Catalytic role of traditional enzymes for biosynthesis of biogenic metallic nanoparticles: a mini-review.
Although the formation mechanism of biogenically metallic nanoparticles is broadly associated to enzyme mediation, major attention has been given to the role of proteins and peptides in oxido-reduction of metallic ions leading to these nanostructures. Among the wide range of biomolecules that can act not only as capping agents but also as non-enzymatic agents to form nanoparticles, disulphide bridge-containing peptides and amino acids particularly stand out. The literature proposes that they actively participate in the process of nanoparticles' synthesis, with thiols groups and disulphide bridge moieties as the reaction catalytic sites. Similarly, denaturated enzymes containing exposed S-S or S-H moieties are also able to reduce metallic ions to form nanoparticles. This mini-review is focused on the biogenic synthesis of metallic nanoparticles such as gold, silver, copper, platinum, palladium, lead and selenium, in which proteins, peptides, reductases and even oxido-reductases act as non-enzymatic catalysts of the reduction reaction, opening economically and ecologically favourable perspectives in the nanoparticles synthesis field.


Non-Markovian rotating unstable processes driven by Gaussian colored noise.
In this paper the statistical properties of the mean passage time distribution are used to characterize the decay process of non-Markovian rotating unstable processes driven by Gaussian colored noise and subjected to the influence of a constant external force. The time characterization will be linear and studied in two limiting cases: large and intermediate times. General systems of two variables are studied. In both schemes we show that, for small correlation time of the noise, the non-Markovian effects are taken into account by an effective noise intensity. To compare qualitatively the non-Markovian time scale with respect to the Markovian case, we apply those results to determine the detection bandwidth of a large external signal in a laser system.


Modeling of temperature-programmed desorption thermograms for the determination of adsorption heat considering pore and surface diffusion.
In this work, two partial differential equation-based models have been proposed for the quantitative analysis of temperature-programmed desorption (TPD) thermograms when the adsorption cell can be modeled as a well-mixed reactor, using the Langmuir equation as the adsorption isotherm and including the effect of diffusional resistance. One model considers pore diffusion, and the other considers surface diffusion. For both models, the rate of adsorption is proportional to the gas pressure. By nondimensionalizing these models, the range of design parameters for which the accumulation in the gas cell, diffusional resistance, and readsorption have an important effect on the TPD signal is proposed. An important conclusion is that the dimensionless numbers accounting for the diffusional resistance and the corresponding range of parameters are quite different for both mechanisms. The models have been validated with two systems where surface and pore diffusion are the relevant mechanisms: (i) CO2-Na-mordenite and (ii) CO2-Na-mordenite pellets.


Structural behaviour differences in low methoxy pectin solutions in the presence of divalent cations (Ca(2+) and Zn(2+)): a process driven by the binding mechanism of the cation with the galacturonate unit.
In this paper, we compare the interactions between low methoxy pectin (LMP) and either Ca(2+) or Zn(2+) in semi-dilute solutions. Intrinsic viscosity and turbidity measurements reveal that pectin-calcium solutions are more viscous, but yet less turbid, than pectin-zinc ones. To get a molecular understanding of the origin of this rather unexpected behavior, we further performed isothermal titration calorimetry, small angle neutron scattering experiments, as well as molecular dynamics simulations. Our results suggest that calcium cations induce the formation of a more homogeneous network of pectin than zinc cations do. The molecular dynamics simulations indicate that this difference could originate from the way the two cations bind to the galacturonate unit (Gal), the main component of LMP: zinc interacts with both carboxylate and hydroxyl groups of Gal, in a similar way to that described in the so-called egg-box model, whereas calcium only interacts with carboxylate groups. This different binding behavior seems to arise from the stronger interaction of water molecules with zinc than with calcium. Accordingly, galacturonate chains are more loosely associated with each other in the presence of Ca(2+) than with Zn(2+). This may improve their ability to form a gel, not only by dimerization, but also by the formation of point-like cross-links. Overall, our results show that zinc binds less easily to pectin than calcium does.


