Flow Cytometric Quantification of Fatty Acid Uptake by Mycobacterium tuberculosis in Macrophages.
Mycobacterium tuberculosis (Mtb) has evolved to assimilate fatty acids from its host. However, until recently, there was no reliable way to quantify fatty acid uptake by the bacteria during host cell infection. Here we describe a new method to quantify fatty acid uptake by intracellular bacilli. We infect macrophages with Mtb constitutively expressing mCherry and then metabolically label them with Bodipy-palmitate. Following the labeling procedure, we isolate Mtb-containing phagosomes on a sucrose cushion and disrupt the phagosomes with detergent. After extensive washes, the isolated bacteria are analyzed by flow cytometry to determine the level of Bodipy-palmitate signal associated with the bacteria. Using a Mtb mutant strain defective in fatty acid uptake in liquid culture we determined that this mutant assimilated 10-fold less Bodipy-palmitate than the wild type strain during infection in macrophages. This quantitative method of fatty acid uptake can be used to further identify pathways involved in lipid uptake by intracellular Mtb and possibly other bacteria.


Use of the QuantiFERON-TB Gold In-Tube Test in the Diagnosis and Monitoring of Treatment Efficacy in Active Pulmonary Tuberculosis.
The value of QuantiFERON in the diagnosis of tuberculosis disease and in the monitoring of the response to anti-tuberculosis treatment is unclear. The aims of this study were to evaluate the accuracy of the QuantiFERON-TB Gold In-Tube (QFT-GIT) test in the diagnosis of tuberculosis and in the monitoring of the response to anti-tuberculosis treatment in patients with active pulmonary tuberculosis (PTB). Between January 2013 and December 2015, 133 cases with active PTB and 133 controls with no mycobacterial infection, matched by age (within 3 years) and by the week that they visited Tainan Chest Hospital, were enrolled in the study. Serial testing by QFT-GIT at baseline and after 2 and 6 months of treatment was performed. At these time points, a comparison of the performance of QFT-GIT with that of sputum culture status among study subjects was conducted. Compared to baseline, 116 (87.2%) cases showed a decreased response, whereas 17 (12.8%) showed persistent or stronger interferon-gamma (IFN-γ) responses at 2 months. PTB patients IFN-γ responses declined significantly from baseline to 2 months (median, 6.32 vs. 4.12; p < 0.005). The sensitivity values of the QFT-GIT test for the detection of pulmonary tuberculosis at cut-off points of 0.35 IU/mL, 0.20 IU/mL, and 0.10 IU/mL were 74.4%, 78.2%, and 80.5%, respectively. The specificity values at cut-off points of 0.35 IU/mL, 0.20 IU/mL, and 0.10 IU/mL were 66.2%, 63.9%, and 57.1%, respectively. Our results support the QFT-GIT assay as a potential tool for diagnosing tuberculosis and for monitoring the efficacy of anti-tuberculosis treatment.


Sensitivity of NOS-dependent vascular relaxation pathway to mineralocorticoid receptor blockade in caveolin-1-deficient mice.
Endothelial caveolin-1 (cav-1) is an anchoring protein in plasma membrane caveolae where it binds endothelial nitric oxide synthase (eNOS) and limits its activation, particularly in animals fed a high salt (HS) diet. Cav-1 also interacts with steroid receptors such as the mineralocorticoid receptor (MR). To test the hypothesis that vascular reactivity is influenced by an interplay between MR and cav-1 during HS diet, we examined the effects of MR blockade on NOS-mediated vascular relaxation in normal and cav-1-deficient mice. Wild-type (WT) and cav-1 knockout mice (cav-1(-/-)) were fed for 14 days a HS (4% NaCl) diet with and without the MR antagonist eplerenone (Epl; 100 mg x kg(-1) x day(-1)). After systolic blood pressure (BP) was measured, the thoracic aorta was isolated for measurement of vascular reactivity, and the aorta and heart were used for measurement of eNOS and MR expression. BP was not different between WT + Epl and WT, but was higher in cav-1(-/-) + Epl than in cav-1(-/-) mice. Phenylephrine (Phe)-induced vascular contraction was less in cav-1(-/-) than WT, and significantly enhanced in cav-1(-/-) + Epl than in cav-1(-/-), but not in WT + Epl compared with WT. Endothelium removal and NOS blockade by N(omega)-nitro-l-arginine methyl ester (l-NAME) enhanced Phe contraction in cav-1(-/-), but not cav-1(-/-) + Epl. ACh-induced aortic relaxation was reduced in cav-1(-/-) + Epl versus cav-1(-/-), but not in WT + Epl compared with WT. Endothelium removal, l-NAME, and the guanylate cyclase inhibitor ODQ abolished the large ACh-induced relaxation in cav-1(-/-) and the remaining relaxation in the cav-1(-/-) + Epl but had similar inhibitory effect in WT and WT + Epl. Real-time RT-PCR indicated decreased eNOS mRNA expression in the aorta and heart, and Western blots revealed decreased total eNOS in the heart of cav-1(-/-) + Epl compared with cav-1(-/-). Vascular and cardiac MR expression was less in cav-1(-/-) than WT, but not in cav-1(-/-) + Epl compared with cav-1(-/-). Plasma aldosterone (Aldo) was not different between WT and cav-1(-/-) mice nontreated or treated with Epl. Thus in cav-1 deficiency states and HS diet MR blockade is associated with increased BP, enhanced vasoconstriction, and decreased NOS-mediated vascular relaxation and eNOS expression. The data suggest that, in the absence of cav-1, MR activation plays a beneficial role in regulating eNOS expression/activity and, consequently, the vascular function during HS diet.


Risk factors for self-reported insufficient milk during the first 6 months of life: A systematic review.
The objective of this systematic review was to identify multifactorial risk factors for self-reported insufficient milk (SRIM) and delayed onset of lactation (DOL). The review protocol was registered a priori in PROSPERO (ID# CDR42021240413). Of the 120 studies included (98 on SRIM, 18 on DOL, and 4 both), 37 (31%) studies were conducted in North America, followed by 26 (21.6%) in Europe, 25 (21%) in East Asia, and Pacific, 15 (12.5%) in Latin America and the Caribbean, 7 (6%) in the Middle East and North Africa, 5 (4%) in South Asia, 3 (2.5%) in Sub-Saharan Africa, and 2 (1.7%) included multiple countries. A total of 79 studies were from high-income countries, 30 from upper-middle-income, 10 from low-middle-income countries, and one study was conducted in a high-income and an upper-middle-income country. Findings indicated that DOL increased the risk of SRIM. Protective factors identified for DOL and SRIM were hospital practices, such as timely breastfeeding (BF) initiation, avoiding in-hospital commercial milk formula supplementation, and BF counselling/support. By contrast, maternal overweight/obesity, caesarean section, and poor maternal physical and mental health were risk factors for DOL and SRIM. SRIM was associated with primiparity, the mother's interpretation of the baby's fussiness or crying, and low maternal BF self-efficacy. Biomedical factors including epidural anaesthesia and prolonged stage II labour were associated with DOL. Thus, to protect against SRIM and DOL it is key to prevent unnecessary caesarean sections, implement the Baby-Friendly Ten Steps at maternity facilities, and provide BF counselling that includes baby behaviours.


Neural substrates of spontaneous narrative production in focal neurodegenerative disease.
Conversational storytelling integrates diverse cognitive and socio-emotional abilities that critically differ across neurodegenerative disease groups. Storytelling patterns may have diagnostic relevance and predict anatomic changes. The present study employed mixed methods discourse and quantitative analyses to delineate patterns of storytelling across focal neurodegenerative disease groups, and to clarify the neuroanatomical contributions to common storytelling characteristics. Transcripts of spontaneous social interactions of 46 participants (15 behavioral variant frontotemporal dementia (bvFTD), 7 semantic variant primary progressive aphasia (svPPA), 12 Alzheimer's disease (AD), and 12 healthy older normal controls (NC)) were analyzed for storytelling frequency and characteristics, and videos of the interactions were rated for patients' level of social attentiveness. Compared to controls, svPPAs told more stories and autobiographical stories, and perseverated on aspects of self during the interaction, whereas ADs told fewer autobiographical stories than NCs. svPPAs and bvFTDs were rated as less attentive to social cues. Aspects of storytelling were related to diverse cognitive and socio-emotional functions, and voxel-based anatomic analysis of structural magnetic resonance imaging revealed that temporal organization, narrative evaluations patterns, and social attentiveness correlated with atrophy corresponding to known intrinsic connectivity networks, including the default mode, limbic, salience, and stable task control networks. Differences in spontaneous storytelling among neurodegenerative groups elucidated diverse cognitive, socio-emotional, and neural contributions to narrative production, with implications for diagnostic screening and therapeutic intervention.


Preoperative biliary drainage for hilar cholangiocarcinoma.
Hilar cholangiocarcinomas grow slowly, and metastases occur late in the natural history. Surgical cure and long-term survival have been demonstrated, when resection margins are clear. Preoperative biliary drainage has been proposed as a way to improve liver function before surgery, and to reduce post-surgical complications. Percutaneous transhepatic biliary drainage (PTBD) with multiple drains was previously the preferred method for the preoperative relief of obstructive jaundice. However, the introduction of percutaneous transhepatic portal vein embolization (PTPE) and wider resection has changed preoperative drainage strategies. Drainage is currently performed only for liver lobes that will remain after resection, and for areas of segmental cholangitis. Endoscopic biliary drainage (EBD) is less invasive than PTBD. Among EBD techniques, endoscopic nasobiliary drainage (ENBD) is preferable to endoscopic biliary stenting (EBS), because secondary cholangitis (due to the retrograde flow of duodenal fluid into the biliary tree) does not occur. ENBD needs to be converted to PTBD in patients with segmental cholangitis, those with a prolonged need for drainage, or when the extent of longitudinal tumor extension is not sufficiently well characterized.


HMGA2 sustains self-renewal and invasiveness of glioma-initiating cells.
Glioblastoma multiforme (GBM) is the most common type of brain tumors with dismal outcomes. The mesenchymal phenotype is the hallmark of tumor aggressiveness in GBMs. Perivascular smooth muscle cells (pericytes) are essential in homeostasis of normal and glioma tissues. Here we found HMGA2, an architectural transcription factor that promotes mesenchymal phenotypes in a number of solid tumors, is highly expressed in mesenchymal subtype of GBMs and labels both glioma pericytes and glioma-initiating cells (GICs). Accordingly, depletion of HMGA2 in GICs resulted in compromised self-renewal and tumorigenic capability, as well as undermined mesenchymal or pericyte differentiation. We further showed HMGA2 allows expressions of FOXM1 and PLAU to maintain GIC propagation, gliomagenesis and aggressiveness both in vitro and in vivo. Therefore, suppressing HMGA2-mediated GIC self-renewal and invasiveness might be a promising means to treat GBMs.


