TSH elevations as the first laboratory evidence for pseudohypoparathyroidism type Ib (PHP-Ib).
Hypocalcemia and hyperphosphatemia because of resistance toward parathyroid hormone (PTH) in the proximal renal tubules are the most prominent abnormalities in patients affected by pseudohypoparathyroidism type Ib (PHP-Ib). In this rare disorder, which is caused by GNAS methylation changes, resistance can occur toward other hormones, such as thyroid-stimulating hormone (TSH), that mediate their actions through G protein-coupled receptors. However, these additional laboratory abnormalities are usually not recognized until PTH-resistant hypocalcemia becomes clinically apparent. We now describe four pediatric patients, first diagnosed with subclinical or overt hypothyroidism between the ages of 0.2 and 15 years, who developed overt PTH-resistance 3 to 20 years later. Although anti-thyroperoxidase (anti-TPO) antibodies provided a plausible explanation for hypothyroidism in one of these patients, this and two other patients revealed broad epigenetic GNAS abnormalities, which included loss of methylation (LOM) at exons AS, XL, and A/B, and gain of methylation at exon NESP55; ie, findings consistent with PHP-Ib. LOM at GNAS exon A/B alone led in the fourth patient to the identification of a maternally inherited 3-kb STX16 deletion, a well-established cause of autosomal dominant PHP-Ib. Although GNAS methylation changes were not detected in additional pediatric and adult patients with subclinical hypothyroidism (23 pediatric and 39 adult cases), hypothyroidism can obviously be the initial finding in PHP-Ib patients. One should therefore consider measuring PTH, along with calcium and phosphate, in patients with unexplained hypothyroidism for extended periods of time to avoid hypocalcemia and associated clinical complications.


New Observations regarding the Assessment of Cilioretinal Arteries Coexistence with Optic Disc Pit.
Purpose: To investigate the coexistence of cilioretinal arteries (CRAs) with optic disc pit (ODP), and to delineate the characteristics of CRAs related to their number, location of their emergence and their association with the size of ODP. Methods: 47 patients (49 eyes) with ODP were diagnosed and followed-up between 1997 and 2017, using slit-lamp biomicroscopy, color fundus photographs, fluorescein angiography and indocyanine green angiography. The presence of CRAs was recorded in association with the size of the ODP, along with their number and location of emergence. The fellow normal eyes of patients were also analyzed. Results: 42 out of 49 eyes with ODP (85.7%) presented CRAs. In 35 out of 42 eyes (83.3%) CRAs emerged from the pit, either from bottom or from its margin. In 7.1% of cases, CRAs were emerged outside the ODP, while in 9.6% of cases, the type of CRA emergence could be characterized as mixed. The number of CRAs, that ranged from 1 to 4, was positively associated with ODP size. In the fellow normal eyes, CRAs was found in 22.2% of cases, difference which was significant compared to patients with ODP. Conclusion: Based on the high percentage of CRAs coexistence with ODP and the excessive frequency of their emergence from ODP (83.3%), it is supported that ODP as a developmental disorder could go along with further anatomic peculiarities, that also include the presence of multiple CRAs.


Historical visit attendance as predictor of treatment interruption in South African HIV patients: Extension of a validated machine learning model.
Retention of antiretroviral (ART) patients is a priority for achieving HIV epidemic control in South Africa. While machine-learning methods are being increasingly utilised to identify high risk populations for suboptimal HIV service utilisation, they are limited in terms of explaining relationships between predictors. To further understand these relationships, we implemented machine learning methods optimised for predictive power and traditional statistical methods. We used routinely collected electronic medical record (EMR) data to evaluate longitudinal predictors of lost-to-follow up (LTFU) and temporal interruptions in treatment (IIT) in the first two years of treatment for ART patients in the Gauteng and North West provinces of South Africa. Of the 191,162 ART patients and 1,833,248 visits analysed, 49% experienced at least one IIT and 85% of those returned for a subsequent clinical visit. Patients iteratively transition in and out of treatment indicating that ART retention in South Africa is likely underestimated. Historical visit attendance is shown to be predictive of IIT using machine learning, log binomial regression and survival analyses. Using a previously developed categorical boosting (CatBoost) algorithm, we demonstrate that historical visit attendance alone is able to predict almost half of next missed visits. With the addition of baseline demographic and clinical features, this model is able to predict up to 60% of next missed ART visits with a sensitivity of 61.9% (95% CI: 61.5-62.3%), specificity of 66.5% (95% CI: 66.4-66.7%), and positive predictive value of 19.7% (95% CI: 19.5-19.9%). While the full usage of this model is relevant for settings where infrastructure exists to extract EMR data and run computations in real-time, historical visits attendance alone can be used to identify those at risk of disengaging from HIV care in the absence of other behavioural or observable risk factors.


Localization of a disease-associated mutation site in the three-dimensional structure of the cardiac muscle ryanodine receptor.
The cardiac muscle ryanodine receptor (RyR2) functions as a calcium release channel in the heart. Up to 40 mutations in RyR2 have been linked to genetic forms of sudden cardiac death. These mutations are largely clustered in three regions of the sequence of the polypeptide: one near the N terminus, one in the central region, and the third in the C-terminal region. The central region includes 11 mutations, and an isoleucine-proline motif (positions 2427 and 2428) in the same region is predicted to contribute to the binding of FKBP12.6 protein. We have mapped the central mutation site in the three-dimensional structure of RyR2 by green fluorescent protein insertion, cryoelectron microscopy, and single-particle image processing. The central mutation site was mapped to a "bridge" of density that connects cytoplasmic domains 5 and 6, which have been suggested to undergo conformational changes during channel gating. Moreover, the location of this central mutation site is not close to that of the FKBP12.6-binding site mapped previously by cryoelectron microscopy.


An Insight Into the Effect of Odontogenic Keratocysts on Surrounding Structures: Cone-Beam Computed Tomography-Based Analysis of Cases.
Introduction An odontogenic keratocyst (OKC) is a benign intraosseous lesion with potential to demonstrate aggressive and invasive behavior. The aim of this retrospective study was to analyze the imaging features of the OKC using cone-beam computed tomography (CBCT) and to evaluate the association between the internal structure of the lesion and the effect of the lesion on surrounding structures. Methods Overall, 32 CBCT scans of histopathologically diagnosed cases of OKC were analyzed retrospectively. The following variables were analyzed: anatomic location of the lesions (mandible body (right/left), ramus (right/left), mandible body+ramus (right/left), maxilla (right/left), and both jaws), the internal structure of the lesion (unilocular/multilocular), and the effect of the lesion on the surrounding anatomical structures (involvement of the inferior alveolar nerve canal (IANC), displacement of the IANC, cortical expansion, displacement of the tooth, resorption of the root, associated impacted tooth, associated missing tooth). We also looked for the association between the internal structure and the effect of the lesion on anatomic structures. Results Out of 32 cases, 29 (90.6%) cases involved the mandible alone. Statistically significant association (p-value 0.005) was present between the internal structure and mean age of presentation as well as between the internal structure and impacted tooth (p-value 0.027). The association between the internal structure and other variables was statistically not significant. Conclusions The radiographic features of OKCs can be variable, and these lesions have a considerable effect on the tooth, IANC, and cortical bone. Significant association was found between the internal structure, age, and impacted tooth. Since OKCs have a high recurrence rate, CBCT is advised for evaluating the extent and location of any cortical perforations.


A Bibliometric Analysis of Research Articles on Midwifery Based on the Web of Science.
This study aimed to bibliometrically analyse the main features of the 100 top-cited articles on the midwifery index on the Web of Science. Academic articles on midwifery' research published from 1985 to 2020 were included. VOSviewer 1.6.15, SPSS 22.0 software and a homemade applet were used to identify, analyse and visualise the citation ranking, publication year, journal, country and organisation of origin, authorship, journal impact factor and keywords along with the total link strength of countries, organisations and keywords. Among the 100 top-cited articles, the highest number of citations of the retrieved articles was 484. The median number of citations per year was 5.16 (interquartile range: 3.74-8.38). Almost two-thirds of the included articles (n = 61) centred on nursing and obstetrics/gynaecology. The top-cited articles were published in 38 different journals, the highest number of which was published by Midwifery (15%). Australia was the most productive country (24%). According to the total link strength, the sequence ran from the United States (28) to England (28) to Australia (19). The University of Technology Sydney and La Trobe University in Australia topped the list with four papers each. Hunter B was the most productive author (n = 4), and the average citations were positively related to the number of authors (r = 0.336, p < 0.05). This study identified the most influential articles on midwifery and documented the core journals and the most productive countries, organisations and authors along with future research hotspots for this field; the findings may be beneficial to researchers in their publication and scientific cooperation endeavours.


A Method for Next-Generation Sequencing of Paired Diagnostic and Remission Samples to Detect Mitochondrial DNA Mutations Associated with Leukemia.
Somatic mitochondrial DNA (mtDNA) mutations have been identified in many human cancers, including leukemia. To identify somatic mutations, it is necessary to have a control tissue from the same individual for comparison. When patients with leukemia achieve remission, the remission peripheral blood may be a suitable and easily accessible control tissue, but this approach has not previously been applied to the study of mtDNA mutations. We have developed and validated a next-generation sequencing approach for the identification of leukemia-associated mtDNA mutations in 26 chronic myeloid leukemia patients at diagnosis using either nonhematopoietic or remission blood samples as the control. The entire mt genome was amplified by long-range PCR and sequenced using Illumina technology. Variant caller software was used to detect mtDNA somatic mutations, and an empirically determined threshold of 2% was applied to minimize false-positive results because of sequencing errors. Mutations were called against both nonhematopoietic and remission controls: the overall concordance between the two approaches was 81% (73/90 mutations). Some discordant results were because of the presence of somatic mutations in remission samples, because of either minimal residual disease or nonleukemic hematopoietic clones. This method could be applied to study somatic mtDNA mutations in leukemia patients who achieve minimal residual disease, and in patients with nonhematopoietic cancers who have a matched uninvolved tissue available.


