[Results of hormonal studies in 23 adolescents with renal failure treated by chronic dialysis].
The hormones regulating growth, growth hormone (hGH), IGF I, sex steroids, thyroxin (T4) and parathormone (PTH) have been measured in 23 adolescents aged from 13.5 to 20 years (14 boys, 9 girls), with chronic renal failure treated with haemodialysis. Growth velocity (GV) was (mean +/- DS) 4 +/- 2.1 cm/year in boys and 1.6 +/- 1.65 in girls, with a bone age of 12.9 +/- 2.4 cm/year. T4 and DHA sulfate (DHAS) differed according to sex (boys: T4 = 70 +/- 4.7 ng/ml; DHAS = 655 +/- 139 ng/ml; girls: T4 = 102 +/- 16.6 ng/ml; DHAS = 118 +/- 35 ng/ml). IGF I, within normal limits, was correlated to bone age and pubertal stage. T4 was negatively correlated to testosterone and SDHA in boys. GV expressed as SD according to bone age was negatively correlated to PTH.hGH deficiency was evidenced in one case, and GV increased under hHG therapy. It is concluded that measuring hormones is necessary in renal failure. Secondary hyperparathyroidism is an inhibiting growth factor. Possible hormonal deficiencies have to be treated.


Toxic effects of the antihistamine cetirizine in mussel Mytilus galloprovincialis.
Recent studies have become increasingly focused on the assessment of pharmaceuticals occurrence in aquatic ecosystems, however the potential toxicity to non-target organisms is still largely unknown. The antihistamine cetirizine is a commonly used pharmaceutical, already detected in surface waters of marine aquatic systems worldwide. In the present study Mytilus galloprovincialis mussels were exposed to a range of cetirizine concentrations (0.3, 3.0, 6.0 and 12.0 μg/L), resembling moderate to highly contaminated areas, over 28 days. The responses of different biochemical markers were evaluated in mussels whole soft tissue, and included energy-related parameters (glycogen content, GLY; protein content, PROT; electron transport system activity, ETS), and oxidative stress markers (superoxide dismutase activity, SOD; catalase activity, CAT; glutathione S-transferases activity, GSTs; lipid peroxidation levels, LPO; reduced (GSH) and oxidized (GSSG) glutathione content). The results obtained demonstrated that with the increase of exposure concentrations mussels tended to increase their energy reserves and maintain their metabolic potential, which was significantly higher only at the highest concentration. Our findings clearly revealed that cetirizine inhibited the activity of GSTs and although induced the activity of antioxidant enzymes (SOD and CAT) mussels were not able to prevent cellular damages observed through the increase of LPO associated to the increase of exposure concentrations. Thus, this study confirmed that cetirizine induces toxic effects in Mytilus galloprovincialis, which, considering their trophic relevance, wide use as bioindicator and wide spatial distribution of this species, can result in ecological and economic negative impacts at a large scale.


Early versus Delayed Strategies for Renal Replacement Therapy Initiation in Adult Patients with Severe Acute Kidney Injury Complicating Septic Shock: A Systematic Review and Meta-analysis.
Sepsis-associated acute kidney injury (AKI) is a frequent complication in hospitalized patients and is associated with significant morbidity and mortality. Renal replacement therapy (RRT) is used to manage AKI. The optimal timing of starting RRT in patients with AKI is still uncertain. This study is aimed to assess the effect of different timing strategies of RRT (early vs. standard) on mortality and dependence on dialysis in severe AKI complicating septic shock. A systematic review was conducted using the Ovid Medline database, trial registries, and manual searches of key journals from January 2000 to October 2020. Appropriate outcomes were pooled and analyzed via a meta-analysis. Only randomized controlled trials (RCTs) were included to compare between the early vs. delayed strategies of RRT. The inverse generic method was used, and the data were pooled using random effects. Five studies were included in this review, with 4329 participants. Overall, most domains were assessed as low-risk or with some concerns about the risk of bias. Compared with standard therapy, early initiation probably results in little or no difference regarding death, and may also result in no or little difference in independence on dialysis. The early strategy may result in a slight increase in adverse events. Compared with the standard strategy, earlier RRT initiation may slightly reduce the length of hospital stay. Further RCTs are needed to define the optimal timing of RRT initiation in this population.


Retrospective comparison of fludarabine in combination with intermediate-dose cytarabine versus high-dose cytarabine as consolidation therapies for acute myeloid leukemia.
This retrospective study compared efficacy and safety of fludarabine combined with intermediate-dose cytarabine (FA regimen) versus high-dose cytarabine (HiDAC regimen) as consolidation therapy in acute myeloid leukemia (AML) patients who achieved complete remission. Disease-free survival (DFS) and overall survival (OS) based on age (≥ 60, <60 years) and cytogenetics were evaluated from data between January 2005 and March 2013. Total 82 patients (FA, n = 45; HiDAC, n = 37; 14-65 years) were evaluated. Five-year DFS was 32.0% and 36.2% for FA and HiDAC groups, respectively (P = 0.729), and 5-year OS was 39.5% and 47.8% (P = 0.568), respectively. Among older patients (≥ 60 years), 3-year DFS was 26.0% for FA group and 12.5% for HiDAC group (P = 0.032), and 3-year OS was 34.6% and 12.5%, respectively (P = 0.026). In FA group, hematological toxicities were significantly lower. FA regimen was as effective as HiDAC regimen in patients with good/intermediate cytogenetics and significantly improved DFS and OS in older patients.


Using AMBER18 for Relative Free Energy Calculations.
With renewed interest in free energy methods in contemporary structure-based drug design, there is a pressing need to validate against multiple targets and force fields to assess the overall ability of these methods to accurately predict relative binding free energies. We computed relative binding free energies using graphics processing unit accelerated thermodynamic integration (GPU-TI) on a data set originally assembled by Schrödinger, Inc. Using their GPU free energy code (FEP+) and the OPLS2.1 force field combined with the REST2 enhanced sampling approach, these authors obtained an overall MUE of 0.9 kcal/mol and an overall RMSD of 1.14 kcal/mol. In our study using GPU-TI from AMBER with the AMBER14SB/GAFF1.8 force field but without enhanced sampling, we obtained an overall MUE of 1.17 kcal/mol and an overall RMSD of 1.50 kcal/mol for the 330 perturbations contained in this data set. A more detailed analysis of our results suggested that the observed differences between the two studies arise from differences in sampling protocols along with differences in the force fields employed. Future work should address the problem of establishing benchmark quality results with robust statistical error bars obtained through multiple independent runs and enhanced sampling, which is possible with the GPU-accelerated features in AMBER.


Cosinor analysis of circadian oscillations of amino acid catabolizing enzymes in temporal pattern of nutrient input.
Circadian oscillations of liver tyrosine aminotransferase (TAT) tryptophan oxygenase (TO), alanine aminotransferase (ALAT), aspartate aminotransferase (ASAT), and glutamate dehydrogenase (GLDH) in temporal pattern of protein input have been investigated. Cosinor analysis of oscillations parameters revealed the glucocorticoid induction of TO activity and protein induction of TAT activity rhythm. ALAT, ASAT, and GLDH activities showed 24 h fluctuations, but the regulation mechanisms remain unclear.


195Pt NMR of heteropolymetallic complexes containing secondary dithiooxamides as binucleating ligands.
Monometallic [Pt{S-S2C2(NR)2H}2] (S-S2C2(NR)2H = kappa2-S,S-S2C2(NR)2H = bis-dialkyl-dithioxamidate, R = methyl, isoamyl, benzyl) and binuclear and trinuclear heterobimetallic complexes [Pt{S-S2C2(NR)2H}{mu-S2C2(NR)2}MLn] (mu-S2C2(NR)2 = kappa2-S,S(Pt)-kappa2-N,N(M)-S2C2(NR)2) and [Pt{{mu-S2C2(NR)2}MLn}2] (MLn+ = [(eta3-allyl)palladium]+, [bis-(2-phenylpyridine)rhodium]+, [(eta6-p-cymene)(chloro)ruthenium]+, [(1,4-cyclooctadiene)rhodium]+, [(pentamethylcyclopentadienyl)(chloro)rhodium]+) have been prepared and characterized. The progressive substitution of the residual amidic hydrogen in the [Pt{S-S2C2(NR)2H}2] complexes with a MLn+ metal fragment results in the deshielding of platinum nuclei, a red shift of the MLCT absorption maximum, and a decrease in the oxidation potential. Such behavior has been interpreted as a progressive electron shift from platinum to the binucleating ligands, the extent of which depends on the nature of MLn+ metal fragment.


Outcome comparison of integrated psycho-oncological care versus unstructured care-Results of a non-randomised open-label two-arm trial.
To compare patients' experiences with a systematic, integrated psycho-oncological care (IC) model to experiences with "care as usual" (CAU). To improve patients' knowledge about psychosocial support options and to facilitate use, an IC model was developed by psycho-oncologists and a health insurance company and implemented in one German cancer care facility. Using a parallel, non-randomised design, these patients' experiences were compared to CAU patients. In 2015, both patient groups received questionnaires 6-12 months post-inpatient treatment. Main outcomes were awareness, use and opinion of psycho-oncological care (PC) and anxiety level (Generalized Anxiety Disorder Scale (GAD-7)). 228 patients (IC = 90; CAU = 138) participated (response rate 24%). More IC patients felt adequately informed about PC (63% vs. 46%, ORadj : 2.5 (CI: 1.3-4.8); p = 0.008). More IC patients recalled being offered various support options and had had at least one PC discussion (44% vs. 33%, ORadj of IC patient saying "yes" instead of "No, didn't want to" compared to a CAU patient: 0.4 (CI: 0.2-0.8); p = 0.01). More IC patients rated their care as good/excellent (49% vs. 38%, ORadj : 1.8 (CI: 0.7-4.1; p = 0.2)). Anxiety levels were similar (GAD-7 score>=10: IC 34% vs. CAU 28%; p = 0.4). Structured psycho-oncological care had some positive results on the outcomes, but anxiety levels did not differ.


Making the relationships visible: testing alternative display design strategies for teaching principles of hemodynamic monitoring and treatment.
A hemodynamic monitoring and control task was used to explore the utility of perceptually based displays to teach basic hemodynamic principles. The baseline display showed discrete values of key hemodynamic data elements. Alternative displays showed (a) anatomical relationships between those elements, and (b) causal constraints. Critical care nurses and student nurses used simulated "drugs" to correct simple hemodynamic disturbances using the three displays. Showing the anatomic constraints on pressure and flow improved treatment coordination by novices. Showing how etiological factors related to symptoms shortened the time required to reach a criterion level of performance and improved treatment coordination for both novices and experts.


