Octreotide versus octreotide plus interferon-alpha in endocrine gastroenteropancreatic tumors: a randomized trial.
The effect of octreotide plus interferon-alpha versus octreotide monotherapy on the primary study end points of time to treatment failure (progression, death, stop of study treatment) and long-term survival was investigated in patients with progressive metastatic neuroendocrine foregut (mainly pancreatic) and midgut tumors. One hundred nine of 125 registered patients were randomized starting in January 1995, and 105 patients (51 monotherapy, 54 combination treatment) were finally analyzed in March 2000. Tumor growth was assessed at 3-month intervals by computed tomography or magnetic resonance imaging. Long-term survival was studied up to April 2004 in all analyzed patients and in 9 patients not randomized because of stable disease. Partial tumor regression occurred in 2.9%, 1.9%, and 5.7% and stabilization of tumor growth in 44.8%, 27.6%, and 15.2% at 3, 6, and 12 months, respectively, with no significant differences between both treatment arms. In March 2000, 9.5% of patients were in treatment. Time to treatment failure and long-term survival did not differ significantly between the 2 groups, with a median survival of 32 and 54 months for the octreotide and the combination groups, respectively. Survival was longer in patients not randomized because of stable disease (median, 68 months) and in those with low nuclear Ki-67. A trend toward longer survival was shown for patients with slow spontaneous tumor growth before randomization. Patients responding to treatment lived longer than unresponsive patients. Combination treatment was not superior to monotherapy concerning progression-free and long-term survival. Patients responding to treatment and those with slow spontaneous tumor growth had a survival advantage.


Inducible Costimulator Contributes to Methicillin-Resistant Staphylococcus aureus Pneumonia.
Staphylococcus aureus is a major cause of both community- and healthcare-acquired pneumonias. Inducible costimulator (ICOS) is part of the CD28 family of proteins and is a target for immune checkpoint therapy. We found ICOS highly expressed on activated CD4 cells in response to S. aureus. In the absence of ICOS, mice had improved survival in a pneumonia model with the methicillin-resistant Staphylococcus aureus (MRSA) strain USA300 and significant reductions in bacterial burden in a nonlethal acute pneumonia model. Infected Icos-/- mice had major reductions in several proinflammatory cytokines, neutrophils, inflammatory monocytes, and eosinophils compared to infected wild-type mice, while there was improved expression of CD11c and macrophage receptor with collagenous structure on the surface of alveolar macrophages. Early during infection infected Icos-/- mice had increased numbers of alveolar macrophages and expression of several surface markers on alveolar macrophages and neutrophils. ICOS signaling also contributed to the pathogenesis of the airway pathogens Klebsiella pneumoniae, Pseudomonas aeruginosa, and Streptococcus pneumoniae, and neutralizing antibody to ICOS led to improved clearance of S. aureus from the airway. Our results indicate that ICOS plays a significant role in orchestrating the innate immune response to S. aureus and other airway pathogens, and could be a potential immunomodulatory target to attenuate S. aureus-related immunopathology.


Impaired sleep after bedtime stress and worries.
Stress is assumed to impair sleep, but there is very little empirical evidence for this using sleep recordings. Here, we recorded sleep (at home) in 33 normal participants on three nights, which followed days with low, high and intermediate stress. The participants made daily ratings of the level of stress/worries at bedtime and also two-hourly ratings of stress. Only those 16 individuals who differed in stress/worries between two nights were analysed. There was a significantly lower sleep efficiency (81.0% versus 85.2%) a higher percent Wake (22.6% versus 15.6%) and a longer latency to Stage 3 (33.9 versus 18.3 min) during the nights with a higher stress/worry bedtime rating. None of the other sleep variables were affected. Also mean daytime stress ratings were significantly higher on the day preceding and following the high stress/worries sleep. It was concluded that moderate increases in stress/worries at bedtime are associated with moderately impaired sleep.


Establishment of an International Collaborative Network for N-of-1 Trials and Single-Case Designs.
In this article we briefly examine the unique features of Single-Case Designs (SCDs) (studies in a single participant), their history and current trends, and real-world clinical applications. The International Collaborative Network for N-of-1 Trials and Single-Case Designs (ICN) is a formal collaborative network for individuals with an interest in SCDs. The ICN was established in 2017 to support the SCD scientific community and provide opportunities for collaboration, a global communication channel, resource sharing and knowledge exchange. In May 2021, there were more than 420 members in 31 countries. A member survey was undertaken in 2019 to identify priorities for the ICN for the following few years. This article outlines the key priorities identified and the ICN's progress to date in these key areas including network activities (developing a communications strategy to increase awareness, collecting/sharing a comprehensive set of resources, guidelines and tips, and incorporating the consumer perspective) and scientific activities (writing position papers and guest editing special journal issues, exploring key stakeholder perspectives about SCDs, and working to streamline ethical approval processes for SCDs). The ICN provides a practical means to engage with this methodology through membership. We encourage clinicians, researchers, industry, and healthcare consumers to learn more about and conduct SCDs, and to join us in our mission of using SCDs to improve health outcomes for individuals and populations.


Identification of Gene Transcription Start Sites and Enhancers Responding to Pulmonary Carbon Nanotube Exposure in Vivo.
Increased use of nanomaterials in industry, medicine, and consumer products has raised concerns over their toxicity. To ensure safe use of nanomaterials, understanding their biological effects at the molecular level is crucial. In particular, the regulatory mechanisms responsible for the cascade of genes activated by nanomaterial exposure are not well-characterized. To this end, we profiled the genome-wide usage of gene transcription start sites and linked active enhancer regions in lungs of C57BL/6 mice 24 h after intratracheal instillation of a single dose of the multiwalled carbon nanotube (MWCNT) Mitsui-7. Our results revealed a massive gene regulatory response, where expression of key inflammatory genes (e.g., Csf3, Il24, and Fgf23) was increased >100-fold 24 h after Mitsui-7 exposure. Many of the Mitsui-7-responsive transcription start sites were alternative transcription start sites for known genes, and the number of alternative transcription start sites used in a given gene was correlated with overall Mitsui-7 response. Strikingly, genes that were up-regulated after Mitsui-7 exposure only through their main annotated transcription start site were linked to inflammatory and defense responses, while genes up-regulated only through alternative transcription start sites were functionally heterogeneous and not inflammation-associated. Furthermore, we identified almost 12 000 active enhancers, many of which were Mitsui-7-responsive, and we identified similarly responding putative target genes. Overall, our study provides the location and activity of Mitsui-7-induced enhancers and transcription start sites, providing a useful resource for targeted experiments elucidating the biological effects of nanomaterials and the identification of biomarkers for early detection of MWCNT-induced inflammation.


Association of Exposure to Biomass Fuels with Occurrence of Chronic Obstructive Pulmonary Disease in Rural Western China: A Real-World Nested Case-Control Study.
This study investigated the potential contribution of biomass fuels exposure to the occurrence of chronic obstructive pulmonary disease (COPD) in rural areas of western China. We analyzed data collected between October 2017 and October 2018 from a nested case-control study of individuals at least 40 years old in the general population in Mianyang City, Sichuan Province, China. Demographic information was collected using a custom-designed questionnaire, and lung function was measured using spirometry. We used multivariate logistic regression to explore the possible relationship between biomass fuels exposure and COPD, as well as between other potential risk factors and COPD. Bayes' theorem was used to estimate weights for different COPD risk factors. COPD was newly diagnosed in 500 of the 11398 adults surveyed, corresponding to an incidence of 4.39%. Individuals who were exposed to biomass fuels were at a significantly greater risk of developing COPD than those not exposed (OR 2.58, 95% CI 2.23-3.05). In subgroup analysis, exposure to biomass fuels increased the risk of COPD in men by 1.71 times (95% CI 1.09-2.68) and in women by 2.88 times (95% CI 2.01-3.48), in never-smokers by 2.18 times. Bayesian weights for COPD risk factors were highest for poor kitchen ventilation (W=31.13%) and biomass fuels exposure (W=18.08%). Our data indicate that rural Chinese who are exposed to biomass fuels during cooking or heating are at greater risk of developing COPD. Efforts should be made to strengthen the construction of clean energy infrastructure, so as to reduce the use of biomass fuels and thereby help prevent COPD.


Exploring nurses' well-being and strategies to support self-care.
Nurses experience a range of challenges in their practice that can adversely affect their well-being, for example work-related stress and workforce issues. These challenges may have been intensified by various factors, such as the coronavirus disease 2019 (COVID-19) pandemic and shift working. This article considers the concept of well-being and explores nurses' well-being in the context of ongoing stressors and workforce issues. It also examines some of the effects of shift work on nurses' well-being and how these could be mitigated. The authors outline a range of self-care practices that nurses could engage in and consider how they may be supported in this by their line managers and healthcare organisations.


Design and Construction of a Single-Tube, LATE-PCR, Multiplex Endpoint Assay with Lights-On/Lights-Off Probes for the Detection of Pathogens Associated with Sepsis.
Aims. The goal of this study was to construct a single tube molecular diagnostic multiplex assay for the detection of microbial pathogens commonly associated with septicemia, using LATE-PCR and Lights-On/Lights-Off probe technology. Methods and Results. The assay described here identified pathogens associated with sepsis by amplification and analysis of the 16S ribosomal DNA gene sequence for bacteria and specific gene sequences for fungi. A sequence from an unidentified gene in Lactococcus lactis subsp. cremoris served as a positive control for assay function. LATE-PCR was used to generate single-stranded amplicons that were then analyzed at endpoint over a wide temperature range in a specific fluorescent color. Each bacterial target was identified by its pattern of hybridization to Lights-On/Lights-Off probes derived from molecular beacons. Complex mixtures of targets were also detected. Conclusions. All microbial targets were identified in samples containing low starting copy numbers of pathogen genomic DNA, both as individual targets and in complex mixtures. Significance and Impact of the Study. This assay uses new technology to achieve an advance in the field of molecular diagnostics: a single-tube multiplex assay for identification of pathogens commonly associated with sepsis.