Inhibition of apoptosis by downregulation of hBex1, a novel mechanism, contributes to the chemoresistance of Bcr/Abl+ leukemic cells.
Overexpression of multidrug resistance proteins (Mdrs) and enhanced antiapoptotic capability are two of the main mechanisms by which Bcr/Abl(+) chronic myeloid leukemia cells acquire drug resistance; however, it has been shown that Mdr-1 expression provides minimal protection against cell apoptosis induced by chemotherapeutic drugs. The mechanism by which cells acquire an enhanced antiapoptosis capacity in the drug-resistant process needs to be further understood. Here, we identified human brain expressed X-linked 1 (hBex1) as a downstream target of the p75 neurotrophin receptor pathway in imatinib-resistant K562 cells by comparing the gene expression profiles with the parent K562 cells. Silencing hBex1 inhibited imatinib-induced cell apoptosis and overexpression of hBex1-sensitized cells to imatinib-induced apoptosis. Further investigation revealed that hBex1 associates with protocadherin 10 (PCDH10). Silencing of pcdh10 attenuated apoptosis induced by imatinib in hBex1 transfected cells, suggesting that, in addition to Mdr and Bcl-2 family members, reduced expression of hBex1 can also inhibit imatinib-induced apoptosis. These data provide evidence that expression of hBex1 in leukemic cells is a novel mechanism by which chemoresistance is achieved and suggests that hBex1 is a potential molecular target for the development of novel leukemia treatments.


Molecular Mechanisms of Cutaneous Inflammatory Disorder: Atopic Dermatitis.
Atopic dermatitis (AD) is a multifactorial inflammatory skin disease resulting from interactions between genetic susceptibility and environmental factors. The pathogenesis of AD is poorly understood, and the treatment of recalcitrant AD is still challenging. There is accumulating evidence for new gene polymorphisms related to the epidermal barrier function and innate and adaptive immunity in patients with AD. Newly-found T cells and dendritic cell subsets, cytokines, chemokines and signaling pathways have extended our understanding of the molecular pathomechanism underlying AD. Genetic changes caused by environmental factors have been shown to contribute to the pathogenesis of AD. We herein present a review of the genetics, epigenetics, barrier dysfunction and immunological abnormalities in AD with a focus on updated molecular biology.


[The chemical constituents of Epimedium koreanum Nakai].
Three new compounds were isolated from the aerial part of Epimedium koreanum Nakai. On the basis of spectroscopic and chemical evidences, they were elucidated as 3-O-beta-D-glucopyranosyl(1-->3)-alpha-L-(4-acetyl) rhamnopyranoside-anhydroicaritin-7-O-beta-D-glucopyranoside, 2-(p-hydroxyphenoxy)-5, 7-dihydroxy-6-prenylchromone, and 7-hydroxy-3, 4, 6-trimethoxy-9, 10-dihydrophenanthrene-2-O-beta-D-glucopyranoside.


[A histochemical evaluation of thrombocyte metabolism in systemic lupus erythematosus].
To determine feasibility of using quantitative histochemical assessment of platelet anaerobic metabolism in lupus nephritis (LN) prognostication and elucidation of its activity, the authors examined 23 SLE patients. 20 of them developed renal lesions. Anaerobic metabolism of platelets was measured according to lactate dehydrogenase levels. All the SLE patients had significantly higher levels of the enzyme than healthy controls showed. Maximal LDG activity was registered in rapidly progressive LN with thrombocytopenia. The findings support activation of platelet hemostatic component in SLE patients and valid utilization of a new quantitative histochemical technique for determination of intracellular metabolism enzymes content.


Differences in gene expression and cytokine levels between newly diagnosed and chronic pediatric ITP.
Immune thrombocytopenia (ITP) is an autoimmune disease where platelets are destroyed prematurely. In the majority of children the disease resolves, but in some it becomes chronic. To investigate whether these 2 phases of the disease are molecularly similar or separate entities we performed DNA microarray analysis (GEO accession number: GSE46922) of T-cells from newly diagnosed children and children with chronic ITP. We found complete separation of the gene expression profiles between the 2 phases of the disease. Furthermore, the gene expression levels of several cytokines differed between the 2 phases of the disease. This was also reflected in plasma with increased levels of interleukin (IL)-16 and TNF-related weak inducer of apoptosis and lower levels of IL-4 in newly diagnosed compared with chronic ITP. Thus, our data indicate that chronic ITP in childhood is a separate disease entity, dissimilar in many aspects to the newly diagnosed phase.


Management of venous thrombosis in the pediatric patient.
The incidence of venous thromboembolism in children has increased significantly over the past decade. The evaluation and management of the child with venous thromboembolism, while based on the adult experience, has its own particularities dictated by the differences in the hemostatic system of the newborn and child. The current review addresses the evaluation of pediatric patient with thrombosis as well as the established and emerging treatment interventions.


[Impedance cardiography following cardiac surgery].
For checking the possibility of using impedance cardiography in intensive care, 10 patients were examined before and up to 2 days after cardiac surgery with extracorporeal circulation. The comparison of stroke volumes examined by thermodilution with those calculated from impedance cardiography showed a good correlation (r = 0.933). The cardiac output measured by impedance cardiography was reduced to 77% of the initial preoperative value. It increased again to 94% on the second postoperative day. HEATHER-index and dZ/dt are well suited for supervision and quantitative treatment control in the postoperative period. The thoracic impedance was diminished more than 20% after extracorporeal circulation and did not yet reach the preoperative value on the second day. The continuous measurement of the thoracic impedance proved to be particularly helpful for assessing the pulmonary hydration and for controlling the fluid balance.


In situ laccase-assisted overdyeing of denim using flavonoids.
A laccase-mediated system for denim overdyeing using phenolic compounds was developed. Laccase from ascomycete Myceliophthora thermophila was able to oxidize phenolic compounds such as catechol and catechin and mediate their attachment to denim surfaces. Laccase-generated polymers gave rise to new coloration states from dark brown to green-yellow and replaced dyes in the overdyeing process. Process parameters, such as enzyme dosage, incubation time and presence of mediator, were studied by considering a compromise between the highest overdyeing level and lower energy/products consumption (2 U/mL laccase; 4 h incubation in the absence of mediator). Enzyme-generated polymers were followed by UV/Vis spectrophotometry and their level of attachment to denim surfaces was evaluated by means of spectral values quantification [k/s, Kubelka-Munk relationship (k=absorption coefficient, s=scattering coefficient)]. Overdyeing of denim with phenolics, such as catechol or catechin, was successfully achieved with acceptable levels in terms of durability.


Individual-specific variation in the respiratory activities of HMECs and their bioenergetic response to IGF1 and TNFα.
Metabolic reprograming is a hallmark of cancer cells. However, the roles of pre-existing differences in normal cells metabolism toward cancer risk is not known. In order to assess pre-existing variations in normal cell metabolism, we have quantified the inter-individual variation in oxidative metabolism of normal primary human mammary epithelial cells (HMECs). We then assessed their response to selected cytokines such as insulin growth factor 1 (IGF1) and tumor necrosis factor alpha (TNFα), which are associated with breast cancer risk. Specifically, we compared the oxidative metabolism of HMECs obtained from women with breast cancer and without cancer. Our data show considerable inter-individual variation in respiratory activities of HMECs from different women. A bioenergetic parameter called pyruvate-stimulated respiration (PySR) was identified as a key distinguishing feature of HMECs from women with breast cancer and without cancer. Samples showing PySR over 20% of basal respiration rate were considered PySR+ve and the rest as PySR-ve . By this criterion, HMECs from tumor-affected breasts (AB) and non-tumor affected breasts (NAB) of cancer patients were mostly PySR-ve (88% and 89%, respectively), while HMECs from non-cancer patients were mostly PySR+ve (57%). This suggests that PySR-ve/+ve phenotypes are individual-specific and are not caused by field effects due to the presence of tumor. The effects of IGF1 and TNFα treatments on HMECs revealed that both suppressed respiration and extracellular acidification. In addition, IGF1 altered PySR-ve/+ve phenotypes. These results reveal individual-specific differences in pyruvate metabolism of normal breast epithelial cells and its association with breast cancer risk.


An in silico and in vitro approach to elucidate the impact of residues flanking the cleavage scissile bonds of FVIII.
Coagulation Factor VIII is activated by an ordered limited thrombin proteolysis with different catalytic efficiency at three P1 Arginine residues: Arg759> Arg1708>Arg391, indicating the flanking residues of the latter to be less optimal. This study aimed to investigate, in silico and in vitro, the impact of possessing hypothetically optimized residues at these three catalytic cleavage sites. The structural impact of the residues flanking Arginine cleavage sites was studied by in silico analysis through comparing the cleavage cleft of the native site with a hypothetically optimized sequence at each site. Moreover, recombinant FVIII proteins were prepared by replacing the sequences flanking native thrombin cleavage sites with the proposed cleavage-optimized sequence. FVIII specific activity was determined by assessing the FVIII activity levels in relation to FVIII antigen levels. We further investigated whether thrombin generation could reflect the haemostatic potential of the variants. Our in silico results show the impact of the residues directly in the cleavage bond, and their neighboring residues on the insertion efficiency of the loop into the thrombin cleavage cleft. Moreover, the in vitro analysis shows that the sequences flanking the Arg1708 cleavage site seem to be the most close to optimal residues for achieving the maximal proteolytic activation and profactor activity of FVIII. The residues flanking the scissile bonds of FVIIII affect the cleavage rates and modulate the profactor activation. We were able to provide insights into the mechanisms of the specificity of thrombin for the P1 cleavage sites of FVIII. Thus, the P4-P2´ residues surrounding Arg1708 of FVIII have the highest impact on rates of thrombin proteolysis which contributes to thrombin activation of the profactor and eventually to the thrombin generation potential.


mtDNA and the origin of Caucasians: identification of ancient Caucasian-specific haplogroups, one of which is prone to a recurrent somatic duplication in the D-loop region.
mtDNA sequence variation was examined in 175 Caucasians from the United States and Canada by PCR amplification and high-resolution restriction-endonuclease analysis. The majority of the Caucasian mtDNAs were subsumed within four mtDNA lineages (haplogroups) defined by mutations that are rarely seen in Africans and Mongoloids. The sequence divergence of these haplogroups indicates that they arose early in Caucasian radiation and gave raise to modern European mtDNAs. Although ancient, none of these haplogroups is old enough to be compatible with a Neanderthal origin, suggesting that Homo sapiens sapiens displaced H. s. neanderthaliensis, rather than mixed with it. The mtDNAs of one of these haplogroups have a unique homoplasmic insertion between nucleotide pair (np) 573 and np 574, within the D-loop control region. This insertion makes these mtDNAs prone to a somatic mutation that duplicates a 270-bp portion of the D-loop region between np 309 and np 572. This finding suggests that certain nonpathogenic mtDNA mutations could predispose individuals to mtDNA rearrangements.


