Urachal abnormalities: clinical and imaging features.
The clinical manifestation of urachal abnormalities may mimic many intraabdominal or pelvic diseases. We present clinical, imaging and pathological findings of a spectrum of complicated urachal abnormalities and determine whether imaging can be used to differentiate tumour from infection. From January 1993 to December 2006, seven patients with surgically-proven complicated urachal abnormalities had their clinical, imaging and pathological features reviewed. There were three men and four women, aged 12-73 years. Four patients had infected urachal remnants and three had urachal carcinoma. The main clinical findings in infected urachal remnants were dysuria, abdominal pain and mass. The patients of urachal carcinoma presented with abdominal mass and haematuria. Computed tomography (CT) was performed in all cases, and ultrasonography (US) was performed in four cases. CT in all cases showed a mass located extraperitoneally in the midline just beneath the rectus abdominis muscle and extending from the umbilicus to the dome of the urinary bladder. There were one well-defined cystic mass and six ill-defined solid masses. US showed one cystic mass and three echogenic masses. Cystography was performed in one patient and it showed indentation to the dome of the urinary bladder with mucosal irregularity. The cystic mass and one ill-defined solid mass were pathologically-proven to be xanthogranulomatous inflammation. The other five solid masses were found to be adenocarcinoma in three and chronic non-specific inflammation in two cases. Preoperative diagnosis of urachal abnormalities may be suggested by clinical presentation and imaging features. However, it is difficult to differentiate tumour from infection based on imaging features alone.


Endosulfan induced cardiac arrest treated with intravenous lipid emulsion.
Endosulfan is an organochlorine pesticide with high lipophilic features that makes it a well-absorbed agent and penetrates easily to the site of action. Endosulfan toxicities may result in disastrous complications and have high rates of mortality. Several case reports and some researchs discuss the evidence supporting intravenous lipid emulsion (ILE) therapy as a rescue therapy in lipophilic agents' toxicity. A 33-years-old healthy woman with a history of endosulfan ingestion of uncertain quantity in a suicide attempt six hours ago was admitted to our emergency department. Cardiac arrest ensued after one hour of admission. Cardiopulmonary resuscitation was initiated in accordance with advanced cardiac life support (ACLS) algorithm for asystole. During resuscitation, 2 mL/kg bolus of 20% intravenous lipid emulsion (ILE) was administered for three times at five-minute intervals in addition to ACLS guidance. Spontaneous circulation returned after twenty minutes of resuscitation. No additional antidotal or vasopressor therapies were required during the hospital course of the patient. To our knowledge, this is the first reported case with responded use of ILE treatment for endosulfan toxicity. This case report indicates that ILE treatment should be considered for life-threatening endosulfan intoxications.


Polish Adaptation of the Psychache Scale by Ronald Holden and Co-workers.
The conducted study was aimed at making a Polish adaptation of the Scale of Psychache by Ronald Holden and co-workers. The scale is a self-assessment method which comprises 13 statements and is designed to assess subjectively experienced psychological pain. 300 persons were examined - undergraduates and postgraduates of the University of Lodz and the Technical University of Lodz. The group of the study participants consisted of 185 women and 115 men. Moreover, there were examined 150 alcohol addicted men, 50 co-addicted women and 50 major depressive episode (MDE) patients. The Polish version of the Scale is a reliable and valid tool. The exploratory and confirmatory factor analysis has proved the existence of one factor. The internal consistency, assessed on the basis of Cronbach's alpha, equalled 0.93. The method displays positive and statistically significant relationships to levels of depression, hopelessness, anxiety, anhedonia and negative relations to levels of optimism, life satisfaction, and positive orientation. Alcohol addicted men with presently diagnosed suicidal thoughts were characterised by a significantly higher level of psychological pain as compared to alcoholics without such thoughts. A higher level of psychache was also reported in people with depression who have a history of attempted suicide compared with those who have not attempted suicide. The effect of the conducted adaptation works on the Psychache Scale speaks for recommending the method for scientific research and use in therapeutic practice.


The stellate cell system (vitamin A-storing cell system).
Past, present, and future research into hepatic stellate cells (HSCs, also called vitamin A-storing cells, lipocytes, interstitial cells, fat-storing cells, or Ito cells) are summarized and discussed in this review. Kupffer discovered black-stained cells in the liver using the gold chloride method and named them stellate cells (Sternzellen in German) in 1876. Wake rediscovered the cells in 1971 using the same gold chloride method and various modern histological techniques including electron microscopy. Between their discovery and rediscovery, HSCs disappeared from the research history. Their identification, the establishment of cell isolation and culture methods, and the development of cellular and molecular biological techniques promoted HSC research after their rediscovery. In mammals, HSCs exist in the space between liver parenchymal cells (PCs) or hepatocytes and liver sinusoidal endothelial cells (LSECs) of the hepatic lobule, and store 50-80% of all vitamin A in the body as retinyl ester in lipid droplets in the cytoplasm. SCs also exist in extrahepatic organs such as pancreas, lung, and kidney. Hepatic (HSCs) and extrahepatic stellate cells (EHSCs) form the stellate cell (SC) system or SC family; the main storage site of vitamin A in the body is HSCs in the liver. In pathological conditions such as liver fibrosis, HSCs lose vitamin A, and synthesize a large amount of extracellular matrix (ECM) components including collagen, proteoglycan, glycosaminoglycan, and adhesive glycoproteins. The morphology of these cells also changes from the star-shaped HSCs to that of fibroblasts or myofibroblasts.


Value of serum glycated albumin and high-sensitivity C-reactive protein levels in the prediction of presence of coronary artery disease in patients with type 2 diabetes.
Coronary artery disease (CAD) is a major vascular complication of diabetes mellitus and reveals high mortality. Up to 30% of diabetic patients with myocardial ischemia remain asymptomatic and are associated with worse prognosis compared to non-diabetic counterpart, which warrants routine screening for CAD in diabetic population. The purpose of this study was to evaluate the clinical value of serum glycated albumin and high-sensitivity C-reactive protein (hs-CRP) levels in predicting the presence of CAD in patients with type 2 diabetes. Three hundred and twenty-four patients with type 2 diabetes were divided into two groups based on presence (CAD group, n = 241) or absence (control group, n = 83) of angiographically-documented CAD (lumen diameter narrowing > or =70%). Serum levels of glycated albumin and hs-CRP as well as serum concentrations of glucose, lipids, creatinine, blood urea nitrogen and uric acid were measured in both groups. Predictors of CAD were determined using multivariate logistic regression model and receiver-operating characteristic (ROC) curves. Serum glycated albumin and hs-CRP levels were significantly increased in diabetic patients with CAD. Multivariate regression analysis revealed that male gender, age, serum levels of glycated albumin, hs-CRP, creatinine and lipoprotein (a) were independent predictors for CAD. Areas under the curve of glycated albumin and hs-CRP and for regression model were 0.654 (95%CI 0.579-0.730, P < 0.001), 0.721 (95%CI 0.658-0.785, P < 0.001) and 0.824 (95% CI 0.768-0.879, P < 0.001), respectively. The optimal values of cut-off point were 18.7% (sensitivity 67.9%, specificity 60.0%) for glycated albumin and 5.2 mg/l (sensitivity 72.2%, specificity 60.0%) for hs-CRP to predict CAD. Logistic regression model was defined as: P/(1-P) = EXP(-1.5 + 1.265 gender + 0.812 age + 1.24 glycated albumin + 0.953 hs-CRP + 0.902 lipoprotein(a) + 1.918 creatinine). The optimal probability value for predicting CAD in type 2 diabetic patients was 0.648 (sensitivity 82.3%, specificity 68.6%). Serum glycated albumin and hs-CRP levels were significantly elevated in patients with type 2 diabetes and CAD. The logistic regression model incorporating with glycated albumin, hs-CRP and other major risk factors of atherosclerosis may be useful for screening CAD in patients with type 2 diabetes.


pROC-Chemotype Plots Enhance the Interpretability of Benchmarking Results in Structure-Based Virtual Screening.
Recently, we have reported a systematic comparison of molecular preparation protocols (using MOE or Maestro) in combination with two docking tools (GOLD or Glide), employing our DEKOIS 2.0 benchmark sets. Herein, we demonstrate how comparable settings of data preparation protocols can affect the profile and AUC of pROC curves based on variations in chemotype enrichment. We show how the recognition of different classes of chemotypes can affect the docking performance, particularly in the early enrichment, and monitor changes in this recognition behavior based on score normalization and rescoring strategies. For this, we have developed "pROC-Chemotype", which is an automated protocol that matches and visualizes ligand chemotype information together with potency classes in the pROC profiles obtained by docking. This tool enhances the understanding of the influence of chemotype recognition in early enrichment, but also reveals trends of impaired recognition of chemotype classes at the end of the score-ordered rank. Identifying such issues helps to devise score-normalization strategies to overcome this potential bias in an intuitive manner. Furthermore, strong perturbations in chemotype ranking between different methods can help to identify the underlying reasons (e.g., changes in the protonation/tautomerization state). It also assists in the selection of appropriate scoring functions that are capable to retrieve more potent and diverse hits. In summary, we demonstrate how this new tool can be utilized to identify and highlight chemotype-specific behavior, e.g., in dataset preparation. This can help to overcome some chemistry-related bias in virtual screening campaigns. pROC-Chemotype is made freely available at www.dekois.com.


Linked data: opportunities and challenges in disability research.
Disability research data often exist in the form of individual records located within discrete registers that may extend across sensitive political boundaries. This paper discusses the opportunities and challenges associated with using linked health and administrative data for disability research, with examples from research projects conducted both in Australia and overseas. Linked data offer distinct value in providing a comprehensive profile for a range of health issues, such as morbidity, mortality, assessing health care costs and/or quality of service provision. While the use of record linkage in health research is not a novel concept, recent advances in technology and electronic data management plus improved data linkage protocols have markedly increased the feasibility and opportunity for successfully utilising data linkage for the purposes of research, while at the same time protecting the privacy of the individual. An awareness and appropriate management of the associated challenges is required to maximise the outcomes of disability research using linked data.


