Mohs micrographic surgery utilization in the Medicare population, 2009.
Mohs micrographic surgery (MMS) is the criterion standard treatment for high-risk skin cancers. Few data on current MMS Utilization are available. To better understand current trends in MMS use in the Medicare population. The 2009 Medicare Limited Data Set Standard Analytic File (LDSSAF), carrier claims, 5% sample and the Physician Supplier Procedure Master File (PSPMF) 100% summary were analyzed. In 2009, 558,447 Medicare MMS cases were performed, with an average of 1.75 stages per case. In the 5% claims sample, 0.3% and 1.3% of MMS cases were performed for melanoma and carcinoma in situ, respectively. Total annual volume predictions for 1,777 providers showed a left-shifted curve. 65.8% of LDSSAF cases had same-day MMS repairs: 48.7% of repairs were complex, 9.8% intermediate, 32.4% flaps, and 7.4% full-thickness skin grafts. The 5% LDSSAF is highly predictive of total claim volumes and is useful for modeling practice trends. There is wide variation in MMS provider annual case volume. These data reflect only Medicare Part B enrollees in 2009; 5% LDDSAF extrapolations are predictions based on sampling.


Association of C677T transition of the human methylenetetrahydrofolate reductase (MTHFR) gene with male infertility.
The human methylenetetrahydrofolate reductase (MTHFR) gene encodes one of the key enzymes in folate metabolism. This gene is located on chromosome 1 (1p36.3), which has 12 exons. The aim of the present study was to investigate the possible association of the two (C677T and A1298C) polymorphisms of this gene with male infertility. In a case-control study, 250 blood samples were collected from IVF centres in Sari and Babol (Iran): 118 samples were from oligospermic men and 132 were from controls. Two single nucleotide polymorphisms of the MTHFR genotype were detected using polymerase chain reaction-restriction fragment length polymorphism. There was no association found between the A1298C variant and male infertility. However, carriers of the 677T allele (CT and TT genotypes) were at a higher risk of infertility than individuals with other genotypes (odds ratio 1.84; 95% confidence interval 1.11-3.04; P=0.0174). Structural analysis of human MTHFR flavoprotein showed that C677T transition played an important role in the change in affinity of the MTHFR-Flavin adenine dinucleotide binding site. Based on our results, we suggest that C677T transition in MTHFR may increase the risk of male infertility, and detection of the C677T polymorphism biomarker may be helpful in the screening of idiopathic male infertility.


Intersubunit communications within KaiC hexamers contribute the robust rhythmicity of the cyanobacterial circadian clock.
Circadian rhythms, endogenous oscillations with periods of ~24 h, are found in many organisms, and they enhance fitness in alternating day/night environments. In cyanobacteria, three clock proteins, KaiA, KaiB, and KaiC, control the timekeeping mechanism. KaiC, the central component of the system, is a hexameric ATPase that also has autokinase and autophosphatase activities. It has been assumed that KaiC's hexameric structure was critical for regulation of the circadian clock; however, the underlying molecular mechanism of such regulation has remained unclear. Recently, we elucidated the regulation of KaiC's activities by its phosphorylation state, in the context of its hexameric structure. We found that local interactions at subunit interfaces regulate KaiC's activities by coupling the nucleotide-binding states. We also discovered the mechanism of regulation by intersubunit communication in KaiC hexamers. Our observations suggest that intersubunit communication precisely synchronizes KaiC subunits to avoid dephasing, and contributes to the robustness of circadian rhythms in cyanobacteria [Kitayama, Y. et al. Nat. Commun. 4:2897 doi: 10.1038/ncomms3897 (2013)].


Does a Nebulized Heparin/N-acetylcysteine Protocol Improve Outcomes in Adult Smoke Inhalation?
Smoke inhalation is a major source of morbidity and mortality. Heparin and N-acetylcysteine treatment has potential efficacy in inhalation injury. We investigated the impact of a heparin/N-acetylcysteine/albuterol nebulization protocol in adult patients with inhalation injury. A retrospective review was performed of adult inhalation injury patients, admitted to a regional burn center between January 2011 and July 2012, who underwent a protocol of alternating treatments of heparin and N-acetylcysteine/albuterol nebulization every 4 hours. The study cohort was matched 1:1 by age, sex, and burn size to a control cohort admitted within 5 years before protocol implementation. The study (n = 20) and control cohorts (n = 20) were well matched, with nearly identical age (50 vs 49 years), sex distribution (70% male), burn size (total body surface area, 22% vs 21%), and inhalation injury, except grade I injuries (79% vs 47%, P = 0.01). The protocol did not change mortality (30% vs 25%, P = 0.72) or duration of mechanical ventilation (8.5 vs 8.8 days, P = 0.9). There was no difference in development of sepsis (40% vs 33%, P = 0.7) or acute respiratory distress syndrome (15% vs 10%, P = 1); however, those who received the protocol were more likely to develop pneumonia (45% vs 11%, P = 0.03). The implementation of a heparin/N-acetylcysteine/albuterol protocol did not reduce mortality or duration of mechanical ventilation in this cohort of adults with inhalation injury and resulted in a significant increase in pneumonia rates. Larger prospective studies are necessary, with close attention paid to minimizing the infection risk incurred from frequent administration of nebulized medications.


The flexible clock: predictive and reactive homeostasis, energy balance and the circadian regulation of sleep-wake timing.
The Darwinian fitness of mammals living in a rhythmic environment depends on endogenous daily (circadian) rhythms in behavior and physiology. Here, we discuss the mechanisms underlying the circadian regulation of physiology and behavior in mammals. We also review recent efforts to understand circadian flexibility, such as how the phase of activity and rest is altered depending on the encountered environment. We explain why shifting activity to the day is an adaptive strategy to cope with energetic challenges and show how this can reduce thermoregulatory costs. A framework is provided to make predictions about the optimal timing of activity and rest of non-model species for a wide range of habitats. This Review illustrates how the timing of daily rhythms is reciprocally linked to energy homeostasis, and it highlights the importance of this link in understanding daily rhythms in physiology and behavior.


Nonclassical correlations from randomly chosen local measurements.
We show that correlations inconsistent with any locally causal description can be a generic feature of measurements on entangled quantum states. Specifically, spatially separated parties who perform local measurements on a maximally entangled state using randomly chosen measurement bases can, with significant probability, generate nonclassical correlations that violate a Bell inequality. For n parties using a Greenberger-Horne-Zeilinger state, this probability of violation rapidly tends to unity as the number of parties increases. We also show that, even with both a randomly chosen two-qubit pure state and randomly chosen measurement bases, a violation can be found about 10% of the time. Among other applications, our work provides a feasible alternative for the demonstration of Bell inequality violation without a shared reference frame.


Synthesis of novel solid scale inhibitors based on silver tungstate loaded KIT-6 for scale removal from produced water: static and modeling evaluation.
Oilfield scaling is a major problem in the oil and gas industry. Scaling issues cost the industry millions of dollars in damage and lost production every year as scaling is one of the main causes of global production decline. In this study, solid scale inhibitors based on silver tungstate loaded KIT-6 were synthesized and evaluated using a static scale inhibition test. The synthesized materials were characterized using wide and low XRD, N2 adsorption-desorption, TGA, and FTIR, SEM, and XPS analyses. Small-angle XRD patterns showed that KIT-6 had 3D-mesopore diffraction peaks with a cubic Ia3d space group. Wide-angle XRD patterns of silver tungstate loaded KIT-6 confirmed the crystallinity. The prepared catalysts are characterized by higher surface areas (394-918 m2 g-1), large pore volumes (0.63-0.98 cm3 g-1), narrow pore size distributions (5.3 nm), and high thermal stability up to 1000 °C. The results of this study demonstrate that the inhibition efficiency of the scale inhibitor increases and that of the calcite scale inhibitor decreases with increasing pH (2 to 8). This proposes that the scale inhibitor is more effective under alkaline conditions. An inhibition efficiency of 99% on calcium carbonate can be achieved at an optimal dosage of 7.5 ppm at 55 °C, indicating that the scale inhibitor exhibits a relatively good inhibition performance on calcium carbonate. The use of these materials can potentially lead to more efficient and cost-effective solutions for scale inhibition in various industrial processes.


Telomeres and Cell Senescence - Size Matters Not.
Telomeres are protective structures present at the ends of linear chromosomes that are important in preventing genome instability. Telomeres shorten as a result of cellular replication, leading to a permanent cell cycle arrest, also known as replicative senescence. Senescent cells have been shown to accumulate in mammalian tissue with age and in a number of age-related diseases, suggesting that they might contribute to the loss of tissue function observed with age. In this review, we will first describe evidence suggesting a key role for senescence in the ageing process and elaborate on some of the mechanisms by which telomeres can induce cellular senescence. Furthermore, we will present multiple lines of evidence suggesting that telomeres can act as sensors of both intrinsic and extrinsic stress as well as recent data indicating that telomere-induced senescence may occur irrespectively of the length of telomeres.


The diagnostic role of 68Ga-DOTATATE PET/CT in the detection of neuroendocrine tumours.
Positron emission tomography (PET) combined with computer tomography (CT) using (68)Ga-DOTATATE is a promising method for the evaluation of patients with recognised or suspected neuroendocrine tumours (NET). The aim of this study was to assess the diagnostic value of (68)Ga-DOTATATE PET/CT in the visualisation of the expression of somatostatin receptors (SSTR) and identification of new lesions. Between December 2009 and January 2011 ninety-seven patients with confirmed (88 cases) or suspected (9 cases) NET underwent (68)Ga DOTATATE PET/CT. The primary, confirmed or suspected, NET localizations were: GEP tumours--71 patients; medullary thyroid carcinoma--4 patients; cancer of an unknown primary--14 patients; and NET in other localisations--8 patients. PET/CT acquisitions were performed using standard techniques, 45 to 60 minutes after the intravenous injection of 111-185 MBq (68)Ga-DOTATATE. (68)Ga-DOTATATE PET/CT detected the presence of lesions demonstrating the somatostatin receptor affinity in 50 of the 97 patients (51.5%) and was negative in 47 patients (48.5%). Among 14 patients with metastatic unknown primary cancer, in 5 patients (45.5%) the primary tumour site was identified, and in 4 patients with medullary thyroid cancer distant metastases with SSTR expression were localized in only one patient. Our findings confirm the diagnostic role of (68)Ga-DOTATATE PET/CT as an accurate method of identifying primary tumours and distant metastases. It provides information on tumour cell receptors status, which has a significant bearing on planning target radionuclide therapy. Overall, (68)Ga-DOTATATE PET/CT can be used in staging, re-staging, and in regular follow up of oncology patients.