Impaired leucocyte rolling, adhesion and transendothelial migration following cuprophane haemodialysis.
In this study, we investigated how different steps in the extravasation process of leucocytes, i.e. rolling, adhesion and transendothelial migration, are affected by haemodialysis with cuprophane membranes. Human leucocytes obtained from whole blood prior to clinical haemodialysis and from the afferent blood line (post-dialyser) 15 min after the initiation of dialysis were injected into the mesenteric microcirculation of urethane anaesthetized rabbits and analysed for their ability to roll in the microvessels by use of intravital fluorescence microscopy. Moreover, neutrophils from the two leucocyte populations were compared with respect to chemoattractant-induced adhesion and transmigration across confluent monolayers of bovine aortic endothelial cells. Our results show that, as compared with pre-dialysis leucocytes, 15 min of cuprophane haemodialysis impaired leucocyte rolling by 78 +/- 7%, reduced N-formyl-methionyl-leucyl-phenylalanin (fMLP)-induced adhesion by 34 +/- 9%, and abolished transendothelial migration. These findings demonstrate that intradialytical activation of leucocytes during cuprophane haemodialysis severely affects leucocyte functions that are critical in the extravasation process of these cells at inflammatory tissue sites, and thus may help explain the increased susceptibility to infections observed in patients on chronic haemodialysis.


The influence of oxazaphosphorine agents on kidney function in rats.
The application of cytostatic oxazaphosphorines such as cyclophosphamide (CP) and ifosfamide (IF) is associated with the risk of kidney damage that, depending on the type of drug, dose and route of administration, adopts a different clinical entity and severity. The aim of our study was to assess the influence of CP and IF on the kidney histology and function in rats intraperitoneally treated with four doses of either CP or IF. A total of 30 rats were divided into three groups (10 in each group): group 1 (control), sham treated with saline solution, group 2 (treated with 75mg/kg b.w. of CP), and group 3 (treated with 60mg/kg b.w. of IF). After the treatment rats were sacrificed, blood was collected and nephrectomy and cystectomy were performed. Qualitative and quantitative parameters (including neutrophil gelatinase-associated lipocalin-1, NGAL-1) of kidney function were assayed in urine and plasma. CP-treated rats were characterized by a significant polyuria, decreased urine pH and by decreased daily urinary excretion of sodium, potassium, urea and uric acid accompanied by increased NGAL-1 excretion. A significant decrease of the plasma uric acid concentration was also observed. IF-treated animals were also characterized by decreased urine pH but with normal daily urinary excretion of assessed substances (except for reduced uric acid excretion). Both CP and IF treated rats did not show any histopathological abnormalities in their kidneys. CP caused more advanced kidney dysfunction and some indices suggested the development of prerenal acute kidney injury. In the CP-treated group some particularly marked urinary and plasma uric acid disturbances suggested compensation of increased oxidative stress as uric acid is considered to exert also antioxidant properties.


Exogenous isoprene modulates gene expression in unstressed Arabidopsis thaliana plants.
Isoprene is a well-studied volatile hemiterpene that protects plants from abiotic stress through mechanisms that are not fully understood. The antioxidant and membrane stabilizing potential of isoprene are the two most commonly invoked mechanisms. However, isoprene also affects phenylpropanoid metabolism, suggesting an additional role as a signalling molecule. In this study, microarray-based gene expression profiling reveals transcriptional reprogramming of Arabidopsis thaliana plants fumigated for 24 h with a physiologically relevant concentration of isoprene. Functional enrichment analysis of fumigated plants revealed enhanced heat- and light-stress-responsive processes in response to isoprene. Isoprene induced a network enriched in ERF and WRKY transcription factors, which may play a role in stress tolerance. The isoprene-induced up-regulation of phenylpropanoid biosynthetic genes was specifically confirmed using quantitative reverse transcription polymerase chain reaction. These results support a role for isoprene as a signalling molecule, in addition to its possible roles as an antioxidant and membrane thermoprotectant.


Integrity of powdered and powder-free latex examination gloves.
The difference in permeability between one brand of powdered and another of powder-free latex examination gloves was evaluated to determine leak rates. Thirty-one of each type of glove were tested for each of three different conditions: usage by dental personnel (1) for 15 minutes or longer, (2) for less than 15 minutes, and (3) directly from the manufacturer's packaging (zero usage time). Each glove was evaluated in the fingers and the palm. The phiX-174 viral solution in the glove was allowed to penetrate for 15 minutes. Powder (cornstarch) was subsequently added to 20 powder-free gloves, and 15 of these were pierced with a 30-gauge needle. Powdered gloves showed no leakage rates. Because of this, 30-, 27-, and 25-gauge needles were used to pierce five gloves each. One glove with 27- and 25-gauge needle holes showed leakage. Leakage rates for powder-free gloves: 45.1 percent for more than 15 minutes of use, 25.8 percent for less than 15 minutes of use, and 16.1 percent for zero minutes of use. Two of the 20 pierced and one of the five unpierced powder-free gloves with added cornstarch leaked. Significant differences in leak results between powdered and powder-free gloves suggest further study is needed.


Human beta defensin 3 alters matrix metalloproteinase production in human dendritic cells exposed to Porphyromonas gingivalis hemagglutinin B.
Matrix metalloproteinases (MMPs) are zinc- or calcium-dependent proteinases involved in normal maintenance of extracellular matrix. When elevated, they contribute to the tissue destruction seen in periodontal disease. Recently, we found that human beta defensin 3 (HBD3), a cationic antimicrobial peptide, alters chemokine and proinflammatory cytokine responses in human myeloid dendritic cells exposed to Porphyromonas gingivalis hemagglutinin B (HagB). In this study, the hypotheses that HagB induces MMP production in dendritic cells and that HBD3 mixed with HagB prior to treatment alters HagB-induced MMP profiles were tested. Dendritic cells were exposed to 0.2 μM HagB alone and HagB + HBD3 (0.2 or 2.0 μM) mixtures. After 16 hours, concentrations of MMPs in cell culture media were determined with commercial multiplex fluorescent bead-based immunoassays. An integrated cell network was used to identify potential HagB-induced signaling pathways in dendritic cells leading to the production of MMPs. 0.2 μM HagB induced MMP1, -2, -7, -9, and -12 responses in dendritic cells. 0.2 μM HBD3 enhanced the HagB-induced MMP7 response (P < 0.05) and 2.0 μM HBD3 attenuated HagB-induced MMP1, -7, and -9 responses (P < 0.05). The MMP12 response was not affected. In the predicted network, MMPs are produced via activation of multiple pathways. Signals converge to activate numerous transcription factors, which transcribe different MMPs. HagB was an MMP stimulus and HBD3 was found to decrease HagB-induced MMP1, -7, and -9 responses in dendritic cells at 16 hours, an observation that suggests HBD3 can alter microbial antigen-induced production of MMPs.


Timing of heart failure development and clinical outcomes in patients with acute myocardial infarction.
To investigate the clinical relevance of the timing of heart failure (HF) development on long-term outcome in patients with acute myocardial infarction (AMI). A total of 1,925 consecutive AMI patients were divided into 4 groups according to the timing of HF development; HF at admission (group I, n = 627), de novo HF during hospitalization (group II, n = 162), de novo HF after discharge (group III, n = 98), no HF (group IV, n = 1,038). Major adverse cardiac events (MACE) defined as the development of death, re-hospitalization, recurrent MI or revascularization were evaluated. HF was developed in 887 patients (46.1%) after an index AMI. HF was most common at the time of admission for AMI, but the development of de novo HF during hospitalization or after discharge was not uncommon. MACE was developed in 619 out of 1,925 AMI patients (31.7%). MACE was highest in group I, lowest in group IV, and significantly different among groups; 275 out of 627 patients (43.9%) in group I, 64 out of 192 patients (39.5%) in group II, 36 out of 98 patients (36.7%) in group III, and 235 out of 1,038 patients (22.6%) in group IV (P < 0.001). MACE free survival rates at 3 years were 56% in group I, 62% in group II, 64% in group III, and 77% in group IV (P < 0.001). HF was not uncommon and can develop at any time after an index AMI, and the development of HF was associated with poor prognosis. The earlier the HF has occurred after AMI, the poorer the clinical outcome was. To initiate the guideline directed optimal medical therapy, therefore, the development of HF should be carefully monitored even after the discharge from an index AMI.


Involvement of health professionals in tobacco control in the South-East Asia Region.
Tobacco use is widely entrenched in the South-East Asia (SEA) Region leading to high morbidity and mortality in this region. Several studies revealed that tobacco use is widespread among youth and school children. Exposure to second-hand smoke was reported as around 50% or more in three countries - Myanmar (59.5%), Bangladesh (51.3%), and Indonesia (49.6%). Health profession students encompassing medical, dental, nursing and pharmacy disciplines, and even qualified health professionals are no exception from tobacco use. While they are regarded as role models in tobacco cessation programs, their tobacco addiction will carry a negative impact in this endeavour. A mere inquiry about the smoking status of patients and a brief advice by doctors or dentists increases quit rates and prompts those who have not thought about quitting to consider doing so. Evidence from some randomized trials suggests that advice from motivated physicians to their smoking patients could be effective in facilitating cessation of smoking. However, the low detection rate of smokers by many physicians and the small proportion of smokers who routinely receive advice from their physicians to quit have been identified as a matter of concern. This paper describes the role and issues of involvement of health professionals in tobacco control. Data from a variety of sources is used to assess the status. Although there are some differences, tobacco use is widespread among the students and health professional students. Exposure to second hand smoke is also a matter of concern. Tobacco-related problems and tobacco control cut across a vast range of health disciplines. Building alliances among the health professional associations in a vertical way will help synergize efforts, and obtain better outcomes from use of existing resources. Health professional associations in some countries in the SEA region have already taken the initiative to form coalitions at the national level to advance the tobacco control agenda. In Thailand, a Thai Health Professional Alliance against Tobacco, with 17 allies from medical, nursing, traditional medicine, and other health professional organizations, is working in a concerted manner toward promoting tobacco control. Indian Dental Association intervention is another good example.


