[The endoscopic release of the transverse carpal ligament for carpal tunnel syndrome.].
Complete division of the flexor retinaculum for decompression of the medial nerve to restore normal neurologic function. Idiopathic and posttraumatic carpal tunnel syndrome. Postoperative recurrence, carpal tunnel syndrome in patients with rheumatoid arthritis, with tumors or with carpal canal compromise due to bony causes. Supine General or regional anaesthesia. Identification of the palmaris longus tendon. 1.5 cm long incision along the flexor crease of the wrist. If the palmaris longus is absent the incision should be made 1.5 cm medial to the flexor carpi radialis tendon. Introduction of the scope and exploration of the ulnar border of the carpal canal with a special instrument until the hook of the hamate has been identified. Endoscopic identification of the distal end of the retinaculum and insertion of the cutter. Complete division of the retinaculum. Posterior plaster splint for 7 days. Elevation of the limb. Active exercises of fingers, elbow and shoulder and, after cast removal, also of the wrist. Lifting and carrying of heavy objects should be avoided for 4 to 6 weeks. Injury of the median nerve or one of its branches, of the superficial palmar arch, and of the flexor tendons. Prospective randomized study of 120 patients of which 101 could be followed up. Forty-five patients (group A) had an open decompression and 47 (group B) were decompressed endoscopically. Average follow-up period for group A 271 days, for group B 275 days. Mean age of both groups: 53 years. There were 13 men and 41 women in group A and 17 men and 30 women in group B. No complications or night pain in either group. No significant difference in atrophy of the thenar eminence in the strength of the hand or in the 2 point discrimination. Results of pre- and postoperative nerve conduction and of temporary disability are listed in Figures 10 and 11. At follow-up 6 to 12 weeks postoperatively no difference could be found between the 2 groups in respect to scar pain, grip power and range of motion. Main advantage of the endoscopic approach: reduced postoperative pain and shorter disability.


National survey describing and quantifying students with communication needs.
Research literature has yet to quantify and describe how students with complex communication needs are supported in the classroom and how special educators are being prepared to offer support. This study sought out special educators to complete a survey about their students with complex communication needs. Over 4,000 teachers representing 50 states reported on the communicative and behavioral characteristics of 15,643 students. Teachers described the training they have received and instructional approaches they used. The majority of students were reported to use speech as their primary communication mode. Over half of students utilizing alternative and augmentative communication (AAC) were reported to have non-proficient communication. Teacher training varied across respondents as well as the supports they used to support these students in the classroom. The majority of students with disabilities using AAC when communicating across the nation are not proficiently communicating. Implications and recommendations will be discussed.


Application of ordered nanoporous silica for removal of uranium ions from aqueous solutions.
Ordered nanoporous silica (MSU-H) with high surface area has been utilized as a solid substrate of a surface-modified hybrid sorbent for the application to the removal of U(VI). Carboxymethylated polyethyleneimine (CMPEI) with a strong complexing property has been introduced to the pore surface of MSU-H substrate. CMPEI-modified MSU-H (CMPEI/MSU-H) has been characterized by scanning electron microscopy and nitrogen sorption. In a kinetic experiment for 12.5 ppm U(VI) solution at pH 4.0, 99% U(VI) was removed from solution by the hybrid sorbent within less than 10 min, indicating that the sorption of U(VI) on the CMPEI/MSU-H proceeds very rapidly. It was evident that a U(VI) sorption capacity increased with pH in the range of 2.0 to 4.0. The CMPEI/MSU-H showed a high sorption capacity of 153 mg/g-sorbent at pH 4.0. In particular, the CMPEI/MSU-H showed a significantly high uranium loading stability. Only about 1% U(VI) was released out of CMPEI/MSU-H during 4 months, when the CMPEI/MSU-H was treated with polyacrylic acid.


A Malay version of the Child Oral Impacts on Daily Performances (Child-OIDP) index: assessing validity and reliability.
The study aimed to develop and test a Malay version of the Child-OIDP index, evaluate its psychometric properties and report on the prevalence of oral impacts on eight daily performances in a sample of 11-12 year old Malaysian schoolchildren. The Child-OIDP index was translated from English into Malay. The Malay version was tested for reliability and validity on a non-random sample of 132, 11-12 year old schoolchildren from two urban schools in Kuala Lumpur. Psychometric analysis of the Malay Child-OIDP involved face, content, criterion and construct validity tests as well as internal and test-retest reliability. Non-parametric statistical methods were used to assess relationships between Child-OIDP scores and other subjective outcome measures. The standardised Cronbach's alpha was 0.80 and the weighted Kappa was 0.84 (intraclass correlation = 0.79). The index showed significant associations with different subjective measures viz. perceived satisfaction with mouth, perceived needs for dental treatment, perceived oral health status and toothache experience in the previous 3 months (p < 0.05). Two-thirds (66.7%) of the sample had oral impacts affecting one or more performances in the past 3 months. The three most frequently affected performances were cleaning teeth (36.4%), eating foods (34.8%) and maintaining emotional stability (26.5%). In terms of severity of impact, the ability to relax was most severely affected by their oral conditions, followed by ability to socialise and doing schoolwork. Almost three-quarters (74.2%) of schoolchildren with oral impacts had up to three performances affected by their oral conditions. This study indicated that the Malay Child-OIDP index is a valid and reliable instrument to measure the oral impacts of daily performances in 11-12 year old urban schoolchildren in Malaysia.


Beneficial Role of Coffee and Caffeine in Neurodegenerative Diseases: A Minireview.
Coffee is among the most widespread and healthiest beverages in the world. Coffee typically contains more caffeine than most other beverages, and is widely and frequently consumed. Thus, it contributes significantly to the overall caffeine consumption within the general population, particularly in adults. Controversies regarding its benefits and risks still exist as reliable evidence is becoming available supporting its health-promoting potential. Several lines of evidence have highlighted the beneficial effects towards several disease conditions including Type II diabetes, hepatitis C virus, hepatocellular carcinoma, nonalcoholic fatty liver disease and neurodegenerative disorders such as Alzheimer's disease (AD), Parkinson's disease (PD) and Amyotrophic Lateral Sclerosis (ALS). The health-promoting properties of coffee are largely attributed to its rich phytochemistry, including caffeine, chlorogenic acid, caffeic acid, and hydroxy hydroquinone. In this minireview, an attempt has been made to discuss the various evidences which are mainly derived from animal and cell models. Various mechanisms chiefly responsible for the beneficial effects of caffeine have also been briefly outlined. A short note on the undesirable effects of excessive coffee intakes is also presented.


Modifiers of prion protein biogenesis and recycling identified by a highly parallel endocytosis kinetics assay.
The cellular prion protein, PrPC, is attached by a glycosylphosphatidylinositol anchor to the outer leaflet of the plasma membrane. Its misfolded isoform PrPSc is the causative agent of prion diseases. Conversion of PrPC into PrPSc is thought to take place at the cell surface or in endolysosomal organelles. Understanding the intracellular trafficking of PrPC may, therefore, help elucidate the conversion process. Here we describe a time-resolved fluorescence energy transfer (FRET) assay reporting membrane expression and real-time internalization rates of PrPC The assay is suitable for high-throughput genetic and pharmaceutical screens for modulators of PrPC trafficking. Simultaneous administration of FRET donor and acceptor anti-PrPC antibodies to living cells yielded a measure of PrPC surface density, whereas sequential addition of each antibody visualized the internalization rate of PrPC (Z' factor >0.5). RNA interference assays showed that suppression of AP2M1 (AP-2 adaptor protein), RAB5A, VPS35 (vacuolar protein sorting 35 homolog), and M6PR (mannose 6-phosphate receptor) blocked PrPC internalization, whereas down-regulation of GIT2 and VPS28 increased PrPC internalization. PrPC cell-surface expression was reduced by down-regulation of RAB5A, VPS28, and VPS35 and enhanced by silencing EHD1. These data identify a network of proteins implicated in PrPC trafficking and demonstrate the power of this assay for identifying modulators of PrPC trafficking.


Exploration of the correlation of serum polychlorinated biphenyl levels with luteal phase hormonal parameters and infertility in women with or without polycystic ovary syndrome.
Polychlorinated biphenyls (PCBs) are organic lipophilic pollutants that accumulate in the body. Previous research has linked PCBs with menstrual function; therefore, this study was undertaken to investigate the correlation of PCBs with luteal phase hormonal parameters of menstrual function at day 21 in a group of non-obese women prior to in vitro fertilization (IVF). Fifty-eight non-obese Caucasian women from a UK academic center, 29 with polycystic ovary syndrome (PCOS) and 29 without, were recruited. PCOS women all had anovulatory infertility. Non-PCOS women: five with unexplained infertility, the remainder with male factor infertility (n=14) or tubal problems (n=10). Blood was withdrawn at day 21 of the menstrual cycle for non-PCOS women, at the time of mock embryo transfer. PCBs were measured using high resolution gas chromatography. Only PCB118, PCB153, PCB138 and PCB180 were detected in all samples, and levels did not differ between PCOS and non-PCOS subjects. In non-PCOS subjects, PCB153, PCB138 and PCB180 inversely correlated with estradiol (p<0.05); PCB118 and PCB138 inversely correlated with follicle stimulating hormone (FSH) (p<0.05); PCB118 (p<0.05), PCB153, PCB138 and PCB180 (all p<0.01) inversely correlated with luteinizing hormone (LH). Control women without PCOS with unexplained infertility showed higher levels of PCB118, PCB153, PCB138 and PCB180 (p<0.05) compared to those control women without PCOS with tubal or male factor infertility, though other hormonal parameters did not differ other than that FSH that was lower in the unexplained group (p=0.01). The only correlation observed in PCOS women with anovulatory infertility was that between PCB180 and progesterone (p<0.05). PCBs correlated with luteal phase menstrual cycle hormones in control women without PCOS and may contribute to the mechanism of unexplained infertility; in PCOS women, no correlations of the PCBs were seen for estradiol, LH or FSH.