Cardiac Multimodality Imaging in Hypertrophic Cardiomyopathy: What to Look for and When to Image.
Hypertrophic cardiomyopathy (HCM), now recognized as a common cardiomyopathy of complex genomics and pathophysiology, is defined by the presence of left ventricular hypertrophy of various morphologies and severity, significant hemodynamic consequences, and diverse phenotypic, both structural and clinical, profiles. Advancements in cardiac multimodality imaging, including echocardiography, cardiac magnetic resonance imaging, and cardiac computed tomography, with and without angiography have greatly improved the diagnosis of HCM, and enable precise measurements of cardiac mass, volume, wall thickness, function, and physiology. Multimodality imaging provides comprehensive and complementary information and hasemerged as the bedrock for the diagnosis, clinical assessment, serial monitoring, and sudden cardiac death risk stratification of patients with HCM. This review highlights the role of cardiac multimodality imaging in the modern diagnosis and management of HCM.


Self-assembly of ligands designed for the building of a new type of [2 x 2] metallic grid. anion encapsulation and diffusion NMR spectroscopy.
The ligands 4,6-bis(pyrazol-1-yl)pyrimidine (bpzpm), 4,6-bis(3,5-dimethylpyrazol-1-yl)pyrimidine (bpz(*)pm), 4,6-bis(4-methylpyrazol-1-yl)pyrimidine (Mebpzpm), and 3,6-bis(3,5-dimethylpyrazol-1-yl)pyridazine (ppdMe) were synthesized and were made to react with Cu(I) centers in the presence of different counteranions. Different [2 x 2] metallic grids were obtained. With ligands bpzpm, bpz*pm, and Mebpzpm, a new type of grid was obtained where the facing ligands were divergent and two counteranions (BF(4-) or PF(6-)) were hosted in the resulting cavities and exhibit C-H...F and anion...pi interactions in the solid state. The presence of methyl groups on the pyrazolyl rings induced several distortions in the structure. In complexes with the ligand ppdMe, there were found two groups of parallel ligands in the grid, and the cavities generated were smaller. The counteranions were situated outside the grid, and the facing ligands exhibited aromatic pi-pi stacking interactions. Anion-pi interactions involving the pyridazine ring were found. The behavior in solution of the new derivatives with a special emphasis on the cation-anion interactions was studied by UV-vis and NMR spectroscopy. Diffusion NMR experiments performed for some complexes allowed us to conclude that weak cation-anion interactions exist in solution, with the counteranions undergoing fast exchange on the diffusion time scale between the free and ion-paired states.


Effects of hip abduction and adduction accuracy on post-stroke gait.
Gait instability often limits post-stroke function, although the mechanisms underlying this instability are not entirely clear. Our recent work has suggested that one possible factor contributing to post-stroke gait instability is a reduced ability to accurately control foot placement. The purpose of the present experiments was to investigate whether post-stroke gait function is related to the ability to accurately abduct and adduct the hip, as required for accurate foot placement. 35 chronic stroke survivors and 12 age-matched controls participated in this experiment. Participants performed hip oscillation trials designed to quantify hip abduction/adduction accuracy, in which they lay supine and moved their leg through a prescribed range of motion in time with a metronome. Stroke survivors also performed overground walking trials at their self-selected speed. 28 of the 35 stroke survivors had sufficient active range of motion to perform the prescribed hip oscillation task. In comparison to controls, these 28 stroke survivors were significantly less accurate at matching the abduction target, matching the adduction target, and moving in time with the metronome. Across these stroke survivors, a multiple regression revealed that only paretic hip abduction accuracy made a unique contribution to predicting paretic step width and paretic step period, metrics of gait performance. The present results demonstrate that the ability to accurately abduct the hip is related to post-stroke gait performance, as predicted from a model-based gait stabilization strategy. Therefore, interventions designed to improve lower limb movement accuracy may hold promise for restoring post-stroke gait stability.


Predictive Clinicopathologic and Dynamic Contrast-Enhanced MRI Findings for Tumor Response to Neoadjuvant Chemotherapy in Triple-Negative Breast Cancer.
The purpose of this study is to investigate whether clinicopathologic factors and dynamic contrast-enhanced MRI (DCE-MRI) features are associated with pathologic tumor response to neoadjuvant chemotherapy (NAC) in patients with triple-negative breast cancer (TNBC). Seventy-three patients with TNBC who underwent pre-NAC MRI, completed NAC, and underwent surgery between January 2009 and December 2010 were included in the study. MRI features and clinicopathologic factors for predicting pathologic responses were analyzed, and residual tumor sizes, as measured using MRI and surgical specimens, were evaluated. Of 73 study patients, 20 (27%) had a pathologic complete response (pCR). Homogeneous enhancement on pre-NAC MRI (odds ratio from multivariate analysis, 14.66) and a concentric shrinkage pattern of tumor volume reduction on post-NAC MRI (odds ratio, 8.63) were independently associated with pCR. Residual tumor sizes, as measured using MRI and surgical specimens, showed a strong correlation (r = 0.652, p < 0.001). The correlation for residual tumor sizes was stronger for patients with pCR (r = 0.600, p < 0.001) and those with a concentric shrinkage pattern (r = 0.818, p < 0.001) than for patients with a response other than near pCR or pCR (i.e., the non-pCR group) (r = -0.128, p = 0.590) and patients with a dendritic shrinkage pattern of tumor volume reduction (r = 0.270, p = 0.182). Homogeneous enhancement of tumors on pre-NAC MRI and the presence of a concentric shrinkage pattern after NAC are associated with pCR in patients with TNBC. Residual tumor sizes on MRI and surgical specimens tended to show a stronger correlation in the pCR group or the concentric shrinkage group than in the non-pCR group or the dendritic shrinkage group.


Apomorphine--test in dystonia.
In a doubleblind, placebocontrolled design subcutaneous apomorphine was given to 7 patients with dystonic movement disorders to assess dopamine sensitivity of their symptoms. Five patients who displayed a marked clinical improvement after the apomorphine test injections subsequently responded to oral or continuous dopaminergic therapy. The effective apomorphine doses correlated with the doses of dopaminergic drugs. Two non-responders to apomorphine did not benefit from dopaminergic therapy. Apomorphine application thus seems to be a valuable test predicting dopamine sensitivity in dystonia.


Enhancing cerebral vasculature analysis with pathlength-corrected 2D angiographic parametric imaging: A feasibility study.
2D angiographic parametric imaging (API) quantitatively extracts imaging biomarkers related to contrast flow and is conventionally applied to 2D digitally subtracted angiograms (DSA's). In the interventional suite, API is typically performed using 1-2 projection views and is limited by vessel overlap, foreshortening, and depth-integration of contrast motion. This work explores the use of a pathlength-correction metric to overcome the limitations of 2D-API: the primary objective was to study the effect of converting 3D contrast flow to projected contrast flow using a simulated angiographic framework created with computational fluid dynamics (CFD) simulations, thereby removing acquisition variability. The pathlength-correction framework was applied to in-silico angiograms, generating a reference (i.e., ground-truth) volumetric contrast distribution in four patient-specific intracranial aneurysm geometries. Biplane projections of contrast flow were created from the reference volumetric contrast distributions, assuming a cone-beam geometry. A Parker-weighted reconstruction was performed to obtain a binary representation of the vessel structure in 3D. Standard ray tracing techniques were then used to track the intersection of a ray from the focal spot with each voxel of the reconstructed vessel wall to a pixel in the detector plane. The lengths of each ray through the 3D vessel lumen were then projected along each ray-path to create a pathlength-correction map, where the pixel intensity in the detector plane corresponds to the vessel width along each source-detector ray. By dividing the projection sequences with this correction map, 2D pathlength-corrected in-silico angiograms were obtained. We then performed voxel-wise (3D) API on the ground-truth contrast distribution and compared it to pixel-wise (2D) API, both with and without pathlength correction for each biplane view. The percentage difference (PD) between the resultant API biomarkers in each dataset were calculated within the aneurysm region of interest (ROI). Intensity-based API parameters, such as the area under the curve (AUC) and peak height (PH), exhibited notable changes in magnitude and spatial distribution following pathlength correction: these now accurately represent conservation of mass of injected contrast media within each arterial geometry and accurately reflect regions of stagnation and recirculation in each aneurysm ROI. Improved agreement was observed between these biomarkers in the pathlength-corrected biplane maps: the maximum PD within the aneurysm ROI is 3.3% with pathlength correction and 47.7% without pathlength correction. As expected, improved agreement with ROI-averaged ground-truth 3D counterparts was observed for all aneurysm geometries, particularly large aneurysms: the maximum PD for both AUC and PH was 5.8%. Temporal parameters (mean transit time, MTT, time-to-peak, TTP, time-to-arrival, TTA) remained unaffected after pathlength correction. This study indicates that the values of intensity-based API parameters obtained with conventional 2D-API, without pathlength correction, are highly dependent on the projection orientation, and uncorrected API should be avoided for hemodynamic analysis. The proposed metric can standardize 2D API-derived biomarkers independent of projection orientation, potentially improving the diagnostic value of all acquired 2D-DSA's. Integration of a pathlength correction map into the imaging process can allow for improved interpretation of biomarkers in 2D space, which may lead to improved diagnostic accuracy during procedures involving the cerebral vasculature.


Renal glycosuria treated as diabetes mellitus: case report.
A case of renal glycosuria is reported. A 55 year old female was diagnosed and treated in an upcountry hospital for diabetes mellitus. She developed symptoms of hypoglycaemia while on an oral hypoglycaemic agent, leading to her admission in Mulago Hospital. Persistent glycosuria was noted despite treatment and normal serum glucose. Oral glucose tolerance test and timed urine glucose showed a normal curve but high urine sugar. A diagnosis of renal glycosuria was made, oral hypoglycaemic therapy was stopped, patient improved and was discharged. Though renal glycosuria is a benign condition, mistaken diagnosis for diabetes mellitus puts patients at risk of hypoglycaemia due to treatment. Diagnosis of the condition requires physicians' awareness of its existence in our community and the use of Marbles' criteria obviates confusion with diabetes mellitus though it does not absolutely exclude Fanconi syndrome.


