Alterations in Dietary Behavior, Appetite Regulation, and Health-Related Quality of Life in Youth with Obesity in Germany during the COVID-19 Pandemic.
This study aimed to evaluate the impact of the COVID-19 pandemic on the nutritional patterns, eating behavior, dietary content, and health-related quality of life (HrQoL) of adolescents with preexisting obesity. Anthropometric and metabolic parameters were measured, and validated questionnaires on eating habits, nutritional content, and HrQoL were administered to 264 adolescents with obesity during the COVID-19 pandemic (June 2020-June 2022) and 265 adolescents with obesity before the pandemic (from June 2017 to June 2019). Both study cohorts were comparable in age and sex distribution. Significant differences were found between the COVID-19 and pre-COVID-19 cohorts in HOMA-index (3.8 (interquartile range [IQR])): 3.3; 4.1) vs. 3.2 (IQR: 2.8; 3.5, p < 0.001), total cholesterol (208.8 mg/dL (IQR: 189.9; 214.5) vs. 198.5 mg/dL (IQR: 189.5; 207.4), p < 0.001), and GPT (93.4 (IQR 88.7; 96.5) vs. 72.8 U/L (IQR 68.9; 75.7), p < 0.001). The COVID-19 cohort reported significantly higher consumption of obesity-promoting food components, such as soft drinks, meat, sausages, fast food and delivery food, chocolate, and sweets. There was also a significant decrease in cognitive hunger control (p = 0.002) and an increase in distractibility potential (p = 0.001) while eating. HrQoL was significantly lower in the COVID-19 cohort (p = 0.001). This study reveals the adverse associations of exposure to the public health measures during the COVID-19 pandemic with nutrition, dietary content, and HrQoL in adolescents with preexisting obesity. These findings underscore the importance of tailored preventive and treatment strategies for addressing the specific challenges of disruptive events such as pandemics, especially in population-based context.


Toxic effects of cadmium and zinc on the transmission of Echinoparyphium recurvatum cercariae.
The toxicity of cadmium, zinc and Cd/Zn mixtures to the transmission of Echinoparyphium recurvatum (Digenea: Echinostomatidae) cercariae into the snail second intermediate hosts was investigated at concentrations ranging from 100 microg l-1 to 10 000 microg l-1 in both soft and hard water. A differential response in the infectivity of metal-exposed cercariae into Lymnaea peregra and Physa fontinalis was demonstrated which was dependent on the snail species being infected. Exposure of L. peregra, P. fontinalis, and L. stagnalis to heavy metals caused a differing susceptibility to E. recurvatum cercariae depending on the snail species being exposed. The mechanism and effects of metal toxicity, together with the importance of the parasite/host strain on cercarial transmission are discussed.


[Low birth weight, stillbirth and congenital malformations. Social differences].
The aim of the study was to describe differences in life style variables according to socioeconomic groupings and to analyse the association between birth weight, stillbirth and congenital malformations according to the socioeconomic groupings for the father as well as the mother. It was conducted as a follow-up of 11,888 pregnant women in Odense and Aalborg, Denmark who were consecutively enrolled in the study from April 1984 to April 1987 as part of a community trial. Consecutively information regarding socioeconomic group and life-style factors were collected by means of self-administered questionnaires in the 36th week of gestation. Data on pregnancy outcomes were collected from birth certificates and medical records according to standardized search routines. It was found that women in the lower socioeconomic groups were younger, smaller, had a higher prepregnancy weight, smoked more and had a higher intake of coffee during pregnancy than women in higher socioeconomic groups. Better off women, on the other hand, had a higher consumption of alcohol, fish, and vegetables. Low birth weight was found to be negatively correlated to socioeconomic grouping. The lowest birth weights were found among babies born to unskilled and unemployed women even after adjustment for smoking habits, prepregnancy height and weight and a number of other potential confounders. Stillbirth and the prevalence of congenital malformations was not associated with socioeconomic grouping, but the amount of information was very limited regarding these outcomes. The study shows that socioeconomic status is especially a risk factor for low birth weight. This association is not only due to differences in life style factors of relevance for the outcome of pregnancy.


Production of recombinant human granulocyte macrophage colony-stimulating factor from silkworm Bombyx mori Bm5 cells.
Using silkworm Bombyx mori Bm5 cells, we established a stable cell line expressing the human granulocyte macrophage colony-stimulating factor (hGM-CSF), which gets its name from the Bm5-hGM-CSF cell in which the glycoprotein of the hGM-CSF is secreted in the cell culture supernatant (CCS). It was demonstrated that secreted hGM-CSF had in vivo biological activity and the white blood cell (WBC) value increased two times that of the control. We expect to produce useful human recombinant glycoproteins from silkworm cultured cells for a low price and a large quantity.


Oxalic acid as the in situ carbon monoxide generator in palladium-catalyzed hydroxycarbonylation of arylhalides.
An efficient palladium-catalyzed hydroxycarbonylation reaction of arylhalides using oxalic acid as a CO source has been developed. The reaction features high safety, low catalyst loading, and a broad substrate scope, and provides a safe and tractable approach to access a variety of aromatic carboxylic acid compounds. Mechanistic studies revealed the decomposition pattern of oxalic acid.


Historical reflection on advocacy in the psychology of intellectual disability.
Advocacy by psychologists has often been portrayed as requiring immersion in the processes of public policy. In the area of intellectual disability, many relevant laws have been passed, court cases fought, and administrative decisions made. These policy decisions have, however, sometimes been based on a division of labor, with psychologists doing the research and lawyers and representatives of parents' groups carrying out most of the advocacy. It now appears that some of the earlier advocacy by psychologists in this area had unfortunate results. This is partly because some of it was based on flawed research and partly because our values have changed over time. Some more recent instances of advocacy, better grounded scientifically, had more favorable effects. Nevertheless, there is clearly not a simple linear relation between research findings and policy. Ample illustrations of these statements are provided in the careers of four psychologists who were influential as advocates in this domain during their lifetimes: Henry Goddard, Cyril Burt, Jack Tizard, and Donald M. Baer.


Impact of comorbidity on adverse drug reaction profile in a cohort of patients treated with Artemisinin combination therapies for uncomplicated malaria in Nigeria.
Artemisinin-based combination antimalarial therapy (ACTs), is still highly effective in uncomplicated falciparum malaria, however, there remain some concerns in relation to its safety and tolerability. Comorbid disease conditions may influence susceptibility to adverse drug reactions (ADRs) as the presence of multiple disease conditions may predisposes patients to ADRs due to the use of many medicines. There is therefore need to assess the impact of comorbidities on the ADR profile of malaria patients treated with ACTs. The study was carried out in health care facilities spread across Nigeria. From the database of over 10,000 patients recruited into an initial cohort, data for 1000 patients with comorbidities was extracted and matched with a control group of 1000 randomly selected patients with no comorbidity. There were 1105 adverse drug reactions in all, of which 66.2% were recorded in patients with comorbidity, and 34% are patients without comorbidity. The mean age of patients with comorbidities was 38.3 ± 17.5 years and 23.8 ± 17.2 for those without comorbidity. Out of the 979 patients with comorbidity, 36% were hypertensive, 2.2% hypertensive-diabetes, 16.4% peptic ulcer disease, 10.4% HIV/AIDS, 4.4% diabetes and 4.3% were asthmatic. Patients with comorbidity were three times more likely to have adverse drug reaction than those without comorbidity (Odds ration = 2.96; 95% CI = 2.23-3.93). HIV/AIDS and osteoarthritis were significantly associated with development of adverse drug reactions. Probability was <0.0001. Age, weight, and height of patients were also found to be risk factor for development of adverse drug reactions.


Papillary carcinoma of the thyroid: methylation is not involved in the regulation of MET expression.
Hypomethylation has been reported to be responsible for the activation of several oncogenes. The possibility that hypomethylation is involved in the regulation of MET transcription was investigated through the analysis of the methylation status of one CpG island containing 43 CpGs in six cases of papillary carcinoma, in the corresponding normal thyroid tissue, and in two cases of hyperplastic goitre. Evidence of methylation was not found in any of the analysed CpG.


An Improved Indirect Procedure for Estimating Pesticide Volatility from Field Trials.
Conventional indirect approaches for estimating pesticide volatility from agricultural fields require an air dispersion model and near-field, temporal air concentration measurements. The model pesticide flux profile is chosen such that field observations are recovered. Ross et al. (1996) first proposed a back-calculation method (BCM) using a single iteration of the Industrial Source Complex Short Term (ISCST) parameterized by a unit source flux. The unit flux is updated by scaling with the slope of a linear regression line between model predictions and actual field observations at each measured time point and location, yielding an estimate for the field flux that occurred over the sampling period. The BCM is expanded using a downhill simplex optimization procedure requiring many ISCST iterations to consecutively adjust the volatility flux rate such that the sum of the squared residuals between predicted and measured air concentrations is minimized (denoted as BCMO). The BCMO is ideally suited for comparing the volatility of different pesticide formulations of the same active from field studies performed simultaneously. Comparison of the BCM and BCMO from field trials containing single (Texas) and multiple simultaneously treated fields (Indiana) are provided for pesticides ranging from low to high volatility. The advanced BCMO is a better alternative than the original BCM, as shown by closer model predictions to measured air concentrations. A major advantage of the BCMO is the ability to extract unique flux source strengths for each field when multiple fields are present and treated consecutively and contiguously with each field emitting pesticide mass at different rates.


Embedding 1D or 2D cobalt-carboxylate substrates in 3D coordination polymers exhibiting slow magnetic relaxation behaviors: crystal structures, high-field EPR, and magnetic studies.
By utilizing well-designed bifunctional ligands derived from 1H-imidazole-4,5-dicarboxylic acid, magnetic coordination polymers (CPs) that exhibit slow magnetic relaxation at the low temperature regions were constructed and further structurally characterized. In 1, 1D cobalt-carboxyl chains were stabilized in the final structure. In contrast, by adjusting the length of the substituted arms on imidazole-4,5-dicarboxylic acid, a novel 3D CP, 2 containing 2D 63 cobalt-carboxyl layer was obtained. A combination of Quantum Monte Carlo (QMC) simulations and the first-principles Density functional theory (DFT) calculations showed that compound 2 features weak ferro- and antiferro-magnetic coupling mechanisms with two different super-exchange paths of -/+/- for syn-anti carboxylate bridges and -/-/- for syn-syn carboxylate bridges. Through HF-EPR measurements performed on polycrystalline samples over the frequency range of 60-260 GHz and field range of 0-12 T, the effective g-values of 1 and 2 were all larger than 2.00, and the signs of their D values were probably positive.