[Health risks connected with the avian flu virus].
The first human cases of infections with entire avian influenza strain were caused by subtype A/H5N1/ and occurred in 1997 in Hong Kong. Since this year until 27 March 2007 World Health Organization confirmed over 370 human cases of infections with avian influenza and almost 160 persons died due to this pathogen. At present there is known that person to person transmission of avian influenza virus is limited. Nevertheless, it is possible that with time virus will adapt to human sufficiently to be able to cause next influenza pandemic. Despite intensive studies and global influenza surveillance there is no possible to predict when pandemic will begin and what kind of virus will cause this outbreak.


Psychiatric symptomatology in crack cocaine abusers.
Many substance abusers present with elevated scores on self-report measures of psychopathological symptoms. We decided to examine this in a sample of 194 crack cocaine abusers. Results indicated that these individuals reported significantly greater psychopathological distress than manual-provided norms, and that this distress was not related to recency of cocaine use. Rank order correlation suggests that a pattern of scores specific to cocaine abusers may exist. Finally, while intake scores of psychopathological distress did not predict treatment retention/outcome, those successfully completing 12 weeks of outpatient treatment were both cocaine abstinent and less psychiatrically distressed.


Atmospheric pressure MALDI-fourier transform mass spectrometry.
The coupling of atmospheric pressure matrix-assisted laser desorption/ionization (AP MALDI) with Fourier transform mass spectrometry (FTMS) is described, and its significance for the high-resolution analysis of complex peptide mixtures is demonstrated. High kinetic energy and extensive metastable decay characteristic of ions generated by vacuum MALDI have been known to constitute a possible obstacle to high-resolution analysis by FTMS. Since the initial coupling of laser desorption techniques with FTMS was realized two decades ago, several different solutions have been proposed to control the energy of the ions and fulfill the promise of high sensitivity and high resolution offered by this analytical method. Initial results obtained on quadrupole time-of-flight and ion trap analyzers have shown that ions generated by MALDI at atmospheric pressure are intrinsically less energetic than those provided by vacuum MALDI. Our report indicates that this characteristic is particularly beneficial for FTMS applications in which a sharp reduction of metastable decay can make larger ion currents available for detection and possible tandem experiments. In our hands, AP MALDI-FTMS has enabled the analysis of complex peptide mixtures with resolution and accuracy comparable to those obtained by analogous electrospray ionization-FTMS experiments, with no evidence of either metastable decomposition or significant formation of matrix adducts. Analysis of a trypsin digest of bovine serum albumin provided signal-to-noise ratios and limits of detection similar to those obtained by ion trap analyzers, but with unmatched resolution and accuracy. AP MALDI has been shown to provide stable precursor ions in amounts that allowed for informative tandem experiments. Finally, the potential of AP MALDI-FTMS for the high-resolution screening of complex mixtures was demonstrated by the analysis of isobaric peptides differing in mass by less than 0.04 Da.


Evaluating the Potential of Oleaginous Yeasts as Feedstock for Biodiesel Production.
Lipid-producing microorganisms, said to be oleaginous have been recognized since several years. We had investigated the effects of medium components and culturing situations on cell growth and lipid accumulation of oleaginous yeasts which were analytically examined so as to enhance lipid yield for biodiesel production. The main objective of this study was to explore oleaginous yeast, Yarrowia lipolytica isolated from soil and optimization of culture conditions and medium components to obtained better quality microbial oil for biodiesel production. Fifty yeast strains were isolated from soil from different regions of Lahore and eleven of them were selected for oil production. The isolated yeast colonies were screened to further check their lipid producing capabilities by the qualitative analysis. Five yeast strains were designated as oleaginous because they produced more than 16% of oil based on their biomass. To estimate the total lipid content of yeast cells, the extraction of lipids was done by performing the procedure proposed by Bligh and Dyer. The transesterification of yeast oils was performed by using different methods. There were three different strategies customized to transesterifying microbial oil using base catalyzed transesterification, acid catalyzed transesterification and enzyme-based transesterification. After completion of transesterification, sample was used for fatty acid methyl esters (FAMEs) were analyzed by gas-chromatograph with ionization detector type MS. The isolate IIB-10 identified as Yarrowia lipolytica produced maximum amount of lipids i.e. 22.8%. More amount of biomass was obtained when cane molasses was utilized as carbon source where it produced 29.4 g/L of biomass while sucrose and lactose were not utilized by IIB-10 and no biomass was obtained. Similarly, meat extracts showed best results when it was used as nitrogen source because it resulted in 35.8 g/L biomass of Yarrowia lipolytica IIB-10. The culturing conditions like size of inoculum, effect of pH and time of incubation were also studied. The 10% of inoculum size produced 25.4 g/L biomass at 120 h incubation time, while the pH 7 was the optimum pH at which 24.8 g/L biomass was produced by Yarrowia lipolytica IIB-10. GC-MS analysis showed that biodiesel produced by transesterification contained similar fatty acids as found in vegetable oil for this reason it is widely accepted feedstock for biodiesel production. The analysis of fatty acids methyl esters showed the similar composition of microbial oil as in vegetable oils and high amount of methyl esters were obtained after transesterification. Therefore, potentially oleaginous yeast could be used to generate a large amount of lipids for biodiesel production that will be the better substitute of petroleum-based diesel and will also control the environmental pollution.


Knowledge, acceptance and perception towards brainstem death among medical students in Hong Kong: a questionnaire survey on brainstem death.
Brainstem death (BSD), defined as the irreversible loss of consciousness, brainstem reflexes and the capacity to breathe, is not an uncommon scenario seen in the day to day practice of medical personnel. Upon the diagnosis of BSD, controversial issues of withdrawing life-supporting treatments and organ procuring for transplantation inevitably arise. This study evaluated the knowledge, acceptance and perception of BSD amongst medical students in Hong Kong. A total of 126 medical students completed a self-administered questionnaire. Ten questions were used to assess their knowledge of BSD and this was correlated with their responses in three hypothetical vignettes. The mean score of the subjects' knowledge was 6.03 out of 10. Less than half (48.8%) of the subjects' knew that BSD is different from persistent vegetative state while 49.2% and 36.3% knew that BSD is accepted as death medically and legally in Hong Kong, respectively. When 'diagnosed' with BSD, 63.7%, 46.8% and 52.4% of the subjects would agree to the withdrawal of life-support from themselves, their most-loved one/family member and a stranger, respectively. Subjects with better knowledge and those who thought that doctors may tend to diagnose BSD to save resources or procure organs for transplantation were more ready to accept the withdrawal of life-support. We concluded that knowledge of BSD amongst medical students was unsatisfactory and that urgent actions should be taken to remedy the situation. A better knowledge of BSD positively influenced the decision-making on withdrawing life-support and that adequate information regarding the outcome of BSD should be provided. On the other hand, the perception of doctors' intentions behind diagnosing BSD has no direct influence on the decision-making. More emphasis is required on medical education, including a specific emphasis in the undergraduate lecture curriculum and bedside exposure to BSD diagnosis and subsequent counselling of patients' family members.


Single species biofilm-forming ability of root canal isolates on gutta-percha points.
The participation of bacterial biofilms in the over-filled gutta-percha points associated with refractory periapical periodontitis has recently been reported. This study investigated the initial biofilm-forming ability of root canal isolates (Enterococcus faecalis, Streptococcus sanguis, Strep. intermedius, Strep. pyogenes, Staphylococcus aureus, Fusobacterium nucleatum, Propionibacterium acnes, Porphyromonas gingivalis and Prevotella intermedia) on gutta-percha points in vitro. Each bacterial strain was suspended in 100% cell culture medium or in culture medium containing 4.5, 45 or 90% (vol/vol) serum. The bacterial suspensions were then co-incubated anaerobically with gutta-percha points for 7 d. The gutta-percha points were processed for scanning electron microscopic observation and examined for biofilm presence and thickness. E. faecalis, Strep. sanguis, Strep. intermedius, Strep. pyogenes and Staph. aureus biofilms were generated on the surfaces of the specimens incubated in culture medium supplemented with 45 or 90% (vol/vol) serum. The E. faecalis and Strep. sanguis biofilms were significantly thicker than those of Strep. intermedius, Strep. pyogenes and Staph. aureus. No biofilms were detected on the specimens incubated with F. nucleatum, Prop. acnes, Porph. gingivalis and Prev. intermedia. These findings suggest that Gram-positive facultative anaerobes have the ability to colonize and form extracellular matrices on gutta-percha points, while serum plays a crucial role in biofilm formation.


Effects of cation charge-site identity and position on electron-transfer dissociation of polypeptide cations.
The effect of cation charge site on gas-phase ion/ion reactions between multiply protonated model peptides and singly charged anions has been examined. Insights are drawn from the quantitative examination of the product partitioning into competing channels, such as proton transfer (PT) versus electron transfer (ET), electron transfer followed by dissociation (ETD) versus electron transfer without dissociation (ET, no D), and fragmentation of backbone bonds versus fragmentation of side chains. Peptide cations containing protonated lysine, arginine, and histidine showed similar degrees of electron transfer, which were much higher than the peptide having fixed-charge sites, that is, trimethyl ammonium groups. Among the four types of cation charge sites, protonated histidine showed the highest degree of ET, no D, while no apparent intact electron-transfer products were observed for peptides with protonated lysine or arginine. All cation types showed side chain losses with arginine yielding the greatest fraction and lysine the smallest. The above trends were observed for each electron-transfer reagent. However, proton transfer was consistently higher with 1,3-dinitrobeznene anions, as was the fraction of side-chain losses. The partitioning of products among the various electron-transfer channels provides evidence for several of the mechanisms that have been proposed to account for electron-transfer dissociation and electron-capture dissociation. The simplest picture to account for all of the observations recognizes that several mechanisms can contribute to the observed products. Furthermore, the identity of the anionic reagent and the positions of the charge sites can affect the relative contributions of the competing mechanisms.


Visible-Light-Induced Intramolecular C(sp2)-H Amination and Aziridination of Azidoformates via a Triplet Nitrene Pathway.
Catalytic intramolecular C-H amination and aziridination reactions of o-allylphenyl azidoformates have been achieved under visible-light irradiation, providing a mild, clean, and efficient method for the synthesis of useful benzoxazolones and [5.1.0] bicyclic aziridines. Mechanistic studies suggest that a triplet nitrene acts as the reactive intermediate. The chemoselectivity of the reaction, with alkyl olefin aziridination ≫ electron deficient olefin aziridination ≈ C(sp2)-H amination ≫ C(sp3)-H amination was observed, which may be instructive in the development of an understanding of visible-light-induced triplet nitrene transformation reactions.


