CT and MR imaging of gastrointestinal tuberculosis.
The purpose of this study was to describe the CT and MR imaging findings of tuberculosis of the gastrointestinal tract. Abdominal and pelvic CT scans and MRI studies of 6 patients with histopathological and microbiological proven intestinal tuberculosis were reviewed by two radiologists in consensus. Location and pattern of bowel wall involvement, signal intensities in relation to the normal bowel wall, pattern of enhancement and associated abdominal abnormalities were evaluated. Gastrointestinal tract tuberculosis may be limited to one bowel segment, with the cecum and ileocecal valve as the predominant site of disease, or may involve multiple bowel segments. Asymmetric thickening of the bowel wall is a common finding. Associated findings include pericecal and mesenteric fat stranding, regional lymphadenopathy showing peripheral, heterogeneous and/or homogeneous enhancement patterns and less commonly, tuberculous 'dry plastic' peritonitis. On magnetic resonance (MR) imaging, tuberculous bowel involvement results in intermediate decreased signal intensities on T1-weighted images, and intermediate increased, slight heterogeneous signal intensities on T2-weighted images. On contrast-enhanced images, slight heterogeneous enhancement is seen.


The relative importance of spectral tilt in monophthongs and diphthongs.
Ito et al. [J. Acoust. Soc. Am. 110, 1141-1149 (2001)] demonstrated that listeners can reliably identify vowel stimuli on the basis of relative formant amplitude in the absence of, or in spite of, F2 peak frequency. In the present study, formant frequencies and global spectral tilt are manipulated independently in synthetic steady-state vowels. Listeners' identification of these sounds demonstrate strong perceptual effects for both local (formant frequency) and global (spectral tilt) acoustic characteristics. Subsequent experiments reveal that effects of spectral tilt are attenuated in synthetic stimuli for which formant center frequencies change continuously. When formant peaks are kinematic, perceptual salience of the relative amplitudes of low- and high-frequency formants (as determined by spectral tilt) is mitigated. Because naturally produced English vowels are rarely spectrally static, one may conclude that gross spectral properties may play only a limited role in perception of fluently produced vowel sounds.


Differential effect of human interferon on normal and neoplastic T- and B-cell lymphocytes.
The effect of human interferon (HIF) on the growth and function of normal and neoplastic proliferating human T and B cells was studied. Cell cycle analysis by flow-cytometry showed that up to 2000 units of HIF had little effect on the proliferating fraction (that is, the present S + G2 + M phases of the cell cycle) of normal T cells grown continuously wit growth-promoting factor from PHA-stimulated lymphocytes, while 500 units of HIF suppressed the percent S + G2 + M of the acute lymphocytic leukemia (ALL) T-cell line, MOLT, by 36%. Up to 2000 units of HIF had a moderate enhancing effect on the percent S + G2 + M of PWM-stimulated lymphocytes. In striking contrast, a single unit of HIF caused nearly 40% suppression of the percent S + G2 + M of Daudi, a Burkitt's lymphoma cell. One-thousand units of HIF did not decrease the number of antibody-forming normal cells, and up to 500 units of HIF did not inhibit the total Ig secreted by these cells. These results suggest that amounts of HIF affecting the proliferation of some neoplastic lymphoid cells has little effect on the proliferation of normal T and B cells. In addition, HIF does not appear to affect polyclonal induction of B-cell differentiation.


A Pale Baby With Blue Blood.
A previously healthy 9-month-old boy presented to the emergency department with sudden onset of pallor and reduced activity. A detailed history and initial blood tests revealed the diagnosis of oxidant stress-induced hemolysis caused by glucose-6-phosphate dehydrogenase deficiency. However, the child also had a second diagnosis that was revealed with additional testing. This case is described to illustrate the dual diagnosis and management guidelines for both potentially serious conditions.


Effect of sorafenib in a murine high risk penetrating keratoplasty model.
To evaluate the effect of sorafenib in murine high risk keratoplasty model. Graft survival, corneal neovascularization, and corneal lymphangiogenesis were compared among the sorafenib, dexamethasone, dimethyl sulfoxide (DMSO), and phosphate buffered saline (PBS) groups following subconjunctival injection in mice that underwent high risk penetrating keratoplasty (HRPK). Real-time polymerase chain reaction was performed to quantify the expression of inflammatory cytokines and vascular endothelial growth factor (VEGF)-A, VEGF-C, vascular endothelial growth factor receptor (VEGFR)-2, VEGFR-3. The two-month graft survival rate for HRPK was 42.86% in sorafenib group, 37.50% in dexamethasone group, 0 in DMSO group, and 0 in PBS group. Sorafenib significantly increased graft survival compared to the DMSO and PBS group (P<0.05). The sorafenib didn't show significant effect in decreasing neovascularization compared with dexamethsone, DMSO, and PBS group. The sorafenib showed less total lymphangiogenesis than the dexamethasone, DMSO, and PBS group (P=0.011, P<0.001, P<0.001, respectively). The sorafenib group showed reduced expression of VEGF-C, tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, VEGFR-2 and VEGFR-3 compared with DMSO group and PBS group (all P<0.05). The sorafenib group didn't show difference in the expression of VEGF-A compared with DMSO, neither with PBS. The sorafenib group showed reduced expression of VEGFR-3 compared with dexamethasone (P=0.051). The subconjunctivally administered sorafenib shows significant anti-lymphangiogenic effect, resulting in increased transplant survival in a murine high risk keratoplasty model. We suggest that a close linkage between decreased VEGF-C/VEGFR-2 and -3 signaling and increased corneal graft survival by sorafenib seems to exist.


In vitro activity of hypochlorous acid generating electrochemical bandage against monospecies and dual-species bacterial biofilms.
As antimicrobial resistance is on the rise, treating chronic wound infections is becoming more complex. The presence of biofilms in wound beds contributes to this challenge. Here, the activity of a novel hypochlorous acid (HOCl) producing electrochemical bandage (e-bandage) against monospecies and dual-species bacterial biofilms formed by bacteria commonly found in wound infections was assessed. The system was controlled by a wearable potentiostat powered by a 3V lithium-ion battery and maintaining a constant voltage of + 1.5V Ag/AgCl, allowing continuous generation of HOCl. A total of 19 monospecies and 10 dual-species bacterial biofilms grown on polycarbonate membranes placed on tryptic soy agar (TSA) plates were used as wound biofilm models, with HOCl producing e-bandages placed over the biofilms. Viable cell counts were quantified after e-bandages were continuously polarized for 2, 4, 6, and 12 hours. Time-dependent reductions in colony forming units (CFUs) were observed for all studied isolates. After 12 hours, average CFU reductions of 7.75 ± 1.37 and 7.74 ± 0.60 log10 CFU/cm2 were observed for monospecies and dual-species biofilms, respectively. HOCl producing e-bandages reduce viable cell counts of in vitro monospecies and dual-species bacterial biofilms in a time-dependent manner in vitro. After 12 hours, >99.999% reduction in cell viability was observed for both monospecies and dual-species biofilms.


Elucidating the Beneficial Effects of Ginger (Zingiber officinale Roscoe) in Parkinson's Disease.
Parkinson's disease (PD) is the second most common neurodegenerative disorder after Alzheimer's disease (AD), and its pathogenesis remains obscure. Current treatment approaches mainly including levodopa and dopamine agonists provide symptomatic relief but fail to halt disease progression, and they are often accompanied by severe side effects. In this context, natural phytochemicals have received increasing attention as promising preventive or therapeutic candidates for PD, given their multitarget pharmaceutical mechanisms of actions and good safety profile. Ginger (Zingiber officinale Roscoe, Zingiberaceae) is a very popular spice used as a medicinal herb throughout the world since the ancient years, for a wide range of conditions, including nausea, diabetes, dyslipidemia, and cancer. Emerging in vivo and in vitro evidence supports the neuroprotective effects of ginger and its main pharmaceutically active compounds (zingerone, 6-shogaol, and 6-gingerol) in PD, mainly via the regulation of neuroinflammation, oxidative stress, intestinal permeability, dopamine synaptic transmission, and possibly mitochondrial dysfunction. The regulation of several transcription factors and signaling pathways, including nuclear factor kappa B (NF-κB), p38 mitogen-activated protein kinase (MAPK), phosphatidylinositol-3-kinase (PI3K)/Ak strain transforming (Akt), extracellular signal-regulated kinase (ERK) 1/2, and AMP-activated protein kinase (AMPK)/proliferator-activated receptor gamma coactivator 1 alpha (PGC1α) have been shown to contribute to the protective effects of ginger. Herein, we discuss recent findings on the beneficial role of ginger in PD as a preventive agent or potential supplement to current treatment strategies, focusing on potential underlying molecular mechanisms.


Flow separation sensing on airfoil using a 3D printed biomimetic artificial hair sensor.
Small-scale unmanned air vehicles require lightweight, compact, and low-power sensors that encompass a variety of sensing modalities to enable flight control and navigation in challenging environments. Flow sensing is one such modality that has attracted much interest in recent years. In this paper, a micro-scale artificial hair sensor is developed to resolve both the direction and magnitude of airflow. The sensor structure employs a high-aspect ratio hair structure and a thin flexible membrane to facilitate the transduction of directional airflow to membrane deflection. The sensor readout is based on capacitive sensing and two pairs of electrodes orthogonal to each other are used to obtain airflow directional information. The sensor structure was fabricated using two-photon polymerization and integration onto a miniature printed circuit board to enable simple measurement. The sensor's responses to static displacement loading from different directions were characterized. The experimental results are in good agreement with the simulation results. Furthermore, the sensor's capability to measure the direction and magnitude of flow was demonstrated. Finally, the sensor was mounted on an airfoil and its ability to detect flow separation was verified.


