Reporting Caesarean Delivery in Quebec Using the Robson Classification System.
The increasing rates of Caesarean sections throughout the world is preoccupant, and a good understanding of which groups of women contribute the most to the CS rate represents an important question in public health. Therefore, we sought to report the CS rate according to the Robson's classification system in the Quebec population. We performed a secondary analysis of the QUARISMA database, including all deliveries after 24 weeks' gestation from 32 maternity wards in the province of Quebec between 2008 and 2011 (n = 184 952 deliveries). CS rates were reported according to the modified Robson criteria from The Society of Obstetricians and Gynaecologists of Canada with the relative contribution to the total number of CSs. We observed a global CS rate of 22.9%. Women with previous CS and a fetus in cephalic presentation at term accounted for 35% of all Caesarean deliveries. Nulliparous women with cephalic presentation at term accounted for 30% of all CSs. Among nulliparous women with cephalic presentation, women with spontaneous labour contributed to 12% of all CSs, whereas women with an induction of labour contributed to 16% of all CSs. Non-cephalic fetal presentation accounted for 19% of all CSs. Other indications accounted for the remaining 16% of CSs. Most CSs are performed for multiparous women with previous CS; nulliparous women with a cephalic presentation at term, especially those undergoing labour induction; and non-cephalic fetal presentation.


Association Between Multiple Chronic Conditions and Depressive Symptoms Among Older Adults in China: Evidence From the China Health and Retirement Longitudinal Study (CHARLS).
Objectives: The purpose of this study was to explore the association between multiple chronic conditions (MCCs) and depressive symptoms among older adults in China. Methods: We used the fourth round of data from the China Health and Retirement Longitudinal Study, and included 9789 older adults aged 60 years old and above. Results: Compared with the older adults without chronic disease, older adults with MCCs and those with one chronic disease had a high risk of depression (MCCs: OR-adjusted: 1.55, 95% CI: 1.37 to 1.75; one chronic disease: OR-adjusted: 1.20, 95% CI: 1.05-1.37). In urban areas, the prevalence among older adults with MCCs was 2.01 times higher than that among older adults without chronic disease (OR-adjusted: 2.01, 95% CI: 1.56-2.60), while it was 1.44 times higher in rural areas (OR-adjusted:1.44, 95% CI: 1.25-1.65). Self-reported health, duration of sleep, social activities, and type of medical insurance were the influencing factors of depressive symptoms in older adults. Conclusion: This study contributed to enriching the research on the relationship between MCCs and depressive symptoms in older adults in China.


Single polypeptide detection using a translocon EXP2 nanopore.
DNA sequencing using nanopores has already been achieved and commercialized; the next step in advancing nanopore technology is towards protein sequencing. Although trials have been reported for discriminating the 20 amino acids using biological nanopores and short peptide carriers, it remains challenging. The size compatibility between nanopores and peptides is one of the issues to be addressed. Therefore, exploring biological nanopores that are suitable for peptide sensing is key in achieving amino acid sequence determination. Here, we focus on EXP2, the transmembrane protein of a translocon from malaria parasites, and describe its pore-forming properties in the lipid bilayer. EXP2 mainly formed a nanopore with a diameter of 2.5 nm assembled from 7 monomers. Using the EXP2 nanopore allowed us to detect poly-L-lysine (PLL) at a single-molecule level. Furthermore, the EXP2 nanopore has sufficient resolution to distinguish the difference in molecular weight between two individual PLL, long PLL (Mw: 30,000-70,000) and short PLL (Mw: 10,000). Our results contribute to the accumulation of information for peptide-detectable nanopores.


When a Painful Rash Keeps Recurring: A Case of Seronegative Amyopathic Dermatomyositis Without Neurological Sequelae.
We present a case of seronegative amyopathic dermatomyositis (SADM). This clinical entity should be considered in the differential diagnosis of patients with recurring, painful erythematous skin manifestations, and requires close monitoring for the development of neurological manifestations and malignancy. SADM is a rare autoimmune disease that affects the skin and muscles. It is considered a subtype of dermatomyositis (DM), which is a systemic autoimmune disease. The exact cause of SADM is not fully understood but is believed to involve a complex interplay between genetic, environmental, and immunological factors. The diagnosis of SADM is typically made based on clinical evaluation, blood tests, muscle biopsy, and skin biopsy. Treatment options for SADM may include corticosteroids, immunosuppressive drugs, and other supportive measures to manage symptoms and prevent disease progression. A 30-year-old female presented with symptoms of intermittent burning, painful rash primarily on the hands and face. Her medical history was remarkable for a six-year history of multifocal joint pain, chronic low back pain, and intermittent, painful recurring rash in the upper body (face, neck, and chest). Neurological examination revealed scalp tenderness and arthralgia in the upper extremities, with normal motor strength examination. Skin findings included described an erythematous rash on the arms and hands bilaterally. Skin punch biopsy showed compact orthokeratosis, atrophy of the epidermis, interface changes, and increased dermal mucin on the colloidal iron stain, which are suggestive of DM. Electromyography and nerve conduction study were normal. The MRI of the left thigh was normal. C3 and C4 levels were reduced. The extended muscle-specific myositis panel including MDA5 was negative. The patient was placed on a multidrug regimen, including methotrexate, hydroxychloroquine, and prednisone. Within one year of follow-up, she was found to have reductions in skin manifestation and flare-ups. Clinicians should consider amyopathic DM (ADM) in the differential diagnosis of patients with recurring, painful skin manifestations. This condition can be easily overlooked as the development of neurological sequelae may be present much later in the course. We highlight the need for a multi-disciplinary management approach for patients with this unique diagnosis. Close monitoring for the development of neurological manifestations and associated sequelae including malignancy is recommended.


Severity of alcohol dependence and its relationship to neurological soft signs, neuropsychological impairment and family history.
We examined the relationship between severity of alcohol dependence, subtle neurological impairment, neuropsychological deficits and genetic vulnerability among 36 day hospital attenders who satisfied the DSM-III-R criteria for alcohol dependence. Severity of alcohol dependence was unrelated to the presence of a family history, but was correlated with neurological soft signs and neuropsychological impairment. Neurological soft signs were correlated with neuropsychological impairment on both Trail A and Trail B. Patients with an affected first-degree relative exhibited more neurological soft signs. These data indicate that severity of alcohol dependence is related not only to neuropsychological impairment, but also to subtle neurological deficits which may not be apparent on conventional neurological examination. Patients with a positive family history of alcohol dependence may be particularly susceptible to the neurological sequelae of alcohol dependence, or may have neurological deficits which antedate their alcohol dependence.


Thumb carpometacarpal joint osteoarthritis: Is there a role for denervation? A systematic review.
Thumb carpometacarpal osteoarthritis (CMCJ OA) is a common problem. Joint denervation presents a number of theoretical advantages over more traditional surgical options; it is minimally invasive, it does not require a prosthesis or postoperative immobilisation, and does not preclude future surgery. It can be of particular benefit in patients who require good range of motion which other forms of surgery may compromise. Despite these potential advantages, selective denervation of the thumb CMCJ is not considered as part of the routine surgical armamentarium for the treatment of thumb base OA. The purpose of this study is to analyse the evidence for thumb CMCJ denervation; evaluating patient selection, surgical techniques, complications and outcomes. A systematic review was performed on all published literature relating to thumb CMCJ denervation. Nine studies were identified with 184 denervation procedures undertaken in 175 patients. The length of follow-up was available in eight studies (mean 36.5 months [range 6-152 months]). All authors reported improvement in pain and seven studies reported improvement in function. Eleven patients in total suffered persistent joint pain, ten of which proceeded to trapeziectomy and one patient underwent a revision denervation to address potentially missed dorsal sensory branches. The overall complication rate was 11.4% (0-27.5%) consisting of minor complications. This review highlights the paucity of high-quality data and the requirement for a multi-centre, randomised study with validated outcome measures to further define the role of denervation in the management of thumb base OA.


[Recent advances in the treatment of neuromyelitis optica].
Neuromyelitis optica is an autoimmune-mediated inflammatory disease affected predominantly optic nerve and spinal cord. The pathogenic mechanism was found to be distinct from multiple sclerosis since the discovery of the disease specific autoantibody against water channel aquaporin-4. The pathogenicity of anti-aquporin-4 antibody causes complement-dependent and cell-mediated astrocyte damage in the central nervous system, resulting in the severe inflammatory lesions including loss of aquaporin-4. The recent elucidation of pathological mechanism contributed to the development of treatment with monoclonal antibodies, e.g., rituximab, tocilizumab and eculizumab. It also raises the possibility that neutralization of the pathogenic autoantibodies, attenuation of polymorphonuclear leukocyte accumulation, and regulation of the proinflammatory cytokine and chemokine production can be efficacious for acute exacerbation and prevention of the relapses.


Dramatically Enhanced Broadband Photodetection by Dual Inversion Layers and Fowler-Nordheim Tunneling.
Silicon photonics is now widely accepted as a key technology in a variety of systems. But owing to material limitations, now it is challenging to greatly improve the performance after decades of development. Here, we show a high-performance broadband photodetector with significantly enhanced sensitivity and responsivity operating over a wide wavelength range of light from near-ultraviolet to near-infrared at low power consumption. The specially designed textured top ceiling electrode works effectively as an antireflection layer to greatly improve the absorption of near-infrared light, thereby overcoming the absorption limitation of near-infrared light. Instead of the conventional p-n junction and p-intrinsic-n junction, we introduce a ∼15 nm thick alumina insulator layer between a p-type Si substrate and n-type ZnO nanowire (NW) arrays, which significantly enhances the charge carrier separation and collection efficiency. The photosensing responsivity and sensitivity are found to be nearly 1 order of magnitude higher than that of a reference device of p-Si/n-ZnO NW arrays, significantly higher than the commercial silicon photodiodes as well. The light-induced charge carriers flow across the appropriate thickness of insulator layer via the quantum mechanical Fowler-Nordheim tunneling mechanism. By virtue of the piezo-phototronic effect, the charge density at the interfaces can be tuned to alter the energy bands and the potential barrier distance for tunneling. Additionally, along with the use of incident light of different wavelengths, the influence of the insulator layer on the transport of electrons and holes separately is further investigated. The demonstrated concepts and study would lead to sensitivity improvement, quality enhancement of data transfer, decrease of power consumption, and cost reduction of silicon photonics.


