Control of descending vasa recta pericyte membrane potential by angiotensin II.
Using nystatin perforated-patch whole cell recording, we investigated the role of Cl(-) conductance in the modulation of outer medullary descending vasa recta (OMDVR) pericyte membrane potential (Psi m) by ANG II. ANG II (10(-11) to 10(-7) M) consistently depolarized OMDVR and induced Psi m oscillations at lower concentrations. The Cl(-) channel blockers anthracene-9-decarboxylate (1 mM) and niflumic acid (10 microM) hyperpolarized resting pericytes and repolarized ANG II-treated pericytes. In voltage-clamp experiments, ANG II-treated pericytes exhibited slowly activating currents that were nearly eliminated by treatment with niflumic acid (10 microM) or removal of extracellular Ca(2+). Those currents reversed at -31 and -10 mV when extracellular Cl(-) concentration was 152 and 34 mM, respectively. In pericytes held at -70 mV, oscillating inward currents were sometimes observed; the reversal potential also shifted with extracellular Cl(-) concentration. We conclude that ANG II activates a Ca(2+)-dependent Cl(-) conductance in OMDVR pericytes to induce membrane depolarization and Psi m oscillations.


Mapping global development potential for renewable energy, fossil fuels, mining and agriculture sectors.
Mapping suitable land for development is essential to land use planning efforts that aim to model, anticipate, and manage trade-offs between economic development and the environment. Previous land suitability assessments have generally focused on a few development sectors or lack consistent methodologies, thereby limiting our ability to plan for cumulative development pressures across geographic regions. Here, we generated 1-km spatially-explicit global land suitability maps, referred to as "development potential indices" (DPIs), for 13 sectors related to renewable energy (concentrated solar power, photovoltaic solar, wind, hydropower), fossil fuels (coal, conventional and unconventional oil and gas), mining (metallic, non-metallic), and agriculture (crop, biofuels expansion). To do so, we applied spatial multi-criteria decision analysis techniques that accounted for both resource potential and development feasibility. For each DPI, we examined both uncertainty and sensitivity, and spatially validated the map using locations of planned development. We illustrate how these DPIs can be used to elucidate potential individual sector expansion and cumulative development patterns.


Specializations of the retinochoroidal juncture.
The occurrence of attachment sites between the basal plasma membrane of the retinal pigment epithelium and its basement lamina have been observed in a variety of animal species, including man. Similar structures connect adjacent basal infoldings of the retinal pigment epithelium. The topographic distribution of such attachment sites and basal infoldings in rat eyes show small differences between the peripapillary, posterior, and peripheral retina. Such attachment sites may help to provide a firm connection between the retinal pigment epithelium and choroid.


Fast, manual, nonradioactive method for DNA sequencing.
We describe a protocol that allows nonradioactive detection of sequencing products after manual, direct, solid-phase sequencing of polymerase chain reaction-amplified DNA. The amplified DNA fragment to be studied is biotinylated at the 5' end of one of the two oligonucleotide primers used for amplification, allowing coupling to streptavidin-coated magnetic beads. The immobilized double-stranded DNA is then separated into single strands by alkaline treatment. A 5'-biotinylated sequencing primer is used after saturating with a biotin solution any possible remaining affinity sites on the streptavidin-coated magnetic beads. Sequencing is performed by using T7 DNA polymerase, and the sequencing products are electrophoresed in denaturing polyacrylamide sequencing gel. After transfer of the products to a nylon membrane, the sequencing pattern is revealed by chemiluminescence. Biotinylated alkaline phosphatase is bound to the 5' end of the sequencing primer via a streptavidin bridge and catalyzes the reaction by cleaving a phosphate group from a chemiluminescent substrate. The emitted photons are detected by exposing the membrane to x-ray film. This method is simple, rapid, and consistently successful and reproducible.


Sustained Local Delivery of Diclofenac from Three-Dimensional Ultrafine Fibrous Protein Scaffolds with Ultrahigh Drug Loading Capacity.
The three-dimensional (3D) ultrafine fibrous scaffolds loaded with functional components can not only provide support to 3D tissue repair, but also deliver the components in-situ with small dosage and low fusion frequency. However, the conventional loading methods possess drawbacks such as low loading capacity or high burst release. In this research, an ultralow concentration phase separation (ULCPS) technique was developed to form 3D ultrafine gelatin fibers and, meanwhile, load an anti-inflammatory drug, diclofenac, with high capacities for the long-term delivery. The developed scaffolds could achieve a maximum drug loading capacity of 12 wt.% and a highest drug loading efficiency of 84% while maintaining their 3D ultrafine fibrous structure with high specific pore volumes from 227.9 to 237.19 cm3/mg. The initial release at the first hour could be reduced from 34.7% to 42.2%, and a sustained linear release profile was observed with a rate of about 1% per day in the following 30 days. The diclofenac loaded in and released from the ULCPS scaffolds could keep its therapeutic molecular structure. The cell viability has not been affected by the release of drug when the loading was less than 12 wt.%. The results proved the possibility to develop various 3D ultrafine fibrous scaffolds, which can supply functional components in-situ with a long-term.


Hinders for continued work among persons with fibromyalgia.
Work disability is common among women with fibromyalgia (FM). The aim of the study was to investigate what health problems and work-related difficulties lead to hinders for continued work among women with FM. A qualitative interview study. Twenty-seven gainfully employed women with FM participated in five focus group interviews. Their median age was 52 years, ranging from 33 to 62. The transcribed interviews were analyzed by content analysis. Health problems and work-related demands were identified. Limited physical capacity, increased stress and an increased need of rest were the major health problems, while physical, psychosocial and work organizational demands were the main work-related problems. Personal factors and factors related to family influenced the strategies used to manage the imbalance between the health problems and work-related demands. Limited physical capacity and an increased need of rest made it difficult for these women to manage the physical, psychosocial and organizational work demands. Adjustment of the work tasks and work environment were the main factors influencing whether the women with FM could work or not.


Airway Management of a Patient With Penetrating Maxillofacial Trauma Caused by Chainsaw Kickback: A Case Report.
Anesthesiologists rarely experience airway management in patients with maxillofacial injuries caused by a chainsaw. A 36-year-old male was referred to our hospital because of maxillofacial injuries caused by chainsaw kickback. There were deep lacerations of the right eyelid, medial canthus, cheek, and jaw with venous bleeding. The laceration of the cheek reached the oral cavity and looked like a "second mouth." The patient was taken to the operating room for urgent laceration repair under general anesthesia. Despite a poor laryngeal view, awake orotracheal intubation with a videolaryngoscope was successful on the second attempt without complications. Oxygenation was optimized by supplemental oxygen administration via a suction catheter inserted from the "second mouth" throughout the airway management. The present case highlights the importance of airway management strategies according to the nature of the trauma in patients with penetrating maxillofacial trauma caused by a chainsaw.


[Subarachnoid hemorrhage in 'Vital Statistics of Japan', 1993-1995: variability with age and sex].
The incidence and death rate of subarachnoid hemorrhage (SAH) varies with age and sex. Female preponderance in the incidence of SAH is a well-known fact. However, the degree varies with age. Autopsy data, records of natural history of unruptured aneurysms, epidemiological and clinical cooperative studies have provided a great amount of information regarding the statistics of subarachnoid hemorrhage. But, each individual study has its own limitation, such as a bias in case selection in autopsy or clinical studies, predominance of aged population in the epidemiological cohort studies, limited frequency in the detection of unruptured aneurysms in the entire population. These shortcomings are reflected in the variability in the statistical data of these studies. Death records in 'Vital Statistics of Japan', published annually by Ministry of Health and Welfare of Japan, exhibit the numbers of deaths by cause (according to ICD-9 or 10 code), sex and age. In this study, we calculated the death rates of SAH (per 100,000) in 1993-1995 for each age group of both sexes based on the published data. Deaths from breast cancers and automobile accidents (AMA) were assessed in the same manner and compared with the results of SAH. The annual death rate of SAH for all people in Japan is 10.7 per 100,000 population and the average age of death is 65.6 y.o. The death rate is 8.2 for men, and 13.1 for women. Average age at the death is 60.2 y.o. in men, and 68.8 y.o. in women (p < 0.001). The age-adjusted death rate to 1985 Japanese population was 7.3 for men and 9.2 for women. Below age 60, rate of death caused by SAH is higher for men than women, but the ratio reverses in the population over 60. For men, the death rates after the age of 40, 50, 60 and 70 were 16.4, 20.4, 24.1 and 29.2 respectively. For women, the rates were 25.0, 32.8, 44.1 and 62.4. The female-to-male ratio of the death rates increases with age. Female sex should be considered as a risk factor for death from SAH. Number of deaths from breast cancers was about 90% of those from SAH in women. There was a difference in the age distribution; deaths caused by breast cancer tend to occur in younger age than those caused by SAHs. Mean age of death was 59.3 for breast cancer and 68.8 for SAH. Deaths caused by SAH is 1.4 times more likely to occur than those by breast cancer for a 50 year-old woman for the rest of her life, 1.9 times for a 60 y.o. woman, and 2.7 times for a 70 y.o. woman. Regular examination to detect breast cancer is widely performed in Japan among elderly women. We believe that a similar screening effort should be targeted for unruptured aneurysms from the standpoint of the medico-social cost. Automobile accidents (AMA) victimize as many people as SAH in Japan, about 13,000 per year. For males over the age of forty, AMA victims are more than those from SAH. However, conversely females' deaths from SAH occur three times frequently as those from AMAs. The fact should be taken into consideration when screening for unruptured aneurysms.


Single Cell Transcriptomic Re-analysis of Immune Cells in Bronchoalveolar Lavage Fluids Reveals the Correlation of B Cell Characteristics and Disease Severity of Patients with SARS-CoV-2 Infection.
The coronavirus disease 2019 (COVID-19) pandemic (severe acute respiratory syndrome coronavirus 2) is a global infectious disease with rapid spread. Some patients have severe symptoms and clinical signs caused by an excessive inflammatory response, which increases the risk of mortality. In this study, we reanalyzed scRNA-seq data of cells from bronchoalveolar lavage fluids of patients with COVID-19 with mild and severe symptoms, focusing on Ab-producing cells. In patients with severe disease, B cells seemed to be more activated and expressed more immunoglobulin genes compared with cells from patients with mild disease, and macrophages expressed higher levels of the TNF superfamily member B-cell activating factor but not of APRIL (a proliferation-inducing ligand). In addition, macrophages from patients with severe disease had increased pro-inflammatory features and pathways associated with Fc receptor-mediated signaling, compared with patients with mild disease. CCR2-positive plasma cells accumulated in patients with severe disease, probably because of increased CCL2 expression on macrophages from patients with severe disease. Together, these results support the hypothesis that different characteristics of B cells might be associated with the severity of COVID-19 infection.