Comparative Evaluation of Preformed Stainless Steel Crown's Crazing at Different Autoclave Cycles.
The study aimed to assess and compare the crazing of preformed stainless steel (SS) crowns at various autoclave cycles. Around 15 SS crowns were subjected to zero (unsterilized), one, three, five, and seven autoclave cycles at 121°C, 15 psi for 20 minutes. After each autoclave cycle, the mesial surface of each crown from occlusal to cervical portions was examined under a 40× stereomicroscope. Crazing was evaluated using Wickersham's criteria. One autoclave cycle does not produce any cracks, whereas the higher the number of autoclave cycles, the higher the cracks, which affects the prognosis of the SS crown treatment. Surface alterations of SS crowns after different autoclave cycles were significant. So, preformed SS crowns should be discarded after sterilizing once or twice during clinical practice. Sowkarthicaa P, Mathian VM, Gawthaman M, et al. Comparative Evaluation of Preformed Stainless Steel Crown's Crazing at Different Autoclave Cycles. Int J Clin Pediatr Dent 2023;16(S-1):S77-S80.


Transcriptome Profile Analysis of Strawberry Leaves Reveals Flowering Regulation under Blue Light Treatment.
Blue light is an important signal that regulates the flowering of strawberry plants. To reveal the mechanism of early flowering under blue light treatment at the transcriptional regulation level, seedlings of cultivated strawberry (Fragaria × ananassa Duch.) "Benihoppe" were subjected to a white light treatment (WL) and blue light treatment (BL) until their flowering. To detect the expression patterns of genes in response to BL, a transcriptome analysis was performed based on RNA-Seq. The results identified a total of 6875 differentially expressed genes (DEGs) that responded to BL, consisting of 3138 (45.64%) downregulated ones and 3737 (54.36%) upregulated ones. These DEGs were significantly enriched into 98 GO terms and 71 KEGG pathways based on gene function annotation. Among the DEGs, the expression levels of genes that might participate in light signaling (PhyB, PIFs, and HY5) and circadian rhythm (FKF1, CCA1, LHY, and CO) in plants were altered under BL. The BBX transcription factors which responded to BL were also identified. The result showed that the FaBBX29, one of strawberry's BBX family genes, may play an important role in flowering regulation. Our results provide a timely, comprehensive view and a reliable reference data resource for further study of flowering regulation under different light qualities.


Gas bubbles in rats after heliox saturation and different decompression steps and rates.
Effects of pressure reduction, decompression rate, and repeated exposure on venous gas bubble formation were determined in five groups (GI, GII, GIII, GIV, and GV) of conscious and freely moving rats in a heliox atmosphere. Bubbles were recorded with a Doppler ultrasound probe implanted around the inferior caval vein. Rats were held for 16 h at 0.4 MPa (GI), 0.5 MPa (GII and GIII), 1.7 MPa (GIVa), or 1.9 MPa (GIV and GV), followed by decompression to 0.1 MPa in GI to GIII and to 1.1 MPa in GIV and GV. A greater decompression step, but at the same rate (GII vs. GI and GIVb vs. GIVa), resulted in significantly more bubbles (P < 0.01). A twofold decompression step resulted in equal amount of bubbles when decompressing to 1.1 MPa compared with 0.1 MPa. The faster decompression in GII and GVa (10.0 kPa/s) resulted in significantly more bubbles (P < 0.01) compared with GIII and GVb (2.2 kPa/s). No significant difference was observed in cumulative bubble score when comparing first and second exposure. With the present animal model, different decompression regimes may be evaluated.


Metformin decreases plasma insulin levels and systolic blood pressure in spontaneously hypertensive rats.
To determine the relationship between hyperinsulinemia and hypertension in spontaneously hypertensive rats (SHR), the antihyperglycemic agent metformin was administered to SHR and their Wistar-Kyoto (WKY) controls, and its effects on plasma insulin levels and blood pressure were examined. Five-week-old rats were started on oral metformin treatment (350 mg.kg-1.day-1, which was gradually increased to 500 mg.kg-1.day-1 over a 2-wk period). Metformin treatment caused sustained decreases in plasma insulin levels in the SHR (27.1 +/- 2.3 vs. untreated SHR 53.5 +/- 2.7 microU/ml, P < 0.001) without having any effect in the WKY (30.7 +/- 2.2 vs. untreated WKY 37.8 +/- 1.6 microU/ml, P > 0.05). The treatment did not affect the plasma glucose levels in any group. Metformin treatment also attenuated the increase in systolic blood pressure in the SHR (157 +/- 6.0 vs. untreated SHR 196 +/- 9.0 mmHg, P < 0.001) but had no effect in the WKY (134 +/- 3 vs. untreated WKY 136 +/- 4 mmHg, P > 0.05). Furthermore, raising plasma insulin levels in the metformin-treated SHR to levels that existed in the untreated SHR reversed the effect of metformin on blood pressure (189 +/- 3 vs. untreated SHR 208 +/- 5.0 mmHg, P > 0.05). These findings suggest that either hyperinsulinemia may contribute toward the increase in blood pressure in the SHR or that the underlying mechanism is closely associated with the expression of both these disorders.


Seasonally bound ovopathy versus "temperature at conception" as cause for anorexia nervosa and other eating disorders.
A preponderance of births between April and June in patients with anorexia nervosa (AN) and other eating disorders (EDs) has recently been explained by a higher environmental temperature at conception. This hypothesis, however, does not explain some other irregularities in the month of birth distribution in contrast to the seasonal preovulatory overripeness ovopathy (SPrOO) and seasonal optimally ripened oocytes (SOptRO) hypotheses. The month of birth distribution of 408 patients with EDs from Southeast England and of 199 patients from Australia has been reassessed in relation to previously determined high-risk and low-risk months based on a priori knowledge from mammals and on the physiologic birth peaks and troughs in humans at population level. The differences between high-risk and low-risk months were assessed by conventional chi-square analyses and by relative risks (RRs) with 95% confidence intervals (CI). In England, fewer AN patients (n = 259) were born at the peaks of the total birth pattern, that is, during the 2 low-risk months, and more were born during the transitional stages, that is, during the remaining 10 high-risk months (p = .004; RR = 1.66 [95% CI = 1.13-2.41]). After the addition of 149 other ED patients (n = 408), this result remained (p = .005; RR = 1.47 [95% CI = 1.10-1.97]). Similar results were found in 199 ED patients from Australia (p = .009; RR =1.70 [95% CI = 1.09-2.64]). ED patients appear to be more frequently conceived during the transitional stages of the ovulatory pattern due to SPrOO and less frequently at the ovulatory peaks due to SOptRO. The pathophysiologic processes of oocyte maturation in estrous animals and the circumstantial evidence of similar phenomena in humans are more appropriate to explain these coincidences than the temperature at conception hypothesis.


Bexarotene Does Not Clear Amyloid Beta Plaques but Delays Fibril Growth: Molecular Mechanisms.
In 2012, it was reported that anticancer drug bexarotene reduced amyloid plaque and improved mental functioning in a small sample of mice engineered to exhibit Alzheimer's like symptoms. It has been suggested that bexarotene stimulates expression of apolipoprotein E (ApoE) leading to intracellular clearance of amyloid beta (Aβ). However, the effect of bexarotene on clearance of plaques has not been seen in some mouse models. Two interesting questions include whether bexarotene can destroy Aβ fibrils via direct interaction with them and how this compound impacts the lag phase in the fibril growth process. By the Thioflavin T fluorescence assay and atomic force microscopy, we have shown that bexarotene prolongs the lag phase, but it does not degrade Aβ fibrils. The impotence of bexarotene in destroying fibrils means that this compound is weakly bound to Aβ. On the other hand, the weak binding would prevent bexarotene from prolonging the lag phase. Thus, our two main in vitro observations seem to contradict each other. In order to settle this problem at the atomic level, we have performed all-atom molecular dynamics simulations in explicit water. We have demonstrated that bexarotene is not capable to reduce amyloid deposits due to weak binding to Aβ fibrils. However, it delays the self-assembly through reduction of the β-content of Aβ monomers at high enough ligand concentrations. Bexarotene is the first compound which displays such an unusual behavior. We have also shown that bexarotene has a low binding propensity to Aβ monomer and dimer.


Thermal ablation as an alternative to liver transplantation for hepatocellular carcinoma with clinically significant portal hypertension: propensity score matching study.
The objectives were to investigate the safety and efficacy of thermal ablation as an alternative to liver transplantation for hepatocellular carcinoma patients with clinically significant portal hypertension (CSPH). From July 2016 to September 2019, hepatocellular carcinoma patients with CSPH treated by liver transplantation (N=37) or thermal ablation (N=114) were enrolled. Cumulative intrahepatic recurrence, overall survival and major complications were compared by propensity score matching. In the two matched groups, the 1-, 2-, and 3-year intrahepatic recurrence rates for the ablation group (22.3%, 50.0%, and 50.0%, respectively) were significantly higher than those for the transplantation group (4.5%, 4.5%, and 4.5%, respectively) (P=0.016). The 1-, 2-, and 3-year overall survival rates were comparable between the two groups [96.1%, 88.7%, and 88.7%, respectively (ablation group) vs. 84.6%, 76.2%, and 76.2%, respectively (transplantation group)] (P=0.07). The major complication rate for the ablation group [4.8% (3/62)] was significantly lower than that for the transplantation group [36.0% (9/25)] (P<0.001). Thermal ablation is a safe and effective alternative for hepatocellular carcinoma patients with CSPH.