Mental performance in CAPD.
Impaired cognitive function is part of an array of neurologic manifestations seen in patients with end stage renal disease. We investigated whether a difference exists in mental performance between patients on hemodialysis and on CAPD. The trial test A was administered in standardized fashion, and the time required to complete the test was used as a function of mental performance. A group of age and sex matched healthy controls was included for comparison. The results indicate that performance in the trail test A was markedly different among the three groups; controls did the test in 30.7 +/- 2.4 sec (n = 17), CAPD in 47.2 +/- 6.4 (p less than 0.05) and hemodialysis patients in 82.6 +/- 11 (p less than 0.005). Patients on CAPD completed the test significantly faster than those on hemodialysis (p less than 0.05). This observation of a significantly better mental performance by patients in CAPD than in patients in hemodialysis is likely to be multifactorial, and its significance is unclear, but this may be of interest to the clinician and patients contemplating different dialysis modalities.


Coated sphere scattering by geometric optics approximation.
A new geometric optics model has been developed for the calculation of light scattering by a coated sphere, and the analytic expression for scattering is presented according to whether rays hit the core or not. The ray of various geometric optics approximation (GOA) terms is parameterized by the number of reflections in the coating/core interface, the coating/medium interface, and the number of chords in the core, with the degeneracy path and repeated path terms considered for the rays striking the core, which simplifies the calculation. For the ray missing the core, the various GOA terms are dealt with by a homogeneous sphere. The scattering intensity of coated particles are calculated and then compared with those of Debye series and Aden-Kerker theory. The consistency of the results proves the validity of the method proposed in this work.


Optical particle size measurements of hygroscopic smokes in laboratory and field environments.
Optical particle size analyzer (PSA) measurements of hygroscopic smokes are reported from experiments conducted in laboratory chambers and in field tests. Three different instruments were used: a particle sizing interferometer; a Climet (model 211); and a Particle Measurement Systems PSA (model CSASP-100-HC). Field measurements were made in relative humidity conditions ranging between 65 and 97%. The results indicate that the size distributions are at least bimodal-not log-normal-and that mean particle diameter does not appear to increase with increasing relative humidity.


Novel collagen sponge reinforced with polyglycolic acid fiber produces robust, normal hair in murine hair reconstitution model.
The hair reconstitution assay is a useful system for studying cell-cell and epithelial-mesenchymal interaction. The current method consists of transplantation of both epidermal and dermal cells, using a silicone chamber placed on an athymic nude mouse. However, because of leakage and tilting of the grafted cells, the rate and area of hair growth vary depending on the chamber. We modified this method by using a collagen sponge as a scaffold and compared two types of collagen sponges, each having different tensile strengths. A conventional collagen sponge disturbed normal hair follicle formation; in contrast, a collagen sponge containing polyglycolic acid (PGA) fiber supported proper restructuring of skin and hair follicles. These data suggested the usefulness of PGA fiber-containing collagen sponges for hair reconstitution in research and clinical applications.


Capacitated Clustering via Majorization-Minimization and Collaborative Neurodynamic Optimization.
This paper addresses capacitated clustering based on majorization-minimization and collaborative neurodynamic optimization (CNO). Capacitated clustering is formulated as a combinatorial optimization problem. Its objective function consists of fractional terms with intra-cluster similarities in their numerators and cluster cardinalities in their denominators as normalized cluster compactness measures. To obviate the difficulty in optimizing the objective function with factional terms, the combinatorial optimization problem is reformulated as an iteratively reweighted quadratic unconstrained binary optimization problem with a surrogate function and a penalty function in a majorization-minimization framework. A clustering algorithm is developed based on CNO for solving the reformulated problem. It employs multiple Boltzmann machines operating concurrently for local searches and a particle swarm optimization rule for repositioning neuronal states upon their local convergence. Experimental results on ten benchmark datasets are elaborated to demonstrate the superior clustering performance of the proposed approaches against seven baseline algorithms in terms of 21 internal cluster validity criteria.


Squamous cell carcinoma of the oral cavity consisting of band-like nests.
Four squamous cell carcinomas of the oral cavity shared common histological and clinical characteristics. The primary lesion was situated at the floor of the mouth or the tongue. The cancer cell nests were band-like. The border between nests and stroma was smooth and distinct, with the continuity of the basement membrane being well maintained. The response to preoperative chemoradiotherapy was relatively poor. Although the lesion was locally advanced, no cervical metastasis was detected. No recurrence has occurred after the operation.


What makes a hydrogel-based dressing advantageous for the prevention of medical device-related pressure ulcers.
The synergistic influences of geometrical, mechanical and thermal mismatches between a skin-contacting medical device and the skin may cause tissue stress concentrations and sharp temperature gradients, both of which contribute to the risk for medical device-related pressure ulcers. In this work, we developed an innovative, integrated experimental bioengineering approach encompassing mechanical stiffness, friction and thermal property studies for testing the biomechanical suitability of a hydrogel-based dressing in prophylaxis of injuries caused by devices. We characterised the viscoelastic stress relaxation of the dressing and determined its long-term elastic modulus. We further measured the coefficient of friction of the hydrogel-based dressing at dressing-device and skin-dressing interfaces, using a tilting-table tribometer. Lastly, we measured the thermal conductivity of the dressing, using a heat-flow meter and infrared thermography-based method. All measurements considered dry and moist conditions, the latter simulating skin perspiration effects. Our results revealed that the long-term stiffness and the thermal conductivity of the hydrogel-based dressing matched the corresponding properties of human skin for both dry and moist conditions. The dressing further demonstrated a relatively high coefficient of friction at its skin-facing and device-facing aspects, indicating minimal frictional sliding. All these properties make the above dressing advantageous for prevention of device-related injuries.


[Long-term effects of environmental endocrine disruptors on male fertility].
Several epidemiologic studies have demonstrated during the last 50 years an increased incidence in testis cancer, male genital tract malformations (cryptorchidism and hypospadias) and a decrease in sperm quality in men. These three pathologies seem to be linked and to belong to the testicular dysgenesis syndrome (TDS). It was suggested that TDS is a consequence of intra-uterine exposure to environmental compounds that disrupt the metabolism of native hormones. Such substances are so called endocrine disruptors (EDs). EDs are present in our daily environment such as food and water (through the use of pesticides), cosmetics, house-care products etc. Experimental models have been carried out to (i) establish a link between EDs exposure and SDT and (ii) identify the mechanisms that are involved in. After a brief definition of EDs and having underlined the importance of the window of exposure to EDs, several mechanisms will be described such as (i) intergenerational transmission (epigenetic), (ii) programmed cell death of testicular cells, (iii) modification of the androgenic signal and (iv) role of the germ cells-nourishing cells. To conclude, we will try to propose some biomarkers that would be useful to identify the potential link between fetal exposure to anti-androgenic EDs and male testicular pathology.


Identification of Mycobacterium tuberculosis in pulmonary and extrapulmonary specimens of Iranian hospitalized patients during 2017-2021.
Tuberculosis (TB) is one of the most serious public health problems worldwide which is a chronic infectious disease and is still one of the major challenges for developing countries. This study was undertaken to identify Mycobacterium TB (MTB) in clinical specimens in hospitalized patients. The study was carried out on specimens from pulmonary and extrapulmonary suspected TB patients that were admitted to one of the largest tertiary hospitals located in Tehran, Iran from 2017 to 2021. The GeneXpert MTB/rifampin (RIF) method was applied to detect MTB and RIF resistance. Characteristics of demography, clinical features, and lifestyle were obtained from medical case records registered in the hospital. Of 957 specimens, 92 (9.61%) were found positive for TB by GeneXpert assay. Of positive samples, 72 (78.26%) were considered pulmonary TB, and 20 (21.73%) of them are associated with extrapulmonary involvement. Four (4.3%) positive TB cases were categorized as rifampicin-resistant. This study showed a relatively high incidence rate of TB in distinct types of specimens in Iranian hospitalized patients but a low level of RIF resistance.


All-trans-retinoic acid activates SDF-1/CXCR4/ROCK2 signaling pathway to inhibit chondrogenesis.
Recent studies have indicated that ATRA inhibits chondrogenesis and can lead to congenital clubfoot (CCF). The molecular mechanism of ATRA-induced chondrogenesis is not clear. As RhoA/ROCK and SDF-1/CXCR4 signaling play important molecular roles for a variety of cellular processes, we hypothesized that RhoA/ROCK2 and SDF-1/CXCR4 signaling are involved in ATRA-induced chondrogenesis in rat embryo hind limb bud mesenchymal cells (rEHBMCs). We found that ATRA dose-dependently inhibits proliferation and expression of chondrogenic transcription factors (SOX9 and COL2A1) in rEHBMCs. In contrast, ATRA increases the expression of ROCK2, SDF-1 and CXCR4. Pharmacological inhibition of ROCK signaling and SDF-1/CXCR4 signaling by Y27632 and AMD3100, respectively, resulted in elevated expression of SOX9 and COL2A1. In addition, we found that disturbing SDF-1/CXCR4 signaling by AMD3100 decreases ATRA-induced ROCK2 expression. In vivo studies we also confirm that SOX9 expression of early-stage cartilage progenitors in the proliferative zone and COL2A1 expression in prehypertrophic chondrocytes are decreased in ATRA-treated rat embryo hind limb. Together, these results show that ATRA activates SDF-1/CXCR4/ROCK2 signaling to inhibit chondrogenesis to lead to CCF by suppressing differentiation through down-regulation of SOX9 and COL2A1 expression in rat embryo hind limb bud mesenchymal cells.


Chemosensory danger detection in the human brain: Body odor communicating aggression modulates limbic system activation.
Although the sense of smell is involved in numerous survival functions, the processing of body odor emitted by dangerous individuals is far from understood. The aim of the study was to explore how human fight chemosignals communicating aggression can alter brain activation related to an attentional bias and danger detection. While the anterior cingulate cortex (ACC) was seen involved in processing threat-related emotional information, danger detection and error evaluation, it still remains unknown whether human chemosignals communicating aggression can potentially modulate this activation. In the fMRI experiment, healthy male and female normosmic odor recipients (n=18) completed a higher-order processing task (emotional Stroop task with the word categories anger, anxiety, happiness and neutral) while exposed to aggression and exercise chemosignals (collected from a different group of healthy male donors; n=16). Our results provide first evidence that aggression chemosignals induce a time-sensitive attentional bias in chemosensory danger detection and modulate limbic system activation. During exposure to aggression chemosignals compared to exercise chemosignals, functional imaging data indicates an enhancement of thalamus, hypothalamus and insula activation (p<.05, FWE-corrected). Together with the thalamus, the ACC was seen activated in response to threat-related words (p<.001). Chemosensory priming and habituation to body odor signals are discussed.