Nitrous oxide and hypnotherapy in paediatric dentistry.
Patient compliance is of paramount importance for proper dental treatment, which can be difficult to achieve in children due to anxiety and fear, hindering the therapeutic procedure. In addition to well-known sedation methods (pharmacological and nitrous oxide), further methods of approach are being tested, such as hypnotherapy. The sample consisted of 150 children (90 males, 60 females). Paper questionnaires, frequency meter, nitrous oxide dispenser in association with the use of the television were exploited. At the end of treatment, subjective pain was assessed using the VAS scale, while objective pain was assessed using the FLACC scale and heart rate. This made it possible to compare two experimental groups, one treated with nitrous oxide, and the other with hypnotherapy. The control group was treated with classic behavioural approach techniques. The results obtained were analysed by SPSS Software (Statistical Package for Social Science, version 27) and the inferences between the results were calculated for confirmation. Hypnotherapy can be a valid substitute for nitrous oxide in paediatric dentistry.


Brazilian Scientific Journals in Surgery: quality control in the abstract structure of non-experimental articles.
To evaluate the quality of abstracts of original non-experimental research articles in Brazilian Journals in Surgery. Convenience sample of 471 abstracts of original research articles from six Brazilian surgical journals indexed in Thomson Reuters (ISI) Web of Knowledge. The quality of abstracts was measured against a checklist of eight evaluation criteria, which were divided into 32 categories. The total score for each abstract was obtained by summing the score of all criteria present. The overall mean score was also determined. The overall mean score of abstract quality was that of a good abstract. Most of the abstracts contained some information from each of the eight basic categories of an abstract. All abstracts were structured ones. The overall quality, for abstracts of original articles of six Brazilian non-experimental journals in surgery, was classified as good.


Dissecting intramyocardial haematoma diagnosed by contrast echocardiography.
Intramyocardial dissecting haematoma is a rare form of cardiac rupture that can occur as a complication following acute myocardial infarction or during the remodelling process. It is usually caused by a haemorrhagic dissection among the spiral myocardial fibres and needs urgent surgical treatment. Here we report the case of a 67-year-old man with indications of a previous infarction, in whom a dissecting intramyocardial haematoma was identified using contrast echocardiography.


Cellulosomes localise on the surface of membrane vesicles from the cellulolytic bacterium Clostridium thermocellum.
Membrane vesicles released from bacteria contribute to cell-cell communication by carrying various cargos such as proteins, nucleic acids and signaling molecules. Cellulolytic bacteria have been isolated from many environments, yet the function of membrane vesicles for cellulolytic ability has been rarely described. Here, we show that a Gram-positive cellulolytic bacterium Clostridium thermocellum released membrane vesicles, each approximately 50-300 nm in diameter, into the broth. The observations with immunoelectron microscopy also revealed that cellulosomes, which are carbohydrate-active enzyme complexes that give C. thermocellum high cellulolytic activity, localized on the surface of the membrane vesicles. The membrane vesicles collected by ultracentrifugation maintained the cellulolytic activity. Supplementation with the biosurfactant surfactin or sonication treatment disrupted the membrane vesicles in the exoproteome of C. thermocellum and significantly decreased the degradation activity of the exoproteome for microcrystalline cellulose. However, these did not affect the degradation activity for soluble carboxymethyl cellulose. These results suggest a novel function of membrane vesicles: C. thermocellum releases cellulolytic enzymes on the surface of membrane vesicles to enhance the cellulolytic activity of C. thermocellum for crystalline cellulose.


One year in review 2021: novelties in the treatment of rheumatoid arthritis.
Management of rheumatoid arthritis (RA) has evolved over the years as a result of better understanding of the role of different therapeutic strategies, as well as following an increasing availability of new disease-modifying antirheumatic drugs. However, the role of patients in sharing decisions, as well as the rules informing precision medicine or the principles to follow in case of specific comorbidities or extra-articular manifestations are still areas for improvement. Moreover, in 2020, the novel Coronavirus disease-19 outbreak has completely changed many attitudes in terms of assessment and treatment paradigms in most clinical diseases, including RA. In this narrative review, the authors report their specific point of view on the management of RA, based on a critical revision of literature published in 2020, focusing on relevant novelties and future research directions.


Changes in antimicrobial susceptibility of native Enterococcus faecium in chickens fed virginiamycin.
The extent of transfer of antimicrobial resistance from agricultural environments to humans is controversial. To assess the potential hazard posed by streptogramin use in food animals, this study evaluated the effect of virginiamycin exposure on antimicrobial resistance in Enterococcus faecium recovered from treated broilers. Four consecutive broiler feeding trials were conducted using animals raised on common litter. In the first three trials, one group of birds was fed virginiamycin continuously in feed at 20 g/ton, and a second group served as the nontreated control. In the fourth trial, antimicrobial-free feed was given to both groups. Fecal samples were cultured 1 day after chickens hatched and then at 1, 3, 5, and 7 weeks of age. Isolates from each time point were tested for susceptibility to a panel of different antimicrobials. Quinupristin/dalfopristin-resistant E. faecium appeared after 5 weeks of treatment in trial 1 and within 7 days of trials 2 to 4. Following removal of virginiamycin in trial 4, no resistant isolates were detected after 5 weeks. PCR failed to detect vat, vgb, or erm(B) in any of the streptogramin-resistant E. faecium isolates, whereas the msr(C) gene was detected in 97% of resistant isolates. In an experimental setting using broiler chickens, continuous virginiamycin exposure was required to maintain a stable streptogramin-resistant population of E. faecium in the animals. The bases of resistance could not be explained by known genetic determinants.


High morbidity and mortality in children with untreated congenital deficiency of leptin or its receptor.
The long-term clinical outcomes of severe obesity due to leptin signaling deficiency are unknown. We carry out a retrospective cross-sectional investigation of a large cohort of children with leptin (LEP), LEP receptor (LEPR), or melanocortin 4 receptor (MC4R) deficiency (n = 145) to evaluate the progression of the disease. The affected individuals undergo physical, clinical, and metabolic evaluations. We report a very high mortality in children with LEP (26%) or LEPR deficiency (9%), mainly due to severe pulmonary and gastrointestinal infections. In addition, 40% of surviving children with LEP or LEPR deficiency experience life-threatening episodes of lung or gastrointestinal infections. Although precision drugs are currently available for LEP and LEPR deficiencies, as yet, they are not accessible in Pakistan. An appreciation of the severe impact of LEP or LEPR deficiency on morbidity and early mortality, educational attainment, and the attendant stigmatization should spur efforts to deliver the available life-saving drugs to these children as a matter of urgency.


Descriptions of the adult male, prepupa and pupa of Xylococcus castanopsis Wu Huang (Hemiptera: Coccomorpha: Xylococcidae).
The morphologies of the adult male, prepupa and pupa of Xylococcus castanopsis Wu Huang (Hemiptera: Xylococcidae) are described and illustrated. These developmental stages were collected at Tianluhu Forest Park, Guangzhou city, Guangdong Province, China, from the same forest stands as the holotype female.


Leaflet tear in a Trifecta aortic bioprosthesis 34 months after implantation.
Bioprosthetic valves are used in aortic valve replacement to avoid lifelong anticoagulation. Bovine pericardial valves have excellent haemodynamics and equivalent freedom from reoperation compared with a porcine bioprosthesis [ 1]. However, early failure (parastent post-cusp tear) can take place due to mechanical stress. We report an acute structural failure on a Trifecta pericardial valve (St Jude Medical, Inc.) explanted after 34 months from a 71-year old woman.


Relationship between carotid atherosclerosis and coronary artery calcification in asymptomatic diabetic patients: A prospective multicenter study.
The value of screening sub-clinical atherosclerosis in asymptomatic patients with type 2 diabetes mellitus (T2DM) remains controversial. An integrated model incorporating carotid intima-media thickness (CIMT) and carotid plaque with traditional risk factors can be used to predict prevalence and severity of coronary artery calcification in asymptomatic T2DM patients. A cohort of 262 asymptomatic T2DM patients were prospectively studied with carotid ultrasound to evaluate CIMT and carotid plaque and also a computed tomography coronary artery calcium (CT-CAC) scan. Carotid plaque was detected in 124 (47%) patients and mean CIMT was 0.75±0.14 mm. Two hundred (76%) patients had a CAC score >0, of whom 57 (22%) had severe coronary atherosclerosis (>400 Au). In this group, carotid plaque was present in 40 (70%) patients (p<0.001). Univariable analysis revealed significant associations between non-zero CAC score and age (p<0.001), hypertension (p=0.01), gender (p=0.003) and duration of diabetes (p=0.004). Carotid plaque and mean CIMT were also significantly associated with non-zero CAC score (odds ratios [95% CI], 3.12 [1.66 -5.85] and 2.98 [0.24 -7.17], respectively). After adjusting for traditional risk factors, carotid plaque continued to be predictive of non-zero CAC score (2.59 [1.17 -5.74]) and CIMT was borderline significant (p=0.05). When analysed with binary logistical regression, the prevalence of carotid plaque significantly predicted severe CAC burden (CAC >400 Au; 3.26 [2.05 -5.19]). Upper CIMT quartiles showed a similar association (2.55 [1.33 -4.87]). Carotid plaque is more predictive of underlying silent coronary atherosclerosis prevalence, severity and extent in asymptomatic T2DM patients.


Acquired peripheral neuropathy: a report on 20 children.
Guillain-Barré syndrome (GBS) is an inflammatory polyneuropathy characterized by acute onset, rapid progression, symmetric muscular weakness, pain, and paresthesias. The incidence of GBS in the pediatric age group is 0.8 cases per 100,000; 50%-70% of the cases are preceded by respiratory or gastrointestinal infectious episodes or vaccination. The etiopathogenesis of GBS has been hypothesized to involve a direct immune-mediated mechanism against the peripheral nerves. A series of 20 patients managed in the Department of Pediatrics of the University of Catania between 2003 and 2011 and evaluated according to epidemiologic, clinical, and therapeutic features is reported.


