190-205) of L. monocytogenes and have divergent primary and secondary responses and different levels of CD5 expression. We found that each T cell has unique calcium mobilization in response to in vitro stimulation with LLO190-205 and that CD5 expression levels in these cells changed over time following stimulation. LLO56 naïve T helper cells, which expresses higher levels of CD5, have higher calcium mobilization than naïve LLO118 T cells. Three days after in vitro stimulation, LLO118 T cells had more robust calcium mobilization than LLO56 and there were no differences in calcium mobilization 8 days after in vitro stimulation. To further evaluate the role of CD5, we measured calcium signaling in CD5 knockout LLO118 and LLO56 T cells at these three time points and found that CD5 plays a significant role in promoting the calcium signaling of naïve CD5-high LLO56 T cells.


T cell receptor-gamma and -delta genes preferentially utilized by adult thymocytes for the surface expression.
To assess the diversity of gamma delta receptors expressed on adult thymocytes we characterized the gamma- and delta-genes used in a panel of T cell hybridomas expressing a TCR-gamma delta-CD3 complex on the cell surface. DNA cloning and sequencing analysis were necessary to determine the used genes because of the presence of multiple rearrangements in these hybridomas. Among eight hybridomas analyzed, five used V gamma 4, two used V gamma 7, and one used V gamma 6 for gamma-genes, and four used V delta 5, two used V delta 4, and two used V delta 7 for delta-genes. The last delta-gene is documented for the first time. V gamma and V delta appear to pair randomly only restricted by the frequency of the utilization of individual V gamma and V delta segments. These gamma- and delta-genes contained N region addition between the V and J region in most cases. Both D delta 1 and D delta 2 regions were used in the most delta-genes as was seen previously. These results show that certain gamma- and delta-gene segments that are rarely used for the expression on fetal thymocytes are preferentially used by adult thymocytes. Also the repertoire of the gamma delta receptors on adult thymocytes is much greater than that on fetal thymocytes. BW5147 specific V4-C1 gamma-gene was expressed in all of the adult hybridomas. Inasmuch as this gene was not expressed in BW5147 cells or in fetal thymocyte hybridomas expressing V5 or V6 gamma genes, there exists a novel V gene segment-dependent control of transcription in the gamma-gene system.


Symptoms of borderline personality and related pathologies behave as temporal and contemporaneous networks.
In contrast to latent variable models suggesting a common etiology, network theory proposes that symptoms of psychopathology co-occur because of direct, dynamic associations among them. We examined how symptoms associated with borderline personality disorder, depression, and anxiety mutually reinforce one another over time, forming a network. We further identified symptoms that drove the network by exerting the most influence on other symptoms. Participants were 37 undergraduate students aged 18 to 26. Following baseline assessment, participants were prompted to answer a Qualtrics-based survey of current symptoms of BPD, depression, and anxiety twice daily for 40 days. Multilevel time-series network analyses were conducted with (a) BPD symptoms alone and (b) BPD, depressive and anxiety symptoms. In the network of BPD symptoms, momentary interpersonal difficulties predicted later dissociation, which predicted later affective fluctuation at the within-person level. Dissociation exerted the strongest influence on the overall symptom network. When depressive and anxiety symptoms were included, the networks identified several cross-disorder connections, such as anhedonia and feeling tense, which highlight potential pathways that describe the comorbidity of BPD with anxiety and depressive syndromes. Overall, cognitive symptoms and dissociation were identified as the most influential symptoms across the networks. This study indicates that BPD, depression, and anxiety symptoms may mutually reinforce one another concurrently and over time. Cognitive symptoms exert the highest influence on the cross-disorder networks, such that they influence BPD, depressive, and anxiety symptoms. Our results support the need of targeting cognitions in the treatment of comorbid BPD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).


Aspiration biopsy cytology in proliferating benign mammary dysplasia.
The accuracy of the cytologic diagnosis from needle biopsy in proliferating mammary dysplasia was tested on the basis of 101 histologically proven cases of mild to severe degree. The cytomorphologic presentation in smeared aspirate is described. A reliable cytologic diagnosis of proliferating mammary dysplasia was possible in about half of the cases. This implies that the fine-needle biopsies give new possibilities for detection and intensive surveillance without surgical biopsies of women with increased risk of developing breast cancer. Study of the individual cases showed that the more severe the proliferation of the mammary epithelium, the greater the accuracy of the cytologic diagnosis. In intraductal and intracystic proliferation the accuracy was higher than in pure adenosis.