Heme oxygenase-1 against vascular insufficiency: roles of atherosclerotic disorders.
Heme oxygenase (HO), an enzyme essential for heme degradation, shows anti-oxidative and anti-inflammatory properties via the production of bile pigments, carbon monoxide (CO) and ferritin induction under various pathophysiological conditions. A number of recent studies have shown biological effects of HO reaction in cardiovascular disorders. An inducible form of HO, HO-1, is induced by a variety of stresses such as oxidized lipoproteins, cytokines, hemodynamic changes, angiotensin II and nitric oxide (NO) in vascular wall. HO-1 induction seems to function as an adaptive response against these injurious stimuli. HO-1 induction in artery wall scavenges reactive oxygen species, which leads to the attenuation of monocyte adhesion and chemotaxis. HO-1 induction also reduces lipid peroxidation in plasma and artery wall. These properties of HO-1 suggest anti-atherogenic roles of this enzyme. In this review, roles of endothelial HO-1 expression and bilirubin in atherogenesis are also discussed. HO-1 also seems to play a significant role in restenosis after angioplasty, which is a major clinical problem associated with atherosclerosis. Recent progress in human HO-1 genetics supports these experimental results. This review aims to reaffirm current problems in the biological aspects of HO and suggest future research direction and clinical application.


Microgravity-Induced Transcriptome Adaptation in Mouse Paraspinal longissimus dorsi Muscle Highlights Insulin Resistance-Linked Genes.
Microgravity as well as chronic muscle disuse are two causes of low back pain originated at least in part from paraspinal muscle deconditioning. At present no study investigated the complexity of the molecular changes in human or mouse paraspinal muscles exposed to microgravity. The aim of this study was to evaluate longissimus dorsi adaptation to microgravity at both morphological and global gene expression level. C57BL/N6 male mice were flown aboard the BION-M1 biosatellite for 30 days (BF) or housed in a replicate flight habitat on ground (BG). Myofiber cross sectional area and myosin heavy chain subtype patterns were respectively not or slightly altered in longissimus dorsi of BF mice. Global gene expression analysis identified 89 transcripts differentially regulated in longissimus dorsi of BF vs. BG mice. Microgravity-induced gene expression changes of lipocalin 2 (Lcn2), sestrin 1(Sesn1), phosphatidylinositol 3-kinase, regulatory subunit polypeptide 1 (p85 alpha) (Pik3r1), v-maf musculoaponeurotic fibrosarcoma oncogene family protein B (Mafb), protein kinase C delta (Prkcd), Muscle Atrophy F-box (MAFbx/Atrogin-1/Fbxo32), and Muscle RING Finger 1 (MuRF-1) were further validated by real time qPCR analysis. In conclusion, our study highlighted the regulation of transcripts mainly linked to insulin sensitivity and metabolism in longissimus dorsi following 30 days of microgravity exposure. The apparent absence of robust signs of back muscle atrophy in space-flown mice, despite the overexpression of Atrogin-1 and MuRF-1, opens new questions on the possible role of microgravity-sensitive genes in the regulation of peripheral insulin resistance following unloading and its consequences on paraspinal skeletal muscle physiology.


Non-traumatic ischaemic myelopathy: a review of 25 cases.
The causes of ischaemic myelopathy are described in 25 patients. Nine developed following surgical manipulation or traumatic laceration of the aorta, 1 following intercostal artery ligation, 3 following aortic aneurysm dissection, 2 following myocardial infarction and/or cardiac arrest, 7 in the absence of any specifically identifiable predisposing factors, and 3 in association with decompression sickness. The degree of clinical recovery was greater among those with incomplete spastic (as opposed to complete flaccid) paralysis and among those in whom sensory loss below the level of injury was incomplete. Despite the diversity of mechanisms that may lead to the development of spinal cord ischaemia, structural damage seems in most instances to affect either grey matter or white matter predominantly. Some of the possible reasons for these preferential sites of damage are discussed.