Perforated amebic liver abscess: clinical analysis of 110 cases.
In this study of 503 consecutive cases of amebic liver abscess documented during a 21-year period, 110 (22%) were complicated by perforation. Perforation sites included pleuropulmonary structures (79 cases, 72%) subphrenic space (15 cases, 14%); and peritoneal cavity (11 cases, 10%). The less common sites were the thoracic and abdominal wall, pericardial sac, bile duct, kidney, mediastinum, colon, and right flank. Trophozoites were recovered in 29% of cases. For the rest of the cases, diagnosis was based on the clinical manifestations and the dramatic response to a therapeutic trial of amebicides. Open surgical drainage was done in 10 of 11 patients who had peritoneal perforation; 6 of them were cured and 5 died. Of 97 patients with perforation sites other than the peritoneal cavity, 64 were treated with metronidazole in addition to needle aspiration and/or percutaneous catheter drainage, and all achieved complete remission without relapse during subsequent follow-up. Of the 36 cases treated with metronidazole alone, 22 (61%) were cured. The mortality rate in the group with perforated abscess was 17% (19/110), compared with 5% (25/503) in the whole series. The results suggested that (1) amebic liver abscess can be difficult to diagnose, especially when the pathogen is not isolated; and (2) metronidazole combined with needle aspiration and/or percutaneous catheter drainage is the treatment of choice for amebic liver abscess with perforation.


Randomized controlled trial of web-based multimodal therapy for children with acquired brain injury to improve gross motor capacity and performance.
To compare efficacy of a web-based multimodal training programme, 'Move it to improve it' (MitiiTM), to usual care on gross motor capacity and performance for children with an acquired brain injury. Randomized waitlist controlled trial. Home environment. A total of 60 independently ambulant children (30 in each group), minimum 12 months post-acquired brain injury were recruited and randomly allocated to receive either 20 weeks of MitiiTM training (30 minutes/day, six days/week, total 60 hours) immediately, or waitlisted (usual care control group) for 20 weeks. A total of 58 children completed baseline assessments (32 males; age 11 years 11 months ± 2 years 6 months; Gross Motor Function Classification System equivalent I = 29, II = 29). The MitiiTM program comprised of gross motor, upper limb and visual perception/cognitive activities. The primary outcome was 30-second, repetition maximum functional strength tests for the lower limb (sit-to-stand, step-ups, half-kneel to stand). Secondary outcomes were the 6-minute walk test, High-level Mobility Assessment Tool, Timed Up and Go Test and habitual physical activity as captured by four-day accelerometry. Groups were equivalent at baseline on demographic and clinical measures. The MitiiTM group demonstrated significantly greater improvements on combined score of functional strength tests (mean difference 10.19 repetitions; 95% confidence interval, 3.26-17.11; p = 0.006) compared with the control group. There were no other between-group differences on secondary outcomes. Although the MitiiTM programme demonstrated statistically significant improvements in the functional strength tests of the lower limb, results did not exceed the minimum detectable change and cannot be considered clinically relevant for children with an acquired brain injury. Australian New Zealand Clinical Trials Registration Number, ANZCTR12613000403730.


Epidemiology of cholera outbreaks and socio-economic characteristics of the communities in the fishing villages of Uganda: 2011-2015.
The communities in fishing villages in the Great Lakes Region of Africa and particularly in Uganda experience recurrent cholera outbreaks that lead to considerable mortality and morbidity. We evaluated cholera epidemiology and population characteristics in the fishing villages of Uganda to better target prevention and control interventions of cholera and contribute to its elimination from those communities. We conducted a prospective study between 2011-15 in fishing villages in Uganda. We collected, reviewed and documented epidemiological and socioeconomic data for 10 cholera outbreaks that occurred in fishing communities located along the African Great Lakes and River Nile in Uganda. These outbreaks caused 1,827 suspected cholera cases and 43 deaths, with a Case-Fatality Ratio (CFR) of 2.4%. Though the communities in the fishing villages make up only 5-10% of the Ugandan population, they bear the biggest burden of cholera contributing 58% and 55% of all reported cases and deaths in Uganda during the study period. The CFR was significantly higher among males than females (3.2% vs. 1.3%, p = 0.02). The outbreaks were seasonal with most cases occurring during the months of April-May. Male children under age of 5 years, and 5-9 years had increased risk. Cholera was endemic in some villages with well-defined "hotspots". Practices predisposing communities to cholera outbreaks included: the use of contaminated lake water, poor sanitation and hygiene. Additional factors were: ignorance, illiteracy, and poverty. Cholera outbreaks were a major cause of morbidity and mortality among the fishing communities in Uganda. In addition to improvements in water, sanitation, and hygiene, oral cholera vaccines could play an important role in the prevention and control of these outbreaks, particularly when targeted to high-risk areas and populations. Promotion and facilitation of access to social services including education and reduction in poverty should contribute to cholera prevention, control and elimination in these communities.


Expression of protein tyrosine kinases in the Ig complex of anti-mu-sensitive and anti-mu-resistant B-cell lymphomas: role of the p55blk kinase in signaling growth arrest and apoptosis.
The src family of non-receptor protein tyrosine kinases (PTKs), including the blk, fyn, lyn and lck kinases, is expressed in B-lineage cells, may associate with the immunoglobulin receptor complex and, therefore, play a role in signal transduction via membrane IgM. To establish which of these PTKs is involved in growth inhibition of B-cell lymphomas by anti-mu, we examined the expression pattern and state of activation of these kinases in nine B-cell lymphomas. Tyrosine-phosphorylated p55blk was constitutively expressed in all growth-inhibitable lymphomas; furthermore, anti-mu caused a relative increase of tyrosine phosphorylation in p55blk and a 2- to 3-fold increase in its kinase activity in these cells within minutes. In contrast, p55blk was not present in three of five anti-mu-resistant lymphomas and there was no detectable increase of blk activity in one of the resistant cell lines tested. Thus, we proposed that activatable blk kinase in the IgM complex is essential for the growth inhibitory effect of anti-mu. To test this hypothesis, CH31 lymphoma cells were treated with antisense oligos for the blk kinase and found to be resistant to anti-mu-mediated growth inhibition and subsequent apoptosis. These studies implicate the blk kinase as an integral part of the growth inhibitory pathway leading to arrest and apoptosis. Transfectants of blk gene constructs are being generated to further test this hypothesis.


[Scientific communication in Spanish anesthesiology: medical congresses (1864-1936)].
This historical-medical study proposed to determine the evolution of knowledge in Spanish anesthesiology by examining conferences and presentations at medical congresses on record for the period between the first Spanish medical congress (1864) and the start of the Spanish Civil War (1936). We have found reports of 34 scientific meetings held during this period. All but two included news on anesthesiology or related matters. Ten were international meetings, while 25 were nation-wide conferences. We have been able to arrive at a good understanding of Spanish anesthesiology's evolution as a scientific discipline during this period.


Utilization of health care services among Medicare beneficiaries who visit federally qualified health centers.
Previous studies have disagreed on whether patients who receive primary care from federally qualified health centers (FQHCs) have different utilization patterns than patients who receive care elsewhere. Our objective was to compare patterns of healthcare utilization between Medicare beneficiaries who received primary care from FQHCs and Medicare beneficiaries who received primary care from another source. We compared characteristics and ambulatory, emergency department (ED), and inpatient utilization during 2013 between 130,637 Medicare beneficiaries who visited an FQHC for the majority of their primary care in 2013 (FQHC users) and a random sample of 1,000,000 Medicare fee-for-service (FFS) beneficiaries who did not visit an FQHC (FQHC non-users). We then created a propensity-matched sample of 130,569 FQHC users and 130,569 FQHC non-users to account for differences in observable patient characteristics between the two groups and repeated all comparisons. Before matching, the two samples differed in terms of age (42% below age 65 for FQHC users vs. 16% among FQHC non-users, p < 0.001 for all comparisons), disability (52% vs. 24%), eligibility for Medicaid (56% vs. 21%), severe mental health disorders (17% vs. 10%), and substance abuse disorders (6% vs. 3%). FQHC users had fewer ambulatory visits to primary care or specialist providers (10.0 vs. 12.0 per year), more ED visits (1.2 vs. 0.8), and fewer hospitalizations (0.3 vs. 0.4). In the matched sample, FQHC users still had slightly lower utilization of ambulatory visits to primary care or specialist providers (10.0 vs. 11.2) and slightly higher utilization of ED visits (1.2 vs. 1.0), compared to FQHC users. Hospitalization rates between the two groups were similar (0.3 vs. 0.3). In this population of Medicare FFS beneficiaries, FQHC users had slightly lower utilization of ambulatory visits and slightly higher utilization of ED visits, compared to FQHC non-users, after accounting for differences in case mix. This study suggests that FQHC care and non-FQHC care are associated with broadly similar levels of healthcare utilization among Medicare FFS beneficiaries.


Linguistic status following closed head injury in children: a follow-up study.
The speech and language functioning of a group of 20 children (aged 8-17) who had sustained a closed head injury at least 12 months previously was assessed with the purpose of developing a comprehensive profile of the type and severity of the long-term speech/language disorders exhibited by this group. The same group of subjects was then re-evaluated 12 months after the initial testing to monitor progress of the closed head-injured group in relation to a group of non-neurologically impaired controls. The subjects were administered a battery of speech/language assessments including articulation/phonological assessment; oromotor assessment; overall language test; and specific language skills assessments. Initial and re-test performance of the head-injured group was compared to that of a group of non-neurologically impaired accident victims matched for age, sex and socioeconomic status. Comparison within the head-injured group of test and re-test performance was also carried out. Overall language performance scores of the head-injured group were found to be consistently significantly lower than achieved by the control group at both initial and re-test stages. Performance of the head-injured group had, however, improved significantly over the 12-month period.


Twelve tips for adapting grand rounds for contemporary demands.
Grand rounds have evolved since inception in the early 1900s and subsequently, there has been a continual debate surrounding the best purpose for the time-honoured event. However, the purpose of grand rounds can be broadened to meet the needs of the medical community today, especially at a time where there is great distribution of medical practitioners and learners geographically and events such as COVID-19, which prevent the community from physically gathering. Using the evidence and lessons available from the literature we developed a grand rounds series with goals and objectives suited to our context. In this guide we provide twelve tips covering goal planning, logistics, presentation preparation and presentation delivery in order to illustrate how one could organize an informed grand rounds which is successful contextually.