Effect of Asymptomatic Hyperuricemia on Mortality of Elderly Patients After Elective Percutaneous Coronary Intervention.
The purpose of this study is to investigate the effect of asymptomatic hyperuricemia on mortality of elderly patients with coronary artery disease (CAD) after elective percutaneous coronary intervention (PCI). One thousand two hundred ninety-six patients with coronary heart disease ≥65 years old who had increased uric acid records and without gout history underwent elective PCI from January 2015 to January 2016 were enrolled. The hyperuricemia is defined as serum uric acid level >420 μ mol/l (7 mg/dl) for males and >357 μ mol/l (6 mg/dl) for females. Patients were divided into hyperuricemia group and non-hyperuricemia group. After an average of 519 days follow-up, the differences in mortality between the two groups were compared. There were 236 patients in hyperuricemia group and 1060 patients in non-hyperuricemia group. In hyperuricemia group, BMI was higher (P = 0.036); the proportions of patients with hypertension (P < 0.001) and myocardial infarction history (P = 0.046) were higher; white blood cells (P = 0.015) and triglyceride levels were higher (P < 0.001); and estimated glomerular filtration rate (P < 0.001) and high-density lipoprotein cholesterol level were lower (P = 0.007). In addition, in hyperuricemia group, during hospitalization, the ratios of patients treated with diuretics (P < 0.001) and the number of PCI lesions were higher (P = 0.030), and the complete revascularization rate was lower (P = 0.017). The mortality rate (2.2 vs. 7.6%, P < 0.001) of hyperuricemia group was significantly higher than that of non-hyperuricemia group. Multivariate Cox regression analysis showed that after adjusting for other factors, hyperuricemia was an independent risk factor for increased mortality after PCI (HR 2.786, 95% CI 1.233-6.297, P = 0.014). Asymptomatic hyperuricemia is an independent risk factor for increased mortality of elderly patients with coronary heart disease undergoing elective PCI.


MONDO: a neutron tracker for particle therapy secondary emission characterisation.
Tumour control is performed in particle therapy using particles and ions, whose high irradiation precision enhances the effectiveness of the treatment, while sparing the healthy tissue surrounding the target volume. Dose range monitoring devices using photons and charged particles produced by the beam interacting with the patient's body have already been proposed, but no attempt has been made yet to exploit the detection of the abundant neutron component. Since neutrons can release a significant dose far away from the tumour region, precise measurements of their flux, production energy and angle distributions are eagerly sought in order to improve the treatment planning system (TPS) software. It will thus be possible to predict not only the normal tissue toxicity in the target region, but also the risk of late complications in the whole body. The aforementioned issues underline the importance of an experimental effort devoted to the precise characterisation of neutron production, aimed at the measurement of their abundance, emission point and production energy. The technical challenges posed by a neutron detector aimed at high detection efficiency and good backtracking precision are addressed within the MONDO (monitor for neutron dose in hadrontherapy) project, whose main goal is to develop a tracking detector that can target fast and ultrafast neutrons. A full reconstruction of two consecutive elastic scattering interactions undergone by the neutrons inside the detector material will be used to measure their energy and direction. The preliminary results of an MC simulation performed using the FLUKA software are presented here, together with the DSiPM (digital SiPM) readout implementation. New detector readout implementations specifically tailored to the MONDO tracker are also discussed, and the neutron detection efficiency attainable with the proposed neutron tracking strategy are reported.


Imaging rotations and vibrations in polyatomic molecules with X-ray scattering.
An approach for calculating elastic X-ray scattering from polyatomic molecules in specific electronic, vibrational, and rotational states is presented, and is used to consider the characterization of specific states in polyatomic molecules using elastic X-ray scattering. Instead of the standard independent atom model (IAM) method, the X-ray scattering is calculated directly from ab initio wavefunctions. The role of molecular symmetry and Friedel's law is examined, with the molecules BF3, C5H5-, NF3, and 1,3-cyclohexadiene used as specific examples. The contributions to the elastic X-ray scattering from the electronic, vibrational, and rotational portions of the molecular wavefunction are examined in CS2. In particular, it is observed that the rotational states give rise to distinct signatures in the scattering signal.


Acute kidney injury in Coronavirus disease-19 related pneumonia in the intensive care unit: a retrospective multicenter study, Saudi Arabia.
Acute kidney injury (AKI) poses a significant morbidity and mortality risk to critically ill COVID-19 patients. The aim of this study was to investigate the incidence, predictors, and outcomes of AKI in patients admitted to the intensive care unit (ICU) with critically ill COVID-19 pneumonia. A multicenter retrospective study in Saudi Arabia of adult patients aged at least 18 years diagnosed with COVID-19 pneumonia and admitted to the intensive care unit between May 2020 and May 2021 was conducted. The occurrence of AKI and associated risk factors, the need for continous renal replacement therapy (CRRT), and the outcome were reported. The study included 340 patients admitted to the ICU with COVID-19. Their mean age was 66.7±13.4 years, ranging from 49 to 84 years, and most of them were men (63.8%). The most common concomitant diseases were hypertension (71.5%), diabetes (62.4%), IHD (37.6%), CKD (20%), heart failure (19.4%), and 81.2% suffered from ARDS. AKI occurred in 60.3% of patients, 38% were stage 1, 16.6% were stage 2, and 45.4% were stage 3. Approximately, 39% of patients required CRRT, out of which 76.2% were stage 3, which was significantly higher than the other stages (p<0.001). AKI patients suffered significantly from asthma and had lower levels of C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), and blood urea nitrogen (BUN) and higher creatinine levels than patients without AKI (p<0.05 all). The overall mortality rate was 39.4%, and the mortality rate was significantly higher in patients with AKI than in patients without AKI (48.3% versus 25.9%; p<0.001). AKI is common in adults admitted to the ICU with COVID-19 and is associated with an increased risk of death. Early detection of AKI and appropriate treatment can positively impact COVID-19 outcome. CRRT is the preferred dialysis method in critically ill ICU patients with AKI.


Steroids in chronic subdural hematomas (SUCRE trial): study protocol for a randomized controlled trial.
Chronic subdural hematoma (CSDH) is a common neurological pathology, especially in older patients. The actual "gold standard" of treatment is surgical evacuation, with various techniques used across neurosurgical teams. Over the years, there has been growing evidence that inflammatory processes play a major role in the pathogenesis of CSDH. In that context, the use of corticosteroids has been proposed alone or as an adjuvant treatment to surgery. However, this practice remains very empirical and there is a need for high-quality-of-evidence studies to clarify the role of corticosteroids in the management of CSDH. We propose a double-blind, randomized controlled trial comparing methylprednisolone versus placebo in the treatment of CSDH without clinical and/or radiological signs of severity. The treatment will be administered daily for a duration of 3 weeks, at a dose of 1 mg/kg. The primary endpoint will be the delay of occurrence of surgical treatment at 1 month following the introduction of the treatment. Secondary endpoints will include the rate of recourse to surgery, survival rate, quality of life and functional assessments, occurrence of systemic secondary effects and radiological assessment of the response to treatment. This multimodal assessment will be done at 1, 3 and 6 months. Two hundred and two patients (101 per arm) are expected to be included considering our primary hypotheses. This trial started in June 2016; its results may open interesting alternatives to surgery in the management of patients harboring a CSDH, and may provide insights into the natural history of this common pathology. ClinicalTrials.gov, ID: NCT02650609 . Registered on 4 January 2016. Graphical output of the OBF boundaries.


The intracavitary electrocardiogram: a routine bedside procedure elucidating obscure arrhythmias. A study in 60 patients.
Right heart intracavitary ECG were studied in 60 patients. The procedure is performed by means of a nonmetallic saline-filled catheter introduced percutaneously. It is a simple, quick bedside method requiring minimal equipment. The intracavitary recording visualizes clear and high-voltage P waves, so that a more precise interpretation of complicated rhythm disturbances is possible. It has a distinct advantage over the esophageal lead recording in the differentiation between atrial and ventricular ectopic rhythms. The precise localization of the tip of the catheter used for central venous pressure monitoring can be determined. In 10 patients, doubtful surface ECG diagnoses were confirmed and in 10 others the original ECG interpretation was changed following intracavitary recording. In the remaining 40 patients, the method was used in order to avoid aberrant placement of the central venous pressure catheter.


Metal-Organic Coordination Networks: Prussian Blue and Its Synergy with Pt Nanoparticles to Enhance Oxygen Reduction Kinetics.
Oxygen reduction reaction (ORR) is the cornerstone in the electrochemical energy conversion devices such as fuel cells and metal-air batteries. It remains a great challenge to develop the ORR electrocatalysts with fast kinetics and high durability. Herein, we report the synthesis of a novel metal-organic coordination networks material, prussian blue crystalline nanograins mosaicked within amorphous membrane (PB CNG-M-AM). Such unique PB CNG-M-AM is designed to enhance the electrocatalysis of Pt toward the ORR by the electrostatic self-assembly. Thus, obtained Pt-PB/C catalysts form numerous Pt-PB-gas three-phase boundaries and present rather high intrinsic activity, four-electron selectivity and superior stability. Moreover, a completely new synergetic mechanism between PB and Pt is discovered, which delicately alters the ORR route and significantly enhances the ORR kinetics. This work provides not only a new strategy and mechanism for developing highly efficient ORR electrocatalysts, but also an alternative way to utilize metal-organic coordination networks materials.


NTP-CERHR monograph on the potential human reproductive and developmental effects of methylphenidate.
The National Toxicology Program (NTP) Center for the Evaluation of Risks to Human Reproduction (CERHR) conducted an evaluation of the potential for methylphenidate to cause adverse effects on reproduction and development in humans. Methylphenidate was selected for evaluation because of 1) widespread usage in children, 2) availability of developmental studies in children and experimental animals, and 3) public concern about the effect of this stimulant on child development. Methylphenidate is a central nervous system stimulant approved by the U.S. Food and Drug Administration for the treatment of attention deficit hyperactivity disorder (ADHD) in persons 6 years of age and older and for narcolepsy. The results of this evaluation on methylphenidate are published in an NTP-CERHR monograph which includes: 1) the NTP Brief, 2) the Expert Panel Report on the Reproductive and Developmental Toxicity of Methylphenidate, and 3) public comments received on the Expert Panel Report. As stated in the NTP Brief, the NTP reached the following conclusions regarding the possible effects of exposure to methylphenidate on human development and reproduction. First, there is negligible concern for methylphenidate-induced tics and movement disorders. This conclusion is based on studies showing that children treated with therapeutic doses of methylphenidate have no evidence of movement disorders or tics due to the medication. Second, there is minimal concern for methylphenidate-induced growth restriction. This conclusion is based on growth restriction being observed in animal studies only at high doses of methylphenidate using a non-therapeutic route of exposure. The effect on growth was reversible. Finally, there are insufficient data to draw conclusions on 1) an association between methylphenidate therapy in pregnant women and pregnancy loss and 2) possible reproductive effects of methylphenidate in humans. NTP-CERHR monographs are transmitted to federal and state agencies, interested parties, and the public and are available in electronic PDF format on the CERHR web site http://cerhr.niehs.nih.gov/ and in printed text or CD-ROM from the CERHR.