Independent generation of 5-(2'-deoxycytidinyl)methyl radical and the formation of a novel cross-link lesion between 5-methylcytosine and guanine.
Reactive oxygen species (ROS) can damage DNA. Although a number of single nucleobase lesions induced by ROS have been structurally characterized, only a few intrastrand cross-link lesions have been identified and characterized, and all of them involve adjacent thymine and guanine or adenine. In mammalian cells, the cytosines at CpG sites are methylated. On the basis of the similar reactivity of 5-methylcytosine and thymine toward hydroxyl radical and the similar orientation of adjacent thymine guanine (TG) and 5-methylcytosine guanine (mCG) in B-DNA, we predict that the cross-link lesion, which was identified in TG and has a covalent bond formed between the 5-methyl carbon atom of T and the C8 carbon atom of G, should also form at mCG site. Here, we report for the first time the independent generation of 5-(2'-deoxycytidinyl)methyl radical, and our results demonstrate that this radical can give rise to the predicted novel intrastrand cross-link lesion in dinucleoside monophosphates d(mCG) and d(GmC). Furthermore, we show that the cross-link lesion can also form in d(mCG) from gamma irradiation under anaerobic conditions.


Saved by the Pupillometer! - A role for pupillometry in the acute assessment of patients with traumatic brain injuries?
There is good evidence that pupil reactivity is useful for prognostication in acute head injuries. Despite this, most pupil assessments are subjective and are performed by physicians who may not be experts. They can therefore be unreliable. We present a case of a patient with seemingly irreversible demise from an acute traumatic subdural haematoma. This was determined by assessment of his pupils, which were non-reactive to light at the time of arrival to the neurosurgical theatre. He was transferred to the neurointensive care for brainstem death testing, where assessment by objective pupillometry determined that his pupils were in fact reactive. He made a good recovery following subsequent surgery to evacuate his subdural haematoma. We propose the widespread adoption of objective pupillometers in the assessment of acute head-injured patients and offer our case as an example of how an objective and accurate assessment can make a difference to patients' outcome.


A Facile Steam Reforming Strategy to Delaminate Layered Carbon Nitride Semiconductors for Photoredox Catalysis.
The delamination of layered crystals that produces single or few-layered nanosheets while enabling exotic physical and chemical properties, particularly for semiconductor functions in optoelectronic applications, remains a challenge. Here, we report a facile and green approach to prepare few-layered polymeric carbon nitride (PCN) semiconductors by a one-step carbon/nitrogen steam reforming reaction. Bulky PCN, obtained from typical precursors including urea, melamine, dicyandiamide, and thiourea, are exfoliated into few-layered nanosheets, while engineering its surface carbon vacancies. The unique sheet structures with strengthened surface properties endow PCNs with more active sites, and an increased charge separation efficiency with a prolonged charge lifetime, drastically promoting their photoredox performance. After an assay of a H2 evolution reaction, an apparent quantum yield of 11.3 % at 405 nm was recorded for the PCN nanosheets, which is much higher than those of PCN nanosheets. This delamination method is expandable to other carbon-based 2D materials for advanced applications.


Use of the Optomap with lid retraction and its sensitivity and specificity.
Optomap uses the ultra-wide field scanning laser ophthalmoscopy to provide retinal examination. It permits fundus examination without the use of a mydriatic, which is more comfortable for the patients. This paper determines the sensitivity and specificity of the Optomap for detecting retinal signs under non-mydriatic conditions. Fifty-four eyes identified with retinal/choroidal signs and eight normal eyes were recruited from 31 Hong Kong Chinese subjects. Photo-documentation of fundal changes was obtained with the Optomap under non-mydriatic conditions before a dilated fundus examination by a clinician using standard procedures. The eyelid was retracted using a cotton bud when necessary. Dilated fundus examinations were performed by another clinician using binocular indirect ophthalmoscopy and slitlamp biomicroscopy with a fundus lens. The Optomap images were evaluated by four other investigators under masked condition. The International Classification of Disease, Ninth Revision (ICD-9-CM) was adopted for recording retinal features. Screening results were compared with those obtained using the dilated fundus examination as the gold standard. The cotton bud method for eyelid retraction showed an improvement in the area of retina that could be visualised. The sensitivity and specificity of the Optomap averaged 76.4 and 71.9 per cent, respectively. Some fundal signs were missed by all observers in the Optomap but not with the biomicroscope. These included white-without-pressure, lattice degeneration, paramacular drusen and pigmentary changes at central fundus. Optomap serves as a reliable screening tool for fundus examination especially because it covers a much wider area of the peripheral retina than other digital instruments for fundus photography.


Enzyme-linked immunosorbent assay for the detection of antibodies to type-B influenza virus.
The Enzyme-Linked Immunosorbent assay (ELISA) has been applied to the detection of antibodies to type B influenza virus. The specificity, the sensitivity and the reproducibility of the indirect method has been evaluated. The Haemagglutination inhibition assay (HAI) was used as reference system. The results obtained at a single serum dilution show good correlation between ELISA and HAI test (r = 0.70). Reproducibility is satisfactory. Our results seem to show a better sensitivity of the ELISA test as compared to the HAI test. This feature may be useful for certain applications such as the detection of antibody responses after vaccination. The need of accurate standardization in carrying out the test is pointed out.


Effect of unmodified eel calcitonin on gastric acid secretion and gastric ulcers in the rat.
A new peptide, eel calcitonin (eCT), synthesized to the sequence of calcitonin (CT) extracted from the ultimo branchial bodies of eels, is now on the market in some countries for clinical use in the treatment of Paget's disease of bone and in the prophylaxis or treatment of certain osteoporoses. We have now studied the effect of eCT on the inhibition of gastric acid secretion and protection against experimentally induced gastric ulcers in rats as other CTs have previously been shown to have such effects. EelCT shows a dose dependent inhibition of gastric acid secretion, both volume and concentration of acid - dose range 100-900 ng/Kg injected subcutaneously. Central administration is also effective at a dose of 100 ng/rat. There is no published evidence for a direct effect of CTs in the stomach and there is considerable speculation on possible mediating pathways. Somatostatin may be involved in the inhibitory effect of eCT on gastric acid secretion because when administered both centrally or peripherally eCT is ineffective in rats depleted of somatostatin by pretreatment with cysteamine. However, other mechanisms must also be involved as eCT has no preventive effect against gastric ulcers induced by ethanol but has a high index of protection against ulcers induced by cold restraint stress or indomethacin.


Well-differentiated Spindle Cell Liposarcoma of the Larynx: A Rare Case Report and Review of Literature.
Liposarcoma of the larynx is a rare entity. Well-differentiated spindle cell liposarcoma of the larynx has not been yet reported in the literature. We report the first case of well-differentiated spindle cell liposarcoma of the larynx on a 59-year-old male who presented with change of voice and phlegmy cough for several months. Laryngoscopy revealed a mucosal covered pedunculated mass on the supraglottis. Computerized tomography (CT) scan showed a low-attenuation mass causing moderate narrowing of the airway. The lesion was excised. Grossly, a 4.2 cm ovoid, solid and soft mass with homogeneously white-gray and rubbery cut surface was identified. Microscopic examination revealed a well-demarcated neoplasm composed of predominantly atypical and pleomorphic spindle cells distributed in collagenous stroma, with admixed adipocytes showing variation in cell size and rare lipoblasts. Immunohistochemical stains showed that the spindle cells were positive for MDM2, CDK4, and CD34. Overall, the histology and immunoprofile are consistent with a well-differentiated liposarcoma, spindle cell type. Due to the positive resection margin, the patient subsequently received endoscopic local re-excision with a carbon dioxide laser. He did well at 4 months after primary excision. This case illustrates that while well-differentiated spindle cell liposarcoma rarely occurs in the larynx, it should be considered in the differential diagnosis of patients with laryngeal lesions. A panel of immunohistochemistry markers including MDM2, CDK4 and CD34 is helpful to render accurate diagnosis. Wide excision with long-term follow-up is necessary for this rare variant of liposarcoma.


Endovascular aortic stenting in patients with chronic traumatic aortocaval fistula.
This study aimed to present the treatment of a case of delay presenting of traumatic aortocaval fistula (ACF) and its effect on hemodynamic problem. A 59-year-old man was admitted to our hospital with heart failure due to a 41-year-old traumatic ACF. ACF closure was performed by endovascular aortic stenting. His hospital course after procedure was complicated by severe bradycardia and torsades de pointes and excessive diuresis. We concluded the endovascular technique provided an attractive alternative to open surgical methods for repair of chronic ACF. However, in chronic cases, complications such as severe bradycardia (Nicoladoni-Branham sign) and excessive diuresis must be anticipated.


Spatiotemporal Specific Blocking of Plasmodesmata by Callose Induction.
Plasmodesmata are nanoscale cell wall channels connecting neighboring cells in plants. Intercellular trafficking of molecules via plasmodesmata plays important roles in various developmental processes and stress responses. The turnover of callose, a β-1,3-glucan polysaccharide depositing in the cell wall around plasmodesmata, controls the plasmodesmal permeability and symplasmic transport. Here, we describe a protocol for the spatiotemporally controlled induction of callose synthesis and plasmodesmata closure using the cals3m system. In this system, cals3m, a mutant CALLOSE SYNTHASE 3 (CALS3) gene, is driven by inducible tissue-specific promoters of interest. After appropriate induction by 17-β-estradiol, callose is overproduced within the corresponding specific domains, resulting in temporal closure of plasmodesmata at the cell-cell interfaces. This approach can be used to validate and dissect the function of plasmodesmata-mediated symplasmic communications.


A new sensor for detection of CH3CN and ClCH2CN vapors based on vapoluminescent platinum(II) complex.
The planar platinum(II) complex [Pt(Me3SiC≡CbpyC≡CSiMe3)(C≡CC6H4Et-4)2] (1) with 5,5-bis(trimethylsilylethynyl)-2,2'-bipyridine was prepared and characterized. Solid-state 1 exhibits unusual, selective and reversible luminescence vapochromism to CH3CN and ClCH2CN vapors, which is useful for the detection of these hazardous vapors. A vapochromic cycle was monitored by dynamic variations in emission spectra and X-ray diffraction (XRD) patterns. Both X-ray crystallographic and density functional theory studies suggest that the vapochromic and vapoluminescent behavior of 1 are induced by the variation in the intermolecular Pt-Pt interactions.