My Command, My Act: Observation Inflation in Face-To-Face Interactions.
When observing another agent performing simple actions, these actions are systematically remembered as one's own after a brief period of time. Such observation inflation has been documented as a robust phenomenon in studies in which participants passively observed videotaped actions. Whether observation inflation also holds for direct, face-to-face interactions is an open question that we addressed in two experiments. In Experiment 1, participants commanded the experimenter to carry out certain actions, and they indeed reported false memories of self-performance in a later memory test. The effect size of this inflation effect was similar to passive observation as confirmed by Experiment 2. These findings suggest that observation inflation might affect action memory in a broad range of real-world interactions.


[Replacing the tuberculin skin test with a specific blood test].
For almost 100 years has the tuberculin skin test (TST) been used for the support the diagnosis of active and latent TB infection. The TST test has, however, a number of limitations most notable low specificity in BCG vaccinated individuals due to cross-reactive components in PPD and the M. bovis BCG vaccine strain and an intensive search for new and more specific diagnostic antigens has therefore be ongoing. In this review we describe the discovery process leading to the identification of the M. tuberculosis specific antigens ESAT6 and CFP10; two low molecular weight proteins which are highly sensitive and specific for detection of a M. tuberculosis infection.


Incidence and mortality of malignant melanoma in Berlin (West) from 1980 to 1986.
Newly diagnosed melanomas were investigated utilizing the histological reports from the 4 Departments of dermatology as well as from 3 Departments of pathology in Berlin (West) during the years 1980-86. The study included 960 melanomas and documented the histological features, age, gender and nationality of the patients involved. 936 patients were Germans (379 males, 557 females), and the mean age-adjusted incidence rate (for the European standard population) was 7.1 cases per 100,000 inhabitants and year for both genders with an increase between 1980-81 and 1985-86 in men from 6.0 to 9.8 and in women from 5.8 to 7.8/100,000 and year. Thus a 49% increase in incidence was observed for both genders combined during a 5-year period. In this study, a preponderance of male incidence rates was observed for the first time in Germany. Interestingly, the age-adjusted incidence rate for the Turkish population, which is the largest foreign population with more than 100,000 inhabitants in Berlin, was only 1.3/100,000 and year. 162 men and 145 women died of melanoma in the time period examined. From 1980-81 to 1985-86, the age-adjusted mortality rate changed from 3.5 to 2.6 for men and from 1.2 to 1.6 for women per 100,000 and year, thus revealing a slight decrease in mortality for both genders combined.


Cross-Cultural Adaptation of Mediterranean Diet Adherence Screener (MEDAS) Into Moroccan Arabic to Measure the Degree of Mediterranean Diet Adherence.
Background The Mediterranean diet (MD) has been recognized by several studies as beneficial for health improvement. The degree of adherence to this diet has also been evaluated using several scales, particularly time-consuming measures such as the Food Frequency Questionnaire (FFQ). This study aims to (a) adapt into Moroccan Arabic the 14-item Mediterranean Diet Adherence Screener (MEDAS), which is a simple and brief tool that assesses the degree of diet adherence and was used in the Prevencion con Dieta Mediterranea (PREDIMED) study, and (b) determine its psychometric properties. Methods MEDAS consists of 12 questions on food frequency and two on dietary habits, with each question scoring 0 or 1. To translate and adapt the scale, Beaton et al.'s six-step cross-cultural adaptation process guidelines were followed. The screener's psychometric properties were tested on staff at the CHU Mohammed VI (Tangier), i.e., the hospital's administrative and maintenance staff, excluding medical and paramedical personnel. Internal consistency was evaluated using the Kuder-Richardson 21 (K-R 21) formula, while test-retest reliability was assessed using the intraclass correlation coefficient (ICC). Moreover, criterion validity was performed using the Spearman correlation between the MEDAS and the MedQ-Sus scores. Discrimination performance was also tested using the receiving operating characteristic (ROC) curve. Results The validation study included 160 participants who completed both questionnaires. The K-R 21 formula estimated strong internal consistency in the range of 0.851. The ICC of test-retest reliability was significant at 0.876 95% CI [0.831-0.909]. The MEDAS score correlated significantly with the comparative MedQ-Sus score (Spearman's rho = 0.494 95% CI [0.363-0.606], p < 0.001). Also, MEDAS can strongly distinguish between MD adherence and non-adherence (optimal cut-off = 7.5, sensitivity 0.81, specificity = 0.57), with an area under the curve (AUC) value of 0.743 95% CI [0.667-0.819], p < 0.001. Conclusion The results showed that MEDAS is a valid and time-saving instrument for assessing adherence to the MD in the Moroccan population.


Estrogen and progesterone receptor expression in the mammary gland tumors.
In the primary mammary malignant tumors, including in situ carcinoma, it is recommended the carrying out of immunohistochemical diagnosis for the estrogen (ER) and the progesterone receptors (PR). We have studied the ER and the PR expression in malignant tumors, trying to identify the corresponding phenotypes according to the presence of these tumors. We have carried out a study on a total number of 80 carcinomas, divided into two groups: the first one constituted of 54 cases of carcinomas on which we had clinical data, and another group, constituted of 26 cases of mammary carcinoma, where no clinical data was available. We have observed that the values and the distribution of the ER and PR taken from the biopsies made in the patients with mammary carcinoma are influenced by the age and menopausal status. The combination of the ER/PR results lead to the definition of many tumoral phenotypes.


Effects of desipramine on clinical liver function tests.
Results of liver function tests in 46 depressed patients changed little during treatment with desipramine and were uncorrelated with drug plasma levels. The findings suggest that tricyclic-associated hepatitis, rather than being dose dependent, is an uncommon, idiosyncratic phenomenon.


Visual attention for social information and salivary oxytocin levels in preschool children with autism spectrum disorders: an eye-tracking study.
This study was designed to ascertain the relationship between visual attention for social information and oxytocin (OT) levels in Japanese preschool children with autism spectrum disorder (ASD). We hypothesized that poor visual attention for social information and low OT levels are crucially important risk factors associated with ASD. We measured the pattern of gaze fixation for social information using an eye-tracking system, and salivary OT levels by the Enzyme-Linked Immunosorbent Assay (ELISA). There was a positive association between salivary OT levels and fixation duration for an indicated object area in a finger-pointing movie in typically developing (TD) children. However, no association was found between these variables in children with ASD. Moreover, age decreased an individual's attention to people moving and pointed-at objects, but increased attention for mouth-in-the-face recognition, geometric patterns, and biological motions. Thus, OT levels likely vary during visual attention for social information between TD children and those with ASD. Further, aging in preschool children has considerable effect on visual attention for social information.


Concordance Between Anticholinergic Burden Scales.
To evaluate concordance of five commonly used anticholinergic scales. Cross-sectional secondary analysis. Pittsburgh, Pennsylvania, and Memphis, Tennessee. Community-dwelling adults aged 70 to 79 with baseline medication data from the Health, Aging, and Body Composition Study (N = 3,055). Any anticholinergic use, weighted scores, and total standardized daily dosage were calculated using five anticholinergic measures (Anticholinergic Cognitive Burden (ACB) Scale, Anticholinergic Drug Scale (ADS), Anticholinergic Risk Scale (ARS), Drug Burden Index anticholinergic component (DBI-ACh), and Summated Anticholinergic Medications Scale (SAMS)). Concordance was evaluated using kappa statistics and Spearman rank correlations. Any anticholinergic use in rank order was 51% for the ACB, 43% for the ADS, 29% for the DBI-ACh, 23% for the ARS, and 16% for the SAMS. Kappa statistics for all pairwise use comparisons ranged from 0.33 to 0.68. Similarly, concordance as measured using weighted kappa statistics ranged from 0.54 to 0.70 for the three scales not incorporating dosage (ADS, ARS, ACB). Spearman rank correlation between the DBI-ACh and SAMS was 0.50. Only low to moderate concordance was found between the five anticholinergic scales. Future research is needed to examine how these differences in measurement affect their predictive validity with respect to clinically relevant outcomes, such as cognitive impairment.


Superoxide initiates oxidation of low density lipoprotein by human monocytes.
Human mononuclear cells were used to evaluate the role of superoxide in the oxidation of low density lipoprotein (LDL). Unstimulated cells produced little superoxide or LDL oxidation as assayed by lipid peroxide content. Stimulation of the cells with phorbol myristate acetate (PMA) resulted in an increase both in superoxide production and in LDL oxidation. Mononuclear cell-mediated LDL oxidation was time- and cell number-dependent and was markedly enhanced by the presence of Fe (10 microM). Superoxide was required for the initiation of LDL oxidation as indicated by inhibition of the reaction by early addition of superoxide dismutase (SOD). Propagation of LDL oxidation was superoxide-independent, since the later addition of SOD resulted in progressively less inhibition of LDL oxidation. Propagation of LDL oxidation also was, in part, cell-independent as indicated by continued oxidation of LDL when mononuclear cells were removed following a 1 to 8 hour period with cells. Optimal LDL oxidation required the presence of mononuclear cells throughout the incubation period, suggesting that cellular factors in addition to superoxide play a role in LDL oxidation. Further evidence for the role of superoxide in the oxidation of LDL by mononuclear cells was obtained with cells from patients with genetic deficiencies of either superoxide generation (chronic granulomatous disease) or myeloperoxidase. PMA-stimulated cells from a patient with chronic granulomatous disease neither generated superoxide nor modified LDL. Incubation of LDL with cells from a patient with myeloperoxidase deficiency (in which superoxide production is normal or increased) resulted in oxidation of the lipoprotein equivalent to that observed with normal cells. Other inhibitors of oxidation reactions also were tested.(ABSTRACT TRUNCATED AT 250 WORDS)


GAMETIC INCOMPATIBILITY BETWEEN SPECIES OF THE SEA URCHIN ECHINOMETRA ON THE TWO SIDES OF THE ISTHMUS OF PANAMA.
The Pliocene rise of the Central American Isthmus has resulted in numerous "geminate pairs," i.e., closely related species, one on each coast. Such species pairs can provide information on the evolution of isolating mechanisms in allopatry and on the relationship between genetic divergence and reproductive isolation in populations separated at a known time. The sea urchin genus Echinometra has one species, E. vanbrunti, in the eastern Pacific, and two, E. lucunter and E. viridis, in the Caribbean. E. viridis is morphologically distinct from the other two species, leading to the conclusion that E. lucunter and E. vanbrunti constitute a geminate pair. Allozyme data, on the other hand, place the speciation event of the two currently sympatric species after the rise of the Isthmus. We report fertilization experiments between the gametes of the three species performed to determine degree of reproductive isolation. Crosses between E. viridis and E. vanbrunti produce rates of fertilization almost equal to those manifested in homogamic crosses. Sperm of E. lucunter can fertilize eggs of the other two species, but few of its eggs permit fertilization by heterospecific sperm. Contrary to the predictions of the "speciation by reinforcement" hypothesis, degree of incompatibility between the allopatric E. lucunter and E. vanbrunti is higher than between the sympatric E. lucunter and E. viridis. Despite the incomplete and unidirectional nature of their gametic isolation, E. lucunter and E. viridis maintain their genetic integrities. Consideration of the likely phylogenetic relationships between the three species suggests that incompatibility of E. lucunter eggs with heterospecific sperm has evolved in the last 3.5 million years, after the rise of the Isthmus. There is no correlation between genetic divergence and strength of reproductive isolation, either within Echinometra, or among the geminate species pairs of echinoids that have been studied to date. Because recognition between echinoid gametes depends on the chemical compositions of a sperm protein and an egg glycoprotein, the appearance of gametic isolation would require only the fixation of a few mutations in each population on either side of a geographic barrier and could be independent of any other kind of genetic divergence. Thus, in animals with external fertilization, speciation need not be accompanied by major genomic reorganization.