A cost-effectiveness evaluation of a jail-based chlamydia screening program for men and its impact on their partners in the community.
Few cost-effectiveness evaluations of screening men in jails for chlamydia have been published, and none have evaluated the cost-effectiveness of providing partner notification services to the partners of chlamydia-infected inmates. The goal of this study was to evaluate the cost-effectiveness of the chlamydia screening and partner notification programs for men conducted by a Massachusetts jail compared with 3 hypothetical alternatives. Using jail cost and testing data, we used decision analyses to compare the cost and effectiveness of universal screening, age-based screening with 2 age cutoffs, and testing of symptomatic inmates at intake using treated cases of chlamydia and gonorrhea as the primary outcome. We also evaluated the cost-effectiveness of adding partner notification to these alternatives. Universal screening was the most effective and expensive alternative. Age-based screening would have identified slightly fewer cases at half the cost of universal screening. The net cost of partner notification was low. Assuming high sequelae costs in female partners made partner notification a cost-saving intervention. Age-based screening could lower costs without substantially sacrificing effectiveness. Notifying partners of infected inmates was a cost-effective adjunct to screening inmates.


Antifeedant effect of Jatropha gossypifolia senescent leaf extract on Spodoptera exigua.
Spodoptera exigua is one of the economic polyphagous pests that is widespread and has been able to develop rapid resistance, thus the development of pest control strategies are required urgently. Botanical insecticides have long been touted as attractive alternatives to synthetic chemical insecticides for pest management because the former pose little threat to the environment or to human health. This research studied the antifeeding effect of Jatropha gossypifolia senescent leaf extract on second instar larvae. J. gossypifolia leaves were extracted using a Soxhlet apparatus with ethanol as the solvent. Concentration in the range from 1 to 4 mg/mL was mixed with the artificial diet and then was put on a plate with the control diet as choice and no-choice assays. A dual standard check was run along with the treatment using no solvent (control A) and ethanol (control B). The mortality and behavior of larvae were observed every day whereas the weight of larvae was observed every 3 days. Observation continued until the larvae developed into the pupal stage. In the no-choice assay, at 4 mg/mL concentration, absolute mortality (100%) was recorded 17 days post-treatment. All concentrations showed toxicity at the first day of exposure. No toxicity was recorded in the control A or B groups. In the choice assay, the results showed that 70-85% of larvae seemed to ignore consumption of the treated diets. Larvae mortality occurred after 3 days of exposure, especially for the larvae that fed on the treated diet. The weight and rate of weight increase of the larvae feeding preferentially on the treated diet were less than for the control diet. However, when larvae moved to feed on the control diet, there was an increase in the rate of weight increase. Larvae that preferred to feed on the control diet reached the adult stage faster than larvae that preferred feeding on the treated diet. In addition, the treated diet produced some abnormal larvae at metamorphosis in the pupal stage from both assays.


Analysis of the Interobserver Variability in Penile Length Assessment.
Many men seek penile augmentation treatments-a standard tool for their counseling is to inform them of what is "normal." Although some studies suggest good correlation between stretched and erect penile length, those that have measured stretched and erect length simultaneously have shown significant variability. To assess the accuracy of differing penile measurements with multiple observers. We recruited 201 adult men (mean age 49.6 years) who achieved full erection using intracavernosal injection. Penile measurements were taken by one of seven andrology specialists in a private, temperature-controlled (21°C, 72°F) environment. Stretched flaccid and erect length and circumference were measured. We analyzed the accuracy of each flaccid measurement using the erect measurements as a reference, for the overall patient population and for each observer. The mean underestimate of length from stretched flaccid to erect was 2.64 cm (21.4%) and girth 2.27 cm (19.5%). Interobserver variability ranged from a mean underestimate of 16-27% (length) and 15-27% (girth). In this large, multicenter, multi-observer study of penis size, flaccid measurements underestimated erect size. It also seems likely that there is significant interobserver variability. We believe erect penis measurements should be used for men being considered for treatment of small penis anxiety.


Dynamics of rumor propagation on small-world networks.
We study the dynamics of an epidemiclike model for the spread of a rumor on a small-world network. It has been shown that this model exhibits a transition between regimes of localization and propagation at a finite value of the network randomness. Here, by numerical means, we perform a quantitative characterization of the evolution in the two regimes. The variant of dynamic small worlds, where the quenched disorder of small-world networks is replaced by randomly changing connections between individuals, is also analyzed in detail and compared with a mean-field approximation.