Detection of CTX-M-14 and TEM-52 extended-spectrum beta-lactamases in fecal Escherichia coli isolates of captive ostrich in Portugal.
The main aim of this study was to determine the frequency of antibiotic resistance among Escherichia coli isolates recovered in Levine agar plates from 54 fecal samples of captive ostriches from a farm in the South of Portugal. Fifty-four nonselected E. coli isolates were obtained (one/sample) and the phenotypes and genotypes of antibiotic resistance were characterized. The following numbers of isolates showed antibiotic resistance: ampicillin (nine), tetracycline (seven), streptomycin (three), amoxicillin-clavulanic acid, cefoxitin, or gentamicin (one), and cefotaxime, ceftazidime, azthreonam, imipenem, nalidixic acid, ciprofloxacin, and trimethoprim/sulfamethoxazole (zero). The bla(TEM) gene was identified in six out of nine ampicillin-resistant isolates, and the tet(A) or tet(B) genes in five out of seven tetracycline-resistant isolates. Mutations at positions -42, -18, -1, and +58 of ampC promoter region were identified in one cefoxitin-resistant isolate. Further, the occurrence of extended-spectrum beta-lactamase (ESBL)-producing E. coli isolates was estimated in the 54 fecal samples of ostriches using cefotaxime-supplemented Levine agar plates for ESBL-positive E. coli recovery. Three samples contained ESBL-positive E. coli isolates of which one isolate/sample was characterized, leading to the detection of the following beta-lactamases: bla(CTX-M-14a) + bla(TEM-1b) (two isolates) and bla(TEM-52c) (one isolate). The three ESBL-positive isolates were classified into the phylogroup B1, and contained class 1 integrons with the gene cassettes dfrA17 + aadA5 (one isolate) and aadA1 (two isolates). This study adds to our knowledge about the wide dissemination of ESBL-producing E. coli isolates in different ecosystems, including captive ostriches, that could be transferred to humans through the food chain.


Influencing adherence among hypertensives.
In the treatment of hypertension, problems of nonadherence and consequent poor blood pressure control are particularly severe. Alternative intervention strategies were compared to explore means of improving adherence and lowering blood pressures. In a 3 x 4 repeated measures analysis of variance design, 115 patients were randomly selected and randomly assigned to one of three treatment modalities (routine clinic care, patient education, and contingency contracting) and were followed over four clinic visits. Subjects' knowledge about hypertension and its management, adherence to requests for regular medical follow-up, and blood pressure levels were measured. Patient education was not effective in lowering blood pressures; it produced an untoward outcome, a dropout rate higher than that for patients receiving only routine clinic care. However, contingency contracting was an effective intervention strategy for improving patient knowledge, F (1,59) = 51.32, p less than .0001; adherence to requests for regular medical care, Max L (2) = 25.9, p less than .0001; and decreasing diastolic blood pressures, F (2,49) = 3.39, p less than .05.


Current perspective on uniportal and multiportal video-assisted thoracic surgery during lobectomy for lung cancer.
Non-small cell lung cancer (NSCLC) is the most typical type of lung cancer, and it is the leading cancer-related mortality globally. Lobectomy for early-stage NSCLC has been characterized in the previous decade using a wide range of methodologies. The development of video-assisted thoracoscopic surgery (VATS) allowed surgeons first to reduce the thoracotomy size, which is generally anterior, limiting it to trocar incisions or a single portal approach. This review aimed to describe current perspectives on operative outcomes, lymph node removal, oncologic outcomes, and advantages for surgeons performing uniportal VATS (uVATS) and multiportal (mVATS) lobectomy. The advantages of uVATS include comfortable operating for surgeons with a direct view and safety, and for patients more favourable operative outcomes. Also, the uVATS approach has previously been demonstrated to be effective and safe, with positive outcomes not just with respect to cosmetics but also in terms of a speedy recovery. Oncological uVATS clearance is comparable to multiportal VATS with respect to early mid-term survivability as well as nodal staging, as per retrospective comparison studies. However, the interpretation of outcomes must be made cautiously due to selection bias as well as lack of long-term follow-up; the choice of which VATS approach to utilize for patients' treatment following pulmonary resection is largely based on the preferences of the surgeon. As a result, it is difficult to say if one VATS method is better than another.


The special prenatal clinic: one approach to women and substance abuse.
We aimed to determine if the trend in substance use in this central core of a large inner-city area confirmed an increase in marijuana use among young women < 22 years of age as childbearing years were beginning or if marijuana use and harder drug use were greatest among women beyond the teens and the early second decade of life and to describe one prenatal care intervention. Statistical reports for the Special Prenatal Clinic, a Harlem clinic for women with a current or past history of substance use, were reviewed from 1985 (the clinic's inception) through March 1996 to determine the trends, patterns, and types of drug use. Findings chronicled the beginning and rise in crack cocaine use, especially after 1986, confirmed an increase in marijuana use by adolescents since 1992, and suggest that the risk for use of hard drugs increases with age, predominantly in the childbearing years. Intervention by the Special Prenatal Clinic aided case-finding, allowed for comprehensive care, offered women opportunities for behavior change, and increased their chances of keeping their babies after delivery.


Effects of selenomethionine on acute toxicities from concurrent chemoradiation for inoperable stage III non-small cell lung cancer.
To prospectively determine the safety and tolerability of oral L-selenomethionine (SLM) with concurrent chemoradiation (CCRT) for Stage III non-small cell lung cancer (NSCLC) and estimate if the incidence and/or severity of adverse events could be reduced by its use. Sixteen patients with stage III NSCLC were accrued to this single arm, phase II study. CCRT consisted of radiation given at 2 Gy per fraction for 30-33 fractions, 5 d per week with concurrent weekly IV paclitaxel 50 mg/m(2) followed by carboplatin dosed at an area under the time-concentration curve of 2. SLM was dosed in a loading phase at 4800 μg twice daily for one week prior to CCRT followed by once daily dosing during treatment. No selenium-related toxicity was observed. Analysis revealed grade 3 or higher esophagitis in 3 of 16 patients (19%), pneumonitis in 0, leukopenia in 2 (12.5%), and anemia in 1 (6%); the latter two were significantly reduced when compared to the protocol-stated expected rate of 35% (P = 0.045 for leukopenia, and P < 0.01 for anemia). Median overall survival was 14.9 mo and median failure-free survival was 9 mo (95%CI: 3.3-21.5). There may be some protective benefit of selenium in the setting of CCRT for inoperable NSCLC. The data suggests decreased rates of myelosuppression when compared to similarly-treated historical and contemporary controls. Further evaluation of selenium in this setting may be warranted.


Characterization of fHbp, nhba (gna2132), nadA, porA, and sequence type in group B meningococcal case isolates collected in England and Wales during January 2008 and potential coverage of an investigational group B meningococcal vaccine.
Invasive disease caused by meningococcal capsular groups A, C, W-135, and Y is now preventable by means of glycoconjugate vaccines that target their respective polysaccharide capsules. The capsule of group B meningococci (MenB) is poorly immunogenic and may induce autoimmunity. Vaccines based on the major immunodominant surface porin, PorA, are effective against clonal epidemics but, thus far, have a limited scope of coverage against the wider MenB population at large. In an alternative approach, the first-generation, investigational, recombinant MenB (rMenB) plus outer membrane vesicle (OMV) (rMenB-OMV) vaccine contains a number of relatively conserved surface proteins, fHBP, NHBA (previously GNA2132), and NadA, alongside PorA P1.4-containing OMVs from the New Zealand MeNZB vaccine. MenB currently accounts for approximately 90% of cases of meningococcal disease in England and Wales. To assess potential rMenB-OMV vaccine coverage of pathogenic MenB isolates within this region, all English and Welsh MenB case isolates from January 2008 (n = 87) were genetically characterized with respect to fHBP, NHBA, NadA, and PorA. Alleles for fHbp, nhba, and porA were identified in all of the isolates, of which 22% were also found to harbor nadA alleles. On the basis of genotypic data and predicted immunological cross-reactivity, the potential level of rMenB-OMV vaccine coverage in England and Wales ranges from 66% to 100%.


Synchronization engineering: tuning the phase relationship between dissimilar oscillators using nonlinear feedback.
A mild, nonlinear, time-delayed feedback signal was applied to two heterogeneous oscillators in order to synchronize their frequencies with an arbitrary and controllable phase difference. The feedback was designed using phase models constructed from experimental measurements of the intrinsic dynamical properties of the oscillators. The feedback signal produced an interaction function that corresponds to the desired collective behaviour. The synchronized phase difference between the elements can be tuned to any value on the interval 0 and 2pi by shifting the phase of the interaction function using the feedback delay. Numerical simulations were conducted and experiments carried out with electrochemical oscillators.


Practical study on the application of full-cycle fast track surgical nursing model in patients with replantation of severed fingers: A retrospective analysis.
To explore the effect of full-cycle fast track surgical (FTS) nursing in patients with replantation of severed fingers, and observe its effect on functional recovery of replanted fingers and quality of life of patients. From January 2021 to December 2022, 86 patients with replantation of severed fingers were selected from Rizhao People's Hospital, 41 patients were given routine perioperative care, 45 patients were given full-cycle rapid rehabilitation surgical care. Compare the relevant indexes of the 2 groups of patients during hospitalization. Three months after discharge, the finger function recovery of the 2 groups were compared, and the quality of life of the patients was scored with the QL-Index scale, and the satisfaction was evaluated at the same time. The first time of getting out of bed and the time of hospitalization in the full-cycle FTS nursing group were significantly shorter than those in the conventional nursing group, and the incidence of postoperative nausea, vomiting, constipation and venous thromboembolism were significantly lower than those in the conventional nursing group. The anxiety score was significantly lower than that in the conventional nursing group, the difference was statistically significant (P < .05). There was no significant difference in the incidence of arteriovenous crisis between the 2 groups (P > .05). Three months after discharge, the scores of finger sensation and movement, quality of life and satisfaction of patients in the FTS nursing group were higher than those in the conventional nursing group, and the difference was statistically significant (P < .05). Full-cycle fast track surgical nursing model can improve the in-patient experience, reduce the incidence of complications, promote rapid rehabilitation, improve the quality of life of patients, and improve satisfaction.