Insulin stimulates phosphorylation of a 120-kDa glycoprotein substrate (pp120) for the receptor-associated protein kinase in intact H-35 hepatoma cells.
The insulin receptor possesses protein kinase activity, which may play a role in mediating insulin action. Recently, we have identified a glycoprotein (pp120) in rat liver plasma membranes that is phosphorylated by the solubilized insulin receptor in a cell-free system. We now report that insulin stimulates phosphorylation of pp120 in intact H-35 cells. H-35 cells were preloaded with [32P]orthophosphate to label the intracellular ATP pool. Insulin caused a 10-fold increase in the phosphorylation of its receptor and a 2-fold increase in phosphorylation of pp120 (P less than 0.001). The time course of insulin's stimulation of pp120 closely paralleled that of insulin receptor phosphorylation over the time period investigated (15-45 min). This effect had the specificity corresponding to the insulin receptor. Epidermal growth factor was inactive, and insulin-like growth factor I had approximately equal to 1% the potency of insulin in this regard. Insulin increased 32P incorporation into pp120 in a linkage that was stable to alkaline hydrolysis, as would be expected for tyrosine-specific phosphorylation. Direct phosphoamino acid analysis confirmed that insulin increased 32P incorporation into phosphotyrosine residues in pp120.


Risk of hepatocellular carcinoma after hepatitis C virus cure.
Hepatitis C virus (HCV) is a significant cause of hepatocellular carcinoma (HCC). The direct-acting antivirals marked a new era of HCV therapy and are associated with greater than 95% cure rate. Successful treatment of chronic hepatitis C greatly reduces the risk of HCC. A proportion of patients, especially those with pre-existing cirrhosis, remain at risk for HCC despite sustained virologic response (SVR). Diabetes mellitus, hepatic steatosis, alcohol consumption and lack of fibrosis regression are associated with risks of HCC after HCV cure. Noninvasive modalities such as aspartate aminotransferase to platelet ratio index and fibrosis-4 index and transient elastography have been used to monitor hepatic fibrosis. More recently, various fibrosis scores have been combined with clinical parameters and other novel biomarkers to predict risks of HCC for patients who achieved SVR. These models still need to be validated and standardized prior to applying to routine clinical care.


Socially Compliant Path Planning for Robotic Autonomous Luggage Trolley Collection at Airports.
This paper describes a socially compliant path planning scheme for robotic autonomous luggage trolley collection at airports. The robot is required to efficiently collect all assigned luggage trolleys in a designated area, while avoiding obstacles and not offending the pedestrians. This path planning problem is formulated in this paper as a Traveling Salesman Problem (TSP). Different from the conventional solutions to the TSP, in which the Euclidean distance between two sites is used as the metric, a high-dimensional metric including the factor of pedestrians' feelings is applied in this work. To obtain the new metric, a novel potential function is firstly proposed to model the relationship between the robot, luggage trolleys, obstacles, and pedestrians. The Social Force Model (SFM) is utilized so that the pedestrians can bring extra influence on the potential field, different from ordinary obstacles. Directed by the attractive and repulsive force generated from the potential field, a number of paths connecting the robot and the luggage trolley, or two luggage trolleys, can be obtained. The length of the generated path is considered as the new metric. The Self-Organizing Map (SOM) satisfies the job of finding a final path to connect all luggage trolleys and the robot located in the potential field, as it can find the intrinsic connection in the high dimensional space. Therefore, while incorporating the new metric, the SOM is used to find the optimal path in which the robot can collect the assigned luggage trolleys in sequence. As a demonstration, the proposed path planning method is implemented in simulation experiments, showing an increase of efficiency and efficacy.


Thymic neoplasms.
Thymomas are infrequent and relatively indolent mediastinal tumors. They are usually encapsulated and readily removed. Invasive tumors, even if completely resected, require additional therapy. Although efforts have been made to relate histopathologic characteristics to outcome, the most important prognostic factors are stage and ability to achieve complete resection. The responsiveness of these tumors to chemotherapy and radiation therapy has led to combining all three modalities in a consistent sequence to derive maximal benefit from each to outcome in patients with locally advanced stage tumors.


Steroidal and nonsteroidal antiestrogens in breast cancer cells in culture.
The mode of action of two types of antiestrogens, tamoxifen and progestins, has been studied in the estrogen responsive cell lines, MCF7 and T47D, established from metastatic human breast cancer. (1) Non steroidal antiestrogens: We present evidence indicating that tamoxifen inhibits the growth of breast cancer cells via an interaction with the estrogen receptor (RE), which leads to a partial activation of the receptor and a dissociated effects on gene expression. At concentrations of less than 4 microM, effects of non steroidal antiestrogens are only observed when RE sites are available. At concentrations greater than 4 microM, an additional (cytotoxic?) effect of tamoxifen is observed which is not mediated by the RE. (2) Progestins: Direct antiestrogenic effect of progestins (R5020, progesterone) on breast cancer cells have been demonstrated. Three series of responses to R5020 are obtained: (a) A decreased cell proliferation (antiestrogenic and progestin specific effect). (b) A decreased production of total proteins in the culture medium (antiestrogenic effect). (c) The increased production of a 48,000 dalton protein which is released into the medium after treatment with several progestins (progesterone, medroxyprogesterone acetate, R5020) but not other steroids (specific progestin effect). These responses appear to be mediated by the progesterone receptor and are not observed in RP negative cell line (BT20). Even though these two types of antiestrogens inhibit cell proliferation via different receptors, a common final mechanism (decreased production of estrogen induced growth factors or increased production of antiestrogen induced inhibitory factor) is not excluded.


Methylation-mediated downregulation of the B-cell translocation gene 3 (BTG3) in breast cancer cells.
The incidence of solid tumors is low in individuals with Down syndrome (trisomy 21), suggesting the presence of one or more tumor suppressor genes on chromosome 21. Consistent with this finding, previous work has demonstrated frequent loss of heterozygosity (LOH) of a small (< 5 Mb) region of chromosome 21, particularly in breast cancer, indicating that a tumor suppressor gene(s) may be located in this region. We investigated the expression of BTG3, a gene in the LOH region on chromosome 21, in breast cancer cell lines. BTG3 has been shown to be a negative regulator of SRC tyrosine kinase, and BTG3 is a target of p53 and inhibits the activity of the E2F1 transcription factor. Here we demonstrate that in a wide variety of human breast cancer cell lines, BTG3 expression is markedly reduced in the absence of detectable mutations in the BTG3 promoter and coding region. In these cell lines, the promoter region of the BTG3 gene is hypermethylated when compared to normal breast cell lines. BTG3 gene expression can be restored by treatment with 5'-aza-deoxycytidine, an inhibitor of DNA methylation. These data support the hypothesis that BTG3 may act to suppress tumorigenesis and that hypermethylation is an important mechanism for inactivation of BTG3 and perhaps other tumor suppressor genes. The findings are consistent with a role for an additional copy of BTG3 in the reduced incidence of breast cancer in individuals with Down syndrome.


Cardiac arrest in the early stage of cardiosurgical procedure.
Cardiosurgical operations remain one of the most demanding and complicated surgical procedures. Cardiac arrest before extra corporeal circulation (ECC) is one of severe intraoperative complications which can occur in any moment of operation. We have tried to evaluate possible risk factors of intraoperative, pre-ECC cardiac arrest in cardiac surgical patients and also have tried to estimate, if such an incident itself can be a risk factor for further post-operative complications. Pre-ECC intraoperative cardiac arrest (ICA) has occurred in 28 (aged 34-9) of 1,288 cardiac surgical patients operated on in our institution between July 1998 and December 2001. In 20 of these patients (71%) CABG was a planned procedure and in the remaining eight heart valve prostheses implantation were planned. In all 28 cases ventricular fibrillation was a cause of ICA and all patients required indirect and/or direct cardiac massage up to the moment of ECC start. In the subgroup with coronary artery disease (CAD) eight patients (35%) had left main stenosis, 13 (46.4%) had myocardial infarction in medical history. In the group of valve patients mitro-aortis valve disease was diagnosed in three cases and mitro-aorto-tricuspid valve disease with CAD or mitral valve disease or aortic valve disease in single patients. ICA was the most frequent during sternotomy (eight cases), pericardium opening (seven cases) and harvesting of left internal mammary artery (LIMA). In 16 cases prolonged reperfusion was necessary after declamping of the aorta, and in two of these cases ECC re-entry was needed. Eight patients (28.6%) have died, in 14 cases (50%) low output syndrome has been diagnosed, in five cases (18%) myocardial infarction has occurred and, in nine cases (32%) different neurological complications have been found postoperatively and five patients required resternotomy. All these complications were significantly more frequent in the investigated group than in the whole population of patients. We conclude that pre-ECC ICA contributes to noticeable post-operative complications rate increase. Sternotomy and opening of pericardium are the most frequent moments when pre-ECC ICA appears. We have not found any significant preoperative risk factors for pre-ECC ICA.


Ethyl 4-acetyl-5-oxo-3-phenyl-hexa-noate.
The reaction of ethyl 3-bromo-3-phenyl-propano-ate with pentane-2,4-dione, in the presence of palladium(II) acetate and triphenyl-phosphine, in dimethyl-formamide, unexpectedly gave the title product, C(16)H(20)O(4). The mol-ecule contains one chiral C atom but the crystal is racemic. In the crystal, neighboring mol-ecules form a chain along [100] through three weak C-H⋯O inter-actions. Furthermore, a double-stranded structure is formed through weak C-H⋯O inter-actions between two parallel chains.


Simian-sarcoma-virus-related sequences in DNAs from human prostatic tissues.
Several prostatic tissue DNAs have been examined for their content of simian-sarcoma-virus-related sequences. This was done by hybridizing fragmented prostatic DNA with simian sarcoma virus complementary DNA (cDNA) synthesized in vitro. The tissue DNAs contained limited amounts of virus-related sequences. The content ranged from about 10 to 30 pg of viral DNA per milligram of cell DNA, depending on the tissue. This corresponds to approximately one viral genome equivalent per 20-100 cell genomes. A clear correlation between viral DNA content and histopathology of the tissue - normal, hyperplastic and neoplastic - has not emerged from the tissue DNAs examined thus far. The trend appeared to be for the hyperplastic tissue to contain more virus-related sequences than normal or neoplastic tissue. The melting point of hybrids of prostatic DNA and viral cDNA was 15 degrees C lower than that of native prostatic DNA. This can be interpreted to suggest that prostatic DNAs contain a distribution of short segments of sequences that hybridize with viral cDNA.