Magnetic Resonance Imaging Underestimation of Prostate Cancer Geometry: Use of Patient Specific Molds to Correlate Images with Whole Mount Pathology.
We evaluated the accuracy of magnetic resonance imaging in determining the size and shape of localized prostate cancer. The subjects were 114 men who underwent multiparametric magnetic resonance imaging before radical prostatectomy with patient specific mold processing of the specimen from 2013 to 2015. T2-weighted images were used to contour the prostate capsule and cancer suspicious regions of interest. The contours were used to design and print 3-dimensional custom molds, which permitted alignment of excised prostates with magnetic resonance imaging scans. Tumors were reconstructed in 3 dimensions from digitized whole mount sections. Tumors were then matched with regions of interest and the relative geometries were compared. Of the 222 tumors evident on whole mount sections 118 had been identified on magnetic resonance imaging. For the 118 regions of interest mean volume was 0.8 cc and the longest 3-dimensional diameter was 17 mm. However, for matched pathological tumors, of which most were Gleason score 3 + 4 or greater, mean volume was 2.5 cc and the longest 3-dimensional diameter was 28 mm. The median tumor had a 13.5 mm maximal extent beyond the magnetic resonance imaging contour and 80% of cancer volume from matched tumors was outside region of interest boundaries. Size estimation was most accurate in the axial plane and least accurate along the base-apex axis. Magnetic resonance imaging consistently underestimates the size and extent of prostate tumors. Prostate cancer foci had an average diameter 11 mm longer and a volume 3 times greater than T2-weighted magnetic resonance imaging segmentations. These results may have important implications for the assessment and treatment of prostate cancer.


Glomerulocystic kidney disease (GCKD) associated with Henoch-Schoenlein purpura: a case report and a review of adult cases of GCKD.
We report on a 71-year-old male with Henoch-Schoenlein purpura (HSP) who developed glomerulocystic kidney disease (GCKD) without congenital abnormality. He had mild renal dysfunction. Renal biopsy findings showed mild proliferation of mesangial cells and matrixes, and tubular atrophy, interstitial fibrosis, cystic dilation of Bowman's capsule and atrophy of the glomerular tuft. The deposition of IgA and C3 in the mesangial area was observed with the fluorescent antibody technique. Therefore he was diagnosed with GCKD-associated HSP. This was the oldest patient among the previous case reports and the patient was the first case to be reported for concurrent GCKD and HSP. In this study, we also reviewed the patient to previously reported adult patients with GCKD.


Expression and function of connexin in normal and transformed human keratinocytes in culture.
We have studied the gap junctional intercellular communication (GJIC) of immortalized and tumourigenic human keratinocyte cell lines and of a spontaneously immortalized non-tumourigenic and a highly differentiating keratinocyte cell line (HaCaT) as the control. In homologous cultures, the GJIC capacity of five squamous cell carcinoma-derived cell lines was 1-27% that of the HaCaT cells. Ha-ras-transfected HaCaT cells with tumourigenic potential and an SV40 DNA-immortalized cell line had markedly reduced GJIC capacities. Northern analysis and immunohistochemistry showed that connexin (Cx) 43 is the major gap junction protein expressed in the communicating cells. They do not express Cx 26 or 32. The low or absent communication observed in certain cell lines was due in some to a lack of Cx 43 gene expression, but in others to aberrant localization of the gap junction protein. GJIC of these cell lines, as well as that of primary normal human epidermal keratinocytes, was susceptible to 12-O-tetradecanoylphorbol-13-acetate-mediated inhibition. Moreover, GJIC of HaCaT cells and their tumourigenic derivatives is Ca(2+)-dependent. These results, when compared with those previously obtained for mouse keratinocyte cell lines, reveal that GJIC of human keratinocytes was correlated to the degree of differentiation and is controlled in a similar way to that of murine keratinocytes. Aberrant GJIC seems to be a common feature of human and murine skin carcinogenesis.


IgA and IgG against Mycobacterium tuberculosis Rv2031 discriminate between pulmonary tuberculosis patients, Mycobacterium tuberculosis-infected and non-infected individuals.
As part of a major project to investigate protective and diagnostic immune markers against tuberculosis (TB), we measured antibody isotype responses to Mycobacterium tuberculosis (Mtb) antigens (LAM, Rv2031, and HBHA) in cohorts of 149 pulmonary tuberculosis patients (PTBP), 148 household contacts (HHCs), and 68 community controls (CCs) in an endemic setting. ELISA was used to measure levels of IgA, IgG, and IgM from sera of cohorts at baseline, and at 6 and 12 months from entry. The results show that there were significant differences in IgA, IgG, and IgM responses to the different antigens and in the three cohorts. At baseline, the level of IgM against RV2031 and LAM did not vary between cohorts, but the levels of IgA and IgG against Rv2031 were significantly higher in PTB patients than HHCs and CCs, followed by HHCs, and the lowest in CCs. In patients, there was a significant variation in antibody responses before and after chemotherapy. The levels of IgA and IgG against HBHA, and IgA against Rv2031 decreased significantly and remained low, while IgA and IgG against LAM increased significantly and remained high following chemotherapy. However, the levels of IgM against Rv2031 and LAM increased at 6 months but decreased again at 12 months. IgM against HBHA did not show any significant variation before and after chemotherapy. Similarly, there were also significant variations in antibody responses in HHCs over time. Our results show that there are significant variations in IgA, IgG and IgM responses to the different antigens and in the three cohorts, implying that not all antibody isotype responses are markers of clinical TB. In addition, the current and previous studies consistently show that IgA and IgG against Rv2031 discriminate between clinical disease, Mtb-infected and non-infected individuals.


SO2- and H2O-Tolerant Catalytic Reduction of NOx at a Low Temperature via Engineering Polymeric VOx Species by CeO2.
Selective catalytic reduction (SCR) of NOx over V2O5-based oxide catalysts has been widely used, but it is still a challenge to efficiently reduce NOx at low temperatures under SO2 and H2O co-existence. Herein, SO2- and H2O-tolerant catalytic reduction of NOx at a low temperature has been originally demonstrated via engineering polymeric VOx species by CeO2. The polymeric VOx species were tactfully engineered on Ce-V2O5 composite active sites via the surface occupation effect of Ce, and the obtained catalysts exhibited remarkable low-temperature activity and strong SO2 and H2O tolerance at 250 °C. The strong interaction between Ce and V species induced the electron transfer from V to Ce and tuned the SCR reaction via the E-R pathway between the NH4+/NH3 species and gaseous NO. In the presence of SO2 and H2O, the polymeric VOx species had not been hardly influenced, while the formation of sulfate species on Ce sites not only promoted the adsorption of NH4+ species and the reaction between gaseous NO and NH4+ but also facilitated the decomposition of ammonium bisulfate through weakening the strong bond between HSO4- and NH4+. This work provided a new strategy for SO2- and H2O-tolerant catalytic reduction of NOx at a low temperature.


LOCALLY ADAPTIVE HALF-MAX METHODS FOR AIRWAY LUMEN-AREA AND WALL-THICKNESS AND THEIR REPEAT CT SCAN REPRODUCIBILITY.
Quantitative computed tomography (CT)-based characterization of bronchial metrics is increasingly being used to investigate chronic obstructive pulmonary disease (COPD)-related phenotypes. Automated methods for airway measurements benefit large multi-site studies by reducing cost and subjectivity errors. Critical challenges for CT-based analysis of airway morphology are related to location of lumen and wall transitions in the presence of varying scales and intensity-contrasts from proximal to distal sites. This paper introduces locally adaptive half-max methods to locate airway lumen and wall transitions and compute cross-sectional lumen area and wall-thickness. Also, the method uses a consistency analysis of wall-thickness to avoid adjoining-structure-artifacts. Experimental results show that computed bronchial measures at individual anatomic airway tree locations are repeat CT scan reproducible with intra-class correlation coefficient (ICC) values exceeding 0.9 and 0.8 for lumen-area and wall-thickness, respectively. Observed ICC values for derived morphologic measures, e.g., lumen-area compactness (ICC>0.67) and tapering (ICC>0.47) are relatively lower.


Involvement of Local Health Departments in Obesity Prevention: A Scoping Review.
Local health department (LHD) obesity prevention (OP) efforts, particularly by rural LHDs, are seemingly uncommon, in part, due to limited infrastructure, workforce capacity, accessible data, and available population-level interventions aimed at social determinants of health (SDOH). We conducted a scoping review to determine LHD roles in OP efforts and interventions. Inclusion criteria were articles including evidence-based OP and LHD leaders or staff. Articles were coded by type of LHD involvement, data use, intervention characteristics, use of an SDOH lens, and urban or rural setting. We found 154 articles on LHD OP-52 articles met inclusion criteria. Typically, LHDs engaged in only surveillance, initial intervention development, or evaluation and were not LHD led. Data and SDOH lens use were infrequent, and interventions typically took place in urban settings. LHDs could likely play a greater role in OP and population-level interventions and use data in intervention decision making. However, literature is limited. Future research should focus on LHD capacity building, including academic-public health partnerships. Studies should include rural populations, data, and SDOH frameworks addressing "upstream" factors.


Endoscopic-ultrasound-guided fine-needle aspiration and the role of the cytopathologist in solid pancreatic lesion diagnosis.
Endoscopic ultrasound (EUS) is the most sensitive imaging modality for solid pancreatic lesions. The specificity, however, is low (about 75%). It can be increased to 100% with an accuracy of 95% by the addition of fine-needle aspiration (FNA). Cytopathology plays an important role. The final diagnosis is based upon the correlation of clinical, EUS, and cytologic features. A close interaction with the cytopathologist is required in improving the diagnostic yield. In this paper, we present an overview of the role of EUS-guided FNA and importance of close interaction with the cytopathologist. Day to day examples of different solid pancreatic lesions have been presented at the end.


MicroRNA‑296 targets AKT2 in pancreatic cancer and functions as a potential tumor suppressor.
Although microRNA-296 (miR-296) has been studied in various types of human cancer, its expression, biological role and mechanism of action in pancreatic cancer remains to be elucidated. The aim of the current study was to investigate the expression level, possible roles and underlying molecular mechanisms of miR‑296 in pancreatic cancer. The present study revealed that miR‑296 is significantly downregulated in tissue from patients with pancreatic cancer and in human pancreatic carcinoma cell lines, when compared with matched healthy tissue and normal human pancreatic cell lines, respectively. In addition, restoration of miR‑296 expression was revealed to inhibit the proliferation, migration and invasive activity of pancreatic cancer cells. Furthermore, bioinformatics analysis and a luciferase reporter assay validated the AKT2 gene as a direct target of miR‑296 in pancreatic cancer. Reverse transcription‑quantitative polymerase chain reaction and western blot analysis revealed that miR‑296 was able to decrease AKT2 expression at the post‑transcriptional level. Notably, the effects of AKT2 knockdown were similar to miR‑296 overexpression in pancreatic cancer. In conclusion, the present findings indicate a role for miR‑296 as a tumor suppressor in pancreatic cancer through directly targeting AKT2, thus suggesting that miR‑296 may serve as a potential therapeutic target for the treatment of pancreatic cancer.