Systolic time intervals and impedance cardiogram in pregnant and toxemic women.
STI measurements and impedance cardiography were carried out during gestation and post partum in 231 cases. In normal pregnant women, prolongation of the Q-I interval, isometric contraction time (ICT), preejection period (PEP) and shortening both of the Q-II interval and ejection time (ET) were all marked in late stages of pregnancy. Mean values for stroke volume (SV), cardiac output (CO) and cardiac index (CI) were at the maximum at 16-23 weeks of pregnancy, and then fell in the antepartum period. The total peripheral resistance (TPR) at 16-23 weeks of pregnancy was lower than in other periods. In the postpartum period, the heart rate was lowered, and the Q-II interval and ICT were prolonged. In toxemic pregnancy, SV, CO and CI were lower than those of the normal group and various changes in STI were more apparent than those of non-toxemic pregnants in the supine position. By the postural change from supine to left lateral in toxemia, the improvement in STI was not as good as in the normal pregnant group and, moreover, SV and CO were decreased and TPR was increased. These results suggest that in toxemic pregnancy the left ventricle might be less complaint and less sensitive to the increase in venous return.


Iron handling and gene expression of the divalent metal transporter, DMT1, in the kidney of the anemic Belgrade (b) rat.
We have previously shown that the rat kidney reabsorbs metabolically significant amounts of iron and that it expresses the divalent metal transporter 1, DMT1. The Belgrade (b) rat carries a mutation in DMT1 gene, which causes hypochromic, microcytic anemia due to impaired intestinal iron absorption and transport of iron out of the transferrin cycle endosome. In the duodenum of b/b rats, expression of DMT1 mRNA and protein is increased, suggesting a feedback regulation by iron stores. The aim of this study was to investigate iron handling and DMT1 expression in the kidneys of Belgrade rats. Animals were maintained for 3 weeks on a synthetic diet containing 185 mg/kg iron (FeSO4), after which functional and molecular parameters were analyzed in male heterozygous (+/b) and homozygous (b/b) rats (N = 4 to 6 for each group). Serum iron concentration was significantly higher in b/b compared to +/b rats while urinary iron excretion rates were unchanged in b/b compared to +/b rats. Northern analysis using a rat DMT1 probe showed comparable mRNA levels between +/b and b/b animals. Western analysis and immunofluorescence microscopy performed using a polyclonal antibody against rat DMT1 showed that DMT1-specific immunoreactivity was almost absent in the kidneys of b/b rats compared to that seen in +/b animals. Our results indicate that the G185R mutation of DMT1 causes protein instability in the kidneys of b/b rats. Given that +/b and b/b rats excrete comparable amounts of iron, the lack of DMT1 protein is compensated by an alternative, yet to be identified, mechanism.


Association of baseline optical coherence tomography angiography with the development of glaucomatous visual field defects in preperimetric glaucoma eyes.
To evaluate whether baseline vessel density (VD) parameters derived from optical coherence tomography angiography (OCT-A) is associated with the development of glaucomatous visual field (VF) defects in preperimetric glaucoma (PPG) patients. One eye from each of 200 consecutive PPG patients with a normal standard automated perimetry and OCT-A at baseline was retrospectively analysed. OCT-A was used to measure the circumpapillary VD (cpVD) and the parafoveal and perifoveal VD. The retinal nerve fibre layer (RNFL) and macular ganglion cell-inner plexiform layer thicknesses were measured as reference standards. Two patient groups were stratified based on the development of repeatable glaucomatous VF loss. A Cox proportional hazards model was constructed to determine the predictive ability of OCT-A parameters for VF defects. The correlation between these baseline OCT-A parameters and the rate of global VF sensitivity loss (dB/year) was calculated using linear regression analysis. During a 3.1-year average follow-up period, 18 eyes (9.0%) developed glaucomatous VF defects. At baseline, the lower inferior temporal cpVD (HR (95% CI)=0.934 (0.883 to 0.988); p=0.017) and thinner inferior RNFL (HR (95% CI)=0.895 (0.839 to 0.956); p=0.001) were predictive of glaucomatous VF loss. A lower inferior temporal cpVD and thinner RNFL at baseline were associated with faster rate of global VF sensitivity loss (β=0.015; p=0.001). In PPG eyes, a lower baseline inferior temporal cpVD is significantly associated with glaucomatous VF defect development and a faster rate of global VF loss.


Patient stories: a way to enhance continuing education.
Using breast health and illness, this article reviews relevant research literature and compares it for congruency with patient stories. Inconsistencies and issues found are related to desired outcomes and decision-making. Patients may view cancer treatment as an unbroken continuum from pre-diagnosis to completion of treatment. While moving through the continuum, they interact with nursing professionals in several roles and locations. Strategic suggestions acknowledge the need to incorporate health professionals, patients and families in the continuing education activity. Nurses working in continuing education have the opportunity to improve care along the treatment continuum and reduce the distance between research and practice. Implications for nursing practice and continuing education are identified. Suggestions for enhancing continuing education related to this continuum are made.


Agrobacterium VirE3 Uses Its Two Tandem Domains at the C-Terminus to Retain Its Companion VirE2 on the Cytoplasmic Side of the Host Plasma Membrane.
Agrobacterium tumefaciens is the causal agent of crown gall disease in nature; in the laboratory the bacterium is widely used for plant genetic modification. The bacterium delivers a single-stranded transferred DNA (T-DNA) and a group of crucial virulence proteins into host cells. A putative T-complex is formed inside host cells that is composed of T-DNA and virulence proteins VirD2 and VirE2, which protect the foreign DNA from degradation and guide its way into the host nucleus. However, little is known about how the T-complex is assembled inside host cells. We combined the split-GFP and split-sfCherry labeling systems to study the interaction of Agrobacterium-delivered VirE2 and VirE3 in host cells. Our results indicated that VirE2 co-localized with VirE3 on the cytoplasmic side of the host cellular membrane upon the delivery. We identified and characterized two tandem domains at the VirE3 C-terminus that interacted with VirE2 in vitro. Deletion of these two domains abolished the VirE2 accumulation on the host plasma membrane and affected the transformation. Furthermore, the two VirE2-interacting domains of VirE3 exhibited different affinities with VirE2. Collectively, this study demonstrates that the anchorage protein VirE3 uses the two tandem VirE2-interacting domains to facilitate VirE2 protection for T-DNA at the cytoplasmic side of the host cell entrance.


Effects of Charge Density on Spread Hyperbranched Polyelectrolyte/Surfactant Films at the Air/Water Interface.
The interfacial structure and morphology of films spread from hyperbranched polyethylene imine/sodium dodecyl sulfate (PEI/SDS) aggregates at the air/water interface have been resolved for the first time with respect to polyelectrolyte charged density. A recently developed method to form efficient films from the dissociation of aggregates using a minimal quantity of materials is exploited as a step forward in enhancing understanding of the film properties with a view to their future use in technological applications. Interfacial techniques that resolve different time and length scales, namely, ellipsometry, Brewster angle microscopy, and neutron reflectometry, are used. Extended structures of both components are formed under a monolayer of the surfactant with bound polyelectrolytes upon film compression on subphases adjusted to pH 4 or 10, corresponding to high and low charge density of the polyelectrolyte, respectively. A rigid film is related to compact conformation of the PEI in the interfacial structure at pH 4, while it is observed that aggregates remain embedded in mobile films at pH 10. The ability to compact surfactants in the monolayer to the same extent as its maximum coverage in the absence of polyelectrolyte is distinct from the behavior observed for spread films involving linear polyelectrolytes, and intriguingly evidence points to the formation of extended structures over the full range of surface pressures. We conclude that the molecular architecture and charge density can be important parameters in controlling the structures and properties of spread polyelectrolyte/surfactant films, which holds relevance to a range of applications, such as those where PEI is used, including CO2 capture, electronic devices, and gene transfection.


Image-Based Food Volume Estimation.
In this paper, we propose an extension to our previous work on food portion size estimation using a single image and a multi-view volume estimation method. The single-view technique estimates food volume by using prior information (segmentation and food labels) generated from food identification methods we described earlier. For multi-view volume estimation, we use"Shape from Silhouettes"to estimate the food portion size. The experimental results of our volume estimation methods demonstrate our results with respect to accuracy and reliability.


Inhibition by PGI-2 of myometrial activity in vivo in non-pregnant ovariectomized sheep.
The effects of PGI-salt and PGI-2 methyl ester on intrauterine pressure (IUP) and uterine electromyographic activity (EMG) were examined in vivo in non-pregnant ovariectomized sheep. PGI-2 salt and PGI-2 methyl ester (50--200 micrograms) reduced significantly the frequency and amplitude of IUP cycles and also inhibited the associated uterine EMG activity. Injections of oxytocin (50 mU) or PGF-2 alpha (2 micrograms) partly overcame the inhibiton of IUP induced by the PGI-2 methyl ester. These results suggest that endogenous PGI-2 may be involved in the regulation of uterine activity in sheep.


Angiosarcoma of bone: a retrospective study of the European Musculoskeletal Oncology Society (EMSOS).
Angiosarcoma of bone (B-AS) is a rare malignant tumor of vascular origin. The aim of this retrospective study is to report on treatments and prognosis. Data were collected from the EMSOS website. 80 patients in 9 centers included: 51 male/29 female; median age 54 years (range 17 to 92); 56% with localized disease, 44% metastatic. Primary tumor surgery: 76% (30% amputation, 26% intralesional margins); radiotherapy (RT): 41%; chemotherapy (CT): 47% (56% in metastatic, 41% in localized cases). With a median follow-up of 31 months (range 40 to 309), 5-year overall survival (OS) was 27% (95%CI 16-30): 41% (95%CI 25-56) for localized patients, and 8% (95%CI 0-20) for metastatic (p = 0.002). In metastatic patients, 1 year OS was significantly influenced by chemotherapy response: 67% (95CI% 29-100) for those who responded or had stable disease (n = 7), and 18% (95CI% 0-41) for patients with progressive disease (n = 11), p 0.002. The surgical complete remission (SCR) status was pivotal in localized patients (5-year OS 45% for SCR, 17% no SCR, p = 0.03); also 5-year OS was significantly influenced by age and site of the tumor. After multivariate analysis, the addition of radiotherapy to surgery significantly influenced the disease-free survival (DFS) rate, whereas the use of chemotherapy lost the significance showed at the univariate analysis. Overall, patients with metastatic B-AS have a dismal prognosis, with a prolonged survival in case with a response to chemotherapy. Experimental trials with more active systemic treatment regimens are needed. In patients with localized disease, the patient's age and site of the tumor are prognostic factors and any effort must be made to achieve an SCR status. No definitive conclusions can be drawn from our data on the use of adjuvant chemotherapy, while the use of adjuvant radiotherapy might improve DSF in patients surgically free of disease.