Cardiovascular risk assessment in rheumatoid arthritis: impact of the EULAR recommendations on a national calibrated score risk index.
To evaluate the impact of the application of the EULAR task force recommendations in the cardiovascular (CV) risk assessment of rheumatoid arthritis (RA) patients according to a national calibrated SCORE. Two hundred and one consecutive RA patients seen at the rheumatology outpatient clinics of the University Hospital 'San Cecilio', Granada, Southern Spain, were studied. Information on demographic, classic CV risk factors, history of CV events and disease clinical features were obtained. Both the systematic coronary risk evaluation (SCORE) risk index and the modified SCORE (mSCORE) following the EULAR recommendations were performed. Based on the classic CV risk factors the mean ± standard deviation SCORE was 2.2 ± 2.6 (median 2). Twenty-two (11%) patients were above the threshold of high risk for the Spanish population. Following the EULAR recommendations 52 of the 124 patients (41.93%) initially classified as having intermediate risk were reclassified as having high CV risk. Therefore, the mean mSCORE was 3.3 ± 4 (median 3) and, due to this, 74 (36.8%) patients were above the threshold of high CV risk for the Spanish population. As expected, patients who had experienced CV events were older, had more CV risk factors and higher mSCORE than those without CV events. These observations support the claim that the mSCORE should be specifically adapted to the population to be assessed. However, the use of additional tools should be considered in an attempt to fully identify high-risk RA patients.


Defining the diagnostic divide: an analysis of registered radiological equipment resources in a low-income African country.
Diagnostic radiology is recognised as a key component of modern healthcare. However there is marked inequality in global access to imaging. Rural populations of low- and middle-income countries (LMICs) have the greatest need. Carefully coordinated healthcare planning is required to meet the ever increasing global demand for imaging and to ensure equitable access to services. However, meaningful planning requires robust data. Currently, there are no comprehensive published data on radiological equipment resources in low-income countries. The aim of this study was to conduct the first detailed analysis of registered diagnostic radiology equipment resources in a low-income African country and compare findings with recently published South African data. The study was conducted in Tanzania in September 2014, in collaboration with the Tanzanian Atomic Energy Commission (TAEC), which maintains a comprehensive database of the country's registered diagnostic imaging equipment. All TAEC equipment data were quantified as units per million people by imaging modality, geographical zone and healthcare sector. There are 5.7 general radiography units per million people in the public sector with a relatively homogeneous geographical distribution. When compared with the South African public sector, Tanzanian resources are 3-, 21- and 6-times lower in general radiography, computed tomography and magnetic resonance imaging, respectively. The homogeneous Tanzanian distribution of basic public-sector radiological services reflects central government's commitment to equitable distribution of essential resources. However, the 5.7 general radiography units per million people is lower than the 20 units per million people recommended by the World Health Organization.


Mnemonic multiples: the case of the columbia panel studies.
This article uses the Bureau of Applied Social Research's mid-century book-length panel studies-The People's Choice (1944), Voting (1954), and Personal Influence (1955)-to identify and illustrate a neglected phenomenon in the remembered history of social science: mnemonic multiples. The article describes the way that the Bureau books, originally published into a post-World War II interdisciplinary social science milieu, have since come to be remembered along distinct disciplinary tracks by sociologists, political scientists, and communication researchers. A contextual analysis of references to the Bureau studies in the flagship journals of the three disciplines, from 1960 through 2011, provides tentative support for the mnemonic multiples concept.


Repurposing medications for treatment of age-related macular degeneration: Insights from novel approaches to data mining.
The economic and visual burdens associated with age-related macular degeneration (AMD) are expected to significantly increase in the coming years. As of now, interventions to delay or prevent AMD are limited. Hence, there is an urgent and unmet need to expand our therapeutic tools for AMD in a manner, that is, both efficient and cost-effective. In this review, we consider the idea of drug repurposing, in which existing medications with other indications can be re-imagined for treating AMD. We detail the results of several population-level studies that have shown associations between several candidates and decreased risk of AMD development or progression. Such candidates include the more extensively studied metformin and statins, in addition to recently identified candidates fluoxetine and l-DOPA (levodopa) that show promise. We then briefly explore results from an advanced bioinformatics study, which provides further evidence that existing medications are associated with AMD risk genes. Many of these candidates warrant further study in prospective, clinical trials, where their potential causal relationships with AMD can be thoroughly assessed.


The effect of gamma-linolenic acid on clinical status, red cell fatty acid composition and membrane microviscosity in infants with atopic dermatitis.
A double blind placebo-controlled study of two doses of gamma-linolenic acid, provided by evening primrose oil (EPO, Epogam, Searle, U.K.), in children with atopic dermatitis was performed: 1) to examine the effect of gamma-linolenic acid administration on the clinical status of children with atopic dermatitis and abnormalities of IgE-mediated immune responses compared to those without such IgE abnormalities; 2) to investigate the effect of gamma-linolenic acid on red cell fatty acid composition and 3) to assess whether treatment with gamma-linolenic acid induced changes in red cell membrane microviscosity. A significant improvement in the overall severity of the clinical condition was seen in children treated with gamma-linolenic acid, independent of whether the children had manifestations of IgE-mediated allergy. Furthermore, gamma-linolenic acid treatment increased the percentage content of n-6 fatty acids in erythrocyte cell membrane; this increase was more marked in the membranes of children treated with high doses of EPO. In the high dose group a significant increase in dihomogamma-linolenic acid (DGLA) occurred. This may be of particular relevance because of the potential importance of DGLA as a precursor of antiinflammatory prostanoids. Red cell membrane microviscosity did not change in any group after treatment with EPO, even in high doses, despite a significant increase in the proportion of long chain polyunsaturated fatty acids.


Additional regulatory activities of MrkH for the transcriptional expression of the Klebsiella pneumoniae mrk genes: Antagonist of H-NS and repressor.
Klebsiella pneumoniae is a common opportunistic pathogen causing nosocomial infections. One of the main virulence determinants of K. pneumoniae is the type 3 pilus (T3P). T3P helps the bacterial interaction to both abiotic and biotic surfaces and it is crucial for the biofilm formation. T3P is genetically organized in three transcriptional units: the mrkABCDF polycistronic operon, the mrkHI bicistronic operon and the mrkJ gene. MrkH is a regulatory protein encoded in the mrkHI operon, which positively regulates the mrkA pilin gene and its own expression. In contrast, the H-NS nucleoid protein represses the transcriptional expression of T3P. Here we reported that MrkH and H-NS positively and negatively regulate mrkJ expression, respectively, by binding to the promoter of mrkJ. MrkH protein recognized a sequence located at position -63.5 relative to the transcriptional start site of mrkJ gene. Interestingly, our results show that, in addition to its known function as classic transcriptional activator, MrkH also positively controls the expression of mrk genes by acting as an anti-repressor of H-NS; moreover, our results support the notion that high levels of MrkH repress T3P expression. Our data provide new insights about the complex regulatory role of the MrkH protein on the transcriptional control of T3P in K. pneumoniae.


Synthesis of CaCO3 nano- and micro-particles by dry ice carbonation.
Here we report a new low temperature dry ice carbonation approach for the synthesis of carbonate-based nano- and micro-particulate materials, which enables the preparation of monodispersed calcium carbonate nanoparticles and microspheres with very high purity phases.


Uterine artery Doppler at 30-33 weeks' gestation in the prediction of preeclampsia.
To investigate the potential value of measuring uterine artery pulsatility index (PI) at 30-33 weeks' gestation in the prediction of preeclampsia (PE) developing at or after 34 weeks. Screening study in singleton pregnancies at 30-33 weeks' gestation including 4,294 cases that were unaffected by PE, gestational hypertension (GH) or delivery of small for gestational age neonates (normal group), 145 that subsequently developed PE, with 37 cases requiring delivery at 34-37 weeks (intermediate-PE) and 108 delivering at or after 38 weeks (late-PE) and 161 that developed GH. The a priori risks for intermediate- and late-PE from maternal demographic characteristics and medical history were derived by logistic regression analysis. The a posteriori risks were calculated by combining the a priori risks with the likelihood ratios for uterine artery PI, which were calculated from fitted bivariate gaussian distributions. In screening for PE by a combination of maternal characteristics and uterine artery PI, the estimated detection rates of intermediate- and late-PE, at a false-positive rate of 10%, were 70.3 and 54.6%, respectively. Combined testing by maternal characteristics and uterine artery PI at 30-33 weeks could effectively identify women at high risk for subsequent development of PE.


A prospective study on gait dominant normal pressure hydrocephalus.
We characterize idiopathic normal pressure hydrocephalus (NPH) following treatment with lumbar puncture (LP) and shunt placement through clinical evaluation and quantitative ProtoKinetics Zeno walkway assessments. We evaluate the symptomology by determining gait characteristics altered by treatment. Patients at Barrow Neurological Institute (BNI) who underwent a LP, removing 30-32 mL cerebrospinal fluid) followed by ventriculoperitoneal shunt placement in February 2015 to February 2017 were analyzed for gait impairments. Inclusion in the study required a diagnosis of NPH, no conflicting comorbidities, and pre-LP, post-LP, and 6-month post-shunt assessments. Analyses of gait and balance data recorded by physical therapists and the ProtoKinetics Zeno Walkway at pre-LP, post-LP, and post-shunt were performed. A total of 28 patients were included and one-way analysis of variance and Tukey-Kramer HSD was performed. Among the 15 clinical assessments, nine were significantly altered. Using the ProtoKinetics Zeno Walkway, 7 out of 10 characteristics recorded were considered significantly different among the three data sets. Furthermore, there were more significant differences between pre-LP assessments and post-shunt assessments in comparison to differences between pre-LP assessments and post-LP assessments. Our results indicate that certain gait characteristics better fit NPH than others. By focusing on the features that are caused by NPH and alleviated by LP and/or shunt placement, a more definitive NPH diagnosis can be attained. Additionally, our findings confirm a cumulative effect of continuous drainage via shunt placement may lead to increased improvement in NPH symptoms over LP results.