Myosin B of Plasmodium falciparum (PfMyoB): in silico prediction of its three-dimensional structure and its possible interaction with MTIP.
The mobility and invasion strategy of Plasmodium falciparum is governed by a protein complex known as the glideosome, which contains an actin-myosin motor. It has been shown that myosin A of the parasite (PfMyoA) is the myosin of the glideosome, and the interaction of PfMyoA with myosin tail domain interacting protein (MTIP) determines its correct location and its ability to function in the complex. Because PfMyoA and myosin B of P. falciparum (PfMyoB) share high sequence identity, are both small proteins without a tail domain, belong to the class XIV myosins, and are expressed in late schizonts and merozoites, we suspect that these myosins may have similar or redundant functions. Therefore, this work examined the structural similarity between PfMyoA and PfMyoB and performed a molecular docking between PfMyoB and MTIP. Three-dimensional (3D) models obtained for PfMyoA and PfMyoB achieved high scores in the structural validation programs used, and their superimposition revealed high structural similarity, supporting the hypothesis of possible similar functions for these two proteins. The 3D interaction models obtained and energy values found suggested that interaction between PfMyoB and MTIP is possible. Given the apparent abundance of PfMyoA relative to PfMyoB in the parasite, we believe that the interaction between PfMyoB and MTIP would only be detectable in specific cellular environments because under normal circumstances, it would be masked by the interaction between PfMyoA and MTIP.


Consumption of fruits and vegetables among older adults: findings from the ELSI-Brazil study.
This study aimed to assess the prevalence of recommended consumption of fruits and vegetables and their associated factors in a national sample representative of the Brazilian population aged 60 or over. Baseline data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), conducted from 2015 to 2016, including 4,982 older individuals, were used. The recommended consumption of fruits and vegetables was assessed based on questions on the weekly and daily frequency of fruits, natural fruit juice, and vegetables. Intake of five or more servings of these foods on five or more days per week was considered as recommended consumption. Exploratory variables included socio-demographic characteristics, health behaviors, health conditions, and use of health services. Univariate and multiple logistic regression were used to examine the factors associated with the recommended consumption of fruits and vegetables. The prevalence of recommended consumption of fruits and vegetables was 12.9% (95%CI: 11.5-14.3). This consumption showed associations with gender (women - OR = 1.40; 95%CI: 1.08-1.82), age group (80 years or older - OR = 1.66; 95%CI: 1.16-2.37), education level (8 years or more - OR = 2.07; 95%CI: 1.51-2.86), smoking (former smokers - OR = 0.69; 95%CI: 0.55-0.85 and current smokers - OR = 0.50; 95%CI: 0.33-0.77) and medical appointments in the previous 12 months (OR = 1.88; 95%CI: 1.31-2.71). Our findings showed a low prevalence of the recommended consumption of fruits and vegetables among older Brazilian adults, drawing attention to the need for policies aimed at increasing this consumption in the studied population.


Prescription privileges and training issues: a pilot study.
Despite all the rhetoric on the controversial issue of prescriptive authority for psychologists, we posit that the major factor will be one of adequate training standards. As several training models have involved lengthy and rigorous curriculum formats, we conducted a brief pilot study on the views of practicing psychologists. Only one of the 20 licensed psychologists in our sample was willing to undertake an intensive one- to two-year program in psychopharmacology at this stage of their careers.


Methods for Exerting and Sensing Force in Polymer Materials Using Mechanophores.
Invited for this month's cover is the group of Dr. Robert Göstl at DWI - Leibniz Institute for Interactive Materials, Germany. The cover shows the mechanochemically induced retro Diels-Alder reaction of the adduct of a π-extended anthracene and maleimide yielding highly fluorescent anthracenes. This mechanophore motif as well as other force-responsive molecules are reviewed with regard to their efficient activation and quantification. Read the full text of the Minireview at 10.1002/cplu.201900737.


Status and influential factors of spiritual well-being in cancer patients with drug clinical trials: a cross-sectional study.
The purpose of this study was to investigate the spiritual well-being status of cancer patients in drug clinical trials and its influencing factors, and to provide theoretical support for the spiritual health intervention of clinical trial cancer patients. This cross-section study was conducted among 244 cancer patients in clinical trials. The Memorial Symptom Assessment Scale Short Form (MSAS-SF), Connor-Davidson Resilience Scale 10 (CD-RISC 10), and Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-SP-12) were used to measure symptom burden, psychological resilience, and spiritual well-being. The Multiple Linear Regression Model was used to determine the influencing factors of patients' spiritual health. The overall spiritual health level of cancer patients with clinical trials was high (36.87 ± 11.0), and the spiritual health level was positively correlated with psychological resilience (r = 0.872, P < 0.001). Religious belief, nationality, treatment regimen, and resilience were independent risk factors for the spiritual health of cancer patients in clinical trials. Patients with religious beliefs (β = 0.097, P = 0.012), ethnic minorities (β = 0.087, P = 0.023), and high resilience scores (β = 0.874, P < 0.001) had higher levels of spiritual health. Patients who received single antineoplastic therapy (β = - 0.079, P = 0.028) had lower levels of spiritual health. Our study found that the spiritual health of cancer patients in clinical trials was at a high level, superior to cancer patients receiving conventional anti-tumor therapy. Religious belief, nationality, treatment regimen, and psychological resilience were the influential factors of spiritual health.


[Strategies for drug delivery to the brain across the blood-brain barrier].
Designing drugs (including peptides) with greater lipophilicity are still effective strategy for the enhancement of the permeability across the blood-brain barrier (BBB), which is considered to be lipoidal membrane barrier of endothelial cells which have tight junctions without fenestrations. However, for the development of brain-specific drug delivery for neuroactive drugs, it may be greater promising strategy to utilize the specific influx transporters existing at the BBB for hexoses, amino acids, monocarboxylic acids, amines or to inhibit the functions of the efflux transporters such as P-glycoprotein which pumps out cytotoxic and/or lipophilic drugs. Attractive approach to the delivery of peptides is to design the peptide to be transported across the BBB via ologopeptide specific transporters, via insulin or transferrin receptor-mediated transcytosis, or via adsorptive-mediated transcytosis specific for positively charged peptides.


Subtoxic Concentrations of Hepatotoxic Drugs Lead to Kupffer Cell Activation in a Human In Vitro Liver Model: An Approach to Study DILI.
Drug induced liver injury (DILI) is an idiosyncratic adverse drug reaction leading to severe liver damage. Kupffer cells (KC) sense hepatic tissue stress/damage and therefore could be a tool for the estimation of consequent effects associated with DILI. Aim of the present study was to establish a human in vitro liver model for the investigation of immune-mediated signaling in the pathogenesis of DILI. Hepatocytes and KC were isolated from human liver specimens. The isolated KC yield was 1.2 ± 0.9 × 10(6) cells/g liver tissue with a purity of >80%. KC activation was investigated by the measurement of reactive oxygen intermediates (ROI, DCF assay) and cell activity (XTT assay). The initial KC activation levels showed broad donor variability. Additional activation of KC using supernatants of hepatocytes treated with hepatotoxic drugs increased KC activity and led to donor-dependent changes in the formation of ROI compared to KC incubated with supernatants from untreated hepatocytes. Additionally, a compound- and donor-dependent increase in proinflammatory cytokines or in anti-inflammatory cytokines was detected. In conclusion, KC related immune signaling in hepatotoxicity was successfully determined in a newly established in vitro liver model. KC were able to detect hepatocyte stress/damage and to transmit a donor- and compound-dependent immune response via cytokine production.


Fixed ratio or lower limit of normal for the FEV1 /VC ratio: relation to symptoms and extended lung function tests.
There is no general agreement on the spirometric definition of chronic obstructive pulmonary disease (COPD). The global initiative for obstructive lung disease recommends a fixed ratio between forced expiratory volume in one-second (FEV1 ) and forced vital capacity (FVC) of <0·7 (FR) for the diagnosis of COPD. European Respiratory Society and American Thoracic Society favour the use of the fifth percentile of the age-related FEV1 /FVC ratio (the lower limit of normal, LLN). The purpose of this study was to analyse extensive lung function tests in groups of subjects fulfilling none, either or both of the spirometric criteria for COPD. From a previous population-based study, 450 subjects were examined with spirometry, body pletysmography diffusing capacity for CO (DL,CO ), Impulse Oscillometry System (IOS) and answered a questionnaire on respiratory symptoms and diseases. Seventy subjects fulfilled both spirometric COPD criteria (FR+LLN+), 62 subjects the fixed ratio criterion (FR+) only. Of the remaining 318 subjects, 236 were ever smokers (N-ES). Significant differences between all groups were seen for FEV1 and DL,CO . Significant differences between groups were also seen for residual volume (RV) and RV/total lung capacity. For IOS, variables and symptoms increasingly abnormal values were seen from never smokers to FR+LLN+. This study shows that subjects meeting both spirometric COPD criteria frequently have symptoms and findings at extended lung function tests compatible with the diagnosis. Also subjects meeting the fixed ratio criterion only tend to have more symptoms and lung function findings compatible with COPD than ever-smoking subjects with FEV1 /VC > 0·7.


Indirect assessment of hydroxymethylglutaryl-CoA reductase (NADPH) activity in liver tissue.
We describe an indirect method for assessing variation in 3-hydroxy-3-methylglutaryl-coenzyme A reductase (NADPH) activity in liver tissue. 3-Hydroxy-3-methyglutaryl-CoA and mevalonate concentrations in the tissue homogenate are estimated in terms of absorbances and the ratio between the two is taken as an index of activity of the enzyme, which catalyzes the conversion of 3-hydroxy-3-methylglutaryl-CoZ to mevalonate. The ratio increases under conditions in which activity of this enzyme in liver reportedly decreases (e.g., fasting, cholesterol feeding) and decreases under conditions in which the activity of this enzyme reportedly increases (e.g., Triton injection, phenobarbital treatment). We assessed the magnitude of hepatic cholesterogenesis in intact male albino rats by using [1,2-14C] acetate, in fed controls, fasted, cholesterol-fed, Triton-treated, and phenobarbital-treated. The ratio, 3-hydroxy-3-methylglutaryl-CoA/mevalonate was estimated in liver tissue for all the above groups. The method is simple, reproducible, and does not require any unusual chemicals.


Associations between depression, anxiety, stress, hopelessness, subjective well-being, coping styles and suicide in Chinese university students.
Suicide is a major public health concern worldwide. This study aimed to predict the suicidal behavior of Chinese university students by studying psychological measures such as hopelessness, orientation to happiness, meaning in life, depression, anxiety, stress, and coping styles. In November 2016, a stratified-clustered-random sampling approach was utilized to select subjects from two large public medical-related universities in Shandong province, China. This sample consisted of 2,074 undergraduate students (706 males, 1,368 females; mean age = 19.79±1.39 years). The students' major risk factors for suicide were depression, anxiety, stress, and hopelessness, and the students' minor risk factors included orientation to happiness and coping styles (including self-distraction, self-blame and substance use). Notably, the presence of meaning in life had a positive effect on preventing suicide and acted as a protective factor, which suggests that it is important to identify risk factors as well as protective factors relevant to the target population group in order to increase the effectiveness of counseling and suicide prevention programs.