Detection, pathogenesis, and therapy of respiratory syncytial virus infections.
Respiratory syncytial virus (RSV) infection is a major cause of serious lower respiratory disease in infancy and early childhood. The unique pathogenesis of lower respiratory illness due to RSV offers some intriguing clues to the role of the human immune system in both protection against and development of respiratory illness. More than any other virus, rapid diagnostic techniques have been especially successful in identifying RSV infection. Many of these techniques could be easily adaptable to diagnosis of influenza virus infection and other agents. Finally, ribavirin therapy of RSV infection represents one of the few instances in which antiviral therapy has been shown to be effective for respiratory illnesses. Fundamental observations in these areas in the case of RSV infection open up new and exciting pathways for investigation of respiratory infection due to other viral, chlamydial, and mycoplasmal agents.


Sleep-disordered breathing and cardiovascular health.
Sleep-disordered breathing is a widely prevalent condition and may have serious medical, social, and economic consequences. This review evaluates the role of sleep-disordered breathing in cardiovascular morbidity and mortality on the basis of recent literature. Epidemiologic studies, retrospective reviews, and prospective clinical trials suggest a strong association between sleep-disordered breathing and adverse cardiovascular events. Individuals with sleep-disordered breathing have a higher prevalence of hypertension, which attenuates with treatment. Furthermore, the presence of sleep-disordered breathing augurs an increased risk of coronary artery disease, cardiac arrhythmias, and heart failure. Recent research provides an emerging evidence of the role of sleep-disordered breathing as a risk factor for diverse cardiovascular disorders.


Tocilizumab Effect on Lipid Profile in Correlation to Cardiovascular Events: A Retrospective Cohort Study.
To study the effect of tocilizumab initiation on the lipid profile, in correlation to a composite of any cardiovascular events. A retrospective cohort study, using data from the King Faisal Specialist Hospital & Research Centre database, from January 2014 to December 2019. Patients with rheumatoid arthritis or juvenile idiopathic arthritis who were ≥18 years old, initiated either on tocilizumab or other biologic treatment (anti-TNFs or Rituximab), were included, with a follow-up interval duration at a minimum of 6-12 months up to 3-5 years. Any patient with established cardiovascular disease or aged <18 were excluded. Only one cardiovascular mortality was reported in the tocilizumab group. Fifty percent of patients reached high cholesterol levels ≥ 5.2 mmol/L and LDL ≥ 3.37 mmol/L in the tocilizumab group at 36 months in a shorter time period compared to controls (60 months), P 0.001. There were no significant differences between groups for statin use (27% vs. 28%) However, there was a significantly higher mean dose of atorvastatin in the tocilizumab group compared to controls (20.6 mg vs. 16.6 mg, P 0.03). There was a lack of evidence of increased cardiovascular risk in correlation to hyperlipidemia secondary to tocilizumab treatment.


Bovine pericardium as a wrapping for orbital implants.
We report the use of bovine pericardium as an alternative wrapping for porous orbital implants after enucleation. We retrospectively reviewed the records of all patients who received a bovine pericardium-wrapped orbital implant after enucleation by the authors between August 1, 1996, and December 1, 1999. Eighty patients underwent placement of bovine pericardium-wrapped orbital implants. The average age at the time of implantation was 49.3 years (range, 5 years to 83 years). The mean follow-up interval was 11.8 months (range, 2 to 41 months). There were no intraoperative complications. No patient had secondary systemic infection or showed evidence of rejection. There was no clinical evidence to suggest that vascularization of the porous implant was unusually delayed, and there were no complications after secondary drilling and placement of a coupling post. Four (5%) of 80 patients had complications requiring removal of the spherical implant. All 4 patients had hydroxyapatite implants. Two patients had significant exposure requiring removal of the implant at 2 months after surgery; 1 patient had a chronic fistulous tract with secondary infection 3 years after surgery: and 1 patient had chronic orbital pain requiring removal of the implant at 1 year after surgery. The incidence of implant exposure was less than 4%. This compares favorably to the incidence of exposure of 9% to 21% reported in recent literature. Other complications were few and of minimal clinical significance. The authors conclude that bovine pericardium is a viable option to sclera as a wrapping for porous orbital implants.


Cryptococcal neoformans profiles in peripheral blood neutrophils: an unusual presentation.
We report an unusual observation of Cryptococcal neoformans profiles engulfed by neutrophils on a routine peripheral blood smear examination in an HIV-negative young female patient who presented with perforation of large bowel following a pregnancy termination procedure by an untrained midwife.


Reduction in central nervous system leukemia with a pharmacokinetically derived intrathecal methotrexate dosage regimen.
During the period 1976-1981, 3241 children were enrolled on three major studies of acute lymphoblastic leukemia by participating institutions of the Children's Cancer Study Group. Each study included a different method of central nervous system (CNS) prophylaxis: (1) standard therapy with cranial irradiation, 2400 rads, and intrathecal methotrexate at 12 mg/m2 six times during consolidation (CCG-141); (2) a modification of CCG-141 in which the intrathecal methotrexate was initiated during induction (CCG-141A); and (3) a reduced cranial irradiation dose of 1800 rads with intrathecal methotrexate given at the same frequency as a CCG-141A, with or without maintenance intrathecal methotrexate, but with a dosage regimen derived from CNS volume considerations rather than based on body surface area (CCG-160 series). Strategy 3, a change in the intrathecal methotrexate dosage, has resulted in the lowest incidence of CNS leukemia to date (p less than 0.007). The cumulative 3-yr CNS relapse rate has decreased from 8%-10% to 2%-5% in average-risk patients (p less than 0.02; life table estimate) and from 23%-27% to 6% in high-risk patients (p less than 0.0002; life table estimate), despite a reduction in the cranial irradiation dose from 2400 to 1800 rads. Maintenance intrathecal chemotherapy has had a marginal effect among patients randomized to receive this additional therapy (p = 0.06). The overall outcome has been an increase in the continuous complete remission rate (p = 0.04) but not in the estimated 3-yr continuous hematologic remission or survival rates.


Proteomic studies in animal models of diabetes.
The aim of this review is to provide an overview of proteomic studies in animal models of diabetes and to give some insight into the different methods available today in the rapidly developing field of proteomics. A summary of 31 papers published between 1997 and 2007 is presented. For instance, proteomics has been used to study the development of both type 1 and type 2 diabetes, diabetic complications in tissues like heart, kidney and retina and changes after treatment with anti-diabetic drugs like peroxisome proliferator-activated receptors agonists. Together, these studies give a good overview of a number of experimental approaches. Proteomics holds the promise of providing major contributions to the field of diabetes research. However, to achieve this, a number of issues need to be resolved. Appropriate data representation to facilitate data comparison, exchange, and verification is required, as well as improved statistical assessment of proteomic experiments. In addition, it is important to follow up the results with functional studies to be able to make biologically relevant conclusions. The potential of proteomics to dissect complex human disorders is now beginning to be realized. In the future, this will result in new important information concerning diabetes.


Unexpected Metastatic Localizations of Prostate Cancer Determined by 68Ga PSMA PET/CT: Series of Four Cases.
Prostate-specific membrane antigen (PSMA) is a transmembrane protein with overexpression in most prostate cancer cells. Gallium-68-(68Ga) PSMA positron emission tomography/computed tomography (PET/CT) imaging is a game-changer in the management of prostate cancer. 68Ga PSMA PET/CT scan is advanced and a promising radioligand has high sensitivity in determining lesions of prostate cancer with a high tumor to background ratio. The most common areas of metastasis are the bone and pelvic lymph nodes. The prognosis of prostate cancer is mainly determined by the status of metastases. The presence and the localization of metastases affects treatment planning. In our cases, we presented some examples of uncommon sites of metastases such as the brain, adrenal glands, penis and orbit. Improvements in imaging techniques, such as 68Ga PSMA PET/CT have led to the possibility to make more determi nation of rare metastase sites in prostate cancer patients.


Physical activity patterns in older men and women in Germany: a cross-sectional study.
Data on physical activity in older adults in Germany is scarce. The aim of this study was to analyze physical activity patterns and to explore factors associated with physical activity in different domains, i.e. sporting activities (SA) and domestic activities (DA), in older men and women. As part of the 7-year follow-up telephone interviews of the getABI cohort (community-dwelling older adults in Germany), the PRISCUS-PAQ was used to survey participants about their everyday physical activity patterns. Time per week (hh:mm) spent in SA and DA (heavy housework, gardening) was analyzed for men and women. Multivariate logistic regression analyses were performed in order to assess the odds of participating in SA and DA for at least 2.5 hours/week in association with sociodemographic factors, a broad range of physical health-related factors and interview date (season of the year). A total of 1,610 primary health care patients (51.6% women) with a median age of 77 (range 72-93) years were included in the analyses. Men engaged in SA more often than women (01:45 vs. 01:10), whereas women did more DA per week than men (04:00 vs. 03:00).Being interviewed in spring or summer was associated with increased performance of DA in both sexes. Participation in these activities was reduced in more highly educated men and women. Living alone increased the odds of sports participation in women, but not in men. Most physical health-related factors were only selectively associated with either SA or DA, in men or women, respectively. The need for a walking aid was the only factor that consistently lowered the odds of being active in both activity domains and sexes. This exploratory study delivers reliable and relevant data on the participation in and correlates of sporting and domestic activities of community-dwelling older adults for whom there had previously been only limited information at a population level in Germany. Findings are discussed and implications for epidemiological research and health promotion practice are provided.


Moldy sweetclover poisoning in cattle.
Some selected clinical and laboratory aspects of moldy sweetclover poisoning in cattle are reviewed. The prothrombin time is preferred when the disease is suspected. The bleeding time and whole blood clotting time test are also used. Dicoumarol is not always detectable in the suspected feed which may be due to sampling technique or inaccuracy in the laboratory assay. The most effective treatment is a whole blood transfusion. Vitamin K(1) (naturally occurring vitamin K) is an effective antidote but too expensive. Vitamin K(3) (synthetic vitamin K) in both the injectable and oral forms are not as effective as K(1) but are used extensively for treatment and prevention. Feeding the suspected feed for two weeks followed by a one week withdrawal successively or by dilution with other feeds will help to reduce the incidence of disease if other feeds are not available. Suspected feed should not be fed to cattle for at least three weeks before surgery or parturition.