How can registries contribute to the development and evaluation of CNS therapeutics?
This article is based on the proceedings from a workshop held during the Autumn 2011 International Society for CNS Clinical Trials and Methodology (ISCTM) Conference in Amelia Island, Florida. The goal of the workshop was to establish preliminary steps in determining whether and how patient registries can augment clinical trials in the field of central nervous system therapeutics. Participants in the workshop first defined several different types of registries and then created a list of questions that should be addressed in order to determine how registries might be used. The workshop concluded with discussion on logistical and practical considerations regarding use of patient registries.


Slow magnetic relaxation mechanisms in erbium SIMs.
The magnetic properties of two similar Er(3+) complexes have been investigated. [Er(tpm)3(bipy)] (Htpm = 1,1,1-trifluoro-5,5-dimethyl-2,4-hexanedione and bipy = 2,2'-bipyridine) displays thermally activated slow relaxation of magnetisation under a zero direct-current (DC) field. Under an applied HDC field of 1000 G, [Er(tpm)3(bipy)] exhibits two thermally activated processes with energy barriers of 9 and 40 K, while [Er(tfa)3(bipy)] (Htfa = 4,4,4-trifluoro-1-(2-furyl)-1,3-butanedione) shows only one activated process with a barrier of 15 K. Both compounds are luminescent in the solid state, emitting in the near IR region.


Population-based estimates of zidovudine and aerosol pentamidine use in San Francisco: 1987-1989.
From the San Francisco Men's Health Study (SFMHS) and the San Francisco General Hospital Cohort we derived partially population-based estimates of zidovudine (ZDV) use in San Francisco from 1987 to 1989. Data from the SFMHS alone were used to make estimates of aerosol pentamidine (AP) use in 1989. From 1987 to 1989, zidovudine use increased from 36 to 68% in participants with AIDS. In participants with symptomatic HIV infection without AIDS and in those with less than 200 CD4 cells, ZDV use increased initially but then leveled off (from 6 to 25% and 24 to 55%, respectively). Zidovudine use with more than 500 CD4 cells increased from 0.5 to 4%. In 1989 AP use with less than 200 CD4 cells was 42% and with AIDS was 44%. Whereas 50% of participants with AIDS and less than 200 CD4 were using both ZDV and AP, only 14% of those without AIDS but with less than 200 CD4 cells were using both. Surprisingly few members of these cohorts are using therapies proven effective in reducing the morbidity and mortality of HIV infection.


Mesothelioma after lung transplantation.
The case history is presented of a lung transplant recipient who developed malignant mesothelioma. This is thought to be the first such report. Mesothelioma should be suspected in lung transplant recipients with a haemorrhagic pleural effusion in the native lung when there is no convincing evidence for bronchogenic carcinoma or post transplant lymphoproliferative disease, even in the absence of exposure to asbestos.


[Prevalence of intestinal metaplasia of the gastric cardia and its relation with Helicobacter pylori strains cagA and vacA].
Esophageal metaplasia progression is a consequence of chronic gastroesophageal reflux (CGR). Patients with this condition are frequently infected by Helicobacter pylori and show several symptoms including gastritis as well as ulcer formation. In addition, they present an increased risk for the development of gastric adenocarcinoma. Several pathogenic markers for Helicobacter pylori such as ureC, vacA and cagA genes have been described. Evidence indicates that direct injury to the epithelial mucosa is caused by cytotoxins and enzymes codified by these genes. We undertook this study to establish a relationship between the presence of pathogenic Helicobacter pylori strains and the presence of metaplasia progression in patients with CGR. We detected the presence of Helicobacter pylori cagA and vacA positive strains in patients with CGR. Using polymerase chain reaction, we analyzed 120 samples obtained from 60 patients with CGR and 60 control group patients, including samples from both anatomic areas: cardia and gastric antrum. We detected 56% of Helicobacter pylori positive patients; 57.5% of these patients were positive for either cagA(+) and/or vacA(+) Helicobacter pylori strains. Cardiac intestinal metaplasia was observed in 35% of the patients. A marked tendency was observed to develop cardiac intestinal metaplasia in those patients diagnosed with high-pathogenicity strains infected in both anatomic areas. These results suggest that infection with Helicobacter pylori can be considered a risk factor for developing gastric cardiac intestinal metaplasia.


Teacher Predictors of Student Progress in Data-Based Writing Instruction: Knowledge, Skills, Beliefs, and Instructional Fidelity.
Teacher-level factors are theoretically linked to student outcomes in data-based instruction (DBI; Lembke et al., 2018). Professional development and ongoing support can increase teachers' knowledge, skills, and beliefs related to DBI, as well as their instructional fidelity (McMaster et al., 2020). However, less is known about how each of these teacher-level factors influences student progress during an intervention. The purpose of this study was to examine the association between several important teacher-level factors-teachers' writing instruction fidelity, knowledge and skills related to DBI, explicit writing orientation, and writing instruction self-efficacy-and students' writing growth. Participants were 49 U.S. elementary teachers and their 118 students struggling with early writing skills. Using hierarchical linear modeling, we found a significant positive relation between DBI knowledge and skills and student writing growth, but no relation was found between writing instruction fidelity, writing orientation, or self-efficacy and student writing growth. Implications for writing instruction fidelity measurement in DBI and professional development related to teachers' DBI knowledge and skills are discussed.


Atypical glandular cells of undetermined significance. Histologic findings and proposed management.
To increase understanding of the clinical significance of atypical glandular cells of undetermined significance (AGUS) on cervical cytology and to suggest a management plan. All Pap smears classified as AGUS over a period of five years at the University of Michigan Medical Center were reviewed and the diagnosis confirmed. The charts of these patients were reviewed for demographics, significant previous medical history, symptoms, diagnostic studies performed and final histologic diagnoses. In 1993-1998, a total of 208,041 Pap smears were read. Two hundred seven smears from 189 patients were classified as AGUS, for an incidence of 0.1%. There were 136 patients with follow-up information and 114 patients with histologic diagnoses. In 55 of the 114 patients (48%), significant histologic abnormalities were observed, including 11 endometrial cancers, 1 invasive adenocarcinoma of the cervix, 3 adenocarcinomas in situ of the cervix, 18 CIN 3 lesions and 5 CIN 2 lesions. Among 20 patients with Pap smears subclassified as "atypical glandular cells of undetermined significance, favor benign process," there were two CIN 2, five CIN 3 and one adenocarcinoma in situ of the cervix. A diagnosis of AGUS requires an aggressive workup because of the high rate of cancer and precancerous lesions. The evaluation, at the very least, should include colposcopy with directed biopsies and endocervical curettage. Postmenopausal patients, those with irregular bleeding and those with high risk characteristics should also undergo endometrial biopsy.


Professionalism in Residency Training: A Compilation of Desirable Behaviors and a Case-Based Comparison Between Pathologists in Training and Practice.
Professionalism is one of the most important competencies for physicians but is also the most difficult to teach, assess, and manage. To better understand professionalism in pathology, we surveyed practicing pathologists and pathology residents and fellows in training. We identified 12 key desirable attributes of professionalism. In addition, 8 case scenarios highlighting unprofessional behavior were presented, and results between pathologists in practice and in training were compared. No significant differences between attending pathologists and residents were identified in how these cases should be managed. Our study demonstrated remarkable concordance between practicing pathologists and residents as to what constitutes professionalism and how to manage unprofessional behavior. Our case-based approach can be a useful technique to teach professionalism to both pathologists in practice and in training.


The prevalence of hepatitis C virus antibodies among hemodialysis patients in jeddah area, saudi arabia.
The prevalence of antibody to hepatitis C virus (HCV) in hemodialysis (HD) patients is high and variable. One hundred and thirty nine patients undergoing maintenance HD at three different renal units in Jeddah, Kingdom of Saudi Arabia, were studied for prevalence of anti-HCV antibody. The overall prevalence in the group examined was 52.5% (73/139). There was a significant correlation between prevalence of anti-HCV and duration of HD; 53/ 74 (71.6%) in patients on HD for > 3 years as against 20/65 (30.8%) for patients on HD for < 3 years (P< 0.05). We were unable to demonstrate a correlation of anti-HCV positivity with history of blood transfusions, previous exposure to hepatitis-B virus, sex, age, or ethnic group. The very high prevalence of anti-HCV found in patients on maintenance HD and the positive correlation between anti-HCV reactivity and duration on dialysis suggest that factors within the dialysis unit might contribute to the spread of the virus.


Petal-like MoS2 Nanosheets Space-Confined in Hollow Mesoporous Carbon Spheres for Enhanced Lithium Storage Performance.
An innovative approach for efficient synthesis of petal-like molybdenum disulfide nanosheets inside hollow mesoporous carbon spheres (HMCSs), the yolk-shell structured MoS2@C, has been developed. HMCSs effectively control and confine in situ growth of MoS2 nanosheets and significantly improve the conductivity and structural stability of the hybrid material. The yolk-shell structured MoS2@C is proven to achieve high reversible capacity (993 mA h g-1 at 1 A g-1 after 200 cycles), superior rate capability (595 mA h g-1 at a current density of 10 A g-1), and excellent cycle performance (962 mA h g-1 at 1 A g-1 after 1000 cycles and 624 mA h g-1 at 5 A g-1 after 400 cycles) when evaluated as an anode material for lithium-ion batteries. This superior performance is attributed to the yolk-shell structure with conductive mesoporous carbon as the shell and the stack of two-dimensional MoS2 nanosheets as the yolk.


Toward culture-free Raman spectroscopic identification of pathogens in ascitic fluid.
The identification of pathogens in ascitic fluid is standardly performed by ascitic fluid culture, but this standard procedure often needs several days. Additionally, more than half of the ascitic fluid cultures are negative in case of suspected spontaneous bacterial peritonitis (SBP). It is therefore important to identify and characterize the causing pathogens since not all of them are covered by the empirical antimicrobial therapy. The aim of this study is to show that pathogen identification in ascitic fluid is possible by means of Raman microspectroscopy and chemometrical evaluation with the advantage of strongly increased speed. Therefore, a Raman database containing more than 10000 single-cell Raman spectra of 34 bacterial strains out of 13 different species was built up. The performance of the used statistical model was validated with independent bacterial strains, which were grown in ascitic fluid.