A randomized trial of cash incentives for sexual behavior change among female sex workers in Dar es Salaam.
Female sex workers (FSW) across the world are at high risk for HIV infection and much work is needed to scale up HIV prevention programs among this group. Conditional cash transfer (CCT) programs have been used successfully in recent years to encourage behavior change. We report the results of a CCT intervention among FSW in Tanzania. We conducted a randomized controlled trial (N = 100) of a CCT intervention among FSW in Dar-es-Salaam, Tanzania in 2013. A respondent-driven sampling approach recruited women and randomized them into two groups based on the value of the cash incentive ($20 vs. $40 per visit). All women received testing for 2 curable sexually transmitted infections (STIs), trichomonas and syphilis, free treatment for those STIs and counseling. Women attended study visits at 0, 2 and 4 months and were tested for STIs and received counseling at each visit. Women testing negative for both STIs at the 2- and 4-month visits received a cash reward. Eighty-four women were retained in the study through all three visits. Participants reported significant reductions in the number of clients per week, and increases in the proportion of clients that they used condoms with over the course of the study. STI results showed decreases in prevalence from baseline to final study visit for syphilis and trichomonas. While this study was not powered to determine if the incentive resulted in statistically significant increases in condom use or decreases in STI prevalence, the results show the acceptability of the intervention, the feasibility of the recruitment methods, and the ability to retain FSW participants across multiple study visits. A follow-up randomized study with a larger number of participants is planned to test the efficacy of the intervention among high-risk populations of women engaging in transactional sex.


Vaginal hysterectomy for the large uterus.
Vaginal hysterectomy for the large uterus is seldom performed in Malaysia. The traditional operation is abdominal hysterectomy. This is a personal series of vaginal hysterectomies for enlarged uterus of more than 12 weeks size (>280g) carried out in a private hospital between 1/1/97 to 30/9/2000. A total of 40 cases were done with the weights of the uterus ranging from 290g to 790g. The mean weight of the uterus was 434g. The average operating time was 92.1 min. The complications were minimal with 2 cases of blood transfusion for intra-operative hemorrhage, 1 case of fever and 1 case of bladder perforation. This series demonstrates feasibility and safety of the operation. The excellent recovery due to the absence of an abdominal scar should be a strong incentive for specialists to learn the skill.


Comparison of the role of somatosensory stimuli in maze learning in a blind subterranean rodent and a sighted surface-dwelling rodent.
We compared the role of tactile perception in maze learning in the blind mole rat and in the laboratory rat. Both species were tested in each of two mazes that were identical in complexity but differed in tunnel width and height: the first was only slightly wider than the animal's body width (narrow maze) while the second was about twice the animal's body width (wide maze). We found that the performances of rats tested in the narrow maze were significantly lower than those tested in the wide maze, as measured by time and number of errors to reach the end of the maze (food reward). The mole rats, in contrast, performed significantly better in the narrow maze than in the wide maze. Further, in contrast to the rats, the mole rats' locomotion in the wide maze was much less continuous than in the narrow maze, reflected in longer and more frequent stops at maze junctions, where they pressed the side of their body tightly against the tunnel walls. Two main conclusions are derived from this experiment. First, subterranean mammals, such as the blind mole rat, appear to rely more on tactile stimuli while exploring and learning a complex maze than do sighted surface-dwelling rodents, such as rat. The extensive use of this somatosensory channel may compensate for the mole rats' visual deficiency, and thus substantially contribute to their excellent spatial orientation ability, previously demonstrated in field and laboratory conditions. Second, poor performance of surface-dwelling rodents, such as the rats, in spatial-maze learning tasks might not be a consequence of impaired cognitive learning ability, but rather due to testing the animal in a physical situation that does not provide the necessary somatosensory stimuli found in their natural habitat.


Race, ethnicity, and geography: disparities in heart disease in women of color.
Cardiovascular disease (CVD) is the leading cause of death in women. Misconceptions about the importance of CVD still persist. These myths affect awareness of CVD and the urgency with which women present for treatment after symptoms develop. Modifiable and nonmodifiable risk factors are more prevalent among ethnic minority women in concentrated geographical locations. The recent publication of the CDC women's atlas presents a unique opportunity for healthcare providers to use derived county-specific data in education, research, and delivery of health promotion and disease prevention services to women of color. Specific recommendations for the nursing profession are provided to assist in eliminating CVD disparities for all women.


Which Classification System Is Most Useful for Classifying Osteonecrosis of the Femoral Head?
Many studies have confirmed that the size and location of necrotic lesions are major factors that affect the prevalence of collapse and prognosis in patients with osteonecrosis of the femoral head (ONFH). Although several classification systems categorize and quantify ONFH, there is no agreement on which one is most useful for the purpose. We compared the Steinberg, modified Kerboul, and Japanese Investigation Committee (JIC) classifications of ONFH in terms of (1) the correlation among the three different classification systems. We further examined (2) the inter- and intraobserver reliability of the three classification systems and (3) the association of higher grades within each classification and the risk of subsequent collapse. Between January 2000 and December 2014, we treated 101 hips in 74 patients for precollapse ONFH, diagnosed either on plain radiographs or MRI. Of those, one patient (1%) died, six patients (8%) were lost to followup, and two patients (3%) underwent osteotomy before 2 years, leaving 86 hips in 65 patients (88%) for analysis here. Three-dimensional spoiled gradient-echo sequence (3D-SPGR) MRI was performed for all hips, and the presence of ONFH was determined by finding the area surrounded by the outer margin of the low-signal-intensity band on 3D-SPGR MRI. Patients with ONFH were categorized using the Steinberg, modified Kerboul, and JIC classification systems, and correlations among these three classification systems were investigated. Inter- and intraobserver reliability was assessed by 10 orthopaedic surgeons using 40 sets of 3D-SPGR MR images. The reliability of each system was evaluated using the kappa coefficient. The cumulative survival rate with collapse and undergoing hip arthroplasty as the endpoints was evaluated for each of the three classification systems (mean followup, 9 years; range, 2-16 years), and the association of higher grades within each classification and the risk of subsequent collapse were also evaluated. We found strong correlations between the Steinberg and modified Kerboul classifications (ρ = 0.83, p < 0.001), the Steinberg and JIC classifications (ρ = 0.77, p < 0.001), and the modified Kerboul and JIC classifications (ρ = 0.80, p < 0.001). Interobserver reliability in the JIC classification (0.72; range, 0.30-0.90) was higher than that in the Steinberg classification (0.56; range, 0.24-0.84; p < 0.001) and the modified Kerboul classification (0.57; range, 0.35-0.80; p < 0.001). The cumulative survival rate with collapse as the endpoint after a minimum of 2 years of followup in the Steinberg classification differed between Grades A (82%; 95% confidence interval [CI], 66%-97%) and B (43%; 95% CI, 21.9%-64.8%; p = 0.007), Grades A and C (20%; 95% CI, 4.3%-35.7%; p < 0.001), and Grades B and C (p = 0.029). Survival was lower for modified Kerboul Grade 4 hips (12%; 95% CI, 0%-27.1%) than for Steinberg Grade C hips (20%; 95% CI, 4.3%-35.7%) and JIC Type C2 hips (18%; 95% CI, 2.8%-34.0%). The JIC classification was best able to identify hips at low risk of collapse because no JIC Type A hips collapsed. The JIC classification was more reliable and effective, at least for early-stage ONFH, than the Steinberg or modified Kerboul classifications. Further investigation might be useful to identify whether each classification system emphasizes specific risk factors for collapse. Level III, diagnostic study.


Reconstituting Natural Cell Elements in Synthetic Cells.
Building a live cell from non-living building blocks would be a fundamental breakthrough in biological sciences, and it would enable engineering new lineages of life, not directly descendant of the Last Universal Common Ancestor. Fully engineered synthetic cells will have architectures that can be radically different from the natural cells, yet most life processes reconstituted in synthetic cells so far are built from natural and biosimilar building blocks. Most natural processes have already been reconstituted in synthetic cell chassis. This paper summarizes recent advancements in using non-living building blocks to reconstitute some of the most crucial features of living systems in a fully engineerable chassis of a synthetic cell.


Fecal Bacterial Communities in treated HIV infected individuals on two antiretroviral regimens.
Intestinal microbiome changes that occur in HIV positive individuals on different antiretroviral therapy (ART) regimens are important to understand, as they are potentially linked with chronic inflammation and microbiome-linked comorbidities that occur at increased incidence in this population. We conducted a cross-sectional study comparing the fecal microbiomes of HIV-uninfected (HIV SN) to HIV-infected individuals on long-term ART (HIV+ LTART) from Mexico using 16S ribosomal RNA (16sRNA) targeted sequencing. These individuals were on two ART regimens based on either Non-Nucleoside Reverse Transcriptase Inhibitors (EFV) or ritonavir-boosted Protease Inhibitors (PI) with the same backbone of Nucleoside Reverse Transcriptase Inhibitors. Microbiome diversity was reduced in treated HIV infection compared to HIV SN (p < 0.05). Several operational taxonomic units (OTUs) related to the Ruminococcaceae family including Faecalibacterium prausnitzii were depleted in EFV and PI compared to HIV SN and negatively correlated with intestinal gut dysfunction as measured by the intestinal fatty binding protein (p < 0.05). This is the first report to address the fecal bacterial communities in HIV-infected individuals on two ARV regimens from Mexico.


Pharmacogenetics of HIV therapy.
Drug treatment in HIV disease is characterized by variable responses, in terms of both efficacy and toxicity. Both genetic and environmental factors are important determinants of this variability, although the relative contributions are unclear and likely to vary with different drugs. Many of the antiretrovirals are metabolized by polymorphically expressed enzymes (cytochrome P450, CYP450; glucuronyl transferase, GT) and/or transported by drug transporters (ABC and SLC families). Initial studies of antiretroviral efficacy have therefore focused on these genes. For example, it has recently been shown that a CYP2B6 genetic variant predicts higher plasma efavirenz exposure and possibly increased central nervous system toxicity. A large number of studies on ABCB1 genetics with antiretrovirals have also been undertaken; however, as in other therapeutic areas, the data have been contradictory, and currently, no firm conclusions can be reached on the effect of ABCB1 variability as a determinant of efficacy. Indeed, this highlights the need for validation of initial association studies in pharmacogenetic research. By contrast, the clearest association between genetic variants and response relates to the hypersensitivity reaction that occurs with abacavir. The identification that the major histocompatibility complex haplotype 57.1 acts as a strong genetic predisposing factor can be regarded as a prime example of how fundamental research can be translated into a pharmacogenetic test. Nevirapine hypersensitivity has also been related to an HLA gene (HLA-DRB1*0101) but the predictive value does not appear to be sufficient to implement in clinical practice. Much more work needs to be done to define the genetic factors determining response to antiretroviral agents. These studies need to be sufficiently powered and utilize a modern genotyping strategy. Most importantly, the phenotype needs to be carefully characterized. We also need to disseminate this information: a pivotal resource for this can be found at www.HIV-pharmacogenomics.org.