Evaluation of a standardized patient education program for inpatient cardiac rehabilitation: impact on illness knowledge and self-management behaviors up to 1 year.
Patient education is an essential part of the treatment of coronary heart disease in cardiac rehabilitation. In Germany, no standardized and evaluated patient education programs for coronary heart disease have been available so far. In this article, we report the evaluation of a patient-oriented program. A multicenter quasi-experimental, sequential cohort design study of patients with coronary heart disease (n = 434) in inpatient cardiac rehabilitation was conducted. Intervention patients received the new patient-oriented program, control patients a traditional lecture-based program (usual care). Primary outcome illness knowledge and secondary behavioral and health outcomes were assessed at admission, discharge and 6- and 12-months follow-up. We found a significant, small between-group intervention effect in both patients' medical illness and treatment knowledge and behavior change knowledge at discharge (medical: η(2) = 0.013; behavior change: η(2) = 0.011) and after 12 months (medical: η(2) = 0.015). Furthermore, a significant, small effect was observed for physical activity after 12 months (η(2) = 0.011), but no effects on healthy diet and medication adherence emerged. Superiority of the patient-oriented educational program for patients with coronary heart disease was partially confirmed. The program produced improved illness knowledge and physical activity compared with usual care after 1 year.


The relativistic complete active-space second-order perturbation theory with the four-component Dirac Hamiltonian.
The relativistic complete active-space second-order perturbation theory (CASPT2) is developed for the four-component relativistic Hamiltonian. The present method can describe the near-degenerated and dissociated electronic states of molecules involving atoms of heavy elements. The present approach is less expensive than the relativistic multireference configuration interaction method. The ground and low-lying excited states of TlH, Tl(2), and PtH molecules are calculated with the Dirac-Coulomb (DC) CASPT2 method and their spectroscopic constants are obtained. These spectroscopic constants are compared with experimental findings and previous theoretical work. For all the molecules, the spectroscopic constants of DC-CASPT2 show good agreement with the experimental or previous theoretical spectroscopic constants. The present theory provides accurate descriptions of bonding or dissociation states and of ground and excited states in a well-balanced way.


Myocardial aging as a T-cell-mediated phenomenon.
In recent years, the myocardium has been rediscovered under the lenses of immunology, and lymphocytes have been implicated in the pathogenesis of cardiomyopathies with different etiologies. Aging is an important risk factor for heart diseases, and it also has impact on the immune system. Thus, we sought to determine whether immunological activity would influence myocardial structure and function in elderly mice. Morphological, functional, and molecular analyses revealed that the age-related myocardial impairment occurs in parallel with shifts in the composition of tissue-resident leukocytes and with an accumulation of activated CD4+ Foxp3- (forkhead box P3) IFN-γ+ T cells in the heart-draining lymph nodes. A comprehensive characterization of different aged immune-deficient mouse strains revealed that T cells significantly contribute to age-related myocardial inflammation and functional decline. Upon adoptive cell transfer, the T cells isolated from the mediastinal lymph node (med-LN) of aged animals exhibited increased cardiotropism, compared with cells purified from young donors or from other irrelevant sites. Nevertheless, these cells caused rather mild effects on cardiac functionality, indicating that myocardial aging might stem from a combination of intrinsic and extrinsic (immunological) factors. Taken together, the data herein presented indicate that heart-directed immune responses may spontaneously arise in the elderly, even in the absence of a clear tissue damage or concomitant infection. These observations might shed new light on the emerging role of T cells in myocardial diseases, which primarily affect the elderly population.


Modeling and Experimentation of the Unidirectional Orthodontic Force of Second Sequential Loop Orthodontic Archwire.
The abnormal tooth arrangement is one of the most common clinical features of malocclusion which is mainly caused by the tooth root compression malformation. The second sequential loop is mostly used for the adjusting of the abnormal tooth arrangement. Now, the shape devise of orthodontic archwire depends completely on the doctor's experience and patients' feedback, this practice is time-consuming, and the treatment effect is unstable. The orthodontic-force of the different parameters of the second sequence loop, including different cross-sectional parameters, material parameters, and characteristic parameters, was compared and simulated for the abnormal condition of root compression deformity. In this paper, the analysis and experimental study on the unidirectional orthodontic-force were carried out. The different parameters of the second sequential loop are analyzed, and the equivalent beam deflection theory is used to analyze the relationship between orthodontic-force and archwire parameters. Based on the structural analysis of the second sequential loop, the device for measuring orthodontic force has been designed. The orthodontic force with different structural characteristics of archwire was compared and was measured. Finally, the correction factor was developed in the unidirectional orthodontic-force forecasting model to eliminate the influence of inherent error. The average relative error rate of the theoretical results of the unidirectional orthodontic-force forecasting model is between 12.6% and 8.75%, which verifies the accuracy of the prediction model.


Efficacy of the low dose apatinib plus deep hyperthermia as third-line or later treatment in HER-2 negative advanced gastric cancer.
Aim: To observe the efficacy of the low dose apatinib plus deep hyperthermia as third-line or later treatment for patients with human epidermal growth factor receptor 2 (HER-2) negative advanced gastric cancer. Methods: 80 eligible patients with HER-2 negative advanced gastric cancer admitted to Jingjiang People's Hospital Affiliated with Yangzhou University-from March 2021 to March 2022 were selected, and they were divided into the control group (n = 40, apatinib) and experimental group (n = 40, apatinib plus deep hyperthermia) on the basis of random number table method. The levels of serum carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA199), and vascular endothelial growth factor (VEGF) were monitored, and the efficacy of the two groups was analyzed by referring to Karnofsky performance status (KPS), overall survival (OS) and disease control rate (DCR) before and after treatment. Results: The levels of CEA, CA199, and VEGF in both groups were lower after treatment than before (p < 0.05), and lower (CEA: 8.85 ± 1.36 vs. 12.87 ± 1.23, CA199: 34.19 ± 4.68 vs. 50.11 ± 5.73, VEGF: 124.8 ± 18.03 vs. 205.9 ± 19.91) in the experimental group than in the control group (p < 0.05). The DCR and KPS of the patients in the experimental group were significantly higher (DCR: 62.50% vs. 40.00%; KPS: 83.25 ± 1.15 vs. 76.25 ± 1.17) than in the control group (p < 0.05). In survival analysis, patients with control group had shorter OS than the experimental group. (median 5.65 vs. 6.50 months; hazard ratio [HR], 1.63 [95% confidence interval (CI) 1.02-2.60], p = 0.0396). Conclusion: The application of low-dose apatinib plus deep hyperthermia for patients with HER-2 negative gastric cancer who failed second-line treatment should be a promising option.


Experience With A Support Group Intervention Offered to Breast Cancer Women.
Breast cancer is the most frequent cancer in Turkey and other countries. It is not sufficient for women with breast cancer to receive medical treatment protocols (i.e. surgery, chemotherapy, radiotherapy and hormone therapy) to overcome their disease. Breast cancer has biopsychosocial effects on the patients. Provision and maintenance of biopsychosocial wellbeing of the patients during and after the medical treatment process should be one of the primary treatment criteria. It is important for women with breast cancer to develop new strategies to adapt to the disease and treatment processes and to cope with their disease. Support groups and education are quite frequently utilized to achieve this adaptation and coping. Support group interventions allow the women to discuss, receive education and share their experiences. These opportunities guide the patients about how to manage their disease and help them fulfill their social support needs. Support groups are very important to promote physical and psychological health, expand social network and increase social support for breast cancer women. The aim of this review is to reveal experiences in the preparatory and implementation stages of a support group intervention designed for women diagnosed with breast cancer in the framework of a PhD dissertation.


Modeling counterion binding in ionic-nonionic and ionic-zwitterionic binary surfactant mixtures.
A predictive molecular-thermodynamic theory is developed to model the effect of counterion binding on micellar solution properties of binary surfactant mixtures of ionic and nonionic (or zwitterionic) surfactants. The theory combines a molecular-thermodynamic description of micellization in binary surfactant mixtures with a recently developed model of counterion binding to single-component ionic surfactant micelles. The thermodynamic component of the theory models the equilibrium between the surfactant monomers, the counterions, and the mixed micelles. The molecular component of the theory models the various contributions to the free-energy change associated with forming a mixed micelle from ionic surfactants, nonionic (or zwitterionic) surfactants, and bound counterions (referred to as the free energy of mixed micellization). Specifically, the various molecular contributions to the free energy of mixed micellization model the underlying physics associated with the assembly of, and the interactions between, the surfactant polar heads, the surfactant nonpolar tails, and the bound counterions. Utilizing known structural characteristics of the surfactants and the counterions, along with the solution conditions, the free energy of mixed micellization is minimized to predict various optimal micelle characteristics, including the degree of counterion binding, the micelle composition, and the micelle shape and size. These predicted optimal micelle characteristics are then used to predict the critical micelle concentration (cmc) and the average micelle aggregation number. Our predictions of the degree of counterion binding, the cmc, and the average micelle aggregation number show good agreement with available experimental results from the literature for several binary surfactant mixtures. In addition, the theory is used to shed light on the relationship between the micelle composition, counterion binding and ion condensation, and the micelle shape transition.


Effect of antioxidant vitamin supplementation on cardiovascular outcomes: a meta-analysis of randomized controlled trials.
Antioxidant vitamin (vitamin E, beta-carotene, and vitamin C) are widely used for preventing major cardiovascular outcomes. However, the effect of antioxidant vitamin on cardiovascular events remains unclear. We searched PubMed, EmBase, the Cochrane Central Register of Controlled Trials, and the proceedings of major conferences for relevant literature. Eligible studies were randomized controlled trials that reported on the effects of antioxidant vitamin on cardiovascular outcomes as compared to placebo. Outcomes analyzed were major cardiovascular events, myocardial infarction, stroke, cardiac death, total death, and any possible adverse events. We used the I(2) statistic to measure heterogeneity between trials and calculated risk estimates for cardiovascular outcomes with random-effect meta-analysis. Independent extraction was performed by two reviewers and consensus was reached. Of 293 identified studies, we included 15 trials reporting data on 188209 participants. These studies reported 12749 major cardiovascular events, 6699 myocardial infarction, 3749 strokes, 14122 total death, and 5980 cardiac deaths. Overall, antioxidant vitamin supplementation as compared to placebo had no effect on major cardiovascular events (RR, 1.00; 95%CI, 0.96-1.03), myocardial infarction (RR, 0.98; 95%CI, 0.92-1.04), stroke (RR, 0.99; 95%CI, 0.93-1.05), total death (RR, 1.03; 95%CI, 0.98-1.07), cardiac death (RR, 1.02; 95%CI, 0.97-1.07), revascularization (RR, 1.00; 95%CI, 0.95-1.05), total CHD (RR, 0.96; 95%CI, 0.87-1.05), angina (RR, 0.98; 95%CI, 0.90-1.07), and congestive heart failure (RR, 1.07; 95%CI, 0.96 to 1.19). Antioxidant vitamin supplementation has no effect on the incidence of major cardiovascular events, myocardial infarction, stroke, total death, and cardiac death.