Defining the boundaries of physiological understanding: the benchmarks curriculum model.
We set out to develop an anatomy and physiology (A&P) curriculum with a content that was relevant and well rationalized. To do this, we developed a benchmarks curriculum process that helps us to determine what our students need to learn in A&P and then to make sure there is alignment between those learning objectives and what we teach and how we assess our students. Using the benchmarks process, we first set the broad skill and content goals of the course. We then prioritize the topic areas to be covered, allocating the course time accordingly, and declare the learning objectives for each topic. To clarify each learning objective, a set of benchmark statements are written that specify in operational terms what is required to demonstrate mastery. After the benchmarks are written, we assemble the learning activities that help students achieve them and write assessment items to evaluate achievement. We have implemented the curriculum in a relational database that allows us to specify the numerous links that exist between its different elements. In the future, the benchmarks model will be used for ongoing A&P curriculum development with geographically distributed contributors accessing it via the World Wide Web. This mechanism will allow for the continuing evolution of the A&P curriculum.


Does childhood adversity account for poorer mental and physical health in second-generation Irish people living in Britain? Birth cohort study from Britain (NCDS).
Worldwide, the Irish diaspora experience elevated mortality and morbidity across generations, not accounted for through socioeconomic position. The main objective of the present study was to assess if childhood disadvantage accounts for poorer mental and physical health in adulthood, in second-generation Irish people. Analysis of prospectively collected birth cohort data, with participants followed to midlife. England, Scotland and Wales. Approximately 17 000 babies born in a single week in 1958. Six per cent of the cohort were of second-generation Irish descent. Primary outcomes were common mental disorders assessed at age 44/45 and self-rated health at age 42. Secondary outcomes were those assessed at ages 23 and 33. Relative to the rest of the cohort, second-generation Irish children grew up in marked material and social disadvantage, which tracked into early adulthood. By midlife, parity was reached between second-generation Irish cohort members and the rest of the sample on most disadvantage indicators. At age 23, Irish cohort members were more likely to screen positive for common mental disorders (OR 1.44; 95% CI 1.06 to 1.94). This had reduced slightly by midlife (OR 1.27; 95% CI 0.96 to 1.69). Although at age 23 second-generation cohort members were just as likely to report poorer self-rated health (OR 1.06; 95% CI 0.79 to 1.43), by midlife this difference had increased (OR 1.25; 95% CI 0.98 to 1.60). Adjustment for childhood and early adulthood adversity fully attenuated differences in adult health disadvantages. Social and material disadvantage experienced in childhood continues to have long-range adverse effects on physical and mental health at midlife, in second-generation Irish cohort members. This suggests important mechanisms over the life-course, which may have important policy implications in the settlement of migrant families.


Impact of helmet use on traumatic brain injury from road traffic accidents in Cambodia.
Rapid urbanization and motorization without corresponding increases in helmet usage have made traumatic brain injury due to road traffic accidents a major public health crisis in Cambodia. This analysis was conducted to quantify the impact of helmets on severity of injury, neurosurgical indication, and functional outcomes at discharge for motorcycle operators who required hospitalization for a traumatic brain injury following a road traffic accident in Cambodia. The medical records of 491 motorcycle operators who presented to a major tertiary care center in Cambodia with traumatic brain injury were retrospectively analyzed using multivariate logistic regression. The most common injuries at presentation were contusions (47.0%), epidural hematomas (30.1%), subdural hematomas (27.9%), subarachnoid hemorrhages (12.4%), skull fractures (21.4%), and facial fractures (18.5%). Moderate-to-severe loss of consciousness was present in 36.3% of patients. Not wearing a helmet was associated with an odds ratio of 2.20 (95% confidence interval [CI], 1.15-4.22) for presenting with moderate to severe loss of consciousness compared to helmeted patients. Craniotomy or craniectomy was indicated for evacuation of hematoma in 20.0% of cases, and nonhelmeted patients had 3.21-fold higher odds of requiring neurosurgical intervention (95% CI, 1.25-8.27). Furthermore, lack of helmet usage was associated with 2.72-fold higher odds of discharge with functional deficits (95% CI, 1.14-6.49). In total, 30.1% of patients were discharged with severe functional deficits. Helmets demonstrate a protective effect and may be an effective public health intervention to significantly reduce the burden of traumatic brain injury in Cambodia and other developing countries with increasing rates of motorization across the world.