Plasma neutrophil gelatinase-associated lipocalin as an early biomarker for prediction of acute kidney injury after cardio-pulmonary bypass in pediatric cardiac surgery.
Cardiopulmonary bypass (CPB) surgery is considered one of the most frequent surgical procedures in which acute kidney injury (AKI) represents a frequent and serious complication. The aim of the present study was to evaluate the efficiency of neutrophil gelatinase-associated lipocalin (NGAL) as an early AKI biomarker after CPB in pediatric cardiac surgery. The study included forty children aged 2 to 78 months undergoing CPB. They were divided into group I: patients who suffered AKI grades II and III; and group II: patients who did not develop AKI or at risk. Peripheral venous blood was withdrawn pre- and post-operatively for serial measurements of NGAL and creatinine. Statistical analysis was performed using Statistical Package for Social Sciences version 14. Mean plasma NGAL levels showed highly significant elevations in group I patients at 2, 12, and 24 h after surgery (p < 0.0001) compared to group II. Significant correlations were found between NGAL and creatinine at different time intervals. Highly significant correlations (p < 0.0001) were found between plasma NGAL and AKI at 2, 12 and 24 h after surgery. A cut-off level of 100 ng/ml at 2 h, and 125 ng/ml at 12 h post-operatively both recorded the highest accuracy, being 95% accurate, with sensitivity of 100% and 89.5% respectively, and specificity of 90.5% and 100% respectively. This study showed that plasma NGAL could be used as an early biomarker for detection of AKI following CPB. We recommend further studies on a wider scale to validate the current study results.


Acute Pancreatitis and Rhabdomyolysis with Acute Kidney Injury following Multiple Wasp Stings.
Multiple wasp stings can induce multiple organ dysfunction by toxic reactions. However, acute pancreatitis is a rare manifestation in wasp sting injury. A 74-year-old woman visited the emergency department by anaphylactic shock because of multiple wasp stings. Acute kidney injury, rhabdomyolysis, hepatotoxicity, and coagulopathy were developed next day. Serum amylase and lipase were elevated and an abdominal computed tomography revealed an acute pancreatitis. Urine output was recovered after 16 days of oliguria (below 500 ml/day). Her kidney, liver, and pancreas injury gradually improved after sessions of renal replacement therapy.


The process group in institutional settings: special techniques for an endangered species.
The process group for staff and trainees in institutional settings has become increasingly unpopular as a resource, although ironically, the need for such a group has grown. The author presents the idea that the process group is not used more often because of a general lack of understanding of the nature of such groups as well as a failure to clearly distinguish process groups from traditional psychotherapy groups. The author goes on to give a clear definition of the task and the boundaries of a process group and, using knowledge of systems thinking, discusses special techniques for running such groups with illustrative examples.


The 5-HT1A receptor agonist 8-hydroxy-2-di-n-(propylamino)tetralin (8-OH-DPAT) induces hyperglucagonemia in rats.
Effects of the 5-HT1A receptor agonist 8-hydroxy-2-di-n-(propylamino)tetralin (8-OH-DPAT) on plasma glucagon levels were investigated. 8-OH-DPAT increased plasma glucose and glucagon levels in rats. Both hyperglycemia and hyperglucagonemia elicited by 8-OH-DPAT were prevented by the 5-HT1A receptor antagonist pindolol and prior adrenodemedullation. These results suggest that increases in plasma glucagon levels induced by 8-OH-DPAT were based on the adrenaline release from the adrenal gland and its effects may contribute to its hyperglycemic effects.


Amyloidosis and Anesthesia.
The aim of this article is to provide a view of amyloidosis and discuss implications for the anesthetic management of patients with this condition. Urine samples from patients with plasma cell dyscrasias were obtained from a urine bank that gathers urine samples from patients who gave research use consent for specimens that would otherwise be considered waste. Patients with amyloidosis may present to the anesthesiologist for procedures relating to diagnosis, surgery relating to the underlying condition (e.g., bronchial laser and organ transplant), or for incidental surgery. The condition carries a significant risk of perioperative morbidity and mortality. The term amyloid was coined by Virchow in the mid 19th century, meaning "starch like." Amyloidosis is a disease complex, in which there is an abnormal deposition of extracellular hyaline material with particular staining characteristics and which contains protein fibrils embedded in a relatively amorphous ground substance. There are numerous clinical manifestations, the onset is insidious, and the diagnosis may not be made in a patient undergoing anesthesia and surgery for an apparently straightforward problem. Unexpected complications such as heart or kidney failure may arise, either before operation or in the postoperative period. Bullous lesions of the skin or oral mucosa and extensive areas of purpura are but two of the ways, in which amyloidosis may first present. The disease spectrum may be inherited or acquired, localized or systemic, and life threatening or an incidental finding.


Experimental investigation of a new process for treatment and valorisation of pot ale wastewaters.
This study investigated an innovative process for the treatment and valorisation of pot ale wastewater. The first phase was to balance the pH to precipitate nitrogen, phosphorus and magnesium, recovering them as fertiliser; the second phase investigated the evaporation of water, reducing the volume of liquid to be transported to an anaerobic digester. In the pH balancing phase we investigated the effect of the final pH, in the range 8-11, on the removal of calcium, magnesium, ammonia, phosphorus and copper. We observed that, for all the species, most of the precipitation occurred when pH was increased from 8 to 9. By pH balancing, a removal from the liquid phase of up to 65% of ammonia and 60% of total phosphorus was obtained. Calcium and magnesium also precipitated from the liquid phase, giving solids with the following composition, calculated from liquid phase measurements: 24-27% magnesium, 4-5% nitrogen, 16-18% phosphorus. We investigated the evaporation process at pH 6 and 10 and at atmospheric pressure and under vacuum. The results showed that only a few % of the chemical oxygen demand (COD) evaporates, indicating very little loss of organic substance for anaerobic digestion. Mass balances for this process in a medium-size whisky distillery were also carried out.


Evaluation of the energy cost of playing a dance simulation video game in overweight and non-overweight children and adolescents.
The purpose of this study was to determine if there were any differences in the submaximal energy cost of movement between overweight (OW) and non-overweight (NO) children while playing a dance simulation video game, Dance Dance Revolution (DDR) and to determine if the cardiorespiratory measures obtained while playing the game met the American College of Sports Medicine (ACSM) recommendations for developing and maintaining cardiorespiratory fitness. Twenty-two children and adolescents (10 OW vs. 12 NO) participated in the study. Cardiorespiratory measurements were taken both during a maximal treadmill walking test and during a 12-minute Dance Dance Revolution protocol. The average absolute VO2 (OW: 917.1 +/- 257.1 vs. 590.6 +/- 147.9 mL . min (-1)) sustained over the DDR protocol was significantly higher in the OW group compared to the NO group. There was no significant difference in the average energy cost of movement when VO2 was normalized to fat-free mass (OW: 17.7 +/- 5.1 vs. NO: 17.3 +/- 3.9 mL . kgFFM (-1) . min (-1)). Both groups were above the minimal ACSM recommended heart rate intensity for developing and maintaining cardiorespiratory fitness when participating in the DDR protocol (OW: 64.83 % +/- 7.14 vs. NO: 64.51 % +/- 7.71), VO2 reserve, however, did not meet ACSM standards for developing and maintaining cardiorespiratory fitness.


Alveolitis during chrysotherapy for rheumatoid arthritis.
A patient who developed dry cough and increasing breathlessness during chrysotherapy for seropositive rheumatoid arthritis is presented. Chest radiograms were repeatedly normal, but there was a moderate decrease in pulmonary diffusing capacity. Transbronchial lung biopsy showed alveolitis. No cellular immunity to gold salts could be demonstrated in vitro. Pulmonary function improved after withdrawal of gold, indicating that chrysotherapy rather than systemic rheumatoid disease was the cause of the alveolitis.


Associations of Peripheral Neuropathy Defined by Monofilament Insensitivity with Mild Cognitive Impairment and Dementia in Older Adults.
The aim of this study was to assess the association of peripheral neuropathy (PN) as defined by monofilament insensitivity with mild cognitive impairment (MCI) and dementia in older adults with and without diabetes. We conducted a cross-sectional analysis of 3,362 Black and White participants in the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS) who underwent monofilament testing at visit 6 (2016-2017, age 71-94 years). Participants' cognitive status was classified by an adjudication committee as cognitively normal, MCI, or dementia after completing a comprehensive battery of neurocognitive assessments. We used logistic regression to evaluate the association of PN with MCI or dementia overall and stratified by diabetes status after adjusting for traditional dementia risk factors. We also compared age-adjusted brain MRI measures among a subset (N = 1,095) of participants with versus without PN. Overall, the prevalence of MCI (21.9% vs. 16.7%) and dementia (7.8% vs. 3.9%) were higher among participants with versus without PN (both p < 0.05). After adjustment, PN was positively associated with MCI or dementia in the overall study population (OR 1.45, 95% CI 1.23, 1.73). Results were similar by diabetes status (diabetes: OR 1.38, 95% CI 1.03-1.87; no diabetes: OR 1.48, 95% CI 1.20-1.83; p-for-interaction = 0.46). Age-adjusted total and lobar brain volumes were significantly lower in participants with versus without PN (both, p < 0.05). PN as defined by monofilament insensitivity was associated with cognitive status independent of vascular risk factors and regardless of diabetes status. Our findings support a connection between PN and cognitive impairment, even in the absence of diabetes.


The treatment of HIV associated thrombocytopenia in haemophiliacs.
HIV associated thrombocytopenia occurs in 5-10% of asymptomatic individuals, and 25-45% of people with AIDS. A variety of treatments are available but the inherited bleeding disorder in addition to the thrombocytopenia makes management in haemophiliacs a special problem. The management of this double coagulopathy is described in seven patients. IV gammaglobulin and steroids were useful only in the short term; zidovudine produced a good response, could be taken orally, had anti-HIV activity and was well tolerated in asymptomatic HIV positive patients. Interferon was an alternative when zidovudine was ineffective or produced intolerable side-effects. Splenectomy was considered only after failure of other treatments because of the increased risks of bleeding.


Treatment of advanced Kaposi's sarcoma using a combination of bleomycin and vincristine.
Eighteen patients with disseminated AIDS-related Kaposi's sarcoma (KS) and compromised bone marrow function were treated with a relatively non-myelosuppressive regimen of bleomycin and vincristine (BV). At study entry, the patients presented with the following median laboratory values: hemoglobin of 9.5 g/dl, granulocyte counts of 1,173/mm3, platelet counts of 218,000/mm3, and CD4 lymphocyte counts of 58/mm3. All patients had extensive Kaposi's sarcoma. Nine patients had visceral involvement: four with pulmonary involvement, two with gastrointestinal involvement, and three with both. Following a median number of seven cycles of biweekly chemotherapy, complete or partial tumor responses were achieved in 13 patients (72%). Two patients experienced bleomycin-induced skin toxicities, whereas 10 others (55%) experienced peripheral sensory neuropathy requiring vincristine dose reductions. Opportunistic infections had occurred in 11 patients prior to initiation of chemotherapy and in 16 after initiation of chemotherapy. Despite the frequent development of opportunistic infections, BV chemotherapy was relatively well tolerated and resulted in a high response rate in this patient population that presented with suboptimal marrow function and extremely low CD4 lymphocyte counts.