Potential Benefits of Psilocybin for Lupus Pain: A Case Report.
Outcomes of treatment for patients with Lupus have shown overall improvement and benefit from the more aggressive use of immunosuppressants and biological agents through a treat-to-target approach. However, chronic musculoskeletal pain can be refractory to treatment despite the use of non-steroidal anti-inflammatory drugs, corticosteroids, and other analgesic agents, leading to patient dissatisfaction. The concept of new neural pathways from psilocybin usage has been proposed in a variety of pain syndromes; however, it is not trialed for patients with Lupus pain. The patient was a 67-year-old male with positive anti-dsDNA antibody Lupus with a predominance of chronic polyarticular joint pain treated with hydroxychloroquine and non-steroidal anti-inflammatory drugs without pain relief. Pain dramatically improved after a one-time macro-dosing of 6 grams of Psilocybin cubensis in Oregon, which he expected would only provide a sense of enlightenment. After 12 months, he continued without debilitating joint pain. The serotonin-2A receptor's activation triggers an array of neurophysiological reactions that disrupt the functional connections in areas of the brain that are associated with chronic pain. These neuroplastic effects can generate healthy connections, resulting in long-lasting pain relief. However, this is a process that has not been fully analyzed. While there is anecdotal evidence to suggest the therapeutic benefits for autoimmune diseases, including rheumatoid arthritis and psoriasis, there is no specific research that explores its use for lupus-related pain. Since this is the first case that shows the benefit of psilocybin in a patient with Lupus, further studies on macro-dosing psilocybin to treat Lupus pain are warranted.


Making the commitment to managed care.
To develop and to implement managed care requires support from key participants including administrators, physicians, nurse managers and all healthcare providers. This multidisciplinary approach assures success and increases support when making the move toward managed care.


The fundamentals of wastewater sludge characterization and filtration.
The move to greater emphasis on the disposal of wastewater sludges through routes such as incineration and the added cost of landfill emplacement puts high demands on dewatering technology for these sludges. A clear problem in this area is that wastewater sludges are slow and difficult to dewater and traditional methods of laboratory measurement for prediction of filtration performance are inadequate. This is highly problematic for the design and operational optimisation of centrifuges, filters and settling devices in the wastewater industry. The behaviour is assessed as being due to non-linear behaviour of these sludges which negates the use of classical approaches. These approaches utilise the linear portion of a t versus V2 plot (where t is the time to filtration and V is the specific filtrate volume) to extract a simple Darcian permeability. Without this parameter, a predictive capacity for dewatering using current theory is negated.


Alteration of free sulphydryl content of rat sperm heads by suppression of intratesticular testosterone.
Subcutaneous injections of testosterone propionate to adult male rats at a dose of 2.5 or 10 mg/kg body weight, 3 times per week for 7 weeks, resulted in a 75% reduction in serum LH and more than 50% reduction in intratesticular testosterone concentration, but serum FSH levels remained unchanged. The free -SH content, measured as iodo[14C]acetamide binding, increased by 70-100% in testicular sperm heads after suppression of testicular testosterone, and by 25-30% in caput epididymal sperm heads but was decreased by 70-80% in cauda epididymal sperm heads. These results demonstrate an alteration in the oxidative state of sperm nuclear basic proteins, suggesting incomplete nuclear maturation. These changes may be specific for the suppression of intratesticular testosterone, thus illustrating the androgen dependency of sperm head maturation. The contrast effects noted between the iodo[14C]iodoacetamide binding by the caput and the cauda epididymal sperm heads indicate that testosterone propionate treatment may affect the mechanisms regulating the oxidation of the sulphydryl residues in sperm heads during epididymal transit. This alteration may not directly relate to the tissue androgen concentrations.


A new approach to left sleeve pneumonectomy: complete VATS left pneumonectomy followed by right thoracotomy for carinal resection and reconstruction.
Left sleeve pneumonectomy is a challenging operation that requires individualized approaches. Here, we present a new minimally invasive combined thoracoscopic approach. A 61-year-old woman was diagnosed with tracheobronchial adenoid cystic carcinoma. The tumor originated from the left main stem bronchus, and tumor with carinal involvement was observed. We judged that complete resection would be possible via left sleeve pneumonectomy. However, because tumor involvement with the esophagus and descending aorta was suspected, evaluation of resectability in advance was necessary. After confirmation via examination thoracoscopy of no involvement with the surrounding organs, complete VATS left pneumonectomy was performed and followed by right thoracotomy for carinal resection and reconstruction. When thoracoscopic surgery becomes mainstream, this minimally invasive combined thoracoscopic approach might be an optimal option for patients who require left sleeve pneumonectomy.


Myocardial injury in critically ill patients: relation to increased cardiac troponin I and hospital mortality.
To examine the relationship between myocardial injury, assessed by cardiac troponin I (cTnI) levels, and outcome in selected critically ill patients without acute coronary syndromes or cardiac dysfunction. Prospective, observational study in the emergency ICU of a university teaching hospital. Over a 6-month period, 217 consecutive patients admitted to the ICU were studied. cTnI assays were performed in all patients on admission to the ICU. The incidence of myocardial injury, defined by cTnI level > 0.1 ng/mL, was 32% (69 of 217 patients). Overall mortality was 27% (58 of 217 patients). Patients with myocardial injury had a mortality rate of 51%, compared with only 16% mortality for those without myocardial injury (p < 0.001). The hospital mortality rate was highest among older patients (71 +/- 14% vs 58.5 +/- 20%, p < 0.0001) and patients with higher simplified acute physiology scale (SAPS) II score (62 +/- 25% vs 37 +/- 17%, p < 0.0001). Mechanical ventilation was associated with higher in-hospital death (50% vs 31%, for patients who died in the hospital vs those who were discharged alive; p = 0.03). Elevated blood levels of cTnI were found to be independently associated with hospital mortality, regardless of the presence of SAPS II score and mechanical ventilation, in the logistic regression analysis (odds ratio, 2.09; 95% confidence interval, 1.06 to 4.11; p = 0.01). This study demonstrates the high frequency of myocardial injury (32%) in critically ill patients without acute coronary syndromes or cardiac dysfunction on admission to ICU. Myocardial injury is an independent determinant of hospital mortality. Assessment of myocardial injury on admission to ICU would make it possible to identify patients at increased risk of death.


Treatment of severe generalized chronic periodontitis in a patient with Behçet's disease: A case report.
Behçet's disease is a systemic disorder of unknown etiology. It involves multiple organ systems and is characterized by recurring episodes of oral ulcers as well as ocular, genital, and skin lesions. Oral ulcers can affect tooth brushing and impair proper oral hygiene. As a result, a dental biofilm accumulates, and the condition of the teeth and periodontal tissue deteriorates. The aim of this case report is to highlight the efficacy of periodontal treatment for patients with Behçet's disease. A 51-year-old man with Behçet's disease presented with generalized severe periodontitis. After basic treatment of the periodontal tissues, periodontal surgery was performed at several sites with bony defects. However, the patient developed severe stomatitis in the oral mucosa and gingiva after periodontal surgery. Administration of the antimicrobial agent cefdinir had little effect on recovery; however, subsequent administration of sitafloxacin resulted in significant improvement of the stomatitis. This case demonstrates that periodontal therapy is very useful for alleviating the oral signs and symptoms of Behçet's disease. Systemic antibiotic treatment with sitafloxacin (but not cefdinir) and mechanical debridement were effective in preventing the recurrence of aphthous ulcer outbreaks after periodontal surgery.


Public Opinion about Management Strategies for a Low-Profile Species across Multiple Jurisdictions: Whitebark Pine in the Northern Rockies.
1. As public land managers seek to adopt and implement conservation measures aimed at reversing or slowing the negative effects of climate change, they are looking to understand public opinion regarding different management strategies. 2. This study explores drivers of attitudes toward different management strategies (i.e., no management, protection, and restoration) for a low-profile but keystone tree species, the whitebark pine (Pinus albicaulis), in the Greater Yellowstone Ecosystem. Since the whitebark pine species has a range that traverses different federal land designations, we examine whether attitudes toward management strategies differ by jurisdiction (i.e., wilderness or federal lands more generally). 3. We conducted a web and mail survey of residents from Montana, Idaho, and Wyoming, with 1,617 valid responses and a response rate of 16%. 4. We find that active management strategies have substantially higher levels of support than does no management, with relatively little differentiation across protection and restoration activities or across different land designations. We also find that support for management strategies is not influenced by values (political ideology) but is influenced by beliefs (about material vs. post-material environmental orientation, global climate change, and federal spending for public lands) and some measures of experience (e.g., knowledge of threats). 5. This study helps land managers understand that support for active management of the whitebark pine species is considerable and nonpartisan and that beliefs and experience with whitebark pine trees are important for support.


Antioxidant, antibacterial and anticancer properties of phyto-synthesised Artemisia quttensis Podlech extract mediated AgNPs.
The focus of this study is on a rapid and cost-effective approach for the synthesis of silver nanoparticles (AgNPs) using Artemisia quttensis Podlech aerial parts extract and assessment of their antioxidant, antibacterial and anticancer activities. The prepared AgNPs were determined by ultraviolet-visible spectroscopy, X-ray diffraction, Fourier transform infra-red spectroscopy, transmission electron microscopy, scanning electron microscopy, energy-dispersive spectroscopy, and dynamic light scattering and zeta-potential analysis. The AgNPs and A. quttensis extract were evaluated for their antiradical scavenging activity by 2, 2-diphenyl, 1-picryl hydrazyl assay and anticancer activity against colon cancer (human colorectal adenocarcinoma cell line 29) compared with normal human embryonic kidney (HEK293) cells. Also, the prepared AgNPs were studied for its antibacterial activity. The AgNPs revealed a higher antioxidant activity compared with A. quttensis extract alone. The phyto-synthesised AgNPs and A. quttensis extract showed a dose-response cytotoxicity effect against HT29 and HEK293 cells. As evidenced by Annexin V/propidium iodide staining, the number of apoptotic HT29 cells was significantly enhanced, following treatment with AgNPs as compared with untreated cells. Besides, the antibacterial property of the AgNPs indicated a significant effect against the selected pathogenic bacteria. These present obtained results show the potential applications of phyto-synthesised AgNPs using A. quttensis aerial parts extract.