Warfarin pretreatment reduces cell death and MMP-9 activity in experimental intracerebral hemorrhage.
Little is known about the pathophysiology of oral anticoagulation-associated intracerebral hemorrhage (OAC-ICH). We compared hematoma volume, number of terminal deoxynucleotidyl dUTP nick-end labeling (TUNEL)-positive cells (indicating cell death), MMP-9 levels, and perilesional edema formation between warfarin-treated mice and controls. Intracerebral hemorrhage was induced by an injection of collagenase into the right striatum. Twenty-four hours later, hematoma volume was measured using a photometric hemoglobin assay. Cell death was quantified using TUNEL staining. MMP-9 levels were determined by zymography, and edema formation was assessed via the wet-dry method. Warfarin increased hematoma volume by 2.6-fold. The absolute number of TUNEL-positive cells in the perihematomal zone was lower in warfarin-treated animals (300.5 ± 39.8 cells/mm2) than in controls (430.5 ± 38.9 cells/mm2; p = 0.034), despite the larger bleeding volume. MMP-9 levels were reduced in anticoagulated mice as compared to controls (p = 0.018). Perilesional edema formation was absent in warfarin mice and modestly present in controls. Our results suggest differences in the pathophysiology of OAC-ICH compared to intracerebral hemorrhage occurring under normal coagulation. A likely explanation is that thrombin, a strong inductor of apoptotic cell death and blood-brain barrier disruption, is produced to a lesser extent in OAC-ICH. In humans, however, we assume that the detrimental effects of a larger hematoma volume in OAC-ICH by far outweigh potential protective effects of thrombin deficiency.


Postconcussive symptom complaints and potentially malleable positive predictors.
The purpose of this study was to examine the relationship between postconcussion symptom complaint (PCS) severity and positive coping factors (knowledge, self-efficacy, and attributions) in a sample of individuals who have sustained a mild TBI, above and beyond the demographic and psychiatric predictors that have been most commonly examined. Ninety-one people with a history of reported mild TBI were surveyed. Hierarchical regression analyses revealed that demographic variables and psychiatric symptom severity predicted PCS severity. Consistent with our hypotheses, knowledge, self-efficacy, and attributions, when taken together, made an independent and significant contribution to prediction of PCS severity (21% of additional variance). The most potent factor was attribution, or the extent to which one attributes symptoms to mild TBI versus other causes. Those who attribute their symptoms to TBI are more likely to report greater symptom severity overall. Taken together, knowledge, self-efficacy, and attributions contribute independently to PCS severity. Additional research is needed to determine if these factors are amenable to intervention.


[Targeting delivery of therapeutic genes using monoclonal antibody; immunogene approach].
We are developing the "immunogene" system for the targeted delivery of therapeutic genes. The immunogene system utilizes the EGF receptor-mediated endocytosis. The Fab fragment of monoclonal antibody B4G7 against human EGF receptor was conjugated with polylysine to form an "Fab immunoporter", which forms an affinity complex with DNA. The transfection efficiency of Fab immunogene was approximately 10-fold higher than the Lipofectin. Gene transfer of HSV-tk gene into A431 tumor cells with Fab immunoporter was successful and the subsequent treatment with ganciclovir induced remarkable suicide effects conferring 1000-fold higher drug sensitivity. Thus, the immunogene system could be useful as a gene transfer vehicle targeting the EGF receptor-hyperproducing tumor cells.


Molecular Basis of Pterygium Development.
Pterygium pathogenesis is mainly related to UV light exposure. However, the exact mechanisms by which it is formed have not been elucidated. Clinical advances in surgical treatment use conjunctival autografts and amniotic membranes in combination with adjuvant therapies, including mitomycin C, β-radiation, and 5-fluoroacil, to reduce recurrence. Several studies aim to unveil the molecular mechanisms underlying pterygium growth and proliferation. They demonstrate the role of different factors, such as viruses, oxidative stress, DNA methylation, apoptotic and oncogenic proteins, loss of heterozygosity, microsatellite instability, inflammatory mediators, extracellular matrix modulators, lymphangiogenesis, cell epithelial-mesenchymal transition, and alterations in cholesterol metabolism in pterygium development. Understanding the molecular basis of pterygium provides new potential therapeutic targets for its prevention and elimination. This review focuses on providing a broad overview of what is currently known regarding molecular mechanisms of pterygium pathogenesis.


A Luminescent 1D Silver Polymer Containing [2.2]Paracyclophane Ligands.
[2.2]Paracyclophane scaffolds have seen limited use as building blocks in supramolecular chemistry. Here, we report the synthesis and characterization of a 1D coordination polymer consisting of silver(I) ions bound to a [2.2]paracyclophane scaffold functionalized with two 4-pyridyl units. The structure of the polymer has been determined from single crystal X-ray diffraction analysis and reveals two different silver coordination motifs that alternate along the 1D coordination polymer. The coordination polymer exhibits strong blue and sky-blue fluorescence in solution and in the crystalline solid state, respectively.


Assessing the effect of noise-reduction to the intelligibility of low-pass filtered speech.
Given the fact that most hearing-impaired listeners have low-frequency residual hearing, the present work assessed the effect of applying commonly-used singlechannel noise-reduction (NR) algorithms to improve the intelligibility of low-pass filtered speech, which simulates the effect of understanding speech with low-frequency residual hearing of hearing-impaired patients. In addition, this study was performed with Mandarin speech, which is characterized by its significant contribution of information present in (low-frequency dominated) vowels to speech intelligibility. Mandarin sentences were corrupted by steady-state speech-shaped noise and processed by four types (i.e., subspace, statistical-modeling, spectral-subtractive, and Wiener-filtering) of single-channel NR algorithms. The processed sentences were played to normal-hearing listeners for recognition. Experimental results showed that existing single-channel NR algorithms were unable to improve the intelligibility of low-pass filtered Mandarin sentences. Wiener-filtering had the least negative influence to the intelligibility of low-pass filtered speech among the four types of single-channel NR algorithms examined.


Structural basis of LAIR1 targeting by polymorphic Plasmodium RIFINs.
RIFIN, a large family of Plasmodium variant surface antigens, plays a crucial role in malaria pathogenesis by mediating immune suppression through activation of inhibitory receptors such as LAIR1, and antibodies with LAIR1 inserts have been identified that bind infected erythrocytes through RIFIN. However, details of RIFIN-mediated LAIR1 recognition and receptor activation have been unclear. Here, we use negative-stain EM to define the architecture of LAIR1-inserted antibodies and determine crystal structures of RIFIN-variable 2 (V2) domain in complex with a LAIR1 domain. These structures reveal the LAIR1-binding region of RIFIN to be hydrophobic and membrane-distal, to exhibit extensive structural diversity, and to interact with RIFIN-V2 in a one-to-one fashion. Through structural and sequence analysis of various LAIR1 constructs, we identify essential elements of RIFIN-binding on LAIR1. Furthermore, a structure-derived LAIR1-binding sequence signature ascertained >20 LAIR1-binding RIFINs, including some from P. falciparum field strains and Plasmodium species infecting gorillas and chimpanzees.


Predictors with regard to ingestion, inhalation and dermal absorption of estimated phthalate daily intakes in pregnant women: The Barwon infant study.
Human exposure to phthalate chemicals, used in consumer product plastics, occurs throughout the day. Phthalate levels in pregnant women are associated with offspring health effects including obesity and neurodevelopmental problems. Knowledge of predictors of exposure is necessary in order to effectively reduce phthalate exposure. The present study aims to identify predictors of phthalate levels in Australian pregnant women from the Barwon Infant study birth cohort. Maternal urine samples from 841 women were analyzed for phthalate metabolites. Maternal diet and food preparation practices, use of volatile household products, household characteristics and personal care product use were assessed with questionnaires. All maternal urine contained phthalate metabolites. Maternal prenatal high-fat milk consumption was associated with higher benzyl butyl phthalate (BBzP) (p < 0.001), and bis(2-ethylhexyl) phthalate (DEHP) (p = 0.0023). Higher phthalate levels were associated with consumption of tinned food (fish and tomatoes). Diethyl phthalate (DEP) levels were significantly higher when women reported using air freshener (35% increase, p = 0.01), aerosols (40% increase, p = 0.005), hair treatment chemicals (28% increase, p = 0.031), and chlorine (34% increase, p = 0.009) compared to no use. Maternal phthalate levels did not vary by reported plastic avoidance during pregnancy. The study showed that phthalate exposure is ubiquitous and increased by multiple factors. Future intervention studies to reduce phthalate levels among pregnant women will need to take into account the variety of sources identified in this study.


Assessing and reducing sources of gene expression variability in Staphylococcus epidermidis biofilms.
Gene expression quantification can be a useful tool in studying the properties of bacterial biofilms. Unfortunately, techniques such as RNA extraction, cDNA synthesis, and quantitative PCR (qPCR) can introduce variability into mRNA transcript measurements, obscuring biologically relevant results. Here we sought to identify the steps that impair accurate gene expression quantification from Staphylococcus epidermidis biofilm samples. We devised an experimental setup that could be used to determine the contribution of each experimental step to the variability of mRNA transcript measurement. Among factors tested, biofilm growth contributed the most bias to gene expression quantification. Additional experiments demonstrated that pooling biofilms together reduced this variability, resulting in more accurate gene expression analysis results. We therefore recommend pooling in order to reduce the variability associated with gene expression quantification from biofilm samples.


Ongoing Professional Practice Evaluation of Radiologists: Strategies and Tools for Simplifying a Complex Process.
The Joint Commission, our major accreditation organization, requires that all physicians who have been granted privileges at an organization must undergo evaluation of and collect data relating to their performance, to make the decisions of privileging more objective and continuous by that organization. For radiologists, this so-called ongoing professional practice evaluation (OPPE) can be assessed by using the six general core competencies. These competencies were initially developed for graduate medical education and defined by the Accreditation Council for Graduate Medical Education and have now been expanded to provide a general framework for defining categories of data to be collected in assessing the performance of practicing radiologists. Within each core competency, various radiology-relevant metrics exist that can be measured to fulfill the OPPE requirements. Each radiology department can determine the specific type of data to be collected, including determining what items are defined as acceptable performance metrics, what data or outcomes require further monitoring, and what specific data or data trends would trigger the need for an additional focused and more thorough professional practice evaluation, also known as a focused professional practice evaluation (FPPE). ©RSNA, 2018.


Hydrocarbon pneumonitis masquerading as acute lung injury.
Hydrocarbon pneumonitis is an acute, intense pneumonitis resulting from aspiration/inhalation of volatile hydrocarbon compounds with low viscosity and surface tension. The authors describe the case of a 24-year-old male who aspirated diesel while siphoning it from heavy duty crane, developed bilateral pneumonitis and responded to 2-day therapy with non-invasive continuous positive airway pressure ventilation.