Biomimetic structured surfaces increase primary adhesion capacity of cartilage implants.
In cartilage repair, scaffold-assisted single-step techniques are used to improve the cartilage regeneration. Nevertheless, the fixation of cartilage implants represents a challenge in orthopaedics, particularly in the moist conditions that pertain during arthroscopic surgery. Within the animal kingdom a broad range of species has developed working solutions to intermittent adhesion under challenging conditions. Using a top-down approach we identified promising mechanisms for biomimetic transfer The tree-frog adhesive system served as a test case to analyze the adhesion capacity of a polyglycolic acid (PGA) scaffold with and without a structural modification in a bovine articular cartilage defect model. To this end, PGA implants were modified with a simplified foot-pad structure and evaluated on femoral articular bovine cartilage lesions. Non-structured PGA scaffolds were used as control. Both implants were pressed on 20 mm × 20 mm full-thickness femoral cartilage defects using a dynamometer. The structured scaffolds showed a higher adhesion capacity on the cartilage defect than the non-structured original scaffolds. The results suggest that the adhesion ability can be increased by means of biomimetic structured surfaces without the need of additional chemical treatment and thus significantly facilitate primary fixation procedures.


Design of a universal reversible bidirectional current switch based on the fullerene-phthalocyanine supramolecular system.
A novel bidirectional current ON-OFF switch controlled by electron injection and deprivation was proposed on the basis of the density functional theory (DFT) calculation over a fullerene-phthalocyanine supramolecular system PcCoC(60) for the first time. The electron density for PcCoC(60) was revealed to move from fullerene to phthlocyanine only in the oxidized form and from phthlocyanine to fullerene only in the reduced form, reaching the control of electron movement direction by changing the oxidation state of this supramolecular system.


Endometrioma Presented as Acute Abdomen in a Peritoneal Dialysis Patient: A Case Report and Literature Review.
Laparoscopic management in patients on peritoneal dialysis offers good postoperative outcome and early resumption to peritoneal dialysis. This is a report of a 43-year-old woman with end-stage kidney disease on peritoneal dialysis presented with left iliac fossa pain due to a large endometrioma. Emergency diagnostic laparoscopy was performed with careful laparoscopic entry, Tenckhoff catheter care and anti-adhesive application. The patient underwent temporary hemodialysis for two weeks before full resumption to peritoneal dialysis. She was planned for GnRH analogue for three months post-operatively. In conclusion, laparoscopy is a safe and advantageous route of surgery for ovarian endometrioma in patients on peritoneal dialysis. However, mindful surgical strategies are needed to ensure the Tenckhoff catheter's longevity and early resumption to peritoneal dialysis post-operatively.


Model for dense granular flows down bumpy inclines.
We consider dense flows of spherical grains down an inclined plane on which spherical bumps have been affixed. We propose a theory that models stresses as the superposition of a rate-dependent contribution arising from collisional interactions and a rate-independent part related to enduring frictional contacts among the grains. We show that dense flows consist of three regions. The first is a thin basal layer where grains progressively gain fluctuation energy with increasing distance from the bottom boundary. The second is a core region where the solid volume fraction is constant and the production and dissipation of fluctuation energy are nearly balanced. The last is a thin collisional surface layer where the volume fraction abruptly vanishes as the free surface is approached. We also distinguish basal flows with the smallest possible height, in which the core and surface layers have disappeared. We derive simple closures of the governing equations for the three regions with insight from the numerical simulations of Silbert et al. [Phys. Rev. E64, 051302 (2001)] and the physical experiments of Pouliquen [Phys. Fluids 11, 542 (1999)]. The theory captures the range of inclination angles at which steady, fully developed flows are observed, the corresponding shape of the mean and fluctuation velocity profiles, the dependence of the flow rate on inclination, flow height, interparticle friction, and normal restitution coefficient, and the dependence of the height of basal flows on inclination.


Reducing 'information overload' in the teaching of pharmacology: the '200 Drug List'.
The author in this report describes the development and use of a restricted list of drugs in the medical pharmacology course at the Medical College of Georgia (MCG) School of Medicine. The "200 Drug List" was developed by the author by analyzing recent examinations given to students at the MCG and other places. The list contained 60 percent fewer drugs than had been taught in the course in prior years. Only those drugs on the list appeared on subsequent pharmacology examinations, regardless of the scope of the teaching program. Despite the limited number of drugs that the students were required to learn to satisfy the requirements of the teaching program, the average score for the class on the pharmacology subtest of the National Board of Medical Examiners Part I examination improved each year since the new approach was adopted. The 200 Drug List concept is viewed as an effective way to reduce the "information overload" for students without sacrificing the quality of an introductory course in pharmacology.


The collective and quantum nature of proton transfer in the cyclic water tetramer on NaCl(001).
Proton tunneling is an elementary process in the dynamics of hydrogen-bonded systems. Collective tunneling is known to exist for a long time. Atomistic investigations of this mechanism in realistic systems, however, are scarce. Using a combination of ab initio theoretical and high-resolution experimental methods, we investigate the role played by the protons on the chirality switching of a water tetramer on NaCl(001). Our scanning tunneling spectroscopies show that partial deuteration of the H2O tetramer with only one D2O leads to a significant suppression of the chirality switching rate at a cryogenic temperature (T), indicating that the chirality switches by tunneling in a concerted manner. Theoretical simulations, in the meantime, support this picture by presenting a much smaller free-energy barrier for the translational collective proton tunneling mode than other chirality switching modes at low T. During this analysis, the virial energy provides a reasonable estimator for the description of the nuclear quantum effects when a traditional thermodynamic integration method cannot be used, which could be employed in future studies of similar problems. Given the high-dimensional nature of realistic systems and the topology of the hydrogen-bonded network, collective proton tunneling may exist more ubiquitously than expected. Systems of this kind can serve as ideal platforms for studies of this mechanism, easily accessible to high-resolution experimental measurements.


Dosage effect of high-amylose modifier gene(s) on the starch structure of maize amylose-extender mutant.
The objective of this study was to investigate how dosages of high-amylose modifier (HAM) gene(s) affected the structure of maize amylose extender (ae) mutant starch. GEMS-0067 (G), a homozygous mutant of ae and the HAM gene(s), and H99ae (H), an ae single mutant, were self-pollinated or inter-crossed to produce maize endosperms of G/G, G/H, H/G, and H/H with 3, 2, 1, and 0 doses of HAM gene(s), respectively. Endosperm starch was fractionated into amylopectin, amylose, and intermediate component (IC) of large and small molecular weights using 1-butanol precipitation of amylose followed by gel-permeation chromatography. Increases in the dosage of HAM gene(s) from 0 to 3 decreased the amylopectin content. The HAM-gene dosage significantly changed the branch chain-length of small-molecular-weight IC, but had little effect on the branch chain-length distributions of amylopectin and large-molecular-weight IC and the molecular structure of amylose.


Microbial Co-occurrence Network and Fermentation Information of Natural Woody-Plant Silage Prepared With Grass and Crop By-Product in Southern Africa.
To facilitate the use of woody plant (WP) as a natural biomass resource to address the shortage of feed for ruminants in the tropics, we use PacBio SMRT sequencing to explore the microbial co-occurrence network and silage fermentation of gliricidia and leucaena prepared with Napier grass (NG) and corn stover (CS) in Southern Africa. Based on dry matter, the crude protein contents of WP are as high as 25%. Compared with NG, the addition of CS speed up the dynamic succession of microorganisms in the silage fermentation process from Gram-negative bacteria to Gram-positive bacteria, and promoted Lactiplantibacillus plantarum to become the dominant community and enhanced the metabolic pathways of lactic acid and citric acid, thus improved the fermentation flavour and quality of WP silage. WP can be mixed with CS to make high-quality silage, which can alleviate the shortage of feed and promote local animal production.


Potassium inhibits nitric oxide and adenosine arteriolar vasodilatation via K(IR) and Na(+)/K(+) ATPase: implications for redundancy in active hyperaemia.
Redundancy, in active hyperaemia, where one vasodilator can compensate for another if the first is missing, would require that one vasodilator inhibits the effects of another; therefore, if the first vasodilator is inhibited, its inhibitory influence on the second vasodilator is removed and the second vasodilator exerts a greater vasodilatory effect. We aimed to determine whether vasodilators relevant to skeletal muscle contraction [potassium chloride (KCl), adenosine (ADO) and nitric oxide] inhibit one another and, in addition, to investigate the mechanisms for this interaction. We used the hamster cremaster muscle and intravital microscopy to directly visualize 2A arterioles when exposed to a range of concentrations of one vasodilator [10(-8) to 10(-5) M S-nitroso-N-acetyl penicillamine (SNAP), 10(-8) to 10(-5) M ADO, 10 and 20 mM KCl] in the absence and then in the presence of a second vasodilator (10(-7) M ADO, 10(-7) M SNAP, 10 mM KCl). We found that KCl significantly attenuated SNAP-induced vasodilatations by ∼65.8% and vasodilatations induced by 10(-8) to 10(-6) M ADO by ∼72.8%. Furthermore, we observed that inhibition of KCl vasodilatation, by antagonizing either Na(+)/K(+) ATPase using ouabain or inward rectifying potassium channels using barium chloride, could restore the SNAP-induced vasodilatation by up to ∼53.9% and 30.6%, respectively, and also restore the ADO-induced vasodilatations by up to ∼107% and 76.7%, respectively. Our data show that vasodilators relevant to muscle contraction can interact in a way that alters the effectiveness of other vasodilators. These data suggest that active hyperaemia may be the result of complex interactions between multiple vasodilators via a redundant control paradigm.


[Cytokines in the pathogeny of celiac disease].
Celiac disease is manifested by an enteropathy caused by intolerance to gluten, a family of proteins found in wheat and other cereals. Following intestinal T-cell activation in predisposed individuals, different inflammatory mechanisms are triggered under the control of the cytokine balance including those with a pro-inflammatory Th1 pattern such as IFNgamma, TNFalpha, IL-15 and IL-18; and regulatory cytokines such as TGFbeta and IL-10. These cytokines, besides increasing the intensity of the activation and the number of immune cells within the intestinal mucosa, regulate the activity of epithelial growth factors and metalloproteinases, a group of molecules involved in the maintenance and turnover of the intestinal mucosa structure; in inflammatory conditions, they also induce the intestinal lesion responsible for malabsorption syndrome.