[Mediastinoscopy in a general surgery department. The evaluation of 186 cases].
A series of 186 cases of mediastinoscopy performed in a department of general surgery is reported. The main indications for this procedure are: histological diagnosis of mediastinal masses, definition of bronchopulmonary neoplasms and thoracic esophagus ones with indication for surgery. The results obtained are: sensibility 90.3%, complications 3.7%, mortality rate 0%. The authors believe in the great utility of mediastinoscopy in case of unknown histotype of primary neoplasms and CT N2? involvement.


The role of the adrenoceptors in the activation of the hypothalamic-pituitary-testicular complex of mice induced by the presence of a female.
A study was made of the role of the adrenergic processes in the activation of the testes endocrine function in male mice of CBA/Lac and A/He strains after their sexual arousal induced by the presence of a sexually receptive female without any tactile contact with a male. The alpha-adrenoceptor blocker phentolamine and the alpha 1-adrenoceptor antagonist prazosin inhibited an increase of testosterone level in the peripheral blood plasma caused by the presence of a female. In contrast, antagonist of the beta-adrenoceptor propranolol and beta 2-adrenoceptor blocker ICI-118.551 significantly intensified the stimulating effect of the female presence on plasma testosterone level. The expression of effects of the adrenoceptor antagonists on the plasma testosterone level depended on a male genotype. At the same time, pretreatment of males with yohimbine, an antagonist of the alpha 2-adrenoceptors, or with metoprolol, a beta 1-adrenoceptor blocker, did not influence the activating effect of a female on the plasma level of testosterone. A conclusion was drawn that during sexual arousal in male mice caused by the presence of a receptive female, the stimulatory effects on the hypothalamic-pituitary-testicular complex were produced through the alpha 1-adrenoceptors, and the inhibitory effects were realized through the beta 2-adrenoceptors.


Accumulation and health implications of metals in topsoil of an urban riparian zone adjacent to different functional areas in a subtropical city.
The riparian zone is a river-land ecotone, and its environmental conditions have a significant effect on the river ecosystem and population health. In this study, As, Cu, Cr, Cd, Mn, Fe, Ni, Pb, and Zn in the topsoils of urban riparian zones in a subtropical city in southeast China were quantitatively estimated by inductively coupled plasma-optical emission spectrometry. The geoaccumulation index and health risk evaluation model were adopted to assess the accumulation characteristic and health risk of residents' exposure to metals. Principle component analysis was used to determine the source of metals. The results showed that the mean contents of metals (except Fe) were higher than the soil background value, but none of the metal contents exceeded the mass limit of environmental quality standards. The order of the geoaccumulation index was Cd > Mn > Cu > Cr > Pb > Zn > As > Ni > Fe. The contamination level of Cd was classified as slight, whereas the other metals did not contribute to pollution. The spatial distribution of metals in the riparian zone was compatible with the pattern of functional zones in the adjacent urban areas, where levels of Cr, Cd, Fe, Mn, and Ni were higher in commercial areas, as were Pb and Zn in under-construction land and As in residential and industrial areas. Carcinogenic risks of Cr, As, and Pb were acceptable. The hazard index indicated no significant noncarcinogenic risks from any metals. However, noncarcinogenic risks of metals other than Mn were higher for children than for adults, and the primary exposure route of metal into the human body was ingestion for children and inhalation for adults. Principle component analysis indicated that the primary sources of Cr, Ni, Mn, Cu, and Fe were pedogenic processes and mineral weathering, whereas Zn, As, Pb, and Cd mainly originated from anthropogenic sources, specifically, Zn from transportation emission, Pb from transportation emission and industry waste, As from coal combustion and residential waste, and Cd from pigments/paint used in commercial buildings, urban greening, consumer waste, and transportation emission.


Protection from procarbazine-induced damage of spermatogenesis in the rat by androgen.
Protection of spermatogenesis from cytotoxic drug-induced damage has been investigated in the rat. Complete germinal aplasia was observed at 8 and 11 weeks after four doses of procarbazine hydrochloride administered weekly (150 mg/kg, first dose; 100 mg/kg, 3 subsequent doses). Pretreatment of rats for 6 weeks plus continued treatment during procarbazine administration with testosterone enanthate, 240 micrograms/100 g body weight, resulted in a marked protection of spermatogenesis. A mean of 22% of seminiferous tubule cross-sections at both 8 and 11 weeks exhibited spermatogenesis, and developing spermatids were observed in 60% of these repopulating tubules at the later time. These results provide evidence that protection of spermatogenesis during chemotherapy may be achieved by androgen treatment.


A gadolinium chelate for detection of beta-glucuronidase: a self-immolative approach.
New classes of physiologically responsive magnetic resonance (MR) contrast agents are being developed that are activated by enzymes, secondary messengers, pH, and temperature. To this end, we have prepared a new class of enzyme-activated MR contrast agents using a self-immolative mechanism and investigated the properties of these agents using novel in vitro assays. We have synthesized in nine steps a Gd(III) agent 1 that is activated by the oncologically significant beta-glucuronidase. 1 consists of Gd(III)DO3A (DO3A = 1,4,7-tricarboxymethylene-1,4,7,10-tetraazacyclododecane) bearing a pendant beta-glucuronic acid moiety connected by a self-immolative linker to the macrocycle. LC-MS analysis reveals that 1 is enzymatically processed as predicted by bovine liver beta-glucuronidase, generating 2-aminoethylGdDO3A, 2. Compound 2 was prepared independently in a four-step synthetic procedure. Complex 1 displays a decrease in relaxivity upon titration with bicarbonate anion. The relaxivity increases when 1 is converted to 2 in a buffer mimicking in vivo anion concentrations (Parker, D. In Crown Compounds: Towards Future Applications; Cooper, S. R., Ed.; VCH: New York, 1992; pp 51-67) by 17%, while the relaxivity decreases by 27% for the same experiment in human blood serum. Hydrolytic kinetics catalyzed by bovine liver beta-glucuronidase at interstitial pH = 7.4 fit the Michaelis-Menten model with k cat/Km = 74.9 +/- 10.9 M(-1) s(-1). Monitoring of bulk water proton T1 during incubation with enzyme shows an increase in T1 that mirrors results obtained through the relaxivity measurements of compounds 1 and 2.


[The cementless Moore prosthesis in femoral neck fractures of the aged].
We report on 207 cases of elderly patients suffering from femoral neck fractures treated with cementless Moore-hip prosthesis in the years 1967 to 1979. Low complication rate and good functional results were also confirmed in 29 follow-up examinations 3 years or more after arthroplastic. Loosening of prosthesis, breaking of material or protrusio acetabuli could not be found. The method is easy to be learned and well tolerated by the aged patients. In regard of the contraindications it leads to good results.


Nocebo Effects of Clinical Communication and Placebo Effects of Positive Suggestions on Respiratory Muscle Strength.
The effects of specific suggestions are usually studied by measuring parameters that are directly addressed by these suggestions. We recently proposed the use of a uniform, unrelated, and objective measure like maximal muscle strength that allows comparison of suggestions to avoid nocebo effects and thus to improve communication. Since reduced breathing strength might impair respiration and increase the risk of post-operative pulmonary complications, the aim of the present study was to evaluate the effects of the suggestions on respiratory muscle power. Both the identification and neutralization of negative suggestions in the clinical context and stimulating suggestions could improve breathing force, a predictor of physical fitness and convalescence. In 50 healthy, adult volunteers, respiratory muscle strength was measured by maximal inspiratory and expiratory pressures, as well as by maximal inspiratory and expiratory flows. Baseline was compared to values after application of eleven suggestions, five out of clinical context, including memory of negative or positive past, risk information for informed consent, and a non-verbal suggestion. Six stimulating suggestions included self-affirmation, empowering words, a heroic mirror image, and an imagination. All suggestions showed an impact on respiratory muscle strength, indicating placebo and nocebo effects. No single parameter could represent the breathing force in its complexity, however, trends and different specific aspects of it were measured. The strongest reaction was observed with the recall of a previous negative situation resulting in a reduction in expiratory flow to 96.1% of baseline (p = 0.041). After risk information, a decrease was observed in three of the parameters, with the highest extend in expiratory pressure by 4.4%. This nocebo effect was neutralized by adding positive aspects to the risk information. Every intended strengthening suggestion resulted in statistically significant increases of at least one parameter, with changes of up to 10% (e.g., MEP 110.3%, p = 0.001), indicating placebo effects. Here, expiration was more affected than inspiration. Sex was the only influencing factor reaching statistical significance, with stronger reactions in women. Respiratory muscle strength proved to be sensitive to suggestions with clinical context, as well as suggestions intended for stimulation. With this objective measurement, evaluation, and comparison of different suggestions is possible to help avoid nocebo effects. The demonstrated effect of supporting suggestions can be followed up and used in clinical practice.


A case of primary syphilis in the rectum.
A 30-yr-old man was referred for suspicious rectal cancer because of ulcerated lesions in the rectum and a palpable mass in left inguinal area. Sigmoidoscopy showed two indurated masses and histologic evaluation of biopsy revealed obliterative endarteritis with heavy plasma cell infiltration. Both venereal disease research laboratories (VDRL) and fluorescent treponemal antibody absorption (FTA-ABS) tests were positive. After injection of penicillin G benzathine for 3 weeks, the rectal chancre and the palpable mass disappeared.


Behavioral and brain asymmetries in primates: a preliminary evaluation of two evolutionary hypotheses.
Contrary to many historical views, recent evidence suggests that species-level behavioral and brain asymmetries are evident in nonhuman species. Here, we briefly present evidence of behavioral, perceptual, cognitive, functional, and neuroanatomical asymmetries in nonhuman primates. In addition, we describe two historical accounts of the evolutionary origins of hemispheric specialization and present data from nonhuman primates that address these specific theories. Specifically, we first discuss the evidence that genes play specific roles in determining left-right differences in anatomical and functional asymmetries in primates. We next consider and present data on the hypothesis that hemispheric specialization evolved as a by-product of increasing brain size relative to the surface area of the corpus callosum in different primate species. Last, we discuss some of the challenges in the study of hemispheric specialization in primates and offer some suggestions on how to advance the field.