Psychobiological characteristics of dissociative identity disorder: a symptom provocation study.
Dissociative identity disorder (DID) patients function as two or more identities or dissociative identity states (DIS), categorized as 'neutral identity states' (NIS) and 'traumatic identity states' (TIS). NIS inhibit access to traumatic memories thereby enabling daily life functioning. TIS have access and responses to these memories. We tested whether these DIS show different psychobiological reactions to trauma-related memory. A symptom provocation paradigm with 11 DID patients was used in a two-by-two factorial design setting. Both NIS and TIS were exposed to a neutral and a trauma-related memory script. Three psychobiological parameters were tested: subjective ratings (emotional and sensori-motor), cardiovascular responses (heart rate, blood pressure, heart rate variability) and regional cerebral blood flow as determined with H(2)(15)O positron emission tomography. Psychobiological differences were found for the different DIS. Subjective and cardiovascular reactions revealed significant main and interactions effects. Regional cerebral blood flow data revealed different neural networks to be associated with different processing of the neutral and trauma-related memory script by NIS and TIS. Patients with DID encompass at least two different DIS. These identities involve different subjective reactions, cardiovascular responses and cerebral activation patterns to a trauma-related memory script.


The sharpening of cochlear frequency selectivity in the normal and abnormal cochlea.
In the normal (anaesthetized) animal cochlea, the frequency threshold curves for single primary fibres are up to an order of magnitude sharper than the analogous function derived from various reported measurements of the basilar membrane amplitude of vibration. This enhanced neural frequency selectivity is found in the same species and under conditions similar to those in which the mechanical measurements are taken. The sharpening process (at least near threshold) appears to be linear and is not dependent upon lateral inhibitory mechanisms. The variability of the neural frequency selectivity and its vulnerability to metabolic, chemical and pathological influences suggests the hypothesis that the sharpening is due to some form of "second filter" subsequent to the relatively broadly tuned basilar membrane. All fibres recorded from in the cochlear nerve in the normal cochlea show this enhanced frequency selectivity; in contrast, in pathological cochleas, all fibres, or a substantial proportion, have high-threshold, broadly tuned characteristics, approximating to those of the basilar membrane. The frequency selectivity of normal cochlear fibres is adequate to account for the analogous psychophysical measures of hearing. It is proposed that loss of this normal frequency selectivity occurs in deafness of cochlear origin, accounting for widening of the critical band. A new hypothesis for recruitment is proposed on this basis.


Primary care team working in Ireland: a qualitative exploration of team members' experiences in a new primary care service.
Team working is an integral aspect of primary care, but barriers to effective team working can limit the effectiveness of a primary care team (PCT). The establishment of new PCTs in Ireland provides an excellent opportunity to explore team working in action. The aim of this qualitative study was to explore the experiences of team members working in a PCT. Team members (n = 19) from two PCTs were interviewed from May to June 2010 using a semi-structured interview guide. All interviews were audio-recorded and transcribed. Data were analysed using NVivo (version 8). Thematic analysis was used to explore the data. We identified five main themes that described the experiences of the team members. The themes were support for primary care, managing change, communication, evolution of roles and benefits of team working. Team members were generally supportive of primary care and had experienced benefits to their practice and to the care of their patients from participation in the team. Regular team meetings enabled communication and discussion of complex cases. Despite the significant scope for role conflict due to the varied employment arrangements of the team members, neither role nor interpersonal conflict was evident in the teams studied. In addition, despite the unusual team structure in Irish PCTs - where there is no formally appointed team leader or manager - general issues around team working and its benefits and challenges were very similar to those found in other international studies. This suggests, in contrast to some studies, that some aspects of the leadership role may not be as important in successful PCT functioning as previously thought. Nonetheless, team leadership was identified as an important issue in the further development of the teams.


[THE CURRENT APPROACH TO METASTATIC RENAL CELL CARCINOMA].
Renal cell carcinona is the most common kidney tumor. In Israel more than 600 cases are diagnosed annually. Risk factors for renal cell carcinoma include obesity, smoking, hypertension, and diabetes; 20-30% of the patients are diagnosed with metastatic disease, and 70-80% of patients are diagnosed with an early non-metastatic tumor. The treatment of an early non-metastatic tumor is resection. At present, the role of adjuvant systemic therapy has not been established; 20-40% of the patients operated on for an early tumor will suffer from metastatic disease recurrence. The lungs are the most common site of metastases. Renal cell carcinoma is relatively refractory to chemotherapy and radiation. In the last decade, an improved understanding of the biology of the tumor, led to the development of biologic therapies targeting specific molecular mechanisms involved in the process of the disease, and a significant expansion of treatment horizon in these patients. The biologic therapies for metastatic renal cell carcinoma belong to two main groups: angiogenesis inhibitors (VEGF-R inhibitors like sunitinib, sorafenib, pazopanib and axitinib), and inhibitors of the mTOR protein (everolimus and temsirolimus). These biologic therapies led to a significant improvement in the patients' survival. Nonetheless, these therapies are associated with a unique profile of side effects like hypertension, mucositis, and hand-foot syndrome with VEGF-R inhibitors therapy, and non-infectious pneumonitis with mTOR inhibitors therapy. The present review will focus on the modern approach to metastatic renal cell carcinoma.


Localization of Alzheimer amyloid beta protein precursor and its relation to senile plaque amyloid.
The authors examined the ultrastructural localization of amyloid beta protein precursor (APP) in normal human brains immunohistochemically using 3 kinds of APP antisera. The patterns of immunoreaction differed between the antisera used. Antiserum 770, against APP1-770, predominantly labeled the cytoplasm of neurons, whereas antiserum Z31, against the pre-beta region of the APP, labeled astroglial processes intensely and neurons to a lesser extent. Antiserum 1736, against the N terminal of beta protein, labeled both neurons and astrocytes. Vascular smooth muscle cells and some of the endothelial cells in the cerebral arterioles and capillaries were labeled with Z31 and 1736. The APP exists in every cells, while various patterns of immunoreactivity may reflect the difference in the metabolic pathway of APP between cell types.


Local Enhancement of Polarization at PbTiO3/BiFeO3 Interfaces Mediated by Charge Transfer.
Ferroelectrics hold promise for sensors, transducers, and telecommunications. With the demand of electronic devices scaling down, they take the form of nanoscale films. However, the polarizations in ultrathin ferroelectric films are usually reduced dramatically due to the depolarization field caused by incomplete charge screening at interfaces, hampering the integrations of ferroelectrics into electric devices. Here, we design and fabricate a ferroelectric/multiferroic PbTiO3/BiFeO3 system, which exhibits discontinuities in both chemical valence and ferroelectric polarization across the interface. Aberration-corrected scanning transmission electron microscopic study reveals an 8% elongation of out-of-plane lattice spacing associated with 104%, 107%, and 39% increments of δTi, δO1, and δO2 in the PbTiO3 layer near the head-to-tail polarized interface, suggesting an over ∼70% enhancement of polarization compared with that of bulk PbTiO3. Besides that in PbTiO3, polarization in the BiFeO3 is also remarkably enhanced. Electron energy loss spectrum and X-ray photoelectron spectroscopy investigations demonstrate the oxygen vacancy accumulation as well as the transfer of Fe3+ to Fe2+ at the interface. On the basis of the polar catastrophe model, FeO2/PbO interface is determined. First-principles calculation manifests that the oxygen vacancy at the interface plays a predominate role in inducing the local polarization enhancement. We propose a charge transfer mechanism that leads to the remarkable polarization increment at the PbTiO3/BiFeO3 interface. This study may facilitate the development of nanoscale ferroelectric devices by tailing the coupling of charge and lattice in oxide heteroepitaxy.


Association of the IFNAR1-17470 and IL-10-592 cytokine variants with susceptibility to chronic hepatitis B viral infections in a Chinese population.
An association between the sequence variants of cytokine genes and various clinical outcomes in subjects infected with the hepatitis B virus (HBV) has been demonstrated. However, the results are inconsistent and inconclusive. Further studies in other populations and the evaluation of a greater number of individuals may contribute to a better understanding of the influence of the cytokine genetic variants on the evolution of HBV infections. This study was performed to explore the relationships between the sequence variants of TNF-A-308, IFNAR1-17470, and IL-10-592 and the susceptibility to chronic hepatitis B (CHB) in a Chinese population. A total of 160 patients with CHB and 124 individuals who had spontaneously recovered (SR) from hepatitis B were enrolled in the present study. The variants at TNF-A-308, IFNAR1-17470, and IL-10-592 were determined by PCR-restriction fragment length polymorphism analysis and were confirmed by bidirectional DNA sequencing. Significant differences were found between the CHB and the SR groups in the frequency and distribution of the genotypes of both IFNAR1-17470 and IL-10-592 genes. In comparison with the CHB patients with the IFNAR1-17470 G/G variant, the odds ratio (OR) of the CHB patients with the IFNAR1-17470 C/C variant developing chronic hepatitis was 2.06 (95%CI = 1.03-4.14). In addition, the OR of the patients with CHB having the IL-10-592 C/C variant developing chronic hepatitis was 2.77 (95%CI = 1.13-4.57) when compared with that of the patients with the IL-10-592 A/A variant. In conclusion, sequence variants of both the IFNAR1-17470 and IL-10-592 genes were correlated with susceptibility to CHB.


Pulmonary tumor embolism presenting as infarcts on computed tomography.
Pulmonary tumor embolism is a rare cause of respiratory failure in patients with cancer and is only infrequently diagnosed during life. Chest radiographs are usually normal. Dilated and beaded peripheral pulmonary arteries may be present on computed tomography scans. The authors describe an unusual case of pulmonary tumor embolism presenting on computed tomography scans as bilateral, peripheral, wedge-shaped opacities. On autopsy, these opacities corresponded to areas of pulmonary infarction.


Mild and efficient Lewis acid-promoted detritylation in the synthesis of N-hydroxy amides: a concise synthesis of (-)-Cobactin T.
An efficient, high-yielding Lewis acid promoted deprotection of O-trityl hydroxylamine derivatives is described. A range of acid-labile protecting groups, such as N-Boc and O-TBS, were tolerated under these mild conditions. The present method is applicable to the synthesis of a broad range of hydroxylamine derivatives, including N-hydroxy amides (hydroxamic acids), N-hydroxy sulfonamides, and N-hydroxy ureas, which often exhibit significant biological activities. An application of this methodology for a concise synthesis of (-)-Cobactin T (18) is also demonstrated.