Epigenetic Germline Variants Predict Cancer Prognosis and Risk and Distribute Uniquely in Topologically Associating Domains.
Cancer is a highly heterogeneous disease caused by genetic and epigenetic alterations in normal cells. A recent study uncovered methylation quantitative trait loci (meQTLs) associated with different levels of local DNA methylation in cancers. Here, we investigated whether the distribution of cancer meQTLs reflected functional organization of the genome in the form of chromatin topologically associated domains (TADs), and evaluated whether cancer meQTLs near known driver genes have the potential to influence cancer risk or progression. At TAD boundaries, we observed differences in the distribution of meQTLs when one or both of the adjacent TADs was transcriptionally active, with higher densities near inactive TADs. Furthermore, we found differences in cancer meQTL distributions in active versus inactive TADs and observed an enrichment of meQTLs in active TADs near tumor suppressors, whereas there was a depletion of such meQTLs near oncogenes. Several meQTLs were associated with cancer risk in the UKBioBank, and we were able to reproduce breast cancer risk associations in the DRIVE cohort. Survival analysis in TCGA implicated a number of meQTLs in 13 tumor types. In 10 of these, polygenic meQTL scores were associated with increased hazard in a CoxPH analysis. Risk and survival-associated meQTLs tended to affect cancer genes involved in DNA damage repair and cellular adhesion and reproduced cancer-specific associations reported in prior literature. In summary, this study provides evidence that genetic variants that influence local DNA methylation are affected by chromatin structure and can impact tumor evolution.


1.3 μm fiber grating in a thin-core fiber for LP01-LP11 mode converters and sensing ability.
We demonstrate an all-fiber structure that can realize LP01-LP11 mode conversion and twist measurement. It is a thin-core fiber (TCF) grating at a wavelength of 1310 nm cascaded to a short segment of a TCF of a different core size. It is found that the different core size of the TCF between the fiber and the grating has an impact on the excitation of a higher-order mode and mode conversion efficiency. The fiber structure exhibits a good linear response to twisting, strain, and temperature. Depending on the associated mode, the mode intensity and the wavelength for exciting the peaks of the grating have different sensitivities to twisting angle, applied strain, and temperature. These properties can be exploited for simultaneous measurement.


Electron microscope study of ribonucleic acid of myxoviruses.
Intact ribonucleic acid (RNA) molecules in an extended form were extracted from purified influenza virus and observed in the electron microscope. For this study, the RNA extraction procedure and the Kleinschmidt protein monolayer technique were modified. The mean lengths of RNA from X7, X7-F1, and WSN strains of influenza virus were found to be 2.69, 2.55, and 2.37 mum, respectively. From these measurements, the corresponding estimated molecular weights would be 2.9, 2.8, and 2.5 x 10(6) daltons. X7 and WSN RNA preparations were exposed to pH 3 to disrupt intact molecules. Histograms of length measurements showed five peaks, which were interpreted to represent the five pieces of RNA reported to exist in the influenza virion. X7 RNA appeared to be more stable than WSN RNA when stored at 4 C. The profiles of histograms of incomplete virus RNA suggest that the high molecular-weight component is missing. In preliminary experiments on Newcastle disease virus RNA, molecules of various lengths were observed.


Talking about medication.
With the increasing use of psychotropic medication concomitant with psychoanalysis, attention must be given to the challenges created by complaints of medication side effects. When confronted with these side effects, analysts may experience specific, uniquely actualized countertransference anxieties that can prompt the abandonment of transference analysis. Particular countertransference fantasies that arise in combined treatments are examined, as are the reasons for the analyst's suspension of curiosity and openness and its clinical consequences. In these situations, effective analysis requires the analyst to be "bilingual," to hold in mind both the analytic and the pharmacological model.


A study on comparative efficacy and cost effectiveness of Pregabalin and Duloxetine used in diabetic neuropathic pain.
The study was designed for comparing the efficacy and cost effectiveness of Pregabalin and Duloxetine used in Diabetic Neuropathic Pain. The prospective interventional 6 month study was conducted in a diabetic clinic of a 500 bedded tertiary care hospital in South India. The subjects having diagnosed with diabetic neuropathy and not treated with Pregabalin and Duloxetine or any other drugs of its class were selected. The data were collected using NPS and Neuro QoL questionnaires. The cost of both drugs used in the study was calculated as the mean of the price of 3 leading common brands of those drugs. The comparative efficacy was calculated by comparing the mean difference produced by both drugs in NPS and QoL scores. The cost effectiveness were calculated by ICER ratio. The results have shown a significant improvement in the mean difference of NPS and Neuro QoL scores of both Pregabalin (p=<0.001) and Duloxetine (p=<0.001) before and after the therapy, the Duloxetine dominates over Pregabalin in both. The mean cost of Pregabalin for 3 months therapy was found to be INR 668.7 and that for Duloxetine was INR 756. Duloxetine showed a better effect but more expensive. ICER ratio was calculated and found that a cost of INR 61.47 per extra QoL gained by Duloxetine. The study have revealed that, both drugs are found to be effective.On conducting cost effective analysis, a significant better improvement in QoL of patients was obtained by Duloxetine with comparatively mild increase in the price.