Perihepatitis as an Initial Manifestation of Systemic Lupus Erythematosus.
A 25-year-old man presented with a fever and right upper quadrant abdominal pain. Computed tomography (CT) of the abdomen revealed diffuse perihepatic capsular enhancement, suggesting perihepatitis. Although the patient was a man, Fitz-Hugh-Curtis syndrome was suspected based on the CT findings. Treatment with several antibiotics was ineffective. Urinary tract infection was ruled out due to negative urinary bacterial screening and careful history taking. He was finally diagnosed with systemic lupus erythematous (malar rash, pleuritis, positive antinuclear antibody, and positive anti-ds-DNA antibody). Perihepatitis resolved quickly with high-dose prednisolone. Perihepatitis may be the first manifestation of SLE.


Do Mast Cells Have a Role in Tendon Healing and Inflammation?
Understanding the links between the tendon healing process, inflammatory mechanisms, and tendon homeostasis/pain after tissue damage is crucial in developing novel therapeutics for human tendon disorders. The inflammatory mechanisms that are operative in response to tendon injury are not fully understood, but it has been suggested that inflammation occurring in response to nerve signaling, i.e., neurogenic inflammation, has a pathogenic role. The mechanisms driving such neurogenic inflammation are presently not clear. However, it has recently been demonstrated that mast cells present within the injured tendon can express glutamate receptors, raising the possibility that mast cells may be sensitive to glutamate signaling and thereby modulate neurogenic inflammation following tissue injury. In this review, we discuss the role of mast cells in the communication with peripheral nerves, and their emerging role in tendon healing and inflammation after injury.


Assessment of the clinical significance of gelatinase activity in patients with juvenile idiopathic arthritis using quantitative protein substrate zymography.
To measure gelatinase activities in paired synovial fluid (SF) and serum of patients with juvenile idiopathic arthritis (JIA), and to assess how these activities relate to clinical and laboratory measures of disease activity. A quantitative protein substrate zymography method was adapted and validated for use with serum and SF. Bands of activity were measured by densitometry and correlated with standard laboratory indicators of inflammation: erythrocyte sedimentation rate and platelet count. Gelatinase activity was found consistently in patients with JIA, with reproducible, quantified bands of activity corresponding to pro-matrix metalloproteinase-9 (pro-MMP-9), including the neutrophil associated lipocalin complex, and pro- and active forms of MMP-2. Both active MMP-2 and pro-MMP-9 were higher in JIA serum than in controls, though no differences were seen between patients grouped according to age, disease duration, or JIA subtype. However, SF MMP-9 correlated significantly with the laboratory indicators of inflammation, as did the relative level of active MMP-2. Both MMP-2 and MMP-9 gelatinolytic activities are raised during active JIA and associated with inflammatory activity regardless of age and disease duration, supporting a role for MMPs in the breakdown of joint components from early in disease. These MMPs may be specific markers of active joint destruction linked to inflammatory JIA, MMP-9 as a product of infiltrating cells, and the activation of MMP-2 produced within the joint.


The development and validation of a multi-dimensional measure of chronic foot pain: the ROwan Foot Pain Assessment Questionnaire (ROFPAQ).
The development and validation of the ROwan Foot Pain Assessment Questionnaire (ROFPAQ) is described. This is the first attempt to develop a multi-dimensional measure of chronic foot pain, and recognizes pain as having sensory, affective and cognitive dimensions. The ROFPAQ was developed from themes that emerged from running focus groups and semi-structured interviews with people with chronic foot pain. Following piloting and selection of appropriate items by both psychometric and semantic means, the scale was found to meet the accepted criteria for validity and reliability. The final scale demonstrates better than standard readability, has a short completion time and a simple scoring method. The scale allows clinicians to determine which dimension(s) of foot pain are the most relevant to the subject, thereby aiding decisions regarding appropriate treatment. Topics for further work on the ROFPAQ are highlighted.


Surgical technique tips and pearls in rotating-platform knee arthroplasty.
Rotating-platform mobile-bearing knee arthroplasties have potential advantages over fixed-bearing knee prostheses that may lead to better long-term wear of the polyethylene articulation. Their potential disadvantages include bearing spin-out that is usually the result of a tight posterior cruciate ligament in need of release. The "slide-back test" can help determine this need during placement of the trial components. Clearing polymerized cement from the back of the knee can be difficult during rotating-platform knee arthroplasty unless cementing is completed using a trial tibial insert without a stem. Exchanging a rotating-platform insert at a future arthrotomy can be facilitated by the use of a shim that provides exposure to the polyethylene tibial post that articulates within the stem of the tibial tray. Severing the post allows extraction of the polyethylene plateau and access to the post within the tray.


TLR4 on follicular dendritic cells: an activation pathway that promotes accessory activity.
Microbial molecular patterns engage TLRs and activate dendritic cells and other accessory cells. Follicular dendritic cells (FDCs) exist in resting and activated states, but are activated in germinal centers, where they provide accessory function. We reasoned that FDCs might express TLRs and that engagement might activate FDCs by up-regulating molecules important for accessory activity. To test this hypothesis, TLR4 expression on FDCs was studied in situ with immunohistochemistry, followed by flow cytometry and RT-PCR analysis. TLR4 was expressed on FDC reticula in situ, and flow cytometry indicated that TLR4 was expressed on surface membranes and TLR4 message was readily apparent in FDCs by RT-PCR. Injecting mice or treating purified FDCs with LPS up-regulated molecules important for accessory activity including, FDC-Fc gammaRIIB, FDC-ICAM-1, and FDC-VCAM-1. Treatment of purified FDCs with LPS also induced intracellular phospho-IkappaB-alpha, indicating NF-kappaB activation, and that correlated with increased Fc gammaRIIB, ICAM-1, and VCAM-1. FDCs in C3H/HeJ mice were not activated with LPS even when mice were reconstituted with C3H/HeN leukocytes, suggesting that engagement of FDC-TLR4 is necessary for activation. Moreover, activated FDCs exhibited increased accessory activity in anti-OVA recall responses in vitro, and the FDC number could be reduced 4-fold if they were activated. In short, we report expression of TLR4 on FDCs for the first time and that engagement of FDC-TLR4 activated NF-kappaB, up-regulated expression of molecules important in FDC accessory function, including Fc gammaRIIB, ICAM-1, and VCAM-1, as well as FDC accessory activity in promoting recall IgG responses.


Determination of the isoflavonoids genistein and daidzein in biological samples by gas chromatography-mass spectrometry.
The marked differences in the incidences of both breast and prostate cancer between the East and the West have been attributed to habitual diet. Traditionally, Japanese and Far Eastern people in general consume large quantities of soya and soya-derived foodstuffs. Diphenolic soya phytoestrogens have weak oestrogenic and anti-oestrogenic properties and have been implicated in preventing or limiting the early processes associated with breast and prostate carcinogenesis. We have developed a gas chromatography-mass spectrometry procedure that is suitable for measurement of the phytoestrogens daidzein and genistein in serum, urine and tissue samples. In serum samples of Japanese subjects mean (standard deviation) concentrations of daidzein [men, 281 (375.5) nmol/L; women, 246 (369.4) nmol/L] and genistein (men, 493 (604.4) nmol/L; women, 502 (717.6) nmol/L] were approximately 15 times higher than the mean levels achieved in British men [daidzein, 18.2 (20.4) nmol/L; genistein, 34.1 (27.2) nmol/L] and women [daidzein, 13.5 (11.6) nmol/L; genistein, 30.1 (31.2) nmol/L]. In pharmacokinetic studies of British subjects, maximum levels of daidzein and genistein were achieved within 6-8 h after the consumption of a cereal bar containing 20 mg of soya isoflavonoids; these levels were very similar to the mean levels achieved in normal Japanese subjects. Unlike serum, the mean daidzein concentration in urine from British subjects was higher than the mean genistein concentration (1.66 and 0.72 micromol per 24 h, respectively); following soy supplementation, urinary isoflavonoid levels were increased at least 10-fold. Serum daidzein and genistein concentrations are lower in British subjects than in Japanese subjects; this may be due to dietary differences.


Arthritis, comorbidities, and care utilization in veterans of operations enduring and Iraqi Freedom.
Veteran populations are known to have frequencies of arthritis higher than civilian populations. The aim of this study is to define the prevalence of arthritis among a cohort of veterans from ongoing U.S. military operations. A retrospective cohort study using Veterans Administration data sources for service connected disability, comorbidities, clinic utilization, and pharmacy utilization was conducted including veterans who deployed in service to operations in Afghanistan or Iraq, comparing veterans with a diagnosis of arthritis, arthritis plus back pain, and veterans with no pain diagnoses. The frequency of arthritis was 11.8%. Veterans with arthritis and arthritis plus back pain had greater frequencies of diabetes, hyperlipidemia, hypertension, and obesity compare to veterans with no pain diagnosis. Veterans with arthritis plus back pain had the highest pain clinic utilization and prescription use of opioids and anti-inflammatories. Veterans with no pain diagnosis had higher frequencies of diagnosis and clinic utilization for mental health disorders. Arthritis is prevalent among the latest generation of combat veterans and is associated with diabetes, obesity, and cardiovascular comorbidities. The need for arthritis care and associated comorbidities is expected to increase as the Veterans Administration and the civilian health care sector assumes care of these veterans. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:682-687, 2017.