An evaluation of irreversible inhibition of synaptosomal high-affinity choline transport by choline mustard aziridinium ion.
Choline mustard aziridinium is a potent, irreversible and selective blocker of sodium-dependent, high-affinity transport of choline into rat forebrain synaptosomes; it was found to be 30 times less potent against low-affinity transport of choline. The IC50 value for high-affinity transport was 0.94 microM, compared to 29 microM for low-affinity uptake. The inhibitory action of choline mustard aziridinium ion on high-affinity transport of choline was graded with respect to time; a 12-fold increase in potency was obtained by increasing the inhibitor preincubation times from 1 to 30 min. Low concentrations of choline mustard aziridinium ion could produce significant blockade of choline carriers providing the exposure time was prolonged. The characteristics of the blockade of synaptosomal high-affinity choline transport by choline mustard aziridinium ion also changed depending upon preincubation time. The kinetics of inhibition of high-affinity choline transport by choline mustard aziridinium ion showed apparent competitive inhibition initially, followed by noncompetitive characteristics at longer preincubations with inhibitor. The rate of irreversible inhibition of carriers by this nitrogen mustard analogue would appear to be rapid; the rate constant was determined to be 5 X 10(-2) s-1 for micromolar concentrations of inhibitor. This action may preclude the transport of the mustard analogue into the nerve terminal, although initially some reversible binding with the carrier may result in the translocation of some choline mustard aziridinium ion into the presynaptic ending. The progressive alkylation of high-affinity carriers by the analogue could indicate the presence of excess carrier sites in the presynaptic membrane, or subpopulations of carriers in an inactive state in equilibrium with active carriers. A model is described for the inhibitory action of choline mustard aziridinium ion on synaptosomal high-affinity choline carriers.


Live imaging using a FRET glucose sensor reveals glucose delivery to all cell types in the Drosophila brain.
All complex nervous systems are metabolically separated from circulation by a blood-brain barrier (BBB) that prevents uncontrolled leakage of solutes into the brain. Thus, all metabolites needed to sustain energy homeostasis must be transported across this BBB. In invertebrates, such as Drosophila, the major carbohydrate in circulation is the disaccharide trehalose and specific trehalose transporters are expressed by the glial BBB. Here we analyzed whether glucose is able to contribute to energy homeostasis in Drosophila. To study glucose influx into the brain we utilized a genetically encoded, FRET-based glucose sensor expressed in a cell type specific manner. When confronted with glucose all brain cells take up glucose within two minutes. In order to characterize the glucose transporter involved, we studied Drosophila Glut1, the homologue of which is primarily expressed by the BBB-forming endothelial cells and astrocytes in the mammalian nervous system. In Drosophila, however, Glut1 is expressed in neurons and is not found at the BBB. Thus, Glut1 cannot contribute to initial glucose uptake from the hemolymph. To test whether gap junctional coupling between the BBB forming cells and other neural cells contributes to glucose distribution we assayed these junctions using RNAi experiments and only found a minor contribution of gap junctions to glucose metabolism. Our results provide the entry point to further dissect the mechanisms underlying glucose distribution and offer new opportunities to understand brain metabolism.


[Treatment of membranous nephropathy with chronic renal insufficiency].
Several studies have suggested that, in patients with membranous nephropathy, immunosuppressive therapy is effective even when started in the presence of already established renal insufficiency. Most of the favorable results reported have been obtained with the use of cytotoxic agents given together with glucocorticoids, which produce a 70-80% reduction of proteinuria and can preserve renal function. However, patients with renal insufficiency are more exposed to the risk of side effects caused by these drugs. Since the published results have shown that the actual target of immunosuppressive agents is the nephrotic syndrome and the favorable response of renal function is always subordinate to its remission, the selection of patients who are likely to benefit from treatment should take this aspect into account. In addition, patient selection should avoid excessive costs associated with negligible benefits when biopsy-proven advanced chronic renal damage or serum creatinine above 3-4 mg/dL are present. Finally, drug dosage should be adjusted in cases of chronic renal insufficiency.


Antioxidant properties of phenolic compounds from Pelargonium reniforme.
Flavonoids and hydrolyzable tannins isolated from Pelargonium reniforme were evaluated for their antioxidant ability using a 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical generating system and a luminol-dependent chemiluminescence assay. In both assays, the polyphenols tested showed higher radical scavenging activities than the reference antioxidant, ascorbic acid (IC50 2.6-32.9 microM vs 40.9 microM in the DPPH test, and 2-25 times stronger effects in the chemiluminescence assay). A comparison of the flavonoids and the tannins showed that the latter have more potential than the former. Structural requirements for marked antioxidant activities of hydrolyzable tannins were the presence of galloyl and hexahydroxydiphenoyl groups, and apparently carbonyl (ester) functionalities in oxidatively modified dehydrohexa-hydroxydiphenoyl moieties. For flavonoids, it appeared that a catechol (3',4'-dihydroxy) element in the B-ring were important determinants and that O-glycosides were more effective than flavone-based C-glucosyls. Conspicuously, introduction of a galloyl group significantly enhanced their potentials. The demonstrated marked antioxidant effects of the polyphenols provide a clue for beneficial effects of P. reniforme in the treatment of liver disorders among several ethnic groups in areas of southern Africa.


Analysis of Weight-Directed Functional Brain Networks in the Deception State Based on EEG Signal.
Although analyzing the brain's functional and structural network has revealed that numerous brain networks are necessary to collaborate during deception, the directionality of these functional networks is still unknown. This study investigated the effective connectivity of the brain networks during deception and uncovers the information-interaction patterns of lying neural oscillations. The electroencephalography (EEG) data of 40 lying persons and 40 honest persons were used to create the weight- directed functional brain networks (WDFBN). Specifically, the connecting edge weight was defined based on the normalized phase transfer entropy (dPTE) between each electrode pair, where the network nodes involved 30 electrode channels. Additionally, the signal connectivity matrices were constructed in four frequency bands: delta, theta, alpha, and beta and were subjected to a difference analysis of entropy values between the groups. Statistical analysis of the classification results revealed that all frequency bands correctly detect deception and innocence with an accuracy of 92.83%, 94.17%, 85.93%, and 92.25%, respectively. Therefore, dPTE can be considered a valuable feature for identifying lying. According to WDFBN analysis, deception has stronger information flow in the frontoparietal, frontotemporal and temporoparietal networks compare to honest people. Furthermore, the prefrontal cortex was also found to be activated in all frequency ranges. This study examined the critical pathways of brain information interaction during deception, providing new insights into the underlying neural mechanisms. Our analysis offers significant evidence for the development of brain networks that could potentially be used for lie detection.


Effects of the basicity on the comelting conditions of municipal solid waste incinerator fly ash and sewage sludge ash.
In this study, the effects of the basicity on the pouring point of the municipal solid waste incinerator fly ash-sewage sludge ash mixture is investigated. Four kinds of sewage sludge ash, which were collected from several primary and secondary sewage treatment plants and were produced by different processes and sludge conditioning alternatives, were used as modifiers. The results indicate that the pouring point of the mixture increased with increasing basicity, within the range of 0.65-1.90. The pouring point is affected by the contents of the mixtures (CaO, SiO2, Al2O3, and the flux). It is suggested that an increase in the CaO content tends to raise the pouring point, whereas an increase in the SiO2 and/or the Al2O3 contents cause as adverse reaction. The prediction equation, obtained by multilinear regression (significant level is 0.05), is as follows: pouring temperature = 1189.6 + 4.19 CaO - 0.96 SiO2 - 4.33 Al2O3 (R2 = 0.91). In general, the pouring point decreased when the basicity was < 1. The pouring point apparently increased when the basicity was > 1.2. The regression squares for the different basicities were between 0.84 and 0.91. From these relationships, we note that a basicity index of 5 gave the best R2 (0.91). From the results of this study, it can be concluded that the modification of the basicity of the fly ash by the addition of sewage sludge ash to lower the pouring point is feasible and leads to a more energy-efficient melting process. In addition, these synthetic slags have a good pozzolanic reactive activity.


Genetic basis of induction and overproduction of chromosomal class I beta-lactamase in nonfastidious gram-negative bacilli.
Pseudomonas and several species of gram-negative enterobacteria produce low levels of chromosomally encoded class I beta-lactamase. The level of synthesis can be greatly increased by the addition of beta-lactam antibiotics into the growth medium. Moreover, mutants overproducing the enzyme arise at a high frequency in these species. The beta-lactamase is encoded by the chromosomal ampC gene, and its induction is governed by the ampR regulatory gene, which encodes an activator of ampC transcription. The ampD gene acts, probably indirectly, as a repressor of beta-lactamase synthesis, and it is in this gene that mutations leading to enzyme overproduction are located.


Retinoic acid-induced heparin-binding factor (RIHB) mRNA and protein are strongly induced in chick embryo chondrocytes treated with retinoic acid.
Retinoic acid-induced heparin-binding factor (RIHB) is a highly basic polypeptide expressed during early chick embryogenesis. We have examined the induction of RIHB by retinoic acid in chondrocytes isolated from the sterna of Day 15 chick embryos and the effects of exogenous RIHB on these cells. There is an induction of RIHB mRNA in chondrocytes which is dose dependent, with maximal levels of expression observed with concentrations of retinoic acid in the 10(-6) M range. RIHB mRNA is first observed 16 h after commencement of treatment, is maximal after 24-48 h, and is completely attenuated after 5 days. This transient pattern of expression is very similar to that of type X collagen; however, RIHB induction precedes that of type X collagen by about 24 h. The expression of both RIHB and type X collagen precedes the drop in keratan sulfate:chondroitin sulfate proteoglycan and type II collagen expression and the surge of fibronectin expression. The induction of RIHB mRNA is accompanied by an increased synthesis of the protein. No RIHB can be detected in untreated chondrocytes; however, large amounts are produced by cells treated with 5 x 10(-7) M retinoic acid. The protein is recovered mainly in the culture medium and bound to the extracellular matrix. Only a small amount can be detected in cell extracts. RIHB can be detected in the culture medium after 16-24 h and, unlike the mRNA, persists over the 5-day period examined. The effect of exogenous RIHB (purified from chick embryos) on chondrocyte proliferation and morphology was examined. When added to the culture medium in concentrations of up to 500 ng/ml RIHB had no effect on [3H]thymidine incorporation or cell morphology. Thus, RIHB is not the direct mediator of retinoic acid for these cells, but is strongly induced during the treatment.


Influence of garlic on serum cholesterol, serum triglycerides, serum total lipids and serum glucose in human subjects.
Human subjects were used for a garlic experiment. The subjects were given a fat-rich diet for 7 days and on the 8th day the fasting blood was analyzed for serum cholesterol, serum triglycerides, serum total lipids and serum glucose. The human subjects were then given a fat-rich diet with 40 g of garlic for 7 days and on the 15th day the fasting blood was analyzed for the above investigations. On a fat-rich diet the serum cholesterol, serum triglycerides and serum total lipids were significantly increased as compared to normally fed diet. When 40 g of garlic was substituted in fat-rich diet for 7 days, the garlic significantly reduced the serum cholesterol and serum triglycerides.