Regulation of the polycomb protein Ring1B by self-ubiquitination or by E6-AP may have implications to the pathogenesis of Angelman syndrome.
The polycomb repressive complex (PRC) 1 protein Ring1B is an ubiquitin ligase that modifies nucleosomal histone H2A, a modification which plays a critical role in regulation of gene expression. We have shown that self-ubiquitination of Ring1B generates multiply branched, "noncanonical" polyubiquitin chains that do not target the ligase for degradation, but rather stimulate its activity toward histone H2A. This finding implies that Ring1B is targeted by a heterologous E3. In this study, we identified E6-AP (E6-associated protein) as a ligase that targets Ring1B for "canonical" ubiquitination and subsequent degradation. We further demonstrated that both the self-ubiquitination of Ring1B and its modification by E6-AP target the same lysines, suggesting that the fate of Ring1B is tightly regulated (e.g., activation vs. degradation) by the type of chains and the ligase that catalyzes their formation. As expected, inactivation of E6-AP affects downstream effectors: Ring1B and ubiquitinated H2A levels are increased accompanied by repressed expression of HoxB9, a PRC1 target gene. Consistent with these findings, E6-AP knockout mice display an elevated level of Ring1B and ubiquitinated histone H2A in various tissues, including cerebellar Purkinje neurons, which may have implications to the pathogenesis of Angelman syndrome, a neurodevelopmental disorder caused by deficiency of E6-AP in the brain.


The association of OPG polymorphisms with risk of osteoporotic fractures: A systematic review and meta-analysis.
Subjects with low bone mineral density and osteoporosis are more likely to suffer osteoporotic fractures during their lifetime. Polymorphisms in osteoprotegerin (OPG) gene are found to be associated with low bone mineral density and osteoporosis risk but their association with fracture risk is inconclusive. Here, we performed a meta-analysis to investigate the relationship between OPG polymorphisms with susceptibility to osteoporotic fractures. Eligible studies investigating the association between common OPG polymorphisms (A164G, T245G, T950C, and G1181C) and risk of osteoporotic fracture were retrieved from PubMed, EMBASE, Web of Science, and the Cochrane Library. Odds ratio (OR) and the 95% confidence interval (CI) were calculated in the allelic, dominant, recessive, and homozygous model. Subgroup analyses of vertebral fractures, Caucasians, and postmenopausal women were also performed. A total of 14 studies comprising 5459 fracture cases and 9860 non-fracture controls were included. A163G was associated with fracture risk in dominant (OR = 1.29, 95%CI 1.11-1.50), recessive (OR = 1.64, 95%CI 1.10-2.44), and homozygous model (OR = 1.73, 95%CI 1.16-2.59). T245G was significantly correlated with susceptibility to fractures in all genetic models. Subjects with CC genotype of T950C had a reduced risk of fracture compared to those with CT or TT genotypes (OR = 0.81, 95%CI 0.70-0.94, P = .004). Subgroup analysis showed that A163G and T245G but not T950C and G1181C were associated with vertebral fracture risk. OPG A163G and T245G polymorphisms were risk factors of osteoporotic fractures while T950C had a protective role. These polymorphisms can be used as predictive markers of fractures.


Prevalence and risk factors for low back pain during pregnancy among women in Abakaliki, Nigeria.
low back pain (LBP) during pregnancy is an important health concern among women globally. The prevalence and risk factors for LBP in pregnancy vary from and within sub-regions and have implications in preventive and treatment strategies. In West African sub-region, there is scanty data on LBP during pregnancy. This study aimed to determine the prevalence and predisposing factors for LBP during pregnancy in this environment. this was a cross-sectional study carried out among pregnant women admitted into the Labour Ward of Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria over a period of 8 months. They were interviewed within 2 to 7 days postpartum with a questionnaire. Sociodemographic and obstetrics characteristics as well as LBP intensity, features and associated factors were evaluated. Significant factors for LBP that emerged from the univariable analysis were entered into multivariable regression analysis to evaluate the risk of each factor when adjusted to other factors. of the 478 women interviewed, 138 (28.9%) of them (95% CI 25.1-33.1) reported LBP in the index pregnancy. The onset of pain was predominantly in the third trimester and the mean pain intensity was 4.3 ± 1.36. In the univariable analysis, six factors were significantly associated with LBP. Logistic regression analysis identified LBP in previous pregnancy (aOR: 24.76, (95% CI 6.88-89.11); p< 0.001), macrosomia (aOR: 4.15(95% CI 2.05-8.42); p< 0.001) and absence of domestic help (aOR: 0.50(95% CI 0.31-0.82); p=0.006) as independent risk factors for LBP during pregnancy among the women. in this study, LBP during pregnancy is within worldwide range and predominantly mild to moderate in intensity. The independent risk factors identified call for high priorities accorded to women with these factors in measures aimed at addressing LBP during pregnancy.


Laser exposure of gold nanorods can increase neuronal cell outgrowth.
The usage of gold nanoparticles (Au NPs) in biological applications has risen significantly over the last 10 years. With the wide variety of chemical and biological functionalization available and their distinctive optical properties, Au NPs are currently used in a range of biological applications including sensing, labeling, drug delivery, and imaging applications. Among the available particles, gold nanorods (Au NRs) are particularly useful because their optical absorption can be tuned across the visible to near infrared region. Here, we present a novel application of Au NRs associated with low power laser exposure of NG108-15 neuronal cells. When cells were irradiated with a 780 nm laser, the average number of neurons with neurites increased. A similar stimulatory effect was observed for cells that were cultured with poly-(4-styrenesulfonic acid)-coated and silica-coated Au NRs. Furthermore, when the NG108-15 cells were cultured with both bare and coated Au NRs and then irradiated with 1.2-7.5 W/cm(2) at 780 nm, they showed a neurite length increase of up to 25 µm versus control. To the best of our knowledge, this effect has never been reported before. While the pathways of the stimulation is not yet clear, the data presented here demonstrates that it is linked to the absorption of light by the Au NRs. These initial results open up new opportunities for peripheral nerve regeneration treatments and for novel approaches to addressing central nervous system axons following spinal cord injury.


Genome wide association study of frost tolerance in wheat.
Winter wheat growing areas in the Northern hemisphere are regularly exposed to heavy frost. Due to the negative impact on yield, the identification of genetic factors controlling frost tolerance (FroT) and development of tools for breeding is of prime importance. Here, we detected QTL associated with FroT by genome wide association studies (GWAS) using a diverse panel of 276 winter wheat genotypes that was phenotyped at five locations in Germany and Russia in three years. The panel was genotyped using the 90 K iSelect array and SNPs in FroT candidate genes. In total, 17,566 SNPs were used for GWAS resulting in the identification of 53 markers significantly associated (LOD ≥ 4) to FroT, corresponding to 23 QTL regions located on 11 chromosomes (1A, 1B, 2A, 2B, 2D, 3A, 3D, 4A, 5A, 5B and 7D). The strongest QTL effect confirmed the importance of chromosome 5A for FroT. In addition, to our best knowledge, eight FroT QTLs were discovered for the first time in this study comprising one QTL on chromosomes 3A, 3D, 4A, 7D and two on chromosomes 1B and 2D. Identification of novel FroT candidate genes will help to better understand the FroT mechanism in wheat and to develop more effective combating strategies.


Associations between serum trace elements and the risk of nasopharyngeal carcinoma: a multi-center case-control study in Guangdong Province, southern China.
Associations between trace elements and nasopharyngeal carcinoma (NPC) have been speculated but not thoroughly examined. This study registered a total of 225 newly diagnosed patients with NPC and 225 healthy controls matched by sex and age from three municipal hospitals in Guangdong Province, southern China between 2011 and 2015. Information was collected by questionnaire on the demographic characteristics and other possibly confounding lifestyle factors. Eight trace elements and the level of Epstein-Barr virus (EBV) antibody were measured in casual (spot) serum specimens by inductively coupled plasma-mass spectrometry (ICP-MS) and enzyme-linked immunosorbent assay (ELISA), respectively. Restricted cubic splines and conditional logistic regression were applied to assess the relationship between trace elements and NPC risk through single-and multiple-elements models. Serum levels of chromium (Cr), cobalt (Co), nickel (Ni), arsenic (As), strontium (Sr) and molybdenum (Mo) were not associated with NPC risk. Manganese (Mn) and cadmium (Cd) were positively associated with NPC risk in both single-and multiple-element models, with ORs of the highest tertile compared with the reference categories 3.90 (95% CI, 1.27 to 7.34) for Mn and 2.30 (95% CI, 1.26 to 3.38) for Cd. Restricted cubic splines showed that there was a linear increasing trend between Mn and NPC risk, while for Cd there was a J-type correlation. Serum levels of Cd and Mn was positively related with NPC risk. Prospective researches on the associations of the two trace elements with NPC ought to be taken into account within the future.


Indications and measures of medical emergency teams: a retrospective evaluation of in-hospital emergency operations of the German Resuscitation Register.
The present study examines characteristics and interventions of medical emergency teams (MET) in in-hospital emergency care. Analysis of all in-hospital emergencies in patients ≥18 years at 62 hospitals with established MET from the database of the German Resuscitation Registry between 2014-2019. The evaluation covered indications for activation using the ABCDE-scheme, time intervals of arrival and patient care as well as the performed invasive/medical interventions. Out of 62 hospitals 14,166 in-hospital emergencies (male: 8033 [56.7%]; mean age: 64±18 years) were included. Causes of activation were circulation (5760 [40.7%]), disability (4076 [28.8%]), breathing (3649 [25.8%]) and airway-problems (1589 [11.2%]). Average arrival time at the emergency scene was 4±3 minutes, supply time of MET was 24±23 minutes. Endotracheal intubation was required in 1757 (12.4%) and difficult intubation occurred in 201 (11.4%) patients with the necessity for cricothyroidotomy in eight cases (3.9%). Invasive blood-pressure-measurement was indicated in 1074 (7.6%) patients. Catecholamines were required for hemodynamic stabilization in 2421 (17.1%) patients (norepinephrine: 1520 [10.7%], epinephrine: 430 [3.0%], dobutamine: 26 [0.2%]). Current in-hospital emergency care requires special skills in invasive hemodynamic and airway interventions. Recommendations from professional societies are necessary to optimize equipment (e.g. videolaryngoscopy, invasive blood pressure management), training, care algorithms and staff composition against the background of an increasing shortage of resources in the healthcare system.