Diagnosis and treatment of lupus nephritis: a summary of the Consensus Document of the Spanish Group for the Study of Glomerular Diseases (GLOSEN).
Lupus nephritis (LN) is the most frequent serious manifestation of patients with systemic lupus erythematosus (SLE). Up to 60% of SLE patients develop LN, which has a significant impact on their quality of life and prognosis. Recent advances have improved the diagnostic approach to LN, and new drugs that block specific pathways and kidney damage progression have been developed. Several randomized and well-powered clinical trials have confirmed the efficacy of these agents in terms of proteinuria remission and preservation of kidney function in the medium and long term, with an acceptable safety profile and good tolerance. The combination of different therapies allows for reduction of the dose and duration of corticosteroids and other potentially toxic therapies and leads to an increase in the number of patients achieving complete remission of the disease. This consensus document carried out by the Spanish Group for the Study of Glomerular Diseases (GLOSEN) provides practical and updated recommendations, based on the best available evidence and clinical expertise of participating nephrologists.


Primary structure of the gene for the murine Ia antigen-associated invariant chains (Ii). An alternatively spliced exon encodes a cysteine-rich domain highly homologous to a repetitive sequence of thyroglobulin.
The gene for murine Ia-associated invariant (Ii) chains (Ii31 and Ii41) was characterized by sequence analysis. The gene extends over approximately 9 kb and is organized in nine exons. Exon 1 encodes the 5' untranslated region and the cytoplasmic segment, exon 2 the membrane spanning segment and adjacent amino acids and exons 3-8 the extracytoplasmic portion of Ii31. Putative promoter sequences were found upstream of the start of the coding sequence. Between exons 6 and 7 an additional, alternatively spliced exon 6b has been identified. This exon is spliced into the mRNA coding for the Ii-related Ii41 protein. Exon 6b encodes a cysteine-rich domain of 64 amino acids. It shows a remarkably high homology to the repetitive elements in thyroglobulin, a precursor for thyroid hormone. Based on this homology, it is suggested that this domain (TgR) in Tg and in Ii41 may play a role either in hormone formation or as a carrier in the transport of molecules (thyroid hormone or processed antigen respectively) between intracellular compartments.


Determinants of Significant Out-Of-Hospital Bleeding in Patients Undergoing Percutaneous Coronary Intervention.
Although several variables have been identified as bleeding determinants (BDs), their occurrence and predictive value in patients undergoing percutaneous coronary intervention (PCI) in the real world remain unclear. We aimed to characterize the rate of BDs in patients undergoing PCI with stent implantation in a large volume tertiary centre. We included patients undergoing coronary stenting at our institution from January 2012 to December 2016, and defined post-discharge bleeding (PDB) as bleeding requiring hospitalization or transfusion. Several BDs, identified by the PARIS bleeding and PRECISE-DAPT scores and inclusion criteria of the LEADERS FREE trial, were analysed. In a population of 10,406 subjects who underwent PCI, 2,938 patients (28.2%) had 1, 2,367 (22.8%) had 2 and 2,913 (28.0%) had ≥3 pre-specified BD. Compared with patients without PDB, subjects who experienced PDB were older (70.43 ± 11.94 vs. 65.90 ± 11.54 years, p < 0.0001) with a higher prevalence of common cardiovascular risk factors. One-year PDB occurred in 177 patients (2.4%), and consistently increased according to the number of BDs involved (1.12, 2.11 and 4.35%, respectively; p < 0.0001). Analogously, 1-year rates of post-discharge myocardial infarction or stent thrombosis increased according to the number of BDs (2.44, 3.38 and 4.87%, respectively; p < 0.0001). Only 7 BDs remained independently associated with PDB at 1 year, with anaemia, oral anticoagulant at discharge and malignancy representing the strongest predictors of such risk. Many risk factors predispose to PDB; they were often clustered together and conferred additive PDB risk at 1-year of follow-up.


[Prenatal diagnosis of fetal aortic stenosis with mitral insufficiency. Review of the ultrasound diagnosis and perinatal prognosis: a case report].
This is a report about a case of prenatal diagnosis of critical fetal aortic stenosis with severe mitral valve insufficiency in a 35+6 weeks fetus. Aortic stenosis represents 3% of congenital heart diseases, but its association with mitral regurgitation is quite unusual. Thanks to the latest advances in fetal ultrasonography we can now achieve a more precise diagnosis and we have been able to improve the understanding of its physiopathology. Based on this case we have reviewed the most recent literature about fetal aortic stenosis and mitral valve insufficiency, with the aim of summarizing its main physiopathological features, highlighting the clues and key points for its intrauterine diagnosis, describing its principal complications and summarizing its current treatment options.


Occult breast cancer in a female with benign lesions.
Occult breast cancer is a carcinoma discovered by the presence of axillary lymph node metastases without the detection of the primary breast tumor. The incidence of this very rare pathology is 0.3%-1.0%. The limited number of these cases does not allow for the precise management of this rare pathology and often, the breast cancer manifestation can take many years to become obvious. We report the case of a 35-year-old woman who presented to our department for annual breast screening examination, without any symptoms. At the time of visit, there were two right and one left tumefactions; unfixed and palpable. Ultrasonography examination confirmed the lesions to be benign. One year later, a palpable hypoechoic axillary left lesion appeared: a lymph node with doubtful morphology. On cytological examination, a biopsy was performed for the axillary left mass which showed irregular masses of large malignant cells with pleomorphism and mitotic figures that suggested a carcinoma. The management of this case is suggestive for cancer of unknown primary syndrome.


[In-flight emergencies].
It is estimated that at least one billion passengers travel by air every year. It is predicted that this number will double in the future, including an increasing number of aged passengers. It is further estimated that for every ten million passengers, 225 acute in-flight incidents and one death will occur. Modern commercial aircraft impose certain physical and physiological stresses on passengers, due mainly to the lowered barometric pressure in the cabin during cruising. The top five in-flight incidents are vasovagal, cardiac, pulmonary, and gastrointestinal attacks and minor traumas and burns. Travel by air is, however, safe and can be tolerated by most people. Each aircraft is equipped with emergency oxygen and medical kits, the crew is trained in advanced first aid, and a link to a ground-based medical centre often exists. Ill and elderly people can have their journey specifically prepared for by communication between their physician and the medical service of the particular company, providing the best opportunity for a smooth journey.


The concise synthesis of unsymmetric triarylacetonitriles via Pd-catalyzed sequential arylation: a new synthetic approach to tri- and tetraarylmethanes.
The selective synthesis of multiarylated acetonitriles via sequential palladium-catalyzed arylations of chloroacetonitrile is reported. The three aryl groups are installed via a Pd-catalyzed Suzuki-Miyaura cross coupling reaction followed by back-to-back C-H arylations to afford triarylacetonitriles in three steps with no over-arylation at any step. The triarylacetonitrile products can be converted into highly functionalized species including tetraarylmethanes. This new strategy provides rapid access to a variety of unsymmetrical tri- and tetraarylmethane derivatives from simple, readily available starting materials.


Antibody to human immunodeficiency virus type 1 (HIV-1) gp160 in mucosal specimens of asymptomatic HIV-1-infected volunteers parenterally immunized with an experimental recombinant HIV-1 IIIB gp160 vaccine. The National Institute of Allergy and Infectious Diseases-sponsored AIDS Vaccine Evaluation Group.
Twenty-two human immunodeficiency virus type 1 (HIV-1)-infected, asymptomatic volunteers with CD4 cell counts of >600 cells/mm3 who were enrolled in a phase I immunotherapy trial comparing two schedules of immunization of an HIV-1 IIIB-based recombinant gp160 (rgp160) experimental vaccine were evaluated for rgp160-specific antibodies in parotid saliva, genital secretions, and serum. When the study was unblinded, it was determined that five volunteers had received rgp160 on a month 0, 1, 2, 3, 4, and 5 immunization schedule, seven volunteers had received rgp160 on a month 0, 1, 2, and 5 schedule, five had received alum/deoxycholate placebo, and seven had received a licensed hepatitis B virus vaccine. Five volunteers consented to the donation of parotid saliva but not genital secretions. Prior to immunization, parotid saliva specimens were available for 11 of 22 volunteers, seminal plasma (SP) specimens were available for 7 of 22 volunteers, cervicovaginal lavage (CVL) specimens were available for 5 of 22 volunteers, and serum was available for 22 of 22 volunteers. These baseline specimens and specimens collected at 1 and 7 months after the final immunizations were assessed by enzyme-linked immunosorbent assay for immunoglobulin G (IgG) and IgA antibodies specific for HIV-1 LAI rgp160 or HIV-1 MN rgp160. No augmentation in HIV rgp160-specific IgG or IgA antibody production in either parotid saliva or serum specimens of vaccinees compared to that in controls was observed after immunization. There were insufficient numbers of SP or CVL specimens available for statistical comparisons between vaccinees and controls. Overall, anti-LAI rgp160 IgG antibodies were detected in the parotid saliva specimens of 20 of 22 volunteers, the seminal plasma specimens of 11 of 11 volunteers, and the CVL specimens of 6 of 6 volunteers and in 21 of 22 serum specimens. Fewer volunteers expressed anti-LAI rgp160 IgA antibodies in mucosal or serum specimens: 11 of 22 parotid saliva specimens, 3 of 11 SP specimens, 3 of 5 CVL samples, and 12 of 22 sera.


Plasminogen binds to plasmin-modulated factor Xa by Ca(2+) - and C-terminal lysine-dependent and -independent interactions.
Plasminogen binding to receptors involves both C-terminal lysine- dependent and -independent interactions. The latter are poorly understood. Our earlier work demonstrated a novel Ca (2+) -enhanced bivalent interaction between plasmin-cleaved FXa (FXa33/13) and plasminogen truncated at Lys78 (Lys-Pg). Here we hypothesized that the effects of Ca (2+) may enable dissection of the C-terminal lysine-dependent and -independent interactions. To evaluate the role of the Glu-plasminogen (Glu-Pg) amino acids 1 - 77, binding of FXa33/13 to immobilized Glu-Pg was compared to Lys-Pg by surface plasmon resonance. Under identical conditions, approximately half the amount of FXa33/13 bound to Glu-Pg. The simplest fit of data suggested a 2:1 plasminogen:FXa33/13 stoichiometry for both, which were proportionately enhanced by Ca (2+) . Only Lys-Pg demonstrated significant Ca (2+) -independent binding to FXa33/13. In the presence of Ca (2+) , weak C-terminal lysine-independent binding could be detected, but only for Glu-Pg. The elastase-generated plasminogen fragment encompassing the angiostatin-like kringle domains 1 to 3 (K1 - 3) inhibited binding of FXa33/13 to Lys-Pg, whereas fragments corresponding to kringle 4- and kringle 5-protease domain had no effect. Immobilized K1 - 3 binding to FXa33/13 had both Ca (2+) -dependent and -independent components. The principal K (d) for the interaction was 10-fold higher than Lys-Pg. In the presence of Ca (2+) , eACA inhibited FXa33/13 binding to K1 - 3 by 30%, but eliminated binding in the absence of Ca (2+) . These studies suggest that Ca (2+) -dependent and -independent binding of Lys-Pg to FXa33/13 are C-terminal lysine-dependent. The N-terminal 1 - 77 amino acids of Glu-Pg confer significant C-terminal lysine-independent binding, which may play a role during the initiating stages of plasminogen activation.