Persistent organic pollutants and non-alcoholic fatty liver disease in morbidly obese patients: a cohort study.
In animal experiments persistent organic pollutants (POPs) cause hepatosteatosis. In epidemiological studies POPs have positive associations with serum markers of nonalcoholic fatty liver disease (NAFLD) and together with obesity synergistic association with insulin resistance. Because insulin resistance and obesity are critical in NAFLD pathogenesis, we investigated the association of serum pollutant levels with liver histology and alanine aminotransferase (ALT) in morbidly obese. Liver biopsies were from 161 participants of the Kuopio Obesity Surgery Study (KOBS) who underwent bariatric surgery 2005-2011. Liver histology was categorized as normal, steatosis and non-alcoholic steatohepatitis (NASH). Liver phenotype at baseline and ALT at baseline and 12 months post-surgery were correlated to serum POP concentrations at respective time points. As lipophilic POPs concentrate to smaller fat volume during weight loss, serum levels before and 12 months after bariatric surgery were compared. Baseline serum concentration of PCB-118, β-HCH and several PFAAs had an inverse association with lobular inflammation possibly due to changes in bile acid metabolism. ALT had negative associations with many POPs at baseline that turned positive at 12 months after major clinical improvements. There was an interaction between some POPs and sex at 12 months, and in stratified data positive associations were observed mainly in females but not in males. We found a negative association between serum concentrations of PCB-118, β-HCH and several PFAAs with lobular inflammation at baseline. Positive POPs-ATL associations at 12 months among women suggest that increased POP concentrations may decrease the degree of liver recovery.


A survey of retracted articles in dentistry.
Publication retraction is a mechanism to preserve the scientific literature against publications that contain seriously flawed or erroneous data, redundant publication, plagiarism, unethical research, and other features that compromise the integrity of science. An increase in the occurrence of retractions in recent years has been reported. Nevertheless, there is scarce information on this topic concerning publications in dentistry and related specialties. Thus, this study aimed to investigate retracted papers published in dental journals. Data collection included an exploratory search in PubMed and a specific search in SCImago Journal Rank indexed journals, complemented by the cases reported on the Retraction Watch website and in PubMed. All 167 dental journals included in SCImago were searched for identification of retracted articles up to March 2016. The selected retracted articles and their corresponding retraction notices were recorded and assessed for classification according to the reason for retraction and other additional information. Forty of the 167 journals scrutinised at SCImago (23.9%) had at least one retracted article, and four additional journals were identified from the Retraction Watch website. A total of 72 retracted found were retracted for the reasons: redundant publication (20.8%), plagiarism (18.1%), misconduct (13.8%), overlap (13.6%) and honest error (9.7%). Higher number of retractions were reported in those journals with cites/doc <2.0-n = 49 (74.2%). The types of studies were mainly laboratory studies (34.7%), case reports (22.2%) and review articles (13.9%). The approach to ethical problems in papers published in dental scientific journals is still incipient; retractions were mostly due to the authors' malpractice and were more frequently related to journals with less impact.


Encapsulation of Anti-Tuberculosis Drugs within Mesoporous Silica and Intracellular Antibacterial Activities.
Tuberculosis is a major problem in public health. While new effective treatments to combat the disease are currently under development, they tend suffer from poor solubility often resulting in low and/or inconsistent oral bioavailability. Mesoporous materials are here investigated in an in vitro intracellular assay, for the effective delivery of compound PA-824; a poorly soluble bactericidal agent being developed against Tuberculosis (TB). Mesoporous materials enhance the solubility of PA-824; however, this is not translated into a higher antibacterial activity in TB-infected macrophages after 5 days of incubation, where similar values are obtained. The lack of improved activity may be due to insufficient release of the drug from the mesopores in the context of the cellular environment. However, these results show promising data for the use of mesoporous particles in the context of oral delivery with expected improvements in bioavailability.