Contribution of 5-HT2A receptors on diaphragmatic recovery after chronic cervical spinal cord injury.
Unilateral C2 spinal cord hemisection (C2Hx) interrupts bulbospinal respiratory pathways innervating ipsilateral phrenic motoneurons, resulting in cessation of ipsilateral diaphragm motor output. Plasticity within the spinal neural circuitry controlling the diaphragm can induce partial recovery of phrenic bursting which correlates with the time-dependent return of spinal serotonin (5-HT) immunoreactivity in the vicinity of phrenic motoneurons. The 5-HT2A receptor subtype is present on phrenic motoneurons and its expression is up-regulated after cervical spinal cord injury; however the functional role of these receptors following injury has not been clearly defined. The present study evaluated the functional role of 5-HT2A receptors by testing the hypothesis that pharmacologic blockade would attenuate diaphragm activity in rats with chronic cervical spinal cord injury. Bilateral diaphragm electromyography (EMG) was performed in vagal-intact and spontaneously breathing rats before and after intravenous administration of the 5-HT2A receptor antagonist Ketanserin (1mg/kg). Intravenous ketanserin significantly attenuated ipsilateral diaphragm EMG activity in C2Hx animals but had no impact on diaphragm output in uninjured animals. We conclude that 5-HT2A receptor activation contributes to the recovery of ipsilateral phrenic motor output after chronic cervical spinal cord injury.


A highly efficient light-harvesting system with sequential energy transfer based on a multicharged supramolecular assembly.
A supramolecular assembly was constructed by the nonconvalent interaction of pillar[5]arene (WP5) with a pyridinium modified tetraphenylethene (Py-TPE) derivative, in which Py-TPE/WP5 acted as a donor, and sulforhodamine 101 and sulfonated aluminum phthalocyanine acted as acceptors to realize a highly efficient light-harvesting system with two-step sequential energy transfer.


Trochanteric arthroplasty in the treatment of sequelae after septic arthritis of the hip in infancy.
The authors describe 17 patients submitted to trochanteric arthroplasty between 1979 and 1999 at the Division of Pediatric Orthopaedics and Traumatology of the Rizzoli Orthopaedic Institute. There were 9 females and 8 males aged from 1 to 8 years (mean of 4) affected with the sequelae of septic arthritis of the hip with complete destruction of the epiphysis and of the femoral neck (types IVB and V according to the Hunka classification system). Mean follow-up was 9 years (minimum 1, maximum 23). Surgery is described and indications are discussed: this is the only type of treatment that may be offered in place of conservative treatment.


The type, amount, frequency and timing of dietary supplement use by elite players in the First Spanish Basketball League.
The aims of this study were to determine the type, frequency and amount of dietary supplement consumption among a group of professional basketball players. The type, amount and specific timing of supplement use were recorded by 55 professional basketball players from seven different teams of the First Spanish Basketball League. Most participants (58%) consumed dietary supplements. Multivitamins and vitamins were the most frequently used supplements among the athletes (50.9%), followed by sport drinks (21.8%), miscellaneous supplements (21.8%), amino acids (14.5%), proteins (12.7%) and carbohydrates (12.7%). The average daily dietary supplement was one capsule of multivitamins, one capsule of antioxidant vitamins, 0.2-1.0 g vitamin C, 10.3 g protein, 1.9 g amino acids, 16.2 g carbohydrates and 377 ml of a commercial sport drink. Although the proportion of participants who consumed dietary supplements before, during and immediately after exercise was 25.4%, 16.3% and 7.3% respectively, only a few consumed a potentially ergogenic supplement at these times. It would appear unlikely that the type or amount of dietary supplements consumed had a beneficial effect on the physical performance of these professional basketball players, with the possible exception of antioxidant vitamins and the commercial sport drinks.


Cushing's first case of transsphenoidal surgery: the launch of the pituitary surgery era.
Transsphenoidal approaches to pituitary tumors have undergone a rigorous test of time since the introduction of the first technique by Schloffer in 1907. Harvey W. Cushing played an instrumental role in launching the era of pituitary surgery by popularizing the transsphenoidal route between 1909 and 1929. Cushing performed his first transsphenoidal operation in 1909 in a patient with acromegaly by using a modified form of the Schloffer method to reach the pituitary gland. He did not find this approach satisfactory and instead favored a modified form of the sublabial-transsphenoidal route described by A. E. Halstead and Theodor Kocher. At that time, the development of intracranial surgical corridors to the sellar region was in its infancy. Later in his career, in 1927, Cushing's mastery of intracranial surgery ultimately led him to favor the subfrontal or "transfrontal" route to treat pituitary tumors. In this article, the authors review the clinical details of Cushing's first case of transsphenoidal pituitary surgery.


Predictor of Self-Perceived Nursing Competency Among New Nurses in Taiwan.
The aim of this article is to identify the factors that predict self-perceived nursing competency among new nurses in Taiwan. This quantitative cross-sectional survey was performed with a convenience sample of 105 new nurses. Data were collected with questionnaires. Multiple linear regression showed perceived benefit of preceptor policies to nursing capacity and age accounted for 21.1% of the variance in dependent variables for self-perceived nursing competency importance. Satisfaction with current preceptor, satisfaction with current nursing job, and participation in interprofessional education conferences accounted for 22% of the variance in dependent variables for self-perceived nursing competency adequacy. The results could be a reference to design nursing education curricula that improve clinical training and retention of new nurses. J Contin Educ Nurs. 2017;48(3):129-137.


Evaluation of the Various Oral Candida Species among Patients on Hemodialysis: A Clinical Study.
Oral candidiasis develops as a result of an opportunistic infection. In patients on hemodialysis who may be immune-compromised, candida can change from a commensal to a pathogen. Identification and classification of Candida species are crucial for the treatment of these patients. To distinguish between distinct species of candida found in hemodialysis patients with chronic renal failure's oral cavity. A total of 100 people were investigated, including 50 patients with "Chronic Renal Failure (CRF)" on hemodialysis and 50 healthy controls. Using "Sabouraud's Dextrose Agar (SDA)" and "CHROM Agar Culture Media", salivary samples were incubated for 24, 48, or 72 hours at 37°C to develop candida species. Colony forming units/milliliter, a unit of measurement for colonies, were counted and calculated (CFU). On SDA and CHROM agar medium, positive candidal growth was seen in the CRF with HD and Control Groups. There was a significant variance in the growth and the subspecies distribution of the colonies among the groups. The most common species was c.albicans followed by c. cruzi and tropical. Other subspecies were negligible. The number of colonies was also greater than 400 CFU in the majority of the dialysis subjects, while it was only 200 CFU for the majority of the controls. Patients with chronic renal failure receiving hemodialysis showed significantly higher levels of candida isolation and differentiation than healthy individuals (P 0.05).


Exciton regeneration at polymeric semiconductor heterojunctions.
Control of the band-edge offsets at heterojunctions between organic semiconductors allows efficient operation of either photovoltaic or light-emitting diodes. We investigate systems where the exciton is marginally stable against charge separation and show via E-field-dependent time-resolved photoluminescence spectroscopy that excitons that have undergone charge separation at a heterojunction can be efficiently regenerated. This is because the charge transfer produces a geminate electron-hole pair (separation 2.2-3.1 nm) which may collapse into an exciplex and then endothermically (E(A)=100-200 meV) back transfer towards the exciton.


Three-dimensional molecular shape analysis-quantitative structure-activity relationship of a series of cholecystokinin-A receptor antagonists.
The three-dimensional molecular shape analysis-quantitative structure-activity relationship (3D-MSA-QSAR) technique has been applied to develop correlations between the calculated physicochemical properties and the in vitro activities of a series of 3-(acylamino)-5-phenyl-2H-1,4-benzodiazepine cholecystokinin-A (CCK-A) antagonists. 3D-MSA-QSARs were developed for varying subsets of 53 analogs (J. Med. Chem. 1988, 31, 2235-2246). An active conformation is hypothesized for these compounds using the loss in biological activity-loss in conformational stability principle. After placing all compounds in the active conformation and performing pairwise molecular shape analysis, it was determined that not any one analog serves as the best shape reference compound. Nonidentical volumes of allowed receptor space are mapped out by different antagonists. A shape reference compound that consists of selected overlapped structures expands the definition of the accessible receptor space. This type of mutant improves the predicted activity of analogs over the value predicted if only one compound is chosen as the reference. Molecular shape, as represented by common overlap steric volume and nonoverlap steric volume, is the major factor contributing to the affinity of this class of compounds. Intramolecular conformational stability, as measured by the difference in energy of the active conformation and the global minimum energy conformation, is also important. It is further concluded from the 3D-MSA-QSAR models that part of the binding pocket for the 3-amido substituent has a preference for lipophilicity. The method used in this study of fragmenting the antagonist into spheres of varying radii and measuring lipophilicity isolates the substructure with highest probability of interacting with the receptor. Two indicator variables marking the presence of an N-methyl group and an o-fluoro atom on the 5'-phenyl substituent of the benzodiazepine ring structure also contribute significantly to the 3D-MSA-QSAR models. The 3D-MSA-QSAR results have led to the proposal of a 3D pharmacophore model for the benzodiazepine CCK-A antagonists.


Active Bilingualism in Aging: Balanced Bilingualism Usage and Less Frequent Language Switching Relate to Better Conflict Monitoring and Goal Maintenance Ability.
Experience-related neuroplasticity suggests that bilinguals who actively manage their two languages would develop more efficient neural organization at brain regions related to language control, which also overlap with areas involved in executive control. Our aim was to examine how active bilingualism-manifested as the regular balanced use of two languages and language switching-may be related to the different domains of executive control in highly proficient healthy older adult bilinguals, controlling for age, processing speed, and fluid intelligence. Participants were 76 community-dwelling older adults who reported being physically and mentally healthy and showed no signs of cognitive impairment. They completed a self-report questionnaire on their language background, two computer measures for previously identified covariates (processing speed as measured by two-choice reaction time (RT) task and fluid intelligence as measured by the Raven's Progressive Matrices), as well as a battery of computerized executive control tasks (Color-shape Task Switching, Stroop, Flanker, and Spatial 2-back task). Regression analyses showed that, even after controlling for age, processing speed, and fluid intelligence, more balanced bilingualism usage and less frequent language switching predicted higher goal maintenance (nonswitch trials RT in Color-shape Task Switching) and conflict monitoring abilities (global RT in Color-shape Task Switching and Flanker task). Results suggest that active bilingualism may provide benefits to maintaining specific executive control abilities in older adult bilinguals against the natural age-related declines.