Semiquantitative Assessment of Tumor Spread through Air Spaces (STAS) in Early-Stage Lung Adenocarcinomas.
Tumor spread through air spaces (STAS) has recently been reported as a form of tumor invasion having an unfavorable prognosis, but the significance of a small amount of STAS is not known. The aim of this study was to perform a semiquantitative assessment of STAS. Small (≤2 cm) stage I lung adenocarcinomas surgically resected at our institution between 2003 and 2009 were assessed semiquantitatively in the most prominent area as no STAS, low STAS (1-4 single cells or clusters of STAS), or high STAS (≥5 single cells or clusters of STAS) by using a 20× objective and a 10× ocular lens. A statistical analysis was performed to determine the impact of clinicopathologic parameters on STAS and to clarify the relationship between STAS and patient survival. STAS was assessed as no STAS in 109 of 208 cases (52.4%), as low STAS in 38 cases (18.3%), and as high STAS in 61 cases (29.3%). There were statistically significant associations between higher STAS and solid predominant invasive adenocarcinoma (p < 0.001), pleural invasion (p < 0.001), lymphatic invasion (p < 0.001), vascular invasion (p < 0.001), and tumor size of 10 mm or more (p = 0.037). There was a significant association between increasing STAS and shorter recurrence-free survival (RFS) in univariate analysis (no STAS, 154.2 months; low STAS, 147.6 months; and high STAS, 115.6 months). In a multivariate Cox proportional hazards model, only STAS (p = 0.015) remained a significant predictor of RFS. We found that one-third of resected small adenocarcinomas had high STAS. Higher STAS was predictive of worse RFS.


Acute alcohol toxicity and withdrawal in the emergency room and medical admissions unit.
Alcohol-related hospital attendances and admissions continue to escalate despite a fall in alcohol consumption levels in the UK population overall. People with alcohol-related problems pose a significant and often disproportionate burden on acute medical services as their management is often complex and challenging. This article focuses on the management of alcohol intoxication, with particular emphasis on aggressive and possibly violent behaviour; alcohol withdrawal; fitting; and the prevention and treatment of Wernicke's encephalopathy.


Enzymatic hydrolysis of Alaska pollack (Theragra chalcogramma) skin and antioxidant activity of the resulting hydrolysate.
Fish skin, a by-product of the food industry, contains a large amount of collagen. However, only a small proportion of fish skin is used in the production of leather materials and animal feedstuffs, most of it being discarded. The aims of this study were to prepare peptides from Alaska pollack (Theragra chalcogramma) skin by enzymatic hydrolysis and to evaluate the antioxidant activity of the resulting hydrolysate. Protamex was the most efficient enzyme for preparing antioxidant peptides from Alaska pollack skin. The optimal hydrolysis conditions were as follows: hydrolysis time 8 h; enzyme/substrate ratio 2:1000; skin/water ratio 1:6; temperature 55 degrees C; pH 6.0. Under these conditions the highest yield of peptides was 83.44%, with 85.95% of the hydrolysate being mainly composed of oligopeptides with molecular weights ranging from 180 to 1000 Da. The hydrolysate showed 2,2-diphenyl-1-picrylhydrazyl radical-scavenging activity, with an IC(50) value of 2.5 mg mL(-1), and its reducing power was 0.14 at 1 mg mL(-1), 53.8% of that of reduced glutathione at the same concentration. This study demonstrated that the hydrolysate of Alaska pollack skin was mainly composed of oligopeptides with two to eight amino acid residues and possessed antioxidant activity.


Solvent Drives Switching between Λ and Δ Metal Center Stereochemistry of M8L6 Cubic Cages.
An enantiopure ligand with four bidentate metal-binding sites and four (S)-carbon stereocenters self-assembles with octahedral ZnII or CoII to produce O-symmetric M8L6 coordination cages. The Λ- or Δ-handedness of the metal centers forming the corners of these cages is determined by the solvent environment: the same (S)-ligand produces one diastereomer, (S)24-Λ8-M8L6, in acetonitrile but another with opposite metal-center handedness, (S)24-Δ8-M8L6, in nitromethane. Van 't Hoff analysis revealed the Δ stereochemical configuration to be entropically favored but enthalpically disfavored, consistent with a loosening of the coordination sphere and an increase in conformational freedom following Λ-to-Δ transition. The binding of 4,4'-dipyridyl naphthalenediimide and tetrapyridyl Zn-porphyrin guests did not interfere with the solvent-driven stereoselectivity of self-assembly, suggesting applications where either a Λ- or Δ-handed framework may enable chiral separations or catalysis.


Metastasis of Primary Cutaneous Adenoid Cystic Carcinoma to the Nasal Septum after 17 years: A Case Report.
Primary cutaneous adenoid cystic carcinoma (PCACC) is extremely rare, and although distant metastasis has been reported, to date, there are no reports regarding metastasis to the nasal septum. We report a rare case of PCACC that metastasized to the nasal septum 17 years after the first surgery in a 59-year-old woman. She initially presented with a mass under the skin of her left mammary papilla. After a biopsy revealed the presence of an adenoid cystic carcinoma, the tumor was excised and definitively diagnosed as a PCACC. Five years after surgery, the patient presented with left lung metastasis and underwent a partial resection of the left lung. However, 8 years after this procedure, the patient had to undergo a partial resection of the right lung because of right lung metastasis. Four years thereafter, the patient presented with nasal septal metastasis. The tumor was excised successfully using a combined technique integrating intranasal and extranasal approaches. The patient is currently undergoing regular follow-up tests. Thus, in such cases, lifelong follow-up is necessary while checking for both distant metastasis and instances of local recurrence.


Acute Paraplegia due to Thoracic Hematomyelia.
Spontaneous intraspinal intramedullary hemorrhage is a rare entity with the acute onset of neurologic symptoms. The etiology of idiopathic spontaneous hematomyelia (ISH) is unknown, and there are few published case reports. Hematomyelia is mostly associated with trauma, but the other nontraumatic etiologies are vascular malformations, tumors, bleeding disorders, syphilis, syrinx, and myelitis. MRI is a good choice for early diagnosis. Hematomyelia usually causes acute spinal cord syndrome due to the compression and destruction of the spinal cord. A high-dose steroid treatment and surgical decompression and evacuation of hematoma are the urgent solution methods. We present idiopathic spontaneous hematomyelia of a previously healthy 80-year-old male with a sudden onset of back pain and paraplegia.


Removing own-limb visual input using mixed reality (MR) produces a "telescoping" illusion in healthy individuals.
The purpose of the present study was to assess changes in body perception when visual feedback was removed from the hand and arm with the purpose of resembling the visual deprivation arising from amputation. The illusion was created by removing the visual feedback from the participants' own left forearm using a mixed reality (MR) and green screen environment. Thirty healthy persons (15 female) participated in the study. Each subject experienced two MR conditions, one with and one without visual feedback from the left hand, and a baseline condition with normal vision of the limb (no MR). Body perception was assessed using proprioceptive drift, questionnaires on body perception, and thermal sensitivity measures (cold, warm, heat pain and cold pain detection thresholds). The proprioceptive drift showed a significant shift of the tip of the index finger (p<0.001) towards the elbow in the illusion condition (mean drift: -3.71 cm). Self-report showed a significant decrease in ownership (p<0.001), shift in perceptual distortions, (e.g. "It feels as if my lower arm has become shorter") (p=0.025), and changes in sensations of the hand (tingling, tickling) (p=0.025). A significant decrease was also observed in cold detection threshold (p<0.001), i.e. the detection threshold was cooler than for the control conditions. The proprioceptive drift together with the self-reported questionnaire showed that the participants felt a proximal retraction of their limb, resembling the telescoping experienced by phantom limb patients. The study highlights the influence of missing visual feedback and its possible contribution to phantom limb phenomena.


Inhibition of Heat Shock Protein 90 as a Novel Platform for the Treatment of Cancer.
Heat shock protein 90 (Hsp90) plays an essential role in various physiological and pathological processes. It activates client proteins to participate in tumor progression. Blocking Hsp90 could enable effective antitumor effects in many tumor types, such as multiple myeloma and colon cancer. Recently, it has motivated an interest in Hsp90 inhibitors that bind to the N-terminal or C-terminal ATP pocket as antitumor drugs. We reviewed the data from experimental and clinical trials on Hsp90 inhibitors in the treatment of different malignancies to explore and summarize their antitumor mechanisms.


Alcoholic ketoacidosis evaluated with a point-of-care capillary beta-hydroxybutyrate measurement device.
The diagnosis of alcoholic ketoacidosis (AKA) has traditionally been made based only on clinical history and the presence of severe metabolic acidosis with a high anion gap (AG); however, the concentration of beta-hydroxybutyrate (BOHB), a pivotal ketone body in AKA, is not evaluated in most cases. The aim of this study was to clarify the clinical spectrum of AKA in terms of the severity of ketoacidosis by using a point-of-care capillary BOHB measurement device. This retrospective case series was conducted at a Japanese private teaching hospital. Patients with suspected AKA, based on their clinical history, who underwent BOHB measurement using a point-of-care capillary measurement device in the emergency department, were included. Data on their clinical presentations, blood tests, and treatments were collected, described, and compared between patients with a BOHB concentration higher than 3.0 mmol/L (H-BOHB) and those with a concentration less than 3.0 mmol/L (L-BOHB). A total of 83 patients were included in this study. Sixty-eight patients were categorized as having H-BOHB and 15 as having L-BOHB. Nausea (71%), vomiting (71%), tachycardia (76%), and tachypnea (46%) were commonly observed at presentation. Hyponatremia (46%), hypokalemia (34%), hypomagnesemia (42%), and hyperphosphatemia (41%) were frequent electrolyte abnormalities upon presentation. Rehydration with balanced crystalloids and glucose-containing intravenous fluids, electrolyte supplementation, and thiamine replacement were the major treatments. The mean length of stay in the ICU and hospital were 4.4 and 7.0 days, respectively, with low overall mortality (1%). The H-BOHB and L-BOHB groups did not differ in terms of clinical data. Seventy percent of patients with L-BOHB had severe metabolic acidosis with a high AG due to hyperlactatemia (mean lactate concentration: 8.5 mmol/L). We described the clinical features of AKA measured by using a point-of-care capillary BOHB measurement device. Although certain patients diagnosed with AKA based only on their clinical history had predominant lactic acidosis with minor elevations in BOHB concentration, the BOHB concentration had no effect on the clinical spectrum of AKA in this study.