BRAFV600E mutation in hairy cell leukemia: A single-center experience.
BRAFV600E mutation has been reported as a unique genetic lesion of hairy cell leukemia (HCL), a subset of which lacks this lesion and shows adverse outcomes. To determine the prevalence of BRAFV600E in HCL from our center and derive clinicopathological correlation, if any. A 9-year retrospective analysis of 46 consecutive cases of HCL diagnosed on morphology and immunophenotyping was done. Stained smears were used as samples for amplification refractory mutation system polymerase-chain reaction using fluorescent primers for mutation detection. BRAFV600E mutation was detected in 41/46 patients (89.1%) while absent in control samples of chronic lymphocytic leukemia. Cases mimicking HCL-variant clinically or immunophenotypically too showed the presence of this mutation. HCL with mutated BRAF presented at a younger age. No statistical difference in blood counts, tumor load, and immunophenotype patterns existed among BRAF mutated and unmutated group. Nine patients (45%) with mutated BRAF had residual disease following treatment with cladribine. BRAFV600E mutation analysis has a definitive role in the diagnosis of HCL.


Primary nursing. The impact on nursing costs within DRGs.
This study compares direct nursing care costs within specific DRGs between a primary and team nursing unit. Using a computerized information system, data relating to length of stay, acuity, and nursing care costs were collected. The data revealed that, despite an increased acuity of 28%, a daily savings of $1.30 per patient per average DRG was realized by the primary nursing unit.


Recent Update on Peripheral Arterial Endovascular Therapy for Peripheral Arterial Occlusive Disease.
Endovascular treatment is effective for symptomatic peripheral arterial disease (PAD). Following recent device improvements, favorable long-term outcomes have been achieved in iliac arteries as well as small arteries such as the femoral and popliteal arteries. This paper outlines the history and recent advances in endovascular treatment of peripheral vascular diseases as well as the characteristics and usage of devices. The history and the advances in endovascular treatment of peripheral vascular disease have been parallel, with the development of devices such as catheters and stents. Accordingly, endovascular treatment is now recommended in guidelines as the first-line for PAD.


Budesonide for the Induction and Maintenance of Remission in Crohn's Disease: Systematic Review and Meta-Analysis for the Cochrane Collaboration.
Budesonide is an oral glucocorticoid designed for the treatment of inflammatory bowel disease (IBD) that may reduce systemic adverse events (AEs). This review examined the efficacy and safety of budesonide for the induction and maintenance of clinical remission in Crohn's disease (CD). MEDLINE, EMBASE, other electronic databases, reference lists and conference proceedings were searched to November 2017 to identify randomized controlled trials of budesonide. Outcomes were the induction and maintenance of remission at eight weeks and one year, respectively, as well as corticosteroid-related AEs and abnormal adrenocorticotropic hormone (ACTH) tests. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were estimated using random effects models. Thirteen induction and 10 maintenance trials were included. Budesonide 9 mg/day was more effective than placebo (RR 1.93; 95% CI, 1.37-2.73; GRADE: moderate) but less effective than conventional steroids (RR 0.85; 95% CI, 0.75-0.97; GRADE: moderate) to induce remission. Corticosteroid-related AEs occurred less often with induction doses of budesonide than steroids (RR 0.64; 95% CI, 0.54-0.76; GRADE: moderate); budesonide did not increase AEs relative to placebo (RR 0.97; 95% CI, 0.76-1.23; GRADE: moderate). Budesonide 6 mg/day was not different from placebo for maintaining remission (RR 1.13; 95% CI, 0.94-1.35; GRADE: moderate). Both induction (GRADE: low for 3 mg/day, moderate for 9 mg/day) and maintenance budesonide treatment (GRADE: very low for 3 mg/day, low for 6 mg/day) increased the risk of an abnormal ACTH test compared with placebo, but less than conventional steroids (GRADE: very low for both induction and maintenance). For induction of clinical remission, budesonide was more effective than placebo, but less effective than conventional steroids. Budesonide was not effective for the maintenance of remission. Budesonide was safer than conventional steroids, but the long-term effects on the adrenal axis and bone health remain unknown.


Perforated ascending colon cancer presenting as colocutaneous fistula with abscess to the anterior abdominal wall at the site of a cholecystectomy scar treated with biologic mesh.
Ascending colon cancer as a colocutaneous fistula to the abdominal wall at the site of a previous postoperative scar is extremely rare. A 69 year old male presented with five day history of pain and foul smelling discharge from right subcostal scar from elective cholecystectomy performed 8 years ago. Last three days, he had fever up to 39 degrees C, with mild pain in right upper abdominal quadrant without vomiting, diarrhea, bloody stools or weight loss. Computed tomography, with peroral contrast, revealed extralumination into abdominal wall with several fistulas reaching the skin. Emergency median laparotomy found infiltrating tumor of ascending colon into abdominal wall. A right hemicolectomy and complete thickness abdominal wall excision (7 x 10 cm) was performed. The abdominal wall defect was too extensive for primary closure and two 20 x 20 cm moist gauzes were placed to cover the defect and were fixed with stitches to the skin. On second postoperative day, due to contamination, porcine dermal collagen implant was placed intraperitoneally. Such emergency presentations and therapeutic options are discussed.


Association of Oral Hygiene and Periodontal Health with Third Molar Pericoronitis: A Cross-Sectional Study.
Pericoronitis is a painful inflammatory condition commonly associated with third molar teeth. The purpose of this study was to investigate the relationship between oral hygiene and periodontal health status and the presence of pericoronitis in semi-impacted third molar teeth. A cross-sectional study was conducted, and 54 patients having at least one mandibular vertically semi-impacted third molar tooth with or without pericoronitis were consecutively enrolled. Subjects with pericoronitis and subjects with healthy third molars were selected according to symptoms in the gingiva overlying semi-impacted third molar teeth. Periodontal health status and oral hygiene were evaluated with the measures of plaque index (PI), gingival index (GI), and total number of sites with a probing depth (PD) ≥ 4 mm. The clinical data collected in this study was analyzed with Mann-Whitney U test using SPSS 20.0 package program. The PI scores were found to be significantly higher in patients with pericoronitis (p < 0.05). Although the GI scores and PD scores were higher in patients with pericoronitis, the difference did not reach statistical significance when compared with those in healthy subjects (p > 0.05). The findings obtained in this study suggest that the amount of dental plaque was positively associated with third molar pericoronitis. Gingival and periodontal health conditions were similar between patients with and without pericoronitis. Improving oral hygiene and controlling dental plaque may help prevent third molar pericoronitis.


Investigation of Porous Metal-Based 3D-Printed Anode GDLs for Tubular High Temperature Proton Exchange Membrane Fuel Cells.
A high-temperature proton exchange membrane fuel cell (HT-PEMFC) conventionally uses a planar design with carbon-based substrates as the gas diffusion layer (GDL) materials. However, the metal-based substrates allow for alternative designs. In this study, the applicability of porous thin-walled tubular elements made of 316L stainless steel as the anode GDL in a multi-layer tubular HT-PEMFC was investigated. The anode GDLs were fabricated via powder bed fusion using a laser beam (PBF-LB) process with defined porosities (14% and 16%). The morphology of the porous elements was compared using scanning electron microscopy (SEM) micrographs. The influence of the porosity on the fuel cell performance was evaluated through electrochemical characterization and a short-term stability test (45 h) in a commercial test station operated at 160 °C and ambient pressure, using hydrogen as the fuel and air as the oxidant. The results showed that the fuel cell manufactured upon the anode GDL with a porosity of 16% had a higher performance with a peak power density of 329.25 W/m2 after 5 h of operation at 125.52 A/m2 and a voltage degradation rate of 0.511 mV/h over the stability test period. Moreover, this work indicates that additive manufacturing could be a useful tool for further fuel cell development.


Approaches to the mechanism of antifungal activity of Zuccagnia punctata-Larrea nitida bi-herbal combination.
In our previous study the synergism of four combinations of Zuccagnia punctata (ZpE) and Larrea nitida (LnE) exudates with the reliable statistical-based MixLow method was assessed, and the markers of the most anti-C. albicans synergistic ZpE-LnE bi-herbal combination were quantified according to European Medicines Agency (EMA). To study the mechanisms of action as well as the cytotoxic properties of the ZpE-LnE most synergistic combination found in the previous work. Minimum Fungicidal Concentration (MFC) and rate of killing of ZpE-LnE were assessed with the microbroth dilution and the time-kill assays respectively. Morphological alterations were observed with both confocal and fluorescence microscopy on the yeast Schizosaccharomyces pombe. The ergosterol exogenous assay, the quantification of ergosterol, the sorbitol as well as glucan synthase (GS) and chitin synthase (ChS) assays were used to detect the effects on the fungal membrane and cell wall respectively. The capacity of ZpE-LnE of inhibiting Candida virulence factors was assessed with previously reported methods. The effect of ZpE-LnE and of ZpE or LnE alone on cell viability was determined on human hepatoma cells line Huh7. ZpE-Ln E was fungicidal killing C. albicans in a shorter time than amphotericin B and produced malformations in S. pombe cells. ZpE-LnE showed to bind to ergosterol but not to inhibit any step of the ergosterol biosynthesis. ZpE-LnE showed a low or moderate capacity of inhibiting GS and ChS. Regarding inhibition of virulence factors, ZpE-LnE significantly decreased the capacity of adhesion to eukaryotic buccal epithelial cells (BECs), did not inhibit the germ tube formation and inhibited the secretion of phospholipases and proteinases but not of haemolysins. ZpE-LnE demonstrated very low toxicity on Huh7 cells, much lower than that each extract alone. The fungicidal properties of ZpE-LnE against C. albicans, its dual mechanism of action targeting the fungal membrane's ergosterol as well as the cell wall, its capacity of inhibiting several important virulence factors added to its low toxicity, make ZpE-LnE a good candidate for the development of a new antifungal bi-Herbal Medicinal Product.