Fabrication and Applications of Potentiometric Membrane Sensors Based on Specific Recognition Sites for the Measurement of the Quinolone Antibacterial Drug Gemifloxacin.
Supramolecular gemifloxacin (GF) sensors have been developed. Supramolecular chemistry is primarily concerned with noncovalent intermolecular and intramolecular interactions, which are far weaker than covalent connections, but they can be exploited to develop sensors with remarkable affinity for a target analyte. In order to determine the dose form of the quinolone antibacterial drug gemifloxacin, the current study's goal is to adapt three polyvinylchloride (PVC) membrane sensors into an electrochemical technique. Three new potentiometric membrane sensors with cylindric form and responsive to gemifloxacin (GF) were developed. The sensors' setup is based on the usage of o-nitrophenyl octyl ether (o-NPOE) as a plasticizer in a PVC matrix, β-cyclodextrin (β-CD) (sensor 1), γ-cyclodextrin (γ-CD) (sensor 2), and 4-tert-butylcalix[8]arene (calixarene) (sensor 3) as an ionophore, potassium tetrakis (4-chlorophenyl) borate (KTpClPB) as an ion additive for determination of GF. The developed method was verified according to IUPAC guidelines. The sensors under examination have good selectivity for GF, according to their selectivity coefficients. The constructed sensors demonstrated a significant response towards to GF over a concentration range of 2.4 × 10-6, 2.7 × 10-6, and 2.42 × 10-6 mol L-1 for sensors 1, 2, and 3, respectively. The sensors showed near-Nernstian cationic response for GF at 55 mV, 56 mV, and 60 mV per decade for sensors 1, 2, and 3, respectively. Good recovery and relative standard deviations during the day and between days are displayed by the sensors. They demonstrated good stability, quick response times, long lives, rapid recovery, and precision while also exhibiting good selectivity for GF in various matrices. To determine GF in bulk and dose form, the developed sensors have been successfully deployed. The sensors were also employed as end-point indicators for titrating GF with sodium tetraphenyl borate.


Chemistry of Amadori rearrangement products: analysis, synthesis, kinetics, reactions, and spectroscopic properties.
The chemistry of the key intermediate in the Maillard reaction, the Amadori rearrangements product, is reviewed covering the areas of synthesis, chromatographic analyses, chemical and spectroscopic methods of characterization, reactions, and kinetics. Synthetic strategies involving free and protected sugars are described in detail with specific synthetic procedures. GC- and HPLC-based separations of Amadori products are discussed in relation to the type of columns employed and methods of detection. Applications of infrared (IR) and nuclear magnetic resonance (NMR) spectroscopy for structural elucidation of Amadori products are also reviewed. In addition, mass spectrometry of free, protected, and protein-bound Amadori products under different ionization conditions are presented. The mechanism of acid/base catalyzed thermal degradation reactions of Amadori compounds, as well as their kinetics of formation, are critically evaluated.


COVID-19 hospitalizations and deaths predicted by SARS-CoV-2 levels in Boise, Idaho wastewater.
The viral load of COVID-19 in untreated wastewater from Idaho's capital city Boise, ID (Ada County) has been used to predict changes in hospital admissions (statewide in Idaho) and deaths (Ada County) using distributed fixed lag modeling and artificial neural networks (ANN). The wastewater viral counts were used to determine the lag time between peaks in wastewater viral counts and COVID-19 hospitalizations as well as deaths (14 and 23 days, respectively). Quantitative measurement of SARS-CoV-2 viral RNA counts in the untreated wastewater was determined three times a week using RT-qPCR over a span of 13 months. To mitigate the effects of PCR inhibitors in wastewater, a series of dilution tests were conducted, and the 1/4 dilution was used to generate the most successful model. Wastewater SARS-CoV-2 viral RNA counts and hospitalization from June 7, 2021 to December 29, 2021 were used as training data to predict hospitalizations; and wastewater SARS-CoV-2 viral RNA counts and deaths from June 7, 2021 to December 20, 2021 were used as training data to predict deaths. These training data were used to make predictive ANN models for future hospitalizations and deaths. To the best of our knowledge, this is the first report of prediction of deaths from COVID-19 based on wastewater SARS-CoV-2 viral RNA counts using machine learning-based multilayered ANN. The applied modeling demonstrates that wastewater surveillance data can be combined with hospitalizations and death data to generate machine learning-based ANN models that predict future COVID-19 hospital admissions and deaths, providing an early warning for medical response teams and healthcare policymakers.


Broad repertoire of the CD4+ Th cell response in spontaneously controlled hepatitis C virus infection includes dominant and highly promiscuous epitopes.
A vigorous hepatitis C virus (HCV)-specific Th cell response is regarded as essential to the immunological control of HCV viremia. The aim of this study was to comprehensively define the breadth and specificity of dominant HCV-specific CD4(+) T cell epitopes in large cohorts of subjects with chronic and spontaneously resolved HCV viremia. Following in vitro stimulation of PBMC, HCV-specific cell cultures from each subject were screened with an overlapping panel of synthetic 20-mer peptides spanning the entire HCV polyprotein. Of 22 subjects who spontaneously controlled HCV viremia, all recognized at least one of a group of six epitopes situated within the nonstructural (NS) proteins NS3, NS4, and NS5, each of which was detected by >30% of subjects, but most subjects recognized additional, more heterogeneous specificities. In contrast, none of the most frequently targeted epitopes was detected by >5% of persons with chronic infection. The most frequently recognized peptides showed promiscuous binding to multiple HLA-DR molecules in in vitro binding assays and were restricted by different HLA-DR molecules in functional assays in different persons. These data demonstrate that predominant CD4(+) T cell epitopes in persons with resolved HCV infection are preferentially located in the nonstructural proteins and are immunogenic in the context of multiple class II molecules. This comprehensive characterization of CD4(+) T cell epitopes in resolved HCV infection provides important information to facilitate studies of immunopathogenesis and HCV vaccine design and evaluation.


Molecular Modelling of Resveratrol Derivatives with SIRT1 for the Stimulation of Deacetylase Activity.
Resveratrol is a polyphenol that is found in plants and has been proposed to have a potential therapeutic effect through the activation of SIRT1, which is a crucial member of the mammalian NAD+-dependent deacetylases. However, how its activity is enhanced toward specific substrates by resveratrol derivatives has not been studied. This study aimed to evaluate the types of interaction of resveratrol and its derivatives with SIRT1 as the target protein, as well as to find out the best ligand with the strangest interaction with SIRT1. In this study, we employed the extensive molecular docking analysis using AutoDock Vina to comparatively evaluate the interactions of resveratrol derivatives (22 molecules from the ZINC database) as ligands with SIRT1 (PDB ID: 5BTR) as a receptor. The ChemDraw and Chem3D tools were used to prepare 3D structures of all ligands and energetically minimize them by the MM2 force field. The molecular docking and visualizations showed that conformational change in resveratrol derivatives significantly influenced the parameter for docking results. Several types of interactions, including conventional hydrogen bonds, carbon-hydrogen bonds, Pi-donor hydrogen bonds, and Pi-Alkyl, were found via docking analysis of resveratrol derivatives and SIRT1 receptors. The possible activation effect of resveratrol 4'-(6-Galloylglucoside) with ZINC ID: ZINC230079516 with higher binding energy score (-46.8608 kJ/mol) to the catalytic domain (CD) of SIRT1 was achieved at the maximum value for SIRT1, as compared to resveratrol and its other derivatives. Finally, resveratrol 4'-(6-Galloylglucoside), as a derivative for resveratrol, has stably interacted with the CD of SIRT1 and might be a potential effective activator for SIRT1.


Neuromuscular characteristics of drop and hurdle jumps with different types of landings.
The objective of this study was to compare drop (DJ) and hurdle jumps using a preferred, flat foot (FLAT) and forefoot (FORE) landing technique. Countermovement jump height was used to establish the hurdle and the DJ heights. The subjects performed forward hurdles and vertical DJs on a force plate. Measures included vertical ground reaction force (VGRF), contact time, leg stiffness, and rate of force development (RFD). Electromyographic (EMG) activity was measured in the rectus femoris, biceps femoris, tibialis anterior, and gastrocnemius during 3 phases: preactivity, eccentric phase, and concentric phase. All the kinetic variables favored hurdles over DJs. Specifically, hurdle-preferred technique and FORE exhibited the shortest contact time and DJ FLAT the longest. The VGRF was higher in hurdle preferred and FORE than in DJ preferred, FLAT, and FORE. For stiffness and RFD, hurdle preferred and FORE were higher than DJ preferred and FLAT. Hurdle jumps showed higher rectus femoris EMG activity than DJ did during preactivity and eccentric phases but lower activity during the concentric phase. Considering the type of landing, FLAT generally demonstrated the greatest EMG activity. During the concentric phase, DJ exhibited higher rectus femoris EMG activity. Biceps femoris activity was higher with hurdles in all the phases. Gastrocnemius showed the highest EMG activity during the concentric phase, and during the eccentric phase, hurdle preferred and FORE showed the highest results. In conclusion, the hurdle FORE technique was the most powerful type of jump.


Effective learner-centered strategies for teaching adults: using visual media to engage the adult learner.
This article offers practical guidance for educators as they prepare specialists to enhance the lives and communities of older persons through the strategic use of visual media in age-related courses. Advantages and disadvantages of this learning innovation are provided as well as seven approaches for enriching instruction. Resources are included for locating effective visual media, matching course content with video resources, determining fair use of copyrighted media, and inserting video clips into PowerPoint presentations. Strategies for accessing assistive services for implementing visual media in the classroom are also addressed. This article promotes the use of visual media for the purpose of enriching gerontological and geriatrics instruction for the adult learner.


Discordance in p53 mutations when comparing ascites and solid tumors from patients with serous ovarian cancer.
We performed a mutational analysis of the p53 gene in matched samples of solid tumors and ascites from patients with ovarian cancer using the single-strand conformation polymorphism technique on exons 5-9 of the p53 gene on fresh and cultured material. We observed a discordance in the pattern of p53 mutations between the ascites and their solid tumor counterpart. In two cases, cancer cells from ascites carried a p53 mutation and the corresponding solid tumor cells retained the wild-type allele, while the opposite pattern was observed in two other patients samples. These results suggest that ovarian tumor cells within the ascites may not simply represent cells shed from the ovarian solid tumor and bear directly on gene therapy strategies in ovarian cancer.