Impaired potency of bone marrow mononuclear cells for inducing therapeutic angiogenesis in obese diabetic rats.
Using Zucker fatty rats, a strain characterized by diabetes and hyperlipidemia, we investigated the diabetes- and hyperlipidemia-related impairment of bone marrow mononuclear cells (BMCs) for inducing therapeutic angiogenesis. BMCs from Zucker fatty and normal Zucker lean rats were collected and cultured. Although the characterization and cell survival of BMCs did not differ, the VEGF production, endothelial differentiation, and endothelial cell colony-forming potential of BMCs from Zucker fatty rats were significantly lower than those of BMCs from lean rats. By using an ischemic hindlimb model, we found that the native recovery of induced limb ischemia in the Zucker fatty rats was also significantly worse than that in the lean rats. Furthermore, the expression of 5-hydroxytryptamine (5-HT(2A)) receptors was obviously higher in the Zucker fatty rats than that in the lean rats and was enhanced after limb ischemia. Although the therapeutic potency was lower than with the implantation of BMCs from normal lean rats, the implantation of BMCs from fatty rats could also induce angiogenesis and increase blood flow significantly in the ischemic hindlimbs of Zucker fatty rats. Furthermore, the blood flow in the ischemic hindlimbs was increased by the administration of sarpogrelate, a selective 5-HT(2A)-receptor antagonist. Our results clearly show diabetes- and hyperlipidemia-related dysfunction and impaired potency for inducing angiogenesis of BMCs. However, the implantation of autologous BMCs into ischemic limbs of diabetic and hyperlipidemic rats has induced therapeutic angiogenesis effectively, and blood flow would be enhanced by the administration of a 5-HT(2A)-receptor antagonist.


Autistic spectrum disorders.
Autistic spectrum disorders (ASD), are a group of disorders characterised by qualitative abnormalities in social and emotional behaviour and are associated with restricted, stereotyped and repetitive interests and activities. There has been considerable understanding of ASD in recent years. This educational review paper focuses on four areas of interest and relevance to trainees preparing for the membership examination of the Royal College of Psychiatrists (MRCPsych): (a) diagnosing ASD; (b) epidemiology of ASD; (c) aetiology, including genetic, cognitive and neurochemical/neuropathological theories in ASD; and (d) treatment of ASD. Relevant papers are discussed and recommendations for further reading are provided.


A time for change of tooth numbering systems.
Tooth numbering provides dentists with an essential shortcut in clinical record-keeping. Today, three systems are favored worldwide: the Zsigmondy/Palmer system, the universal system, and the FDI two-digit system. Histories of these tooth numbering methods are traced, and the strengths and deficiencies of each are discussed. The FDI two-digit system-used throughout the world, but not in the USA-is the only method that makes visual sense, cognitive sense, and computer sense. It deserves consideration by American dentists as our official tooth numbering system.


Advance Directives for Refusing Life-Sustaining Treatment in Dementia.
Aid-in-dying laws in the United States have two important restrictions. First, only patients who are terminally ill, defined as having a prognosis of six months or less to live, qualify. Second, at the time the patients take the lethal medication, they must be competent to make medical decisions. This means that an advance directive requesting aid in dying for a later time when the patient lacks decision-making capacity would be invalid. However, many people are more concerned about avoiding living into severe dementia for years-a time when they will lack decision-making capacity-than they are about preventing suffering or the loss of dignity or autonomy for a few months at the end of life. Gillian Bennett is an example of someone determined not to live into severe dementia. She opted for preemptive suicide in 2014, explaining why in a letter she posted online: "Every day I lose bits of myself, and it's obvious that I am heading toward the state that all dementia patients eventually get to: not knowing who I am and requiring full-time care." A major problem with Bennett's solution, however, is that the individual is likely thereby to be giving up some "good time." A legal alternative to preemptive suicide is to create an advance directive stating the circumstances under which one wants not to receive any lifesaving or life-sustaining treatment, even the most basic and noninvasive. This option is our focus in this paper: how to create effective advance directives to avoid living into severe dementia. To be relevant to progressive dementia, the directive would need to state what kinds of care should be withheld and when. At the same time, advance directives for severe dementia face serious challenges. Before addressing these, we review the normative force of directives themselves.


Effectiveness of vertical ridge augmentation interventions: A systematic review and meta-analysis.
The primary aim of this systematic review was to evaluate the effect of various techniques used for vertical ridge augmentation on clinical vertical bone gain. A protocol was developed to answer the following focused question: "In patients with vertical alveolar ridge deficiencies, how effective are different augmentation procedures for clinical alveolar ridge gain?" Randomized and controlled clinical trials and prospective and retrospective case series were included, and meta-analyses were performed to evaluate vertical bone gain based on the type of procedure and to compare bone gains in controlled studies. Thirty-six publications were included. Results demonstrated a significant vertical bone gain for all treatment approaches (n = 33; weighted mean effect = 4.16 mm; 95% CI 3.72-4.61; p < 0.001). Clinical vertical bone gain and complications rate varied among the different procedures, with a weighted mean gain of 8.04 mm and complications rate of 47.3% for distraction osteogenesis, 4.18 mm and 12.1% for guided bone regeneration (GBR), and 3.46 mm and 23.9% for bone blocks. In comparative studies, GBR achieved a significant greater bone gain when compared to bone blocks (n = 3; weighted mean difference = 1.34 mm; 95% CI 0.76-1.91; p < 0.001). Vertical ridge augmentation is a feasible and effective therapy for the reconstruction of deficient alveolar ridges, although complications are common.


Modulation detection interference in listeners with normal and impaired hearing.
Listeners were asked to detect amplitude modulation (AM) of a target (or signal) carrier that was presented in isolation or in the presence of an additional (masker) carrier. The signal was modulated at a rate of 10 Hz, and the masker was unmodulated or was modulated at a rate of 2, 10, or 40 Hz. Nine listeners had normal hearing, 4 had a bilateral hearing loss, and 4 had a unilateral hearing loss; those with a unilateral loss were tested in both ears. The listeners with a hearing loss had normal hearing at 1 kHz and a 30- to 40-dB loss at 4 kHz. The carrier frequencies were 984 and 3952 Hz. In one set of conditions, the lower frequency carrier was the signal and the higher frequency carrier was the masker. In the other set, the reverse was true. For the impaired ears, the carriers were presented at 70 dB SPL. For the normal ears, either the carriers were both presented at 70 dB SPL or the higher frequency carrier was reduced to 40 dB SPL to simulate the lower sensation level experienced by the impaired ears. There was considerable individual variability in the results, and there was no clear effect of hearing loss. These results suggest that a mild, presumably cochlear hearing loss does not affect the ability to process AM in one frequency region in the presence of competing AM from another region.


Childhood cognitive ability and risk of late-onset Alzheimer and vascular dementia.
Risk factors for dementia can be divided into those that lead to pathologic insults and those that render the brain more vulnerable to such insults. Dementia prevention strategies need to be informed as to whether to prioritize reducing risk of pathology or to reduce the vulnerability of the brain to pathologic insult. Lower premorbid cognitive ability is associated with both increased vascular risk and reduced cognitive reserve, a measure of brain vulnerability. We investigated differential effects of premorbid cognitive ability on dementia subtypes to clarify which causal pathway was predominant. A total of 297 cases of late onset dementia were identified from local case registers, born in 1921, and thus may have participated in the Scottish Mental Survey of 1932 (SMS1932). A total of 183 had mental ability scores identified in the SMS1932. A total of 173 of these were matched by birth records to one set of controls (controls1) by date of birth, sex, and district of birth registration. A further set of controls (controls2) was generated additionally matched on paternal occupation. Vascular dementia cases had significantly lower premorbid cognitive ability (OR 0.62, 95% CI 0.41-0.94, for every 10-point increase [0.7 SD] in mental ability score vs controls2), but there was no significant difference in the premorbid cognitive ability of Alzheimer disease cases (OR 1.02, 95% CI 0.82-1.28) vs controls2. Lower premorbid cognitive ability is a risk factor for vascular dementia, but not Alzheimer disease. This suggests its effect acts mainly through vascular pathology rather than brain vulnerability.


Exhaled breath temperature increases during mild exacerbations in children with virus-induced asthma.
Exhaled breath temperature (EBT) has been suggested as a non-invasive surrogate marker of airway inflammation in asthma. The aim of the study was to evaluate differences in EBT between periods of controlled disease and during exacerbations in children with virus-induced asthma. Twenty-nine children (aged 6-14 years) with a history of intermittent, virus-induced asthma were included in this case-control study. Cases presented with a common cold and/or mild exacerbation of asthma, while controls were free of asthmatic or common cold symptoms during the previous 6 weeks. A baseline questionnaire was obtained. Atopy assessment, central temperature and a spirometric measurement were recorded. EBT was measured with a new device (Delmedica, Singapore). A nasal wash (for identification of common respiratory viruses) was obtained. Twenty-four children (12 from each group) completed the study. Groups were homogeneous with respect to baseline characteristics. PCR revealed the presence of a virus in 3 out of 17 controls and 10 out of 12 cases (17.6 and 83.3%, respectively, p = 0.002). The most commonly identified virus was rhinovirus (3/3 controls and 7/10 cases, p = 0.02). EBT values were significantly higher for cases (34.91 +/- 0.62 degrees C) compared to controls (34.18 +/- 1.1 degrees C, p = 0.032). No important differences were observed in the increase rate of EBT (Deltae degrees T) between groups. Changes in airway inflammation during virus-induced asthma exacerbations are reflected in EBT changes. These preliminary data suggest a possible role of EBT measurements in the assessment of airway inflammation in children with virus-induced asthma.