Smaller Left Ventricle Size at Noncontrast CT Is Associated with Lower Mortality in COPDGene Participants.
Background Smokers with chronic obstructive pulmonary disease (COPD) have smaller left ventricles (LVs) due to reduced preload. Skeletal muscle wasting is also common in COPD, but less is known about its contribution to LV size. Purpose To explore the relationships between CT metrics of emphysema, venous vascular volume, and sarcopenia with the LV epicardial volume (LVEV) (myocardium and chamber) estimated from chest CT images in participants with COPD and then to determine the clinical relevance of the LVEV in multivariable models, including sex and anthropomorphic metrics. Materials and Methods The COPDGene study (ClinicalTrials.gov identifier: NCT00608764) is an ongoing prospective longitudinal observational investigation that began in 2006. LVEV, distal pulmonary venous blood volume for vessels smaller than 5 mm2 in cross section (BV5), CT emphysema, and pectoralis muscle area were retrospectively extracted from 3318 nongated, unenhanced COPDGene CT scans. Multivariable linear and Cox regression models were used to explore the association between emphysema, venous BV5, pectoralis muscle area, and LVEV as well as the association of LVEV with health status using the St George's Respiratory Questionnaire, 6-minute walk distance, and all-cause mortality. Results The median age of the cohort was 64 years (interquartile range, 57-70 years). Of the 2423 participants, 1806 were men and 617 were African American. The median LVEV between Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1 and GOLD 4 COPD was reduced by 13.9% in women and 17.7% in men (P < .001 for both). In fully adjusted models, higher emphysema percentage (β = -4.2; 95% confidence interval [CI]: -5.0, -3.4; P < .001), venous BV5 (β = 7.0; 95% CI: 5.7, 8.2; P < .001), and pectoralis muscle area (β = 2.7; 95% CI: 1.2, 4.1; P < .001) were independently associated with reduced LVEV. Reductions in LVEV were associated with improved health status (β = 0.3; 95% CI: 0.1, 0.4) and 6-minute walk distance (β = -12.2; 95% CI: -15.2, -9.3). These effects were greater in women than in men. The effect of reduced LVEV on mortality (hazard ratio: 1.07; 95% CI: 1.05, 1.09) did not vary by sex. Conclusion In women more than men with chronic obstructive pulmonary disease, a reduction in the estimated left ventricle epicardial volume correlated with a loss of pulmonary venous vasculature, greater pectoralis muscle sarcopenia, and lower all-cause mortality. © RSNA, 2020 Online supplemental material is available for this article.


Spheres of influence: Porphyromonas gingivalis outer membrane vesicles.
Outer membrane vesicles (OMVs) are asymmetrical single bilayer membranous nanostructures produced by Gram-negative bacteria important for bacterial interaction with the environment. Porphyromonas gingivalis, a keystone pathogen associated with chronic periodontitis, produces OMVs that act as a virulence factor secretion system contributing to its pathogenicity. Despite their biological importance, the mechanisms of OMV biogenesis have not been fully elucidated. The ~14 times more curvature of the OMV membrane than cell outer membrane (OM) indicates that OMV biogenesis requires energy expenditure for significant curvature of the OMV membrane. In P. gingivalis, we propose that this may be achieved by upregulating the production of certain inner or outer leaflet lipids, which causes localized outward curvature of the OM. This results in selection of anionic lipopolysaccharide (A-LPS) and associated C-terminal domain (CTD) -family proteins on the outer surface due to their ability to accommodate the curvature. Deacylation of A-LPS may further enable increased curvature leading to OMV formation. Porphyromonas gingivalis OMVs that are selectively enriched in CTD-family proteins, largely the gingipains, can support bacterial coaggregation, promote biofilm development and act as an intercessor for the transport of non-motile bacteria by motile bacteria. The P. gingivalis OMVs are also believed to contribute to host interaction and colonization, evasion of immune defense mechanisms, and destruction of periodontal tissues. They may be crucial for both micro- and macronutrient capture, especially heme and probably other assimilable compounds for its own benefit and that of the wider biofilm community.


Neurocognitive performance as an endophenotype for bipolar disorder.
Identification of the underlying liability to develop bipolar disorders (BD) is hindered by the genetic complexity and phenotypic heterogeneity of the disease. The use of endophenotypes has been acknowledged as a promising approach that may detect the hidden manifestations of a genetic liability for an illness. One of the most commonly proposed endophenotypes in BD is neurocognitive performance. We identified and examined previously published review articles that had any data pertaining to endophenotypes in BD and combined this with an extensive review of studies of cognitive deficits in BD from 2000 onwards. Using criteria for a valid endophenotype, we identifed that the domains of executive functioning and verbal memory are the most promising candidate endophenotypes for BD. However, they do not meet the criteria for specificity as similar deficits present in schizophrenia and/or severe or psychotic major depressions. Further research is needed as the findings regarding endophenotypes show between-study heterogeneity. In the future, examination of quantitative traits may offer a more promising approach to the study of endophenotypes rather than solely focusing on diagnostic categories.


In vitro comparison of NiTi rotary instruments and stainless steel hand instruments in root canal preparations of primary and permanent molar.
This study is an attempt to compare the NiTi rotary and K-files hand instrumentation on root canal preparation of primary and permanent molars for their efficiency in preparation time, instrument failure and shaping the canals. About 20 primary mandibular second molar (I) and 20 permanent mandibular first molar (II) were selected. Each was further divided into 10 for K-files (a) and 10 for NiTi (b) groups, respectively. Results showed that preparation time Ib Ia and IIab<IIa, which was highly significant. In instrument failure, Ia (40%), IIa (30%) showed more deformation but not fracture and Ib (10%), IIb (20%) showed fracture, but not deformation. Profiles showed good canal taper and smoothness compared to the K-files. To conclude profile 0.04 taper 29 series, prepared canal rapidly than conventional K-file with good taper, smoothness though the flow was not satisfactory. Instrument failure with K-files was less. In primary teeth preparation time, instrument failure with profile was less compared to the permanent. To conclude it's encouraging to use the profiles in primary teeth.


Food safety and sanitation challenges of public university students in a developing country.
Inadequate catering facilities in Kenyan public universities compel students to handle and prepare their own food, in environments not designated for food preparation such as rooms in hostels. This study investigated the level of food safety and sanitation knowledge, attitude, and practice, among students in an effort to prevent food-borne diseases. A cross-sectional study was conducted among 535 students from two public universities in Kenya. Data were obtained through a piloted, structured questionnaire in line with Food and Agriculture Organization (FAO) guidelines, administered to students from seven different departments. Eighty percent of the students had adequate levels of food safety and hygiene knowledge, while 70% had a positive attitude toward food safety and sanitation. An average of 74% engaged in inadequate food safety and hygiene practices, with majority citing lack of equipment as a major contributor. ANOVA results revealed significant correlation between the gender and knowledge and practice of food safety and sanitation (F = 30.328, ρ = 0.000) and (F = 18.177,ρ = 0.000), respectively. Binary logistic regression showed that knowledge (β = 3.677, p < .000) fostered the practice of food safety and sanitation more in comparison with attitude (β = 2.244, p < .000). Kenyan universities should consider introducing food safety courses that emphasize Food Safety Management System (FSMS) and Hazard Analysis Critical Control Point (HACCP) practices and procedures especially to non-science-based courses, in addition to providing students with proper cooking and food handling facilities.


Activity Preferences Among Older People With Dementia Residing in Nursing Homes.
The study aimed to examine the influence of personal characteristics on activity preferences using decision tree analysis and examine the effects of the variables using conventional approaches (logistic regression analysis). A descriptive study was conducted with 251 nursing home residents with dementia in Korea (76.9% female) to examine the relationship between their personal characteristics and activity preferences. Decision tree analysis was used to classify participants' activity preferences, and preference levels were examined using logistic regression analysis. Activities were classified as either physical and social activities or cognitive and affective activities. This model showed an accuracy rate of 85.7% for positively predicting physical and social activity preference and 30.3% for positively predicting cognitive and affective activity preference. Gender was the strongest determinant of activity preference. The odds of preferring physical and social activities were 3.179 times higher among women, while the odds for preferring cognitive and affective activities were 0.412 times higher among men. Notably, cognitive and affective activity preference increased to 58.8% for married male participants. This study's findings can contribute to the development of programs to decrease behavioral and psychological symptoms among older people with dementia residing in nursing homes and provide scientific evidence for integrating these activities into long-term services for this population.


[Effects of parameter spatial distribution on non-point pollution source model].
The SWAT model was used to simulate the effects of parameter spatial distribution on flow and nutrients loadings in the Daning river watershed. It was first calibrated and validated using the measured data for the period of 2000 - 2004. Then the model was used to simulate the effects of watershed delineation scenarios on flow and nutrients loadings, using six watershed delineations, each with a different number of sub-watersheds. The max relative error is 19.6% for the annual mean flow under different watershed delineation scenarios. The flow increase first and then decrease with the number of sub-watersheds. The efficiencies coefficient is 0.52 - 0.82 for annual mean flow and 0.80 - 0.83 for monthly mean flow under six delineation scenarios. Outlet nutrients simulations are slightly affected by changes in watershed delineation scenarios. The relative errors of organic nitrogen and organic phosphorous are 16.2% and 7.7% respectively and no explicit trend is observed.


Coping and Psychopathological Profile in Nonsuicidal Self-Injurious Chilean Adolescents.
The aims of this study were to establish the roles of coping typologies and the psychological problems associated with nonsuicidal self-injury (NSSI) and to identify adolescents who are at greater risk of engaging in this practice. The total sample comprised 965 adolescents (57% girls, aged 12-18 years) from several Chilean schools who answered the Inventory of Statements About Self-Injury questionnaire. Young people with and without NSSI present different coping patterns, especially when compared by gender. Adolescents with repetitive NSSI (R-NSSI) report using escape, search for friendship, and venting feelings as coping strategies as well as a more avoidant style and less search for family support than those adolescents without NSSI. Adolescents who present avoidance coping typology are three times more likely (relative risk = 3.5) to engage in NSSI than adolescents who present approach coping typology. R-NSSI adolescents present higher scores on psychological symptomatology (within clinical ranges) than their N-NSSI counterparts. Girls were more likely to present psychological symptoms than boys. The authors highlight the usefulness of coping typologies for the detection of high-risk populations for NSSI as well as the need to consider the gender variable. Professionals who detect clinical levels of symptomatology should also assess the presence of NSSI.