Neurofibromas and neurotized melanocytic nevi are immunohistochemically distinct neoplasms.
Neurofibromas are often clinically, as well as histologically, indistinguishable from completely neurotized melanocytic nevi. We tested the hypothesis that immunologic markers would differentiate the perineural fibroblasts and Schwann cells of neurofibromas from the neurotized cells of melanocytic origin. We examined eight partially neurotized acquired melanocytic nevi, three partially neurotized congenital melanocytic nevi, and five neurofibromas, with antibodies directed against S-100 protein, Leu-7(HNK-1), glial fibrillary acid protein (GFAP), and myelin-basic protein (MBP). A histologic diagnosis of neurofibroma was based on identification of a dermal proliferation of spindle-shaped cells with wavy nuclei, in a background of loose reticulated collagen. Neurotized nevi were diagnosed upon recognition of scattered nests of type A or B nevus cells, surrounded by basement membrane, present in the papillary dermis of lesions otherwise indistinguishable from neurofibromas. The congenital nevi were all large melanocytic nevi known to be present at birth. S-100 stained the majority of neoplastic cells in all neurofibromas, neurotized acquired nevi, and neurotized congenital nevi. Neurofibromas showed focal staining for Leu-7, GFAP, and MBP. In contrast, neurotized acquired and congenital nevi failed to express these markers. We believe that Leu-7, GFAP, and MBP may be helpful in differentiating neurofibromas from completely neurotized melanocytic nevi. The differences in the immunohistochemical profiles of neurofibromas and neurotized nevi support the concept that these neoplasms are histogenically distinct, despite their similar histologic appearance.


Spectral dynamics of shift current in ferroelectric semiconductor SbSI.
Photoexcitation in solids brings about transitions of electrons/holes between different electronic bands. If the solid lacks an inversion symmetry, these electronic transitions support spontaneous photocurrent due to the geometric phase of the constituting electronic bands: the Berry connection. This photocurrent, termed shift current, is expected to emerge on the timescale of primary photoexcitation process. We observe ultrafast evolution of the shift current in a prototypical ferroelectric semiconductor antimony sulfur iodide (SbSI) by detecting emitted terahertz electromagnetic waves. By sweeping the excitation photon energy across the bandgap, ultrafast electron dynamics as a source of terahertz emission abruptly changes its nature, reflecting a contribution of Berry connection on interband optical transition. The shift excitation carries a net charge flow and is followed by a swing over of the electron cloud on a subpicosecond timescale. Understanding these substantive characters of the shift current with the help of first-principles calculation will pave the way for its application to ultrafast sensors and solar cells.


Bravo! Neurology at the opera.
Opera is a complex musical form that reflects the complexity of the human condition and the human brain. This article presents an introduction to the portrayal of medical professionals in opera, including one neurologist, as well as two characters in whom neurological disease contributes to the action of the musical drama. Consideration is also given to the neuroanatomy and neuropathology of opera singers with further speculation regarding the neural underpinnings of the passion of opera's audience.


Adoptive parenting and attachment: association of the internal working models between adoptive mothers and their late-adopted children during adolescence.
Recent literature has shown that the good outcome of adoption would mostly depend on the quality of adoptive parenting, which is strongly associated with the security of parental internal working models (IWMs) of attachment. Specifically, attachment states-of-mind of adoptive mothers classified as free and autonomous and without lack of resolution of loss or trauma could represent a good protective factor for adopted children, previously maltreated and neglected. While most research on adoptive families focused on pre-school and school-aged children, the aim of this study was to assess the concordance of IWMs of attachment in adoptive dyads during adolescence. Our pilot-study involved 76 participants: 30 adoptive mothers (mean age = 51.5 ± 4.3), and their 46 late-adopted adolescents (mean age = 13.9 ± 1.6), who were all aged 4-9 years old at time of adoption (mean age = 6.3 ± 1.5). Attachment representations of adopted adolescents were assessed by the Friend and Family Interview (FFI), while adoptive mothers' state-of-mind with respect to attachment was classified by the Adult Attachment Interview (AAI). Adolescents' verbal intelligence was controlled for. Late-adopted adolescents were classified as follows: 67% secure, 26% dismissing, and 7% preoccupied in the FFI, while their adoptive mothers' AAI classifications were 70% free-autonomous, 7% dismissing, and 23% unresolved. We found a significant concordance of 70% (32 dyads) between the secure-insecure FFI and AAI classifications. Specifically adoptive mothers with high coherence of transcript and low unresolved loss tend to have late-adopted children with high secure attachment, even if the adolescents' verbal intelligence made a significant contribution to this prediction. Our results provides an empirical contribution to the literature concerning the concordance of attachment in adoptive dyads, highlighting the beneficial impact of highly coherent states-of-mind of adoptive mothers on the attachment representations of their late-adopted adolescent children.