Change gout: how to deal with this "silently-developing killer" in everyday clinical practice.
Despite being regarded as an easily-treatable disease, gout diagnosis and management can be challenging. This review discusses current issues in gout management and proposes some potential solutions. Gout diagnosis should be reached as early as possible and often requires specific tests, such as synovial fluid analysis or imaging techniques that are not available in most centers, leaving healthcare professionals to rely only on clinical presentations and their experience. In addition, gout management requires the evaluation of multiple aspects, such as monitoring of serum uric acid (sUA) level (which should be reduced to <6 mg/dL) to ensure adherence and efficacy of treatment, evaluation of patient's risk profile and comorbidities, and continuous assessments to manage clinical manifestations. An important premise in gout management is non-pharmacological intervention; however, pharmacological urate-lowering therapy is crucial for an optimal control of the disease. Available options include xanthine-oxidase inhibitors (XOI), targeting uric acid overproduction, and uricosuric agents which target the predominant cause of hyperuricemia (under-excretion). Among these, lesinurad is the novel uricosuric agent to be used in combination with XOI in patients with gout not adequately controlled with XOI alone, which can further contribute to the control of hyperuricemia in gout. Multidisciplinary management is crucial for the diagnosis and treatment of gout, in order to ensure treatment continuity and improve management. This review, therefore, advises that educational activities for General Practitioners and specialists should be implemented to help raise awareness on gout diagnosis, monitoring, and treatment.


Race/Ethnicity Modifies the Relationship Between Diet Quality at the Home- and Individual-Levels and Weight Status Among African American and Hispanic/Latinx Households With Preschool-Age Children.
Background: Higher obesity prevalence and poorer diet quality disproportionately impacting groups based on income and race/ethnicity may be partially attributed to the home food environment. This study examined home- and individual-level diet quality with weight status among racially/ethnically diverse households. Methods: This cross-sectional study included African American (AA) and Hispanic/Latinx (H/L) households with preschool-age children (n = 97). Home-level diet quality was based on comprehensive home food inventories and individual-level diet quality was based on 24-hour dietary recalls; scores were estimated with the Healthy Eating Index. Child and adult appropriate weight categories based on BMI were estimated with measured heights and weights. Multiple linear regression models (independent variable: weight status, outcome: diet quality scores) with an interaction term for weight status and race/ethnicity and adjusting for potential confounding factors were used to estimate adjusted mean diet quality scores. Postestimation pairwise comparisons of these scores were used to look for within and between group differences by weight status and race/ethnicity. Results: Home-level diet quality scores were significantly higher among H/L households compared to AA counterparts regardless of weight status. AA parents with BMI <30 and AA children with BMI <85th percentile had poorer individual-level diet quality scores compared to AA parents and children of lower weight status and all H/L parents and children. Conclusions: These findings offer evidence that race/ethnicity modifies the relationship between diet quality and weight among AA and H/L households. Future research needs to examine the distinctive ways race/ethnicity shapes the relationship between weight and diet quality in these households.


[Pathogenic concepts, nosological limits and diagnostic criteria of Behçet's disease].
Behçet's disease, a multi-system disease, raises aetiological and classification problems. Its aetiology is unknown, although several factors have been incriminated in its pathogenesis: immunogenetic, toxic, viral, hormonal,... It overlaps with several groups of diseases: seronegative spondyloarthritis, connective tissue diseases, angiitis, uveomeningitis and aphthosis. Several diagnostic criteria proposed by various authors are discussed.


Influence of esmolol on requirement of inhalational agent using entropy and assessment of its effect on immediate postoperative pain score.
Beta-blockers have been used for attenuation of stress response, decreasing anaesthetic requirement and augmentation of the effect of opioids during general anaesthesia. The present study aims to evaluate the influence of esmolol on the requirement of an inhalational agent while monitoring the depth of anaesthesia by entropy and also its effect on immediate postoperative pain score. Fifty American Society of Anaesthesiologists (ASA) I and II patients, between 25 and 65 years of age who underwent lower abdominal surgeries were randomly allocated to two groups: Group E and Group S of 25 patients each. Group E received esmolol infusion while Group S received the same volume of saline infusion. Demographic data, haemodynamics, amount of isoflurane used, end-tidal isoflurane concentration, postoperative pain score and total dose of morphine consumed in immediate postoperative period of 30 min were analyzed by using appropriate statistical tests. Value of P<0.05 was considered significant and P<0.001 as highly significant. The two groups were comparable with respect to age, weight, ASA physical status, duration of surgery and amount of isoflurane used during anaesthesia. Assessment of postoperative pain was assessed by Visual Analogue Scale (VAS) which showed significant difference at 30 min. The total dose of morphine consumption was significantly less (P<0.05) in Group E for relief of postoperative pain. We conclude that in light of depth of anaesthesia monitor esmolol has no effect on requirement of isoflurane, but it decreases the postoperative pain as well as postoperative requirement of morphine without increasing the risk of awareness.


The Utility of the Modified Frailty Index in Outcome Prediction for Elderly Patients with Acute Traumatic Subdural Hematoma.
This study aimed to evaluate the utility of the 11-variable modified Frailty Index (mFI) in prognosticating elderly patients with traumatic acute subdural hematomas (aSDHs). A state-service level 1 trauma center registry was interrogated to investigate consecutive patients ≥65 years of age presenting with traumatic aSDH, with or without major extracranial injury, between January 2013 and December 2017. mFI on admission, demographics, and admission details, including Glasgow Coma Scale (GCS) and pupillary status and radiological findings, were retrospectively retrieved from institutional records. Clinical outcome data were retrieved from medical records and the Victorian State Trauma Registry (VSTR). Outcome measures were 1) 30-day mortality and 2) 6-month unfavorable outcome, defined by the Extended Glasgow Outcome Scale (GOS-E). Five hundred twenty-nine consecutive cases were identified from the registry. Demographic data included: 1) age (median; interquartile range) = 80.46; 74.17-85.89; 2) mFI (mean ± standard deviation) = 1.96 ± 1.42 of 11 variables. Four hundred sixteen cases (79%) had complete outcome data. As mFI increased from 0/11 variables to ≥5/11 variables (≥0.45), 30-day mortality risk increased from 17.72% to 39.29% (p = 0.023) and 6-month unfavorable outcome risk increased from 40.51% to 96.43% (p < 0.001). Multi-variate analysis showed that greater mFI score of ≥3/11 variables (≥0.27) suggested a significantly higher risk of 30-day mortality (p = 0.009) and unfavorable outcome (p < 0.001). We conclude that increasing frailty, as measured by the mFI, was associated with significantly higher risk of 30-day mortality and 6-month unfavorable outcome in elderly patients presenting with aSDH to a level 1 neurotrauma center. Assessment of mFI in elderly patients with aSDH may be a useful determinant of outcome for this rapidly growing population.


[HIGH VOLTAGE ELECTRIC INJURY: MECHANISM OF INJURY, CLINICAL FEATURES AND INITIAL EVALUATION.]
Electrical injury is an infrequent but potentially devastating form of multisystem injury associated with high morbidity and mortality. Despite significant improvement in injury prevention and implementation of safety protocols at work places, electrical injury accounts for more than 500 deaths per year in the United States with a mortality rate of 10-30%. Electrical injuries are traditionally divided into low-voltage electric power injuries (less than 1,000V) and high-voltage )more than 1,000V). In contrast with other types of trauma, high voltage injuries present some rather unique problems that require a high index of suspicion and awareness of all possible manifestations. Electrical injury should be viewed and managed as a multisystem injury, since there is virtually no organ that is protected against it. The most essential concept of successful management of patients who sustain high voltage injury is that there is no relationship between skin burn, vital organs involvement and severity of injuries. This review aims to provide a comprehensive overview of reported high voltage electrical injury manifestations in an attempt to gain a better understanding of the distribution of morbidity and clinical features of the injury. We tried to encompass most of the reported cases of high voltage electrical injuries in order to give the readers a general view of the spectrum of injuries that can be encountered in victims suffering high voltage current, aiming to increase the awareness of emergency care and trauma teams to this rare but dangerous and potentially fatal type of injury.


[The role of the novel hypothalamic peptide PACAP in regulating endocrine functions].
During last ten years in the hypothalamus various neuropeptides have been identified. These peptides play the role of neurotransmitters, neuromodulators, neurohormones, regulator substances in neuroendocrine neurones etc. The last discovery of a novel neuropeptide was determined by experimental results suggested that the ovine hypothalamus contains an unknown substance, which simulated adenylate cyclase level in the pituitary cells culture. This substance is a novel 38 acid peptide named as pituitary adenylate cyclase activating polypeptide (PACAP). Recently PACAP complementary DNA has been cloned in human and some species of mammals. Besides the localization of PACAP-synthetizing neurones have described in the mammalian brain. Moreover PACAP was detected in the hypophysial and general circulation. Since the information about PACAP has not published in Russia. So far the review is dedicated to analyzing of foreign literature as well author's own data on biochemistry, molecular biology, neuroanatomy and physiology of PACAP-synthetizing structures in the hypothalamo-hypophysial neuroendocrine complex.


Cross-cultural adaptation, translation, and validation of the functional assessment scale for acute hamstring injuries (FASH) questionnaire for French-speaking patients.
Study design: This consisted of a translation and validation study.Background: Acute hamstring injury is a frequent muscle strain in sports that require high explosive strength, impulsion or running phases. Therefore, the Functional Assessment Scale for Hamstring Injury questionnaire was developed to assess pain, physical activity level and ability to perform various exercises in patients with hamstring injuries. The Functional Assessment Scale for Hamstring Injury questionnaire is currently available in English, German, and Greek.Objectives: The goal of this study was to provide a cross-culturally adapted French-translation of the FASH questionnaire and to assess its psychometric performance.Methods: The French-translation and cross-cultural adaptation process were based on international recommendations, following six rigorous steps: (a) two initial translations from English to French; (b) synthesis of the two translations; (c) back-translations; (d) comparisons between the back-translations and the original questionnaire by an expert committee; (e) pretest; and (f) approval of the final French version of the Functional Assessment Scale for Hamstring Injury questionnaire. To validate this French version, 116 subjects (17 pathological patients, 19 patients with other muscle injury, 40 athletes at risk, and 40 healthy control athletes) were recruited to complete the Functional Assessment Scale for Hamstring Injury questionnaire. The Short Form Health Survey (SF-36) was used as a comparative questionnaire. The psychometric properties of the questionnaire were evaluated by determining the test-retest reliability after a 48-60-h interval, internal consistency, construct validity, and floor/ceiling effects.Results: All of the items of the Functional Assessment Scale for Hamstring Injury questionnaire were translated without any major difficulties. The questionnaire showed excellent discriminative power by obtaining significantly different scores from the four groups (p = 0.01). Regarding psychometric performances, the test-retest reliability was excellent (IntraClass Coefficient Correlation of 0.997). Very high internal consistency was also observed (Cronbach's alpha of 0.969). Correlations with the physical health subscales of the SF-36 were significant and considered to be strong, indicating an excellent convergent validity. The other subscales of the SF-36 (mental health) were weakly correlated with the FASH, reflecting good divergent validity. No floor or ceiling effects were observed.Conclusion: The French-translation of the Functional Assessment Scale for Hamstring Injury questionnaire and its cross-cultural adaptation can be considered to be successful. Functional Assessment Scale for Hamstring Injury-French questionnaire is now a reliable and valid tool for patients suffering from acute hamstring injury, and its application in clinical practice is particularly relevant.Implications for rehabilitationThe FASH-F can be considered to be discriminant, reliable and valid for the evaluation of the severity of symptoms and sports ability in individuals with hamstring injuries.FASH-F is now a reliable and valid tool for French-speaking patients suffering from acute hamstring injury, and its application in clinical practice is particularly relevant.A limitation of our study could be that the distribution between the different study groups was not homogeneous implying that our findings may not be fully representative of the general population.