STAT3 as an adapter to couple phosphatidylinositol 3-kinase to the IFNAR1 chain of the type I interferon receptor.
STAT (signal transducers and activators of transcription) proteins undergo cytokine-dependent phosphorylation on serine and tyrosine. STAT3, a transcription factor for acute phase response genes, was found to act as an adapter molecule in signal transduction from the type I interferon receptor. STAT3 bound to a conserved sequence in the cytoplasmic tail of the IFNAR1 chain of the receptor and underwent interferon-dependent tyrosine phosphorylation. The p85 regulatory subunit of phosphatidylinositol 3-kinase, which activates a series of serine kinases, bound to phosphorylated STAT3 and subsequently underwent tyrosine phosphorylation. Thus, STAT3 acts as an adapter to couple another signaling pathway to the interferon receptor.


Differentiating Branch Duct and Mixed IPMN in Endoscopically Collected Pancreatic Cyst Fluid via Cytokine Analysis.
Background. Differentiating branch duct from mixed intraductal papillary mucinous neoplasm (BD-IPMN) is problematic, but clinically important as mixed IPMNs are managed surgically, while some BD-IPMN may be followed. Inflammatory mediator proteins (IMPs) have been implicated in acute and chronic inflammatory and malignant pancreatic diseases. Aim. To compare IMP profile of pancreatic cyst fluid collected endoscopically from BD-IPMN and mixed IPMN. Methods. Pancreatic cyst fluid from ten patients (5 BD-IPMN and 5 mixed IPMN) was collected by endoscopic ultrasound-guided fine needle aspiration or endoscopic retrograde cholangiopancreatography. Concentrations of 89 IMPs in these samples were determined using a multiplexed bead-based microarray protein assay and compared between BD-IPMN and mixed IPMN. Results. Eighty-six of 89 IMPs were detected in at least one of the 10 samples. Fourteen IMPs were detected only in mixed IPMN, while none were only in BD-IPMN. Of these, TGF-β1 was most prevalent, present in 3 of 5 mixed IPMNs. Seventy-two IMPs were detected in both BD-IPMN and mixed IPMNs. Of these, only G-CSF (P < 0.05) was present in higher concentrations in mixed IPMNs. Conclusion. TGF-β1 and G-CSF detected in endoscopically collected pancreatic cyst fluid are potential diagnostic biomarkers capable of distinguishing mixed IPMN from BD-IPMN.


Proteomic data exchange and storage: the need for common standards and public repositories.
The ever increasing volumes of proteomic data now being produced by laboratories across the world have resulted in major issues in data storage and accessibility. The further demands of multilaboratory initiatives has highlighted issues when collaborators cannot import data generated within the same project but generated by different hardware types and processed by laboratory-specific work flows and analyses packages. There is an increasing need for common data standards that will allow the interchange of data between different instrumentation, search engines, and between laboratory databases. This could then lead to the establishment of data repositories from where benchmark datasets could be accessed and reanalyzed. The Human Proteome Organization is currently supporting efforts to establish such standards. The work of the Proteomics Standards Initiative has lead to the development of the mzData XML interchange standard and is now broadening its scope to produce a spectral analysis output format, mzIdent. Accompanying controlled vocabularies allow the accurate, while systematic, representation of metadata throughout both schema.


Role of acetyl-CoA acetyltransferase 1 expression in the molecular mechanism of adenomyosis.
Adenomyosis is a benign uterine illness characterized by endometrial gland and stromal invasion into the myometrium. Acetyl-CoA acetyltransferase 1 (ACAT1) is an enzyme localized in mitochondria that is involved in ketogenesis and ketolysis processes by reversibly catalyzing the formation of acetoacetyl-CoA from two acetyl-CoA molecules. The current study investigated the expression of the ACAT1 molecule in tissue samples of patients diagnosed with adenomyosis and healthy endometrial tissues. It is aimed to determine the differences in ACAT1 gene expression and in this way to discover the first information about the role of ACAT1 in the development and molecular mechanism of adenomyosis. In the current retrospective study, formalin-fixed paraffin-embedded archival tissues were employed. A total of 76 patient samples were included in the study. Of these samples, 28 are adenomyotic tissue (Group I), 30 are eutopic endometrial tissue (Group II), and 18 are the Control Group. In these groups, the expression levels of the ACAT1 gene were determined by the reverse transcription-polymerase chain reaction method. When the expression results of the ACAT1 gene were evaluated, statistically significant differences were found between the groups (p<0.05). There was a difference between Group I-Group II and Group I-Control Group regarding the ACAT1 gene. No statistically significant change was observed between Group II and Control Group. It is a remarkable finding that the expression of ACAT1 in adenomyosis tissue is decreased compared with both eutopic endometrium and control groups tissues. The results suggest that ACAT1 may be associated with the molecular pathogenesis of adenomyosis.


Effect of storage of blood on the osmotic fragility of mammalian erythrocytes.
The osmotic fragility of mammalian erythrocytes during blood storage was determined. Significant changes were observed in the fragility of goat, cattle, pig, mouse, rat and rabbit erythrocytes but not in sheep erythrocytes during the storage of blood for 24 hours at 10 degrees C.


ABCC6 plays a significant role in the transport of nilotinib and dasatinib, and contributes to TKI resistance in vitro, in both cell lines and primary patient mononuclear cells.
ATP Binding Cassette family efflux proteins ABCB1 and ABCG2 have previously been demonstrated to interact with Tyrosine Kinase Inhibitors (TKIs); however, evidence for the interaction of other potentially relevant drug transporters with TKIs is lacking. Through Taqman transporter array technology we assessed the impact of nilotinib on mRNA expression of ABC transporters, with ABCC6 identified as a transporter of interest. Additionally, increased expression of ABCC6 mRNA was observed during in vitro development of nilotinib resistance in BCR-ABL1-expressing cell lines. K562 cells exposed to gradually increasing concentrations of nilotinib (to 2 μM) expressed up to 57-fold higher levels of ABCC6 mRNA when compared with control cells (p = 0.002). Analogous results were observed in nilotinib resistant K562-Dox cells (up to 33-fold higher levels of ABCC6, p = 0.002). IC50 experiments were conducted on patient mononuclear cells in the absence and presence of three ABCC6 inhibitors: indomethacin, probenecid and pantoprazole. Results demonstrated that all three inhibitors significantly reduced nilotinib IC50 (p<0.001) indicating ABCC6 is likely involved in nilotinib transport. Cell line data confirmed these findings. Similar results were obtained for dasatinib, but not imatinib. Combined, these studies suggest that nilotinib and dasatinib are likely substrates of ABCC6 and to our knowledge, this is the first report of ABCC6 involvement in TKI transport. In addition, ABCC6 overexpression may also contribute to nilotinib and dasatinib resistance in vitro. With nilotinib and dasatinib now front line therapy options in the treatment of CML, concomitant administration of ABCC6 inhibitors may present an attractive option to enhance TKI efficacy.


Mucoepidermoid carcinoma of the conjunctiva.
A 73-year-old man had a limbal nodule that, on histopathologic examination, proved to be mucoepidermoid carcinoma of the conjunctiva. Despite radiation therapy and extensive corneoscleral lamellar resection, widespread invasion of the lids and orbit ultimately led to exenteration. Although mucoepidermoid carcinoma of the conjunctiva resembles squamous cell carcinoma clinically and histopathologically, it pursues a more rapid and destructive clinical course. Intraepithelial invasion often leads to tumor involvement of conjunctiva and skin that seem normal on clinical examination. Special stains and a high level of suspicion are required for diagnosis of mucoepidermoid carcinoma of the conjunctiva, and proper initial management demands more aggressive surgical resection than is usually indicated for squamous cell carcinoma.


Optimization of exposure in panoramic radiography while maintaining image quality using adaptive filtering.
Objective The purpose of the present study was to investigate the potential of using advanced external adaptive image processing for maintaining image quality while reducing exposure in dental panoramic storage phosphor plate (SPP) radiography. Materials and methods Thirty-seven SPP radiographs of a skull phantom were acquired using a Scanora panoramic X-ray machine with various tube load, tube voltage, SPP sensitivity and filtration settings. The radiographs were processed using General Operator Processor (GOP) technology. Fifteen dentists, all within the dental radiology field, compared the structural image quality of each radiograph with a reference image on a 5-point rating scale in a visual grading characteristics (VGC) study. The reference image was acquired with the acquisition parameters commonly used in daily operation (70 kVp, 150 mAs and sensitivity class 200) and processed using the standard process parameters supplied by the modality vendor. Results All GOP-processed images with similar (or higher) dose as the reference image resulted in higher image quality than the reference. All GOP-processed images with similar image quality as the reference image were acquired at a lower dose than the reference. This indicates that the external image processing improved the image quality compared with the standard processing. Regarding acquisition parameters, no strong dependency of the image quality on the radiation quality was seen and the image quality was mainly affected by the dose. Conclusions The present study indicates that advanced external adaptive image processing may be beneficial in panoramic radiography for increasing the image quality of SPP radiographs or for reducing the exposure while maintaining image quality.


The Marginal Costs of Adverse Drug Events Associated With Exposures to Anticoagulants and Hypoglycemic Agents During Hospitalization.
Anticoagulants and hypoglycemic agents are 2 of the most challenging drug classes for medical management in the hospital resulting in many adverse drug events (ADEs). Estimating the marginal cost (MC) of ADEs associated with anticoagulants and hypoglycemic agents for adults in 5 patient groups during their hospital stay and the total annual ADE costs for all patients exposed to these drugs during their stay. Data are from 2010 to 2013 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases and Medicare Patient Safety Monitoring System (MPSMS). Deidentified patients were linked using probabilistic matching in the same hospital and year for 5 patient groups. ADE information was obtained from the MPSMS using retrospective structured record review. Costs were derived using HCUP cost-to-charge ratios. MC estimates were made using Extended Estimating Equations controlling for patient characteristics, comorbidities, hospital procedures, and hospital characteristics. MC estimates were applied to the 2013 HCUP National Inpatient Sample to estimate annual ADE costs. Adjusted MC estimates were smaller than unadjusted measures with most groups showing estimates that were at least 50% less. Adjusted anticoagulant ADE costs added >45% and Hypoglycemic ADE costs added >20% to inpatient costs. The 2013 hospital cost estimates for ADEs associated with anticoagulants and hypoglycemic agents were >$2.5 billion for each drug class. This study demonstrates the importance of accounting for confounders in the estimation of ADEs, and the importance of separate estimates of ADE costs by drug class.