Advancing educators and education by defining the components and evidence associated with educational scholarship.
This study aimed to establish documentation standards for medical education activities, beyond educational research, for academic promotion consistent with principles of excellence and scholarship. In 2006 a Consensus Conference on Educational Scholarship was convened by the Association of American Medical Colleges (AAMC) Group on Education Affairs (GEA) to outline a set of documentation standards for use by educators and academic promotion committees. Conference participants' work was informed by more than 15 years of literature on scholarship, educator portfolios and academic promotion standards. The 110 conference participants, including medical school deans, academic promotion committee members, department chairs, faculty and AAMC leaders, re-affirmed the 5 education activity categories (teaching, curriculum, advising and/or mentoring, education leadership and/or administration, and learner assessment), the contents of each category, and cross-category documentation standards. Educational excellence requires documentation of the quantity and quality of education activities. Documenting a scholarly approach requires demonstrating evidence of drawing from and building on the work of others, and documenting scholarship requires contributing work through public display, peer review and dissemination; both involve engagement with the community of educators. Implementation of these standards - quantity, quality and engagement with the education community - should occur in parallel with the development of an infrastructure to support educators, including sustained faculty development for educators, access to educational resources and journals, peer review mechanisms and consultation and support specific to each activity category. Educators' contributions to their institutions must be visible to be valued. The establishment of documentation standards for education activities provides the foundation for academic recognition of educators.


Activation of protein kinase C betaII/epsilon-c-Jun NH2-terminal kinase pathway and inhibition of mitogen-activated protein/extracellular signal-regulated kinase 1/2 phosphorylation in antitumor invasive activity induced by the polymethoxy flavonoid, nobiletin.
Flavonoids from medicinal plants have been therapeutically administered for cancer therapy. We recently reported that nobiletin (5,6,7,8,3',4'-hexamethoxy flavone) exhibits novel antitumor invasive activities by suppressing the production of pro-matrix metalloproteinases (proMMPs) and augmenting the expression of tissue inhibitor of metalloproteinases-1 (TIMP-1) in vivo and in vitro. In the present study, intracellular target molecules associated with the actions of nobiletin against tumor invasion were identified. Nobiletin inhibited the phosphorylation of mitogen-activated protein/extracellular signal-regulated kinase (MEK) 1/2, but not the activity of Ras or the phosphorylation of Raf. Moreover, a MEK1/2 inhibitor, U0126, mimicked nobiletin's ability to decrease the production of proMMPs-1 and 9 in human fibrosarcoma HT-1080 cells stimulated by 12-O-tetradecanoyl phorbol-13-acetate (TPA). In addition, neither the activity of phosphatidylinositol 3-kinase (PI3K) nor the phosphorylation of Akt was influenced by nobiletin. However, nobiletin was found to augment the phosphorylation of c-Jun NH2-terminal kinase (JNK), a downstream signal factor of the PI3K-Akt pathway, in TPA-treated HT-1080 cells. A similar augmentation of JNK phosphorylation was observed on treatment with a PI3K inhibitor, LY-294002. Furthermore, nobiletin enhancement of TIMP-1 production in TPA-stimulated HT-1080 cells was found to be diminished by adding a JNK inhibitor, SP600125. Moreover, protein kinase C (PKC) inhibitor experiments showed that PKCbetaII/epsilon were associated with the nobiletin-mediated augmentation of JNK phosphorylation. Therefore, these results introduce novel evidence that the antitumor effects of nobiletin are finely regulated by the following intracellular mechanisms: (1) the inhibition of MEK1/2 activity is involved in the suppression of MMP expression and (2) the activation of the novel PKCbetaII/epsilon-JNK pathway is associated with the augmentation of TIMP-1 expression.


Atomic Scale Interface Manipulation, Structural Engineering, and Their Impact on Ultrathin Carbon Films in Controlling Wear, Friction, and Corrosion.
Reducing friction, wear, and corrosion of diverse materials/devices using <2 nm thick protective carbon films remains challenging, which limits the developments of many technologies, such as magnetic data storage systems. Here, we present a novel approach based on atomic scale interface manipulation to engineer and control the friction, wear, corrosion, and structural characteristics of 0.7-1.7 nm carbon-based films on CoCrPt:oxide-based magnetic media. We demonstrate that when an atomically thin (∼0.5 nm) chromium nitride (CrNx) layer is sandwiched between the magnetic media and an ultrathin carbon overlayer (1.2 nm), it modifies the film-substrate interface, creates various types of interfacial bonding, increases the interfacial adhesion, and tunes the structure of carbon in terms of its sp(3) bonding. These contribute to its remarkable functional properties, such as stable and lowest coefficient of friction (∼0.15-0.2), highest wear resistance and better corrosion resistance despite being only ∼1.7 nm thick, surpassing those of ∼2.7 nm thick current commercial carbon overcoat (COC) and other overcoats in this work. While this approach has direct implications for advancing current magnetic storage technology with its ultralow thickness, it can also be applied to advance the protective and barrier capabilities of other ultrathin materials for associated technologies.