Is there a lesser hyperparathyroidism in diabetic patients with chronic renal failure?
Diabetic patients on dialysis have lower levels of parathyroid hormone (PTH); however, there is no data regarding PTH levels with different degrees of chronic renal failure (CRF). We compared 58 diabetic patients with different degrees of CRF with 268 non-diabetic patients with CRF (serum creatinine >1.2 mg/dl). In both groups, we investigated the main biochemical parameters together with plasma calcium, phosphorus, magnesium, PTH and calcitriol. Diabetic patients showed lower levels of PTH than non-diabetics (P=0.003). The differences were observed in patients with creatinine clearance <70ml/min. We also observed differences in phosphorus, magnesium and tubular resorption of phosphate. In the group of diabetic patients, serum glucose correlated inversely with PTH. Our study suggests that poor control of diabetes (hyperglycaemia) may play a role in the pathogenesis of the hypoparathyroidism observed in patients with diabetes and CRF.


Assessment of the ecological effects of arsenic on a southern Ohio, USA stream.
Davis Creek is a southern Ohio, USA stream that receives a permitted discharge from the Belpre Elastomers Plant (BEP). A sediment quality triad investigation of Davis Creek was conducted over a 2-y period that included sediment and surface water chemistry measurements, toxicity tests of whole sediment, interstitial and surface water, and benthic and artificial substrate community assessments. The concentration of arsenic in surface and interstitial water was below United States Environmental Protection Agency ambient water quality criteria and was not toxic in laboratory tests (Ceriodaphnia dubia, Pimephales promelas). Similarly, sediments did not significantly affect survival and growth of Hyalella azteca and Chironomus tentans at most sampling locations despite sediments exceeding arsenic sediment screening values in nearly all samples collected. Differences in benthic community structure, determined by rapid bioassessment and Hester-Dendy sampling methods, were related primarily by variations in sediment moisture, particle size, and ammonia and not to arsenic concentrations. The Invertebrate Community Index (ICI) for Davis Creek was lower than values established for other warm-water ecoregional reference streams in Ohio. However, this ICI comparison may have been invalid because, unlike the reference streams, the Davis Creek watershed is small with intermittent headwater flow that limits macroinvertebrate recruitment and energy input. The sediment quality triad investigation indicated that Davis Creek was not significantly affected by arsenic associated with the BEP discharge despite having measured arsenic concentrations that exceeded sediment screening values.


Burnout and self-actualization in public school teachers.
Public school teachers (N = 211) in six northwestern Ohio school districts completed the Maslach Burnout Inventory (MBI), Shostrom's Personal Orientation Inventory (POI), and a brief, biographic questionnaire. The responses to the MBI produced the three factors previously named by Maslach as Emotional Exhaustion, Depersonalization, and Personal Accomplishment. Each of the three scales correlated with the summed POI score (r = -.28, -.22, and .35, respectively) and produced high to moderate levels of internal consistency (alphas of .92, .85, and .88, respectively). Teachers with more students tended to produce higher scores on the Depersonalization scale.


Halo Assay for Toxic Peptides and Other Compounds in Microorganisms.
We describe an assay for determination of toxicity in S. cerevisiae involving spotting of a toxic peptide on a lawn of yeast cells. This assay may be generalized to determine toxicity of a variety of compounds by substituting a putative toxic compound in place of the peptide. The general protocol may also be used to determine toxicity of any small compound toward another microorganism by replacing S. cerevisiae with the target microbe and modifying growth conditions accordingly. Di-/tripeptides are one of the major sources of nitrogen, carbon, and amino acids for all organisms. Synthetic peptides containing a toxic amino acid residue provide an experimental approach to measure peptide transport and/or utilization in Saccharomyces cerevisiae. Hydrolysis of internalized peptides by intracellular peptidases or proteases releases the toxic residue leading to an easily detectable zone (halo) of growth arrest on a lawn of cells plated in a Petri plate. For example, upon intracellular hydrolysis the toxic peptide Ala-Eth releases ethionine (Eth), a methionine antagonist which interferes with the incorporation of amino acids into proteins and with the normal methylation of DNA and other methylation pathways, thereby leading to cell death. When spotted onto a lawn of yeast cells, the transported dipeptide Ala-Eth will inhibit growth, and a clear 'halo' will form in the lawn of cells around the region where the Eth-containing toxic peptide is spotted (Figure 1A). The assay described here for determination of peptide toxicity in S. cerevisiae may be generalized as follows: (1) it may be modified to determine toxicity of any substrate by simply using a putative toxic compound in place of a peptide containing a toxic amino acid, or (2) it may be modified to determine toxicity of a substrate toward any microorganism by replacing S. cerevisiae in the assay with the target organism. It is a simple, inexpensive and relatively rapid method for determining substrate toxicities as modified for the specific organism and toxic moiety assayed.


Tunability of aluminum nitride acoustic resonators: a phenomenological approach.
A phenomenological approach is developed to identify the physical parameters causing the dc-voltage-induced tunability of aluminum nitride (AlN) acoustic resonators, widely used for RF filters. The typical resonance frequency of these resonators varies from 2.038 GHz at -200 V to 2.062 GHz at +200 V. This indicates, based on these RF measurements versus dc bias and the model used, that the AlN stiffness variation versus dc bias is the prominent effect because both resonance and antiresonance experience a similar variation, respectively, 24 MHz and 19 MHz at 400 V. Picosecond ultrasonics were also used to prove independently that the acoustic velocity (and therefore AlN stiffness) is sensitive to dc bias and that the variation induced is comparable to that extracted from the resonance measurements. It turned out that the stiffness relative variation for an electric field of 1 V/μm extracted from picosecond ultrasonics is 54 ppm-μm/V. This is in good agreement with the value extracted from the RF measurements, namely 57.2 ppm-μm/V. The overall tunability of these AlN resonators reaches 1.1%, which is an interesting figure, although probably not high enough for genuine applications.


Nonconvex-sparsity and Nonlocal-smoothness Based Blind Hyperspectral Unmixing.
Blind hyperspectral unmixing (HU), as a crucial technique for hyperspectral data exploitation, aims to decompose mixed pixels into a collection of constituent materials weighted by the corresponding fractional abundances. In recent years, nonnegative matrix factorization (NMF) based methods have become more and more popular for this task and achieved promising performance. Among these methods, two types of properties upon the abundances, namely the sparseness and the structural smoothness, have been explored and shown to be important for blind HU. However, all of previous methods ignores another important insightful property possessed by a natural hyperspectral images (HSI), non-local smoothness, which means that similar patches in a larger region of an HSI are sharing the similar smoothness structure. Based on previous attempts on other tasks, such a prior structure reflects intrinsic configurations underlying a HSI, and is thus expected to largely improve the performance of the investigated HU problem. In this paper, we firstly consider such prior in HSI by encoding it as the nonlocal total variation (NLTV) regularizer. Furthermore, by fully exploring the intrinsic structure of HSI, we generalize NLTV to non-local HSI TV (NLHTV) to make the model more suitable for the bind HU task. By incorporating these two regularizers, together with a non-convex log-sum form regularizer characterizing the sparseness of abundance maps, to the NMF model, we propose novel blind HU models named NLTV/NLHTV and log-sum regularized NMF (NLTV-LSRNMF/NLHTV-LSRNMF), respectively. To solve the proposed models, an efficient algorithm is designed based on alternative optimization strategy (AOS) and alternating direction method of multipliers (ADMM). Extensive experiments conducted on both simulated and real hyperspectral data sets substantiate the superiority of the proposed approach over other competing ones for blind HU task.


Double-Stranded RNA High-Throughput Sequencing Reveals a New Cytorhabdovirus in a Bean Golden Mosaic Virus-Resistant Common Bean Transgenic Line.
Using double-strand RNA (dsRNA) high-throughput sequencing, we identified five RNA viruses in a bean golden mosaic virus (BGMV)-resistant common bean transgenic line with symptoms of viral infection. Four of the identified viruses had already been described as infecting common bean (cowpea mild mottle virus, bean rugose mosaic virus, Phaseolus vulgaris alphaendornavirus 1, and Phaseolus vulgaris alphaendornavirus 2) and one is a putative new plant rhabdovirus (genus Cytorhabdovirus), tentatively named bean-associated cytorhabdovirus (BaCV). The BaCV genome presented all five open reading frames (ORFs) found in most rhabdoviruses: nucleoprotein (N) (ORF1) (451 amino acids, aa), phosphoprotein (P) (ORF2) (445 aa), matrix (M) (ORF4) (287 aa), glycoprotein (G) (ORF5) (520 aa), and an RNA-dependent RNA polymerase (L) (ORF6) (114 aa), as well as a putative movement protein (P3) (ORF3) (189 aa) and the hypothetical small protein P4. The predicted BaCV proteins were compared to homologous proteins from the closest cytorhabdoviruses, and a low level of sequence identity (15⁻39%) was observed. The phylogenetic analysis shows that BaCV clustered with yerba mate chlorosis-associated virus (YmCaV) and rice stripe mosaic virus (RSMV). Overall, our results provide strong evidence that BaCV is indeed a new virus species in the genus Cytorhabdovirus (family Rhabdoviridae), the first rhabdovirus to be identified infecting common bean.