The presence of dental fluorosis in the permanent dentition in Doha.
The main purpose of this study is to draw attention to the presence and the severity of dental fluorosis in Doha (Qatar) through the high level of registered cases of fluorosis found among the groups examined. Of 4800 people aged 8-50 years, 2654 (55.29%) had dental fluorosis of some degree. This problem urgently requires more studies throughout the country to provide an accurate assessment.


Palliative temporal resection for the treatment of intractable bioccipital epilepsy.
Temporal resection is usually ineffective in patients with occipital seizures. However, when seizures are unilateral occipital resections are now, occasionally, considered. When bilateral seizures and visual field defects exist, occipital resection can not be carried out. When predominantly lateralized, temporal seizure onset can be shown in such patients, palliative temporal resection may be justified. We report two patients with medically refractory, bilateral occipital lobe seizures. Clinical and electrophysiological patterns suggested consistent spread of the ictal discharge to temporal lobe structures. Long-term EEG video monitoring was followed by stereoelectroencephalography (SEEG) to assess involvement of temporal and occipital regions symmetrically. Both patients had non-lateralized, elementary visual aura followed by loss of contact, automatisms, frequent falls and occasionally secondary generalization. Brain MR imaging revealed bilateral parieto-occipital ischemic lesions without concomitant temporal volumetric abnormalities. They had bilateral or unilateral visual field defects. Scalp EEGs showed bilateral temporal or temporo-parieto-occipital interictal and ictal epileptic abnormalities. Intracranial SEEG recordings confirmed the presence of multifocal, temporo-occipital epileptic abnormalities. In both however, disabling seizures originated in, or rapidly spread to the right hippocampus. Since occipital resections were inadvisable, both patients underwent selective, right amygdalohippocampectomy. Seizures continued in both (two-year follow-up), but were much less severe, not associated with falling or secondary generalization, not followed by fatigue or headache and with faster recovery. When occipital resection is inadvisable because of bilateral or diffuse visual problems, palliative temporal resection may be considered in patients with lesional, bilateral occipital lobe epilepsy, and rapid seizure spread to mesial temporal structures. (Published with videosequences).


The lived experience of physical exertion for persons with advanced multiple sclerosis: making connections with the world.
To explore the lived experience of physical exertion for persons living with advanced multiple sclerosis (MS). An interpretive (hermeneutic) phenomenological approach was undertaken with 8 persons living with advanced MS. Interviews were conducted with exploratory questions that explored participants' experiences of physical exertion. Data was analysed using phenomenological methods and the findings presented as hermeneutic stories. Participants conveyed physical exertion as a means of influencing their connection with the world. Interpretation identified four subthemes; Lived Body, Sense of Self, Purpose of exertion, and Attributes of the World and an overarching superordinate theme Body-World engagement. Hermeneutic stories illuminated the intertwined relationship between the themes and the idiographic nature of physical exertion. The experience of physical exertion was meaningfully related to participants' sense of self, agency, and 'being in the world'.


Nurses deterred by grim realities of senior roles.
Who would want to be a nurse director at an NHS trust? Not many of you, it would seem, given the findings of a study by think tank The King's Fund involving 134 organisations across England. Its report on the study reveals that it takes an average of more than nine months to replace nursing directors, which is much longer than the time taken to fill other board-level vacancies.


LncRNA-RP11-296A18.3/miR-138/HIF1A Pathway Regulates the Proliferation ECM Synthesis of Human Nucleus Pulposus Cells (HNPCs).
During the process of Intervertebral disc degeneration (IDD), nucleus pulposus apoptosis increases, extracellular matrix (ECM) alters and/or degrades, abnormal proliferation of cells forms cell clusters, and the expression of various inflammatory factors increases. Thus, regulation of human nucleus pulposus cell (HNPC) proliferation and ECM synthesis present promising strategies for IDD treatment. Accumulating evidence indicates that non-coding RNAs are involved in various cellular processes, including cell proliferation, differentiation, apoptosis, and metastasis. High expression of long non-coding RNA (lncRNA) RP11-296A18.3, as well as a low expression of miR-138 during the IDD process has been reported; yet their functional roles in HNPC proliferation and ECM synthesis still remain unclear. MTT and BrdU assays showed that knockdown of RP11-296A18.3 inhibited the proliferation of HNPC. The ECM marker, MMP-13 and Collagen I expressions were also reduced. Bioinformatics target prediction, qPCR, and luciferase assays identified LncRNA-RP11-296A18.3 interacted with miR-138. Moreover, RP11-296A18.3 regulates HNPC proliferation and ECM synthesis through miR-138. As the target gene of miR-138, hypoxia-inducible factor 1-alpha (HIF1A) was closely associated with cell proliferation which was also regulated by RP11-296A18.3 via miR-138. Immunochemistry and qPCR results showed that miR-138 expression was inversely correlated to RP11-296A18.3 and HIF1A in IDD tissues, respectively; RP11-296A18.3 was positively correlated to HIF1A. We revealed that RP11-296A18.3 promote HIF1A expression through sponging miR-138, thus to promote HNPC proliferation and ECM synthesis. Targeting RP11-296A18.3 to rescue miR-138 expression in HNPCs and IDD tissues presents a promising strategy for IDD improvement. J. Cell. Biochem. 118: 4862-4871, 2017. © 2017 Wiley Periodicals, Inc.


Evaluation of an oncology outpatient orientation program: patient satisfaction and outcomes.
A person's first visit to an outpatient cancer center is typically marked by considerable stress and negative emotion. Thus, innovative support interventions that aim to ameliorate such stress and emotion are warranted. This study evaluated one such intervention--a new-patient orientation program in a cancer center. The program is designed to: (1) provide patients with information about the center's facilities and procedures, (2) give them an opportunity to ask questions and discuss personal concerns, (3) provide them with detailed information concerning support services available in both the community and the cancer center, and (4) provide them with access to a support care practitioner for follow-up contact. Following the orientation program, 213 participants completed a mailed questionnaire designed to measure their level of satisfaction with various aspects of the orientation program and the effect of the program on their emotional state. The results showed that participants were extremely satisfied with the program, it helped them deal more effectively with their first visit to the center, and it increased their feelings of relaxation and comfort and reduced their feelings of fear and anxiety. These results support the use of informational and support interventions as an effective means of improving cancer care.


Copper activates metallothionein gene transcription by altering the conformation of a specific DNA binding protein.
Copper homeostasis in yeast involves a copper binding protein, metallothionein, and a trans-acting regulatory protein that activates transcription of the metallothionein gene in response to copper ions. We show that the regulatory protein specifically binds to the metallothionein gene control sequences in the presence, but not in the absence, of copper. Both the DNA binding and metalloregulatory functions of the transacting factor are contained within its aminoterminal domain, and partial proteolysis experiments show that copper activates this domain by causing a major switch in its conformation. Silver also activates the DNA binding domain in vitro and induces metallothionein gene transcription in vivo. We propose a novel copper cluster model for the DNA binding domain based on its surprising structural similarities to metallothionein itself.


Biochemistry of fluoroprolines: the prospect of making fluorine a bioelement.
Due to the heterocyclic structure and distinct conformational profile, proline is unique in the repertoire of the 20 amino acids coded into proteins. Here, we summarize the biochemical work on the replacement of proline with (4R)- and (4S)-fluoroproline as well as 4,4-difluoroproline in proteins done mainly in the last two decades. We first recapitulate the complex position and biochemical fate of proline in the biochemistry of a cell, discuss the physicochemical properties of fluoroprolines, and overview the attempts to use these amino acids as proline replacements in studies of protein production and folding. Fluorinated proline replacements are able to elevate the protein expression speed and yields and improve the thermodynamic and kinetic folding profiles of individual proteins. In this context, fluoroprolines can be viewed as useful tools in the biotechnological toolbox. As a prospect, we envision that proteome-wide proline-to-fluoroproline substitutions could be possible. We suggest a hypothetical scenario for the use of laboratory evolutionary methods with fluoroprolines as a suitable vehicle to introduce fluorine into living cells. This approach may enable creation of synthetic cells endowed with artificial biodiversity, containing fluorine as a bioelement.


Intergenerational payoffs of education.
Better-educated parents generally have children who are themselves better educated, healthier, wealthier, and better off in almost every way than the children of the less educated. But this simple correlation does not prove that the relationship is causal. Neeraj Kaushal sifts through the evidence from economics and public policy and reviews large national and international studies to conclude that, indeed, education has large intergenerational payoffs in many areas of children's lives, and that these payoffs persist over time. Kaushal shows that, if anything, traditional measures of returns to education--which focus on income and productivity--almost certainly underestimate the beneficial effects that parents' education has on their children. She reports causal positive effects not only on children's test scores, health, and behavior, but also on mothers' behaviors that can affect their children's wellbeing, such as teenage childbearing and substance use. Her findings suggest that, as a component of two-generation programs, helping parents extend their education could go a long way toward reducing inequality across generations and promoting children's healthy development. Thus the rationale for two-generation programs that boost parents' education is compelling. However, Kaushal cautions, the U.S. education system reinforces socioeconomic inequality across generations by spending more money on educating richer children than on educating poorer children. By themselves, then, two-generation programs will not necessarily ameliorate the structural factors that perpetuate inequality in this country.


A comparison of neurological event and mortality rates between transcatheter aortic valve implantation and surgical aortic valve replacement.
Transcatheter aortic valve implantation (TAVI) is the treatment of choice for patients with symptomatic severe aortic stenosis. To evaluate the neurological event and mortality rates of TAVI in comparison with those of surgical aortic valve replacement (SAVR). A systematic literature search identified pertinent full-text journal articles published from 2000 to 2022 that were taken as the study materials. Patients were at the age of 79.3 ±2.8 years and 79.9 ±2.9 years at the time of intervention/open surgery in the TAVI and SAVR groups, respectively. Patients' age and preoperative comorbidity rates were similar in both groups. A self-expanding valve prosthesis and a percutaneous transfemoral route were the most commonly used in patients receiving TAVI. The duration of the procedure and the hospital stay were much shorter, and the number of transfused blood units was much lower in the TAVI group than in the SAVR group. No significant intergroup difference was found in the prevalence of postoperative stroke, 1-month all-cause mortality, and 1-month and 1-year cardiovascular mortality rates. However, 1-year all-cause mortality was much lower in the TAVI than the SAVR group. The subgroups of risk stratification showed better outcomes for non-high-risk patients compared with high-risk patients. Irrespective of other postoperative complications of TAVI, this study emphasizes the postoperative major neurological events and mortality. TAVI appears to be superior to SAVR with regard to 1-year all-cause mortality. TAVI is thus recommended for elderly patients with symptomatic severe aortic stenosis at very high surgical risk contraindicated for SAVR.