Falls associated with electroconvulsive therapy among the geriatric population: a case report.
Electroconvulsive therapy (ECT) is the treatment of choice in many older individuals with depression and a few other conditions. Like all medical treatments, this intervention has certain possible risks, which include undesirable reactions associated with general anesthesia and those attributed specifically to ECT itself, such as short-term memory loss. The potential association of falls with ECT has not been well studied. Our recent literature search revealed that information on this topic consists mainly of chart reviews and case reports. We present a case of an older woman with a history of recurrent major depressive disorder that required intervention with ECT. She suffered 2 falls during her course of ECT. This case adds to the growing body of anecdotal evidence supporting an association of falls with ECT and highlights the need for more scientifically rigorous data to clarify whether this apparent association is real and/or causally related.


Immunophenotyping of human dendriform cells from the conjunctival epithelium.
Conjunctival Langerhans cells are bone marrow-derived, antigen-presenting cells that play a major role in the immune response of the ocular surface, but they have as yet been little investigated, either functionally or phenotypically. This study was undertaken in impression cytology to provide an extended immunophenotype of human conjunctival dendriform cells. Immunostaining procedures were used to seek for the expression of the following 30 membrane antigens related to the immune system, using dendriform cells obtained in conjunctival specimens from 80 normal subjects and 105 with chronic conjunctivitis: class II antigens HLADR and DQ, CD1a (T6) and CD5, which usually mark Langerhans cells, macrophage markers CD14, CD36 and CD63, various lymphocyte antigens (CD2, CD4 and CD8), receptor to interleukin 2 (CD25), adhesion molecules and integrins (CD11a, CD11b, CD11c, CD18, CD29, CD41, CD61), the selectin CD62, ICAM-1 (CD54), ICAM-3 (CD50) and ELAM-1, CD45RO, related to activation of immune cells, and its ligand CD22, receptors to immunoglobulins (CD23 and CD32) and complement (CD21), transferrin receptor CD71, tryptase and vimentin, were thus investigated. Conjunctival dendriform cells reliably expressed several antigens: class II antigens HLA DR and HLA DQ, CD1a, vimentin, CD11a and CD18 (LFA-1), CD14, CD22, CD36, CD45RO, ICAM-3 and CD63. Other markers were only occasionally found (CD4, CD11b, CD29, CD32 and CD54), and the remaining above antigens were not expressed. No relevant difference was found between normal and inflammatory specimens in the immunophenotype of dendriform cells. This study sheds light on the main antigen-presenting cells of the ocular surface. The conjunctival cells share common immunophenotypic features with those from skin or mucosae, but our results showed some discrepancies, probably related to the specific immune status of the ocular structures.


[Giant uterine leiomyoma causing acute symptoms].
The case history of a 71-year-old woman with acute dyspnoea caused by a giant leiomyoma and severe acute anemia due to intratumoral hemorrhage is presented. Urgent operation was performed, and a 13.5 kg pendular tumor was removed. The cornerstones of the differential diagnoses and therapy of giant abdominal tumors is discussed.


A rare presentation of oral pemphigus vulgaris as multiple pustules.
Pemphigus vulgaris is an autoimmune blistering disease affecting the mucous membrane and skin. Ulcers, vesicles, bulla, erosions are the common manifestations of the disease. It is uncommon to find multiple pustular lesions in the oral cavity. Here, we report the first case of multiple pustules involving the lateral borders of tongue, buccal mucosa, hard palate, soft palate, vestibule and the gingiva of a 53 year old male. Histopathologic and Immunofluoroscence study was suggestive of pemphigus vulgaris. The condition improved with systemic corticosteroid along with adjuvant therapy. Key words: pemphigus vulgaris, multiple pustules, immunofluorescence, corticosteroids.


Effect of Stopper Size on Squaraine Rotaxane Stability.
A series of new squaraine rotaxanes have been synthesized with a tetralactam macrocycle and stopper groups of varying sizes and functionalities. In chloroform solvent, the relative size of the stopper group appears to have little influence on the high mechanical stability of the rotaxane structure. There is no evidence for unthreading (sometimes referred to as deslipping), even in the presence of competing chloride salts or elevated temperatures. A difference in rotaxane stability emerges as the polarity of the organic solvent is increased. Squaraine rotaxanes with small stopper groups undergo unthreading in the polar aprotic solvent DMSO. However, a water soluble tetracarboxylic acid derivative was found to be highly stable in aqueous solvents containing serum.


[Genetics of laryngeal cancer: an experimental study].
Squamous cell laryngeal carcinoma accounts for 1% of all cancer deaths and 95% of all laryngeal malignancies. It is most frequently found in smokers over 40 years of age. This neoplasm is presently the object of cytogenetic studies in an attempt to identify a specific chromosome pattern. In a study of 29 cases of malignant primary laryngeal tumor, Nawroz (1993) found a loss of alleles in different loci mapped in the short arm of chromosome 9 (9p) in more than two-thirds of the cases. In the same chromosome region, the loss of heterozygotes (LOH) was previously described in other neoplasms (leukemia, hematic tumors, melanomas). In an attempt to verify the predominant chromosome pattern and the loss of heterozygotes in chromosome 9, a cytogenetic, genetic-molecular study was performed on ten cases of laryngeal carcinoma. Among these subjects, two showed a hyperdiploid chromosome pattern (metaphase with more than 46 chromosomes per cell), five had a hypodiploid pattern (with less than 46 chromosomes per cell) while, for the remaining three cases, it was not possible to identify any metaphase. Numerous structural and numerical karyotype defects were found in chromosomes 1, 3, 4, 5, 9, 10, 13, 14, 16, 18, and Y. In 6 of the cases abnormality was found in chromosome 9 while in 10 it was apparently a homozygote. The study was performed with the use of fluorescent in situ hybridization (FISH) using a chromosome library specific for chromosome 9. A loss of the 9p segment could be found as a result of different types of alterations: deletion (case 1, 2, 5, 7); non uniform transfer between chromosome 2 and chromosome 9 (case 2); other transfers involving the 9p segment (case 1, 4, 5, 7, 10). In six cases, analysis was further detailed at the molecular level by means of DNA amplification methods (PCR) and electrophoresis on denatured 10% polyacrylammide gels. LOH was studied using a polymorphic system specific for the short arm of chromosome 9. Four of the cases examined showed LOH for the system used while one case (case 4) gave no information. Case 9 did not show any loss of alleles. The present study suggests that the loss of a DNA sequence on chromosome 9p is primary to the neoplastic progression in laryngeal cancer.


The use of a surgical patch coated with human coagulation factors in surgical routine: a multicenter postauthorization surveillance.
Local hemostyptic agents are of great value to significantly reduce bleeding complications and various devices have become available for clinical use. The aim of this multicenter postauthorization surveillance was to study the surgeons' expectations regarding efficacy and safety of the surgical patch coated with human coagulation factors (TachoSil) under routine clinical conditions. A total of 408 patients had been included in this trial and the patients had to have an expected increased bleeding risk either due to patient related hemorrhagic risk factors or operations associated with an expected increase of bleeding complications. The main types of surgical interventions were operations on the liver (26%), vascular system (16%), gastrointestinal tract (10%), heart (8%), kidney (7%), thorax (7%), spleen (4%), and pancreas (4%). Other operations (18%) were reported in the fields of neurosurgery, urology, gynecology, dermatology, and on the thyroid gland. Based on subjective assessments the results have shown that TachoSil has met the surgeons' expectations to be efficacious and safe as a hemostatic treatment in a broad variety of surgical interventions. The observed benefits far exceed the frequencies of complications and many of the observed benefits easily translate into cost savings. In almost 50% of the cases the surgeons thought that the use of the topical hemostat TachoSil may have led to savings in blood component therapy. The savings of intra- and postoperative transfusions may lead to less frequent transfusion-related adverse effects and the lower probability of postoperative complications is of clinical importance. In particular, it is worth mentioning that based on the surgeons' assessment, the use of TachoSil may have helped to save the organ in 17% of the cases. Thus, these clinically relevant benefits may offer opportunities for improvements of hemostasis in patients at risk for bleeding complications and may facilitate the management of excessive bleeding.


Organizational influences on healthcare system adoption and use of advanced health information technology capabilities.
The adoption of advanced health information technology (HIT) capabilities, such as predictive analytic functions and patient access to records, remains variable among healthcare systems across the United States. This study is the first to identify characteristics that may drive this variability among health systems. Responses from the 2017/2018 National Survey of Healthcare Organizations and Systems were used to assess the extent to which healthcare system organizational structure, electronic health record (EHR) standardization, and resource allocation practices were associated with use of 5 advanced HIT capabilities. Of 732 systems surveyed, 446 responded (60.9%), 425 (58.1%) met sample inclusion criteria, and 389 (53.1%) reported consistent EHR use. Measures of adoption, resource allocation, and organizational structure were developed based on survey responses. Multivariate linear regression with control variables estimated the relationships. Adoption of advanced HIT capabilities is low and variable, with a mean of 2.4 capabilities adopted and only 8.4% of systems reporting widespread adoption of all 5 capabilities. In adjusted analyses, EHR standardization (β = 0.76; P = .001) was the strongest predictor of the number of advanced capabilities adopted, and ownership and management of medical groups (β = 0.32; P = .04) was also a significant predictor. Health systems that standardize their EHRs and that own and manage hospitals and medical groups have higher rates of advanced HIT adoption and use. System leaders looking to increase the use of advanced HIT capabilities should consider ways to better standardize their EHRs across organizations.