Case Report: A PD-L1-Positive Patient With Pleomorphic Rhabdomyosarcoma Achieving an Impressive Response to Immunotherapy.
There is currently a lack of effective systemic treatment for patients with advanced pleomorphic rhabdomyosarcoma (PRMS). Although programmed death protein 1 (PD-1) inhibitors have shown efficacy in various solid tumors, their effects on PRMS have not been well established. Here, we present a case of a 12-year-old Chinese male adolescent with metastatic PRMS who benefited from the PD-1 inhibitor nivolumab. The patient initially underwent primary tumor resection but failed to respond to subsequent first-line chemotherapy and second-line pazopanib treatment. Pathological examination showed positive PD-L1 expression and tumor-infiltrating lymphocytes in the tumor tissue, and the patient was administered nivolumab as a posterior-line treatment. After attaining a clinically partial response (PR), surgical resection was performed, which was followed by adjuvant nivolumab. At the time of the submission of this manuscript, the patient achieved recurrence-free survival (RFS) lasting 45 months and counting. This is the first clinical evidence that a patient with refractory PRMS was controlled by anti-PD-1 antibody, with an RFS lasting more than 3 years. This case suggests that PD-L1 expression and T-cell infiltration could be used as potential biomarkers for PRMS immunotherapy.


Short-Term Outcomes of the Grammont Reverse Shoulder Arthroplasty: Comparison between First and Second Generation Delta Prosthesis.
Purpose This article compares short-term outcomes of two series of patients, who underwent reverse total shoulder arthroplasty (RTSA) with two different implants, both based on Grammont's principles: the Delta III (D-3) and the Delta Xtend (D-XT) prostheses. Methods The D-3 group included a consecutive series of 26 patients (mean age 75 years), that were treated between 2000 and 2006; the D-XT group included a consecutive series of 31 patients (mean age 72.5 years), for a total of 33 implants performed between 2011 and 2015. In both groups the most common diagnoses were cuff tear arthropathy (18 and 22 shoulders, respectively) and malunion of proximal humerus fractures (3 and 5). All procedures were performed by the same surgeon. Constant-Murley score (CMS) was used to assess clinical and functional outcomes. Radiographic evaluation included the true anteroposterior and axillary views. Results Twenty-three patients of the D-3 group and 22 patients (24 shoulders) of the D-XT group were evaluated at a mean follow-up of 42 months (range 26-84) and 44 months (range 26-66), respectively. Four complications occurred in the D-3 group (1 partial deltoid detachment, 1 dislocation, and 2 glenoid component loosening), while one early postoperative infection occurred in the D-XT group. Increases in elevation and CMS between preoperative and postoperative period were observed in both groups; only the D-XT group showed a slight improvement in rotations. The incidence of scapular notching was significantly different between the two groups: 100% for D-3 and 22.2% for D-XT in patients with a minimum follow-up of 5 years. Conclusion Prosthetic design evolution and greater acquaintance with this surgery have undoubtedly led to an improvement in short-term outcomes with second generation implants of RTSA. Future studies will have to ascertain whether newer implants, relying on biomechanical solutions alternative to Grammont's original concept, might provide additional advantages and minimize drawbacks.


Understanding the Effect of Cathode Composition on the Interface and Crosstalk in NMC/Si Full Cells.
Crosstalk between the cathode and the anode in lithium-ion batteries has a great impact on performance, safety, and cycle lifetime. However, no report exists for a systematic investigation on crosstalk behavior in silicon (Si)-based cells as a function of transition metal composition in cathodes. We studied the effect of crosstalk on degradation of Si-rich anodes in full cells with different cathodes having the same crystal structure but different transition metal compositions, such as LiNi1/3Mn1/3Co1/3O2 (NM111), LiNi0.5Mn0.3Co0.2O2 (NMC532), and LiNi0.8Mn0.1Co0.1O2 (NMC811). We found that the transition metal composition in cathodes, especially Mn ion concentration, significantly affects electrolyte decomposition reactions, even from very early cycles. This change causes differences in the solid electrolyte interphase (SEI) chemistry of each aged Si sample. As a result, each of the aged Si samples has a different electrochemistry, in terms of initial Coulombic efficiency and the mechanism of capacity fade.


[Digital radiation monitoring system with a personal computer].
This paper describes a data processing system of monitors with a personal computer for a radioisotope laboratory. A monitoring system includes 6 area, 6 dust, and 3 gas monitors. Monitor signals through a multiplexer were fed to the personal computer which has analogue ports. Processed data were displayed on a color CRT, stored on a 5 inch mini floppy disk, and printed out as a report. We developed a data processing program with BASIC language. This system largely reduced manpower required to estimate radiation levels in the laboratory. The personal computer has sufficiently enough ability to construct a digital monitoring system for a small radioisotope laboratory.


Orthostatic hypotension in treated hypertensive patients.
Orthostatic hypotension (OH) is a risk factor for morbidity and mortality and one of the causes of non compliance to treatment among medicated hypertensive subjects. Our objective was to assess the prevalence of OH among treated hypertensive patients and its association with clinical characteristics and antihypertensive drug class. This was a cross-sectional study in which we assessed the prevalence of OH, defined according to the American Autonomic Society and American Academy of Neurology guidelines, among adult treated hypertensive patients who performed a home blood pressure monitoring at our institution. We also determined the prevalence of OH according to age group (< 65, 65-79 and > 80), antihypertensive drug class, office and home hypertension control status. We included 302 medicated patients in the study. Mean age was 66.6 (+13.8), 67% were women. We found a 9.7% global prevalence of OH, which was significantly higher among older individuals (3.6% among patients < 65 years-old, 12.2% in the 65-79 year-old group and 16.7% among octogenarians, p = 0.02) and those who consumed alpha-blockers (75 vs. 8.5%, p < 0.01). Uncontrolled hypertensive patients at office and/or at home had also a significantly higher prevalence of OH: uncontrolled vs. controlled office blood pressure (BP), 14.3 vs. 6.5%, p = 0.03 and uncontrolled vs. controlled home BP, 15.1 vs. 6.6%, p = 0.02. Remarkably, 64% of patients with OH had their BP under control when considering office-standing BP. OH is a prevalent entity among treated hypertensive patients and systematic measurement of standing BP should be mandatory in the evaluation of these patients.


Effect of transcutaneous electrical nerve stimulation (TENS) on central nervous system amplification of somatosensory input.
The effect of transcutaneous electrical nerve stimulation (TENS) on the central nervous system amplification process was investigated focusing on the dorsal column-medial lemniscal pathway, because the dorsal column nucleus was recently shown to receive multiple sources of sensory information, including pain. Short latency somatosensory evoked potentials (SSEPs) were recorded in ten healthy normal volunteers. Amplitude changes in each SSEP component (the N9 brachial plexus potential, the P14 potential that originates from the cervicomedullary junction, spinal N13/P13 generated by the cervical dorsal horn and the cortical N20/P25 potential) were studied at stimulus strengths ranging from the threshold (40% maximum stimulus) to 2.5 times the threshold (maximum). The findings suggest that sensory amplification begins at the P14 generator source near the cuneate nucleus. There was no statistically significant difference in sensory amplification between P14 and cortical N20/P25, indicating that the cuneate nucleus is the main site of the central amplifying process. When TENS was applied to the palm distal to the median nerve stimulation used for SSEP, cortical N20/P25 amplification disappeared, evidence that TENS suppresses the central amplification phenomenon, most probably at the level of the cuneate nucleus.


Cloning of the HLA class II region in yeast artificial chromosomes.
Yeast artificial chromosomes (YACs) have been applied to clone the entire class II region of the human major histocompatibility complex (MHC), including its flanking regions, in a contig over 1.5 million base pairs (bp) long. The human DNA inserts in the YACs have a size between 60 and 1300 kbp and were isolated from two EcoRI partial digest libraries. The gaps between DRA and DRB, DRB and DQA, and DOB and DPA, which had not been cloned by other means, have been bridged with YAC clones. The contig extends through the 400 kpb of DNA between the DRA and C4 genes, thus linking the class II region with the complement gene cluster in the class III region. The cloning in YACs has been supported by a conventional cosmid walk of 290 kbp in the C4-DRA region. Restriction enzyme sites in the YAC clones were compared to the sites in the cosmid walk, to published cosmid clones, and to the already existing physical maps, leading to a detailed characterization of a region of the human genome over 1500 kbp. The YAC clones will be valuable for functional analysis of the MHC.


TiO₂-SiO₂ Coatings with a Low Content of AuNPs for Producing Self-Cleaning Building Materials.
The high pollution levels in our cities are producing a significant increase of dust on buildings. An application of photoactive coatings on building materials can produce buildings with self-cleaning surfaces. In this study, we have developed a simple sol-gel route for producing Au-TiO₂/SiO₂ photocatalysts with application on buildings. The gold nanoparticles (AuNPs) improved the TiO₂ photoactivity under solar radiation because they promoted absorption in the visible range. We varied the content of AuNPs in the sols under study, in order to investigate their effect on self-cleaning properties. The sols obtained were sprayed on a common building stone, producing coatings which adhere firmly to the stone and preserve their aesthetic qualities. We studied the decolourization efficiency of the photocatalysts under study against methylene blue and against soot (a real staining agent for buildings). Finally, we established that the coating with an intermediate Au content presented the best self-cleaning performance, due to the role played by its structure and texture on its photoactivity.


Psychological sequelae of elective abortion.
A mild, short, depressive and guilt ridden period following abortion is quite common, but a severe psychological reaction is rare. The indication for the abortion and the preabortal psychological state of the patient are the two most important factors. Almost all reported instances of postabortion psychoses have occurred in patients who had severe preabortal psychiatric problems. Women undergoing abortion for socioeconomic or psychosocial indications appear to be at minimal risk for long-term negative psychological sequelae. In contrast, women in whom abortion is carried out because of exposure to rubella and the risk of fetal malformation, maternal organic disease or the prenatal diagnosis of a genetically defective fetus are at greater risk and may need supportive psychotherapy.