Pulmonary complications following cardiac surgery.
Coronary heart disease is a common diseases of atherosclerosis. Despite the development of noninvasive therapies and the advancement of pharmacological methods and extensive drug regimens, coronary artery bypass grafting surgery is still the ultimate treatment option in many patients. Among the various complications following open heart surgery, one of the common difficulties is pulmonary complications associated with subsequent morbidity and mortality, which should be studied according to preoperative, perioperative, and postoperative factors. Preoperative factors include genetics, age, family history of pulmonary disease, smoking, coexisting disease, etc. Perioperative factors include surgical procedures like sternotomy incision, cardioplegia, and internal mammary artery harvesting; anaesthesia procedure effects like pulmonary collapse, maintenance drugs and morphine administration; and cardiopulmonary bypass pump by systemic inflammatory response syndromes. And finally, postoperative factors, especially mediastinitis and the role of nursing in the intensive care unit. Pulmonary complications after cardiac surgery include atelectasis, pleural effusions, pneumonia, pulmonary oedema, cardiogenic pulmonary oedema, acute respiratory distress syndrome, pulmonary embolism, phrenic nerve injury, pneumothorax, sternal wound infection, and mediastinitis, with different outbreaks in patients reported. Although the preoperative, perioperative, and postoperative factors play an important role in the occurrence of these complications, the preoperative factors, as factors that can be adjusted, should be considered more than the others and explained to the patient, and the preoperative patient's assessment should be noted. Also, postoperative care with the goal of reducing infections and pulmonary complications should be addressed by the nursing team.


Scorpion Envenomation in Pregnancy.
Scorpion envenomation affects more than 1 million people every year and represents an important public health problem worldwide. The effects of envenomation range from localized pain and paresthesias to overactivation of the sympathetic nervous system, leading to neurotoxicity and even death. Of the individuals affected by scorpion envenomation, certain populations, such as young children and older adults, are at high risk for severe disease. Substantial literature exists on the management of envenomation in children; however, scant literature exists that addresses the same phenomenon in pregnant women. This review serves to identify the effects of scorpion envenomation on pregnant women and the treatment options available to them. After thorough review of the treatment modalities that are used to treat scorpion envenomation, we developed a treatment algorithm that may help guide the management of pregnant women who present with scorpion envenomation.


Extent of smoking at a Danish hospital with a smoke-free policy.
One-fifth of the Danish population smoke and exposure to second-hand smoke has well-documented adverse health effects. The smoking policy at hospital level prohibits hospital staff from smoking on the hospital grounds while patients and visitors may smoke in outdoor smoking cabins. This study aimed to quantify smoking at a Danish hospital and document any policy breaches. In April 2020, we collected cigarette butts and observed smokers at the outdoor grounds to document smoking behaviour. In total, 7152 cigarette butts were collected during one week and 368 people were observed smoking at the outdoor grounds during four observation days. Of all collected cigarette butts, 55% were collected outside the smoking cabins and 62% of all smokers were observed smoking outside the smoking cabins. In addition, 31 staff were observed smoking. This study documents that smoking is prevalent at a smoke-free hospital and that the smoking policy is frequently violated. The frequency of smoking outside the cabins may at least partly be influenced by the COVID-19 pandemic. Smoking at a hospital can expose patients, visitors and staff to second-hand smoke with subsequent adverse health effects. Hospitals could play an exemplary role towards a smoke-free society (and not the exception), but the opportunity is not always seized.


The Relationship Among Shame, Nonsuicidal Self-Injury, and Suicidal Behaviors in Borderline Personality Disorder.
Shame has been individually linked to nonsuicidal self-injury and suicidal ideation and behavior and is highly prevalent in individuals with borderline personality disorder. The current study investigated the relationship between shame, nonsuicidal self-injury, and suicidal ideation in a sample of women with borderline personality disorder. Participants were 40 women recruited from a Women's Dialectical Behavior Therapy Partial Hospital Program in a psychiatric hospital in New England as part of a larger, six-month treatment development study. Results indicated that shame-proneness predicts nonsuicidal self-injury and suicidal ideation and behavior above and beyond the severity of borderline personality disorder symptoms, suggesting that shame may be an important treatment target for individuals with borderline personality disorder. Clinical implications, limitations, and future directions are discussed.


Registered report protocol: Perceptual effects of Arabic grammatical gender on occupational expectations in a gamified speech production task.
The default use of masculine morphology to refer to all genders in Arabic-speaking countries is largely unquestioned and widely accepted. However, research on masculine generic morphology in other gender-marked languages has shown that this can create an over-representation of men and a male-bias in perception. Given the extensive use of default masculine grammatical gender in the context of job recruitment, education, and formal communication where women are typically underrepresented and men overrepresented, this widely accepted notion needs to be investigated. The primary aim of this research is to understand how grammatical gender in Arabic mediates occupational expectations based on the language currently used in job recruitment in Arabic speaking countries. Specifically, the study explores how the use of default masculine grammatical gender can create a male-bias in perception. The secondary aim of this research is to test whether gender-inclusive language can reduce this male-bias in perception and instead increase the accessibility, activation, and retrieval of exemplars related to other gender minorities (i.e., reduce male-bias in perception). This is achieved through a novel prompted speech production experiment, based on an adaptation of the popular board game 'Taboo' where participants are asked to describe role nouns presented (e.g., doctor or nurse) in different language conditions.


Prevalence of Abdominal Obesity and Associated Factors in Urban Brazilian Women: A Comparison Between Two Population-Based Cross-Sectional Studies in 2003 and 2015.
Background: Abdominal fat accumulation is a known risk factor for cardiometabolic diseases and mortality, particularly in women. This study aimed to compare the prevalence of abdominal obesity and its associated factors in 2003 and 2015. Methods: Two cross-sectional, population-based surveys were conducted, including representative and independent samples of adult women 20-60 years of age residing in the urban area of São Leopoldo/RS municipality in 2003 (n = 981) and 2015 (n = 984). Abdominal obesity was assessed using waist circumference, with a measurement of ≥88 cm indicating its presence. Factors, such as demographics, socioeconomic status, reproductive health, family history, morbidity, and behavioral characteristics, were studied. Poisson regression was used to assess the associations. Results: The mean age of individuals in the samples was 38.5 years (±11.1 years) and 40.3 years (±11.4 years) in 2003 and 2015, respectively. The prevalence of abdominal obesity doubled from 23.3% (95% confidence interval [CI]: 20.7-26.0) in 2003 to 46.9% (95% CI: 43.7-50.0) in 2015. After adjustment, the prevalence of abdominal obesity remained higher in both 2003 and 2015 with increasing age, low family income, higher number of pregnancies, earlier age at menarche, and presence of a family history of obesity in the father and mother and in women with a history of hypertension. Conclusions: This study demonstrates an increase in the prevalence of abdominal obesity in women between 2003 and 2015 and highlights the sociodemographic, reproductive, family history, and comorbidity aspects associated with its occurrence.


Description of a stochastic system by a nonadapted stochastic process.
An approach for the description of stochastic systems is derived. Some of the variables in the system are studied forward in time, others backward in time. The approach is based on a perturbation expansion in the strength of the coupling between forward and backward variables, and it is well suited for situations in which initial and final conditions are imposed on different components of the system, and the coupling between those components is weak. The form of the stochastic equations in our approach is determined by requiring that they generate the same statistics obtained in a forward description of the dynamics. Numerical tests are carried out on a few simple two-degrees-of-freedom systems. The merit and the difficulties of the approach are discussed and compared to more traditional strategies based on transition path sampling and simple shooting algorithms.


Treatment of class ii in adulthood by forsus frd device.
Scientific research data show that the Forsus FRD seems to have a great potential in the correction of Class II in childhood. The conclusions reached by the various Authors seem to support the hypothesis of an exclusively or mainly dentoalveolar correction, as the skeletal correction seems to have no - or little - appreciable results. In the light of such provided by different Authors, the potential of dentoalveolar compensation in adult patients with mild skeletal class II was investigated. At the UOC (Complex Operative Unit) of Orthodontics at "G. Eastman" Hospital Rome, 3 cases of skeletal class II mild (ANB <5 °) in adult patients were selected. They were treated with fixed multibracket appliance and Forsus EZ2 module. Cephalometric tracings were compared at the beginning and at the end of the treatment in order to assess the skeletal and dentoalveolar changes. The occlusal correction was achieved through a dentoalveolar compensation characterized by the flaring of the lower teeth. Forsus FRD equipment is an excellent compromise for the correction of mild Class II, even during the post development age. The resulting correction is appreciated at dental alveolar level with a mesial movement of the incisors and molars.


Pelvic Inlet Shape Is Not as Dimorphic as Previously Suggested.
It is well known that there are significant differences in the pelves of males and females due, in part, to differing constraints. The male and female pelves must be suitable for upright posture and locomotion, but the female pelvis must also be suitable for reproduction. These differing requirements lead to differences in the shape and size of various pelvic dimensions. These differences are reflected in the pelvic inlet, midplane, and outlet. Current research has documented dimorphisms in the posterior and anterior spaces in all three of these planes. One measure however, that is calculated from the relationship between the length of the anterior-posterior diameter (APD) and the transverse diameter (TD) of the inlet, is not as dimorphic as previously suggested. This computed value is used to describe four main categories of inlet shape: android, gynecoid, anthropoid, and platypelloid. Current textbooks in anatomy and midwifery describe these forms and identify the typical male inlet shape as android and the typical female inlet shape as gynecoid. In this study, however, using skeletonized pelves of 378 adult individuals from three identified skeletal collections, the most common inlet shape for both males and females was android. In addition, when examining shape as a continuous variable, inlet shape is not sexually dimorphic in two of the three populations examined in this study. Based on the results of this study, the inlet shape for males and females is less dimorphic than previously thought, and we need to discontinue using pelvic categories to describe typical inlet shape. Anat Rec, 300:706-715, 2017. © 2017 Wiley Periodicals, Inc.


Differentiation of fetal rat somatotropes in vitro: effects of cortisol, 3,5,3'-triiodothyronine, and glucagon, a light microscopic and radioimmunological study.
Cortisol stimulates somatotrope differentiation in vitro. T3 and/or glucagon may also be involved. Fetal rat pituitary primordia were explanted at 14 days gestation and cultured for 7 days in medium supplemented with cortisol (50-500 nM), and either T3 (0.67 nM) or glucagon (0.5 nM). Also, to determine the time of first appearance of the somatotropes, explants were cultured 4, 5, or 6 days with cortisol alone. Immunoreactive somatotropes were detected by immunohistochemistry, and their size and number were estimated for each medium. GH was measured by RIA in explants and media. Immunoreactive somatotropes first appear at 18-19 days gestation. Their size and number depend on cortisol concentration: no cells at 50 nM, a few small ones at 100 nM, and many large ones at 250-500 nM. This progression was reflected by RIA of GH in explants and media, although small quantities were detected with 50 nM. The effect of T3 was only visible with a low dose of cortisol. With 100 nM cortisol, it increased the size and number of cells. Differentiation was also triggered with 50 nM cortisol plus T3. RIA detected significantly higher GH content and secretion after T3 stimulation. The decreases in number, size, and GH secretion and content elicited by glucagon were not significant, probably due to the high variability. Both techniques used provide similar information on somatotrope differentiation: stimulation by cortisol alone, or alternatively by a synergistic action between cortisol and T3.