Inpatient intervention in an indigent, minority population with uncontrolled diabetes.
To study whether a program of brief, intensive, inpatient intervention could improve glycemic control in an indigent, minority population with uncontrolled diabetes unresponsive to outpatient treatment. Patients with uncontrolled diabetes unresponsive to treatment in our outpatient Diabetes Clinic were admitted to our inpatient Diabetes Unit, where their care was directed by the Diabetes Team (an attending diabetologist, an endocrinology fellow, two nurses, and two nutritionists). Of 108 patients admitted, data were available for 96. Patients from minority populations constituted 91.7% of the group. All patients were indigent. The mean duration of stay was 4.3 days. After dismissal, patients underwent follow-up again in our Diabetes Clinic. During the 540-day follow-up period, 25 patients were electively readmitted when satisfactory improvement in glycemic control was not achieved. Hemoglobin A1c levels were averaged and plotted for the group at defined time points up to 360 days before admission and up to 540 days after admission. During the year before admission, hemoglobin A1c increased slowly from 10.1 +/- 0.3% (mean +/- standard error) at day -360 to 10.3 +/- 0.2% at day -210 (F5 = 29; P<0.01) and then rapidly to 11.4 +/- 0.2% at admission (F7 = 1,541; P<0.001). After admission, hemoglobin A1c declined rapidly to 9.5 +/- 0.2% at day 90 (F4 = 121; P<0.005), plateaued at that level until day 240, and then declined again slowly to 9.0 +/- 0.3% at day 540, the end of the follow-up period (F10 = 70; P<0.01). All hemoglobin A1c levels 30 days or more after admission were significantly lower than the mean level at admission (P<0.05 at day 30 and P<0.001 from day 45 to day 540). Brief, intensive, inpatient intervention in an indigent, minority population with uncontrolled diabetes unresponsive to outpatient treatment produced and sustained a significant improvement in glycemic control. This mode of treatment is a practical approach to achieving the improvement in glycemic control that the Diabetes Control and Complications Trial demonstrated to be effective in delaying the onset and slowing the progression of diabetic retinopathy, nephropathy, and neuropathy.


Intraoperative endoscopy during colorectal surgery.
In cases where preoperative studies may have been inadequate or could not be performed, intraoperative endoscopy (IOE) becomes an essential investigative tool for identification of synchronous lesions, of nonpalpable lesions, of sources of bleeding, and localization of lesions during laparoscopic colonic surgery. We report our experience with IOE, and describe our techniques of transabdominal colonoscopy. A review of the IOE performed in hospitals affiliated with the University of Miami was done. Fifty-eight patients received IOE from July 1994 to August 1996. There were 47 colonoscopies (38 transanal and 9 transabdominal), and 11 flexible sigmoidoscopies. Colorectal cancer, diverticulitis, inflammatory bowel disease, and lower gastrointestinal bleeding represented 83% of cases. In 10% of cases IOE changed the extent of the surgical procedure. There were no complications related to IOE. We conclude that in selected patients undergoing colorectal procedures, IOE is an essential tool. It can be performed safely, effectively, and rapidly.


Accumulation of gliotoxin, a cytotoxic mycotoxin from Aspergillus fumigatus, in blue mussel (Mytilus edulis).
A strain of Aspergillus fumigatus has been isolated from sediments of a mussel bed. When cultured in hyper saline conditions (with sea-water), it produces a cytotoxic and immunosuppressive toxin, gliotoxin, which is excreted in an exudate. In order to know if this toxin could represent a risk for shellfish consumers, an experiment of bioaccumulation of gliotoxin in mussel has been carried out. After 6 days of contamination, toxin was accumulated in the meat of the mussels, at a level up to 2.9 microg/mg of extract weight, with a mode of contamination different to the classical digestive process described for a majority of marine toxins, but similar to the contamination mode of domoic acid.


Clinical experience with a lipid-free, ready-made parenteral nutrition solution in dogs: 70 cases (2006-2012).
To review the clinical use of a lipid-free, ready-made amino acid and glucose parenteral nutrition (PN) solution in dogs. Retrospective study of dogs from 2006 to 2012 that received this form of PN. University veterinary teaching hospital. Seventy dogs presented to the hospital for treatment of various diseases in which PN was used as part of patient management. Dogs were administered PN at the discretion of the primary clinician. A lipid-free, ready-made solution containing amino acid (59 g/L) and dextrose (100 g/L) was administered intravenously as a constant rate infusion to provide nutritional support. PN was provided for a median of 2.2 days (range 0.5-9.5 days) in the 70 dogs, totaling 168 days of PN. The PN provided a median of 5.5 g/100 kcal of protein (range 1-9.5 g/100 kcal) and a median of 2.2 mg/kg of bodyweight per minute (range 0.8-5.2 mg/kg/min) of glucose, which reflected a median of 57% of the resting energy requirement (range 9-100%). Metabolic complications developed in 43 of 67 dogs where these data were recorded, but the development of hyperkalemia was the only complication associated with a poor outcome (eg, death or euthanasia). Mechanical complications were seen in 28 dogs, and all but one of these occurred when PN was delivered through peripheral catheters. Septic complications were confirmed in 5 dogs. This form of PN is suitable for clinical use and can provide both protein and calories to ill dogs. It was, however, associated with a high rate of complications and requires careful patient monitoring.


Aberrant expression of cytokine genes in peritoneal macrophages from mice infected with LP-BM5 MuLV, a murine model of AIDS.
Mice infected with LP-BM5 murine leukemia virus (MuLV) develop a syndrome denoted as murine AIDS. Macrophages harvested from the peritoneal cavities of these mice at 4 or 9 wk postinoculation with LP-BM5 MuLV were analyzed by Northern hybridization for the presence of the defective LP-BM5 virus and their ability to synthesize various cytokines upon induction with Newcastle disease virus (NDV) or (LPS). Neither IFN-alpha or IFN-beta was found to be constitutively expressed in LP-BM5-infected macrophages and in NDV induction studies, and the levels of biologically active IFN-alpha and its mRNA were found to be lower in LP-BM5 MuLV-infected macrophages than in the macrophages from uninfected controls. Similarly, after NDV or LPS induction, the levels of TNF mRNA and TNF protein were significantly lower in LP-BM5-infected macrophages than in macrophages from uninfected mice. The LP-BM5 MuLV-infected macrophages constitutively expressed low levels of IL-1 beta, and when induced with LPS, the relative levels of IL-1 beta were significantly higher in infected than in uninfected macrophages. Although no constitutive expression of IL-6 was detected, the levels of IL-6 mRNA induced with NDV were higher in LP-BM5 MuLV-infected macrophages than in controls. Thus, we found alterations in the expression of selected cytokines in macrophages from mice inoculated with LP-BM5 MuLV rather than a general deregulation of all cytokine expression. These results show that macrophages infected with the defective LP-BM5 virus respond differently to NDV- or LPS-stimulation and suggest that aberrant expression of certain cytokine genes may play a role in the immunopathologic condition in mice with murine AIDS.


Significance of MRI in Bouveret's Syndrome.
Impaction of a big gallstone in the duodenum, after migration through a bilioduodenal fistula, causing gastric outlet obstruction (GOO) is known as Bouveret's syndrome. In computed tomography (CT), pneumobilia and calcified bile stone in duodenal bulb leading to GOO is typical for diagnosis. Most of the cases presented to date are diagnosed with CT and their imaging features were discussed. On the other hand, there are very few published researches about the magnetic resonance imaging (MRI) findings of Bouveret's syndrome. In this paper, a case of Bouveret's syndrome diagnosed with MRI is discussed in the view of the present literature. KEY WORDS: Bouveret's syndrome, Cholecystoduodenal fistula, Gastric outlet obstruction, Gallstone ileus, MRI.


Systematic method for determining intravenous drug treatment strategies aiding the humoral immune response.
This paper delineates a systematic method for determining "optimal" intravenous drug delivery strategies for patients having illnesses that primarily evoke a humoral immune response and are treatable by antibiotics. The method derives from a nonlinear, distributed predator-prey model that captures the dominant antigen and antibody interaction. This model is developed from relevant physiology, past predator-prey-type modeling work, available data, and pertinent parameter identification. Embedding this predator-prey model into a larger class of uncertain systems, by a finite dimensional approximation and a transformation to a linear fractional representation, enables the application of robust control based on linear matrix inequality optimization techniques. The optimization problem is solved by minimizing an upper bound on a measure of the total drug delivered subject to patient recovery (stability to healthy equilibrium state). Specifically, the paper addresses the treatment of Haemophilus influenzae through modeling, controller development, and simulations of infected adult patients subjected to typical and proposed intravenous antibiotic treatments. Through simulations the proposed intravenous drug strategy shortens patient recovery time, lowers peak drug concentrations and decreases the total drug administered when compared to standard antibiotic strategies.


[Relationships between the Biomass and Production of Bacterio- and Phytoplanktonic Communities].
Quantitative ratios of the biomasses of bacterio- and phytoplankton, interrelation of their production characteristics, and association of the functional characteristics with environmental factors were studied for Lake Khanka, the Yenisei River and the Krasnoyarsk Reservoir. The ratio between the biomasses of bacterioplankton (Bb) and phytoplankton (Bp) in these water bodies was shown to vary within the range exceeding three orders of magnitude. Bacterioplankton biomass was relatively stable and varied from sample to sample by an order of magnitude. In more than 50% of the samples (total sample number, 495), bacterioplankton biomass exceeded that of the phytoplankton. The average Bb/Bp ratios for Lake Khanka, Yenisei River, and Krasnoyarsk Reservoir were 5.1, 2, and 1.4, respectively. Increased Bb/Bp ratios were found to correlate with elevated specific (per unit biomass) phytoplankton production. This finding indicated additional supply of biogenic elements to phytoplankton due to their recycling by bacterial communities. The ratio between bacterioplankton and phytoplankton production for Lake Khanka varied from year to year (0.07 to 0.76). For the Yenisei River and the Krasnoyarsk Reservoir these ratios were on average 0.19 and 0.27, respectively. According to the literature data for other water bodies, bacterial production may reach from 10 to over 100% of the primary production. The equilibrium density of bacterioplankton (maximal density of the population) in Lake Khanka was ~1.5 times higher than in the Yenisei River and the Krasnoyarsk Reservoir due to higher content of suspended mineral matter and associated organo-mineral detritus in the lake. The interaction between dissolved organic compounds sorbed of the surface of mineral particles results in chemical alteration of biochemically stable substrate into compounds which may be assimilated by aquatic micoorganisms.