Standardization of allergenic extracts: a manufacturer's perspective.
The current procedure for standardizing allergenic extracts utilizes quantitative skin testing techniques and in vitro techniques. A reference preparation is selected and tested using a sensitive intradermal skin test technique to determine allergy units. Subsequent batches of standardized extracts are compared to the reference preparation using in vitro techniques. The standardization program has accelerated over the past few years and all indications are that it will continue to do so in the future.


A field demonstration of the simulation optimization approach for remediation system design.
While significant progress has been made in the theoretical development of the simulation/optimization (S/O) approach for ground water remediation design, its application to large, field-scale problems has remained limited. To demonstrate the applicability and usefulness of the S/O approach under real field conditions, an optimization demonstration project was conducted at the Massachusetts Military Reservation in Cape Cod, Massachusetts, involving the design of a pump-and-treat system for the containment and cleanup of a large trichloroethylene (TCE) plume. The optimization techniques used in this study are based on evolutionary algorithms coupled with a response function approach for greater computational efficiency. The S/O analysis was performed parallel to a conventional trial-and-error analysis based on simulation alone. The results of this study demonstrate that not only would it be possible to remove more TCE mass under the same amount of pumping assumed in the trial-and-error design, but also substantial cost savings could be achieved by reducing the number of wells needed and adapting dynamic pumping. In spite of the large model size of more than 500,000 nodes and a long planning horizon of 30 years, the optimization modeling was carried out successfully on desktop PCs. This field demonstration project clearly illustrates the potential benefits of applying optimization techniques in remediation system design.


Nematode symbiont for Photorhabdus asymbiotica.
Photorhabdus asymbiotica is an emerging bacterial pathogen that causes locally invasive soft tissue and disseminated bacteremic infections in the United States and Australia. Although the source of infection was previously unknown, we report that the bacterium is found in a symbiotic association with an insect-pathogenic soil nematode of the genus Heterorhabditis.


RBoost: Label Noise-Robust Boosting Algorithm Based on a Nonconvex Loss Function and the Numerically Stable Base Learners.
AdaBoost has attracted much attention in the machine learning community because of its excellent performance in combining weak classifiers into strong classifiers. However, AdaBoost tends to overfit to the noisy data in many applications. Accordingly, improving the antinoise ability of AdaBoost plays an important role in many applications. The sensitiveness to the noisy data of AdaBoost stems from the exponential loss function, which puts unrestricted penalties to the misclassified samples with very large margins. In this paper, we propose two boosting algorithms, referred to as RBoost1 and RBoost2, which are more robust to the noisy data compared with AdaBoost. RBoost1 and RBoost2 optimize a nonconvex loss function of the classification margin. Because the penalties to the misclassified samples are restricted to an amount less than one, RBoost1 and RBoost2 do not overfocus on the samples that are always misclassified by the previous base learners. Besides the loss function, at each boosting iteration, RBoost1 and RBoost2 use numerically stable ways to compute the base learners. These two improvements contribute to the robustness of the proposed algorithms to the noisy training and testing samples. Experimental results on the synthetic Gaussian data set, the UCI data sets, and a real malware behavior data set illustrate that the proposed RBoost1 and RBoost2 algorithms perform better when the training data sets contain noisy data.


Stereotactic Volume Modulated Arc Radiotherapy in Canine Meningiomas: Imaging-Based and Clinical Neurological Posttreatment Evaluation.
A prospective study to assess high-dose hypofractionated volume modulated arc radiotherapy feasibility and efficacy in canine meningiomas was conducted. Thirty-nine patients with encephalic and spinal meningiomas assumed from MRI findings were recruited and received high-dose hypofractionated volumetric modulated arc radiotherapy by a linear accelerator equipped with an external beam modulator micro-multileaf collimator and an XVI cone beam computed tomography system. The prescribed mean dose was 33 Gy in five fractions. The treatment feasibility was tested through planned and delivered dose agreement checks. Regular clinical examinations were performed during and after irradiation time, with regard to mentation, deambulation, cranial nerve dysfunction, and seizures. Serial MRI exams were done 60 days after irradiation and after 4, 6, 12, 18, and 24 mo. Volumetric disease reduction criteria implemented with clinical neurological systematic evaluation were adopted to assess the course and to categorize patients' responses. Complete and partial responses were observed on the whole in 65.5% of alive patients 24 mo after irradiation. Two-yr overall and disease-specific survival rates were 74.3% and 97.4%, respectively, and the putative radiotoxic effects were found to be few and slight.


Control of aldehyde emissions in the diesel engines with alcoholic fuels.
The major pollutants emitted from compression ignition (CI) engine with diesel as fuel are smoke and nitrogen oxides (NOx). When the diesel engine is run with alternate fuels, there is need to check alcohols (methanol or ethanol) and aldehydes also. Alcohols cannot be used directly in diesel engine and hence engine modification is essential as alcohols have low cetane number and high latent hear of vaporization. Hence, for use of alcohol in diesel engine, it needs hot combustion chamber, which is provided by low heat rejection (LHR) diesel engine with an air gap insulated piston with superni crown and air gap insulated liner with superni insert. In the present study, the pollution levels of aldehydes are reported with the use of methanol and ethanol as alternate fuels in LHR diesel engine with varying injection pressure, injection timings with different percentage of alcohol induction. The aldehydes (formaldehyde and acetaldehyde) in the exhaust were estimated by wet chemical technique with high performance liquid chromatograph (HPLC). Aldehyde emissions increased with an increase in alcohol induction. The LHR engine showed a decrease in aldehyde emissions when compared to conventional engine. However, the variation of injection pressure showed a marginal effect in reducing aldehydes, while advancing the injection timing reduced aldehyde emissions.


Treating Central Catheter-Associated Bacteremia Due to Methicillin-Resistant Staphylococcus aureus: Beyond Vancomycin.
Methicillin-resistant Staphylococcus aureus is a frequent cause of hospital-associated infections, including central catheter-associated bacteremia. Vancomycin has been the drug of choice for treating this type of bacteremia for decades in patients who have no contraindications to the antibiotic. However, resistance to vancomycin is an emerging problem. Newer antibiotics approved by the Food and Drug Administration have activity against methicillin-resistant S aureus Some of the antibiotics also have activity against strains of S aureus that are intermediately susceptible or resistant to vancomycin. This article uses a case study to highlight the clinical signs of vancomycin failure and describes the indications for and appropriate use of alternative antimicrobials such as ceftaroline, daptomycin, linezolid, tigecycline, and telavancin. (Critical Care Nurse 2016;36[4]:46-57).


The gene for retinal rod 33-kDa protein is on mouse chromosome 1, near Lamb2.
A water-soluble protein (called "33-kDa protein") that exhibits light-dependent phosphorylation has been shown to be a major protein of mammalian rod photoreceptors. Although the function of this protein is unknown, it has been implicated in the biochemical cascade mediating the rod visual response. Using a retinal cDNA from the rat and somatic cell hybrids, we have mapped the gene corresponding to this protein to mouse Chromosome 1 and, by analyzing the progeny of an intersubspecific backcross, have positioned it near Lamb2 (the beta 2 chain of laminin). We have designated the gene Rpr-1 (rod photoreceptor protein-1).


[Molecular genetics of cardiovascular diseases].
This review introduces recent progress in molecular genetics of cardiovascular diseases. Many genes and their mutations causing familial cardiovascular diseases have been discovered, including familial hypertrophic cardiomyopathy which is caused by mutated cardiac beta myosin heavy chain, light chains, troponin T, troponin I, or alpha-tropomyosin, and long QT syndrome by KvLQT1, HERG, minK or cardiac voltage-dependent Na channel mutation. The mutations in causative genes can affect clinical courses of diseases; amino acid substitutions of cardiac beta myosin heavy chain with charge changes seem to cause poorer prognosis of hypertrophic cardiomyopathy. Besides monogenic diseases, there are many cardiovascular diseases affected with genetic polymorphisms, such as hypertension, ischemic heart disease and atherosclerosis. Specific amino acid mutations or polymorphisms in the promoter region of the genes are known to become a risk factor of these diseases. Polymorphisms of genes encoding apolipoprotein E, angiotensin converting enzyme, angiotensinogen and endothelial NO synthase (ecNOS) have been well characterized as an important risk factor of cardiovascular diseases. We recently found a novel gene which seems to affect human aging phenotype and vascular endothelial function. It is important as a future study to clarify the regulatory mechanisms of the klotho gene in the cardiovascular system and the clinical significance of klotho gene polymorphisms.


Paired gap states in a semiconducting carbon nanotube: deep and shallow levels.
Several paired, localized gap states were observed in semiconducting single-wall carbon nanotubes using spatially resolved scanning tunneling spectroscopy. A pair of gap states is found far from the band edges, forming deep levels, while the other pair is located near the band edges, forming shallow levels. With the help of a first-principles study, the former is explained by a vacancy-adatom complex while the latter is explained by a pentagon-heptagon structure. Our experimental observation indicates that the presence of the gap states provides a means to perform local band-gap engineering as well as doping without impurity substitution.


Dental health behaviors, dentition, and mortality in the elderly: the leisure world cohort study.
In the last decade the effect of oral health on the general health and mortality of elderly people has attracted attention. We explored the association of dental health behaviors and dentition on all-cause mortality in 5611 older adults followed from 1992 to 2009 (median = 9 years) and calculated risk estimates using Cox regression analysis in men and women separately. Toothbrushing at night before bed, using dental floss everyday, and visiting the dentist were significant risk factors for longevity. Never brushing at night increased risk 20-35% compared with brushing everyday. Never flossing increased risk 30% compared with flossing everyday. Not seeing a dentist within the last 12 months increased risk 30-50% compared with seeing a dentist two or more times. Mortality also increased with increasing number of missing teeth. Edentulous individuals (even with dentures) had a 30% higher risk of death compared with those with 20+ teeth. Oral health behaviors help maintain natural, healthy and functional teeth but also appear to promote survival in older adults.