Effect of Fermented Fish Oil on Fine Particulate Matter-Induced Skin Aging.
Skin is exposed to various harmful environmental factors such as air pollution, which includes different types of particulate matter (PM). Atmospheric PM has harmful effects on humans through increasing the generation of reactive oxygen species (ROS), which have been reported to promote skin aging via the induction of matrix metalloproteinases (MMPs), which in turn can cause the degradation of collagen. In this study, we investigated the effect of fermented fish oil (FFO) derived from mackerel on fine PM (particles with a diameter < 2.5 µm: PM2.5)-induced skin aging in human keratinocytes. We found that FFO inhibited the PM2.5-induced generation of intracellular ROS and MMPs, including MMP-1, MMP-2, and MMP-9. In addition, FFO significantly abrogated the elevation of intracellular Ca2+ levels in PM2.5-treated cells and was also found to block the PM2.5-induced mitogen-activated protein kinase/activator protein 1 (MAPK/AP-1) pathway. In conclusion, FFO has an anti-aging effect on PM2.5-induced aging in human keratinocytes.


Hospital-based study of risk factors associated with development of myopic macular neovascularization in highly myopic eyes.
Myopic macular neovascularization (MNV) is the most common cause of a reduction of central vision in eyes with pathologic myopia, and it can progress to macular atrophy in the long-term. The aim of this study was to determine the risk factors associated with the development of MNVs. There were 17,198 follow-up records from 5,409 eyes of 2,784 highly myopic patients that were reviewed. The general information and ophthalmic information in the records were studied. The significance of the correlations of factors associated with the development and predicting the development of myopic MNV were determined. Being a woman (odds ratio [OR]: 0.727, P<0.001), having a longer axial length (OR = 0.948, P<0.001), a poorer baseline best-correct visual acuity (BCVA, OR = 2.098, P<0.001), having severe myopic maculopathy (overall: P<0.001), prior myopic MNV in the fellow eye (OR = 4.105, P<0.001), presence of patchy atrophy (overall P<0.001), lacquer cracks (OR = 1.718, P<0.001), prior foveal retinal detachment (RD, OR = 3.269, P<0.001), prior macular hole (MH, OR = 0.641, P <0.001), prior macular retinoschisis (OR = 1.533, P<0.001), and prior macular edema (OR = 1.508, P<0.001) were significantly correlated with the development of myopic MNV. Eyes with MNV and patchy atrophy would require an intensive follow-up examination for myopic patients as the fellow eye would have a risk of >70% for the development of myopic MNV in 3-years and nearly 80% in 5-years. Clinicians need to pay special attention to eyes with severe grades of myopic maculopathy, prior myopic MNV in the fellow eye, presence of patchy atrophy, and prior foveal retinal detachment to determine the onset of myopic MNV.


[Endoscopic resection of juvenile nasopharyngeal fibromas].
Current surgical approaches to juvenile nasopharyngeal angiofibromas (JNA) are exclusively external. This implies not only incisions that are mostly visible, but also a potential loss of function as well as secondary lesions and high perioperative risks. Radiotherapy aims to avoid surgery, but cannot exclude complications and possible sequelae. These consequences are commonly accepted as the "costs" for both therapies, although neither is negligible. For both surgery and radiotherapy, recurrences or persistence rates have been described, so that outcome may result in questions for the treatment used as well as the complications or sequelae. We report our experiences with two cases of JNA operated on under endoscopic control and discuss our indications for the endoscopic approach to these tumors, preoperative conditions, surgical technique, and the possible difficulties of surgery and outcome. Our results encourage us to recommend use of endoscopic surgery as a valid alternative method to approach resections of certain JNA.


A speckle tracking echocardiographic study on right ventricular function in primary aldosteronism.
We investigated right ventricular function using speckle tracking echocardiography (STE) in patients with primary aldosteronism. Our study included 51 primary aldosteronism patients and 50 age and sex-matched primary hypertensive patients. We performed two-dimensional echocardiography to measure cardiac structure and function. We performed STE offline analysis on right ventricular four-chamber (RV4CLS) and free wall longitudinal strains (RVFWLS). Primary aldosteronism patients, compared with primary hypertensive patients, had a significantly (P ≤ 0.045) greater left ventricular mass index (112.0 ± 22.6 vs. 95.8 ± 18.5 g/m) and left atrial volume index (26.9 ± 6.0 vs. 24.7 ± 5.6 ml/m) and higher prevalence of left ventricular concentric hypertrophy (35.3 vs. 12.0%), although they had similarly normal left ventricular ejection fraction (55-77%). Primary aldosteronism patients also had a significantly (P ≤ 0.047) larger right atrium and ventricle, lower tricuspid annular plane systolic excursion, and higher E/E't (the peak early filling velocity of trans-tricuspid flow to the peak early filling velocity of lateral tricuspid annulus ratio), estimated pulmonary arterial systolic pressure and right ventricular index of myocardial performance. On the right ventricular strain analysis, primary aldosteronism patients had a significantly (P < 0.001) lower RV4CLS (-18.1 ± 2.5 vs. -23.3 ± 3.4%) and RVFWLS (-21.7 ± 3.7 vs. -27.9 ± 4.5%) than primary hypertensive patients. Overall, RV4CLS and RVFWLS were significantly (r = -0.58 to -0.41, P < 0.001) correlated with plasma aldosterone concentration and 24-h urinary aldosterone excretion. After adjustment for confounding factors, the associations for RV4CLS and RVFWLS with 24-h urinary aldosterone excretion remained significant (P < 0.001), with a standardized coefficient of -0.48 and -0.55, respectively. In addition to left ventricular abnormalities, primary aldosteronism patients also show impaired right ventricular function, probably because of hyperaldosteronism.


[Radical surgical treatment of differentiated thyroid cancer--necessity or over-enthusiasm?].
The extent of surgical treatment of well differentiated thyroid cancer has been controversial and widely discussed for years. Although the recommendations defining the strategy of thyroid surgery were approved in 1995, a lot of questions remained. The aim of this retrospective study was to analyse long-term results of surgical treatment of thyroid cancer according to the type of applied surgical procedure. The study group consisted of 206 patients surgically treated for well differentiated thyroid cancer with the minimal follow-up period of 5 years. The median age patients was 49.1 years. 159 patients (77.2%) have still remained in the follow-up programme, 23 died because of thyroid cancer (11.1%) and the remaining 24 have either refused to participate in the programme or died of other causes. Median follow-up period was 10.7 years. Total thyroidectomy was performed in 90 patients (43.7%) and less extensive procedures in 106 (51.4%). The remaining patients were qualified for palliative reduction of the tumour mass and they were not included in this study. The comparison of the patients with I and II stage of the disease according to the type of surgical procedure did not show differences in 10-year survival. In stage III the difference was very close to statistical significance. The same results were observed with regard to disease recurrence. Long-time survival in low risk patients was not related to the extent of surgical procedure. The risk of recurrence and death was higher in the patients with advanced disease in stage III who underwent less radical procedures like total resection of involved lobe with isthmus and subtotal resection of contralateral lobe.


Capsaicin ameliorates renal fibrosis by inhibiting TGF-β1-Smad2/3 signaling.
Chronic kidney disease (CKD), characterized by renal fibrosis, is a global refractory disease with few effective therapeutic strategies. It has been reported that capsaicin exerts many pharmacological effects including liver and cardiac fibrosis. However, whether capsaicin plays a therapeutic role in renal fibrosis remains unclear. We investigated antifibrotic effects of capsaicin in two mouse renal fibrosis models as follows: C57BL/6J mice were subjected to unilateral ureteral obstruction (UUO) and fed with an adenine-rich diet. We uncovered and verified the mechanisms of capsaicin in human proximal tubular epithelial cells (HK2). We mainly used histochemistry, immunohistochemistry and immunofluorescence staining, western blot assay, biochemical examination and other tools to examine the effects of capsaicin on renal fibrosis and the underlying mechanisms. Capsaicin treatment significantly alleviated fibronectin and collagen depositions in the tubulointerstitium of the injured kidneys from UUO and adenine-fed mice. Meanwhile, capsaicin treatment obviously reduced α-SMA expression. Moreover, capsaicin treatment dramatically protected against the phenotypic alteration of tubular epithelial cells by increasing E-cadherin expression and decreasing vimentin expression during renal fibrosis. Mechanistically, capsaicin treatment effectively suppressed α-SMA and vimentin expressions but promoted E-cadherin expression in HK2 cells mainly through the inhibition of TGF-β1-Smad2/3 signaling. Capsaicin significantly ameliorated renal fibrosis possibly by retarding the activation of myofibroblasts and protecting against the phenotypic alteration of tubular epithelial cells mainly through the inhibition of TGF-β1-Smad2/3 signaling. Thus, our findings may provide a new insight into the clinical application of capsaicin in renal fibrosis.


Kohonen's Map Approach for the Belief Mass Modeling.
In the framework of the evidence theory, several approaches for estimating belief functions are proposed. However, they generally suffer from the problem of masses attribution in the case of compound hypotheses that lose much conceptual contribution of the theory. In this paper, an original method for estimating mass functions using Kohonen's map derived from the initial feature space and an initial classifier is proposed. Our approach allows a smart mass belief assignment, not only for simple hypotheses but also for disjunctions and conjunctions of hypotheses. Thus, it can model at the same time ignorance, imprecision, and paradox. The proposed method for a basic belief assignment (BBA) is of interest for solving estimation mass functions problems where a large quantity of multivariate data is available. Indeed, the use of Kohonen's map simplifies the process of assigning mass functions. The proposed method has been compared with the state-of-the-art BBA technique on benchmark database and applied on remote sensing data for image classification purpose. Experimentation shows that our approach gives similar or better results than other methods presented in the literature so far, with an ability to handle a large amount of data.


Platelet rich plasma. The use of autologous growth factors to enhance bone and soft tissue grafts.
The addition to a graft site of an easily obtained autologous concentrate of blood platelets, called platelet rich plasma (PRP), offers improved quality and faster healing for both hard and soft tissue. This article will outline the sequence of bone regeneration, the role of PRP in bone regeneration, the methods to acquire PRP and the uses for PRP in clinical practice.