Tuning Light Emission of a Pressure-Sensitive Silicon/ZnO Nanowires Heterostructure Matrix through Piezo-phototronic Effects.
Based on white light emission at silicon (Si)/ZnO hetrerojunction, a pressure-sensitive Si/ZnO nanowires heterostructure matrix light emitting diode (LED) array is developed. The light emission intensity of a single heterostructure LED is tuned by external strain: when the applied stress keeps increasing, the emission intensity first increases and then decreases with a maximum value at a compressive strain of 0.15-0.2%. This result is attributed to the piezo-phototronic effect, which can efficiently modulate the LED emission intensity by utilizing the strain-induced piezo-polarization charges. It could tune the energy band diagrams at the junction area and regulate the optoelectronic processes such as charge carriers generation, separation, recombination, and transport. This study achieves tuning silicon based devices through piezo-phototronic effect.


Regulation of Fimbrial Expression.
Fimbria-mediated interaction with the host elicits both innate and adaptive immune responses, and thus their expression may not always be beneficial in vivo. Furthermore, the metabolic drain of producing fimbriae is significant. It is not surprising, therefore, to find that fimbrial production in Escherichia coli and Salmonella enterica is under extensive environmental regulation. In many instances, fimbrial expression is regulated by phase variation, in which individual cells are capable of switching between fimbriate and afimbriate states to produce a mixed population. Mechanisms of phase variation vary considerably between different fimbriae and involve both genetic and epigenetic processes. Notwithstanding this, fimbrial expression is also sometimes controlled at the posttranscriptional level. In this chapter, we review key features of the regulation of fimbrial gene expression in E. coli and Salmonella. The occurrence and distribution of fimbrial operons vary significantly among E. coli pathovars and even among the many Salmonella serovars. Therefore, general principles are presented on the basis of detailed discussion of paradigms that have been extensively studied, including Pap, type 1 fimbriae, and curli. The roles of operon specific regulators like FimB or CsgD and of global regulatory proteins like Lrp, CpxR, and the histone-like proteins H-NS and IHF are reviewed as are the roles of sRNAs and of signalling nucleotide cyclic-di-GMP. Individual examples are discussed in detail to illustrate how the regulatory factors cooperate to allow tight control of expression of single operons. Molecular networks that allow coordinated expression between multiple fimbrial operons and with flagella in a single isolate are also presented. This chapter illustrates how adhesin expression is controlled, and the model systems also illustrate general regulatory principles germane to our overall understanding of bacterial gene regulation.


A cystic fibrosis pancreatic adenocarcinoma cell line.
We established a pancreatic adenocarcinoma cell line (CFPAC-1) from a patient with cystic fibrosis (CF) and assessed some of its properties. The cells show epithelial morphology and express cytokeratin and oncofetal antigens characteristic of pancreatic duct cells. Basal and stimulated levels of cAMP and cAMP-dependent protein kinase and the biophysical properties of single Cl- channels in CFPAC-1 are similar to those of airway and sweat gland primary cultures and Cl(-)-secreting epithelial cell lines. Anion transport and single Cl- channel activity was stimulated by Ca2+ ionophores but not by forskolin, cAMP analogs, or phosphodiesterase inhibitors. The cells express the CF gene and manifest the most common CF mutation, deletion of three nucleotides resulting in a phenylalanine-508 deletion. These properties have been stable through greater than 80 passages (24 months), suggesting that CFPAC-1 can serve as a continuous cell line that displays the CF defect.


The role of anthropometric characteristics in modern pentathlon performance in female athletes.
In order to determine the role of body build characteristics in modern pentathletes, 65 female participants at the IXth World Modern Pentathlon Championships, 1989 (Wiener Neustadt, Austria) were investigated. Of these, 54 participate in the competition; the other 11 were reserves. Their mean (+/- S.D.) age was 22.34 +/- 3.97 years (range 16.08-32.58 years). Anthropometric characteristics (body mass, lengths, breadths, girths and skinfolds), somatotype and body composition estimates were determined. Compared with other female athletes (e.g. swimmers, runners, fencers), the elite modern pentathletes were rather tall (x = 168.1 cm) and, as indicated by the body mass index (x = 21.6), they had a high mass relative to their stature. Based on skinfolds, body fat was estimated as 16%, and anthropometrically determined somatotype was on average 2.5-3.9-2.8. The relationship between the athletes' anthropometric characteristics and modern pentathlon performance was investigated by means of Pearson zero-order correlations between the physical traits and the competitive performance scores. Significant correlations were found mainly for the 'fat' variables, such as skinfolds, percent fat and the endomorphy component, r varying from -0.34 to -0.58, which indicated an inverse relationship between the amount of fatness and modern pentathlon performance. To investigate this relationship further, Pearson zero-order correlations were calculated between the respective factors scores, derived from a rotated factor pattern (Varimax) carried out on selected somatic variables, and the performance scores. The results demonstrated that, in relation to anthropometric characteristics, modern pentathlon performance in females is mainly associated with the 'fat development' factor, and to a lesser degree with the 'bone-muscle development' factor. Variables representing linearity of physique seem to be unrelated to modern pentathlon performance. Stepwise regression analysis revealed that 42.4% of the variance in modern pentathlon performance can be explained by the following anthropometric variables: sum of 10 skinfolds, biacromial breadth and humerus diameter. To obtain a high level of modern pentathlon performance, it would seem that a female athlete must above all have a low level of body fatness and, to a lesser degree, a relatively high level of lean body mass.


Use of flanking sequences to study secondary structure-activity correlations of a Mycobacterium leprae T cell epitope.
The 65-kDa protein of the intracellular pathogen M. leprae is prominent in the immune response to this mycobacterium, and individual T cell epitopes from this protein sequence have been defined. We have tested the stimulatory activity of extended analogs of the minimal peptide representing one such epitope, LQAAPALDKL, with a variety of tetrapeptide extensions added to enhance or destabilize alpha helix formation. The conformational potential of the peptides was measured by circular dichroism using aqueous trifluoroethanol as a secondary structure inducer. Although analogs with high helical potential activated T cells at low concentrations, a less helical variant was similarly potent. Activity also did not correlate with predicted overall alpha helical amphipathicity. One analog was found which stimulated T cell proliferation in the 50 pM range. The effect of tetrapeptide extensions on epitope activity is not consistent with the importance in activity of only a single stable secondary structure such as an alpha helix.


NOX4-Dependent Hydrogen Peroxide Overproduction in Human Atrial Fibrillation and HL-1 Atrial Cells: Relationship to Hypertension.
Atrial fibrillation (AF) is the most common type of cardiac arrhythmia with patients dying frequently of stroke. In view of the unclear etiologies of AF and a potential role of oxidative stress, the present study examined cardiac reactive oxygen species production and NADPH oxidase (NOX) expression in AF patients. Patients with AF were older than those without (58.8 ± 11.7 vs. 47.8 ± 19.2, p = 0.047). Whereas total [Formula: see text] production (determined by electron spin resonance) was similar in patients with and without AF, H(2)O(2) production was more than doubled in AF patients (149.8 ± 26.28 vs. 66.9 ± 7.14 pmol/mg/min, p = 0.0055), which correlated well with a doubling in NOX isoform 4 (NOX4) expression. AF patients with co-existing hypertension had three-fold higher H(2)O(2) production compared to those without (239.0 ± 125.1 vs. 83.6 ± 51.3 pmol/mg/min, p = 0.003). Treatment of HL-1 atrial cells with angiotensin II, a known modulator of atrial structural remodeling, resulted in upregulation of NOX4 and H(2)O(2) production, further implicating a potential role of NOX4 in atrial remodeling. Our data represent the first implication that NOX4-derived H(2)O(2) may play an important role in the etiologies of AF.


Virtual Screening of Anti-Mycobacterial Plant Compounds.
Deaths from tuberculosis have long gripped people and threatened human health. The need for new drug compounds are critically sensed by medical scientists and practitioners due to the emergence of new strains and the slow rate of discovering novel medicines for this disease. Since plants are a rich source of diverse drug compounds, they are among the best choices to achieve new ones. The study of all plants or their compounds is an almost impossible scenario; hence bio/cheminformatics methodology can be used to reduce time and cost spent in drug discovery. For this purpose, we made several databases of anti-mycobacterial plant compounds and further found filter criteria which were able to describe more predicted bioactive compounds by the established algorithm. Also, we present the survey of the developed resource by using bio/cheminformatics tools. The presence of several anti-mycobacterial compounds in the predicted algorithm and introduction of new active compounds represent the high potential of this method. In addition, the general profile of such bioactive molecules is pinpointed using molecular descriptors and cheminformatics approach.


How adiabatic is activated adsorption/associative desorption?
Using density-functional theory we calculate friction coefficients describing the damping of nuclear motion into electron-hole pair excitation for the two best-known examples of activated adsorption: H2 dissociation on a Cu(111) surface and N2 dissociation on a Ru(0001) surface. In both cases, the frictions increase dramatically along the reaction path towards the transition state and can be an order of magnitude larger there than typical in the molecularly adsorbed state. In addition, the frictions for N2/Ru(0001) are typically an order of magnitude larger than for H2/Cu(111). We rationalize these trends in terms of the electron structure as the systems proceed to dissociation along the reaction paths. Combining these friction coefficients with the potential-energy surface in quasiclassical dynamics allows first-principles studies of the importance of the breakdown in the Born-Oppenheimer approximation in describing the chemistry. We find that nonadiabatic effects are minimal for the H2/Cu(111) system, but are quite important for N2/Ru(0001).


Antropo: An open-source platform to increase the anthropomorphism of the Franka Emika collaborative robot arm.
Robot-to-human communication is important for mutual understanding during human-robot collaboration. Most of the current collaborative robots (cobots) are designed with low levels of anthropomorphism. Therefore, the ability of cobots to express human-like communication is limited. In this work, we present an open-source platform named Antropo to increase the level of anthropomorphism of Franka Emika-a widely used collaborative robot arm. The Antropo platform includes three modules: a camera module for expressing eye gaze, a light module for visual feedback, and a sound module for acoustic feedback. These modules can be rapidly prototyped through 3D printers, laser-cutters, and off-the-shelf components available at a low cost. The Antropo platform can be easily installed on the Franka Emika robot. The added communication channels can be synchronised with the robot's motions to enhance mutual understanding. All hardware CAD design files and software files are released. The platform can be used to study human-like behaviours of cobots and the effects of these behaviours on different aspects of human-robot collaboration. We demonstrate the Antropo platform in an assembly task in which the Franka Emika robot expresses various human-like communicative behaviours via the added communication channels. We also present two industrial applications in which the Antropo platform was customised for the Universal Robots UR16e.