Two new sesquiterpenoids from the fruits of Alpinia oxyphylla.
Two undescribed sesquiterpenoids, including one nor-eudesmane type (1) and one guaiane type (2), together with two known analogues (3-4) have been isolated and identified from the fruits of Alpinia oxyphylla. The structures of these new compounds were elucidated by extensive spectroscopic analyses (1D-, 2D-NMR, HRESIMS, IR, UV) and NMR calculations with DP4+ analysis. The anti-inflammatory activities of all isolates were evaluated by measuring their inhibitory effects on PGE2 production in LPS stimulated RAW 264.7 macrophages.


Occurrence of cancer pain.
Occurrence of cancer pain is highly variable and incompletely understood. Surveys are not population-based, are characterized by small heterogeneous samples, and provide sketchy data on etiology of pain, pain syndromes, and clinical or demographic factors. Moreover, the multiple dimensions of pain have not been thoroughly elucidated. Cancer-related pain is caused by the following: 1) direct tumor involvement, 2) diagnostic/therapeutic procedures, and 3) side effects or toxicities of treatment. Individuals may have more than one type of cancer-related pain simultaneously. Occurrence rates range from 14% to 100%, and between 33 and 50% of patients experience pain at some point in the cancer trajectory. Rates are higher (e.g., 70%-100%) in palliative care or pain management settings. Few researchers have focused solely on specific causes of pain in specific patient populations, and only a few included groups at higher risk for pain, such as the elderly or underserved. In general, researchers have not followed pain over time to determine its course, severity, effects on quality of life and functional status, and other related factors. Future researchers should aim to acquire specific information on occurrence of pain in a variety of cancer diagnoses, settings, and groups of people. Longitudinal designs, in-depth exploration of dimensions of pain, and delineation of specific issues in groups such as the elderly, children, and vulnerable populations are essential. Addressing these critical areas will improve our understanding of the occurrence and effects of pain and enhance our ability to provide appropriate interventions, thereby increasing patients' quality of life.


Correlates of Condom-use Self-efficacy on the EPPM-based Integrated Model among Chinese College Students.
To explore the predictors of condom-use self-efficacy in Chinese college students according to the extended parallel process model (EPPM)-based integrated model. A total of 3,081 college students were anonymously surveyed through self-administered questionnaires in Guangzhou and Harbin, China. A structural equation model was applied to assess the integrated model. Among the participants, 1,387 (46.7%) were male, 1,586 (53.3%) were female, and the average age was 18.6 years. The final integrated model was acceptable. Apart from the direct effect (r = 0.23), perceived severity had two indirect effects on condom-use self-efficacy through the attitude to HIV education (r = 0.40) and intention to engage in premarital sex (r = -0.16), respectively. However, the perceived susceptibility mediated through the intention to engage in premarital sex (intent-to-premarital-sex) had a poor indirect impact on condom-use self-efficacy (total effect was -0.06). Furthermore, attitude toward HIV health education (r = 0.49) and intent-to-premarital-sex (r = -0.31) had a strong direct effect on condom-use self-efficacy. In addition, male students perceived higher susceptibility, stronger intent-to-premarital-sex, and lower condom-use self-efficacy than female students. The integrated model may be used to assess the determinants of condom-use self-efficacy among Chinese college students. Future research should focus on raising the severity perception, HIV-risk-reduction motivation, and the premarital abstinence intention among college students. Furthermore, considering the gender differences observed in the present survey, single-sex HIV education is required in school-based HIV/sex intervention.