Role of Kir4.1 channels in growth control of glia.
The inwardly rectifying potassium channel Kir4.1 is widely expressed by astrocytes throughout the brain. Kir4.1 channels are absent in immature, proliferating glial cells. The progressive expression of Kir4.1 correlates with astrocyte differentiation and is characterized by the establishment of a negative membrane potential (> -70 mV) and an exit from the cell cycle. Despite some correlative evidence, a mechanistic interdependence between Kir4.1 expression, membrane hyperpolarization, and control of cell proliferation has not been demonstrated. To address this question, we used astrocyte-derived tumors (glioma) that lack functional Kir4.1 channels, and generated two glioma cell lines that stably express either AcGFP-tagged Kir4.1 channels or AcGFP vectors only. Kir4.1 expression confers the same K+ conductance to glioma membranes and a similar responsiveness to changes in [K+]o that characterizes differentiated astrocytes. Kir4.1 expression was sufficient to move the resting potential of gliomas from -50 to -80 mV. Importantly, Kir4.1 expression impaired cell growth by shifting a significant number of cells from the G2/M phase into the quiescent G0/G1 stage of the cell cycle. Furthermore, these effects could be nullified entirely if Kir4.1 channels were either pharmacologically inhibited by 100 microM BaCl2 or if cells were chronically depolarized by 20 mM KCl to the membrane voltage of growth competent glioma cells. These studies therefore demonstrate directly that Kir4.1 causes a membrane hyperpolarization that is sufficient to account for the growth attenuation, which in turn induces cell maturation characterized by a shift of the cells from G2/M into G0/G1.


A comprehensive review of protein-based carriers with simple structures for the co-encapsulation of bioactive agents.
The rational design and fabrication of edible codelivery carriers are important to develop functional foods fortified with a plurality of bioactive agents, which may produce synergistic effects in increasing bioactivity and functionality to target specific health benefits. Food proteins possess considerable functional attributes that make them suitable for the delivery of a single bioactive agent in a wide range of platforms. Among the different types of protein-based carriers, protein-ligand nanocomplexes, micro/nanoparticles, and oil-in-water (O/W) emulsions have increasingly attracted attention in the codelivery of multiple bioactive agents, due to the simple and convenient preparation procedure, high stability, matrix compatibility, and dosage flexibility. However, the successful codelivery of bioactive agents with diverse physicochemical properties by using these simple-structure carriers is a daunting task. In this review, some effective strategies such as combined functional properties of proteins, self-assembly, composite, layer-by-layer, and interfacial engineering are introduced to redesign the carrier structure and explore the encapsulation of multiple bioactive agents. It then highlights success stories and challenges in the co-encapsulation of multiple bioactive agents within protein-based carriers with a simple structure. The partition, protection, and release of bioactive agents in these protein-based codelivery carriers are considered and discussed. Finally, safety and application as well as challenges of co-encapsulated bioactive agents in the food industry are also discussed. This work provides a state-of-the-art overview of protein-based particles and O/W emulsions in co-encapsulating bioactive agents, which is essential for the design and development of novel functional foods containing multiple bioactive agents.


Strategic action in health information technology: why the obvious has taken so long.
Recent enthusiasm for the automation of medical records and the creation of a health information infrastructure must be viewed in the context of a four-decade history of anticipation and investment. To understand the current opportunities and challenges, we must understand both the evolution of attitudes and accomplishments in health care information technology (IT) and the cultural, economic, and structural phenomena that constrain our ability to embrace the technology. Because prudent IT investment could make a profound difference in U.S. health and disease management, our strategic response must begin with an understanding of the pertinent history plus the challenges that lie ahead.


Impact of Joule Heating and pH on Biosolids Electro-Dewatering.
Electro-dewatering (ED) is a novel technology to reduce the overall costs of residual biosolids processing, transport, and disposal. In this study, we investigated Joule heating and pH as parameters controlling the dewaterability limit, dewatering rate, and energy efficiency. Temperature-controlled electrodes revealed that Joule heating enhances water removal by increasing evaporation and electro-osmotic flow. High temperatures increased the dewatering rate, but had little impact on the dewaterability limit and energy efficiency. Analysis of horizontal layers after 15-min ED suggests electro-osmotic flow reversal, as evidenced by a shifting of the point of minimum moisture content from the anode toward the cathode. This flow reversal was also confirmed by the pH at the anode being below the isoelectric point, as ascertained by pH titration. The important role of pH on ED was further studied by adding acid/base solutions to biosolids prior to ED. An acidic pH reduced the biosolids charge while simultaneously increasing the dewatering efficiency. Thus, process optimization depends on trade-offs between speed and efficiency, according to physicochemical properties of the biosolids microstructure.


[Anastomotic recurrence following colorectal cancer].
Reported in this paper are 22 patients with recurrence of anastomosis, following curative resection of colorectal carcinoma. Recurrence in all cases was diagnosed by colonoscopy. Seventy-five per cent of all patients under follow-up care were without symptoms, and 83 per cent underwent intended radical surgery to cope with their recurrence. Curative re-operations were followed by mean survival of 39.4 months, while the five year survival rate amounted to 44 per cent. Hence, the prognosis of recurrence at the suture line appeared to be better than that of colorectal carcinoma recurrences localised elsewhere.


Epidemiological and clinical features of paediatric open globe injuries in southwestern Turkey.
To evaluate the epidemiologic, anatomic, and clinical features of open globe injuries in children. The medical files of patients under the age of 16 who had been operated for an open globe injury at Akdeniz University Hospital's Department of Ophthalmology were retrospectively evaluated. A total of 90 patients were evaluated in this study. Among these patients, 26 (28.9%) were female and 64 (71.1%) were male. The mean age of the patients was 7.7±4.2 years. The male/female ratio was observed to increase with increasing age (P=0.006, r=7.48). Injuries were most likely to occur in spring and autumn (P=0.028). The time interval between the injury and the surgical repair was 9.36±27.4h. Forty (44.4%) of the injuries occurred in the home, 27 (30%) occurred in the yard, and 21 (23.3%) happened while playing in the street. The most common causes of injury were sharp metal objects (P<0.001). Injury to the cornea occurred in 47 (52.2%) of the patients (P<0.001). The most common complication to occur was cataract formation. Additional operations were necessary for 37 (41.1%) of the patients. The final visual acuity was correlated with both the initial visual acuity of the wounded eye prior to surgery and the length of the wound (P<0.001, r=0.502 and P<0.001, r=-0.442, respectively). Open globe injuries that are suffered in childhood generally occur either at home, in the yard, or on the street, with sharp metal objects being the most common cause of injury. The initial visual acuity and the length of the wound are the most important determinants of the final visual acuity.


Characteristics of stress fractures in young athletes under 20 years.
With the popularization of organized sports among adolescents and children, the clinical cases of stress fractures in young athletes have increased. This study was carried out to investigate the characteristics of stress fractures in young athletes. During the 18-month period between January 1996 and June 1997, new clinical cases of stress fracture due to sports activities were collected from 39 hospitals in Japan. We analyzed 222 stress fractures in 208 athletes under 20 years of age (108 males: 14.4+/-2.2 years, 100 females: 15.2+/-1.5 years). Among these cases, the peak age of occurrence was 16. The most common sport causing stress fracture was basketball. The tibia was the most common location. About 70% of the patients participated in the respective sport for 6 or 7 days per week. High school students trained significantly more often than the primary and junior high school students (p<0.0001). There was a statistically significant difference in the return time to the sport between the cases who visited a hospital within 3 weeks and those who waited for more than 3 weeks after the onset of symptoms (return time, 10.4 vs 18.4 wks). Several cases visited a hospital beyond 8 weeks after the onset of symptoms regardless of the continuous pain of stress fracture, and their recovery was prolonged. It is important to educate young athletes that continuous pain lasting over 3 weeks is a warning signal to the body, and that early diagnosis leads to early recovery.


Telling different stories, making new realities: The ontological politics of 'addiction' biographies.
Personal narratives of alcohol and other drug addiction circulate widely in popular culture and they also have currency in professional therapeutic settings. Despite this, relatively little research has explored the conventions operating in these narratives and how they shape people's experiences and identities. While research in this area often proceeds on the premise that addiction biographies are straightforwardly 'true' accounts, in this paper we draw on the insights of critical alcohol and other drug scholarship, and the concept of 'ontological politics' to argue that biographies produce normative ideas about addiction and those said to be experiencing it. Our analysis compares traditional addiction narratives with the biographies we reconstructed from qualitative interviews with 60 people in Australia who describe themselves as having an 'addiction', 'dependence' or drug 'habit'. We track how addiction is variously enacted in these accounts and comment on the effects of particular enactments. By attending to the ways in which people cope, even thrive, with the kind of consumption that would attract a diagnosis of addiction or dependence, the biographies we produced disrupt the classic narrative of increasing drug use, decline and eventual collapse. Doing so allows for consideration of the benefits of consumption, as well as the ways that people carefully regulate it to minimise harms. It also constitutes individuals as active in managing consumption-an important move that challenges dominant understandings of addiction as a disorder of compulsivity. We conclude by considering the implications of our attempt to provide an alternative range of narratives, which resonate with people's diverse experiences.


Clinical features and intervention timing in patients with pregnancy-associated non-small-cell lung cancer.
There is no standard procedure available to diagnose and treat with pregnancy-associated non-small cell lung cancer (NSCLC). The present study was to investigate the clinical and molecular features, and the proper intervention timing for this population. This is a retrospective, pooled analysis. Cases from Guangdong Lung Cancer Institute and other published cases were collected and reviewed. The overall survival (OS) was analyzed according to the diagnosis timing, the treatment timing and the molecular character. The safety profile during pregnancy was also evaluated. Seventy-seven cases were collected including 11 patients from our center. The anaplastic lymphoma kinase (ALK) gene rearrangement and epidermal growth factor receptor (EGFR) mutation rates were 47% and 32%, respectively. The OS of patients treated during pregnancy, after delivery, and those not treated differed significantly [12 months vs. not reached (NR) vs. 1 month; P<0.001]. However, the OS between patients treated during pregnancy and after delivery was similar (P=0.173). Patients with ALK or EGFR exhibited a significantly better OS than those with wild-type [NR vs. 22 months vs. 8 months; P<0.001; hazard ratio (HR) =0.02, 95% confidence interval (CI): 0.00-0.22; HR =0.08, 95% CI: 0.01-0.76]. Fetal complications were observed in babies whose mothers were treated during pregnancy. The pregnancy-associated NSCLC population exhibited a high prevalence of driver genes and a promising effect of targeted therapy. No significant difference in the OS was observed between patients treated during pregnancy and patients treated after delivery.