Behavioural problems in young children with language problems.
Analysis of behavioural problems in young children with language problems. From 38 children diagnosed with a language problem, the opinion of the parents about the behaviour of their child, scored by the Child Behaviour Checklist 1.5-5 was compared with the behavioural problems in the Dutch population with the Chi-square test. T-tests and Mc Nemar tests were used to compare the opinion of the fathers about the behavioural problems with the opinion of the mothers and to compare the scores on internalizing problems with scores on externalizing problems. Plots display the measurement of the mean behavioural problems of the parents against the discrepancy between the parents and of the total behavioural problems against the discrepancy between internalizing and externalizing problems. The relation between the behavioural problems, the language score and the non-verbal intelligence score was also compared and is presented in a bar chart. All children had an inadequate language production (GDS). Twenty-seven children had an adequate and 11 children had an inadequate Language Comprehension Quotient (LCQ). Twenty-eight children had an adequate and 10 children had an inadequate non-verbal IQ (SON-IQ). In the clinical population mothers report more internalizing behavioural problems than in Dutch peers. The fathers also experience differences, but these are not significant. There is agreement between the parents in how they experience problems on the internalizing, externalizing and total problem scale. And there are no significant differences between the internalizing and externalizing problem scales, between boys and girls, and in behavioural problems in children with both adequate LCQ and SON-IQ and with inadequate LCQ and/or SON-IQ. Compared to their peers in the Dutch population, young children with language problems show more internalizing problems according to their mothers. The fathers also experience differences, but these are not significant. Fathers and mothers agree on the behaviour analysis of their child and there are no differences between the occurrences of internalizing or externalizing problems and between boys and girls. There is also no relation between the behavioural problems and the severity of the language problem or the level of non-verbal functioning.


Characterization of Croatian Rape (Brassica sp.) Honey by Pollen Spectrum, Physicochemical Characteristics, and Multielement analysis by ICP-OES.
Rape (Brassica sp.) unifloral honey from Croatia was characterized by certain physicochemical parameters, micro- and macroelement content, and pollen spectrum, as determined in 21 honey samples. The Brassica sp. pollen type was predominant in the analyzed samples and ranged between 60 and 98%, with Trifolium spp., Robinia pseudoacacia, Rosaceae, Helianthus annuus, Salix spp., and Taraxacum officinale as the main accompanying pollen types. The electrical conductivity mean value was 0.22 ± 0.05 mS/cm and the glucose/fructose ratio mean value was 1.1 ± 0.07, whereas sucrose was absent in the samples. The most abundant macroelement was potassium (K) (268.49 mg/kg), followed by phosphorus (P) (60.23 mg/kg), calcium (Ca) (54.02 mg/kg), sodium (Na) (22.52 mg/kg), sulfur (S) (15.79 mg/kg), and magnesium (Mg) (12.58 mg/kg). Toxic elements were mainly bellow the LODs; only arsenic (As) concentration was detectable in higher amount (0.233 mg/kg), which may be related to the high arsenic concentration in the soil and groundwater of eastern Croatia. The differences between the two harvesting seasons observed in a large number of elements could be related to climatic and soil conditions and different nectar yields originating from the associated plant species.


Intraarterial occlusion by radiofrequency.
Arterial occlusion using radiofrequency energy was performed. The length of the noninsulated part of the guidewire was 10 mm and the duration of radiofrequency supply was 20 s. Animal experiments were carried out in 17 canine arteries; 4 out of 6 arteries less than 2.3 mm in diameter were completely occluded during the 20 s radiofrequency supply. A clinical application was also successfully performed without any complications. Arterial occlusion with radiofrequency can be applied to vessels less than about 2 mm in diameter.


Cardiac computed tomography and computed tomography angiography in the evaluation of patients prior to transcatheter aortic valve implantation.
Advancements in the use of multidetector computed tomography (CT) in transcatheter aortic valve implantation/transcatheter aortic valve replacement (TAVI/TAVR) over the last year reaffirm its role in the evaluation of preprocedural planning and procedural guidance. The purpose of this review is to provide an up-to-date review of recently published data, with a particular focus on annular sizing and transcatheter heart valve selection to help reduce paravalvular regurgitation. Recent data have confirmed that multidetector computed tomography (MDCT) measures of the annulus are highly reproducible across multiple readers and workstation platforms. MDCT has also been shown to have a strong discriminatory ability to predict and reduce postprocedural paravalvular regurgitation (PAR), as well as presenting the current data for integrating CT measures of the annulus into sizing. Over the last year, MDCT has solidified itself as an essential tool for the evaluation of the aortic root and annulus prior to TAVI. MDCT annular measurements are highly reproducible and now form the basis for transcatheter heart valve selection, with early data suggesting that CT integration can reduce paravalvular regurgitation.