Gender differences in non-alcoholic fatty liver disease in obese children and adolescents: a large cross-sectional study.
Previous studies have reported sex differences in non-alcoholic fatty liver disease (NAFLD) among adults; however, little is known about its occurrence in children and adolescents. This study aims to examine the prevalence of NAFLD among them and investigate the relationship between sex hormones and NAFLD. This study included 2999 obese Chinese children aged 2-18 years. We examined the prevalence of NAFLD by sex, age, and Tanner stage. The regression model and principal component analysis were used to analyze the relationship between sex hormones and NAFLD. The prevalence of NAFLD increased with age in both sexes, and the gender difference appeared before puberty. The prevalence in boys tended to stabilize at the age of 11 years, whereas girls reached their peak temporarily. NAFLD prevalence was positively associated with estradiol in boys (p = 0.011), but the opposite trend was observed in girls (p = 0.031). Testosterone levels decreased with the increase of NAFLD prevalence in boys (p < 0.001). Luteinizing hormone and prolactin were inversely associated with NAFLD prevalence in boys and girls, respectively. Results from the principal component analysis showed that sex hormone levels and fat distribution were important risk factors for the prevalence of NAFLD in obese children (p < 0.001). The significant difference in NAFLD prevalence between genders in obese children begins in early childhood. This distinction emerges long before puberty onset and tends to stabilize during late adolescence. Sex hormones are associated with NAFLD prevalence and are influenced by the Tanner stages and fat distribution.


Pediatric eosinophilic esophagitis effectively treated with a short-term 6-food-group elimination diet and reintroduction therapy: A case report.
Eosinophilic esophagitis (EoE) is an inflammatory disease diagnosed based on clinical symptoms and pathological findings. EoE is treated with proton pump inhibitors (PPIs), topical steroids, and elimination diet-reintroduction therapy. After remission is achieved with the elimination diet, foods can be reintroduced sequentially to identify specific food triggers; however, this reintroduction method was not previously standardized. A 12-year-old girl presented to our hospital with a 3-year history of epigastric pain. Esophagogastroduodenoscopy revealed linear furrows, esophageal rings, white exudates, and pallor throughout the esophagus. Histopathological findings revealed eosinophilic infiltration >15 eos/hpf on esophageal biopsy. There were no obvious abnormal findings in the stomach and duodenum. EoE INTERVENTIONS AND OUTCOMES:: Because PPI was ineffective, we proposed a 6-food-group elimination diet (SFGED) and reintroduction therapy for EoE, which was initially planned out over a 6-week interval. However, a 5-day interval of SFGED and reintroduction therapy was performed instead. The treatment was effective and causative food antigens (egg and nuts) were identified. Since her symptoms recovered following short-term treatment, the nutritional impact was minimized, as was the duration of her hospitalization. Consequently, the patient's quality of life was well-preserved. SFGED and reintroduction therapy for EoE may be effective even for short-term treatments involving 5-day intervals.


Value of prednisone in combination chemotherapy of stage IV Hodgkin's disease. Report from the British National Lymphoma Investigation.
A combination of mustine, vincristine (Oncovin), procarbazine, and prednisione (MOPP) and the same combination without prednisone (MOP) were compared in the treatment of stage IV Hodgkin's disease in a prospective randomized trial. The complete remission rates were 80% with MOPP and 44% with MOP; the difference was highly significant. Prednisone seems to be an important component of the MOPP combination in the management of stage IV Hodgkin's disease.


A High-Density EEG Study Investigating the Neural Correlates of Continuity Editing Theory in VR Films.
This paper presents a cognitive psychology experiment to explore the differences between 2D and virtual reality (VR) film editing techniques. We recruited sixteen volunteers to view a range of different display modes and edit types of experimental material. An electroencephalogram (EEG) was recorded simultaneously while the participants watched. Subjective results showed that the VR mode reflects higher load scores, particularly in the effort dimension. Different editing types have no effect on subjective immersion scores. The VR mode elicited stronger EEG energy, with differences concentrated in the occipital, parietal, and central regions. On the basis of this, visual evoked potential (VEP) analyses were conducted, and the results indicated that VR mode triggered greater spatial attention, while editing in 2D mode induced stronger semantic updating and active understanding. Furthermore, we found that while the effect of different edit types in both display modes is similar, cross-axis editing triggered greater cognitive violations than continuity editing, which could serve as scientific theoretical support for the development of future VR film editing techniques.