[A brief textual research on Mei shi fang (Prescriptions of Master Mei) and Yi men fang (Prescriptions of Medical Professionals)].
Mei shi fang (Prescriptions of Master Mei) cited in Zheng lei ben cao (Classified Syndromes Materia Medica) and Yi men fang (Prescriptions of Medical Professionals) cited in Yi xin fang (Ishinpo) are actually the same book with different titles, which is actually called Yi men mi lu (Secret Records of Medical Professionals) with 5 volumes or the 5-volume Mei chong xian fang (Prescriptions of Mei Chongxian) approximately compiled during the years of Zhenyuan to Yuanhe reigns of the Tang Dynasty (785-820) written by Mei Chongxian, a Tang taoist. Mei Chongxian and Mei Biao, the author of Shi yao er ya (Dictionary of Mineral Medicines), might probably be the same person. According to the citations of Yi xin fang and Zheng lei ben cao, Yi men mi lu should be a comprehensive medical book including theories, methods, prescriptions and medications, recorded classical prescriptions of predecessors extensively, with some innovations and high clinical and documentary significance.


Concurrent comparison of endoluminal repair vs. no treatment for small abdominal aortic aneurysms.
Endoluminal repair of abdominal aortic aneurysms (AAA) requires the aneurysm to have a proximal neck of at least 1.5 cm between the renal arteries and the aneurysm. Therefore, there may be advantages in performing endoluminal repair in the early stages of aneurysm development. However, the results of endoluminal repair performed in patients with small aneurysms with favourable morphology are not known. The aim of this study was to determine whether a randomised trial of endoluminal repair vs. no treatment for small aneurysms would be justified by using a concurrent comparison of endoluminal repair vs. no treatment for AAA 5 cm or less in diameter in patients presenting to the same centre during a 4-year period. Data on 117 patients presenting with AAA 5 cm or less in diameter were entered into a registry. The decision to perform endoluminal repair vs. no treatment was based on the patient's preference following surgical consultation and investigation by computed tomography. This study reports the mortality, morbidity and survival of patients presenting between June 1992 and August 1996. During this time 43 patients had endoluminal repair and 67 patients had no treatment for small AAA. Seven patients were unfit for any intervention. Despite patient selection for different management in each group, close analysis revealed that the groups were similar with regard to co-morbidities and risk factors, as well as age, sex, and size of aneurysm. Follow-up was by progress CT scanning and ranged from 1 to 51 months (mean 18 months (NT) and 22 months (ER)). Endoluminal repair failed in six of 43 patients (14%) and resulted in 11 (25%) local vascular complications. There were two perioperative deaths and one late death in this group. Twenty-one of 67 AAA (31%) patients in the no treatment group enlarged beyond 5 cm in diameter during the study period. There was one death from aneurysm rupture and one death from myocardial infarction in this group. The patients in the endoluminal repair group have gained an asset in having their aneurysms repaired at a cost of early morbidity following operation. These results suggest that a randomised trial of endoluminal repair vs. no treatment will become justified in the subset of patients with small AAA 5 cm or less, if the incidence of complications can be reduced by further improvements in endoluminal technology.


Social Anxiety and Orthognathic Surgery Effect on Oral Health-Related Quality of Life.
This study aimed to investigate the impact of patients' social anxiety on oral health-related quality of life (OHRQoL) in the context of orthognathic surgery. The study involved a cohort of 70 patients who were tasked with completing a comprehensive questionnaire aimed at assessing various facets of their OHRQoL at distinct stages of treatment: pre-surgery, within one month post surgery, and more than one month post surgery. Statistical analyses were conducted in the form of t-test. Out of the 70 participants, 27 were male (38.57%) and 43 were female (61.43%). The sample distribution comprised 30 (43%) subjects in the pre-surgical stage, two (3%) at one month post surgery, and 38 (54%) more than one month post surgery. In relation to the t-test results, we found variations in the significance of the results for each question, with multiple results showing patients who reported experiencing discomfort significantly outnumbering those who did not (p < 0.05). Social anxiety and orthognathic surgery both demonstrate significant influences on OHRQoL. Subsequent research should delve into specific areas where patients experience the greatest impact.


A case study on better iconographic design in electronic medical records' user interface.
It is a known fact that there is a conflict between what users expect and what user interface designers create in the field of medical informatics along with other fields of interface design. The objective of the study is to suggest, from the 'design art' perspective, a method for improving the usability of an electronic medical record (EMR) interface. The suggestion is based on the hypothesis that the user interface of an EMR should be iconographic. The proposed three-step method consists of a questionnaire survey on how hospital users perceive concepts/terms that are going to be used in the EMR user interface. Then icons associated with the terms are designed by a designer, following a guideline which is prepared according to the results of the first questionnaire. Finally the icons are asked back to the target group for proof. A case study was conducted with 64 medical staff and 30 professional designers for the first questionnaire, and with 30 medical staff for the second. In the second questionnaire 7.53 icons out of 10 were matched correctly with a standard deviation of 0.98. Also, all icons except three were matched correctly in at least 83.3% of the forms. The proposed new method differs from the majority of previous studies which are based on user requirements by leaning on user experiments instead. The study demonstrated that the user interface of EMRs should be designed according to a guideline that results from a survey on users' experiences on metaphoric perception of the terms.


Reversible and tissue-specific activation of MAP kinase signaling by tamoxifen in Braf(V637)ER(T2) mice.
Deregulated MAP kinase (MAPK) signaling plays key roles in developmental and adult disease processes, but the experimental activation of MAPK is a currently unresolved task. For the reversible induction of MAPK signaling, we generated transgenic mice harboring a tamoxifen inducible BRAF(V637E)ER(T2) fusion protein. The expression of the inducible BRAF kinase can be directed by Cre/loxP-mediated recombination to selected cell types and enables the highly specific activation of MAPK signalling in vivo. We show that MAPK signaling can be transiently activated in the brain, liver, or kidney of Braf(V637E)ER(T2) mice by a single injection of tamoxifen. Braf(V637E)ER(T2) mice provide a new versatile tool to study disease mechanisms elicited by MAPK activation, complementing gene knockout technology that is restricted to the analysis of loss-of-function phenotypes.


Continuous-flow chemiluminometric determination of tetracyclines in pharmaceutical preparations and honey by oxidation with N-bromosuccinimide.
A continuous flow chemiluminometric method for determining 0.050-3.00 micrograms cm-3 of tetracycline, 0.50-5.00 micrograms cm-3 of oxytetracycline, 0.50-7.00 micrograms cm-3 of doxycycline and chlorotetracycline and 0.30-3.00 micrograms cm-3 of demeclocycline in pharmaceutical preparations and honey is described. The method is based on the chemiluminescence produced by the action of N-bromosuccinimide on tetracyclines in alkaline solution. The emission intensity is greatly enhanced by the presence of ammonia. The procedure is automated and solutions can be analysed at a rate of 130 h-1 with a relative error of about 2%. During evaluation of possible interferences of the method, recoveries from solutions with common excipients and other concomitant compounds were in the ranges 97.8-104.0 and 96.6-109.4%, respectively. Recoveries of various tetracyclines from commerical formulations and honey samples were in the ranges 95.2-103.7 and 89.2-106.6%, respectively. The results obtained for the assay of commerical pharmaceutical preparations compared well with those obtained by an official method and demonstrated accuracy and precision (< or = 5%).


Design of a cost-effective weighing facility for PM2.5 quality assurance.
The U.S. Environmental Protection Agency (EPA) Quality Assurance (QA) Guidance Document 2.12: Monitoring PM2.5 in Ambient Air Using Designated Reference or Class I Equivalent Methods (Document 2.12) requires conditioning of PM2.5 filters at 20-23 degrees C and 30-40% relative humidity (RH) for 24 hr prior to gravimetric analysis. Variability of temperature and humidity may not exceed +/-2 degrees C and +/-5% RH during the conditioning period. The quality assurance team at EPA Region 2's regional laboratory designed a PM2.5 weighing facility that operates well within these strict performance requirements. The traditional approach to meeting the performance requirements of Document 2.12 for PM2.5 filter analysis is to build a walk-in room, with costs typically exceeding $100,000. The initial one-time capital cost for the laboratory at EPA's Edison, NJ, facility was approximately $24,000. Annual costs [e.g., National Institute of Standards and Technology (NIST) recertifications and nitrogen replacement cylinders used for humidity control] are approximately $500. The average 24-hr variabilities in temperature and RH in the Region 2 weighing chamber are small, +/-0.2 degrees C and +/-0.8% RH, respectively. The mass detection limit for the PM2.5 weighing system of 47-mm stretched Teflon (lab blank) filters is 6.3 microg. This facility demonstrates an effective and economical example for states and other organizations planning PM2.5 weighing facilities.


Concise total synthesis of (+/-)-aloperine and 6-epi-aloperine.
[reaction: see text] Total synthesis of aloperine and 6-epi-aloperine is reported. The crucial steps of the synthetic strategy are an aza-annulation reaction and an intermolecular Diels-Alder reaction. The synthetic plan proceeds from commercially available piperidine-2-ethanol.


Myocyte changes and their left atrial distribution in patients with chronic atrial fibrillation related to mitral valve disease.
It has been found that the pulmonary veins and adjacent left atrial posterior wall (LAPW) are deeply involved in both the initiation and maintenance of atrial fibrillation (AF), and the identification of these high-risk sites has aroused great interest in investigating their histopathologic substrate. We used light and conventional electron microscopy to evaluate the differential myocyte and interstitial changes in LAPW and left atrial appendage (LAA) samples from 28 patients with chronic AF undergoing mitral valve surgery and from 12 autoptic controls. There were always more myocytes with loss of sarcomeres in the LAPW than in the LAA (19.9% +/- 7.7% versus 8.2% +/- 5.0%; P < .0001), and the LAPW showed more marked immunohistochemical evidence of dedifferentiation, characterized by the reexpression of smooth muscle actin. In pathological left atria, myocyte diameter in the LAPW and LAA was comparable (19.0 +/- 1.5 versus 18.5 +/- 2.0 microm; not significant) but larger than in the controls (11.9 +/- 0.8 and 12.1 +/- 1.3 microm, respectively; P < .0001). A terminal deoxynucleotidyltransferase assay did not reveal any myocyte apoptosis. The LAPW also showed more interstitial fibrosis than the LAA (7.49% +/- 3.34% versus 2.80% +/- 1.35%; P < .0001). Ultrastructural examination confirmed the presence of myocyte myocytolysis in the perinuclear area and showed changes in mitochondrial shape. In conclusion, the LAPW in patients with chronic AF related to mitral valve disease seems to be a particular anatomical site in which major myocyte and interstitial changes are concentrated, whereas the LAA is more protected. This remodeling may increase the heterogeneity of LAPW electrical conduction, thus confirming this location as an elective target for the ablation treatment of AF.