Protein kinase CK2 inhibitor 4,5,6,7-tetrabromobenzotriazole (TBB) induces apoptosis and caspase-dependent degradation of haematopoietic lineage cell-specific protein 1 (HS1) in Jurkat cells.
Incubation of Jurkat cells with 4,5,6,7-tetrabromobenzotriazole (TBB), a specific inhibitor of protein kinase CK2, induces dose-and time-dependent apoptosis as judged by several criteria. TBB-promoted apoptosis is preceded by inhibition of Ser/Thr phosphorylation of haematopoietic lineage cell-specific protein 1 (HS1) and is accompanied by caspase-dependent fragmentation of the same protein. Both effects are also observable if apoptosis is promoted by anti-Fas antibodies and by etoposide. Moreover, in vitro experiments show that HS1, once phosphorylated by CK2, becomes refractory to cleavage by caspase-3. These findings, in conjunction with similar data in the literature concerning two other CK2 protein substrates, Bid and Max, suggest that CK2 may play a general anti-apoptotic role through the generation of phosphorylated sites conferring resistance to caspase cleavage.


[TRIAL OF LABOR AFTER CESAREAN IN TWIN GESTATIONS: DOES IT INCREASE MATERNAL OR NEONATAL COMPLICATIONS?]
To investigate the rate, success and pregnancy outcome following a trial of labor after cesarean (TOLAC) in twin gestations. Study design: A retrospective study including all twin pregnancies with a single prior cesarean delivery between the years 2006 to 2011 was performed. Women with medical indications for cesarean delivery (CD) were excluded. Maternal and neonatal outcomes were compared between women who delivered by CD to those who underwent TOLAC. Stratified analysis using a multiple logistic regression model was performed to control for confounders. During the years 2006-2011, 110 women met the inclusion criteria. Of these, 20% (n=22) underwent a TOLAC. The success rate of vaginal birth after cesarean was 77.2% (n=17). No cases of uterine rupture or dehiscence were noted. No significant difference was documented in neonatal outcome (including pH and Apgar scores) between the TOLAC and the CD group. Fertility treatment was noted as a risk factor for repeated CD (35.2 vs. 4.5%, OR=8.6, 95% CI 1.21-61.3, P=0.005). Using a multivariable analysis, with repeated CD as the outcome variable, controlling for confounders such as maternal age, and gestational age, fertility treatment was an independent risk factor for repeated CD (adjusted OR=5.2, 95% CI 0.01-0.70; P=0.02). A TOLAC in twin gestation seems to be a safe option for the mother and newborn. Fertility treatment is an independent risk factor for repeated CD in twins.


Diquat-induced oxidative stress increases intestinal permeability, impairs mitochondrial function, and triggers mitophagy in piglets.
In the present study, we investigated the influence of diquat-induced oxidative stress on intestinal barrier, mitochondrial function, and the level of mitophagy in piglets. Twelve male Duroc × Landrace × Yorkshire 35-d-old pigs (weaned at 21 d of age), with an average body of 9.6 kg, were allotted to two treatments of six piglets each including the challenged group and the control group. The challenged pigs were injected with 100 mg/kg bodyweight diquat and control pigs injected with 0.9% (w/v) NaCl solution. The results showed that diquat injection decreased ADFI and ADG. Diquat decreased (P < 0.05) the activities of superoxide dismutase and glutathione peroxidase and increased (P < 0.05) the malondialdehyde concentrations. The lower (P < 0.05) transepithelial electrical resistance and higher (P < 0.05) paracellular permeability of fluorescein isothiocyanatedextran 4 kDa were found in diquat challenged piglets. Meanwhile, diquat decreased (P < 0.05) the protein abundance of claudin-1, occluding, and zonula occludens-1 in jejunum compared with the control group. Diquat-induced mitochondrial dysfunction, as demonstrated by increased (P < 0.05) reactive oxygen species production and decreased (P < 0.05) membrane potential of intestinal mitochondria. Diquat-injected pigs revealed a decrease (P < 0.05) of mRNA abundance of genes related to mitochondrial biogenesis and functions, PPARg coactivator-1α, mammalian-silencing information regulator-1, nuclear respiratory factor-1, mt transcription factor A, mt single-strand DNA-binding protein, mt polymerase r, glucokinase, citrate synthase, ATP synthase, and cytochrome coxidase subunit I and V in the jejunum. Diquat induced an increase (P < 0.05) in expression of mitophagy-related proteins, phosphatase and tensin homologue deleted on chromosome 10-induced putative kinase, and Parkin in the intestinal mitochondria, as well as an enhancement of the ratio of light chain 3-II (LC3-II) to LC3-I content in the jejunal mucosa. These results suggest that oxidative stress disrupted the intestinal barrier, caused mitochondrial dysfunction, and triggered mitophagy.