In vivo promoter analysis on refeeding response of hepatic sterol regulatory element-binding protein-1c expression.
Sterol regulatory element-binding protein (SREBP)-1c is the master regulator of lipogenic gene expression in liver. The mRNA abundance of SREBP-1c is markedly induced when animals are refed after starvation, although the regulatory mechanism is so far unknown. To investigate the mechanism of refeeding response of SREBP-1c gene expression in vivo, we generated a transgenic mouse model that carries 2.2kb promoter region fused to the luciferase reporter gene. These transgenic mice exhibited refeeding responses of the reporter in liver and adipose tissues with extents essentially identical to those of endogenous SREBP-1c mRNA. The same results were obtained from experiments using adenovirus-mediated SREBP-1c-promoter-luciferase fusion gene transduction to liver. These data demonstrate that the regulation of SREBP-1c gene expression is at the transcription level, and that the 2.2kb 5'-flanking region is sufficient for this regulation. Moreover, when these transgenic or adenovirus-infected mice were placed on insulin-depleted state by streptozotocin treatment, the reporter expression was upregulated as strongly as in control mice, demonstrating that this regulation is not dominated by serum insulin level. These mice are the first models to provide the mechanistic insight into the transcriptional regulation of SREBP-1c gene in vivo.


The involvement of Nek2 and Notch in the proliferation of rat adrenal cortex triggered by POMC-derived peptides.
The adrenal gland is a dynamic organ that undergoes constant cell turnover. This allows for rapid organ remodeling in response to the physiological demands of the HPA axis, which is controlled by proopiomelanocortin (POMC)-derived peptides, such as adrenocorticotropic hormone (ACTH) and N-Terminal peptides (N-POMC). In the rat adrenal cortex, POMC-derived peptides trigger a mitogenic effect, and this process increases cyclins D and E, while inhibiting p27Kip1. The goal of the present study was to further explore the mitogenic effect of ACTH and synthetic N-POMC1-28 peptides by investigating the differences in the expression of key genes involved in the cell cycle of the rat adrenal cortex, following inhibition of the HPA axis. Moreover, we evaluated the differences between the inner and outer fractions of the adrenal cortex (ZF-fraction and ZG-fraction) in terms of their response patterns to different stimuli. In the current study, the inhibition of the HPA axis repressed the expression of Ccnb2, Camk2a, and Nek2 genes throughout the adrenal cortex, while treatments with POMC-derived peptides stimulated Nek2, gene and protein expression, and Notch2 gene expression. Furthermore, Notch1 protein expression was restricted to the subcapsular region of the cortex, an area of the adrenal cortex that is well-known for proliferation. We also showed that different regions of the adrenal cortex respond to HPA-axis inhibition and to induction with POMC-derived peptides at different times. These results suggest that cells in the ZG and ZF fractions could be at different phases of the cell cycle. Our results contribute to the understanding of the mechanisms involved in cell cycle regulation in adrenocortical cells triggered by N-POMC peptides and ACTH, and highlight the involvement of genes such as Nek2 and Notch.


Body stalk anomaly in a monochorionic-diamniotic twin pregnancy - case report and review of the literature.
Body stalk anomaly (BSA) is a rare abdominal defect, generally considered to be lethal. Reported prevalence ranges from 0.4 to 3.2 per 100 000 live births. An early prenatal diagnosis offers the possibility of parental counseling and the termination of pregnancy. Also called limb-body wall complex, the anomaly is characterized by finding the intrathoracic and abdominal organs outside the cavity comprised by amnio-peritoneal membrane attached directly to the placenta and the umbilical cord short or absent. We report a case of BSA in a monochorionic-diamniotic twin pregnancy, diagnosed antenatal by the massive midline thoraco-abdominal wall defect, severe scoliosis and absent umbilical cord, presented at fetal ultrasound first trimester examination; portions of the heart, kidney and lung were contained into the placenta. The second fetus was echographically normal. At 18 weeks of gestation, a recommended amniocentesis exam was performed, an abnormal karyotype being excluded through this method. At 33 weeks of gestation, the patient presented with spontaneous preterm rupture of membranes. Delivery occurred by emergency Caesarean section for acute fetal distress; extracted first live fetus was admitted in the neonatal intensive care; the second live fetus with a severe thoraco-abdominal wall defect, fragments of organs included into the placental mass and severe reduction defect of the inferior right limb, deceased at 30 minutes from delivery. The fetus together with the placenta has been sent for histopathological exam. Clinical examination confirmed the diagnosis suspected by ultrasound examination. There are only a few reports in the literature about BSA in multiple gestations, and fewer about twin pregnancies in which only one fetus was affected by this condition.


Dissipation in molecular junctions.
A recently developed theory that formulates the phenomena of inelastic transport and current-driven dynamics in molecular-scale electronics within a time-dependent scattering approach is extended to account for dissipation of the current-induced excitation through coupling to electrode phonons and electron-hole pairs. Our approach treats the electronic transport, the nuclear dynamics, and the energy and phase exchange between the electronic and the vibrational subspaces in the course of the inelastic scattering event within the Schrodinger picture, whereas the dissipation of the energy deposited in the nuclear modes is accounted for within a density matrix approach. Subsequent to formulation of the theory in terms of population relaxation and phase decoherence rates, we develop approaches for computing these rates, treating on equal footing the dissipation due to excitation of electron-hole pairs and that due to the interaction with phonons. Finally, we test the derived rates by application to the model problem of CO adsorbed on metal surfaces, an example that has been extensively studied previously and for which several experimental results are available for comparison.


Status and Risk Factors in Patients Requiring Unplanned Intensive Care Unit Readmission Within 48 Hours: A Retrospective Propensity-Matched Study in China.
This study investigated the current status and related risk factors of 48-hour unplanned return to the intensive care unit (ICU) to reduce the return rate and improve the quality of critical care management. Data were collected from 2365 patients discharged from the comprehensive ICU. Multivariate and 1:1 propensity score matching analyses were performed. Forty patients (1.69%) had unplanned readmission to the ICU within 48 hours after transfer. The primary reason for return was respiratory failure (16 patients, 40%). Furthermore, respiratory failure (odds ratio [OR] = 5.994, p = 0.02) and the number of organ failures (OR = 5.679, p = 0.006) were independent risk factors for unplanned ICU readmission. Receiver operating characteristic curves were drawn for the predictive value of the number of organ injuries during a patient's unplanned transfer to the ICU (area under the curve [AUC] = 0.744, sensitivity = 60%, specificity = 77.5%). The reason for patient transfer and the number of organ injuries during the process were independent risk factors for patients who were critically ill. The number of organs damaged had a predictive value on whether the patient would return to the ICU within 48 hours.


[The first dentist in Tärna--a story with many turnabouts].
This article is about a Norwegian dentist who in 1911 applied for permission to practice in Tärna, a Swedish community bordering on Norway in the North of Sweden. The application passed local and central authorities but the government refused.


Multidisciplinary diagnosis and management of orofacial pain.
Dentistry has enjoyed a remarkable period of technological and scientific growth over the past several decades. With the increase in life expectancy, the number of individuals seeking dental care also has escalated. One of the most common reasons for seeking care is because of pain and/or dysfunction, usually involving the teeth or periodontal tissues. However, musculoskeletal, vascular, and neuropathic causes of orofacial pain occur frequently. The need to understand pain and all of its ramifications is of utmost importance in diagnosis and case-specific, evidence-based management of conditions afflicting the masticatory system. This article reviews current concepts with regard to the multiple etiologic and/or perpetuating factors now thought to be associated with myogenous and arthrogenous orofacial pain. Important distinctions between acute and chronic pain are discussed. The rationale for consideration of multidisciplinary evaluation and management is highlighted.


[Argon plasma coagulation through a flexible endoscope. Evaluation of a new therapeutic method after 1606 uses].
Argon plasma coagulation (APC) through a flexible endoscope provides a new technique for thermal devitalization or blood coagulation which is gaining wider attention. This study was undertaken to test clinically the efficacy, safety and ergonomics of the method. 697 consecutive patients (386 men, 311 women; mean age 67 years [3 months--97 years]) had undergone the procedure in 1606 sitting since 1991. Applications included various forms and causes of bleeding in the upper or lower gastrointestinal tract or bronchial system, malignant and benign tumours, ingrowth of tissues and over-growth in stents, fistulas and, since 1993, angiodysplasias and other dysplasias. The precisely defined therapeutic aim was achieved in nearly all cases during an average of 2.3 sittings per patient, while it failed in 1.5%. Perforations occurred in 5 (0.31%), ending fatally in one. Intestinal wall emphysema was diagnosed in 8 cases (0.5%), all remaining symptom-free. During a mean follow-up period of 23 (1-72) months there were no other serious immediate or late complications or side effects ascribable to the procedure. APC is a new efficacious, repeatable, safe and easily learned method for devitalization of tissues and for achieving haemostasis, especially for bleeding from surfaces. Similar applications are being developed in other specialties.


Male-pattern vertex baldness trajectories, chest hair patterns, and odds of overall and aggressive prostate cancer.
The link between hormones and hair growth is well established. Inconsistent associations have been found between hair patterns and cancer of the prostate, a hormone-dependant organ. We assessed vertex baldness trajectories, chest hair amount, and their relationships with the odds of developing prostate cancer in a large case-control study in Montreal, Canada. In-person interviews were conducted with 1,931 incident prostate cancer cases and 1,994 population-based age-matched (±5 years) controls. Participants reported their hair patterns using the validated Hamilton-Norwood scale of baldness for 10-year increments starting at age 30, and their current amount of chest hair. Group-based trajectories were used to identify men sharing similar patterns of vertex baldness severity over adulthood. Multivariable logistic regression assessed associations between indicators of baldness (frontal, vertex, age at onset, severity and trajectories), chest hair, and odds of prostate cancer. Vertex balding onset at age 30 was associated with increased odds of overall prostate cancer (OR=1.30; 95%CI: 1.03-1.64). Men in the trajectory characterized by early moderate vertex baldness and developing severe baldness had increased odds of overall (OR=1.42; 95%CI: 1.03-1.96) and especially aggressive prostate cancer (OR=1.98; 95%CI: 1.21-3.22) compared to men without baldness. Men with little chest hair had higher odds of aggressive tumours than those with a moderate amount/a lot of chest hair. Early-onset moderate vertex baldness that progresses and having little chest hair may be useful biomarkers of aggressive prostate cancer. Integration of early-onset vertex balding patterns into risk prediction models of aggressive prostate cancer should be envisaged.