Relativistic quantum revivals.
Quantum revivals are now a well-known phenomena within nonrelativistic quantum theory. In this Letter we display the effects of relativity on revivals and quantum carpets. It is generally believed that revivals do not occur within a relativistic regime. Here we show that while this is generally true, it is possible, in principle, to set up wave packets with specific mathematical properties that do exhibit exact revivals within a fully relativistic theory.


An experimental setup to study delayed electron emission upon photoexcitation of trapped polyatomic anions.
A Velocity Map Imaging (VMI) spectrometer has been designed and integrated with an electrostatic ion beam trap to study delayed electron emission from trapped polyatomic anions upon photodetachment. The VMI spectrometer is small in size and can record a wide range of photoelectron energies, with variable magnification. Delayed electron emission can be recorded in our experimental setup for any time duration after the photoexcitation of the polyatomic anions. Experiments were carried out with trapped O- and C5- ions to demonstrate the capability of the spectrometer. Delayed electron emissions from C5- as well as prompt photoelectrons from O- were detected by the VMI spectrometer upon photoexcitation. The design and performance of the spectrometer are presented in detail.


The treatment of distal radius articular fractures through lcp system.
We analysed LCP efficiency in type B and type C wrist fractures (according to the AO Classification). We treated 58 wrist fractures (19 B-type fractures and 39 C-type fractures) in 35 male and 23 female patients, aged 19 to 87 years. Forty-one cases were followed up for an average period of 13 months. We performed a volar approach on 32 patients, a dorsal approach on five, and a double approach on four (both volar and dorsal). Twenty-six cases were pre-operatively examined with CT. All patients were evaluated using the "Mayo modified wrist score", with an excellent/good result in 76% of patients and a satisfactory/poor result in 24%. The LCP system proved to be adequately reliable and stable to keep the reduction in complex fractures (e.g. the C-type fractures in patients with low bone quality).


Primary Herpes Simplex Virus Infection Mimicking a Cervical Malignancy in an Immunocompetent Individual.
Herpes simplex virus (HSV) is a common sexually transmitted infection. Although primary HSV typically presents with ulcerations, atypical presentations are possible. Only one other case report of HSV manifesting as a cervical mass exists. A 35-year-old immunocompetent female with dysuria was found to have a cervical mass concerning for cancer. She had a history of abnormal pap smears and a loop electrosurgical excision procedure (LEEP) with poor follow-up. The patient was taken to the operating room for biopsies and staging and was found to have new vulvar ulcers. The biopsies confirmed an HSV infection with cervical, bladder, and vulvar involvement and were negative for cervical neoplasia. This report examines an atypical presentation of a primary HSV infection and reviews the literature regarding the association of HSV with cervical cancer.


Direct C-H Cyanoalkylation of Quinoxalin-2(1H)-ones via Radical C-C Bond Cleavage.
An efficient synthesis of cyanoalkylated heteroarenes via iron-catalyzed direct C-H cyanoalkylation of heteroarenes has been developed. Structurally diverse cyanoalkyl motifs generated through C-C bond cleavage of cyclobutanone oxime esters have been introduced into quinoxalin-2(1H)-ones, flavone, benzothiazoles, and caffeine in good to excellent yields. Remarkably, less-strained cyclopentanone and unstrained cyclohexanone oxime esters were also amenable substrates in this cyanoalkylation reaction.


Ultrasound for the early diagnosis of tibial fracture healing after static interlocked nailing without reaming: clinical results.
Based on the results of a pilot study indicating the potential value of ultrasound (US) as a diagnostic tool for the early assessment of fracture healing and the related need for secondary operative procedures in patients treated by statically locked intramedullary (IM) nailing without reaming, a protocol was established for a larger scale prospective trial. The purpose of this study was to evaluate the outcome of this follow-up trial. All skeletally mature patients admitted to the Henry Ford Hospital (Detroit, Michigan) from January 1993 to August 1994 who had sustained an acute fracture of the tibial shaft and who were treated by statically locked IM nailing, without reaming, were candidates for study. Forty-seven patients with fifty fractures that could be evaluated by US were included. The adopted determinants for fracture healing were complete disappearance of the IM nail on US examination performed at six weeks postoperatively, or progressive disappearance of the nail noted between the initial six-week study and a second nine-week US examination, both in conjunction with periosteal callus formation. Radiographs were obtained to monitor maintenance of reduction and to further evaluate fracture healing. Of thirty-eight fractures with a positive US (thirty-two at six weeks, six at nine weeks), thirty-seven healed uneventfully, a positive predictive value of 97 percent. Radiographic fracture healing was not evident until, on average, nineteen weeks after injury. The single false-positive fracture progressed to nonunion. Of the twelve fractures with negative US studies, ten underwent secondary procedures (nine dynamization, one bone graft), with four progressing to nonunion. Two patients refused secondary surgery; screw failure occurred in both. Otherwise, there were no hardware failures in this series. The results of this study indicate that US may provide important prognostic information concerning fracture healing after unreamed tibial nailing, upon which subsequent treatment can be based.


The Rab11 pathway is required for influenza A virus budding and filament formation.
Influenza A virus buds through the apical plasma membrane, forming enveloped virus particles that can take the shape of pleomorphic spheres or vastly elongated filaments. For either type of virion, the factors responsible for separation of viral and cell membranes are not known. We find that cellular Rab11 (a small GTP-binding protein involved in endocytic recycling) and Rab11-family interacting protein 3 ([FIP3] which plays a role in membrane trafficking and regulation of actin dynamics) are both required to support the formation of filamentous virions, while Rab11 is additionally involved in the final budding step of spherical particles. Cells transfected with Rab11 GTP-cycling mutants or depleted of Rab11 or FIP3 content by small interfering RNA treatment lost the ability to form virus filaments. Depletion of Rab11 resulted in up to a 100-fold decrease in titer of spherical virus released from cells. Scanning electron microscopy of Rab11-depleted cells showed high densities of virus particles apparently stalled in the process of budding. Transmission electron microscopy of thin sections confirmed that Rab11 depletion resulted in significant numbers of abnormally formed virus particles that had failed to pinch off from the plasma membrane. Based on these findings, we see a clear role for a Rab11-mediated pathway in influenza virus morphogenesis and budding.


Foot deformities in rheumatoid arthritis patients and their effects on foot functions.
Foot problems are common clinical disorders in patients with Rheumatoid Arthritis (RA). The aim of this study was to investigate the frequency and impact of foot and ankle problems in patients with RA. A total of 164 feet of 82 RA patients with a diagnosis of one year or more were evaluated. Deformities including HV, CT, SF, PC, PP, MPS, MPV, and HT were examined in all RA patients. The Foot Function Index was used to measure the impact of these deformities on pain, disability, and movement limitations. Radiological changes were measured using the modified Larsen score. The frequency of deformity in RA patients was found to be 95.1%, with HV deformity being the most common at 84.1%. There was a statistically significant relationship between SF, HV, PP, and PC deformities and disease duration. In our sample of 82 patients, 70 (85.3%) reported past or present foot pain complaints. The most common site of pain was the ankle joint, with 44 (53.7%) patients experiencing ankle pain. A statistically significant increase in the frequency of ankle pain was found as DAS28 scores, body mass index (BMI), and disease duration increased. There was also a correlation between an increase in DAS28 scores and the frequency of forefoot pain. A significant correlation was found between MPV, HV, PP, and PC deformities and high FFI scores. Larsen radiological scores were not correlated with foot-ankle pain or duration of pain. These findings suggest that foot deformities are common in RA, and it is important to address them early in the disease course to minimize functional disability and improve quality of life.


Partition of fatty acids and fluorescent fatty acids into membranes.
We have measured the membrane/water partition of free fatty acids, of a fluorescent analogue, and of chlorpromazine into plasma membranes from lymphoma, platelets, red cells, and liposomes of egg phosphatidylcholine. Three different methods were used: hygroscopic desorption [ Conrad , M.J., & Singer, S.J. (1979) Proc. Natl. Acad. Sci. U.S.A. 76, 5202-5206; Conrad , M.J., & Singer, S.J. (1981) Biochemistry 20, 808-818], centrifugation, and fluorescence titration. The partition coefficients for chlorpromazine and all fatty acid/membrane combinations were in the range 10(2)-10(5). No significant partition difference was observed between liposomes and plasma membranes. These results suggest, therefore, that fatty acids and chlorpromazine can readily partition into artificial and cell plasma membranes.


Science to Practice: Can MR Imaging Cell Tracking of Macrophage Infiltration Be Used as a Predictive Imaging Biomarker for Transplanted Stem Cell Rejection?
Ferumoxytol-enhanced magnetic resonance (MR) imaging of donor-matched and mismatched stem cell transplants demonstrated decreased signal intensity not only for a xenogeneic mismatch in species but, surprisingly, also for a syngeneic mismatch in sex. MR imaging findings were corroborated with intravital fluorescence microscopy (IVM), where nearly 90% of all ferumoxytol-containing cells were found to be macrophages. Hence, MR imaging cell tracking of infiltrating macrophages may have predictive value in determining whether transplanted stem cell rejection will occur.


Sneutrino condensate source for density perturbations, leptogenesis, and low reheat temperature.
We bring together some known ingredients beyond the standard model physics that can explain the hot big bang model with the observed baryon asymmetry and also the fluctuations in the cosmic microwave background radiation with a minimal set of assumptions. We propose an interesting scenario where the inflaton energy density is dumped into an infinitely large extra dimension. Instead of the inflaton it is the right handed sneutrino condensate, which is acquiring a nonzero vacuum expectation value during inflation, whose fluctuations are responsible for the density perturbations seen in the cosmic microwave background radiation with a spectral index n(s) approximately 1. The decay of the condensate is explaining the reheating of the Universe with a temperature, T(rh)< or =10(9) GeV, and the baryon asymmetry of order one part in 10(10) with no baryon-isocurvature fluctuations.


Limited susceptibility of chickens, turkeys, and mice to pandemic (H1N1) 2009 virus.
To determine susceptibility of chickens, turkeys, and mice to pandemic (H1N1) 2009 virus, we conducted contact exposure and inoculation experiments. We demonstrated that chickens were refractory to infection. However, oculo-oronasally inoculated turkeys and intranasally inoculated mice seroconverted without clinical signs of infection.