Bone mineral density changes after 2 years of ARV treatment, compared to naive HIV-1-infected patients not on HAART.
The prevalence of osteopenia and osteoporosis is increased in human immunodeficiency virus (HIV)-infected patients. The pathogenesis of this low bone mineral density (BMD) is multifactorial. We conducted a prospective study over a 2-year period of the BMD in non-treated ARV-naïve HIV-infected-males, in comparison to HIV-infected males commencing a first ARV treatment, and analyzed the evolution of bone turnover markers. A total of 39 caucasian males (median age 38.6 years) were enrolled, including 10 who started ARV treatment (group 1), and 29 without indications for ARV therapy (group 2). In the latter group, 11 subjects commenced ARV during the study; therefore the remainder of their follow-up was within group 1, which finally consisted of 21 patients. At baseline, 9 patients (19.5%) had osteoporosis at least at 1 site, while 28 (61%) showed osteopenia. Lower BMD was correlated with tobacco use. Lumbar spine and total hip BMD significantly decreased in group 1 patients after 6 months of treatment, then stabilized (2.4% and 4% loss, respectively, at 24 months), while no significant change in BMD was observed in group 2 subjects. At baseline, one patient had an increased CTX (C-terminal cross-linking telopeptide of type 1 collagen) and all BSAP (bone-specific alkaline phosphatase) results were normal. During follow-up, both CTX and BSAP increased in group 1 patients, while they did not change in group 2. Osteoporosis and osteopenia are frequent in HIV-infected males. After ARV initiation, BMD decreased, and bone turnover markers increased, even though the BMD remained stable in non-treated patients. These results underline the impact of HIV treatment on BMD and bone metabolism.


Retention of cardiopulmonary resuscitation skills after hands-only training versus conventional training in novices: a randomized controlled trial.
Cardiopulmonary resuscitation (CPR) training can improve performance during simulated cardiac arrest; however, retention of skills after training remains uncertain. Recently, hands-only CPR has been shown to be as effective as conventional CPR. The purpose of this study is to compare the retention rate of CPR skills in laypersons after hands-only or conventional CPR training. Participants were randomly assigned to 1 of 2 CPR training methods: 80 minutes of hands-only CPR training or 180 minutes of conventional CPR training. Each participant's CPR skills were evaluated at the end of training and 3 months thereafter using the Resusci Anne manikin with a skill-reporting software. In total, 252 participants completed training; there were 125 in the hands-only CPR group and 127 in the conventional CPR group. After 3 months, 118 participants were randomly selected to complete a post-training test. The hands-only CPR group showed a significant decrease in average compression rate (P=0.015), average compression depth (P=0.031), and proportion of adequate compression depth (P=0.011). In contrast, there was no difference in the skills of the conventional CPR group after 3 months. Conventional CPR training appears to be more effective for the retention of chest compression skills than hands-only CPR training; however, the retention of artificial ventilation skills after conventional CPR training is poor.


Controversies in the management of cervical spondylotic myelopathy.
Cervical spondylotic myelopathy (CSM) is a common clinical entity that can be a significant cause of disability in the adult population. Although our CSM knowledge has markedly grown in recent years, a variety of controversies exist regarding the optimal treatment strategies. The goal of this paper is to review and discuss current areas of controversy in the management of CSM patients. Topics addressed in this manuscript include: operative versus nonoperative management for patients with mild CSM, optimal surgical approaches for CSM, the utility of intraoperative monitoring, and radiographical prognostic indicators for outcome following surgery for CSM. A current review reveals several areas where Class I evidence exists regarding these controversies. However, many other studies consist contain Class III or weaker data, thereby making it difficult to draw any definitive conclusions. Despite the lack of a consensus in some areas, it appears that CSM patients can often achieve satisfactory treatment through a variety of different options. CSM remains a challenging clinical problem where several areas of controversy still exist. Large, multi-center, randomized prospective trials will be required to help resolve some of the controversies.


Longevity in vivo of primary cell wall cellulose synthases.
Our work focuses on understanding the lifetime and thus stability of the three main cellulose synthase (CESA) proteins involved in primary cell wall synthesis of Arabidopsis. It had long been thought that a major means of CESA regulation was via their rapid degradation. However, our studies here have uncovered that AtCESA proteins are not rapidly degraded. Rather, they persist for an extended time in the plant cell. Plant cellulose is synthesized by membrane-embedded cellulose synthase complexes (CSCs). The CSC is composed of cellulose synthases (CESAs), of which three distinct isozymes form the primary cell wall CSC and another set of three isozymes form the secondary cell wall CSC. We determined the stability over time of primary cell wall (PCW) CESAs in Arabidopsis thaliana seedlings, using immunoblotting after inhibiting protein synthesis with cycloheximide treatment. Our work reveals very slow turnover for the Arabidopsis PCW CESAs in vivo. Additionally, we show that the stability of all three CESAs within the PCW CSC is altered by mutations in individual CESAs, elevated temperature, and light conditions. Together, these results suggest that CESA proteins are very stable in vivo, but that their lifetimes can be modulated by intrinsic and environmental cues.


Factors associated with behavior change in family physicians after CME presentation.
Registrants of a four-day family practice refresher course responded to a survey assessing their reaction to a brief presentation recommending the use of penile anesthesia in newborn circumcision. Of the 110 respondents who had attended that session, 56 percent reacted favorably to the recommendation, 27 percent rejected it, and 17 percent had mixed reactions. Twenty-three percent of the respondents who were performing circumcisions at the time of the survey said they began using the recommended procedure following the conference, most with good results. Those who did not adopt the recommendation said using penile anesthesia for newborn circumcision was unnecessary, potentially dangerous, or both. The results suggest that evaluation of behavior change resulting from continuing medical education efforts should consider attitudinal variables on the part of those attending conferences in addition to variables related to the overall quality of the conference.


[Cultivation of primary animal cells on microcarriers of various types].
Primary cells of chick embryos (CEC), new-born piglet kidneys (NPK), and green monkey kidney (GMK) obtained by the conventional method of tissue trypsinization were shown to grow satisfactorily on microcarriers of various types. CEC formed a confluent monolayer on Supperbead particles within 38--48 hours when seeded in a dose of 3 x 10(5) cells/ml and on DEAE-Sephadex A-50 within 60--72 hours when seeded in a dose of 4 x 10(5) cells/ml. In both instances, with microcarriers used in a concentration of 1 mg/ml the number of CEC by the end of the cultivation period reached 0.9 million cells/ml. Primary NPK and GMK cells formed monolayers not on all microcarrier particles, nevertheless the number of cells in both cultures increased 2--2 1/2-fold in 7 days. The optimal seed concentration of cells depended both on the quality of the primary cell suspension and on the microcarrier type. The monolayer of CEC cells formed on DEAE-Sephadex A-50 particles persisted for 7--14 days.


Absolute numbers versus proportions in the assessment of differentiation of beta-cells in the embryonic avian pancreas.
Environmental factors may influence the proliferation and differentiation of embryonic pancreatic endocrine cells, creating a need for the quantification of such effects. The explanted dorsal pancreatic bud (DPB) of the 5-day chick embryo is a useful in vitro model. Since all explants cannot be assumed to have the same number of endocrine cells at the start of culture, the proportion of beta-cells with respect to alpha-cells may be a more meaningful measure than absolute numbers. This study aimed to establish baseline values for the proportion of beta-cells in both intact and mesoderm-depleted DPBs before culture. Buds were excised from 12 chick embryos and the surrounding mesoderm was removed from 6 buds following collagenase treatment. All the buds were freeze-dried, fixed in parabenzoquinone vapour, embedded in resin and sectioned at 1 micro m. alpha- and beta-cells were detected by an indirect immunoenzyme method. alpha-cells outnumbered beta-cells in 9 of the 12 buds. The proportion of beta-cells in the intact buds varied from 16% to 64% (mean 39.5%) and in the mesoderm-depleted buds from 17% to 66% (mean 39%). There was no significant difference between the absolute numbers or the proportions of cells in either case. The proportions of beta-cells in the 5-day DPBs were higher than those in buds cultured in previous studies for 7 days under various conditions. This result may reflect the role of apoptosis in response to the culture conditions.


Keratin 7 is a marker for a subset of trophoblastic cells in human germ cell tumors.
Human testicular germ cell tumors were studied immunohistochemically with the monoclonal antibody to the 54-kd keratin polypeptide (keratin 7) to determine whether this antibody could be used selectively to identify trophoblastic cells. The antibody reacted with the intermediate filaments in the cytoplasm of some cells in choriocarcinoma cell lines, and in trophoblastic cells in mixed germ cell tumors and a seminoma. It did not react with classic seminoma cells, embryonal carcinoma, yolk sac carcinoma, or somatic tissues of mixed germ cell tumors. On the basis of these data we conclude that monoclonal antibody to keratin 7 is a marker for a subset of trophoblastic cells in human germ cell tumors.


Association of lncRNA H19 rs217727 polymorphism and cancer risk in the Chinese population: a meta-analysis.
Reports on the relationship between the lncRNA H19 rs217727 polymorphism and the risk of cancer in the Chinese population have been inconsistent. Therefore, we performed a meta-analysis to evaluate this association, by searching the Embase, PubMed, Web of Science, Wanfang, and CNKI databases. Four case-control studies with 3,157 cases and 3,564 controls were selected for this meta-analysis. The odds ratios with 95% confidence intervals were examined using the random effect model. Allelic (A vs. G), dominant (AA + GA vs. GG), recessive (AA vs. GA + GG), and additive (AA vs. GG) genetic models were used to determine the association. Overall, no significant association was observed between the rs217727 polymorphism and cancer susceptibility in any of the four genetic models. Sensitivity analysis revealed that the results were stable in the allelic and dominant genetic models, but those from the recessive and additive models were unstable, which should be treated with caution. Our meta-analysis suggests that the lncRNA H19 rs217727 polymorphism might not be associated with overall cancer risk. However, well-designed, large-scale studies with different ethnic populations need to be conducted in the future to elucidate the potential association.