Effects of non-local competition on plankton-fish dynamics.
In ecology, the intra- and inter-specific competition between individuals of mobile species for shared resources is mostly non-local; i.e., competition at any spatial position will not only be dependent on population at that position, but also on population in neighboring regions. Therefore, models that assume competition to be restricted to the individuals at that position only are actually oversimplifying a crucial physical process. For the past three decades, researchers have established the necessity of considering spatial non-locality while modeling ecological systems. Despite this ecological importance, studies incorporating this non-local nature of resource competition in an aquatic ecosystem are surprisingly scarce. To this end, the celebrated Scheffer's tri-trophic minimal model has been considered here as a base model due to its efficacy in describing the pelagic ecosystem with least complexity. It is modified into an integro-reaction-diffusion system to include the effect of non-local competition by introducing a weighted spatial average with a suitable influence function. A detailed analysis shows that the non-locality may have a destabilizing effect on underlying nutrient-plankton-fish dynamics. A local system in a stable equilibrium state can lose its stability through spatial Hopf and Turing bifurcations when strength of a non-local interaction is strong enough, which eventually generates a large range of spatial patterns. The relationship between a non-local interaction and fish predation has been established, which shows that fish predation contributes in damping of plankton oscillations. Overall, results obtained here manifest the significance of non-locality in aquatic ecosystems and its possible contribution to the phenomena of "spatial patchiness."


Host function of MAK16: G1 arrest by a mak16 mutant of Saccharomyces cerevisiae.
The MAK16 gene was first defined as a gene whose mutation resulted in loss of M1 double-stranded RNA virus-like particles. The mak16-1 mutation also produces temperature-sensitive cell growth. We report here that mak16-1 cells arrest at the nonpermissive temperature in G1 phase, such that they are mating competent. We sequenced the MAK16 gene and found an open reading frame of 306 amino acids encoding a predicted protein of Mr 35,694. Two typical nuclear localization signal sequences were found. MAK16-LacZ fusion proteins that include one of these putative signals entered the nucleus, while unfused beta-galactosidase did not, as judged by subcellular fractionation experiments. In the C-terminal third of the MAK16 open reading frame is an acidic region in which 25 of 41 residues are either glutamate or aspartate. This region contains potential phosphorylation sites for "casein kinases," protein kinases specific for serine or threonine residues in an acidic environment.


Mesenteric lipoblastoma: a rare location in children.
Lipoblastoma is a rare childhood tumor composed of embryonic fat. It is benign and most often presents in children younger than 3 years. These tumors primarily present as a rapidly enlarging mass in the extremities or trunk with abdominal lipoblastomas comprising less than 10% of all reported cases. Abdominal lipoblastomas are most commonly found in the retroperitoneum with less than 15 reported cases arising in the mesentery. We report the unusual presentation of a lipoblastoma arising in the mesentery of a 3-year-old boy.


Tuning the target composition of amine-grafted CPO-27-Mg for capture of CO2 under post-combustion and air filtering conditions: a combined experimental and computational study.
A computational and experimental screening of hypothetical and real compounds exhibiting different degrees of ethylenediamine grafted to the CPO-27-Mg or Mg-DOBDC skeleton is performed in order to determine the target composition that optimizes the CO2 adsorption properties under flue gas and air filtering conditions. On the basis of the [Mg2(dobdc)] formula, eighteen hypothetical models involving 15-100% of functionalization of the coordinatively unsaturated sites (CUS) were considered by means of Grand Canonical Monte Carlo simulations to evaluate the CO2 adsorption at 298 K. In addition, post-synthesis modification was applied to CPO-27-Mg leading to three kinds of samples exhibiting 15, 50, and 60% of CUS functionalization with ethylenediamine, named CPO-27-Mg-a, CPO-27-Mg-b and CPO-27-Mg-c. Compounds were characterized using elemental analysis, TGA, FTIR spectroscopy, PXRD and DSC. Finally, bare and functionalized CPO-27-Mg materials were evaluated using gas adsorption and microcalorimetry in the 0.001-1 bar range, which is pertinent for the mentioned applications. Valuable information related to design criteria for synthesis of tuned CO2 adsorbents is derived through this computational and experimental investigation.


Leukocytoclastic vasculitis and acute allergic interstitial nephritis following ceftriaxone exposure.
Leukocytoclastic vasculitis (LCV), also known as hypersensitivity vasculitis is a small vessel inflammatory disease which mainly involves the postcapillary venules. A 17-year-old girl developed palpable purpura over lower limbs and acute allergic interstitial nephritis 5 days after exposure to ceftriaxone. Skin biopsy from the lesion over lower limbs confirmed the diagnosis of LCV. Discontinuation of drug and treatment with steroid resulted in resolution of skin lesions and normalization of kidney functions. Beta-lactams are commonly used antibiotics in various types of infection in day-to-day practice. LCV, a rare complication of ceftriaxone should be kept in mind while using this drug.


Clinical skills evaluation of trainees in a neurology department.
Three to 12 evaluations of clinical performance using the mini-clinical evaluation exercise (Mini-CEX) (n = 124) or direct observation of procedural skills (DOPS) (n = 21) were performed on 27 trainees working in an NHS neurology department. The communications/ counselling skills subdomain was scored in 64 evaluations. For Mini-CEX the focus was on gathering data (22%), diagnosis (31%), management (34%) and counselling (7%) (focus not recorded in 6%). For DOPS, lumbar puncture was the most common evaluated procedure (57%). Mini-CEX evaluations lasted 23.8 minutes (10.6) (mean, sd) and DOPS 25.9 minutes (12.6). Mini-CEX scores for overall competence and communication skills were mean 5.99 (sd 0.95, range 4-8) and 5.98 (sd 1.21, range 3-9) and for DOPS 5.71 (sd 0.90, range 4-8) both on scales of 1 to 9. Overall trainee competence and communication scores increased with year of training (p < 0.001, p < 0.004 univariate analysis). Assessors undertook up to three or four assessments in a session. Assessors and trainees considered that the observation and feedback had been 'very' or 'quite' useful in providing a relevant element of assessment. These assessments were feasible and useful in a neurology department and provided some evidence for increasing performance with trainee seniority. More assessor time (approximately one hour) than trainee time (24-26 min) was needed for each assessment undertaken.


Simultaneous carotid endarterectomy and excision of ipsilateral branchial cleft fistula--a case report.
Branchial cleft sinuses are congenital anomalies that usually present in childhood or early adulthood. It is uncommon that such a sinus will remain asymptomatic to the sixth decade of life. This case describes the presence of a second branchial cleft sinus in the setting of carotid artery disease, where both were treated surgically simultaneously without complication.


Canine distemper virus antigen detection in external epithelia of recently vaccinated, sick dogs by fluorescence microscopy is a valuable prognostic indicator.
Currently, there are no reliable predictors of the clinical outcomes of domesticated dogs that have been recently vaccinated against canine distemper virus (CDV) and develop respiratory disease. In this study, vaccinated dogs from Oklahoma City that were showing clinical signs of respiratory disease were evaluated for CDV antigen using a direct fluorescent antibody test (FAT). Clinical outcomes after standard symptomatic therapy for respiratory disease were recorded, and a statistical analysis of the results was performed. We present our study showing that CDV FAT results were predictive of clinical recovery (prognostic indicator, prospects of clinical recovery) among vaccinated dogs showing clinical signs of respiratory disease. Negative CDV FAT results equated to 80% chances of recovery after symptomatic therapy, compared to 55% chances of recovery when the CDV FAT results were positive. Based on the results of this study, we show that veterinarians can make better informed decisions about the clinical outcomes of suspected CDV cases, with 2-h turnaround times, by using the CDV FAT. Thus, antemortem examination with the CDV FAT on external epithelia of recently vaccinated, sick dogs is a clinically useful diagnostic test and valuable prognostic indicator for veterinarians. Application of the CDV FAT to these samples avoids unnecessary euthanasia of dogs with suspected CDV.


Neuroticism, marital interaction, and the trajectory of marital satisfaction.
Theories of how initially satisfied marriages deteriorate or remain stable over time have been limited by a failure to distinguish between key facets of change. The present study defines the trajectory of marital satisfaction in terms of 2 separate parameters--(a) the initial level of satisfaction and (b) the rate of change in satisfaction over time--and seeks to estimate unique effects on each of these parameters with variables derived from intrapersonal and interpersonal models of marriage. Sixty newlywed couples completed measures of neuroticism, were observed during a marital interaction and provided reports of marital satisfaction every 6 months for 4 years. Neuroticism was associated with initial levels of marital satisfaction but had no additional effects on rates of change. Behavior during marital interaction predicted rates of change in marital satisfaction but was not associated with initial levels.


Pseudomonas stutzeri MJL19, a rhizosphere-colonizing bacterium that promotes plant growth under saline stress.
The aim of this study was to find and use rhizobacteria able to confer plants advantages to deal with saline conditions. We isolated 24 different bacterial species from the rhizosphere of halophyte plants growing in Santiago del Estero, Argentina salt flat. Four strains were selected upon their ability to grow in salinity and their biochemical traits associated with plant growth promotion. Next, we tested the adhesion on soybean seeds surface and root colonization with the four selected isolates. Isolate 19 stood out from the rest and was selected for further experiments. This strain showed positive chemotaxis towards soybean root exudates and a remarkable ability to form biofilm both in vitro conditions and on soybean roots. Interestingly, this trait was enhanced in high saline conditions, indicating the extremely adapted nature of the bacterium to high salinity. In addition, this strain positively impacted on seed germination, plant growth and general plant health status also under saline stress. A bacterium isolate with outstanding ability to promote seed germination and plant growth under saline conditions was found. The experimental approach allowed us to find a suitable bacterial candidate for a biofertilizer intended to alleviate saline stress on crops. This would allow the use of soil now considered inadequate for agriculture and thus prevent further advancement of agriculture frontiers into areas of environmental value.


Isolation of Listeria: a review of procedures and future prospects.
Recent documented foodborne outbreaks of listeriosis have underscored the need for improved isolation and identification procedures for Listeria. This review considers the development of selective enrichment media, various approaches to improving efficiency of isolation, and efforts to shorten enrichment periods. The application of simplified rapid nucleic acid hybridization techniques, in combination with improved cultural methods is the most promising of these approaches. Such methodological improvements should facilitate gathering data on important questions concerning the epidemiology of Listeria, and the natural history of listeriosis.