[Purgatory, mercy and charity: structural conditions of care in Portugal (15th to 19th centuries)].
The aim of this article is to show how the Portuguese welfare system was organized and how it survived for several centuries. It was rebuilt by the monarchy in the late 15th century, a process that coincided with the birth of the Misericordias under the protection of the King. After the Council of Trent, these fraternities ran the health system, which was financed by people who believed in the power of perpetual Masses to evade Purgatory. These institutions were run by the political elite, who exploited them for their own benefit. The article also analyses the main measures taken by the state in the 18th century to change the old and weak system of public care. These laws were ineffectual and unable to change the real situation: the Misericordias were alone--the elite had run away when money was short--and they received no support from the public purse or from the faithful, who at that time had less faith in the perpetual Mass.


Rabdosichuanin C inhibits productions of pro-inflammatory mediators regulated by NF-κB signaling in LPS-stimulated RAW264.7 cells.
Chronic pharyngitis (CP) is an inflammatory disease of the pharyngeal mucosa and its lymphatic tissues that is difficult to treat clinically. However, research on the exact therapeutic agents and molecular mechanisms of CP is still unclear. In this study, we investigated Rabdosichuanin C (RC) to attenuate lipopolysaccharide (LPS)-induced inflammatory damage in RAW264.7 cells by a combination of targeted virtual screening and in vitro activity assay and further clarified its molecular mechanism of action centering on the IκB/nuclear factor kappa B (NF-κB) pathway. Molecular docking and pharmacophore simulation methods were used to screen compounds with IκB inhibitory effects. Expression of genes and proteins related to the IκB/NF-κB signaling pathway by RC in LPS-induced inflammatory injury model of RAW264.7 cells was detected by PCR, enzyme-linked immunosorbent assay, and Western blot. The docking of RC with IκB protein showed good binding energy, and pharmacophore simulations further confirmed the active effect of RC in inhibiting IκB protein. RC intervention in LPS-induced RAW264.7 cells significantly reduced the expression levels of inflammatory factors tumor necrosis factor-α, interleukins-6, iNOS, and CD-86 at the messenger RNA and protein levels, downregulated IκB, p65 protein phosphorylation levels, and significantly inhibited IκB/NF-κB signaling pathway activation. Virtual screening provided us with an effective method to rapidly identify compounds RC that target inhibit the action of IκB, and the activity results showed that RC inhibits NF-κB signaling pathway activation. It is suggested that RC may play a role in the treatment of CP by inhibiting the IκB/NF-κB signaling pathway.


Neglected food-borne trematodiases: echinostomiasis and gastrodiscoidiasis.
In the present paper, we review two of the most neglected intestinal food-borne trematodiases: echinostomiasis, caused by members of the family Echinostomatidae, and gastrodiscoidiasis produced by the amphistome Gastrodiscoides hominis. Both parasitic infections are important intestinal food-borne diseases. Humans become infected after ingestion of raw or insufficiently cooked molluscs, fish, crustaceans, amphibians or aquatic vegetables. Thus, eating habits are essential to determine the distribution of these parasitic diseases and, traditionally, they have been considered as minor diseases confined to low-income areas, mainly in Asia. However, this scenario is changing and the population at risk are currently expanding in relation to factors such as new eating habits in developed countries, growing international markets, improved transportation systems and demographic changes. These aspects determine the necessity of a better understanding of these parasitic diseases. Herein, we review the main features of human echinostomiasis and gastrodiscoidiasis in relation to their biology, epidemiology, immunology, clinical aspects, diagnosis and treatment.


Terpene constituents of the aerial parts, phenolic content, antibacterial potential, free radical scavenging and antioxidant activity of Callistemon citrinus (Curtis) Skeels (Myrtaceae) from Eastern Cape Province of South Africa.
Volatile oil from aromatic plants has been used by ancient Egyptians in embalming for the inhibition of bacterial growth and prevention of decay, Callistemon citrinus is used in traditional therapies for the treatment of bronchitis, cough, inflammation and as an antimicrobial herbs. This study examines the essential constituents of the volatile oils obtained from the aerial parts of the plant as well as its antioxidant activity, free radical scavenging, phenolic content and the antibacterial potential of the oils. A portion of 500 g, 250 g and 150 g of the leaves, flowers and stems of this plant respectively were subjected to hydro-distillation process for three hours. The oils collected from the various plant parts were immediately subjected to GC-MS analysis. The overall phenolic content of the leaves oil, radical scavenging, antibacterial action and antioxidant activities of the essential oils of both the leaves and flowers of Callistemon citrinus were determined using standard methods, with free radical DPPH and ABTS as a reference antioxidant. Analyses of the three oils revealed a total of twenty-six components for the leaves oil representing 96.84% of the total oil composition, forty-one components for the flowers oil accounting for 98.92% of the whole composition and ten components for the stem oil amounting to 99.98% of the entire oil constituents. The dominant compounds in the leaves oil were eucalyptol (48.98%) and α-terpineol (8.01%), while α-eudesmol (12.93%), caryophyllene (11.89%), (-)-bornyl-acetate (10.02%) and eucalyptol (8.11%) were the main constituents of the flowers oil. In the same vein, the leading constituents in the stems oil were eucalyptol (56.00%) and α-pinene (31.03%). The antioxidant capacities of both the leaves and flowers oils of the plant were evaluated and their IC50 were (1.49 and 1.13) for DPPH and (0.14 and 0.03) for ABTS assay respectively. The antibacterial activities of the oils from the (leaves and flowers) were also examined and were found to have wide range of activities against the bacterial strains used in this study. Observations drawn from this experiment shows clearly that the leaves and flowers of Callistemon citrinus possess phenolic compounds and cyclic ether of several pharmacological behaviors.


GATA2 Deficiency and Epstein-Barr Virus Disease.
GATA2 is a transcription factor that binds to the promoter of hematopoietic genes. Mutations in one copy of the gene are associated with haploinsufficiency and reduced levels of protein. This results in reduced numbers of several cell types important for immune surveillance including dendritic cells, monocytes, CD4, and NK cells, as well as impaired NK cell function. Recently, GATA2 has been associated with several different presentations of severe Epstein-Barr virus (EBV) disease including primary infection requiring repeated hospitalizations, chronic active EBV disease, EBV-associated hydroa vacciniforme with hemophagocytosis, and EBV-positive smooth muscle tumors. EBV was found predominantly in B cells in each of the cases in which it was studied, unlike most cases of chronic active EBV disease in which the virus is usually present in T or NK cells. The variety of EBV-associated diseases seen in patients with GATA2 deficiency suggest that additional forms of severe EBV disease may be found in patients with GATA2 deficiency in the future.


Neonatal stroke involving the middle cerebral artery in term infants: clinical presentation, EEG and imaging studies, and outcome.
Six children with neonatal cerebral infarction of the middle cerebral artery are reported. Seizures or respiratory distress were the initial symptoms. In some cases abnormal findings appeared earlier on EEG than on ultrasound. The EEG changes were concordant with the localization of the lesion. Ultrasound examinations revealed an echodense structure within the vascular territory, after a phase of appearing to be normal, highly suggestive of cerebral infarction. The diagnosis was confirmed by CT scan. Findings on EEG, cranial ultrasound and CT suggested that the stroke represented a late intra-uterine event. At long-term follow-up, six children had failed to develop normally for age and had become obviously hemiplegic as gross motor development proceeded. Four of the patients had developed epilepsy. These data indicate that the outcome of neonatal stroke may not be as positive as previously reported.


[Evaluation of bronchial mucosa involvement in sarcoidosis patients using ¹⁸F-FDG PET-CT].
To explore the value of ¹⁸F-FDG PET-CT in evaluating bronchial mucosa involvement in patients with saroidosis. A retrospective analysis was conducted among 6 sarcoidosis patients with and 14 patients without bronchial mucosa involvement to collect the data including the standard uptake value (SUVMax/Mean) of ¹⁸F-FDG, serum angiotensin converting enzyme (sACE), and proportion of lymphocytes and CD4⁺/CD8 ⁺ T lymphocyte ratio in bronchoalveolar lavage fluid (BALF). The lung focal SUV(Max/Mean) was higher in patients with bronchial mucosa involvement than those without (7.04 ± 5.83/5.00 ± 4.69 vs 5.68 ± 3.66/3.82 ± 2.39), but such differences were not statistically significant (P=0.565/0.495). The SUV(Max/Mean) of the hilum of the lung and the mediastina lymph nodes were significantly higher in patients with bronchial mucosa involvement (13.28 ± 5.57/10.48 ± 4.43 vs 6.20 ± 1.77/4.52 ± 1.43, P=0.0003/0.0002; 13.84 ± 4.35/9.69 ± 2.74 vs 7.16 ± 2.52/5.28 ± 1.77, P=0.0004/0.0004). The level of sACE and CD4⁺/CD8 ⁺ T lymphocyte ratio in BALF were also significantly higher in patients with bronchial mucosa involvement (60.58 ± 16.3 vs 49.16 ± 13.3 IU/L, P=0.045; 7.30 ± 5.0 vs 2.90 ± 3.1, P=0.026). The proportion of lymphocytes in BALF was comparable between the patients with and without bronchial mucosa involvement (44.10 ± 10.3% vs 35.30 ± 12.5%, P=0.148). For patients with saroidosis, ¹⁸F-FDG PET-CT is useful in evaluating bronchial mucosa involvement, which is one of the key features of active sarcoidosis.


MDCT of abdominopelvic oncologic emergencies.
Acute complications arising in abdominopelvic malignancies represent a unique subset of patients presenting to the emergency room. The acute presentation can be due to complications occurring in the tumor itself or visceral or vascular structures harboring the tumor. Multidetector computed tomography (MDCT) is the investigation of choice in the workup of these patients and enables appropriate and timely management. Management of the complication depends primarily on the extent of the underlying malignancy and the involvement of other viscera. The purpose of this article is to depict the imaging features of these complications on MDCT.


The effect of topical pilocarpine on intraocular pressure and pupil size in the normotensive and glaucomatous beagle.
Topical 1, 2, and 4 percent pilocarpine were evaluated in the normotensive and glaucomatous beagles, comparing intraocular pressure (IOP), pupillary size, and time. In normotensive beagles pilocarpine produced maximal decreases of 25 percent (5.5 mm. Hg) at 1 percent concentration; 34 percent (7.26 mm. Hg) at 2 percent concentration; and 25 percent (6.9 mm. Hg) at 4 percent concentration. The maximum reductions in IOP after pilocarpine instillation in the glaucomatous beagle were 30 percent (9.1 mm. Hg) at 1 percent concentration; 44 percent (14.92 mm. Hg) at 2 percent concentration; and 31 percent (10.89 mm. Hg) at 4 percent concentration. The glaucomatous beagles responded with a greater reduction of IOP than did the normotensive beagles.