Stilbenes from Vitis vinifera L. Waste: A Sustainable Tool for Controlling Plasmopara Viticola.
Stilbene-enriched extracts from Vitis vinifera waste (cane, wood, and root) were characterized by UHPLC-MS. Eleven stilbenes were identified and quantified as follows: ampelopsin A, (E)-piceatannol, pallidol, (E)-resveratrol, hopeaphenol, isohopeaphenol, (E)-ε-viniferin, (E)-miyabenol C, (E)-ω-viniferin, r2-viniferin, and r-viniferin. The fungicide concentration inhibiting 50% of growth of Plasmopara viticola sporulation (IC50) was determined for the extracts and also for the main compounds isolated. r-Viniferin followed by hopeaphenol and r2-viniferin showed low IC50 and thus high efficacy against Plasmopara viticola. Regarding stilbene extracts, wood extract followed by root extract showed the highest antifungal activities. These data suggest that stilbene complex mixtures from Vitis vinifera waste could be used as a cheap source of bioactive stilbenes for the development of natural fungicides.


Association between mycophenolic acid 12-h trough levels and clinical endpoints in patients with autoimmune disease on mycophenolate mofetil.
Triggered by heightened interest in mycophenolate mofetil (MMF) for the treatment of autoimmune diseases (AID) and encouraged by the results from a previous study, we hypothesized that therapeutic drug monitoring of mycophenolic acid (MPA) based on troughs may be useful for effective MMF dosing in patients with AID. A two-step approach was pursued. First, we confirmed in 38 AID patients (26 with antineutrophil cytoplasmic antibody-associated vasculitis; 12 with systemic lupus erythematosus) a significant correlation (r = 0.545, P < 0.001) between MPA C(12 h) and MPA exposure (AUC). Second, we performed an analysis of 294 MPA 12-h trough levels serially collected from 39 patients (same indications) receiving MMF for remission maintenance therapy to elucidate possible associations with disease activity and MMF toxicity. Higher MPA trough levels were associated with better protection from recurrence of active disease. While at levels <3 mg/L 29% of collected samples (43/147) were from patients with active disease, this was only the case in 2% of samples (3/147) with an MPA concentration of >or=3 mg/L. Remission persisted in all patients with MPA troughs >or=3.5 mg/L. Upon combined analysis of efficacy and safety data, most favourable results were obtained with MPA troughs between 3.5 and 4.5 mg/L. There was no discernable relationship between MMF dose and clinical endpoints. The target range proposed by this explorative study may serve as an initial guidance for MPA monitoring in the context of further prospective controlled trials in patients with AID.


Vanadium and molybdenum peroxides: synthesis and catalytic activity in oxidation reactions.
Catalysis by transition metal ions in oxidation reactions with hydrogen peroxide and alkyl hydroperoxides is a leading topic in the pursuit of more sustainable and selective processes, to obtain compounds with high added value. The most recent achievements concerning the synthesis and characterization, as well as the key aspects of reactivity, of V(V) and Mo(VI) peroxo complexes have been collected here.


Excellence in medical training: developing talent-not sorting it.
Many medical schools have reconsidered or eliminated clerkship grades and honor society memberships. National testing organizations announced plans to eliminate numerical scoring for the United States Medical Licensing Examination Step 1 in favor of pass/fail results. These changes have led some faculty to wonder: "How will we recognize and reward excellence?" Excellence in undergraduate medical education has long been defined by high grades, top test scores, honor society memberships, and publication records. However, this model of learner excellence is misaligned with how students learn or what society values. This accolade-driven view of excellence is perpetuated by assessments that are based on gestalt impressions influenced by similarity between evaluators and students, and assessments that are often restricted to a limited number of traditional skill domains. To achieve a new model of learner excellence that values the trainee's achievement, growth, and responsiveness to feedback across multiple domains, we must envision a new model of teacher excellence. Such teachers would have a growth mindset toward assessing competencies and learning new competencies. Actualizing true learner excellence will require teachers to change from evaluators who conduct assessments of learning to coaches who do assessment for learning. Schools will also need to establish policies and structures that foster a culture that supports this change. In this new paradigm, a teacher's core duty is to develop talent rather than sort it.


Microbial factors and gingival crevicular fluid aspartate aminotransferase levels. A cross-sectional study.
The aim of this cross-sectional study was to investigate the clinical application of chairside tests for gingival crevicular fluid (GCF) aspartate aminotransferase (AST) levels and plaque BANA hydrolysis activity with the presence of the periodontal pathogens Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans. The study comprised 100 periodontitis sites (pocket depths > or =4 mm, GI=3) from 10 patients with chronic adult periodontitis and 100 control sites (pocket depths <4 mm, GI<3) from 10 periodontally healthy patients comprising 55 healthy sites (pocket depths <4 mm, GI=0) and 45 gingivitis sites (pocket depths <4 mm, GI=1 or 2). The values for both BANA hydrolysis and AST levels were significantly higher in samples from periodontitis compared with gingivitis and healthy sites (p<0.001). A. actinomycetemcomitans was identified in 45% and P. gingivalis in 17% of periodontitis sites but neither pathogen was recovered from control sites and there was no significant correlation with the clinical parameters measured. There was no significant relationship between the presence of P. gingivalis and/or A. actinomycetemcomitans with BANA hydrolysis or AST levels. A significant correlation (p=0.0017) was observed between BANA hydrolysis and pocket depth and between AST hydrolysis and the GI (p=0.01). This study failed to demonstrate a positive association between chairside analysis of GCF metabolites for AST levels and/or BANA hydrolysis with P. gingivalis and A. actinomycetemcomitans. However, the GCF metabolites had a significant correlation with periodontally diseased sites in patients with chronic adult periodontitis and may help confirm clinical observations.


IGENDA protocol: gender differences in awareness, knowledge and perception of cardiovascular risk: an Italian multicenter study.
Recent reports evidenced gender differences in the knowledge, perception and awareness of cardiovascular risk factors (CVRFs) and cardiovascular diseases (CVDs). Despite the number of high-quality trials that attempted to establish the efficacy of different preventive interventions on CVDs, in the Italian scenario the differences by gender in awareness, knowledge and perception of CVD have not been addressed yet. So, the aims of this cross-sectional, observational and multicenter study will be to evaluate the gender differences in the awareness and perception of CVD risk, to assess the knowledge of CVD symptoms and preventive behaviors/barriers in men and women participating in this study, and to provide a national primary care approach for gender-oriented cardiovascular prevention strategies and therapy. A self-administered questionnaire will be completed by 5000 consecutive Italian women and men aged 18-70 years. Moreover, a health questionnaire will be completed by the physicians. The present study will be the largest to be conducted in Italy, and probably in the European countries, to comprehensively demonstrate the current level of the knowledge, awareness and perception of CVRFs and CVD in both men and women. The present project could shed new light on the knowledge, awareness and perception of CVRFs and CVDs. If substantial differences will be detected by gender, the findings of this study may contribute to ultimately provide a new gender-oriented primary care approach inside the Italian healthcare system related to cardiovascular prevention and therapy strategies.


Contribution of inherited heart disease to sudden cardiac death in childhood.
In children aged 1 to 18 years, the causes of sudden cardiac death may remain unresolved when autopsy results are negative. Because inherited cardiac diseases are likely, cardiologic and genetic investigations of relatives may still yield the diagnosis in these cases. Moreover, these investigations provide timely identification of relatives who are also at risk of sudden cardiac death. We aimed to establish the cause of sudden cardiac death in the children of whom the family was referred to our cardiogenetics department and the diagnostic yield of these investigations. We genetically counseled 25 consecutive, unrelated families after sudden cardiac death of a child (aged 1 to 18 years) who was disease-free during lifetime and in whose family there was no known inherited heart disease. We performed cardiac investigation (electrocardiography, exercise testing, and echocardiography) of first-degree and second-degree relatives and performed diagnosis-directed DNA analysis. Autopsy was performed in 20 case subjects. A diagnosis was identified in 14 of 25 families. In addition, we studied 10 children after aborted sudden cardiac death; in 6 of them, a diagnosis was made. Overall, in 17 of the 19 families in whom an inherited disease was diagnosed, a disease-causing mutation in either a first-degree relative or the index patient confirmed the diagnosis. Sudden cardiac death in children seems to be caused often by inherited cardiac diseases. Cardiac and genetic examination of relatives combined, if possible, with postmortem analysis after sudden cardiac death of a child has a high diagnostic yield (14 of 25), comparable to analysis in surviving victims of sudden cardiac death (6 of 10). Because sudden cardiac death can be prevented by timely treatment, these results warrant active family screening after unexplained sudden cardiac death of a child.


Reproduction in Risky Environments: The Role of Invasive Egg Predators in Ladybird Laying Strategies.
Reproductive environments are variable and the resources available for reproduction are finite. If reliable cues about the environment exist, mothers can alter offspring phenotype in a way that increases both offspring and maternal fitness ('anticipatory maternal effects'-AMEs). Strategic use of AMEs is likely to be important in chemically defended species, where the risk of offspring predation may be modulated by maternal investment in offspring toxin level, albeit at some cost to mothers. Whether mothers adjust offspring toxin levels in response to variation in predation risk is, however, unknown, but is likely to be important when assessing the response of chemically defended species to the recent and pervasive changes in the global predator landscape, driven by the spread of invasive species. Using the chemically defended two-spot ladybird, Adalia bipunctata, we investigated reproductive investment, including egg toxin level, under conditions that varied in the degree of simulated offspring predation risk from larval harlequin ladybirds, Harmonia axyridis. H. axyridis is a highly voracious alien invasive species in the UK and a significant intraguild predator of A. bipunctata. Females laid fewer, larger egg clusters, under conditions of simulated predation risk (P+) than when predator cues were absent (P-), but there was no difference in toxin level between the two treatments. Among P- females, when mean cluster size increased there were concomitant increases in both the mass and toxin concentration of eggs, however when P+ females increased cluster size there was no corresponding increase in egg toxin level. We conclude that, in the face of offspring predation risk, females either withheld toxins or were physiologically constrained, leading to a trade-off between cluster size and egg toxin level. Our results provide the first demonstration that the risk of offspring predation by a novel invasive predator can influence maternal investment in toxins within their offspring.