Theory of pressure acoustics with thermoviscous boundary layers and streaming in elastic cavities.
We present an effective thermoviscous theory of acoustofluidics including pressure acoustics, thermoviscous boundary layers, and streaming for fluids embedded in elastic cavities. By including thermal fields, we thus extend the effective viscous theory by Bach and Bruus [J. Acoust. Soc. Am. 144, 766 (2018)]. The acoustic temperature field and the thermoviscous boundary layers are incorporated analytically as effective boundary conditions and time-averaged body forces on the thermoacoustic bulk fields. Because it avoids resolving the thin boundary layers, the effective model allows for numerical simulation of both thermoviscous acoustic and time-averaged fields in three-dimensional models of acoustofluidic systems. We show how the acoustic streaming depends strongly on steady and oscillating thermal fields through the temperature dependency of the material parameters, in particular the viscosity and the compressibility, affecting both the boundary conditions and spawning additional body forces in the bulk. We also show how even small steady temperature gradients ( ∼1 K/mm) induce gradients in compressibility and density that may result in very high streaming velocities ( ∼1 mm/s) for moderate acoustic energy densities ( ∼100 J/m3).


Effects of the Informed Health Choices podcast on the ability of parents of primary school children in Uganda to assess claims about treatment effects: a randomised controlled trial.
As part of the Informed Health Choices project, we developed a podcast called The Health Choices Programme to help improve the ability of people to assess claims about the benefits and harms of treatments. We aimed to evaluate the effects of the podcast on the ability of parents of primary school children in Uganda to assess claims about the effects of treatments. We did this randomised controlled trial in central Uganda. We recruited parents of children aged 10-12 years who were in their fifth year of school at 35 schools that were participating in a linked trial of the Informed Health Choices primary school resources. The parents were randomly allocated (1:1), via a web-based random number generator with block sizes of four and six, to listen to either the Informed Health Choices podcast (intervention group) or typical public service announcements about health issues (control group). Randomisation was stratified by parents' highest level of formal education attained (primary school, secondary school, or tertiary education) and the allocation of their children's school in the trial of the primary school resources (intervention vs control). The primary outcome, measured after listening to the entire podcast, was the mean score and the proportion of parents with passing scores on a test with two multiple choice questions for each of nine key concepts essential to assessing claims about treatments (18 questions in total). We did intention-to-treat analyses. This trial is registered with the Pan African Clinical Trial Registry, number PACTR201606001676150. We recruited parents between July 21, 2016, and Oct 7, 2016. We randomly assigned 675 parents to the podcast group (n=334) or the public service announcement group (n=341); 561 (83%) participants completed follow-up. The mean score for parents in the podcast group was 67·8% (SD 19·6) compared with 52·4% (17·6) in the control group (adjusted mean difference 15·5%, 95% CI 12·5-18·6; p<0·0001). In the podcast group, 203 (71%) of 288 parents had a predetermined passing score (≥11 of 18 correct answers) compared with 103 (38%) of 273 parents in the control group (adjusted difference 34%, 95% CI 26-41; p<0·0001). No adverse events were reported. Listening to the Informed Health Choices podcast led to a large improvement in the ability of parents to assess claims about the effects of treatments. Future studies should assess the long-term effects of use of the podcast, the effects on actual health choices and outcomes, and how transferable our findings are to other countries. Research Council of Norway.


Recognition of facial expressions of emotion by Chinese adults with mental retardation.
We compared the ability of Chinese adults with mental retardation and nonhandicapped Chinese children to recognize the six basic facial expressions of emotion. Each subject was told a story identifying an emotion, presented with an array of six photographs of basic facial expressions of emotion, and asked to point to the photograph that depicted the story's emotion. Results showed that the children were more accurate than the adults in recognizing facial expressions of emotion except happiness on which both groups achieved 100% accuracy. Surprise, fear, anger, and disgust were confused most often by both groups. Recognition proficiency was not significantly correlated with age in the children or with IQ in the adults. Our results partially replicated those reported in earlier studies with non-Chinese individuals with mental retardation and raised the possibility that there may be cultural influences on a person's ability to recognize facial expressions of emotion.


The study of microanatomy of intestinal epithelium in the Chinese soft-shelled turtle (Pelodiscus sinensis).
The microanatomy of the intestinal epithelium in the Chinese soft-shelled turtle (CST) was studied by light and transmission electron microscopy (TEM). The small intestinal epithelium (SIE) was single layered or pseudostratified. The enterocytes contained mitochondria or mitochondria and lipid droplets. The enterocytes were arranged tightly in the apical parts of epithelium and connected by desmosomes and interdigitations. The large intestinal epithelium (LIE) was pseudostratified and the enterocytes did not contain lipid droplets. Enterocytes were arranged compactly in the apical part, forming spaces in the middle and basal parts of epithelium. Numerous mucous cells were scattered in the epithelium and there were intraepithelial lymphocytes (IELs) with their pseudopodia extended into the intestinal lumen. This study provides detailed features of intestinal epithelium in the Pelodiscus sinensis that could be related to function. In addition, these findings are discussed in relation to other vertebrates.


Reassessing Preterm Birth Prevention After the Withdrawal of 17-α Hydroxyprogesterone Caproate.
The U.S. Food and Drug Administration has recently withdrawn approval for 17-α hydroxyprogesterone caproate for prevention of recurrent preterm birth, and recent studies have called into question benefits of the pessary in the setting of a short cervix. Obstetric health care professionals are once again left with limited remaining options for preterm birth prevention. This narrative review summarizes the best current evidence on the use of vaginal progesterone, low-dose aspirin, and cerclage for the prevention of preterm birth; attempts to distill possible lessons learned from studies of progesterone and pessary, as well as their implementation into practice; and highlights areas where inroads into preterm birth prevention may be possible outside of the progesterone-aspirin-cerclage paradigm.


Hepatitis B virus X protein activates E3 ubiquitin ligase Siah-1 to control virus propagation via a negative feedback loop.
The seven in absentia homologue 1 (Siah-1) protein is an E3 ubiquitin ligase that induces ubiquitin-dependent proteasomal degradation of HBx, the principal regulatory protein of hepatitis B virus (HBV); however, its role in HBV propagation remains unknown. Here, we found that HBx upregulates Siah-1 levels in HepG2 but not in Hep3B cells, in which p53 is absent. For this effect, HBx sequentially activated ataxia telangiectasia mutated kinase and checkpoint kinase 2 via phosphorylation at the Ser-1981 and Thr-68 residues, respectively, which led to the activation of p53 via phosphorylation at the Ser-15 and Ser-20 residues. As a result, HBx was heavily ubiquitinated by Siah-1 and degraded by the ubiquitin-proteasome system in HepG2 cells, whereas this effect was marginal or undetectable in Hep3B cells. Knock-down of p53 in HepG2 cells downregulated Siah-1 levels and subsequently upregulated HBx levels, whereas ectopic p53 expression in Hep3B cells upregulated Siah-1 levels and subsequently downregulated HBx levels. In addition, Siah-1 knock-down impaired the ubiquitination and proteasomal degradation of HBx in HepG2 cells, whereas ectopic Siah-1 expression induced ubiquitin-dependent proteasomal degradation of HBx in Hep3B cells. The effects of HBx on p53 and Siah-1 were exactly reproduced in a 1.2-mer HBV replicon system, mimicking the natural course of HBV infection. In particular, Siah-1 knock-down upregulated the levels of HBx derived from the HBV replicon, resulting in an increase in HBV production. In conclusion, HBx modulates its own protein level via a negative feedback loop involving p53 and Siah-1 to control HBV propagation.


The relationship between substance use and physical activity among people living with HIV, chronic pain, and symptoms of depression: a cross-sectional analysis.
ABSTRACTChronic pain, depression, and substance use are common among people living with HIV (PLWH). Physical activity can improve pain and mental health. Some substances such as cannabis may alleviate pain, which may allow PLWH to participate in more physical activity. However, risks of substance use include poorer mental health and HIV clinical outcomes. This cross-sectional analysis examined the relationships of self-reported substance use (alcohol, cannabis, and nicotine use), gender, and age with self-reports of walking, moderate physical activity, and vigorous physical activity, converted to Metabolic Equivalent of Task Units (METs), among 187 adults living with HIV, chronic pain, and depressive symptoms in the United States. Women reported less walking, vigorous activity, and total physical activity compared to men. Individuals who used cannabis reported more vigorous physical activity relative to those who did not use cannabis. These findings were partially accounted for by substance use*gender interactions: men using cannabis reported more vigorous activity than all other groups, and women with alcohol use reported less walking than men with and without alcohol use. Research is needed to increase physical activity among women who use substances and to evaluate reasons for the relationship between substance use and physical activity among men.


Paintings discrimination by mice: Different strategies for different paintings.
C57BL/6 mice were trained on simultaneous discrimination of paintings with multiple exemplars, using an operant chamber with a touch screen. The number of exemplars was successively increased up to six. Those mice trained in Kandinsky/Mondrian discrimination showed improved learning and generalization, whereas those trained in Picasso/Renoir discrimination showed no improvements in learning or generalization. These results suggest category-like discrimination in the Kandinsky/Mondrian task, but item-to-item discrimination in the Picasso/Renoir task. Mice maintained their discriminative behavior in a pixelization test with various paintings; however, mice in the Picasso/Renoir task showed poor performance in a test that employed scrambling processing. These results do not indicate that discrimination strategy for any Kandinsky/Mondrian combinations differed from that for any Picasso/Monet combinations but suggest the mice employed different strategies of discrimination tasks depending upon stimuli.