[Allopurinol in treatment of cutaneous sarcoidosis].
Several reports more than ten years ago provided evidence that allopurinol may be effective for cutaneous sarcoidosis. We therefore treated two patients with histologically confirmed scar sarcoidosis and two with nodular sarcoidosis. A daily dosage of 300 mg allopurinol was given over a period of 4-7 months as single drug therapy. In both patients with scar sarcoidosis, the skin manifestations completely regressed while in the patients with nodular sarcoidosis there was significant improvement. The concomittant pulmonary involvement in two patients was unpredictable, in one patient improved while the other was deteriorated, The mode of action is still unclear but because of the positive results and the low rate of side effects, allopurinol seems a reasonable agent for treating cutaneous sarcoidosis.


The role of light in the treatment of non-melanoma skin cancer using methyl aminolevulinate.
Photodynamic therapy (PDT) is a developing approach to the treatment of cancer and other diseases that involves the use of light to activate photosensitizer molecules. The light energy absorbed by the photosensitizer is transferred to molecular oxygen, which is converted into the highly reactive and cytotoxic species, singlet oxygen. Topical agents such as aminolevulinic acid (ALA) or methyl aminolaevulinate (MAL) may be used for PDT of non-melanoma skin cancers (NMSC) because, in vivo, these agents stimulate the production of porphyrins which act as powerful photosensitisers. This brief review focuses on the use of light to activate MAL, which is now an approved drug (Metvix for certain NMSCs in the European Union. Porphyrins produced by the action of MAL can be activated using red light, which is also capable of deeply penetrating the skin. A number of light sources are available for treatment of NMSC using MAL, including very convenient non-laser sources such as non-coherent filtered lamps and, more recently, sources containing arrays of light-emitting diodes (LEDs). The Aktilite lamp, specifically designed for use with Metvix cream, has an emission spectrum that closely matches the red light absorption profile of PpIX.


Decision-making when data and inferences are not conclusive: risk-benefit and acceptable regret approach.
The absolute truth in research is unobtainable, as no evidence or research hypothesis is ever 100% conclusive. Therefore, all data and inferences can in principle be considered as "inconclusive." Scientific inference and decision-making need to take into account errors, which are unavoidable in the research enterprise. The errors can occur at the level of conclusions that aim to discern the truthfulness of research hypothesis based on the accuracy of research evidence and hypothesis, and decisions, the goal of which is to enable optimal decision-making under present and specific circumstances. To optimize the chance of both correct conclusions and correct decisions, the synthesis of all major statistical approaches to clinical research is needed. The integration of these approaches (frequentist, Bayesian, and decision-analytic) can be accomplished through formal risk:benefit (R:B) analysis. This chapter illustrates the rational choice of a research hypothesis using R:B analysis based on decision-theoretic expected utility theory framework and the concept of "acceptable regret" to calculate the threshold probability of the "truth" above which the benefit of accepting a research hypothesis outweighs its risks.


Spectroscopy of spin-orbit quantum bits in indium antimonide nanowires.
A double quantum dot in the few-electron regime is achieved using local gating in an InSb nanowire. The spectrum of two-electron eigenstates is investigated using electric dipole spin resonance. Singlet-triplet level repulsion caused by spin-orbit interaction is observed. The size and the anisotropy of singlet-triplet repulsion are used to determine the magnitude and the orientation of the spin-orbit effective field in an InSb nanowire double dot. The obtained results are confirmed using spin blockade leakage current anisotropy and transport spectroscopy of individual quantum dots.


Recurrent endoleak detection and measurement of aneurysm size with CTA after coil embolization of endoleaks.
The optimal modality for following aneurysm size and detecting endoleaks after endovascular aneurysm repair (EVAR) remains controversial. Computed tomographic angiography (CTA) has been widely employed but can be limited by metal artifact from stents, which is exacerbated by embolization coils placed during the treatment of type 2 endoleaks. The authors assessed interobserver agreement of CTA for measuring aneurysm size and presence of recurrent endoleak in patients with prior coil embolization of type 2 endoleaks. A total of 65 CTAs were retrospectively reviewed in a cohort of 27 patients (25 men; two women; mean age, 77.4 years) who had prior endoleak embolization after EVAR. Endoleak embolizations included transarterial (n=8) and translumbar (n=19) approaches. In each patient, maximal aneurysm diameter and presence/absence of recurrent endoleak was measured independently by two observers. Cohen's Kappa statistic was used to assess interobserver agreement, as well as paired two-tailed Student t tests for aneurysm diameter. Recurrent type 2 endoleaks were detected with CTA in eight of 27 patients (30%) and on 13 of 65 CTAs (20%). A high degree of correlation (98.5%) was also seen between the two observers for presence of endoleak (Kappa=0.95). Mean aneurysm diameter for the entire cohort correlated closely between both observers: 54.8 mm+/-1.1 for observer A and 54.9 mm+/-1.1 for observer B (P=.66). There was a disagreement between the readers of greater than 2 mm regarding aneurysm size in 13.8% of the CTAs (nine of 65 CTAs). Despite the presence of streak artifact on CTA following coil embolization of type 2 endoleaks, CTA remains a useful study for following patients. The presence of embolization coils does not prevent CTA measurement of aneurysm diameter and detection of recurrent endoleak with a high degree of interobserver agreement.


Mortality, body weight, food and water consumption, and clinical signs in Slc: B6C3F1 (C57BL/6 x C3H) mice utilized in chronic toxicity and carcinogenicity studies.
In vivo historical control data for Slc: B6C3F1 mice, including mortality, body weight, food and water consumption, and clinical signs and which were obtained from long-term toxicity and carcinogenicity studies (11 male and 12 female studies) conducted at the Biosafety Research Center, Foods, Drugs and Pesticides, (An-Pyo Center) during the last five years are presented. Mean survival at 83 and 109 weeks of age was 96.4% (min: 94.0%, max: 100%) and 79.0% (min: 74.0%, max: 86.0%) in males and 98.7% (min: 96.0%, max: 100%) and 81.7% (min: 70.0%, max: 90.0%) in females, respectively. The maximum mean body weight of males and females was 45.1 +/- 3.1 g (mean +/- S.D.) and 39.2 +/- 4.1 g, respectively. Male mice attained their maximum body weight at 72.7 +/- 4.3 weeks of age and females at 76.2 +/- 5.9 weeks of age. Clinical symptoms increased with age, particularly after week 84, and included: wasting, piloerection and palpable abdominal masses. Hypothermia and auricular pallor were common findings in moribund animals from week 79 to 104 of the studies. The use of in-house, historical control data can prove invaluable in the evaluation and interpretation of experimental results, especially in long-term and life-time studies.


Dual-Recognition Triggered Proximity Ligation Combined with a Rolling Circle Amplification Strategy for Analysis of Exosomal Protein-Specific Glycosylation.
Exosomal surface glycan reveals the biological function and molecular information on the protein, especially in indicating the pathogenesis of certain diseases through monitoring of specific protein glycosylation accurately. However, in situ and nondestructive measurement techniques for certain Exosomal glycoproteins are still lacking. In this work, combined with on-chip purification, we designed a proximity ligation assay-induced rolling circle amplification (RCA) strategy for highly sensitive identification of Exosomal protein-specific glycosylation based on a couple of proximity probes to target Exosomal protein and the protein-specific glycosylation site. Benefiting from efficient separation, scalable dual-recognition, and proximity-triggered RCA amplification, the proposed strategy could convert different protein-specific glycan levels to prominent changes in absorbance signals, resulting in accurate quantification of specific glycosylated Exosomal protein. When detecting the glycosylated PD-L1 on MDA-MB-231 exosomes and glycosylated PTK7 on HepG2 exosomes, the detection limits were calculated to be as low as 1.04 × 104 and 2.759 × 103 particles/mL, respectively. In addition, we further expand the dual-recognition site to investigate the potential correlation of Exosomal glycosylation with polarization of THP-1 cells toward the tumor-suppressive M1 phenotype. Overall, this strategy provides a universal tool for multiple analyses of diverse protein-specific glycosylated exosomes, exhibiting enormous potential to explore exosome function and search for new early diagnosis markers.


Multi-View Learning With Incomplete Views.
One underlying assumption of the conventional multi-view learning algorithms is that all examples can be successfully observed on all the views. However, due to various failures or faults in collecting and pre-processing the data on different views, we are more likely to be faced with an incomplete-view setting, where an example could be missing its representation on one view (i.e., missing view) or could be only partially observed on that view (i.e., missing variables). Low-rank assumption used to be effective for recovering the random missing variables of features, but it is disabled by concentrated missing variables and has no effect on missing views. This paper suggests that the key to handling the incomplete-view problem is to exploit the connections between multiple views, enabling the incomplete views to be restored with the help of the complete views. We propose an effective algorithm to accomplish multi-view learning with incomplete views by assuming that different views are generated from a shared subspace. To handle the large-scale problem and obtain fast convergence, we investigate a successive over-relaxation method to solve the objective function. Convergence of the optimization technique is theoretically analyzed. The experimental results on toy data and real-world data sets suggest that studying the incomplete-view problem in multi-view learning is significant and that the proposed algorithm can effectively handle the incomplete views in different applications.


Incidental detection of obstructive uropathy during scrotal imaging.
The customary method for radionuclide imaging in patients with testicular pain is to image the scrotal region using Tc-99m pertechnetate. Acute obstructive uropathy was found to be the cause of the testicular pain in three adult patients with normal testicular perfusion using Tc-99m DTPA. Tc-99m DTPA is recommended for testicular imaging with concomitant imaging of the kidneys and ureters, particularly in the adult patient.


Evolution of uniforms to cater for the needs of staff and patients.
Uniforms were originally developed to distinguish nurses from servants. However, with the arrival of the NHS in 1948, designs became less complex and an updated style of dress was created. This article examines how uniforms have changes since 1860 and how workwear has been adapted to meet developments in healthcare regulations. The styles have become more practical and comfortable, and modern materials incorporate properties that reduce risk of cross-contamination and infection.


An international consensus definition for contextual factors: findings from a nominal group technique.
Emerging literature suggests contextual factors are important components of therapeutic encounters and may substantially influence clinical outcomes of a treatment intervention. At present, a single consensus definition of contextual factors, which is universal across all health-related conditions is lacking. The objective of this study was to create a consensus definition of contextual factors to better refine this concept for clinicians and researchers. The study used a multi-stage virtual Nominal Group Technique (vNGT) to create and rank contextual factor definitions. Nominal group techniques are a form of consensus-based research, and are beneficial for identifying problems, exploring solutions and establishing priorities. International. The initial stages of the vNGT resulted in the creation of 14 independent contextual factor definitions. After a prolonged discussion period, the initial definitions were heavily modified, and 12 final definitions were rank ordered by the vNGT participants from first to last. The 10 international vNGT participants had a variety of clinical backgrounds and research specializations and were all specialists in contextual factors research. A sixth round was used to identify a final consensus, which reflected the complexity of contextual factors and included three primary domains: (1) an overall definition; (2) qualifiers that serve as examples of the key areas of the definition; and (3) how contextual factors may influence clinical outcomes. Our consensus definition of contextual factors seeks to improve the understanding and communication between clinicians and researchers. These are especially important in recognizing their potential role in moderating and/or mediating clinical outcomes.