Supramolecular assemblies of dimetal complexes with polydentate N-donor ligands: from a discrete pyramid to a 3D channel network.
Reactions of a dinuclear metal complex in the form of dirhodium(II) tetra(trifluoroacetate), [Rh(2)(O(2)CCF(3))(4)] (1), with a number of strong N-donor ligands having functional groups rigidly oriented at different directing angles have been found to yield supramolecular architectures of differing complexity. All structures have been established by X-ray crystallography. From reaction of 1 with neutral tris(4'-pyridyl)methylsilane ligand, CH(3)Si(C(5)H(4)N)(3) (L1), a discrete pyramid-shaped hexanuclear complex [[Rh(2)(O(2)CCF(3))(4)](3)CH(3)Si(C(5)H(4)N)(3)(eta(1)-C(6)H(6))(3)].C(6)H(6) (2.C(6)H(6)) has been isolated from benzene. In 2 three molecules of 1 are strongly coordinated to one L1 ligand at only one axial position of each dirhodium unit at the Rh-N distances of 2.152(6) A. The second rhodium atom of each dimetal complex in 2 weakly coordinates a benzene molecule with an Rh-C distance of 2.69(2) A. A supramolecular complex of the composition [[Rh(2)(O(2)CCF(3))(4)](2)(C(6)H(5))(2)Si(C(5)H(4)N)(2)] (3) has been prepared by reacting the dinuclear units 1 with a potentially bidentate ligand, bis(4'-pyridyl)diphenylsilane, (C(6)H(5))(2)Si(C(5)H(4)N)(2) (L2), having two pyridyl groups rigidly oriented at 109 degrees. In 3, one L2 ligand coordinates two dirhodium molecules 1 through their axial positions with the Rh-N distance of 2.150(5) A. An interesting extended 2D layered motif is formed by additional contacts of open axial positions of dirhodium units with phenyl groups of the neighboring ligands at Rh-C distances which average to 2.88(1) A. A supramolecular compound of the composition [[Rh(2)(O(2)CCF(3))(4)](3)(HO)C(C(5)H(4)N)(3)(eta(1)-C(6)H(6))].(1)/(2)C(6)H(6) (4.(1)/(2)C(6)H(6)) has been formed when linear dirhodium units 1 were reacted with tris(4'-pyridyl)methanol (L3) having tetrahedral directing angles that average to 110 degrees. A building block in the solid structure of 4 is a hexanuclear molecule in which one L3 ligand binds three dimetal units of 1 through N atoms of pyridyl groups at the average Rh-N distance of 2.143(7) A. A unique extended pseudo-3D structure in 4 is created by additional Rh-O coordination bonds as well as by weak metal-arene interactions.


[Dislocation of the proximal hallux interphalangeal joint with interposition of a sesamoid bone: a blibliographic review].
The irreducible dislocation of the hallux interphalangeal joint is an infrequent condition and only a few cases have been described. It presents as dorsal dislocation with interposition of the sesamoid bone, which has the possibility of being radiologically undetectable. We present the case of a 29 year-old patient who, after a sports trauma sustained a hallux interphalangeal dislocation that went unnoticed for eight days. Since, closed reduction was not possible, as occurred in several cases reported in the literature, open reduction was performed through a dorsal incision. Based on a bibliographic review, it is possible to state that there are several treatment options and multiple approaches, and that these lesions usually have a good prognosis.


Quantifying landscape linkages among giant panda subpopulations in regional scale conservation.
Understanding habitat requirements and identifying landscape linkages are essential for the survival of isolated populations of endangered species. Currently, some of the giant panda populations are isolated, which threatens their long-term survival, particularly in the Xiaoxiangling mountains. In the present study, we quantified niche requirements and then identified potential linkages of giant panda subpopulations in the most isolated region, using ecological niche factor analysis and a least-cost path model. Giant pandas preferred habitat with conifer forest and gentle slopes (>20 to ≤30°). Based on spatial distribution of suitable habitat, linkages were identified for the Yele subpopulation to 4 other subpopulations (Liziping, Matou, Xinmin and Wanba). Their lengths ranged from 15 to 54 km. The accumulated cost ranged from 693 to 3166 and conifer forest covered over 31%. However, a variety of features (e.g. major roads, human settlements and large unforested areas) might act as barriers along the linkages for giant panda dispersal. Our analysis quantified giant panda subpopulation connectivity to ensure long-term survival.


Reliability of random digit dialing calls to enumerate an adult female population.
Challenges to random digit dialing have been documented, but the reliability of random digit dialing outcomes from telephone number calling, household identification, and enumeration has never been addressed, despite its potential to bias population representativeness by affecting completeness of coverage. The authors explored interobserver reliability of calls to numbers generated by random digit dialing for a 1990-1996 population-based case-control study in San Francisco, California, area women, using data from a quality control effort in which 122 of 4,890 random digit dialing numbers were assigned to a second interviewer for recontacting within 4 months. The 34 numbers discrepant between the first and second calls did not differ from the 88 unchanged outcomes, and reliability was good (kappa = 0.65, 95% confidence interval: 0.55, 0.75). Eligibility (an adult woman in the household) was confirmed for nine of 11 eligible households. However, six of 29 households originally ineligible because of gender were eligible on recontact, and eligible residences rose from 24% to 39% between the two calls, although the two groups of eligible women did not differ in age or race. This underenumeration of women by random digit dialing confirms prior observations, although interviewer differences or changes in respondents or household composition between the first and second calls may have contributed. Recontact of gender-ineligible households may improve completeness of random digit dialing coverage for female populations.


Lesbian mothering in the context of intimate partner violence.
Twenty-four lesbian mothers (12 African American, 9 White, and 3 Latina) who had experienced physical abuse by a same-sex partner were interviewed. Three types of IPV were found: intimate terrorism, situational violence, and mutual violent control. Further, relationships between mothers/abusers, mothers/children, and abusers/children were examined. Regarding relationships with abusers, 71% of mothers reported lengthy sagas, 17% had worked it out, and 13% made a clean break from the abuser. Regarding relationships with their children, 48% of mothers hid the violence, 26% minimized it, and 26% openly communicated about the situation. Relationships between abusers and the mothers' children were found to be either co-parental (29%), playmate (21%), abusive (21%), or non-parental (21%). Correlations among relational and demographic variables were also examined.


Evidence-based public health: an evolving concept.
Evidence-based public health (EBPH) has been proposed as a practice model that builds upon the success of evidence-based medicine (EBM). EBM has been described as a more scientific and systematic approach to the practice of medicine. It has enhanced medical training and practice in many settings. Both EBM and EBPH systematically use data, information, and scientific principles to enhance clinical care and population health, respectively. In this paper, we review the evolution of EBPH, propose a new definition for EBPH, and discuss developments that may support its further advancement.


[Acute mitral insufficiency secondary to dehiscence of a Carpentier-Edwards Physio ring: diagnosis with transthoracic echocardiography].
We describe a case of a 63-year-old patient admitted to our hospital because of cardiogenic shock. Past medical records showed anterior myocardial necrosis, myocardial surgery revascularization with apical aneurysmectomy and, 3 weeks before, another coronary artery bypass operation due to malfunction of the previous grafts and mitral annuloplasty with placement of a Carpentier-Edwards Physio no. 28 prosthetic ring. Transthoracic echocardiography revealed, in the middle of the mitral orifice, the presence of an echogenic structure with hypermobility and severe peri-ring mitral regurgitation due to dehiscence of the posterior side of the prosthetic ring. The diagnosis was finally confirmed by surgery and then mitral valve replacement was performed.


Complications with reverse total shoulder arthroplasty and recent evolutions.
Since its description by Paul Grammont from Dijon, France, several tens of thousands of reverse total shoulder arthroplasties (RTSA) have been performed for diverse conditions. The purpose of this analysis is to identify the complications of this procedure in the literature and in clinical practice. A total of 240 papers concerning RTSA published between 1996 and 2012 have been identified. Over 80 papers describe complications associated with this type of implant. A list of prostheses satisfying European and US standards, CE and FDA approved, has been produced on the basis of information provided by the manufacturers. Data from the literature do not support a meta-analysis. The inventory of best practices shows excellent results in the short and medium term in specific indications, while the number of complications varies between 10 and 65 % in long-term series. Complications can be classified into (A) non-specific including infections (superficial and deep), phlebitis, haematoma, neurological complications of the suprascapular, radial and axillary nerves and (B) specific complications associated with RTSA including (1) on the glenoid side: intraoperative fracture of the glenoid and acromion, late fracture of the scapula, impingement at the scapular neck (notching), glenoid loosening, dissociation of the glenoid component (snatching of the glenosphere) and fractures of the glenoid baseplate; (2) on the humeral side: metaphyseal deterioration, humeral loosening, instability of the shoulder, stiffness with limitation of external and/or internal rotation; and (3) muscular complications with fatty degeneration of the deltoid. Additionally we have identified specific situations related to the type of implant such as the disassembly of the humeral or the glenoid component, dissociation of the polyethylene humeral plate, dissociation of the metaphysis and osteolysis of the tuberosities. The integration of results from different clinical series is difficult because of the lack of a database and the multitude of implants used.


Subthalamic nucleus stimulation affects a frontotemporal network: a PET study.
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has become an effective strategy in the treatment of motor symptoms in advanced Parkinson's disease. However, clinical studies have shown that DBS can affect verbal fluency. Seven Parkinson's disease patients with bilateral DBS of the STN were studied with positron emission tomography (PET) to investigate the effects of STN stimulation on regional cerebral blood flow during a verbal fluency task. Activation of the right orbitofrontal cortex and verbal fluency-associated activation within a left-sided frontotemporal network were decreased during STN stimulation compared with the OFF state. Our results offer an explanation for the commonest neuropsychological side effect of STN stimulation and show that STN stimulation affects a frontotemporal network during a fluency task.