Effects of straw amendment on selenium aging in soils: Mechanism and influential factors.
Soil dissolved organic matter (DOM) alters heavy metal availability, but whether straw amendment can manipulate soil selenium (Se) speciation and availability through DOM mineralization remains unclear. In this study, allochthonous maize straw and selenate were incubated together in four different soils for 1 y. The transformation and availability of DOM associated Se (DOM-Se) was investigated during aging. Results indicated that soil solution and soil particle surfaces were dominated by hexavalent hydrophilic acid-bound Se (Hy-Se). The amount of fulvic acid bound Se in soil solution (SOL-FA-Se) was higher than humic acid bound Se in soil solution (SOL-HA-Se), except in krasnozems, and mainly existed as hexavalent Se (Se(VI)). Tetravalent Se (Se(IV)) was the main valence state of FA-Se adsorbed on soil particle surfaces (EX-FA-Se) after 5 w of aging. The proportion of soil-available Se (SOL + EX-Se) decreased with increasing straw rate. However, under an application rate of 7500 kg·hm-2, soluble Se fraction (SOL-Se) reduction was minimal in acidic soils (18.7%-34.7%), and the organic bound Se fraction (OM-Se) was maximally promoted in alkaline soils (18.2%-39.1%). FA and HON could enhance the availability of Se in the soil solution and on particle surfaces of acidic soil with high organic matter content. While Se incorporation with HA could accelerate the fixation of Se into the solid phase of soil. Three mechanisms were involved in DOM-Se aging: (1) Reduction, ligand adsorption, and inner/outer-sphere complexation associated with the functional groups of straw-derived DOM, including hydroxyls, carboxyl, methyl, and aromatic phenolic compounds; (2) interconnection of EX-FA-Se between non-residual and residual Se pools; and (3) promotion by soil electrical conductivity (EC), clay, OM, and straw application. The dual effect of DOM on Se aging was highly reliant on the characteristics of the materials and soil properties. In conclusion, straw amendment could return selenium in soil and reduce soluble Se loss.


Development of an efficient enzymatic production of gamma-D-glutamyl-L-tryptophan (SCV-07), a prospective medicine for tuberculosis, with bacterial gamma-glutamyltranspeptidase.
Gamma-D-Glutamyl-L-tryptophan (SCV-07) is a prospective medicine for the treatment of tuberculosis, according to the phase two clinical trial. Because gamma-D-glutamyl-L-tryptophan has several reactive groups in its molecule, consists of D- and L-amino acids, and is connected by gamma-glutamyl linkage, its chemical synthesis is complicated. An efficient enzymatic method to synthesize gamma-D-glutamyl-L-tryptophan from D-glutamine and L-tryptophan employing bacterial gamma-glutamyltranspeptidase was developed. The optimum reaction conditions were 50 mM D-glutamine, 50 mM L-tryptophan, and 0.2 U ml(-1) gamma-glutamyltranspeptidase, pH 9-9.5, and incubation at 37 degrees C for 5 h. After a 5 h incubation, 33 mM gamma-D-glutamyl-L-tryptophan was obtained, the conversion rate being 66%. The product was purified by Dowex 1 x 8 column and was considered to be gamma-D-glutamyl-L-tryptophan.


Expression and functional activity of receptor-Ck in mononuclear cells of a homozygous hypercholesterolemic family.
The study was addressed to explore the expression and functional activity of a novel cholesterol-specific cell surface receptor-Ck in a typical homozygous familial hypercholesterolemic family. Functional activity of receptor-Ck was characterized by its ability to downregulate Bcl-2 gene expression through a 47 kDa factor having an affinity for the sterol-regulatory element in the promoter region of this gene. The result of such a study revealed normal expression and functional activity of receptor-Ck accompanied by a lack of Apolipoprotein B-specific low-density lipoprotein receptor gene expression in the mononuclear cells derived from these patients. On the basis of these results, it is tempting to speculate that receptor-Ck may be involved in the maintenance of cellular cholesterol homeostasis observed in homozygous familial hypercholesterolemic patients.


[Evaluation of two immunochromatography kits for rapid diagnosis of rotavirus infections].
A prospective study was conducted to evaluate two immunochromatography (ICG) commercial kits for diagnosis of rotavirus infection, VIKIA Rota-Adeno (bioMérieux) and Simple Rota-Adeno (Operon). Reverse transcriptase and polymerase chain reaction (RT-PCR) with specific primers for the VP7 gene of group A rotavirus was used as the reference method. The sensitivity and specificity of the ICG tests compared with those of the reference method were 98.4% and 84.8%, respectively, for Simple Rota-Adeno (Operon), and 100% and 24.2% for VlKIA Rota-Adeno (bioMérieux). It is remarkable the low specificity of the latter method, which yields a high number of false positive results. The predictive value of a positive result by this method was only 71.6%. Most of the detected rotavirus strains corresponded to genotype G9P[8] (65%), followed by G1P[8] (25.4%) and G2P[8] (3.2%).


Changes in brain activation patterns associated with learning of Korean words by Japanese: an fMRI study.
We used functional magnetic resonance imaging (fMRI) to explore the change in brain activation associated with the learning of Korean words written in Han-gul characters (K-words) by young Japanese at two stages. Subjects were 12 right-handed native Japanese without previous knowledge of Korean words and characters. On the first day they were taught the pronunciation and meaning of 20 K-words. Then, after the first fMRI session (on day 2), they were given a set of 20 cards with the words and corresponding photographs. They also received a tape and were instructed to memorize the 20 K-words by studying them every day until the day of the second fMRI session (day 16). During the fMRI sessions, 20 Japanese words written in kana syllabograms (J-words) and the 20 previously presented K-words, as well as 20 new K-words (Kn-words) were presented visually for silent reading. The first J-word reading, relative to the first K-word reading, showed activation in the left angular gyrus. K-word reading relative to J-word reading during both sessions showed activation in occipital regions. Within these activated areas, session by condition interaction was found only in the left angular gyrus. The interaction between session and condition resulted from the fact that the differences in blood oxygenation-level-dependent signals between K-words and J-words and between Kn-words and J-words were significantly greater in the first session than in the second session. From the results, we concluded that patterns of brain activation changed as the memory of the 20 K-words became fixed through daily practice and that reading of both Korean words and Japanese syllabograms engaged the left angular gyrus.


Vitamin E status in Italian children subsisting on a Mediterranean diet.
Serum vitamin E levels and food intake of 83 Italian children subsisting on a 'Mediterranean-type' diet were measured. Total fat intake was 66 g/d and polyunsaturated fatty acids (PUFA) intake was 7.6 g/d. The dietary ratio of polyunsaturated to saturated fatty acids (P/S) was 0.30. Vitamin E intake was estimated to be about 4.5 mg/d and the theoretical requirement, calculated on the basis of their PUFA intake was 4.6 mg/d. The mean serum concentration of vitamin E was found to be 1.02 mg/dl which is similar or higher than reported by others. No correlation was found between serum level of vitamin E and total or HDL cholesterol, while a slightly significant correlation was found between PUFA intake and serum vitamin E. We conclude that the Mediterranean type of diet, characterized by a relatively low P/S ratio and PUFA content, provides a satisfactory vitamin E status.


Patterns among sexual assault victims seeking treatment services.
The validity and reliability of research on the nature and extent of sexual assault tends to be affected by different definitions, methodologies, and measurements. As a result, two important aspects of sexual assault associated with patterns of symptom expression and therapeutic interventions are not often reflected in the research; the severity of the assault, including the duration of the abuse, and the age at the time of the assault and the gender of the victim. This research is based on intake forms from Hawai;i's only statewide provider of services to the victims of sexual assault. The analyses reveal that significant differences exist between male and female victims, by age and by assault characteristics, including the type of sexual assault, use of force and injury, length of assault, and the relationship between victim and offender.


Spontaneous Fibrillation of Bovine Serum Albumin at Physiological Temperatures Promoted by Hydrolysis-Prone Ionic Liquids.
This study highlights the role of time-dependent hydrolysis of ionic liquid anion, [BF4]-, of ionic liquid (IL), 1-ethyl-3-methylimidazolium tetrafluoroborate, [C2mim][BF4], which results in ever-changing pH conditions. Such pH changes along with the ionic interactions bring conformational changes in bovine serum albumin (BSA), leading to the formation of amyloid fibers at 37 °C without external control of pH or addition of electrolyte. The fibrillation of BSA occurs spontaneously with the addition of IL; however, the highest growth rate has been observed in aqueous solution of 10% IL (v/v %) among investigated systems. Thioflavin T (ThT) fluorescence emission has been employed to monitor the growth and development of β-sheet content in amyloid fibrils. The structural alterations in BSA have also been investigated using intrinsic fluorescence measurements. Circular dichroism (CD) measurements confirmed the formation of amyloid fibrils. Transmission electron microscopy (TEM) has been explored to establish the morphologies of BSA fibrils at different intervals of time, whereas atomic force microscopy (AFM) has established the helically twisted nature of grown amyloid fibrils. The docking studies have been utilized to understand the insertion of IL ions in different domains of BSA, which along with decreased pH cause the unfolding and growth of BSA into amyloid fibrils. It is expected that the results obtained from this study would help to understand the impact of IL containing [BF4]- anion on protein stability and aggregation along with providing a new platform to control the formation of amyloid fibrils and other biomaterials driven via ionic interactions and alterations in pH.


Green Or preparation in dentin hypersensitivity treatment.
The effectiveness of Green Or preparation in the treatment of cervical dental hypersensitivity was evaluated. This problem is difficult for patients and for dentists because of dual and unknown methods of treatment. The preparation was used in 30 patients between the ages of 20 and 70 years on 240 teeth with exposed and hypersensitive necks. The obtained results are acceptable, as total elimination of hypersensitivity was attained in 85% of cases, partial reduction of hypersensitivity in 15% cases.


Platelet membrane-coated alterbrassicene A nanoparticle inhibits calcification of the aortic valve by suppressing phosphorylation P65 NF-κB.
Rationale: Calcific aortic valve disease (CAVD) is a leading cause of cardiovascular mortality and morbidity with increasing prevalence and incidence. The pathobiology of CAVD involves valvular fibrocalcification, and osteogenic and fibrogenic activities are elevated in aortic valve interstitial cells (VICs) from diseased valves. It has been demonstrated that activated NF-κB pathway was present in the early stage of CAVD process. There is currently no effective clinical drugs targeting NF-κB pathway for CAVD treatment. Therefore, it is of great clinical significance to seek effective treatments for valve calcification. Methods: In this study, we established immortal human valve interstitial cells (im-hVICs) with pGMLV-SV40T-puro lentivirus. Alizarin red staining and western blotting were performed to evaluate the calcification of immortal VICs supplemented with different compounds. The natural fusicoccane diterpenoid alterbrassicene A (ABA) was found to have potential therapeutic functions. Ribonucleic acid sequencing was used to identify the potential target of ABA. Platelet membrane-coated nanoparticle of ABA (PNP-ABA) was fabricated and the IBIDI pump was used to evaluate the adhesion ability of PNP-ABA. Murine wire-induced aortic valve stenosis model was conducted for in vivo study of PNP-ABA. Results: The natural fusicoccane diterpenoid ABA was found to significantly reduce the calcification of human VICs during osteogenic induction via inhibiting the phosphorylation P65. Runt-related transcription factor 2 (Runx2) and bone morphogenetic protein-2 (BMP2) were down regulated with the treatment of ABA in human VICs. Additionally, molecular docking results revealed that ABA bound to RelA (P65) protein. Phosphorylation of P65 (Ser536) was alleviated by ABA treatment, as well as the nuclear translocation of P65 during osteogenic induction in human VICs. Alizarin red staining showed that ABA inhibited osteogenic differentiation of VICs in a dose-dependent manner. PNP-ABA attenuated aortic valve calcification in murine wire-induced aortic valve stenosis model in vivo. Conclusions: The establishment of im-hVICs provides a convenient cell line for the study of CAVD. Moreover, our current research highlights a novel natural compound, ABA, as a promising candidate to prevent the progression of CAVD.