Implementation of DHIS2 for Disease Surveillance in Guinea: 2015-2020.
A robust epidemic-prone disease surveillance system is a critical component of public health infrastructure and supports compliance with the International Health Regulations (IHR). One digital health platform that has been implemented in numerous low- and middle-income countries is the District Health Information System Version 2 (DHIS2). In 2015, in the wake of the Ebola epidemic, the Ministry of Health in Guinea established a strategic plan to strengthen its surveillance system, including adoption of DHIS2 as a health information system that could also capture surveillance data. In 2017, the DHIS2 platform for disease surveillance was piloted in two regions, with the aim of ensuring the timely availability of quality surveillance data for better prevention, detection, and response to epidemic-prone diseases. The success of the pilot prompted the national roll-out of DHIS2 for weekly aggregate disease surveillance starting in January 2018. In 2019, the country started to also use the DHIS2 Tracker to capture individual cases of epidemic-prone diseases. As of February 2020, for aggregate data, the national average timeliness of reporting was 72.2%, and average completeness 98.5%; however, the proportion of individual case reports filed was overall low and varied widely between diseases. While substantial progress has been made in implementation of DHIS2 in Guinea for use in surveillance of epidemic-prone diseases, much remains to be done to ensure long-term sustainability of the system. This paper describes the implementation and outcomes of DHIS2 as a digital health platform for disease surveillance in Guinea between 2015 and early 2020, highlighting lessons learned and recommendations related to the processes of planning and adoption, pilot testing in two regions, and scale up to national level.


Robot Fully Assisted Upper-Limb Functional Movements Against Gravity to Drive Recovery in Chronic Stroke: A Pilot Study.
Stroke is becoming more and more a disease of chronically disabled patients, and new approaches are needed for better outcomes. An intervention based on robot fully assisted upper-limb functional movements is presented. To test the immediate and sustained effects of the intervention in reducing impairment in chronic stroke and to preliminarily verify the effects on activity. Nineteen patients with mild-to-severe impairment underwent 12 40-min rehabilitation sessions, 3 per week, of robot-assisted reaching and hand-to-mouth movements. The primary outcome measure was the Fugl-Meyer Assessment (FMA) at T1, immediately after treatment (n = 19), and at T2, at a 6-month follow-up (n = 10). A subgroup of 11 patients was also administered the Wolf Motor Function Test Time (WMFT TIME) and Functional Ability Scale (WMFT FAS) and Motor Activity Log (MAL) Amount Of Use (AOU), and Quality Of Movement (QOM). All patients were compliant with the treatment. There was improvement on the FMA with a mean difference with respect to the baseline of 6.2 points at T1, after intervention (n = 19, 95% CI = 4.6-7.8, p < 0.0002), and 5.9 points at T2 (n = 10, 95% CI = 3.6-8.2, p < 0.005). Significant improvements were found at T1 on the WMFT FAS (n = 11, +0.3/5 points, 95% CI = 0.2-0.4, p < 0.004), on the MAL AOU (n = 11, +0.18/5, 95% CI = 0.07-0.29, p < 0.02), and the MAL QOM (n = 11, +0.14/5, 95% CI = 0.08-0.20, p < 0.02). Motor benefits were observed immediately after intervention and at a 6-month follow-up. Reduced impairment would appear to translate to increased activity. Although preliminary, the results are encouraging and lay the foundation for future studies to confirm the findings and define the optimal dose-response curve. www.ClinicalTrials.gov, identifier: NCT03208634.


Agricultural buffer zone thresholds to safeguard functional bee diversity: Insights from a community modeling approach.
Wild bee species are important pollinators in agricultural landscapes. However, population decline was reported over the last decades and is still ongoing. While agricultural intensification is a major driver of the rapid loss of pollinating species, transition zones between arable fields and forest or grassland patches, i.e., agricultural buffer zones, are frequently mentioned as suitable mitigation measures to support wild bee populations and other pollinator species. Despite the reported general positive effect, it remains unclear which amount of buffer zones is needed to ensure a sustainable and permanent impact for enhancing bee diversity and abundance. To address this question at a pollinator community level, we implemented a process-based, spatially explicit simulation model of functional bee diversity dynamics in an agricultural landscape. More specifically, we introduced a variable amount of agricultural buffer zones (ABZs) at the transition of arable to grassland, or arable to forest patches to analyze the impact on bee functional diversity and functional richness. We focused our study on solitary bees in a typical agricultural area in the Northeast of Germany. Our results showed positive effects with at least 25% of virtually implemented agricultural buffer zones. However, higher amounts of ABZs of at least 75% should be considered to ensure a sufficient increase in Shannon diversity and decrease in quasi-extinction risks. These high amounts of ABZs represent effective conservation measures to safeguard the stability of pollination services provided by solitary bee species. As the model structure can be easily adapted to other mobile species in agricultural landscapes, our community approach offers the chance to compare the effectiveness of conservation measures also for other pollinator communities in future.


Experimental chimaerism in sheep.
Composite sheep embryos (N = 110) were produced by aggregation of blastomeres from 2-, 4- or 8-cell embryos. Each composite embryo consisted of equal numbers of blastomeres from 2-8 parent embryos, the total cell number ranging from one quarter of the normal cell number to 8 times the normal cell number. The embryos were embedded in agar and transferred to ligated sheep oviducts to allow development up to the early blastocyst stage. Of the 101 embryos subsequently recovered, 77 had formed normally organized blastocysts and 74 of these were transferred to 51 recipients. Thirty-eight recipients went to full term, producing a total of 53 lambs. Of the 48 lambs which survived to be blood typed at 60 days of age, 36 were judged to be chimaeric on the basis of their blood type and/or on the basis of external features. The proportion of chimaeras was larger amongst the lambs produced from composite embryos of the normal number of cells or more (25/26) than amongst lambs produced from composite embryos of less than the normal cell number (11/22).


Molecular structure of tris(pentafluoroethyl)phosphane P(C2F5)3.
The structure of tris(pentafluoroethyl)phosphane, P(C(2)F(5))(3), has been determined in the solid state by in situ single crystal growth and subsequent X-ray diffraction and in the gas phase by electron diffraction. The experimental structure determinations have been supported by and compared to quantum chemical calculations at different levels of theory. P(C(2)F(5))(3) prefers a conformation of C(3) symmetry with the CF(3) groups of the three C(2)F(5) units oriented to the same side of the molecule as the phosphorus lone pair of electrons, leading to an estimated Tolman cone angle of 193 degrees (solid) and 191 degrees (gas), whereas a second stable conformer of C(3) symmetry, (only 5 kJ mol(-1) higher in energy) has a smaller Tolman cone angle of 171 degrees . The structures are discussed in context with related molecules E(CF(3))(3) (E = N, P, As, Sb) as well as N(C(2)F(5))(3) and P(C(2)H(5))(3).


Adjusting age and stage distributions for misclassification errors.
Ecologists often use samples from the age or stage structure of a population to make inferences about population-level processes and to parameterize matrix models. Typically, researchers make a simplifying assumption that age and stage classes are determined without error, when in fact some level of misclassification often can be expected. If unaccounted for, misclassification will lead to overly optimistic levels of precision and can cause biased estimates of age or stage structure. Although several studies have used information from known-age individuals to quantify errors in age or stage distribution, the problem of estimating the age or stage structure in face of such errors has received comparably little attention. In this paper, we describe a general statistical framework for estimating the true stage distribution of a sample when misclassification rates can be estimated. The estimation process requires auxiliary information on misclassification rates, such as data from individuals of known age. We analyze age-structured harvest records from black bears in Pennsylvania to illustrate how incorporating misclassification errors leads to changes in point estimates and provides a measure of precision.


Impact of glycation on antibody clearance.
Glycation of therapeutic proteins occurs during mammalian cell culture expression and upon administration to patients. Since the chemical attachment of mannose or other sugars via a chemical linker has been shown to increase a protein's clearance rate in mice through the mannose receptor, we explored the effect of mannose glycation on the clearance of an IgG in mice. An IgG decorated with high levels of mannose (~18 mol/mol protein) through glycation did not clear faster in mice than the underivatized protein, whereas the same IgG decorated with mannose attached in a way to maintain the normal glycosidic bond (2-imino-2-methoxyethyl-1-thiomannoside, or IMT-mannose) at similar derivatization levels cleared significantly faster. Surface plasmon resonance studies revealed that the IgG derivatized with IMT-mannose bound tightly to the mannose receptor (KD = 20 nM) but the IgG glycated with mannose did not bind. These results indicate that glycation, even at unnaturally elevated levels, does not appear to be a clearance concern for therapeutic proteins.


Influence of olfactory epithelium on mitral/tufted cell dendritic outgrowth.
Stereotypical connections between olfactory sensory neuron axons and mitral cell dendrites in the olfactory bulb establish the first synaptic relay for olfactory perception. While mechanisms of olfactory sensory axon targeting are reported, molecular regulation of mitral cell dendritic growth and refinement are unclear. During embryonic development, mitral cell dendritic distribution overlaps with olfactory sensory axon terminals in the olfactory bulb. In this study, we investigate whether olfactory sensory neurons in the olfactory epithelium influence mitral cell dendritic outgrowth in vitro. We report a soluble trophic activity in the olfactory epithelium conditioned medium which promotes mitral/tufted cell neurite outgrowth. While the trophic activity is present in both embryonic and postnatal olfactory epithelia, only embryonic but not postnatal mitral/tufted cells respond to this activity. We show that BMP2, 5 and 7 promote mitral/tufted cells neurite outgrowth. However, the BMP antagonist, Noggin, fails to neutralize the olfactory epithelium derived neurite growth promoting activity. We provide evidence that olfactory epithelium derived activity is a protein factor with molecular weight between 50-100 kD. We also observed that Follistatin can effectively neutralize the olfactory epithelium derived activity, suggesting that TGF-beta family proteins are involved to promote mitral/tufted dendritic elaboration.


CTRM raises the bar for patient safety and staff productivity.
Ever since the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) included medical communications among its National Patient Safety Goals, hospital administrators have become increasingly aware of this weak link in healthcare delivery. A growing number of hospitals, including Parkland Memorial Hospital in Dallas, are implementing critical test result management (CTRM) technology that specifically addresses and solves the problem of critical values reporting. CTRM technology did not even exist until 2-3 years ago. Now that it is here, it will likely become standard practice for hospitals everywhere.