Symptoms at postmenopause: genetic and psychosocial factors.
Menopause symptoms result from the interaction of estrogen deprivation, psychosocial influences, and genetic factors. We examined the influence of stress and of estrogen receptor-α (ER-α; PvuII and XbaI) and serotonin transporter (5-HTT) polymorphisms on symptoms at postmenopause. We studied 290 urban women from three cities in Mexico. General characteristics, menopause symptoms, and scores of perceived stress, effort-reward imbalance, dominance, and submission were collected. A fasting blood sample was obtained for hormone measurements and genotypification. Women had a mean ± SD age of 54.4 ± 4.5 years and BMI of 29.5 ± 4.9 kg/m. The frequency of hot flashes was 75.5%; vaginal dryness, 57.8%; and diminished sexual interest, 78.7%. Follicle-stimulating hormone and estradiol levels were 59 ± 27 mIU/mL and 22 ± 29 pg/mL, respectively. Women from Torreón had higher schooling and less parity but higher scores for depression and lower submission. Hot flashes were more frequent in women from León. Genotype distribution was similar among cities. Lower scores for dominance were found in women with the pp and xx ER-α genotypes. Increased smoking habit was found for the SS genotype of 5-HTT. Factors significantly associated with symptoms were years since menopause, with hot flashes (negative), and with diminished sexual interest (positive); dominance was negatively associated with depression, perceived stress, and vaginal dryness; submission was positively associated with depression, perceived stress, anxiety, and hot flashes; and effort-reward imbalance was positively associated with anxiety, hot flashes, and perceived stress. Symptoms at postmenopause were associated mainly with dominance, submission, and effort-reward imbalance. The pp genotype of ER-α showed lower scores of dominance.


Soleus Atrophy Is Common After the Nonsurgical Treatment of Acute Achilles Tendon Ruptures: A Randomized Clinical Trial Comparing Surgical and Nonsurgical Functional Treatments.
It remains controversial whether nonsurgical or surgical treatment provides better calf muscle strength recovery after an acute Achilles tendon rupture (ATR). Recent evidence has suggested that surgery might surpass nonsurgical treatment in restoring strength after an ATR. To assess whether magnetic resonance imaging (MRI) findings could explain calf muscle strength deficits and the difference between nonsurgical and surgical treatments in restoring calf muscle strength. Randomized controlled trial; Level of evidence, 1. From 2009 to 2013, 60 patients with acute ATRs were randomized to surgery or nonsurgical treatment with an identical rehabilitation protocol. The primary outcome measure was the volume of calf muscles assessed using MRI at 3 and 18 months. The secondary outcome measures included fatty degeneration of the calf muscles and length of the affected Achilles tendon. Additionally, isokinetic plantarflexion strength was measured in both legs. At 3 months, the study groups showed no differences in muscle volumes or fatty degeneration. However, at 18 months, the mean differences between affected and healthy soleus muscle volumes were 83.2 cm3 (17.7%) after surgery and 115.5 cm3 (24.8%) after nonsurgical treatment (difference between means, 33.1 cm3; 95% CI, 1.3-65.0; P = .042). The study groups were not substantially different in the volumes or fatty degeneration of other muscles. From 3 to 18 months, compensatory hypertrophy was detected in the flexor hallucis longus (FHL) and deep flexors in both groups. In the nonsurgical treatment group, the mean difference between affected and healthy FHL muscle volumes was -9.3 cm3 (12%) and in the surgical treatment group was -8.4 cm3 (10%) ( P ≤ .001). At 18 months, Achilles tendons were, on average, 19 mm longer in patients treated nonsurgically compared with patients treated surgically ( P < .001). At 18 months, surgically treated patients demonstrated 10% to 18% greater strength results ( P = .037). Calf muscle isokinetic strength deficits for the entire range of ankle motion correlated with soleus atrophy (ρ = 0.449-0.611; P < .001). Treating ATRs nonsurgically with a functional rehabilitation protocol resulted in greater soleus muscle atrophy compared with surgical treatment. The mean Achilles tendon length was 19 mm longer after nonsurgical treatment than after the surgical treatment of ATRs. These structural changes partly explained the 10% to 18% greater calf muscle strength observed in patients treated with surgery compared with those treated nonsurgically. Registration: NCT02012803 ( ClinicalTrials.gov identifier).


Spinal Navigation for Lateral Instrumentation of the Thoracolumbar Spine.
Three-dimensional imaging-based navigation in spine surgery is mostly applied for pedicle screw placement. However, its potential reaches beyond. In this study, we analyzed the incorporation of spinal navigation for lateral instrumentation of the thoracolumbar spine in clinical routine at a high-volume spine center. Patients scheduled for lateral instrumentation were prospectively enrolled. A reference array was attached to the pelvis, and a computed tomography scan was acquired intraoperatively. A control computed tomography scan was routinely performed after final cage placement, replacing conventional 2-dimensional X-ray imaging. 145 cases were enrolled from April to October 2021 with a median of 1 (1-4) level being instrumented. Indications for surgery were trauma (35.9%), spinal infection (31.7%), primary and secondary tumors of the spine (17.2%), and degenerative spine disease (15.2%). The duration of surgery after the first scan was 98 ± 41 (20-342) minutes. In total, 190 cages were implanted (94 expandable cages for vertebral body replacement (49.5%) and 96 cages for interbody fusion [50.5%]). Navigation was successfully performed in 139 cases (95.9%). The intraoperative mental load was rated on a scale from 0 to 150 (maximal effort) by the surgeons, showing a moderate effort (median 30 [10-120]). Three-dimensional imaging-based spinal navigation can easily be incorporated in clinical routine and serves as a reliable tool to achieve precise implant placement in lateral instrumentation of the spine. It helps to minimize radiation exposure to the surgical staff.


[Nonocclusive intestinal infarct and necrotizing enterocolitis in the adult].
A case of full-thickness necrosis of the small bowel, and colon, which required partial resection of the jejunum and total resection of the ileum and colon is reported. The case gives the chance for a review of the Literature on intestinal necrosis not caused by vascular occlusion. Nonocclusive intestinal ischemia, acute neonatal necrotizing enterocolitis and adult necrotizing enterocolitis including the Pig-bel disease, common in Papua-New Guinea, are examined. Resemblances and differences in etiology, pathophysiology and clinical findings are discussed. The hypothesis that the process of "bacterial translocation" plays a central role in the pathogenesis of bowel infarction, representing therefore a possible link between infective and vascular mechanisms, is emphasized. Important suggestions on massive intestinal necrosis management are also reported.


Prognostic evaluation in node-positive breast carcinoma: stage versus growth rate.
The range in survival time in operable node-positive breast carcinoma is considerable. Postoperative management is thus dependent on accurate prognostic assessment. This involves the choice of relevant prognostic factors. Theoretically these should include measurements of both stage and growth rate. In a series of 96 cases it is demonstrated that the diameter of the primary (3 cm and under/over 3 cm) can be used as a measure of tumour stage; the histological grade of the primary as one of tumour growth rate; and the presence/absence of tumour cells in the efferent nodal vessels (EVI status) as a measure of nodal stage. The latter is proposed as an alternative to the number of tumour-bearing nodes recovered from the axilla. Division of the cases on this basis was sufficient to assess high or low risk using routine histological methods.


CD95 ligand induces senescence in mismatch repair-deficient human colon cancer via chronic caspase-mediated induction of DNA damage.
CD95 is best known for its ability to induce apoptosis via a well-characterized pathway involving caspase-mediated proteolytic events. However, in apoptosis-resistant cell lines of diverse cancer types stimulation of CD95 primarily has pro-tumorigenic effects that affect many of the hallmarks of cancer. For instance, in colon cancer cells with a mutant KRAS gene CD95 primarily promotes invasion and metastasis. In the current study, we further investigated the context dependency of the consequences of CD95 activation in colon cancer. We used a series of patient-derived three-dimensional colon cancer cultures and studied their response to stimulation with CD95 ligand (CD95L). CD95L had a strong inhibitory effect on the clone-forming capacity of five out of nine cultures. In line with previous work, these cultures all had a wild-type KRAS gene and expressed high levels of CD95. Furthermore, the most sensitive cultures were characterized by microsatellite instability (MSI) and deficient mismatch repair. The reduced clonogenic growth of MSI-type colonospheres resulting from chronic CD95 stimulation was only partly due to apoptosis as many tumor cells survived treatment, yet were unable to regenerate clones. CD95 stimulation caused an irreversible cell cycle arrest, which was associated with cytokine secretion, similar to the senescence-associated secretory phenotype (SASP), and expression of senescence-associated β-galactosidase. In human colon cancer cohorts, CD95 expression was strongly correlated with the recently identified consensus molecular subtype 1 (CMS1), which mainly consists of MSI-high tumors, and with two independent SASP signatures. Mechanistically, CD95-induced senescence was caused by chronic DNA damage via caspase-activated DNAse resulting in p53 activation and p21 expression, with a minor contribution of the SASP. We conclude that induction of senescence is a hitherto unrecognized consequence of high CD95 expression, which appears to be most relevant for CMS1.


A comparison of recombinant urokinase with vascular surgery as initial treatment for acute arterial occlusion of the legs. Thrombolysis or Peripheral Arterial Surgery (TOPAS) Investigators.
Recent controlled trials suggest that thrombolytic therapy may be an effective initial treatment for acute arterial occlusion of the legs. A major potential benefit of initial thrombolytic therapy is that limb ischemia can be managed with less invasive interventions. In this randomized, multicenter trial conducted at 113 North American and European sites, we compared vascular surgery (e.g., thrombectomy or bypass surgery) with thrombolysis by catheter-directed intraarterial recombinant urokinase; all patients (272 per group) had had acute arterial obstruction of the legs for 14 days or less. Infusions were limited to a period of 48 hours (mean [+/-SE], 24.4+/-0.86), after which lesions were corrected by surgery or angioplasty if needed. The primary end point was the amputation-free survival rate at six months. Final angiograms, which were available for 246 patients treated with urokinase, revealed recanalization in 196 (79.7 percent) and complete dissolution of thrombus in 167 (67.9 percent). Both treatment groups had similar significant improvements in mean ankle-brachial blood-pressure index. Amputation-free survival rates in the urokinase group were 71.8 percent at six months and 65.0 percent at one year, as compared with respective rates of 74.8 percent and 69.9 percent in the surgery group; the 95 percent confidence intervals for the differences were -10.5 to 4.5 percentage points at six months (P=0.43) and -12.9 to 3.1 percentage points at one year (P=0.23). At six months the surgery group had undergone 551 open operative procedures (excluding amputations), as compared with 315 in the thrombolysis group. Major hemorrhage occurred in 32 patients in the urokinase group (12.5 percent) as compared with 14 patients in the surgery group (5.5 percent) (P= 0.005). There were four episodes of intracranial hemorrhage in the urokinase group (1.6 percent), one of which was fatal. By contrast, there were no episodes of intracranial hemorrhage in the surgery group. Despite its association with a higher frequency of hemorrhagic complications, intraarterial infusion of urokinase reduced the need for open surgical procedures, with no significantly increased risk of amputation or death.