Comparison of the canine corneal epithelial cell sheets cultivated from limbal stem cells on canine amniotic membrane, atelocollagen gel, and temperature-responsive culture dish.
The current study compared canine corneal epithelial cell sheets cultivated from limbal stem cells on amniotic membrane, atelocollagen gel, and temperature-responsive culture dish. We collected limbal epithelial cells from the intact eyes of beagles and cultivated the cells on denuded canine amniotic membranes, temperature-responsive cell culture labware, and collagen gel with 3T3 feeder cells. Immunofluorescence staining for Ki-67 was used to analyze the capacity of cell proliferation in the sheets. Immunofluorescence staining was also performed for the corneal epithelium-specific marker cytokeratin 3 and putative stem cell markers ABCG2 and p63. Reverse-transcription polymerase chain reaction (RT-PCR) was performed to detect ABCG2 and p63. The growth rates of the cultivated cells, or the times it took them to reach confluency, were different for the three scaffolds. The cultivated sheet on the temperature-responsive dish consisted of 2-3 layers, while those on the collagen gel and on the amniotic membrane consisted of 5-8 layers. The basal layer cells grown on all three scaffolds expressed putative stem cell markers. In real-time RT-PCR analysis, the highest level of p63 was observed in the sheets grown on collagen gel. In this study, the cells cultured on the collagen gel demonstrated a capacity for cell proliferation, and the expressions of stem cells in the sheets suggested that collagen gel is the most suitable carrier for clinical use.


The role of Delta(9)-desaturase in the production of cis-9, trans-11 CLA.
Biomedical studies with animal models have demonstrated that cis-9, trans-11 conjugated linoleic acid (CLA), the predominant isomer found in milk fat from dairy cows, has anticarcinogenic effects. We recently demonstrated endogenous synthesis of cis-9, trans-11 CLA from ruminally derived trans-11 C18:1 by Delta(9)-desaturase in lactating dairy cows. The present study further examined endogenous synthesis of cis-9, trans-11 CLA and quantified its importance by increasing substrate supply using partially hydrogenated vegetable oil (PHVO) as a source of trans-11 C18:1 and blocking endogenous synthesis using sterculic oil (SO) as a source of cyclopropene fatty acids which specifically inhibit Delta(9)-desaturase. Four cows were abomasally infused with 1) control, 2) PHVO, 3) SO, and 4) PHVO+SO in a 4 x 4 Latin square design. With infusion of PHVO, cis-9, trans-11 CLA was increased by 17% in milk fat. Consistent with inhibition of desaturase, SO treatments increased milk fat ratios for the fatty acid pairs effected by Delta(9)-desaturase, C14:0/cis-9 C14:1, C16:0/cis-9 C16:1, and C18:0/cis-9 C18:1. The role of endogenous synthesis of CLA was evident from the 60-65% reduction in cis-9, trans-11 CLA which occurred in milk fat with SO treatments. cis-9 C14:1 originates from desaturation of C14:0 by Delta(9)-desaturase and can be used to estimate the extent of SO inhibition of Delta(9)-desaturase. When this correction factor was applied, endogenous synthesis was estimated to account for 78% of the total cis-9, trans-11 CLA in milk fat. Thus, endogenous synthesis was the major source of cis-9, trans-11 CLA in milk fat of lactating cows.


Low-grade gliomas in adults.
Making treatment decisions for patients with infiltrating low-grade gliomas (LGGs) is challenging. Patients frequently present with seizures and usually have little or no neurologic deficit. In this younger and relatively well patient population, despite the potential for significant morbidity, we believe that surgical resection, radiation therapy, and chemotherapy each play an important role in the optimal management of these tumors. Randomized clinical trials have begun to address some of the many questions about prognosis, natural history, and treatment, but most questions have yet to be answered. We believe that, when possible, a maximal surgical resection consistent with preservation of neurologic function should be performed, even though it is likely that no randomized clinical trial will ever be done to demonstrate a survival advantage for this approach. External beam radiation therapy is most often given to a total dose of 50.4 or 54 Gy in 1.8-Gy fractions. The role of chemotherapy is less certain, but a growing body of evidence suggests that temozolomide, a generally well-tolerated drug, is active in the treatment of LGGs. In recent years, loss of heterozygosity of chromosome 1p and 19q, as well as silencing of the MGMT gene, have been identified as promising predictors of response to adjuvant therapy in gliomas. Although randomized trials have not yet shown a survival benefit for early radiation therapy or chemotherapy, one study by the European Organisation for Research and Treatment of Cancer did show an improvement in time to tumor progression with the earlier use of radiation therapy. In addition, a trial by the Radiation Therapy Oncology Group (soon to be analyzed and reported) is comparing radiation alone with radiation followed by a year (six cycles) of standard-dose PCV chemotherapy (procarbazine, CCNU, and vincristine); this trial may shed light on the use of chemotherapy in conjunction with radiation therapy for the initial treatment of LGGs. Because patients remain at risk for tumor progression for the remainder of their lives, we recommend lifelong follow-up with MRI scans, even for patients without documented tumor regrowth over long intervals. To give clinicians a more solid basis for guiding therapy recommendations, we encourage participation in large cooperative group clinical trials.


Transcutaneous cervical vagus nerve stimulation improved motor cortex excitability in healthy adults: a randomized, single-blind, self-crossover design study.
To investigate the effect of transcutaneous cervical vagus nerve stimulation (tcVNS) on motor cortex excitability in healthy adults. Twenty eight healthy subjects were assigned to receive real and sham tcVNS for 30 min. The interval between the real and sham conditions was more than 24 h, and the sequence was random. The central and peripheral motor-evoked potential (MEP) of the right first dorsal interosseous (FDI) muscle was measured by transcranial magnetic stimulation (TMS) before and after stimulation. MEP latency, MEP amplitude and rest motor threshold (rMT) were analyzed before and after stimulation. MEP amplitude, MEP latency and rMT had significant interaction effect between time points and conditions (p < 0.05). After real stimulation, the MEP amplitude was significantly increased (p < 0.001). MEP latency (p < 0.001) and rMT (p = 0.006) was decreased than that of baseline. The MEP amplitude on real condition was higher than that of sham stimulation after stimulation (p = 0.027). The latency after the real stimulation was significantly shorter than that after sham stimulation (p = 0.005). No significantly difference was found in rMT after stimulation between real and sham conditions (p > 0.05). tcVNS could improve motor cortex excitability in healthy adults.


Haplotype matching is not an essential requirement to achieve remyelination of demyelinating CNS lesions.
Transplantation of oligodendrocyte precursor cells (OPCs) results in efficient remyelination in animal models of demyelination. However, the experiments so far undertaken have not addressed the need for tissue-type matching to achieve graft-mediated remyelination. Examination of MHC expression (main determinant of allograft rejection) by OPCs showed nondetectable levels under standard culture conditions and upregulation of MHC Class I expression only upon exposure to interferon gamma. We therefore hypothesized that MHC matching of OPC grafts may not be crucial to achieve transplant-mediated remyelination. Transplant experiments performed using a nonself repairing toxin-induced demyelination model showed that, similarly to allogeneic neurons, survival of allogeneic oligodendrocyte lineage cells is influenced by donor-host haplotype combination and graft composition. Transplantation of allogeneic mixed glial cell cultures resulted in remyelination failure by 1 month postengraftment due to a rejection response targeting both myelinating oligodendrocytes and OPCs, suggesting that inflammation-induced upregulation of OPC MHC I expression results in susceptibility to cytotoxic T cell attack. In contrast, remyelination persisted for at least 2 months following transplantation of OPC-enriched cultures whose overall MHC expression level was significantly decreased. While OPC-enriched preparations elicited delayed type hypersensitivity responses in hosts sensitized to alloantigens, allografting of such preparations into a central nervous system demyelinating lesion did not result in recipient priming. We conclude that while allografted oligodendrocyte lineage cells become targets of a graft rejection response once this response has been initiated, transplantation of OPC-enriched preparations can evade priming against alloantigens and graft rejection. This finding indicates that close tissue matching may not be an essential requirement for successful transplant-mediated remyelination.


Adherence to HAART and its principal determinants in a cohort of Senegalese adults.
Access to programmes providing highly active antiretroviral therapy (HAART) is recent in Africa. In Senegal, a national initiative was launched in 1998. The capacity of African patients to adhere to complex antiretroviral treatments (ARV) is largely unknown. We assessed adherence and identified the main reasons for treatment interruption in a prospective observational cohort of patients participating in an ARV access programme in Dakar, Senegal. Adherence was estimated each month on the basis of the patients' stated consumption and on the proportion of the prescribed dose returned unused to the dispensing pharmacy. A total of 158 patients were studied between November 1999 and October 2001. A cross-section analysis showed that the stated level of adherence was high: on average, over the study period, the patients said they had taken 91% of each monthly dose and that they had taken the full monthly dose during two-thirds of the months studied. Adherence tended to be better among patients who were required to make little or no contribution to the cost of their treatment, through an appropriate pricing structure. Adherence was also better with efavirenz-containing regimens than with indinavir-containing regimens. These results show that adherence to HAART can be as high in Africa as that generally observed in industrialized countries, and that the cost and type of drug regimen must be taken into account when designing ARV access programmes for poor communities.


Effect of cooling rate on the microstructure and luminescence properties of Sr2 MgSi2 O7 :Eu2+ ,Dy3+ materials.
Sr2 MgSi2 O7 :Eu2+ ,Dy3+ long afterglow materials were prepared by a high-temperature solid-state reaction method with different cooling rates. The cooling rate had a slight effect on X-ray diffraction patterns and photoluminescence performance, but significantly modified the grain boundaries and long afterglow properties of the Sr2 MgSi2 O7 :Eu2+ ,Dy3+ materials. When the cooling rate was 1°C/min, grains remained intact with clear grain boundaries. As the cooling rate increased from 1°C/min to 5°C/min, some grain boundaries became indistinguishable. The afterglow properties were optimized, presenting best performance at the cooling rate of 3°C/min. The trap state was investigated and illustrated through thermoluminescence curves. The depths of the traps of all the samples were unchanged, whereas densities changed to a large extent, leading to different afterglow properties. The retrapping process is discussed based on the afterglow curves.