Topological properties determined by atomic buckling in self-assembled ultrathin Bi(110).
Topological insulators (TIs) are a new type of electronic materials in which the nontrivial insulating bulk band topology governs conducting boundary states with embedded spin-momentum locking. Such edge states are more robust in a two-dimensional (2D) TI against scattering by nonmagnetic impurities than in its three-dimensional (3D) variant, because in 2D the two helical edge states are protected from the only possible backscattering. This makes the 2D TI family a better candidate for coherent spin transport and related applications. While several 3D TIs are already synthesized experimentally, physical realization of 2D TI is so far limited to hybrid quantum wells with a tiny bandgap that does not survive temperatures above 10 K. Here, combining first-principles calculations and scanning tunneling microscopy/spectroscopy (STM/STS) experimental studies, we report nontrivial 2D TI phases in 2-monolayer (2-ML) and 4-ML Bi(110) films with large and tunable bandgaps determined by atomic buckling of Bi(110) films. The gapless edge states are experimentally detected within the insulating bulk gap at 77 K. The band topology of ultrathin Bi(110) films is sensitive to atomic buckling. Such buckling is sensitive to charge doping and could be controlled by choosing different substrates on which Bi(110) films are grown.


Barriers and facilitators to implementing evidence-based guidelines in long-term care: a qualitative evidence synthesis.
The long-term care setting poses unique challenges and opportunities for effective knowledge translation. The objectives of this review are to (1) synthesize barriers and facilitators to implementing evidence-based guidelines in long-term care, as defined as a home where residents require 24-h nursing care, and 50% of the population is over the age of 65 years; and (2) map barriers and facilitators to the Behaviour Change Wheel framework to inform theory-guided knowledge translation strategies. Following the guidance of the Cochrane Qualitative and Implementation Methods Group Guidance Series and the ENTREQ reporting guidelines, we systematically reviewed the reported experiences of long-term care staff on implementing evidence-based guidelines into practice. MEDLINE Pubmed, EMBASE Ovid, and CINAHL were searched from the earliest date available until May 2021. Two independent reviewers selected primary studies for inclusion if they were conducted in long-term care and reported the perspective or experiences of long-term care staff with implementing an evidence-based practice guideline about health conditions. Appraisal of the included studies was conducted using the Critical Appraisal Skills Programme Checklist and confidence in the findings with the GRADE-CERQual approach. After screening 2680 abstracts, we retrieved 115 full-text articles; 33 of these articles met the inclusion criteria. Barriers included time constraints and inadequate staffing, cost and lack of resources, and lack of teamwork and organizational support. Facilitators included leadership and champions, well-designed strategies, protocols, and resources, and adequate services, resources, and time. The most frequent Behaviour Change Wheel components were physical and social opportunity and psychological capability. We concluded moderate or high confidence in all but one of our review findings. Future knowledge translation strategies to implement guidelines in long-term care should target physical and social opportunity and psychological capability, and include interventions such as environmental restructuring, training, and education.


Phytochemical analysis of the ethanolic extract of Agathis robusta (C. Moore ex F. Muell.) F.M. Bailey.
This work reports the phytochemical analysis of the ethanolic extract obtained from the leaves of Agathis robusta (C. Moore ex F. Muell.) F.M. Bailey. The methodology utilised during this study comprised classical chromatographic and spectroscopic techniques. Six compounds were identified: agathisflavone (1), 7″-O-methyl-agathisflavone (2), cupressuflavone (3), rutin (4), shikimic acid (5) and (2S)-1,2-Di-O-[(9Z,12Z,15Z)-octadeca-9,12,15-trienoyl]-3-O-β-d-galactopyranosyl glycerol (6). These belong to four major classes of natural compounds: bi-flavonoids (1-3); diglycosidic flavonoids (4); cycloexen-carboxylic acids (5); glycerol-glycolipids (6). To the best of our knowledge, compounds (3-6) were identified for the first time in this study as constituents of A. robusta. Anyway, the majority of these compounds has chemotaxonomic relevance and is mostly in accordance with the current botanical classification of this species. Moreover, they also present several pharmacological properties among which, the antibacterial, anti-inflammatory and protective ones are the most important and may explain why this species is used in the ethno-medicinal field.


The natural history of coronary artery stenosis. A longitudinal angiographic assessment.
Comparison of sequential large film coronary angiograms was performed for 58 patients with coronary artery disease, and no coronary surgery, to determine the relationship between the location, type, and degree of stenoses and their tendency to progress. Of 230 stenoses, 76 (33%) showed progression and 154 (67%) remained stable on the follow-up studies. Progression occurred in 38 (66%) patients. A statistically significant higher tendency to progress was found with tubular stenosis with ulcerating plaques (100%) and stenoses with collateral circulation (58%). A significant linear trend for progression was also found with the increasing number of risk factors of coronary disease. The above-average progression tendency of stenoses of the right coronary artery, tubular irregular stenoses, and Grade 2 stenoses, was not statistically significant.


Nocturnal haemodialysis increases pharyngeal size in patients with sleep apnoea and end-stage renal disease.
Sleep apnoea is common in patients with end-stage renal disease (ESRD) and is improved by nocturnal haemodialysis (NHD). Recent findings from our laboratory indicate the development of ESRD is associated with pharyngeal narrowing. We hypothesized that NHD increases pharyngeal cross-sectional area and that this is associated with an improvement in sleep apnoea. Twenty-four patients (aged 32-68 years), receiving conventional haemodialysis (CHD) (4 h/day, 3 days/week), were recruited for overnight polysomnography and estimation of pharyngeal cross-sectional area at functional residual capacity (FRC) and residual volume (RV). Patients were divided into apnoeic and non-apnoeic groups based on an apnoea-hypopnoea index (AHI) > or = 15/h. Following conversion from CHD to NHD (8 h/night, 3-6 nights/week) all measurements were repeated and apnoeic patients were classified as 'responders' if AHI fell to < 15 events/h. Conversion from CHD to NHD was associated with an increase in pharyngeal cross-sectional area (FRC: 3.29 +/- 0.67 vs 3.39 +/- 0.75 cm(2); RV: 1.91 +/- 0.51 vs 2.13 +/- 0.48 cm(2), P < 0.05), which was not significantly different between groups. Sleep apnoea improved in three patients. Conversion from CHD to NHD is associated with an increase in pharyngeal cross-sectional area. This may play a role in some patients whose sleep apnoea improves on NHD.


Development and Validation of a MATLAB Software Program for Decoding the Treatment Errors in Real-time Position Management™ Gating-generated Breathing Trace.
The Real-time Position Management™ (RPM) is used as a motion management tool to reduce normal tissue complication. However, no commercial software is available to quantify the "beam-on" errors in RPM-generated breathing traces. This study aimed to develop and validate an in-house-coded MATLAB program to quantify the "beam-on" errors in the breathing trace. A graphical user interface (GUI) was developed using MATLAB (Matrix Laboratory Ra2016) software. The GUI was validated using two phantoms (Varian-gated phantom and Brainlab ET gating phantom) with three regular motion profiles. Treatment time delay was calculated using regular sinusoidal motion profile. Ten patient's irregular breathing profiles were also analyzed using this GUI. The beam-on comparison between the recorded reference trace and irradiated trace profile was done in two ways: (1) beam-on time error and (2) beam-on displacement error. These errors were ≤1.5% with no statistical difference for phase- and amplitude-based treatments. The predicated amplitude levels of reference phase-based profiles, and the actual amplitude levels of amplitude-based irradiated profiles were almost equal. The average treatment time delay was 47 ± 0.003 ms. The irregular breathing profile analysis showed that the amplitude-based gating treatment was more accurate than phase based. The developed GUI gave the same and acceptable results for all regular profiles. These errors were due to the lag time of the linear accelerator with gating treatment. This program can be used as to quantifying the intrafraction "beam-on" errors in breathing trace with both mode of gating techniques for irregular breathing trace, and in addition, it is capable to convert phase-based gating parameters to amplitude-based gating parameters for treatment.


Direct retroviral-mediated transfer of a dystrophin minigene into mdx mouse muscle in vivo.
At the cellular level, the primary pathology in Duchenne muscular dystrophy (DMD) is caused by deficiency of the sarcolemmal-associated protein, dystrophin, in the striated musculature. Here we describe the somatic transfer and long-term expression of a human dystrophin minigene corresponding to a mild Becker muscular dystrophy (BMD) phenotype in skeletal muscle tissues of the dystrophin-deficient mdx mouse by direct retroviral transduction. Following a single intramuscular injection of recombinant retrovirus, sarcolemmal expression of dystrophin was observed in an average of approximately 6% of myofibres in treated tibialis anterior muscles and was associated with activated reappearance of at least one component (43kD) of the dystrophin-glycoprotein membrane complex (DGC). Furthermore, expression of recombinant dystrophin was observed in muscle tissues up to 9 months after treatment and a significant enhancement of retrovirus-mediated myofibre transduction was obtained in mdx muscle undergoing experimentally-induced regeneration. The results clearly demonstrate that retroviral transduction of activated satellite cells in regenerating skeletal muscle is a feasible route for direct and stable dystrophin gene transfer into muscle tissues in vivo.


Use of implantable bone growth stimulation in Charcot ankle arthrodesis.
The purpose of this study was to review the results of arthrodesis of the Charcot hindfoot when an implantable bone growth stimulator was added to the procedure. Arthrodesis of the Charcot hindfoot has a high nonunion and complication rate. Ten patients (ages 50 to 69 years) with Charcot neuroarthropathy of the ankle, hindfoot, or both had arthrodesis with use of rigid internal fixation and an implantable bone growth stimulator. There were six tibiotalocalcaneal, two pantalar, and two tibiocalcaneal arthrodeses. An intramedullary nail was used in nine patients and a blade plate was used in one patient. All but one patient was diabetic. Four of the ten patients had preoperative osteomyelitis or postoperative infection. Another patient had purulent drainage, although cultures were negative. Four patients had a preoperative ulceration. Five patients had a two-stage procedure for debridement of infected bone, removal of hardware, and placement of antibiotic beads. Autogenous bone graft from the distal fibula or proximal tibia was used in all patients. One patient with a preoperative osteomyelitis developed a stable ankle pseudarthrosis. The other nine patients fused at an average of 3.7 months after surgery for a fusion rate of 90%. There were two major complications and eight minor complications. There were no amputations. All patients were ambulatory in a double upright brace or shoes for diabetic patients and were free of ulceration at the time of followup. Average American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score improved from 21 preoperatively to 59 postoperatively. The adjunctive use of an implantable bone growth stimulator in conjunction with rigid internal fixation, autogenous bone grafting, and sound operative technique may enhance the outcome and fusion rate in patients undergoing arthrodesis for Charcot neuroarthropathy of the ankle and hindfoot.


Moustache reconstruction in patients with cleft lip: (final aesthetic touches in clefts-part ii).
Men with clefts often have limited or even missing moustache growth in scar areas or in the upper lip prolabium. However the histological testing showed the absence or at least the inactive form of androgenic receptor in hair follicle of cleft site, transplantation of autologous grafts harvested from hair was successful in all six cases either into scars or the prolabium. A more natural effect was achieved by using micrografts. The positive reaction of patients proved there is a need for detailed treatment in highly outgoing individuals.