Simple approach to broadband mid-infrared pulse generation with a mode-locked Yb-doped fiber laser.
Broadband mid-infrared (MIR) molecular spectroscopy demands a bright and broadband light source in the molecular fingerprint region. To this end, intra-pulse difference frequency generation (IDFG) has shown excellent properties among various techniques. Although IDFG systems pumped with 1.5- or 2-µm ultrashort pulsed lasers have been extensively developed, few systems have been demonstrated with 1-µm lasers, which use bulky 100-W-class high-power Yb thin-disk lasers. In this work, we demonstrate a simple and robust approach of 1-µm-pumped broadband IDFG with a conventional mode-locked Yb-doped fiber laser. We first generate 3.3-W, 12.1-fs ultrashort pulses at 50 MHz by a simple combination of spectral broadening with a short single-mode fiber and pulse compression with chirped mirrors. Then, we use them for pumping a thin orientation-patterned gallium phosphide crystal, generating 1.2-mW broadband MIR pulses with the -20-dB bandwidth of 480 cm-1 in the fingerprint region (760-1240 cm-1, 8.1-13.1 µm). The 1-µm-based IDFG system allows for additional generations of ultrashort pulses in the ultraviolet and visible regions, enabling, for example, 50-MHz-level high-repetition-rate vibrational sum-frequency generation spectroscopy or pump-probe spectroscopy.


[Tuberculosis risk assessment in the staff of the National University Pneumologic Hospital of Havana].
tuberculosis is traditionally considered as a professional disease in health care workers. to evaluate the individual and collective tuberculosis infection risk by areas or departments in the National University Pneumologiic Hospital of Havana, Cuba. the individual risk was assessed during 2008-2009 by means of a survey administered to the staff that includes personal data, labor location and exposition to M. tuberculosis, and a Tuberculin Skin Test (TST) was applied to 112 of them. A > or = 10 mm cut-off point was used for positivity. The collective risk was measured in each area or department by the prevalence of TB infection, the tuberculin conversion rate and the number of tuberculosis cases hospitalized per year. of the 183 surveyed workers, 60.7% had workers for more than 5 years in the institution. Of the 64 negative workers in the previous survey, 34.4% became positive in this survey. The latent TB infection prevalence was 50.8% (CI 95%: 43.36-58.23); higher prevalence found in nurses (64.7%-CI 95%: 38.6-84.7) and lower in health non-related technicians(30%-CI 95%: 8.1-64.6). Half of the departments or areas (17/34) were evaluated as high risk, 23.5% as intermediate risk, 11.8% as low risk and 14.7% as very low risk. the National Pneumologic Hospital, as it was expected, is a high risk facility for Micobacterium tuberculosis infection that may affect its workers, and most of its areas pose a potential risk potential for the staff working there.


An Investigation of Petrol Metabolizing Bacteria Isolated from Contaminated Soil Samples Collected from Various Fuel Stations.
The present study aimed to isolate the high-efficiency petrol metabolizing thermophilic bacteria from petrol contaminated soil samples. Isolation was carried out through enrichment culture, serial dilution and pour plate methods using the petrol supplemented minimal salt media. The isolated bacteria were analyzed to document growth behavior, petrol removal efficiencies, antibiotic resistance profile, and biochemical characteristics. The 16S rRNA based phylogenetic analysis helped to reveal the identity of isolated bacterial species and construct the phylogenetic trees. Total nine bacteria were isolated, out of which three (IUBP2, IUBP3, IUBP5) were identified as Brevibacillus formosus, one (IUBP1) was found similar to Brevibacillus agri, four (IUBP7, IUBP8, IUBP13, and IUBP14) shared homology with Burkholderia lata, and one (IUBP15) with Burkholderia pyrrocinia. All the isolates were fast growing and exhibited considerable petrol degradation potential. The highest petrol removal efficiency (69.5% ± 13.44/6 days) was recorded for the strain IUBP15 at a petrol concentration of 0.1% (v/v). All bacteria studied (100%) were positive for esculinase and phosphatase. Many strains exhibited positive responses for arginine dehydrolase (22%), β-naphthylamidase (11%), β-D-glucosaminide (33%), mannitol (55%), sorbitol (66%) and inulin (88%) fermentation test. While all were sensitive to the antibiotics, some of them were found resistant against chloramphenicol and oxacillin. The remarkable biochemical characteristics and considerable petrol removal potential (40-70%) highlights utilization of the bacteria isolated for petrol bioremediation, mineralization of organophosphates, dairy and food industry, and also as biofertilizers and biocontrol agents. The present study aimed to isolate the high-efficiency petrol metabolizing thermophilic bacteria from petrol contaminated soil samples. Isolation was carried out through enrichment culture, serial dilution and pour plate methods using the petrol supplemented minimal salt media. The isolated bacteria were analyzed to document growth behavior, petrol removal efficiencies, antibiotic resistance profile, and biochemical characteristics. The 16S rRNA based phylogenetic analysis helped to reveal the identity of isolated bacterial species and construct the phylogenetic trees. Total nine bacteria were isolated, out of which three (IUBP2, IUBP3, IUBP5) were identified as Brevibacillus formosus, one (IUBP1) was found similar to Brevibacillus agri, four (IUBP7, IUBP8, IUBP13, and IUBP14) shared homology with Burkholderia lata, and one (IUBP15) with Burkholderia pyrrocinia. All the isolates were fast growing and exhibited considerable petrol degradation potential. The highest petrol removal efficiency (69.5% ± 13.44/6 days) was recorded for the strain IUBP15 at a petrol concentration of 0.1% (v/v). All bacteria studied (100%) were positive for esculinase and phosphatase. Many strains exhibited positive responses for arginine dehydrolase (22%), β-naphthylamidase (11%), β-D-glucosaminide (33%), mannitol (55%), sorbitol (66%) and inulin (88%) fermentation test. While all were sensitive to the antibiotics, some of them were found resistant against chloramphenicol and oxacillin. The remarkable biochemical characteristics and considerable petrol removal potential (40–70%) highlights utilization of the bacteria isolated for petrol bioremediation, mineralization of organophosphates, dairy and food industry, and also as biofertilizers and biocontrol agents.


Microtubule transport, concentration and alignment in enclosed microfluidic channels.
The kinesin-microtubule system has emerged as a versatile model system for biologically-derived microscale transport. While kinesin motors in cells transport cargo along static microtubule tracks, for in vitro transport applications it is preferable to invert the system and transport cargo-functionalized microtubules along immobilized kinesin motors. However, for efficient cargo transport and to enable this novel transport system to be interfaced with traditional microfluidics, it is important to fabricate enclosed microchannels that are compatible with kinesin motors and microtubules, that enable fluorescence imaging of microtubule movement, and that provide fluidic connections for sample introduction. Here we construct a three-tier hierarchical system of microfluidic channels that links microscale transport channels to macroscopic fluid connections. Shallow microchannels (5 microm wide and 1 microm deep) are etched in a glass substrate and bonded to a cover glass using PMMA as an adhesive, while intermediate channels (approximately 100 microm wide) serve as reservoirs and connect to 250 microm deep microchannels that hold fine gauge tubing for fluid injection. To demonstrate the utility of this device, we first show the performance of a directional rectifier that redirects 96% of moving microtubules and, because any microtubules that detach rapidly rebind to the motor-coated surface, suffers no microtubule loss over time. Second, we develop an approach, using a headless kinesin construct, to eliminate gradients in motor adsorption and microtubule binding in the enclosed channels, which enables precise control of kinesin density in the microchannels. Finally, we show that a 60 microm diameter circular ring functionalized with motors concentrates and aligns bundles of approximately 3000 uniformly oriented microtubules, while suffering negligible ATP depletion. These aligned isopolar microtubules are an important tool for microscale transport applications and can be employed as a model in vitro system for studying kinesin-driven microtubule organization in cells.


Induction of peripheral blood eosinophilia in mice by excretory and secretory antigen of Toxocara canis larvae.
Medium in which T. canis larvae had been cultured was applied to a Sephadex G-25 gel column and four fractions (Fr. 1-Fr. 4) were isolated. Each fraction was administered to mice by implanting a mini-osmotic pump into the peritoneal cavity and the subsequent peripheral blood eosinophilic counts were recorded. Mice given Fr. 1 showed a markedly greater eosinophilic response than did those given the other fractions. Complement activation by each fraction was investigated using normal human serum. Fr. 1 and Fr. 3 had a capacity to activate complement. The results suggest that Fr. 1 may be not only antigenetic and allergenic but also could induce eosinophilia and activate complement.


Penalty dynamic programming algorithm for dim targets detection in sensor systems.
In order to detect and track multiple maneuvering dim targets in sensor systems, an improved dynamic programming track-before-detect algorithm (DP-TBD) called penalty DP-TBD (PDP-TBD) is proposed. The performances of tracking techniques are used as a feedback to the detection part. The feedback is constructed by a penalty term in the merit function, and the penalty term is a function of the possible target state estimation, which can be obtained by the tracking methods. With this feedback, the algorithm combines traditional tracking techniques with DP-TBD and it can be applied to simultaneously detect and track maneuvering dim targets. Meanwhile, a reasonable constraint that a sensor measurement can originate from one target or clutter is proposed to minimize track separation. Thus, the algorithm can be used in the multi-target situation with unknown target numbers. The efficiency and advantages of PDP-TBD compared with two existing methods are demonstrated by several simulations.


New constraints on Ti diffusion in quartz and the priming of silicic volcanic eruptions.
Titanium diffusion profiles in quartz crystals are widely applied to constrain the duration of magmatic processes. However, experimentally determined Ti diffusion coefficients in quartz diverge by three orders of magnitude. To rectify this problem we derive Ti diffusion coefficients from natural quartz phenocrysts from the 1991 eruption at Mt. Pinatubo, by combining U-Th ages of small (15-40 µm long) zircon inclusions with Ti diffusion profiles measured at nearby growth zone contacts in the same quartz crystals. Application of the obtained data to quartz crystals with Ti-rich rims from thirteen silicic volcanic tuffs worldwide suggests that the magmas erupted years to thousands of years after magma chamber rejuvenation, with the priming time increasing with magma volume and decreasing temperature. Here we show that the time scales involved in the generation of silicic volcanic eruptions are much longer than originally thought.