Drug resistance and R plasmids in Escherichia coli strains isolated from imported pet birds.
Drug resistance in Escherichia coli strains isolated from pet birds (mynahs, macaws, finches, common bengals, parrots, and flamingos) imported into Japan from 10 foreign countries in 1977 and 1978 was investigated. Of the 309 strains isolated from 127 pet birds in the Animal Quarantine Service, 232 (75.1%) were drug resistant. Furthermore, strains resistant to oxytetracycline hydrochloride, dihydrostreptomycin, and sulfadimethoxine were relatively common. Resistance patterns varied from single to sextuple resistance, and 148 (63.8%) of the resistant strains had conjugative R plasmids. These results suggest that the high incidence of drug resistance and R plasmids in E. coli strains isolated from these pet birds may be a reflection of the prophylactic use of antibiotics for the prevention of diseases which increasingly occur with importation of the birds. Furthermore, the results suggest that the birds may be potential reservoirs of drug-resistant E. coli for families who raise and have intimate contact with such birds.


Sparse partial least squares classification for high dimensional data.
Partial least squares (PLS) is a well known dimension reduction method which has been recently adapted for high dimensional classification problems in genome biology. We develop sparse versions of the recently proposed two PLS-based classification methods using sparse partial least squares (SPLS). These sparse versions aim to achieve variable selection and dimension reduction simultaneously. We consider both binary and multicategory classification. We provide analytical and simulation-based insights about the variable selection properties of these approaches and benchmark them on well known publicly available datasets that involve tumor classification with high dimensional gene expression data. We show that incorporation of SPLS into a generalized linear model (GLM) framework provides higher sensitivity in variable selection for multicategory classification with unbalanced sample sizes between classes. As the sample size increases, the two-stage approach provides comparable sensitivity with better specificity in variable selection. In binary classification and multicategory classification with balanced sample sizes, the two-stage approach provides comparable variable selection and prediction accuracy as the GLM version and is computationally more efficient.


TGF-beta 1 prevents the noncognate maturation of human dendritic Langerhans cells.
TGF-beta 1 is critical for differentiation of epithelial-associated dendritic Langerhans cells (LC). In accordance with the characteristics of in vivo LC, we show that LC obtained from human monocytes in vitro in the presence of TGF-beta 1 1) express almost exclusively intracellular class II Ags, low CD80, and no CD83 and CD86 Ags and 2) down-regulate TNF-RI (p55) and do not produce IL-10 after stimulation, in contrast to dermal dendritic cells and monocyte-derived dendritic cells. Surprisingly, while LC exhibit E-cadherin down-regulation upon exposure to TNF-alpha and IL-1, TGF-beta 1 prevents the final LC maturation in response to TNF-alpha, IL-1, and LPS with respect to Class II CD80, CD86, and CD83 Ag expression, loss of FITC-dextran uptake, production of IL-12, and Ag presentation. In sharp contrast, CD40 ligand cognate signal induces full maturation of LC and is not inhibited by TGF-beta 1. The presence of emigrated immature LCs in human reactive skin-draining lymph nodes provides in vivo evidence that LC migration and final maturation may be differentially regulated. Therefore, due to the effects of TGF-beta 1, inflammatory stimuli may not be sufficient to induce full maturation of LC, thus avoiding potentially harmful immune responses. We conclude that TGF-beta 1 appears to be responsible for both the acquisition of LC phenotype, cytokine production pattern, and prevention of noncognate maturation.