ATP gated potassium channels in acute myocardial hibernation and reperfusion.
ATP gated potassium (KATP) channels and adenosine are of crucial importance in coronary blood flow regulation and activation of KATP channels and adenosine receptor stimulation protect against infarction and development of stunning. The aim of this study was to test the hypothesis that opening of KATP channels and adenosine receptor stimulation are involved in perfusion-contraction matching, in acute hibernation, and in recovery after reperfusion. 30 isolated piglet hearts (2-10 d old) and 20 isolated rabbit hearts were studied. The isolated piglet hearts were perfused with modified Krebs Henseleit (KH) solution enriched by washed human red blood cells; the isolated rabbit hearts were perfused with modified KH buffer. The effects of the KATP channel opener aprikalim (1 microM), the KATP channel antagonist glibenclamide (30 microM), and the adenosine receptor antagonist 8-(p-sulphophenyl)theophylline (SPT, 300 microM) on 2 h of low flow (10%) ischaemia and 1 h reperfusion were compared with saline in the piglet hearts. The effects of aprikalim (1 microM), glibenclamide (30 microM), and saline during 90 min of low flow (10%) ischaemia followed by 1 h reperfusion were also examined in the isolated rabbit hearts. At constant coronary flow aprikalim reduced perfusion pressure from 53(SEM 5) to 25(1) mm Hg (p < 0.001) in piglet hearts and from 55(5) to 39(5) mm Hg (p < 0.05) in rabbit hearts. Glibenclamide increased perfusion pressure from 47(5) to 61(6) mm Hg (p < 0.01) in piglet hearts and from 45(4) to 81(5) mm Hg (p < 0.001) in rabbit hearts. SPT increased perfusion pressure from 55(6) to 67(6) mm Hg (p < 0.05) in piglet hearts. Left ventricular systolic pressure remained unchanged in both models. During stepwise reductions in coronary flow a parallel stepwise reduction in left ventricular systolic pressure was observed in all groups. At 2 h of low flow ischaemia systolic pressure was 39(4)%, 37(5)%, 41(4)%, and 37(3)% of control for hearts treated with saline aprikalim, glibenclamide, and SPT, respectively. During the low flow period systolic pressure and MVO2 stabilised. An almost identical pattern occurred in rabbit hearts. After 30 min of recovery of piglet hearts left ventricular systolic pressure increased to 78(5)% (saline), 74(5)% (aprikalim), 84(5)% (glibenclamide), and 77(4)% (SPT) of control. The recovery as percentage of control in rabbit hearts was 63(11) (saline), 69(8) (aprikalim) and 56(13) (glibenclamide). Coronary vascular tone is highly responsive to KATP channel modulation and adenosine receptor blockade. KATP channels do not modulate either perfusion-contraction matching or acute hibernation and functional recovery during reperfusion in the red blood cell perfused piglet heart or the crystalloid perfused rabbit hearts. Moreover, adenosine receptor antagonism does not affect these phenomena in piglet hearts.


The role of palliative care in trauma.
Trauma remains a leading cause of morbidity and mortality in the United States. Despite the aggressive and heroic nature of trauma care, including trauma surgery, 10% to 20% of patients admitted to trauma intensive care units die. As the population continues to age, it is predicted that by 2050, approximately 40% of those experiencing traumatic injury will be older than 65 years. For multiple reasons, people in this age group who experience trauma are at greater risk for death. Palliative care is the specialty of health care that provides care for patients with serious, life-threatening, or life-limiting illness or injury, regardless of the stage of disease or treatment. The goal of palliative care is to reduce or alleviate suffering through expert pain and symptom management, as well as assistance with decision making. The integration of palliative and trauma care can assist and support patients and families through stressful, often life-changing times, regardless of the final outcome.


Acardiac twin pregnancies part II: Fetal risk of chorangioma and sacrococcygeal teratoma predicted by pump/acardiac umbilical vein diameters.
We recently published pump/acardiac umbilical venous diameter (UVD) ratios, representing the pump twin's excess cardiac output fraction, of 27 acardiac twin pregnancies. There was a clear separation between the 17 pump twins that had life-threatening complications and the 10 that did not. The hypothesis of this study is that placental chorangioma and sacrococcygeal teratoma (SCT), tumors whose perfusion also causes high-output complications, have the same fetal outcome as pump twins when perfusion of the tumor requires the same excess cardiac output fraction. We compared the three fetoplacental circulations. Fetuses with a placental chorangioma and acardiac twin pregnancies both have their feeding artery and draining vein located at the placental cord insertion. In contrast, SCT lacks a prescribed feeding artery and draining vein. We, therefore, had to modify our model to assume that the diameter of the hypothetical draining vein is related to the flow difference between inferior vena cava and superior vena cava. The latter flow has been estimated sonographically and is the same as the inferior vena cava flow in the absence of an SCT. Furthermore, a simple modification accounts for the different location of the tumor with respect to the placental cord insertion. We propose to apply the clinical pump/acardiac UVD ratios to pregnancies complicated by placental chorangiomas and the modified pump/acardiac UVD ratios for SCT. Risk prediction of these rare fetal tumors may be possible based on application of data on excess cardiac output fractions from pump/acardiac UVD ratios and will require future clinical validation. Birth Defects Research (Part A) 106:733-738, 2016. © 2016 Wiley Periodicals, Inc.


Comparison of cross-sectional and longitudinal measurements of age-related changes in bone mineral content.
Age-related, postmenopausal bone loss was examined among a cohort of Japanese-American women living in Hawaii. None of the women were using estrogens or thiazides. Cross-sectional and longitudinal measurements of bone mineral content were compared at the calcaneus, the proximal radius, and the distal radius. Cross-sectional measurements were also available for the lumbar spine. The longitudinal data showed a slowing rate of bone loss with increasing age at the radius sites. By contrast, the cross-sectional data suggested constant rates of bone loss for all ages at both radius sites and the spine. The calcaneus demonstrated a complex pattern of bone loss in both cross-sectional and longitudinal analyses. The loss rates among women in their fifties were greater than for those in their sixties. From the middle sixties onward calcaneal bone loss remained essentially constant. Because of the sustained bone loss, however, women in their seventies were actually losing greater percentages of their calcaneal bone mineral than they had in their sixties.


BMI is important in predicting the loss of response in inflammatory bowel disease patients on tumour necrosis factor-α inhibitors.
Obesity is an emerging phenomenon among patients with inflammatory bowel disease (IBD). This study aims to evaluate whether the response to tumour necrosis factor-α (TNF-α) inhibitors (infliximab and adalimumab) could be influenced by BMI in IBD. We identified a cohort of 181 IBD patients attending a single-tertiary centre, naive to biologic therapy and stratified them according to their BMI. The primary outcome is the first occurrence of loss of response (LOR). The median BMI was 26 kg/m2 (15-63 kg/m2). Approximately 68% of patients had LOR on both adalimumab (ADA) (n = 52) and infliximab (IFX) (n = 71). However, 83% on ADA with BMI ≥30 kg/m2 had LOR compared to 61% on IFX with BMI ≥30 kg/m2. For patients on ADA, Cox regression analysis revealed that after accounting for age, sex, disease type, duration of disease, fistulising disease, smoking status, haemoglobin, C-reactive protein, albumin and platelet levels, there were statistically significant associations between BMI (≥30 kg/m2 vs. <30 kg/m2) and LOR [P = 0.010; hazard ratio (HR) 3.2; confidence interval (CI), 1.3-7.6]. However, for patients on IFX, after accounting for the same factors, the only significant factor was the association of lower rate of LOR with higher albumin levels (P = 0.024; HR 0.95; CI, 0.91-0.99). There was an increased accelerated time to LOR for patients on ADA with BMI ≥30 kg/m2 compared to BMI <30 kg/m2 (P = 0.026). However, there was no difference in time to LOR for patients on IFX (P = 0.177). BMI is important in predicting the LOR among IBD patients on TNF-α inhibitors, especially among patients receiving ADA.


Comparison of five commercial serological tests for the detection of anti-Chlamydia trachomatis antibodies.
Screening for Chlamydia trachomatis-specific antibodies is valuable in investigating recurrent miscarriage, tubal infertility and extrauterine pregnancy. We compared here the performance of immunofluorescence (IF) to four other commercial tests in detecting IgG antibodies directed against C. trachomatis: two enzyme-linked immunosorbent assays (ELISAs) using the major outer membrane protein (MOMP) as the antigen, commercialised respectively by Medac and R-Biopharm (RB), one ELISA using the chlamydial heat shock protein 60 (cHSP60) as the antigen (Medac), as well as a new automated epifluorescence immunoassay (InoDiag). A total of 405 patients with (n = 251) and without (n = 154) miscarriages were tested by all five tests. The prevalence of C. trachomatis-specific IgG antibodies as determined by the IF, cHSP60-Medac, MOMP-Medac, MOMP-RB and InoDiag was 14.3, 23.2, 14.3, 11.9 and 26.2%, respectively. InoDiag exhibited the highest sensitivity, whereas MOMP-RB showed the best specificity. Cross-reactivity was observed with C. pneumoniae using IF, MOMP-RB and InoDiag, and Parachlamydia acanthamoebae using the cHSP60 ELISA test. No cross-reactivity was observed between C. trachomatis and the other Chlamydiales (Neochlamydia hartmannellae, Waddlia chondrophila and Simkania negevensis). Given its high sensitivity, the new automated epifluorescence immunoassay from InoDiag represents an interesting alternative. The MOMP-based ELISA of R-Biopharm should be preferred for large serological studies, given the high throughput of ELISA and its excellent specificity.