The occurrence of spontaneous functional and nonfunctional orofacial activities in subjects without pain under laboratory conditions: a descriptive study.
To assess the occurrence and the modality of spontaneous orofacial behaviors of awake healthy subjects without pain who were unaware of bruxism during wakefulness. Sixteen asymptomatic subjects read silently for 30 minutes while polygraphic recordings, including electromyographic (EMG) activity from masticatory and leg muscles, chest respiratory movements, and the movements and sounds of larynx, were made with simultaneous audio-video monitoring. Orofacial behaviors were scored based on the polygraphic and audio-video records. The activity and duration of masseter EMG bursts were calculated for the types of orofacial behaviors. The number of orofacial behaviors varied between subjects; swallowing was most frequently observed. Approximately half of the orofacial behaviors occurred closely with body movements. Of all masseter EMG bursts detected, 55% were associated with functional orofacial behaviors, while 45% were regarded as nonfunctional. More than 80% of these masseter bursts lasted for less than 2 seconds, with an activity less than 20% of maximal voluntary clenching. These values did not differ between the types of associated orofacial behaviors. Although the occurrence of spontaneous orofacial motor activity is variable, asymptomatic subjects can exhibit substantial masseter bursts during wakefulness that are not associated with functional orofacial behaviors. The use of physiological and audio-video records permits spontaneous orofacial behaviors to be specifically identified, thereby allowing nonfunctional masseter EMG activity to be differentiated from functional masseter EMG activity.


Prostate cancer in transgender women: considerations for screening, diagnosis and management.
Transgender individuals represent 0.55% of the US population, equivalent to 1.4 million transgender adults. In transgender women, feminisation can include a number of medical and surgical interventions. The main goal is to deprive the phenotypically masculine body of androgens and simultaneously provide oestrogen therapy for feminisation. In gender-confirming surgery (GCS) for transgender females, the prostate is usually not removed. Due to limitations of existing cohort studies, the true incidence of prostate cancer in transgender females is unknown but is thought to be less than the incidence among cis-gender males. It is unclear how prostate cancer develops in androgen-deprived conditions in these patients. Six out of eleven case reports in the literature presented with metastatic disease. It is thought that androgen receptor-mediated mechanisms or tumour-promoting effects of oestrogen may be responsible. Due to the low incidence of prostate cancer identified in transgender women, there is little evidence to drive specific screening recommendations in this patient subpopulation. The treatment of early and locally advanced prostate cancer in these patients warrants an individualised thoughtful approach with input from patients' reconstructive surgeons. Both surgical and radiation treatment for prostate cancer in these patients can profoundly impact the patient's quality of life. In this review, we discuss the evidence surrounding screening and treatment of prostate cancer in transgender women and consider the current gaps in our knowledge in providing evidence-based guidance at the molecular, genomic and epidemiological level, for clinical decision-making in the management of these patients.


[Case of tuberculous bronchial stenosis followed-up by spirogram and successfully treated with a Dumon stent].
A 47-year-old man visited his family doctor because of chronic productive cough. Though there were no abnormal chest X-ray film findings, he was diagnosed as tuberculosis on the basis of a sputum examination. Therefore, he was introduced to our hospital and as tracheobronchial tuberculosis was diagnosed by the bronchofiberscopic findings, showing ulceration with a white nodules from the lower part of trachea to the left main bronchus. By treatment, the ulcer change was improved, but the left main bronchus narrowed to pinhole size. Furthermore, the flow-volume curve became worse, and stridor appeared. We inserted Dumon stent in the left main bronchus 4 months later. As a result, his symptoms and flow-volume curve were improved, and we removed the stent 4 years and 6 months later. In this valuable case, we could observe the progress of the post-tuberculosis bronchial stenosis respiratory physiologically.


Managements of sleep bruxism in adult: A systematic review.
This systematic review aimed to update the management of sleep bruxism (SB) in adults, as diagnosed using polysomnography (PSG) and/or electromyography (EMG). Management methods covered were oral appliance therapy (OAT) with stabilization splints, cognitive-behavioral therapy (CBT), biofeedback therapy (BFT), and pharmacological therapy. A comprehensive search was conducted on MEDLINE, Cochrane Library, and Web of Science up to October 1st, 2021. Reference list searches and hand searches were also performed by an external organization. Two reviewers for each therapy independently performed article selection, data extraction, and risk of bias assessment. The reviewers resolved any disagreements concerning the assortment of the articles by discussion. Finally, 11, 3, 14, and 22 articles were selected for each therapy. The results suggested that OAT tended to reduce the number of SB events, although there was no significant difference compared to other types of splints, that the potential benefits of CBT were not well supported, and that BFT, rabeprazole, clonazepam, clonidine, and botulinum toxin type A injection showed significant reductions in specific SB parameters, although several side effects were reported. It can be concluded that more methodologically rigorous randomized large-sample long-term follow-up clinical trials are needed to clarify the efficacy and safety of management for SB.


Influence of implant-abutment connection structure on peri-implant bone level in a second molar: A 1-year randomized controlled trial.
This study aimed to evaluate the effect of two different implant-abutment connection structures with identical implant design on peri-implant bone level. This clinical study was a patient-blind randomized controlled trial following the CONSORT 2010 checklists. This trial was conducted in 24 patients recruited between March 2013 and July 2015. Implants with internal friction connection were compared to those with external hex connection. One implant for each patient was installed, replacing the second molar. Implant-supported crowns were delivered at four months after implant insertion. Standardized periapical radiographs were taken at prosthesis delivery (baseline), and one year after delivery. On the radiographs, distance from implant shoulder to first bone-to-implant contact (DIB) and peri-implant area were measured, which were the primary and secondary outcome, respectively. Eleven external and eleven internal implants were analyzed. Mean changes of DIB from baseline to 1-year postloading were 0.59 (0.95) mm for the external and 0.01 (0.68) mm for the internal connection. Although no significant differences were found between the two groups, medium effect size was found in DIB between the connections (Cohen's d = 0.67). Considering the effect size in DIB, this study suggested the possibility of the internal friction connection structure for more effective preservation of marginal bone.


Free radical scavenging activity and secondary metabolites from in vitro cultures of Sanicula graveolens.
An in vitro propagation system was developed to obtain shoot and root cultures from the Andean spice Sanicula graveolens (Apiaceae). Propagation of shoots, roots and plantlets was achieved by the temporary immersion system. The free radical scavenging effect of the methanol/water (7:3 v/v) extracts was determined by the discoloration of the 1,1-diphenyl-2-picrylhydrazyl radical (DPPH). Total phenolic, flavonoid, chlorogenic acid (CA) and quercetin 3-O-glucoside content in the samples was assessed by spectrophotometry and DAD-HPLC analysis, respectively. On a dry weight basis, the crude extracts showed total phenolic values ranging from 3.57 to 6.93%, with highest content for the root culture sample. Total flavonoid content ranged from 1.23 to 2.23% and was lower for the root culture. Chlorogenic acid and neochlorogenic acid were identified by TLC in all samples. Highest free radical scavenging effect was observed for the root culture which also presented the highest CA content. Two of the shoot culture samples, with similar IC50 values in the DPPH discoloration assay, also presented close quercetin-3-O-glucoside content.


The case for faculty development: A realist evaluation.
It seems logical to suggest that investing in educators will lead to improved educational outcomes. However, in the case of faculty development, it is unclear how these benefits arise and decisions about investment typically have little basis in evidence. The aim of this realist evaluation was to understand the mechanisms by which investment in faculty development may lead to improved educational outcomes for staff and students. This realist evaluation involved three phases: the development of an initial programme theory based on existing peer-reviewed literature (Phase 1), which was used within 32 realist interviews with key stakeholders at 17 UK medical schools (Phase 2), to underpin the creation of a series of recommendations for faculty development programme designers (Phase 3). The findings highlighted the complex and heterogeneous nature of faculty development programmes. Programme developers must consider a range of contexts (accreditation, meeting educational needs, learning culture, accessibility and interactivity) that can impact faculty members in variable ways (engagement, sense of value and belonging, motivation, reassurance and building relationships), potentially resulting in a range of staff outcomes (improved competence, satisfaction, confidence, faculty member collaboration and curriculum changes) that may ultimately benefit students. The improved understanding resulting from Phases 1 and 2, and the recommendations from Phase 3, will enable the design and tailoring of new and existing faculty development initiatives. This study deepens our understanding of the role of context in faculty development through the realist methodology employed and extends pre-existing knowledge to provide insights into evidence-based interventional strategies that may be effective. In particular, faculty development leads need to develop a clear implementation strategy, improve transparency of cashflow, establish effective formal or informal communication systems and evaluate the efficacy of their faculty development initiatives.


Pharmacological Treatment of Vagal Hyperactivity, a Rare but Potentially Fatal Cause of Sudden Cardiac Death.
Vasovagal reaction, resulting in bradycardia and/or hypotension in response to a number of stimuli, is usually self-limiting, but potentially life-threatening exceptions have been described. Pharmacological treatment of proven efficacy is still lacking and the administered compounds are often chosen on the basis of either case reports or outdated small studies with a short-term follow up. In refractory cases, pacemaker implantation may be considered, although no responder patients represent a severe challenge for clinicians. The aim of this review is to examine the state of the art about this controversial issue.


Iris Metastasis in a Patient With Small Cell Lung Cancer: A Case Report.
Small cell carcinoma constitutes the most aggressive type of lung cancer, with the greatest propensity for early disseminated disease. Although commonly neglected due to its rarity and the presence of other comorbidities, cases of iris metastasis from small cell lung cancer have been reported in the literature. We present the case of a 76-year-old female. Once diagnosed, the patient already had disseminated disease with metastatic foci found in the spleen, liver, and brain. The patient received six cycles of combination carboplatin/etoposide chemotherapy, followed by cranial irradiation. After an initial response, two months after the completion of cranial irradiation, the patient complained of visual impairment and was referred to an ophthalmologist. A diagnosis of secondary glaucoma was made, caused by metastasis to the left iris. Physicians should be aware of this rare site of metastasis. Early diagnosis is of paramount importance in order to effectively prevent the significant morbidity this condition can cause if left untreated.


Early histological evaluation of bone defect healing with and without guided bone regeneration techniques: experimental animal studies.
To obtain osseous tissue regeneration, treatment methods referred to as guided bone regeneration are used which utilize the mechanical, chemical, and biological properties of materials. Eighteen white rabbits were used. Under general anesthesia, a 5 mm in diameter defect was created transcutaneously in the femur trochanter major. The rabbits were divided into three groups depending on the type of the intraosseous defect (ID) treatment: in group I (C) the control IDs were left to heal spontaneously, in II (BOC+BG) the IDs were filled with Bio-Oss Collagen and Bio Gide Perio membrane, and in III (PRP) the IDs were filled with BOC and platelet-rich plasma (Curasan Centrifuge). The animals were sacrificed 1 and 3 months after the surgical procedure. The histological material was stained with hematoxylin and eosin and using the van Gieson method. In the earlier histological examinations (1 and 3 months after the procedures), resorption of the biomaterial and the formation of new bone trabeculas were observed in both groups II and III. At the first observation the extent of biomaterial resorption and the intensity of the osteogenic process were greater in group III, but after 3 months group II had a slight advantage. Fragmented remnants of the biomaterial in both groups were surrounded by newly formed bone and locally by fibrous connective tissue. At both observation times the number of bone trabeculas after implantation in groups II and III was greater than in the control group.