Predictive Values of Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Other Prognostic Factors in Pediatric Patients With Bell's Palsy.
Bell's palsy (BP) is the most frequent cause of unilateral facial paralysis, and inflammation is believed to play an important role in pathogenesis. Due to its rarity, however, no consensus has been reached regarding optimum treatment or factors affecting prognosis. In the present study, treatment outcomes and prognostic factors of BP were investigated in pediatric patients who underwent steroid therapy. The goal was to investigate the relationship between BP and inflammation using multiple inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), and red cell distribution width (RDW). In all, 54 patients diagnosed with BP and 39 healthy randomly selected controls were enrolled in this retrospective study. Demographic characteristics and complete blood cell count test results were compared. In addition, prognostic factors were sought by dividing the 54 patients with BP into 2 groups according to the House-Brackmann grading system: low grade BP (grades II and III) and high grade BP (grades IV and V). Serum samples were analyzed retrospectively on initial presentation and 6 months after the symptom begins. Meaningful hematological parameters include NLR, PLR, MPV, and RDW. The NLR values in the BP group were significantly higher than in the control group. The NLR value in the 2 groups of patients with BP differed significantly. The mean PLR value in the BP group was higher than in the control group; however, there were no significant differences between the low-grade and high-grade BP groups nor were there any statically significant differences in the other characteristics. The NLR and PLR values are readily accessible parameters that may be useful prognostic markers in pediatric patients with BP. Further studies are required to confirm these results and their utility in predicting prognosis and treating pediatric patients with BP.


Impact of Wolfmet Tungsten Alloys as Parallel-Hole Collimator Material on Single-Photon Emission Computed Tomography Image Quality and Functional Parameters: A Simulating Medical Imaging Nuclear Detectors Monte Carlo Study.
Objectives Collimators have a significant role in image quality and detectability in single-photon emission computed tomography (SPECT) imaging. Using an appropriate alloy that effectively absorbs scattered photons, without induced secondary x-rays, and with proper rigidity and weight may provide an effective approach to the image improvement that conventionally collimators made of lead (Pb). Materials and Methods A Siemens E.CAM SPECT imaging system equipped with low-energy high-resolution (LEHR) collimator was simulated by the Simulating Medical Imaging Nuclear Detectors Monte Carlo program. Experimental and simulated data were compared based on a 2-mm 99m Tc point source in an acrylic cylindrical Deluxe phantom (Data Spectrum, Inc). Seven types of tungsten (W) alloys (Wolfmet), with W content from 90 to 97% by weight, were then used as collimator materials of the simulated system. Camera parameters, such as energy- and spatial resolution, image contrast, and collimator-related parameters, such as fraction of septal penetration, scatter-to-primary ratios, and percentage of induced secondary x-rays, due to interactions in the collimator, were evaluated. Results Acceptable conformity was found for the simulated and experiment systems in terms of energy spectra, 10.113 and 10.140%, full width at half-maximum (FWHM) of the point spread function (PSF) curves, 8.78 and 9.06 mm, sensitivity, 78.46 and 78.34 cps/MBq, and contrast in images of 19.1 mm cold spheres in the Deluxe phantom, 79.17 and 78.97%, respectively. Results on the parameters of the simulated system with LEHR collimator made from the alloys showed that the alloy consisting of 90% W, 6% nickel, and 4% copper provided an FWHM of 8.76 mm, resulting in a 0.2% improvement in spatial resolution. Furthermore, all the Wolfmet collimators showed a 48% reduction in the amount of X-rays production compared to the Pb. Conclusion A Wolfmet LEHR collimator, made by a combination of W (90%), Ni (6%), and Cu (6%) provides a better image quality and detectability compared to the Pb.


Emergency physicians and rapid sequence intubation: a survey of Scottish teaching hospitals.
Emergency definitive airway management is a fundamental skill for physicians in the emergency department. The aim of this survey was to determine the perceived confidence in the assessment and control of the emergency airway, including rapid sequence intubation, among physicians in Scottish teaching hospital emergency departments. A postal survey of senior and middle-grade physicians in seven Scottish teaching hospital emergency departments. The response rate was 78% (47/60). A total of 98% of physicians rated their confidence at assessing the difficult airway as 'reasonable' to 'very high'; 79% were confident concerning their ability to administer drugs to facilitate emergency intubation; 47% had used drugs for emergency intubation within the month preceding the survey, and 72% had done so within the 6 months before the survey. Consultants were more confident than trainees, as were those possessing the Fellow of the Royal College of Anaesthetists qualification or a Diploma in Anaesthetics (UK). Those possessing the Fellowship of the Royal College of Anaesthetists qualification had all performed a rapid sequence intubation within the past month. Physicians in Scottish teaching hospital emergency departments have high levels of self-rated confidence in assessment and their ability to secure the emergency airway utilizing drugs to facilitate emergency intubation. Consultants and those with anaesthetic qualifications are more confident than trainees and those without such a qualification.


Knowledge of causes, clinical features and diagnosis of common zoonoses among medical practitioners in Tanzania.
Many factors have been mentioned as contributing to under-diagnosis and under-reporting of zoonotic diseases particularly in the sub-Sahara African region. These include poor disease surveillance coverage, poor diagnostic capacity, the geographical distribution of those most affected and lack of clear strategies to address the plight of zoonotic diseases. The current study investigates the knowledge of medical practitioners of zoonotic diseases as a potential contributing factor to their under-diagnosis and hence under-reporting. The study was designed as a cross-sectional survey. Semi-structured open-ended questionnaire was administered to medical practitioners to establish the knowledge of anthrax, rabies, brucellosis, trypanosomiasis, echinococcosis and bovine tuberculosis in selected health facilities within urban and rural settings in Tanzania between April and May 2005. Frequency data were analyzed using likelihood ratio chi-square in Minitab version 14 to compare practitioners' knowledge of transmission, clinical features and diagnosis of the zoonoses in the two settings. For each analysis, likelihood ratio chi-square p-value of less than 0.05 was considered to be significant. Fisher's exact test was used where expected results were less than five. Medical practitioners in rural health facilities had poor knowledge of transmission of sleeping sickness and clinical features of anthrax and rabies in humans compared to their urban counterparts. In both areas the practitioners had poor knowledge of how echinococcosis is transmitted to humans, clinical features of echinococcosis in humans, and diagnosis of bovine tuberculosis in humans. Knowledge of medical practitioners of zoonotic diseases could be a contributing factor to their under-diagnosis and under-reporting in Tanzania. Refresher courses on zoonotic diseases should be conducted particularly to practitioners in rural areas. More emphasis should be put on zoonotic diseases in teaching curricula of medical practitioners' training institutions in Tanzania to improve the diagnosis, reporting and control of zoonotic diseases. Veterinary and medical collaboration should be strengthened to enable more effective control of zoonotic diseases in Tanzania.


Extraovarian peritoneal serous papillary carcinoma mimicking colonic obstruction.
Involvement of the colon by extraovarian peritoneal serous papillary carcinoma (EPSPC) is considered as rare. During a 10-year period the records of five female patients with a mean age of 73.4 years who were admitted for colonic obstruction due to EPSPC were reviewed. Preoperative and postoperative data were studied. All patients presented with symptoms of colonic obstruction and high concentrations of CA-125. Involvement of the sigmoid colon was demonstrated preoperatively both in CT and colonoscopy. Operative findings of multiple peritoneal implantations involving the surface of the ovaries in two cases, the greater omentum in three cases and invasion of the sigmoid colon in all cases prompted us to perform sigmoidectomy and omentectomy in all cases with bilateral salpingo-oophorectomy in four of them. All patients received adjuvant paclitaxel plus platinum-based combination chemotherapy.


Treatment of dyslipidemias.
To summarize recommended treatment strategies for various dyslipidemias. The basic pathways of lipoprotein metabolism are reviewed, and the potential for interventional alterations to correct specific dyslipidemias is outlined. Guidelines for treatment based on published clinical trials, including the consensus report of the National Cholesterol Education Program, are discussed. The nonpharmacologic options of diet and exercise are important elements in the treatment of dyslipidemias. In most patients, a reduced dietary intake of fat (particularly saturated fat) should be maintained for 3 months before drug therapy is initiated. The various mechanisms of action of the bile acid resins, niacin, hydroxy-methylglutaryl-coenzyme A reductase inhibitors, and fibric acid derivatives are described, and their roles in monotherapy or combination therapy for hypercholesterolemia, combined hyperlipidemia, and hypertriglyceridemia are examined. With an understanding of the metabolic pathways responsible for the production and removal of lipoproteins and an overview of results of previous pharmacologic interventions, clinicians can optimize lipid-lowering treatment in individual patients with dyslipidemia.


Coral Productivity Is Co-Limited by Bicarbonate and Ammonium Availability.
The nitrogen environment and nitrogen status of reef-building coral endosymbionts is one of the important factors determining the optimal assimilation of phototrophic carbon and hence the growth of the holobiont. However, the impact of inorganic nutrient availability on the photosynthesis and physiological state of the coral holobiont is partly understood. This study aimed to determine if photosynthesis of the endosymbionts associated with the coral Stylophora pistillata and the overall growth of the holobiont were limited by the availability of dissolved inorganic carbon and nitrogen in seawater. For this purpose, colonies were incubated in absence or presence of 4 µM ammonium and/or 6 mM bicarbonate. Photosynthetic performances, pigments content, endosymbionts density and growth rate of the coral colonies were monitored for 3 weeks. Positive effects were observed on coral physiology with the supplementation of one or the other nutrient, but the most important changes were observed when both nutrients were provided. The increased availability of DIC and NH4+ significantly improved the photosynthetic efficiency and capacity of endosymbionts, in turn enhancing the host calcification rate. Overall, these results suggest that in hospite symbionts are co-limited by nitrogen and carbon availability for an optimal photosynthesis.