Emergency Medicine Resident Perceptions About the Need for Increased Training in Communicating Diagnostic Uncertainty.
Introduction Diagnostic uncertainty is common in healthcare encounters. Effective communication is important to help patients and providers navigate diagnostic uncertainty, especially at transitions of care. This study sought to assess the experience and training of emergency medicine (EM) residents with communication of diagnostic uncertainty. Methods This was a survey study of a national sample of EM residents. The survey questions elicited quantitative and qualitative responses about experiences with and educational preparation for communication with patients in the setting of diagnostic uncertainty. Results A sample of 263 emergency medicine residents who had trained at over 87 medical schools and 37 residency programs responded to the survey. Nearly half of participants noted they frequently encountered challenges with these conversations; 63% reported having been "somewhat" or less trained to have these conversations during residency, and 51% expressed a strong desire for more training in how to approach these discussions. Survey respondents reported that prior educational experiences in the communication of diagnostic uncertainty were largely informal and that many residents experience frustration in clinical encounters due to inability to meet patients' expectations of reaching a diagnosis at the time of discharge. Conclusion This study found that emergency medicine residents frequently struggle in communicating with patients when there is diagnostic uncertainty upon emergency department discharge and perceived the need for training in how to communicate in these situations. The development of targeted educational strategies for improving communication in the setting of diagnostic uncertainty is consistent with emergency medicine core competencies and may improve patient and provider satisfaction with these clinical encounters.


Case Report: The Second Near-Infrared Window Indocyanine Green Angiography in Giant Mediastinal Tumor Resection.
Giant mediastinal tumors are often accompanied by the abundant blood supply and have an unclear border with adjacent vessels, making surgical resection difficult. Failure to distinguish the complex vessels during the operation often results in vascular injury or hemorrhage, which severely increases the operation time and perioperative risk. At present, surgeons can only determine the vessel's location and course by preoperative imaging and intraoperative exploration in visible light. Therefore, we report a case of a giant anterosuperior mediastinal tumor resection assisted by near-infrared (NIR) indocyanine green (ICG) angiography. Furthermore, we applied the second near-infrared window (NIR-II, 1,000-1,700 nm) to detect the fluorescence signals in the clinic for the first time. The NIR-II window is able to explore deeper tissues in centimeters and obtain higher resolution in millimeters than the traditional first near-infrared window (NIR-I, 700-900 nm). Finally, NIR-II ICG angiography shows the clear location and course of the vessels, which can help surgeons reduce unnecessary blood vessel injury and increase the safety of mediastinal tumor resection.


Aerodynamic diameter measurement of cellulose acetate fibers from cigarette filters: what is the potential for human exposure?
Aerodynamic diameter is a major determinant of particle and fiber deposition and toxicity in the respiratory tract. To characterize cellulose acetate fibers released from the filter end of cigarettes puffed under conditions approximating smoking, we designed multistage impactors to determine the aerodynamic diameters of large fibers with circumscribed diameters between 20 and 35 microm and aspect ratios ranging from subfiber ratios up to 40. This range of diameters encompasses all of the cellulose acetate fiber sizes that are commercially manufactured. When commercially available cigarettes with filters made from acetate fibers in this circumscribed diameter range were puffed directly into the impactor, on average 10 fibers/cigarette were released and their aerodynamic diameters were determined. In our studies, we found that the aerodynamic diameters of the cellulose acetate fibers were always greater than 23 microm. Using standard lung deposition models, we concluded that the fibers are nonrespirable with a very low probability of penetration to the distal lung. Our findings, which demonstrate release of only a small number of these large fibers with an extremely low likelihood of reaching the distal lung, indicate that these fibers are not a risk for human lung disease.


Prophylactic Use of Nonsteroidal Anti-Inflammatory Drugs after Cataract Surgery and Corneal Melt.
To describe a case where prophylactic use of nonsteroidal anti-inflammatory drugs (NSAID) eye drops lead to recurrent corneal melt with loss of vision and a brief literature review. This is a case report of an 84-year-old diabetic female with chronic dry eye, operated by two different surgeons on each eye at different time intervals. She received topical NSAID prophylaxis after the second surgery only, which led to blindness due to recurrent corneal melt and chronic choroidal effusions. We also present a brief literature review. This lady presented with corneal melt and perforation 5 days following the use of topical NSAIDs prophylaxis after a routine cataract surgery in the second eye. Unfortunately, all efforts to save her vision and eye were unsuccessful as she developed repeated complications in spite of corneal gluing, amniotic membrane, penetrating keratoplasty, and tarsorrhaphy. She also had chronic choroidal effusions. She ended up with an opaque cornea and a subtotal tarsorrhaphy, with no other option to improve her vision as she did not qualify for sedation or general anesthesia due to her poor systemic health. Although it is a common practice for diabetic patients to have topical NSAIDs prophylaxis in combination with steroid eye drops to reduce the risk of cystoid macular edema after cataract surgery, the elderly diabetic patients with concomitant dry eyes should be considered high risk for corneal melt and should be closely monitored. This case highlights the rare but serious complication of topical NSAIDs prophylaxis in the vulnerable cornea, which warrants careful consideration.


Novel and stereocontrolled synthesis of (+/-)-tetrodotoxin from myo-inositol.
[reactions: see text] The novel and stereocontrolled synthesis of (+/-)-tetrodotoxin from myo-inositol is described. The key steps involve the stepwise oxidation of hydroxyl groups to the carbonyl function, followed by the addition of specific nucleophiles, including the successive spiro alpha-chloroepoxide formation and its ring-opening with the azide anion, to give the desired branched chain structures (5-->6, 17-->18-->19-->20 and 23-->24-->25) with the desired regio- and stereoselectivities in high yields. The stepwise conversion of the alpha-azido aldehyde 25 to the delta-lactone 29, followed by reduction of the azide, introduction of a guanidine moiety, aldehyde formation, and deprotection, produced the (+/-)-tetrodotoxin.


Plasticity of monocytes and macrophages in cirrhosis of the liver.
Cirrhosis of the liver is a systemic condition with raising prevalence worldwide. Patients with cirrhosis are highly susceptible to develop bacterial infections leading to acute decompensation and acute-on-chronic liver failure both associated with a high morbidity and mortality and sparse therapeutic options other than transplantation. Mononuclear phagocytes play a central role in innate immune responses and represent a first line of defence against pathogens. Their function includes phagocytosis, killing of bacteria, antigen presentation, cytokine production as well as recruitment and activation of immune effector cells. Liver injury and development of cirrhosis induces activation of liver resident Kupffer cells and recruitment of monocytes to the liver. Damage- and pathogen-associated molecular patterns promote systemic inflammation which involves multiple compartments besides the liver, such as the circulation, gut, peritoneal cavity and others. The function of circulating monocytes and tissue macrophages is severely impaired and worsens along with cirrhosis progression. The underlying mechanisms are complex and incompletely understood. Recent 'omics' technologies help to transform our understanding of cellular diversity and function in health and disease. In this review we point out the current state of knowledge on phenotypical and functional changes of monocytes and macrophages during cirrhosis evolution in different compartments and their role in disease progression. We also discuss the value of potential prognostic markers for cirrhosis-associated immuneparesis, and future immunotherapeutic strategies that may reduce the need for transplantation and death.


[The chloroquine resistance of Plasmodium falciparum in Vanuatu (1980-1984): appearance, evolution, distribution].
Chloroquine resistance of P. falciparum was studied in Vanuatu from March 1981 to July 1984, with limited means, and a non-systematic procedure; it was first evidenced in 1980. In vivo chloroquine resistance criteria were those established by W. H. O. In vitro testing methods were the standard W. H. O. macro-test and micro-test. 124 in vivo chloroquine resistant cases were seen: 111 cases in hospital (63 R III, 28 R II and 20 R I) and 13 cases in field studies (1 R III, 4 R II and 8 R I). 87 in vitro chloroquine sensitivity tests were carried out. A high failure rate was apparently due to a defective batch of lyophilised culture medium. Out of the 25 isolates successfully tested, 22 showed in vitro chloroquine resistance (88%). Correlation between in vivo and in vitro resistance was good in 13 cases studied by both methods. Moreover, 13 in vitro mefloquine sensitivity tests evidenced a high sensitivity to this drug. Chloroquine resistant malaria thus appears to be extended to the whole country. Its prevalence remains unknown but was estimated at 60% at least in 1984. Moreover, a geographical spread of chloroquine resistance from north to south of the group was evidenced between 1980 and 1984, identical to that of the dramatic increase of P. falciparum incidence at the same period of time. Possible mechanisms of the advent of chloroquine resistance in Vanuatu are discussed.


Installation of a fast framing visible camera on KSTAR.
Visible camera technologies have made remarkable progress in recent years, and the fast camera has proven itself to be a capable imaging diagnostic in studies of specific fusion plasma issues such as the start-up physics, plasma wall interactions, edge-localized modes, and disruptions. For the purpose of favorable visible imaging, a fast framing camera has recently been installed on the Korea Superconducting Tokamak Advanced Research (KSTAR) device. The camera uses a complementary metal-oxide semiconductor detector with a maximum resolution of 1280x1024 at 1000 frames/s (fps) and a minimum resolution of 1280x16 at 64 kfps. A 2-m-long viewport having a novel optical rail system was installed on a tangential port to view the tokamak interior. The system is fully controlled from the main control room and protected by a shutter from deposits. To verify that the camera electronics are safe from the high magnetic field and its rapid time variation, possible influences are considered theoretically and experimentally. In this work, we present the design and installation of the fast camera system on the KSTAR device with discussions on the field variation effect issues.


A pictorial review of traumatic pericardial injuries.
Thoracic injuries are the third most common injuries in trauma patients with cardiac injuries amongst the most lethal. Imaging is essential in diagnosis and triage of patients with pericardial injuries, and this review aims to highlight the spectrum of imaging findings of pericardial trauma. Focussed assessment with sonography for trauma (FAST) is the preferred initial examination, being rapid and accurate. Sensitivity of FAST for pericardial fluid detection is high with reported sensitivities of 97-100%. Plain chest radiography has low sensitivity for pericardial injuries but is useful in the evaluation of associated injuries. Computed tomography (CT) is the modality of choice for stable patients and can accurately diagnose traumatic pathology of the pericardium being especially useful in identification of cardiac herniation. The spectrum of CT findings includes pericardial fluid collections, focal pericardial defects and pneumopericardium. A selection of cases of pericardial trauma encountered at a level one trauma centre is presented. Operative findings were correlated with the FAST scan, plain radiography and computed tomography imaging. The imaging findings of pericardial trauma with various imaging modalities (ultrasound, plain radiography and computed tomography) are presented in order to aid interpretation during the acute trauma setting.