The role of metallic stents in malignant duodenal obstruction.
Malignant duodenal obstruction is a common complication of carcinoma of the head of the pancreas. We report successful palliative treatment of malignant duodenal strictures by the peroral placement of metallic endoprostheses in two patients in whom palliative surgery was not possible.


[Formula: see text]Parent rating of executive function in fetal alcohol spectrum disorder: A review of the literature and new data on Aboriginal Canadian children.
Aboriginal children in Canada are at high risk of fetal alcohol spectrum disorder (FASD) but there is little research on the cognitive impact of prenatal alcohol exposure (PAE) in this population. This paper reviews the literature on parent report of executive functioning in children with FASD that used the Behavior Rating Inventory of Executive Function (BRIEF). New data on the BRIEF is then reported in a sample of 52 Aboriginal Canadian children with FASD for whom a primary caregiver completed the BRIEF. The children also completed a battery of neuropsychological tests. The results reveal mean scores in the impaired range for all three BRIEF index scores and seven of the eight scales, with the greatest difficulties found on the Working Memory, Inhibit and Shift scales. The majority of the children were reported as impaired on the index scores and scales, with Working Memory being most commonly impaired scale. On the performance-based tests, Trails B and Letter Fluency are most often reported as impaired, though the prevalence of impairment is greater for parent ratings than test performance. No gender difference is noted for the parent report, but the boys had slightly slower intellectual functioning and were more perseverative than the girls on testing. The presence of psychiatric comorbidity is unrelated to either BRIEF or test scores. These findings are generally consistent with prior studies indicating that parents observe considerable executive dysfunction in children with FASD, and that children with FASD may have more difficulty with executive functions in everyday life than is detected by laboratory-based tests alone.


[Osteoporosis screening--indications for bone densitometry].
Osteoporosis is a major public health problem because of increasing prevalence and the cost of related morbidity, especially fractures of the spine and hip. The perimenopausal evaluation of risk patients by assessment of clinical risk factors and bone-mass measurements are used to select patients for prevention of postmenopausal and age-associated bone loss. The value of bone-mass for prediction of fracture-risk and the clinical significance of bone-densitometry for patient management is reviewed. Four essential clinical indications for bone mass assessment are discussed.


Adhesive lesions of the nerve root in the dural orifice as a cause of sciatica.
The cause of sciatica is elusive in some cases. In a few instances it is due to the development of adhesions about the nerve root at the point of its entrance into the dural sleeve. Seven patients with sciatica in whom surgical exploration disclosed no evidence of a herniated intervertebral disc or other extradural pathology were found to have such involvement of the L5 or S1 root at the dural orifice inside the dural sac. This condition occurred in partial form in two cases and with total incarceration in five. Relief followed radicolysis and partial or total radicotomy.


Self-pulsing dynamics of ultrasound in a magnetoacoustic resonator.
A theoretical model of parametric magnetostrictive generation of ultrasound is considered, taking into account magnetic and magnetoacoustic nonlinearities. The stability and temporal dynamics of the system is analyzed with standard techniques revealing that, for a given set of parameters, the model presents a homoclinic or saddle-loop bifurcation, which predicts that the ultrasound is emitted in the form of pulses or spikes with arbitrarily low frequency.


"How We Stay Together Without Going Crazy:" Reconstruction of Reality Among Women of Mixed-Orientation Relationships.
Until recently, the literature that addressed the phenomenon of mixed-orientation relationships, in which the female partner is straight and the male partner is non-straight, has focused mainly on the men's perspective. Most of the studies have employed a pessimistic tone, underscoring the obstacles faced by each of the partners. This study was designed to understand how women of mixed-orientation relationships construct their reality within such a relationship, focusing on elements that assist them in maintaining those relationships. Based on the phenomenological paradigm, in-depth interviews with eight women in mixed-orientation relationships were conducted. The findings indicate that in order to adapt to their newly constructed reality, women reframe various individual, marital, and social aspects in their lives. Those reframing processes constituted a point of departure to developing a conceptual model, which outlines the journey to reality reconstruction among women in mixed-orientation relationships.


Multiple leiomyosarcoma of the stomach.
Leiomyosarcoma is the second most common non epithelial malignant tumor of the stomach. It is almost always a single lesion. Multiple leiomyosarcomas of the stomach are extremely rare. To our knowledge only three cases have been reported so far. We present a 40 year old female with epigastric pain, nausea, diarrhea, weight loss and melena in whom we diagnosed multiple lesions of the stomach. At operation, we found a total of 11 submucosal or subserosal lesions ranging in size from 0.5 to 6 cm in diameter localized throughout the stomach. Histological examination showed leiomyosarcoma in every lesion. Almost all the lymph nodes along curvatures had metastases. Other lymph nodes, peritoneum, liver and other organs were disease free. A total gastrectomy and Roux-en-Y esophagojejunostomy was performed. She had an uneventful recovery and has remained symptom-free so far (nine months).


Neurochemical analyses in pediatric obsessive-compulsive disorder in patients treated with cognitive-behavioral therapy.
To investigate neurochemical changes in the caudate nucleus of pediatric obsessive-compulsive disorder (OCD) patients before and after cognitive-behavioral therapy (CBT), and to examine corresponding changes in symptom severity. Single-voxel proton magnetic resonance spectroscopic (1H-MRS) examination of the left caudate was conducted in 21 treatment-naïve children, aged 6 to 16 years, before and after 12 weeks of CBT. Subjects were measured at baseline and posttreatment by the Yale-Brown Obsessive Compulsive Scale for Children, Hamilton Depression Rating Scale, and Hamilton Anxiety Rating Scale. No significant changes in caudate neurochemistry were observed in OCD patients before and after CBT despite unambiguous improvement in OCD symptoms, depression, and anxiety. Findings suggest that reduction in caudate Glx may be specific to SSRI treatment and not due to a more generalized treatment response or spontaneous improvement of symptoms. Differential sets of pathophysiologic and treatment response markers may moderate/mediate the effects of particular treatments on outcome.


A Reading Model from the Perspective of Japanese Orthography: Connectionist Approach to the Hypothesis of Granularity and Transparency.
This study presents a computer simulation model of reading in Japanese syllabic kana and morphographic kanji. The model was based on the simulation model developed by Harm and Seidenberg for reading in English. The purpose of building the current model was to verify the validity of the hypothesis of granularity and transparency (HGT) postulated by Wydell and Butterworth, focusing on the granularity dimension. The HGT was developed in order to explain the behavioral dissociation between excellent reading skills in Japanese and poor reading skills in English of an English-Japanese bilingual individual as well as the relatively low incidence of developmental dyslexia in Japan. The current model was successful in simulating the granularity dimension of the HGT. The study also identified several limitations, which need to be addressed in future research.


Association of S100B 3'UTR polymorphism with risk of chronic heart failure in a Chinese Han population.
To study the correlation between single nucleotide polymorphism (SNP) of the 3' untranslated region (UTR) rs9722 locus in S100B and the risk of chronic heart failure (CHF), plasma levels of S100B protein as well as has-miR-340-3p in a Chinese Han population.A total of 215 patients with CHF (124 ischemic cardiomyopathy (ICM) and 91 dilated cardiomyopathy (DCM)) and 215 healthy controls were recruited to analyze the S100B rs9722 genotype by Sanger sequencing. The levels of hsa-miR-340-3p in the plasma were detected by RT-PCR, and S100B levels were detected by ELISA.The risk of CHF in S100B rs9722 locus T allele carriers was 4.24 times higher than that in those with the C allele (95% CI: 2.84-6.33, P < .001). The association of S100B rs9722 locus SNP with ICM and DCM risk was not affected by factors such as age, gender, and body mass index (BMI). The levels of plasma S100B and hsa-miR-340-3p in patients with ICM and DCM were significantly higher than those in the control group (P < .001). There was no significant difference in plasma S100B levels between patients with ICM and DCM (P > .05). Among ICM, DCM, and control subjects, TT genotype carriers had the highest levels of plasma S100B and hsa-miR-340-3p, followed by the CT genotype and TT genotype, and the difference was statistically significant (P < .05). Plasma hsa-miR-340-3p levels were positively correlated with S100B levels in the control subjects and patients with ICM and DCM.The S100B rs9722 locus SNP is associated with CHF risk in a Chinese Han population.


What are the Benefits of Exercise for Alzheimer's Disease? A Systematic Review of the Past 10 Years.
To identify and characterize the scientific literature on the effects of exercise on Alzheimer's disease, research was conducted in the following databases: MEDLINE, CINAHL, Web of Science, and Scopus. These MeSH terms--"exercise", "motor activity", "physical fitness", "Alzheimer disease", and its synonyms in English--were used in the initial search to locate studies published between 2003 and 2013. After reading the 12 final articles in their entirety, two additional articles, found by a manual search, were included. Of these, 13 had beneficial results of exercise in Alzheimer's disease. Given the results discussed here, the exercise may be important for the improvement of functionality and performance of daily life activities, neuropsychiatric disturbances, cardiovascular and cardiorespiratory fitness, functional capacity components (flexibility, agility, balance, strength), and improvements in some cognitive components such as sustained attention, visual memory, and frontal cognitive function in patients with AD.


Excess Gibbs potential model for multicomponent hydrogen clathrates.
A new thermodynamic calculation procedure is introduced to predict the equilibrium conditions of multicomponent gas hydrates containing hydrogen. This new approach utilizes an excess Gibbs potential term to account for second- or higher-order water-cavity distortions due to the presence of multiple guest species. The excess Gibbs potential describes changes in reference chemical potentials according to different compositions of guest mixtures in the hydrate phase. To determine the equilibrium conditions of multicomponent gas hydrates, the excess Gibbs potential term is incorporated to the Lee-Holder model along with the Zele-Lee-Holder cell distortion model. For binary gas hydrates between hydrogen and the other gas molecule, the predicted equilibrium pressure deviates within 10-20% from the experimental value. For the ternary and quaternary mixture hydrates, the model prediction is reasonably good but its error increases with increasing pressure and temperature under the presence of THF.