[A case of ischemic skin necrosis after glypressin therapy in liver cirrhosis].
Terlipressin is a synthetic analogue of vasopressin, which has been used in the treatment of acute variceal hemorrhage. In contrast to vasopressin, terlipressin can be administered as intermittent injections instead of continuous intravenous infusion. Thus, it has a less adverse reaction than vasopressin. We report a case of ischemic skin complication in a cirrhotic patient treated with terlipressin. A 71-year-old man with liver cirrhosis was admitted because of hematemesis and melena. He was commenced on terlipressin at a dose 1 mg every 6 hours for the treatment of varicieal bleeding. After 36 hours of treatment, skin blistering and ecchymosis was noted on the skin of his upper thigh, scrotal area and trunk. We found that terlipressin was a possible cause of ischemic skin complication based on the skin biopsy finding. Terlipressin may induce a complication of the ischemic event. In spite of rarity, special attention needs to paid on the peripheral ischemic complication of terlipressin.


Incisional hernia after ovarian debulking surgery.
The purpose of our study was to explore the incidence and contributing variables of an incisional hernia after debulking surgery for advanced ovarian cancer. The imaging of patients who underwent debulking surgery with an extended vertical incision was re-evaluated for incisional hernias at one-year follow-up, and their medical records were reviewed. We performed univariate and multivariate analysis to find out the risk factors for an incisional hernia. The overall annual incidence of incisional hernia was 26.7 percent (46 of 172). Univariate analysis revealed a statistically significant relationship between age, body mass index (BMI), and the length of the incision and the incidence of an incisional hernia. The only factor identified by multivariate analysis as being independently related with the development of an incisional hernia within a year of the operation was BMI (OR 1.12, 95% CI 1.01-1.25, p = 0.04). Incisional hernia rates were high after ovarian cancer surgeries, and BMI was the independent factor significantly linked to hernia formation. To reduce the high ratio of incisional hernia among these group of patients, preventative strategies should be researched and applied.


Supportive therapy as the treatment model of choice.
Supportive and expressive techniques in psychotherapy can be located on a continuum. Traditionally, psychotherapy has been oriented toward the expressive end of the continuum, applying the model of psychoanalytic or expressive therapy to all therapy. The authors propose that for most patients, the model for individual dynamic psychotherapy should be based on concepts from the supportive end of the continuum.


Thermodynamic profiling during irreversible electroporation in porcine liver and pancreas: a case study series.
First, the aim of the study was to determine whether irreversible electroporation (IRE) is associated with heat generation in the liver and pancreas at clinical (≤1,500 V/cm) and supraclinical (>1,500 V/cm) electroporation settings; second, to assess the risk of thermal tissue damage in and adjacent to the treated volume in highly perfused versus moderately perfused parts of both organs; third, to investigate the influence of perfusion and of the presence and the orientation of a metal stent on the maximal thermal elevation (ΔTSession,max) in the tissue during an IRE session at fixed IRE settings, and finally, to determine whether the maximum temperature elevation within the IRE-subjected organ during an IRE treatment (single or multiple sessions) is reflected in the organ's surface temperature. The aims were investigated in 12 case studies conducted in five female Landrace pigs. Several IRE settings were applied for lateral (2), triangular (3), and rectangular (4) electrode configurations in the liver hilum, liver periphery, pancreas head, and pancreas tail. IRE series of 10-90 pulses were applied with pulse durations that varied from 70 μs to 90 μs and electric field strengths between 1,200 V/cm and 3,000 V/cm. In select cases, a metal stent was positioned in the bile duct at the level of the liver hilum. Temperatures were measured before, during, and after IRE in and adjacent to the treatment volumes using fiber optical temperature probes (temperature at the nucleation centers) and digital thermography (surface temperature). The occurrence of thermal damage was assumed to be at temperatures above 50 °C (ΔTSession,max ≥ 13 °C relative to body temperature of 37 °C). The temperature fluctuations at the organ surface (ΔTLocSurf) were compared to the maximum temperature elevation during an IRE treatment in the electroporation zone. In select cases, IRE was applied to tissue volumes encompassing the portal vein (PV) and a constricted and patent superior mesenteric vein (SMV) to determine the influence of the heatsink effect of PV and SMV on ΔTSession,max. The median baseline temperature was 31.6 °C-36.3 °C. ΔTSession,max ranged from -1.7 °C to 25.5 °C in moderately perfused parts of the liver and pancreas, and from 0.0 °C to 5.8 °C in highly perfused parts. The median ΔTLocSurf of the liver and pancreas was 1.0 °C and 10.3 °C, respectively. Constricting the SMV in the pancreas head yielded a 0.8 °C higher ΔTSession,max. The presence of a metal stent in the liver hilum resulted in a ΔTSession,max of 19.8 °C. Stents parallel to the electrodes caused a ΔTSession,max difference of 4.2 °C relative to the perpendicular orientation. Depending on IRE settings and tissue type, IRE is capable of inducing considerable heating in the liver and pancreas that is sufficient to cause thermal tissue damage. More significant temperature elevations are positively correlated with increasing number of electrode pairs, electric field strength, and pulse number. Temperature elevations can be further exacerbated by the presence and orientation of metal stents. Temperature elevations at the nucleation centers are not always reflected in the organ's surface temperature. Heat sink effects caused by large vessels were minimal in some instances, possibly due to reduced blood flow caused by anesthesia. Appropriate IRE settings must be chosen based on the tissue type and the presence of stents to avoid thermal damage in healthy peritumoral tissue and to protect anatomical structures [Table: see text].


[Additional data on superficial argentophilic structures of the miracidium and cercaria of Fasciola gigantica (Cobbold, 1855) (Trematoda:Fasciolidae) and on the epidemiology of this parasite].
The life cycle of a senegalese strain of Fasciola gigantica was carried out in France from adults recovered in the liver of naturally infected cattle (Bos taurus). Laboratory-reared Lymnaea natalensis experimentally infected shed numerous cercariae. Metacercariae were used for successful infection of sheep. In the miracidium, variations are observed in the disposition of the medio-ventral epithelial cell of the second tier. The distribution of the superficial argentophilic structures is similar to that of the miracidium of F. hepatica. The chaetotaxy of the cercaria is very closely related to that of the cercaria of a strain of F. gigantica from Madagascar shed by Lymnaea hovarum but it differs clearly from that of the cercaria of F. hepatica. The encystment of a great number of cercariae (25 %) on the surface of water suggests that this is an important factor in the extension of the foci of contamination, and therefore increases greatly the risks of infection not only for animal but also for man. It is possible that human fascioliasis caused by F. gigantica is a disease, the importance of which is under-estimated.


[Cochlear otosclerosis].
A rare case of cochlear otosclerosis is described with clinical data, CT and RMN images. The aim of this note is to improve the acknowledgement of in vivo otosclerosis physiopathology.


Virus and cell requirements for Friend virus granulocytic leukemogenesis in long-term bone marrow cultures of NIH swiss [N:NIH(S)] mice.
The effect of hematopoietic stem cell age on leukemogenesis in vitro was tested in nonrecharged, corticosterold-supplemented NIH Swiss [N:NIH(S)] mouse long-term bone marrow cultures infected with Friend murine leukemia virus of anemia-inducing strain (F-MuLV-A) or spleen focus-forming virus (SFFV) [Rauscher murine leukemia virus (R-MuLV)], a pseudotype virus derived by rescue of the SFFV genome from SFFV-Balb/3T3 clone A31 nonproducer cells with clonal helper R-MuLV. Cultures at 33 degrees C derived from 10-day-old or adult mouse marrow generated colony-forming unit culture granulocytic macrophage (CFUc) progenitor cells for over 20 weeks and colony-forming unit spleen cells for 14 weeks and generated permanent granulocytic leukemia cell lines after infection with F-MuLV-A at week 1, 2, or 4 but not at week 8. Leukemia lines were of granulocyte phenotype whether induced by F-MuLV-A or SFFV (R-MuLV) and synthesized myeloperoxidase and lysozyme but were restricted in ability to generate superoxide in response to phorbol myristate acetate stimulation. Cultures (31 degrees C) infected with temperature-sensitive (ts) helper virus mutant pseudotypes of SFFV as well as SFFV (R-MuLV) generated granulocytic leukemia lines, whereas only SFFV (R-MuLV) pseudotype virus-infected cultures became leukemic at 37 degrees C. R-MuLV wild type or ts mutant helper virus infection alone increased cell proliferation and numbers of CFUc but did not generate leukemia. These data indicated that gene(s) specific to F-MuLV-A or a virus rescued from SFFV-Balb/3T3 clone A31 nonproducer cells are required for transformation in vitro of a hematopoietic stem cell present in early but absent in late bone marrow cultures.


Diagnostic efficacy and prognostic value of serum procalcitonin concentration in patients with suspected sepsis.
Procalcitonin is released in response to bacterial infection and it is not released in Inflammatory and viral diseases. To show the diagnostic efficacy and prognostic value of procalcitonin for sepsis. A consecutive series of 103 patients with suspected sepsis were admitted to the intensive care unit over a 2-year period. During the first 24 hours of the admission procalcitonin, C-reactive protein, and complement proteins were determined. The diagnostic efficacy was tested with predictive values, likelihood ratios, receiver operating characteristic curves, and multiple logistic regression. The association of procalcitonin with mortality was assessed by the Multivariate Cox proportional hazards model. Procalcitonin had a better positive likelihood ratio than C-reactive protein -2.2 (95% confidence interval: 1.3-3.7) versus 1.1 (95% confidence interval: 0.9-1.2). Sequential Organ Failure Assessment yielded the highest discriminative value, with an area under the curve of 0.82 (95% confidence interval: 0.73-0.92), followed by procalcitonin (0.81; 95% confidence interval: 0.72-0.89). Multivariate regression analysis showed procalcitonin (adjusted odds ratio: 3.8; 95% confidence interval: 1.2-11.8) and Sequential Organ Failure Assessment score (adjusted odds ratio: 5.3; 95% confidence interval: 1.4-19.9) as the only variables independently associated with infection. Multivariate Cox regression analysis revealed that procalcitonin was not independently associated with mortality. The diagnostic accuracy of procalcitonin was higher than C-reactive protein and complement proteins. Procalcitonin in combination with Sequential Organ Failure Assessment was useful to diagnose infection. C-reactive protein, Sequential Organ Failure Assessment score, age, and gender showed to be helpful to improve the prediction of mortality risk, but not procalcitonin.