Agrobacterium tumefaciens Small Lipoprotein Atu8019 Is Involved in Selective Outer Membrane Vesicle (OMV) Docking to Bacterial Cells.
Outer membrane vesicles (OMVs), released from Gram-negative bacteria, have been attributed to intra- and interspecies communication and pathogenicity in diverse bacteria. OMVs carry various components including genetic material, toxins, signaling molecules, or proteins. Although the molecular mechanism(s) of cargo delivery is not fully understood, recent studies showed that transfer of the OMV content to surrounding cells is mediated by selective interactions. Here, we show that the phytopathogen Agrobacterium tumefaciens, the causative agent of crown gall disease, releases OMVs, which attach to the cell surface of various Gram-negative bacteria. The OMVs contain the conserved small lipoprotein Atu8019. An atu8019-deletion mutant produced wildtype-like amounts of OMVs with a subtle but reproducible reduction in cell-attachment. Otherwise, loss of atu8019 did not alter growth, susceptibility against cations or antibiotics, attachment to plant cells, virulence, motility, or biofilm formation. In contrast, overproduction of Atu8019 in A. tumefaciens triggered cell aggregation and biofilm formation. Localization studies revealed that Atu8019 is surface exposed in Agrobacterium cells and in OMVs supporting a role in cell adhesion. Purified Atu8019 protein reconstituted into liposomes interacted with model membranes and with the surface of several Gram-negative bacteria. Collectively, our data suggest that the small lipoprotein Atu8019 is involved in OMV docking to specific bacteria.


Plasma cystatin C as a marker of renal function in patients with liver cirrhosis.
Cystatin C is a low molecular weight protein and the plasma level of cystatin C is mainly determined by glomerular filtration, making cystatin C an endogenous marker of glomerular filtration rate. The aim of the study was to elucidate the applicability of plasma cystatin C as a marker of renal function in patients with liver cirrhosis. Serum cystatin C and creatinine concentrations were compared with creatinine clearance. Thirty-six patients (14 females and 22 males aged between 33 and 81 years) with liver cirrhosis with normal to severely impaired kidney function were included. Plasma cystatin C was measured by an automated particle-enhanced nephelometric immunoassay (Dade Behring Diagnostics) and plasma creatinine by an enzymatic method. Plasma levels of cystatin C and creatinine were found to increase with decreasing values of creatinine clearance. The reciprocal values of cystatin C and creatinine were compared with those for creatinine clearance revealing an r2 of 0.37 and 0.18, respectively. Comparison of the areas under the curves (AUC) of the non-parametric receiver-operating characteristic plots for plasma cystatin C (AUC=0.7364; SE=0.0929) and plasma creatinine (AUC=0.6309: SF=0.1028) revealed a significant difference between plasma cystatin C and plasma levels of creatinine (p-value=0.03). The results demonstrate that the diagnostic accuracy of plasma cystatin C was better than plasma creatinine in identifying liver cirrhotic patients with reduced glomerular filtration rate.


[Results of radiation therapy in 214 primary cerebral tumors and 27 metastases to the brain (1969--1978) (author's transl)].
The results of radiation therapy in 241 patients with a cerebral tumor are reported. A total of 214 primary cerebral tumors and of 27 metastases to the brain was irradiated at the medical radiation institute of the University of Tübingen within the period from 1969 to 1978. Of the cases, 56% underwent primary radiation therapy, and 44% postoperative treatment. Histologically verified diagnoses are existing for 68.5% of all the cases. The average survival rate (months) for the different tumor groups--according to the classification of Zülch--is compared with data in literature. The problems concerning the indication of radiation therapy are discussed. The results underline the merely palliative character of actual radiation therapy in the treatment of most cerebral tumors. Its value is to be found in the prevention resp. retardation of recurrences. Irradiation, even palliative irradiation, or cerebral metastases may be recommended without restriction, as special importance has to be attached to the aspect of an improvement of life quality.


Immune complexes and immunoconglutinin interactions associated with altered lymphocyte activity in Plasmodium chabaudi infections.
Fresh plasma from rats infected with Plasmodium chabaudi, incubated with splenic lymphocytes from rats immunized 5 days previously with sheep blood cells, suppressed the capacity of the spleen cells to produce antibody against the sheep cells as was indicated by reductions in the numbers of hemolytic Jerne plaques formed by the treated cells. The effect was maximal in plasma of rats drawn on the 7th day of infection at a time the rats experienced a hemolytic crisis. Serologic studies indicated that the active plasma contained elevated titers of antibody against fibrinogen products, antibody against the soluble serum antigens elaborated during blood infections and antibody against the third component of fixed complement (C3) or immunoconglutinin. Titers of lytic complement were reduced and amounts of soluble immune complex precipitated with polyethylene glycol 6000 were elevated. The active plasma may have affected the antibody producing cells by one or both of two mechanisms. Soluble antigen-antibody complexes could have interacted with Fc receptors of activated lymphocytes to alter their function. Alternatively, the complexes may have fixed complement and interacted with receptors for fixed C3 on the lymphocyte membrane. Such cells, being coated with the antigen for immunoconglutinin, could be altered by immunoconglutination. Inasmuch as the immune complexes in the active plasma were generated in vivo, it would seem unlikely that the plasma would contain significant amounts of complex that had not fixed complement. With immunoconglutinin present in the plasma, alteration of the cells by immunoconglutination seems a more likely possibility.


[Selection of modeling time for type 2 diabetes mellitus mouse].
To analyze the changes of blood biochemical index and the pathological changes of myocardium and kidney in type 2 diabetic mouse at different time points, which can provide the basis for the selection of type 2 diabetic modeling time for later research. After 6 weeks of feeding with high-fat diet, 24 healthy male ICR mice were injected with streptozocin (STZ, 30 mg/kg) intraperitoneally for 5 days to establish diabetic models. After 9 days, a random blood glucose ≥ 11.1 mmol / L was measured as diabetic mice. 4, 6 and 8 weeks after successfully preparing the diabetic mouse, 8 diabetic mice (a group)would be sacrificed each time. Then the biochemical and pathological conditions were analyzed: ① the indexes of heart and kidney were calculated. ②the serum levels of creatine kinase (CK), lactate dehydrogenase (LDH), creatinine (Cr) and blood urine nitrogen (BUN) were determined. ③ Histopathological changes of myocardium and renal tissues were observed by hematoxylin and eosin (HE) staining. Masson staining was used to observe the fibrosis of myocardium. PAS staining was adopted to observe the pathological changes of renal tissue. In addition, 8 ICR male mice were taken as the control group. At the 4th, 6th and 8th week, cardiac organ coefficient, the values of LDH and CK were all increased compared with the control group. Cardiomyocyte hypertrophy and myocardial fibrosis could be observed. Renal organ coefficient, the values of Cr and BUN were increased. Glomerular hypertrophy, basement membrane thickening and atrophy could be perceived. At the 6th week, related biochemical and pathological changes in diabetic mice were comparatively obvious and breeding time was relatively short. Thus, 6 weeks after the preparation of the diabetic mice would be the optimal time for type 2 diabetes mellitus modeling, proper for inventions of drugs and other research purposes including pathology, physiology, biochemistry, etc.


A review of the antihypertensive effects of felodipine alone or in combination.
Felodipine is a dihydropyridine that blocks the slow entry channel for calcium. It is highly vascular selective and reduces blood pressure (BP) by dilatation of peripheral arterioles. It reduces BP in mild, moderate, and severe hypertension, and the fall in BP depends upon the initial level. It has been compared with a variety of other drugs as monotherapy or as add-on therapy. In these studies, felodipine (10-40 mg/day) has caused a similar or greater fall in BP and a similar or greater percentage of patients have achieved a diastolic BP less than or equal to 90 mm Hg. The plain tablet of felodipine needs to be given twice a day but an extended-release form can be given once daily. Some patients respond to 5 mg/day and most patients respond to a daily dose of 20 mg or less. The adverse effects are few except for a constellation of symptoms related to the vasodilator ability of the drug. These include palpitations, flushing, fatigue, dizziness, and headaches. These occur, if at all, usually within the first 2 weeks and diminish as the drug is continued. They can be limited by starting on a small dose of felodipine (5 mg/day). People who have these adverse effects usually have a good response to the drug. Another adverse effect, which is the most frequent reason for drug withdrawal, is ankle edema. This is more common on the higher doses of the drug. It is due to dilatation of the precapillary resistance vessels rather than sodium and water retention. Felodipine is a useful and effective antihypertensive drug and can be used as monotherapy or added to other antihypertensive drugs. It is effective in people with all grades of hypertension.


Potential effects of raising Medicare's eligibility age.
Recent fiscal pressures on Medicare and an already enacted increase in Social Security's normal retirement age have generated discussion of raising Medicare's age of entitlement. This DataWatch examines potential impacts of raising Medicare's eligibility age to sixty-seven on public-sector health spending and individual insurance coverage. The proposed increase would affect a substantial fraction of beneficiaries without having a commensurate effect on expenditures, even in the long run. It is estimated that if the eligibility age were sixty-seven, upwards of 500,000 persons ages sixty-five and sixty-six would be left without any insurance, and even more would not be able to afford coverage with benefits similar to those of Medicare.


Poleward increase in feeding efficiency of leafminer Stigmella lapponica (Lepidoptera: Nepticulidae) in a latitudinal gradient crossing a boreal forest zone.
Damage to plant communities imposed by insect herbivores generally decreases from low to high latitudes. This decrease is routinely attributed to declines in herbivore abundance and/or diversity, whereas latitudinal changes in per capita food consumption remain virtually unknown. Here, we tested the hypothesis that the lifetime food consumption by a herbivore individual decreases from low to high latitudes due to a temperature-driven decrease in metabolic expenses. From 2016 to 2019, we explored latitudinal changes in multiple characteristics of linear (gallery) mines made by larvae of the pygmy moth, Stigmella lapponica, in leaves of downy birch, Betula pubescens. The mined leaves were larger than intact leaves at the southern end of our latitudinal gradient (at 60°N) but smaller than intact leaves at its northern end (at 69°N), suggesting that female oviposition preference changes with latitude. No latitudinal changes were observed in larval size, mine length or area, and in per capita food consumption, but the larval feeding efficiency (quantified as the ratio between larval size and mine size) increased with latitude. Consequently, S. lapponica larvae consumed less foliar biomass at higher latitudes than at lower latitudes to reach the same size. Based on space-for-time substitution, we suggest that climate warming will increase metabolic expenses of insect herbivores with uncertain consequences for plant-herbivore interactions.