Drug development in rheumatoid arthritis.
In the United States, therapies to treat rheumatoid arthritis and juvenile rheumatoid arthritis are approved and regulated by the Food and Drug Administration. This article explores certain aspects of the current Food and Drug Administration guidance for drugs, devices, and biologic products intended to treat these diseases (in this article, the term "drug" refers to any therapy in rheumatoid arthritis). Newer therapeutics are targeting not only important molecular pathways but also new labeling claims intended to represent clinically relevant outcomes. Questions regarding whether the risks of these new therapies are balanced by their effectiveness will evolve. The process of improvement in clinical trial design and metrics, along with improved therapies, will undoubtedly present both familiar and new challenges in the future.


Desert particulate matter from Afghanistan increases airway obstruction in human distal lungs exposed to type 2 cytokine IL-13.
Deployment related asthma-like symptoms including distal airway obstruction have been described in U.S. military personnel who served in Iraq and Afghanistan. The mechanisms responsible for the development of distal airway obstruction in deployers exposed to desert particulate matter (PM) is not well understood. We sought to determine if respiratory exposure to PM from Afghanistan (PMa) increases human distal airway hyperresponsiveness (AHR) with or without exposures to IL-13, a type 2 cytokine. We further tested whether mitochondrial dysfunction, such as ATP signaling and oxidative stress, may contribute to PMa- mediated AHR. Precision-cut lung slices from donors without a history of lung disease, tobacco smoking, or vaping were pre-treated with IL-13 for 24 h. This was followed by exposure to PMa or PM from California (PMc, control for PMa) for up to 72 h. The role of hydrogen peroxide and ATP in AHR was assessed using the antioxidant enzyme catalase or an ATP receptor P2Y13 antagonist MRS2211. AHR in response to methacholine challenges as well as cytokine IL-8 production were measured. PMa alone, but not PMc alone, trended to increase AHR. Importantly, the combination of PMa and IL-13 significantly amplified AHR compared to control or PMc+IL-13. PMa alone and in combination with IL-13 increased IL-8 as compared to the control. PMa increased H2O2 and ATP. MRS211 and catalase reduced AHR in PCLS exposed to both PMa and IL-13. Our data suggests that PMa in a type 2 inflammation-high lung increased AHR in part through oxidative stress and ATP signaling.


Obinutuzumab-atezolizumab-lenalidomide for the treatment of patients with relapsed/refractory follicular lymphoma: final analysis of a Phase Ib/II trial.
We evaluated the triplet regimen obinutuzumab-atezolizumab-lenalidomide (G-atezo-len) for patients with relapsed/refractory (R/R) follicular lymphoma (FL) in an open-label, multicenter phase Ib/II study (BO29562; NCT02631577). An initial 3 + 3 dose-escalation phase to define the recommended phase II dose of lenalidomide was followed by an expansion phase with G-atezo-len induction and maintenance. At final analysis, 38 patients (lenalidomide 15 mg, n = 4; 20 mg, n = 34) had completed the trial. Complete response rate for the efficacy population (lenalidomide 20 mg, n = 32) at end-of-induction was 71.9% (66.7% in double-refractory patients [refractory to rituximab and alkylator] [n = 12]; 50.0% in patients with progressive disease within 24 months of first-line therapy [n = 12]). The 36-month progression-free survival rate was 68.4%. All treated patients had ≥1 adverse event (AE; grade 3-5 AE, 32 patients [84%]; serious AE, 18 patients [47%]; AEs leading to discontinuation of any study drug, 11 patients [29%]). There were 2 fatal AEs (1 merkel carcinoma, 1 sarcomatoid carcinoma; both unrelated to any study drug). The G-atezo-len regimen is effective and tolerable in patients with R/R FL. AEs were consistent with the known safety profile of the individual drugs.


Surgical reconstruction of posterior tibial tendon dysfunction: prospective comparison of flexor digitorum longus substitution combined with lateral column lengthening or medial displacement calcaneal osteotomy.
Posterior tibial tendon dysfunction (PTTD) may require surgical intervention when nonoperative measures fail. Different methods of bony reconstruction may supplement tendon substitution. This study compares two types of bony procedures used to reinforce reconstruction of the posterior tibial tendon-the lateral column lengthening (LCL), and the medial displacement calcaneal osteotomy (MDCO). Twenty patients with PTTD were evaluated before and after scheduled reconstruction comprised of either flexor digitorum longus (FDL) substitution combined with MDCO (MDCO group, 14 patients) or FDL substitution with LCL fusion or osteotomy (LCL group, 6 patients). Foot/ankle kinematics and temporal-spatial parameters were analyzed using the Milwaukee Foot Model, and results were compared to a previously evaluated normal population of 25 patients. Post-operatively, both patient groups demonstrated significantly improved stride length, cadence and walking speed, as well as improved hindfoot and forefoot position in the sagittal plane. The LCL group also demonstrated greater heel inversion. All post-operative subjects revealed significant improvement in the talo-MT1 angle in the A/P and lateral planes, calcaneal pitch and medial cuneiform-MT5 height. Surgical reconstruction of PTTD with either the LCL or MDCO shows comparable improvements in gait parameters, with better heel inversion seen with the LCL, but improved 1st ray plantarflexion and varus with the MDCO. Both procedures demonstrated comparable improvements in radiographic measurements.


Reconstruction of Chronic Boutonniere Deformity of the Thumb in a Golf Player.
We present the case of a professional golf player who gradually developed a boutonniere deformity of the thumb due to chronic repetitive injury to the thumb and was treated with reconstruction of its insertion onto the proximal phalangeal base. The athlete showed an insertion variation of the extensor pollicis brevis, where some slips attached onto the extensor hood and the other slips ran along with the extensor pollicis longus to the distal phalanx, providing no slip to the proximal phalanx. The slips inserting to the distal phalanx were transferred to the base of the proximal phalanx and sagittal band reconstruction. As a result, the boutonniere deformity of the thumb fully recovered with satisfactory outcomes.Level of Evidence: Level V.


Electro-absorption optical modulator using dual-graphene-on-graphene configuration.
An electro-absorption optical modulator based on dual-graphene-on-graphene configuration is presented and investigated. Four graphene layers are embedded in a silicon-on-insulator (SOI) waveguide, the total metal-graphene contact resistance of this structure is reduced 50% by the graphene layers co-electrode design. By optimizing the position of each graphene-on-graphene (GOG) layer in the waveguide, a strong interaction between graphene layers and light is obtained, which leads to a significant change of the effective mode index (EMI) in the waveguide. Calculations show that an electro-absorption optical modulator can achieve 34 dB extinction ratio (ER) and 100 GHz modulation bandwidth with 5 µm-long active region and 17.6 fJ/bit consumption.


[Review in the studies on tannins activity of cancer prevention and anticancer].
This paper reviewed the biological activities of tannins in cancer prevention and anticancer, and mainly discussed related mechanisms. The results suggest that tannins, whether total tannins or pure tannin compound, have remarkable activity in cancer prevention and anticancer. It has wealthy foreground for developing new cancer prevention agents and/or new anticancer drugs screening among tannin compounds.


Awareness among parents of children with thalassemia major.
To determine the awareness among parents of children with thalassaemia major (TM) regarding the disease. This (cross sectional) study was conducted at Paediatric OPD of Civil Hospital Karachi from May 2007 to October 2007. Parents of thalassaemic children presenting to out patient department, receiving blood transfusion from Patient Welfare Association (PWA) were interviewed using a pre designed questionnaire. Informed verbal consent was taken from the parents. Questions regarding duration of illness, awareness regarding screening of blood, mode of transmission of disease, prevention and treatment were asked. A total of 120 care takers were questioned. Majority was of low socioeconomic class and 66.7% were illiterate. Although nearly 100% of the patients were receiving blood transfusions either from PWA or Hussaini blood bank or both, only 15.8% knew the importance of blood screening. Knowledge regarding desferrol was present in 55% of the patient's parents but only 10.9% were receiving it adequately. Only 15% knew that thalassaemia is an inherited disorder and family screening of the siblings and antenatal diagnosis in subsequent pregnancies was done in 5.8% and 5% respectively. Awareness of parents regarding the disease was inadequate. General public and parents of thalassemic children should be sensitized in this regard.


[Structure-activity relationship of phenylallyl compounds inhibiting PGE2 release in mouse cerebral microvascular endothelial cells induced by IL-1beta].
To observe the effects of phenylallyl compounds on prostaglandin E2 (PGE2) release in mouse cerebral microvascular endothelial cells (bEnd. 3) stimulated by IL-1beta, and to analyze their structure-activity relationship. Different concentrations of phenylallyl compounds were added separately, and the content of PGE2 induced by IL-1beta in the culture media was measured by ELISA assay. The 50% inhibitory concentration (IC50) of PGE2 was calculated. Studies showed that phenylallyl compounds could affect the PGE2 release differently in bEnd. 3 cells induced by IL-1beta. Close relationships were shown between the inhibitory activities and the location and number of the substituent groups. In conclusion, phenylallyl compounds exhibited inhibitory activities at different extent on PGE2 release in bEnd. 3 cells stimulated by IL-1beta and presented certain structure-activity relationship.


Molybdenum(III) Amidinate: Synthesis, Characterization, and Vapor Phase Growth of Mo-Based Materials.
The synthesis, characterization, and thermogravimetric analysis of tris(N,N'-di-isopropylacetamidinate)molybdenum(III), Mo(iPr-AMD)3, are reported. Mo(iPr-AMD)3 is a rare example of a homoleptic mononuclear complex of molybdenum(III) and fills a longstanding gap in the literature of transition metal(III) trisamidinate complexes. Thermogravimetric analysis (TGA) reveals excellent volatilization at elevated temperatures, pointing to potential applications as a vapor phase precursor for higher temperature atomic layer deposition (ALD), or chemical vapor deposition (CVD) growth of Mo-based materials. The measured TGA temperature window was 200-314 °C for samples in the 3-20 mg range. To validate the utility of Mo(iPr-AMD)3, we demonstrate aerosol-assisted CVD growth of MoO3 from benzonitrile solutions of Mo(iPr-AMD)3 at 500 °C using compressed air as the carrier gas. The resulting films are characterized by X-ray photoelectron spectroscopy, X-ray diffraction, and Raman spectroscopy. We further demonstrate the potential for ALD growth at 200 °C with a Mo(iPr-AMD)3/Ar purge/300 W O2 plasma/Ar purge sequence, yielding ultrathin films which retain a nitride/oxynitride component. Our results highlight the broad scope utility and potential of Mo(iPr-AMD)3 as a stable, high-temperature precursor for both CVD and ALD processes.