Detection of bacteremia with the BACTEC 16B resin blood culture medium.
A new blood culture medium (16B) containing adsorbent and cationic exchange resins has become available for use with the BACTEC instrument (Johnston Laboratories, Towson, MD). Its purpose is to enhance the detection of bacteremia through binding of antimicrobials. The performance of the BACTEC 16B resin medium was compared with the routine BACTEC 6B medium in patients with suspected sepsis receiving antibiotics. A total of 1,227 blood specimens were inoculated in 6B and 16B media and yielded 93 positive cultures from 43 clinically septic patients. Of 103 bacterial isolates recovered, 63 (61.2%) were recovered in both media, 14 (13.6%) in the routine 6B medium only, and 26 (25.2%) in the resin medium only (P greater than 0.05). Staphylococci, both coagulase positive and negative, were recovered much more frequently in resin medium (P less than 0.01). When the results of all the blood culture sets collected for each patient on any given day were considered, the routine 6B medium was the only source of isolation for seven bacterial species in six patients, and the resin medium was the only source of isolation for nine species in nine patients. However, of the nine organisms whose sole isolation source was the resin medium, eight were recovered early in the course of antibiotic therapy (6 within 24 to 36 hours and 2 within 36 to 48 hours of the first antibiotic dose) and had been isolated previously in routine 6B medium. In no instance was the antibiotic regimen changed as a result of the persistence of the organism in resin medium in the early phases of treatment. The use of resin medium did not improve overall detection time for 63 isolates recovered in both media. In conclusion, although the 16B resin medium did recover a greater number of bacterial isolates, it contributed very little information that might be of use in modifying and improving the treatment of septic patients receiving antimicrobials.


Association of polymorphisms in PRKCI gene and risk of prostate cancer in a sample of Iranian Population.
The atypical protein kinase C iota (aPKCι) is an oncoprotein encoded by the PRKCI gene. It has been reported to play multifunctional roles in cellular maintenance, cell proliferation, survival, differentiation and apoptosis. In the present study we aimed to assess the impact of PRKCI rs546950 C>T and rs4955720 C>A polymorphisms on prostate cancer (PCa) risk in a sample of Iranian population. This case-control study was done on 169 patients with pathologically confirmed PCa and 182 benign prostatic hyperplasia (BPH). The PCR-RFLP method was used for detection rs546950 C>T and rs4955720 C>A polymorphisms. Our findings showed that rs546950 polymorphism of PRKCI decreased the risk of PCa in codominant (OR=0.35, 95%CI=0.19-0.64, P<0.001, CT vs CC) and dominant (OR=0.39, 95%CI=0.22-0.69, P=0.001, CT+TT vs CC) inheritance model tested. No significant association was found between rs4955720 C>A polymorphism and PCa. In the combined analysis of these two variants subjects carrying CT/CC, CT/CA, TT/AA and CT/AA significantly decreased the risk of PCa in comparison with rs546950 CC/rs4955720 CC genotype. Haplotype analysis indicated that rs546950T/rs4955720A decreased the risk of PCa compared to CC. In conclusion, the results revealed that PRKCI rs546950 variant decreased the risk of PCa in an Iranian population. Further studies with larger sample sizes and different ethnicities are required to confirm our findings.


A case of monogenic diabetes mellitus caused by a novel heterozygous RFX6 nonsense mutation in a 14-year-old girl.
Monogenic diabetes mellitus (DM) is a single gene disorder, primarily characterized by impairment in the development or function of pancreatic beta cells. A 14-year-old girl was initially diagnosed with type 2 DM. The patient did not have any anti-islet autoantibody and showed acanthosis nigricans. She was managed with long-acting insulin and oral hypoglycemic agent, but HbA1c was still 9.3% after 1 year of management. Her mother already had type 2 DM at 46-year-old and was on medication. Under the possibility of familial monogenic DM, targeted exome sequencing was performed which included 29 genes associated with monogenic DM. Nonsense mutation of the gene RFX6 (c.2661T>A, p.Tyr887∗) was found. After adding Glucagon-like peptide-1 (GLP-1) receptor agonist, HbA1c improved from 8.8 to 6.8% and body mass index (BMI) also improved from 31.0 to 29.2 kg/m2. It may be worth investigating genetic etiology in early-onset autoantibody-negative DM for specific genetic diagnosis and better management.


Successfully treated massive pulmonary thromboembolism and thrombus in the right atrium due to diffuse malignant lymphoma: a case report.
A 40-year-old man presented with massive pulmonary embolism related to diffuse large B cell lymphoma. His hemodynamic state worsened rapidly to shock after sudden onset of dyspnea. Echocardiography and thoracic computed tomography indicated pulmonary thromboembolism due to deep venous thromboembolism, associated with a mass in the anterior mediastinum and a 5 x 8 cm mass in the left pelvis compressing the left femoral vein. He underwent emergent surgery to remove a huge thrombus from the right atrium through the bilateral pulmonary arteries. Soon after this surgery, his hemodynamic state recovered and excision of the left cervical lymph node revealed diffuse large B cell lymphoma. Venous compression by the lymphoma mass had caused hemostasis and thrombus formation in the present case.


[Ruptures in the rotator aponeurosis (author's transl)].
Ruptures in the rotator aponeurosis occur frequently. Minor defects are usually not discovered and are classified in the "painful shoulder" syndrome. Depending on the localization and extent, extensive destruction, which occurs suddenly under particular circumstances, leads to various functional disturbances including the so-called pseudoparalysis of the arm. Smaller ruptures generally respond to the usual conservative measures used for the supraspinous syndrome. Surgical treatment of larger ruptures is promising and good results can be achieved with the appropriate technique and adequate follow-up treatment. In the case of extensive defects, they represent the only chance for restoring satisfactory function. Even with long standing, unsuccessful treatment for "periarthritis humeroscapularis", the necessary diagnostic and/or surgical consequences, should be carried out.


Fear of missing out (FoMO) mediate relations between social self-efficacy and life satisfaction.
The purpose of this study was to examine whether fear of missing out (FoMO) mediate relations between social self-efficacy and life satisfaction among undergraduates. The participants involved 323 undergraduates (female, 66.3%; male, 33.7%). The age of participants ranged between 18 and 32 years (M = 21.52, SD = 2.69). The study data was gathered using the Fear of Missing out Scale, the Social Efficacy and Social Outcome Expectation Scale and the Satisfaction with Life Scale. The research data were analyzed using the structural equation model and bootstrapping method. As a result of the structural equation model, FoMO mediates the relationship between social self-efficacy and life satisfaction. As a result of the bootstrapping analysis, it was seen that all direct and indirect effects are significant. The results, recommendations, and limitations of the study were discussed.


Novel nomogram for predicting the 3-year incidence risk of osteoporosis in a Chinese male population.
To establish a rapid, cost-effective, accurate, and acceptable osteoporosis (OP) screening model for the Chinese male population (age ≥ 40 years) based on data mining technology. This was a 3-year retrospective cohort study, which belonged to the sub-cohort of the Chinese Reaction Study. The research period was from March 2011 to December 2014. A total of 1834 subjects who did not have OP at the baseline and completed a 3-year follow-up were included in this study. All subjects underwent quantitative ultrasound examinations for calcaneus at the baseline and follow-ups that lasted for 3 years. We utilized the least absolute shrinkage and selection operator (LASSO) regression model to select feature variables. The characteristic variables selected in the LASSO regression were analyzed by multivariable logistic regression (MLR) to construct the predictive model. This predictive model was displayed through a nomogram. We used the receiver operating characteristic (ROC) curve, C-index, calibration curve, and clinical decision curve analysis (DCA) to evaluate model performance and the bootstrapping validation to internally validate the model. The predictive factors included in the prediction model were age, neck circumference, waist-to-height ratio, BMI, triglyceride, impaired fasting glucose, dyslipidemia, osteopenia, smoking history, and strenuous exercise. The area under the ROC (AUC) curve of the risk nomogram was 0.882 (95% CI, 0.858-0.907), exhibiting good predictive ability and performance. The C-index for the risk nomogram was 0.882 in the prediction model, which presented good refinement. In addition, the nomogram calibration curve indicated that the prediction model was consistent. The DCA showed that when the threshold probability was between 1 and 100%, the nomogram had a good clinical application value. More importantly, the internally verified C-index of the nomogram was still very high, at 0.870. This novel nomogram can effectively predict the 3-year incidence risk of OP in the male population. It also helps clinicians to identify groups at high risk of OP early and formulate personalized intervention measures.


Nitric oxide modulates anoxia-induced gasping in the developing rat.
Gasping is an important mechanism for survival. Nitric oxide (NO) plays an excitatory role in brainstem regions mediating respiratory responses to hypoxia. We hypothesized that neural structures mediating anoxia-induced gasping would display NO dependency. Two- to 15-day-old rat pups underwent anoxic exposures with 100% N2 in a plethysmograph following administration of N-nitro-L-arginine methyl ester (L-NAME), a nitric oxide synthase (NOS) blocker, L-arginine (L-Arg), a NO precursor, or normal saline. In general, gasp latencies were significantly shorter after L-Arg, and were prolonged with L-NAME. Furthermore, NOS inhibition prolonged gasping duration and reduced gasping frequency at all postnatal ages, although this effect was particularly increased with advancing postnatal age. NADPH-diaphorase staining and Western blots of protein lysates from the lateral tegmental field, the putative neural center underlying gasp generation, revealed progressively increased neuronal NOS abundance with animal maturation. We conclude that anoxia-induced gasping neurogenesis is modulated by NO mechanisms in neonatal pups. We postulate that higher NO brainstem concentrations may favor early autoresuscitation but be detrimental to overall survival during prolonged asphyxia.


The alexander surgical technique for the treatment of severe burns.
The extensive loss of skin in burned patients is a critical clinical condition, and the choice of an effective technique to cover and protect the damaged area has always been a challenge in the surgical field. Despite its wide clinical use, there is little data in the literature on using the Alexander technique to treat severe burns, while several studies have focused on alternative approaches. The present study aims to evaluate the effectiveness of the Alexander surgical technique on 117 patients with severe burns. The characteristics of the burned patients, factors related to etiology of burns as well as adverse prognostic factors and their incidence in discharged versus deceased patients were also taken into account. Finally, a comparison is made with an alternative surgical procedure described in the literature. Our results show a satisfactory level of survival for patients with severe burns surgically treated with the Alexander technique, accounting for 63% of all clinical cases reported here. This treatment is also less expensive and more rapid than the alternative approach we compared it with. The Alexander technique is a lifesaving method for the treatment of severe burns that provides a satisfactory chance of survival at lower cost than the alternative surgical procedure examined.