Comparative Analysis of Topical Versus Intravenous Administration of Epsilon-Aminocaproic Acid on Blood Management in Total Knee Arthroplasty.
Although the use of antifibrinolytics to reduce perioperative blood loss during total knee arthroplasty (TKA) has shown unequivocal benefit in regard to blood conservation, the best route of administration remains in question. This study tested the hypothesis that topical delivery of epsilon-aminocaproic acid (EACA) was superior to intravenous (IV) administration in the setting of primary TKA. This cross-sectional study included a six-year retrospective chart review of TKA patients done by a single surgeon. Post-operative hemoglobin levels and the incidence of blood transfusions were compared among three patient subgroups: no EACA, topical EACA, or IV EACA. Key outcome measures included post-operative hemoglobin, need for post-operative transfusion, and length of hospital stay. Of the 668 patients included in this study, 351 (52.5%) received IV EACA, 298 (44.6%) received topical EACA, and 19 (2.8%) received no EACA. For the three-way comparisons, significant differences were observed for post-operative mean hemoglobin on day one (p < 0.001), day two (p < 0.001), and day three (p = 0.004), with consistently higher means for participants in the topical group. Eight patients required transfusions in the IV EACA group, but none were needed in the topical EACA group (p = 0.027). Length of stay was shortest for patients in the topical group, with 66% hospitalized for two days, while 84% of the IV group remained hospitalized for three days (p < 0.001). The topical delivery of EACA is superior to IV administration with respect to blood conservation for patients undergoing primary TKA.


Recurrence of thymoma and myasthenia gravis after 19 years. A case report.
Myasthenia gravis developed in a 51-year-old woman in 1956; she was found to have a thymoma. Complete remission of the myasthenia gravis occurred within 18 months of thymomectomy. In 1975, myasthenia gravis recurred in association with recurrence of the thymoma. Remission of the myasthenic state once more followed the thymomectomy. The asymptomatic period of 18 years is, to our knowledge, the longest reported interval for recurrence of a thymoma-associated myasthenia gravis; 15 years is the longest reported interval for recurrence of a thymoma.


[A Norwegian conference on updating of the treatment of Helicobacter pylori in peptic ulcer. Interessegruppe for Gastroenterologi].
Recent data on peptic ulcer and Helicobacter pylori colonization of the ventricle were discussed. Agreement was reached to re-adjust the pharmacological treatment of this condition. All patients for whom antibiotic therapy is considered should be examined by gastroscope. The bacterial agent should be proved by at least one out of several available methods. Two different established regimens are prescribed, either triple therapy with bismuth, metronidazole and tetracycline or double treatment without bismuth, for instance amoxicillin and omeprazole. Clinical control should take place after about eight weeks, with a "breath-test" in the case of duodenal ulcers, or with gastroscopy and a urease test. Many pointed out that treatment aimed at gastric acid reduction is to be preferred in cases of first occurrence of ventricular ulcers. Long-term acid reduction by drugs should not be offered to a patient until an attempt has been made to eradicate existing bacteria. No patient should be operated on before he being given antibacterial treatment. Treatment of non-ulcer dyspepsia with antibiotics has not shown to have an affect.


Cloned Bacillus subtilis alkaline protease (aprA) gene showing high level of keratinolytic activity.
The Bacillus subtilis alkaline protease(aprA) gene was previously cloned on a pUBHO-derivative plasmid. High levels of expression and gene stability were demonstrated when B. subtilis cells were grown on the laboratory medium 2XSG. B. subtilis cells harboring the multicopy aprA gene were grown on basal medium, supplemented with 1 % chicken feather as a source of energy, carbon, and nitrogen. Proteolytic and keratinolytic activities were monitored throughout the cultivation time. A high level of keratinolytic activity was obtained, and this indicates that alkaline protease is acting as a keratinase. Furthermore, considerable amounts of soluble proteins and free amino acids were obtained as a result of the enzymatic hydrolysis of feather. Biodegradation of feather waste using these cells represents an alternative way to improve the nutritional value of feather, since feather waste is currently utilized on a limited basis as a dietary protein supplement for animal feedstuffs. Moreover, the release of free amino acids from feather and the secreted keratinase enzyme would promote industries based on feather waste.