Lymph nodes can accurately be measured on PET-CT for lymphoma staging/restaging without a concomitant contrast enhanced CT scan.
Dual imaging with both contrast enhanced CT scan and PET-CT is recommended for evaluation of lymphoma. We compared the performance in identification and size measurements of involved lymph nodes in FDG-avid lymphomas on the low dose non-contrast enhanced CT of a PET-CT scan with those on a diagnostic contrast enhanced CT scan. The size of FDG-avid lymph nodes was measured in both the short and long axis on both the low dose non-contrast CT of the PET-CT and the contrast enhanced CT by two independent readers. A total of 307 FGD avid lymph nodes were identified in 52 patients. There was no statistically significant differences in the measured size of the nodes on the non-contrast and contrast enhanced scans (p=0.21). Baseline staging and restaging of FDG-avid lymphomas can be performed with one test, PET-CT, without an accompanying contrast enhanced CT scan, with no effect on the measured nodal size.


A Solitary Metastasis for a Malignant Schwannoma in the Gallbladder Detected by 18F-FDG PET/CT.
A 63-year-old woman with a history of malignant schwannoma in the left shoulder (pT1aNxMx) was treated with surgical resection in 2012. During follow-up, patient developed a metastasis in the right lung treated by further surgical intervention. For a suspicion on persistent disease in the lung, patient was sent to FDG PET/CT examination, which showed a focal uptake in the gallbladder. The patient underwent cholecystectomy, and a solitary metastasis from schwannoma was diagnosed by pathology. This case highlights that, in patients with a malignant schwannoma, a careful differential diagnosis should be made in case of a significant FDG uptake in the gallbladder.


Aberrant cytoplasmic expression of proliferating cell nuclear antigen in Hodgkin's disease.
During a study using a monoclonal antibody directed against proliferating cell nuclear antigen (PCNA) to assess the proliferative activity of tumors, it was noted that the cytoplasm of Reed-Sternberg (RS) cells and variants of these cells in cases of Hodgkin's disease reacted very positively. This aberrant expression of PCNA has not been observed in any other tumor or in cells from normal tissues. The biological significance of this observation is currently unknown, but it may have diagnostic utility in detecting and identifying RS cells.


Shedding new light on the origin and spread of the brinjal eggplant (Solanum melongena L.) and its wild relatives.
While brinjal eggplant (Solanum melongena L.) is the second most important solanaceous fruit crop, we lack firm knowledge of its evolutionary relationships. This in turn limits efficient use of crop wild relatives in eggplant improvement. Here, we examine the hypothesis of linear step-wise expansion of the eggplant group from Africa to Asia. We use museum collections to generate nuclear and full-plastome data for all species of the Eggplant clade. We combine a phylogenomic approach with distribution data to infer a biogeographic scenario for the clade. The Eggplant clade has Pleistocene origins in northern Africa. Dispersals to tropical Asia gave rise to Solanum insanum, the wild progenitor of the eggplant, and to African distinct lineages of widespread and southern African species. Results suggest that spread of the species to southern Africa has been recent and likely facilitated by large mammalian herbivores, such as the African elephant and impala feeding on Solanum fruit. Rather than a linear 'Out Of Africa' sequence, our results are more consistent with an initial dispersal event into Asia, and subsequent wide dispersal and differentiation across Africa driven by large mammalian herbivores. Our evolutionary results will affect future work on eggplant domestication and affect the use of wild relatives in breeding of this increasingly important solanaceous crop.


Spatially resolved imaging of inhomogeneous charge transfer behavior in polymorphous molybdenum oxide. II. Correlation of localized coloration/insertion properties using spectroelectrochemical microscopy.
A newly developed spectroelectrochemical imaging approach for directly assessing lithium ion insertion energetics and kinetics in mixed-phase, polymorphous MoO3 is reported. Two variants of spectroelectrochemical microscopy were used to monitor insertion dynamics and to follow electrochemically induced phase transformations at specifically identified structural and compositional domains. Cyclovoltoabsorptometric (dOD/dE) measurements carried out in LiClO4/propylene carbonate solutions reveal that the lithium insertion is nonuniform and can be directly correlated with phase-segregated domains comprising alpha-MoO3, beta-MoO3, and intermixed alpha-/beta-MoO3. Lithium insertion is found to proceed by a staging process where each phase displays energetically distinct insertion behaviors. Chronoabsorptometric imaging measurements allow for the simultaneous estimation of lithium diffusion coefficients, ionic conductivities, and lithium capacities at isolated phases within the polymorphous material. The lithium diffusion coefficient and ionic conductivity is largest for domains comprising intermixed alpha-/beta-MoO3, whereas it is smallest at domains consisting of beta-MoO3. The higher diffusion coefficient observed for intermixed alpha-/beta-MoO3 domains is most likely due to larger thermodynamic enhancement factors for the mixed phase domains than for domains consisting of either alpha-MoO3 or beta-MoO3. Estimation of capacity values within each uniquely identified domain reveals that the lithium insertion capacity is about 4 times greater in alpha-MoO3 than in beta-MoO3. The discrepancies between the lithium insertion capacities can be rationalized in terms of lattice oxygen defects, which effectively reduce the number of available lithium insertion sites in beta-MoO3 as compared to alpha-MoO3.


Quantitative determination of the neutral glycosyl ceramides in human blood.
A method is described for the qualitative and quantitative estimation of four neutral glycosyl ceramides from human plasma and erythrocytes. Total lipids extracted from 50 ml of plasma or packed erythrocytes were separated by silicic acid chromatography into neutral lipids, a fraction of mixed glycolipids that was eluted with acetone-methanol 9:1, and phospholipids. After mild alkali-catalyzed methanolysis to remove contaminants from the crude fraction of glycolipids, individual glycosyl ceramides were isolated by preparative thin-layer chromatography. The oligosaccharide portions of these lipids were characterized by cleavage with methanolic hydrogen chloride and gas chromatography of the O-trimethylsilyl methyl glycosides. It was possible to study the composition of the carbohydrate and sphingolipid base fractions in the same gas chromatographic analysis. With mannitol as an internal standard for gas chromatographic estimation of glucose, concentrations of each of the glycosyl ceramides were determined with a precision of about 10%. Recoveries of the lipids from plasma varied with the complexity of the oligosaccharide moiety and ranged from 94% with glucosyl ceramide to 71% with globoside. Concentrations of the four glycosyl ceramides in plasma and in erythrocytes were determined for samples from young, healthy males. Amounts of glycolipid as low as 0.1 micromole can be determined conveniently by this procedure.


Flaking corn: processing mechanics, quality standards, and impacts on energy availability and performance of feedlot cattle.
Based on performance of feedlot cattle, steam flaking increases the value of corn by 18%, considerably more than is suggested by tabular values. Tabular values underestimate the energy availability of flaked corn by failing to account for digestibility of the nonstarch OM that is increased by flaking by the same magnitude (10%) as starch. Correcting for improvement in digestibility of nonstarch OM increases the NEg value of steam-flaked corn to 1.70 Mcal/kg, a value very close to values calculated from cattle performance trials. Digestibility of starch from corn grain is limited by the protein matrix that encapsulates starch granules, and by the compact nature of the starch itself. Disruption of the protein matrix (by shear forces on hot grain during flaking) is the first limiting step toward optimizing starch digestion. Five critical production factors influence the quality of steam-flaked corn: steam chest temperature, steaming time, roll corrugation, roll gap, and roll tension. For optimal shear, it is important that rolls be hot and that kernels be hot when flaked. Steam chests should be designed to allow a steaming time of at least 30 min at maximum roller mill capacity producing a flake of 0.31 kg/L (24 lb/bushel). As little as 5% moisture uptake during steaming appears adequate. The rate of flaking and distribution of kernels across the rolls also are critical. Quality standards for steam-flaked corn include measurements of flake thickness, flake density, starch solubility, and enzyme reactivity. Flake density, the most common quality standard, closely associated with starch solubility (r2 = 0.87) and enzyme reactivity (r2 = 0.79), still explains only 63% of the variability in percentage fecal starch and 52% of the variability in starch digestibility. Direct determination of fecal starch can explain 91% of the variability in starch digestion. The NEg value of corn can be predicted from fecal starch: NEg= 1.78 - 0.0184FS. Starch digestion is a Kappa Curve function of hot flake density, reaching a maximum at a flake density of approximately 0.31 kg/L. Flaking to a density of less than 0.31 kg/L, though increasing starch solubility, may reduce DMI, increase variability of weight gain among animals within a pen, and predispose cattle to acidosis and bloat without increasing starch digestion. We recommend that the steam-flaking process be optimized on the basis of fecal starch analysis.


Proposing a New Indicator for the National Human Immunodeficiency Virus/AIDS Strategy: Percentage of Newly Diagnosed Persons Achieving Viral Suppression Within 3 Months of Diagnosis.
We propose an outcome indicator, the percentage of newly diagnosed persons achieving viral suppression within 3 months of diagnosis, to be included in the US National HIV/AIDS Strategy to monitor the progress in human immunodeficiency virus (HIV) care among persons newly diagnosed with HIV. Using HIV registry data, we reported that the percentage in New York City increased from 9% in 2007 to 37% in 2016. We recommend that the Centers for Disease Control and Prevention and local health agencies use this new indicator to monitor the progress in HIV care among persons newly diagnosed with HIV in the United States.


Defocus-based three-dimensional particle location with extended depth of field via color coding.
A color-coded lens system is designed and built for three-dimensional (3D) particle location. As it has wavelength-dependent focal length, it can obtain a series of multifocus images in a single snapshot by separating the red, green, and blue channels of the image captured by a color camera. A light source consisting of red, green, and blue LEDs is customized to provide narrowband illumination. In this way, the depth of field can be extended. A three-pinhole aperture is introduced into the system to produce defocus-based triangular patterns that help to encode the particle depth. The accurate 3D particle position can finally be obtained by fusing the information from the three color channels. Experimental results demonstrate that the system is well suited for applications where particles may be irregular or extended depth of field is needed.


[Clinical significance of erythrocyte phosphoenolpyruvate in elderly and senior patients with iron deficiency anemia].
The article presents a part of the study dealing with erythrocyte glycolysis observed in 29 elderly and senior patients with iron deficiency anemia. The accumulation of phosphoenolpyruvate which is high-energy product of glycolysis testifies that erythrocyte glycolytic reactions are further enhanced. The change in phosphoenolpyruvate content may reflect the restoration and normalization of erythropoiesis and testify the appearance of new forms of erythrocytes, in particular, reticulocytes with natural type of glycolysis and energy metabolism. Clinical significance of obtained data is discussed in the article.