[Transcriptome analysis reveals candidate genes involved in flavonoid biosynthesis in Ziziphora bungeana].
Ziziphora bungeana is a kind of medicinal plants belongs to Labiatae,and it also a kind of geoherbs in Xinjiang. The main active ingredient linarin has a higher content in inflorescence than in other parts. In this study,high-throughput sequencing technology was used to reveal the transcriptome of the inflorescence of Z. bungeana,77 366 unigenes were acquired,of which 56 375 unigenes were annotated based on search of the database and classification. Through the analysis of metabolic pathways,sixty unigenes were probably encoding some enzymes involved in the flavonoid biosynthesis pathways. The contents of linarin in different parts were determined and the key genes were verified by qRT-PCR. The discovery provides the research basis for further analysis of the enzyme genes involved in the biosynthesis of the major flavonoid components in Z. bungeana.


Outcomes in Obese vs Non-Obese Injured Patients at a Level 1 Trauma Center and Bariatric Surgery Center of Excellence.
We hypothesized that the outcomes of trauma patients with a body mass index (BMI) equal to or greater than 30 compared to patients with BMI less than 30 would not differ at a level 1 trauma center that is also a Metabolic and Bariatric Surgery Center of Excellence in the Metabolic and Bariatric Surgery Accreditation Quality Improvement Program (MBSAQIP). Patients equal to and greater than 18 years old treated between 1/1/2018 and 12/31/2020 were included. Demographics, BMI, comorbidities, and outcomes (hospital-LOS, ICU-LOS, blood products used, and mortality) were compared between 2 groups: obese (BMI ≥30) vs non-obese (BMI <30). Of the 4192 patients identified, 3821 met the inclusion criteria; 3019 patients had a BMI <30, and 802 had a BMI ≥30. There was a statistically significant difference between the 2 groups with respect to gender (females: 57% vs 47%, P < .0001) and age (median: 80 [IQR: 63-88] vs 69 [IQR: 55-81], P < .0001). When adjusted for age, sex, DM, dementia, ISS, and ICU admission, there was no statistically significant difference in hospital-LOS (4.30 [95% CI: 4.10, 4.52] vs 4.48 [95% CI: 4.18, 4.79]) or mortality. No statistical differences were seen between the 2 groups in blood product use. Obesity did not correlate with poorer outcomes at an ACS-verified level 1 Trauma Center and Bariatric Surgery Center of Excellence. Further studies are needed to determine whether outcomes vary at hospitals without both designations.


Immunoprotective oral whole cell vaccine for enterotoxigenic Escherichia coli diarrhea prepared by in situ destruction of chromosomal and plasmid DNA with colicin E2.
Vaccine regimens which mimic actual infection with bacterial enteropathogens should offer the best opportunity for successful long-term immunoprotection against diarrheal disease caused by enterotoxigenic Escherichia coli (ETEC) or Vibrio cholerae. Based on this principle, we designed and tested an oral whole cell anti-ETEC vaccine consisting of intact cells of ETEC strain H-10407 (ST+LT+; O78:H11:CFA/I) which were rendered incapable of replication by treatment with a potent DNA endonuclease, colicin E2. Young healthy volunteers were administered two oral doses of either placebo or approx. 3 X 10(10) vaccine cells. In a double-blind study, 9 of 10 vaccinees responded with an increase in CFA/I-specific intestinal IgA antibody, determined as percent of total IgA. Challenge with virulent strain H-10407 (5 X 10(9) living cells) produced diarrhea in 8 of 9 (89%) of the placebo-treated volunteers and in 2 of 10 (20%) of the vaccinees. Thus, the colicin E2-killed whole cell vaccine afforded both a significant intestinal immune response and significant protection against challenge with the virulent organism. The data presented here suggest that for this vaccine preparation an intestinal anti-CFA/I IgA response is a good indicator of a protective immune response, which most likely involves antibody responses to a number of antigens in addition to CFA/I. We conclude that the colicin E2 method for preparing an oral anti-ETEC vaccine merits further study and that this method may also be applicable to other enteropathogens.


Broad-band efficiency calibration of ITER bolometer prototypes using Pt absorbers on SiN membranes.
The energy resolved efficiency of two bolometer detector prototypes for ITER with 4 channels each and absorber thicknesses of 4.5 μm and 12.5 μm, respectively, has been calibrated in a broad spectral range from 1.46 eV up to 25 keV. The calibration in the energy range above 3 eV was performed against previously calibrated silicon photodiodes using monochromatized synchrotron radiation provided by five different beamlines of Physikalische Technische Bundesanstalt at the electron storage rings BESSY II and Metrology Light Source in Berlin. For the measurements in the visible range, a setup was realised using monochromatized halogen lamp radiation and a calibrated laser power meter as reference. The measurements clearly demonstrate that the efficiency of the bolometer prototype detectors in the range from 50 eV up to ≈6 keV is close to unity; at a photon energy of 20 keV the bolometer with the thick absorber detects 80% of the photons, the one with the thin absorber about 50%. This indicates that the detectors will be well capable of measuring the plasma radiation expected from the standard ITER scenario. However, a minimum absorber thickness will be required for the high temperatures in the central plasma. At 11.56 keV, the sharp Pt-L3 absorption edge allowed to cross-check the absorber thickness by fitting the measured efficiency to the theoretically expected absorption of X-rays in a homogeneous Pt-layer. Furthermore, below 50 eV the efficiency first follows the losses due to reflectance expected for Pt, but below 10 eV it is reduced further by a factor of 2 for the thick absorber and a factor of 4 for the thin absorber. Most probably, the different histories in production, storage, and operation led to varying surface conditions and additional loss channels.


Atypical language cortex in the left temporal lobe: relationship to bilateral language.
The intracarotid amobarbital procedure (IAP) is widely used in the preoperative evaluation for epilepsy surgery to lateralize language dominance and memory functions. However, language mapping has most often been accomplished with cortical brain stimulation. To examine left temporal lobe language cortex representation using this technique in patients with bilateral language (BL) as compared with patients with left language dominance (LD). The language maps of each patient were reviewed retrospectively. Group I consisted of 10 patients with BL and Group II consisted of 10 matched control patients with LD. Each stimulation trial included a brief assessment of confrontation naming, automatic speech, reading, repetition, and comprehension. Clusters of errors that included comprehension, repetition, and naming defined primary temporal lobe language areas. Mapping revealed two distinct language areas in 60% of patients in Group I and 10% in Group II (p = 0.019). In Group I, two patients had both language areas in the same gyrus (either the superior or the middle temporal gyrus), whereas two showed one language area each in the superior and middle temporal gyri and the remaining two had one in the superior temporal gyrus and the other intermixed between the superior and middle temporal gyri. In Group II, both language areas were intermixed between the superior and middle temporal gyri. Bilateral language (BL) representation in the intracarotid amobarbital procedure is frequently associated with more than one noncontiguous language area in the left temporal lobe. A careful search for multiple language areas, particularly in patients with BL, is prudent prior to surgical resection.


A preliminary psychometric analysis of a computer-assisted administration of the Telephone Interview of Cognitive Status-modified.
Most screening tests of cognitive functioning require face to face administration by trained examiners. This limits their utility in epidemiology and in primary care settings. Further, existing screening tests have not been developed using established psychometric principles. We adapted the Telephone Interview of Cognitive Status-modified (TICSm) for administration as a computer-assisted telephone interview (CATI). We screened 3,681 elderly women with the CATI version of the TICSm, using lay staff as part of a longitudinal study. A preliminary analysis of the psychometric properties of the TICSm indicated good internal consistency. Test-retest reliability is needed to confirm reliability. Further work remains to adequately judge the validity of the TICSm including comparisons with well-standardized tests and assessment of its predictive properties in identifying dementia. However, the CATI version of the TICSm appears to have potential as a cost-effective means of testing cognitive performance.


The caliber persistent artery of the stomach: a unifying approach to gastric aneurysm, Dieulafoy's lesion, and submucosal arterial malformation.
The caliber persistent artery of the stomach is the most dangerous form of gastrorrhagias; the overall lethality rate is 60.5%. A literature review aimed at completeness, a study of the hitherto largest case material (24 cases), and a comparative analysis of the bleeding and normal gastric arteries gave the following results: (1) the walls of the pathologic arteries are of normal structure; (2) as submucous arteries, they are of normal diameter; (3) they are attached to the mucosa by virtue of Wanke's musculoelastic mantle; (4) at the level of the muscularis mucosae, they are definitely oversized; (5) in the area of the linkage of the artery to the mucosa, a vulnerable mucosal spot is created; (6) the artery is accompanied by a vein of similar caliber; and (7) perforation of the vein takes place before that of the artery. In addition to surgical pathology and pathogenesis, the pitfalls of its diagnosis and treatment are also discussed. Caliber persistent artery of the stomach is much more common than the literature indicates, necessitating an increased awareness of the condition.


[The nursing process at a burns unit: an ethnographic study].
This ethnographic study aimed at understanding the cultural meaning that nursing professionals working at a Burns Unit attribute to the nursing process as well as at identifying the factors affecting the implementation of this methodology. Data were collected through participant observation and semi-structured interviews. The findings indicate that, to the nurses from the investigated unit, the nursing process seems to be identified as bureaucratic management. Some factors determining this perception are: the way in which the nursing process has been taught and interpreted, routine as a guideline for nursing activity, and knowledge and power in the life-world of the Burns Unit.


Intercultural gerontology curriculum: Principles and practice.
The internationalization of universities and the aging of the global population are two current issues that converge and challenge undergraduate gerontology curriculum development in Canada. One response to this challenge is to envision an intercultural gerontology curriculum. What might this curriculum encompass? How might it be taught? An exploratory study was undertaken to address these two questions. This paper presents findings from this study based primarily on interviews with university-based stakeholders from Canada, the United States, and Europe. Thematic analysis of the interviews resulted in five themes: multiple perspectives on cultural diversity; the dynamic nature of cultural diversity and aging; flow of an intercultural curriculum; institutional culture and intercultural curricula; and principles and practice for intercultural gerontology. Framed by principles of gerontology theory and educational approaches, this paper focuses on the principles and practice suggested by study participants. Scaffolding learning, active learning strategies, experiential learning opportunities, teacher modelling, and internet-based learning are discussed as key to intercultural learning. An appendix includes a list of resources that may be useful to developing an intercultural gerontology curriculum.