The burden of diarrhoea, shigellosis, and cholera in North Jakarta, Indonesia: findings from 24 months surveillance.
In preparation of vaccines trials to estimate protection against shigellosis and cholera we conducted a two-year community-based surveillance study in an impoverished area of North Jakarta which provided updated information on the disease burden in the area. We conducted a two-year community-based surveillance study from August 2001 to July 2003 in an impoverished area of North Jakarta to assess the burden of diarrhoea, shigellosis, and cholera. At participating health care providers, a case report form was completed and stool sample collected from cases presenting with diarrhoea. Infants had the highest incidences of diarrhoea (759/1,000/year) and cholera (4/1,000/year). Diarrhea incidence was significantly higher in boys under 5 years (387/1,000/year) than girls under 5 years (309/1,000/year; p < 0.001). Children aged 1 to 2 years had the highest incidence of shigellosis (32/1,000/year). Shigella flexneri was the most common Shigella species isolated and 73% to 95% of these isolates were resistant to ampicillin, trimethoprim-sulfamethoxazole, chloramphenicol and tetracycline but remain susceptible to nalidixic acid, ciprofloxacin, and ceftriaxone. We found an overall incidence of cholera of 0.5/1,000/year. Cholera was most common in children, with the highest incidence at 4/1,000/year in those less than 1 year of age. Of the 154 V. cholerae O1 isolates, 89 (58%) were of the El Tor Ogawa serotype and 65 (42%) were El Tor Inaba. Thirty-four percent of patients with cholera were intravenously rehydrated and 22% required hospitalization. V. parahaemolyticus infections were detected sporadically but increased from July 2002 onwards. Diarrhoea causes a heavy public health burden in Jakarta particularly in young children. The impact of shigellosis is exacerbated by the threat of antimicrobial resistance, whereas that of cholera is aggravated by its severe manifestations.


TLR9-based immunotherapy for the treatment of allergic diseases.
Toll-like receptors (TLRs), a family of pattern recognition receptors expressed on many cell types of innate immunity, recognize the pathogen-associated molecular patterns of microbes. The hygiene hypothesis suggests that a reduced microbial exposure in early childhood increases the susceptibility to allergic diseases due to deviation in development of the immune system. TLRs are key roles in the right and healthy direction of adaptive immunity with the induction of T-helper 2 toward Th1 immune responses and regulatory T cells. TLR ligand CpG-ODN-based immunomodulation is independent of allergen and it mainly affects innate immune system. While, CpG-oligodeoxynucleotide-based vaccination is allergen specific and induces adaptive immune system. The use of agonists of TLR9 in two distinct strategies of immunotherapy, immunomodulation and vaccination, could be presented as the curative method for the treatment of allergic diseases.


Retinal Capillary Damage Is Already Evident in Patients With Hypertension and Prediabetes and Associated With HbA1c Levels in the Nondiabetic Range.
We analyzed whether any change in capillary density in the retinal circulation could be detected in patients with hypertension in the prediabetic stage. In a cross-sectional analysis, we assessed capillary density in the foveal (CDF) and parafoveal retinal areas using optical coherence tomography-angiography in 62 patients with hypertension and normal glucose metabolism and 40 patients with hypertension and prediabetes. The CDF was lower in patients with prediabetes than in those with normal glucose metabolism. Moreover, we found a correlation between CDF and HbA1c and glucose levels for the entire cohort. In patients with HbA1c <6.5% (48 mmol/mol), CDF was lower in patients with HOMA for insulin resistance (HOMA-IR) ≥2.5 than in patients with HOMA-IR <2.5. Patients with hypertension and prediabetes display retinal capillary changes, and an association with markers of glucose metabolism exists, even within a nondiabetic HbA1c range.


Interactive effects of apelin, renin-angiotensin system and nitric oxide in treatment of obesity-induced type 2 diabetes mellitus in male albino rats.
Apelin and its receptor (APJ) are involved in the regulation of a variety of pathophysiological processes. We studied the effect of apelin treatment on obesity-induced type 2 diabetes mellitus (T2DM) and possible interaction between apelin/APJ system and renin-angiotensin system (RAS). Forty eight male albino rats were divided into two groups: control group and diabetic group. Diabetic group was subdivided into: control diabetic, apelin-treated, apelin + losartan-treated, apelin + l-NAME-treated and losartan-treated diabetic subgroup. Administration of apelin-13 yielded an improvement of IR, dyslipidaemia, inflammation, oxidative stress with significant decrease in AT1R gene expression and significant increase in ACE2 gene expression in adipose tissues. Losartan + apelin yielded a further significant decrease in ATR1 gene expression, glycaemic indices, serum TGs and TPA versus Apelin only. Adding l-NAME in subgroup (2D) reversed the effect of apelin. We suggested that the beneficial effect of Apelin is mainly mediated by NO-activated pathway and/or ACE2/Ang (1-7) dependent pathway.


The royal food of termites shows king and queen specificity.
Society in eusocial insects is based on the reproductive division of labor, with a small number of reproductive individuals supported by a large number of nonreproductive individuals. Because inclusive fitness of all colony members depends on the survival and fertility of reproductive members, sterile members provide royals with special treatment. Here, we show that termite kings and queens each receive special food of a different composition from workers. Sequential analysis of feeding processes demonstrated that workers exhibit discriminative trophallaxis, indicating their decision-making capacity in allocating food to the kings and queens. Liquid chromatography tandem-mass spectrometry analyses of the stomodeal food and midgut contents revealed king- and queen-specific compounds, including diacylglycerols and short-chain peptides. Desorption electrospray ionization mass spectrometry imaging analyses of 13C-labeled termites identified phosphatidylinositol and acetyl-l-carnitine in the royal food. Comparison of the digestive tract structure showed remarkable differences in the volume ratio of the midgut-to-hindgut among castes, indicating that digestive division of labor underlies reproductive division of labor. Our demonstration of king- and queen-specific foods in termites provides insight into the nutritional system that underpins the extraordinary reproduction and longevity of royals in eusocial insects.


Mouse CD1-autoreactive T cells have diverse patterns of reactivity to CD1+ targets.
Humans and mice contain significant populations of T cells that are reactive for autologous CD1 molecules. Using a panel of five mouse CD1 (mCD1)-autoreactive T cell hybridomas, we show here that this autoreactivity does not correlate with the level of CD1 expression. In some cases, these autoreactive T cells can distinguish between different cell types that express the same CD1 molecule, suggesting that some factor in addition to CD1 expression is critical for autoreactive T cell stimulation. To determine whether a CD1-bound ligand may be required, we expressed mutant mCD1 molecules that are defective for the putative endosomal localization sequence in the cytoplasmic domain. We demonstrate that mCD1, like its human CD1 homologues, is found in endosomes, and that it colocalizes extensively with the DM molecule. We further demonstrate, by site-directed mutagenesis, that the tyrosine in the cytoplasmic sequence is required for this endosomal localization. A T cell hybrid expressing Vbeta8 and Valpha14, the major TCR expressed by NK1+ T cells, exhibited greatly diminished reactivity to mutant CD1 molecules that do not traffic through endosomes, although the reactivity of other T cell hybrids to this mutant was not greatly affected. Therefore, we propose that at least some of the autoreactive T cells require endosomally derived CD1-bound ligands, and that they are capable of distinguishing between a diverse set of such self-ligands, which might be either autologous lipoglycans or peptides.


Overlapping brain network and alpha power changes suggest visuospatial attention effects on driving performance.
When humans perform prolonged, continuous tasks, their performance fluctuates. The etiology of these fluctuations is multifactorial, but they are influenced by changes in attention reflected in underlying neural dynamics. Previous work with electroencephalography has suggested that prestimulus alpha power is a neural signature of attention allocation with higher power portending relatively poorer performance. The functional mechanisms subserving these changes in alpha power and behavior are postulated to be the result of networked neural activity that permits flexibility in the allocation of attention. Here, we directly examine the similarity between prestimulus alpha connectivity and power in relation to performance fluctuations in a continuous driving task. Participants were asked to maintain their vehicle in the center of a simulated highway, and we evaluated their performance by randomly perturbing the vehicle and assessing their steering correction. We then used the 3 seconds of neural activity before the unexpected event to derive alpha functional connectivity in the first analysis and alpha power in the second analysis, and we employed linear regression to separately investigate their relationship to 3 metrics of driving performance (lane deviation, reaction time (RT), and heading error). We find that the locations involved in our network analysis also show the strongest modulation of alpha activity. Interestingly, the network pattern suggests a posterior to anterior directionality, consistent with bottom-up theories of attention, and these results may reflect a gain control model of attention in which ongoing attention is modulated through coordinated, network activity. (PsycINFO Database Record


Emergency Department Utilization Report to Decrease Visits by Pediatric Gastroenterology Patients.
Emergency department (ED) utilization is a major driver of health care costs. Specialist physicians have an important role in addressing ED utilization, especially at highly specialized, academic medical centers. We sought to investigate whether reporting of ED utilization to specialist physicians can decrease ED visits. This study analyzed an intervention to reduce ED utilization among ED patients who were followed by pediatric gastroenterologists. In May 2013, each pediatric gastroenterologist began receiving reports with rates of ED use by their patients. The reports generated discussion that resulted in a cultural and process change in which patients with urgent gastrointestinal (GI)-related complaints were preferentially seen in the office. Using control charts, we examined GI-related and all-diagnoses ED use over a 2-year period. The rate of GI-related ED visits decreased by 60% after the intervention, from 4.89 to 1.95 per 1000 office visits (P < .001). Similarly, rates of GI-related ED visits during office hours decreased by 59% from 2.19 to 0.89 per 1000 (P < .001). Rates of all-diagnoses ED visits did not change. Physician-level reporting of ED utilization to pediatric gastroenterologists was associated with physician engagement and a cultural and process change to preferentially treat patients with urgent issues in the office.


A 2-month-old girl with bifrontal/bitemporal meningococcal subdural empyema: complete radiological and clinical recovery after treatment.
This report describes a 2-month-old girl who developed a subdural empyema as a rare complication of meningococcal disease. The initial presentation was compatible with bacterial meningitis and sepsis and remarkable only for a lymphocytic pleocytosis of the cerebrospinal fluid (CSF), which was confirmed at a later occasion. After a week, when the patient continued to have fever, and subsequently developed focal seizure activity, MRI brain revealed a subdural empyema, necessitating craniectomy with a washout. Initial CSF and blood cultures were negative, but PCR analysis of the CSF from the primary lumbar puncture was positive for Neisseria meningitidis. She responded well to 6 weeks of intravenous meropenem and CT scan of the brain at the end of the treatment was normal. At 4-month follow-up, she was seizure-free with normal neurological examination and development.