Coexistence of giant cell tumor of tendon sheath and enchondroma in the middle phalanx of the little finger mimicking a malignant tumor: A case report.
Giant cell tumor of the tendon sheath is a type of slow-growing benign soft tissue tumor that typically arises from the synovium of the tendon sheath. Enchondroma is a benign bone tumor comprising of mature hyaline cartilage that centrally develops within the tubular bone. While giant cell tumor of the tendon sheath or enchondroma are common benign soft tissue and bone tumors, respectively the simultaneous occurrence of these tumors in the same region of the hand is exceedingly rare, and it can mimic a malignant tumor, thereby making the diagnosis more challenging. Herein, we report an unusual imaging presentation of the coexistence of these tumors in the middle phalanx of the little finger, which to the best of our knowledge has not been previously reported, and this initially present as a single intrinsic osseous lesion mimicking malignancy. The coexistence of these tumor types must be considered in the differential diagnosis of an intramedullary lytic lesion with a poor margin associated with a soft tissue mass of the fingers, and a meticulous preoperative magnetic resonance imaging investigation was required.


Cellular origin(s) of chronic lymphocytic leukemia: cautionary notes and additional considerations and possibilities.
Several cell types have been suggested as giving rise to chronic lymphocytic leukemia (CLL), and these suggestions have reflected the sophistication of technology available at the time. Although there is no consensus as to the normal cellular counterpart(s) in the disease, an antigen-experienced B lymphocyte appears required based on surface membrane phenotypes and gene expression profiles. However, what is still unclear is whether a single or multiple normal precursors were stimulated to evolve into CLL and at what stage(s) this occurred. A unifying, parsimonious theory is that CLL clones with either mutated or unmutated IGHVs derive from marginal zone B cells. However, evidence for remarkably similar B-cell receptor amino acid sequence and striking differences in polyantigen and autoantigen-binding activity, found in some but not all CLL clones, challenge a single-cell derivation for CLL. In this Perspective, we summarize data regarding normal counterparts of CLL cells and suggest that a multistep process of leukemogenesis is important to consider when assigning a cellular origin for this disease. Finally, although available data do not definitively identify the cell(s) of origin, we offer possibilities for single- and multiple-cell origin models as straw men that can be improved on and hopefully lead to final answers to this puzzle.


CoS2@C catalyzes polysulfide conversion to promote the rate and cycling performances of lithium-sulfur batteries.
Lithium-sulfur (Li-S) batteries have been considered one of the most promising candidates for next-generation energy storage devices due to their high theoretical energy density and low cost. Nonetheless, the practical application of Li-S batteries is still inhibited by their lithium polysulfide (LiPS) shuttling and sluggish redox kinetics, which cause rapid capacity decay and inferior rate performance. Hence, anchoring LiPSs and catalyzing their conversion reactions are imperative to enhance the performance of Li-S batteries. In this work, one-dimensional (1D) porous carbon-encapsulated CoS2 (CoS2@C) fiber structures were prepared through a simple two-step hydrothermal reaction and they exhibited a robust LiPS trapping ability and rapid catalytic conversion of LiPSs. The formed three-dimensional (3D) architecture (CoS2@C/MWCNT) facilitates the physical adsorption of LiPSs and rapid ion transport. The electrode exhibited a high initial capacity of 1329.5 mA h g-1 at a current density of 0.1 C and a reversible capacity of 1060.6 mA h g-1 after 100 cycles, with an 80% capacity retention rate. Meanwhile, the decay rate of the electrode is 0.048% per cycle at 1 C and after 500 cycles. With a sulfur loading of 3 mg cm-2, the capacity retention rate is approximately 83.7% after 80 cycles.


Loss of capsaicin-induced meningeal neurogenic sensory vasodilatation in diabetic rats.
Neuropathic alterations of sensory nerves involved in the mediation of neurogenic inflammation of the meninges may contribute to the increased incidence of headaches in diabetics. In the rat, activation of capsaicin-sensitive nociceptors, which express the transient receptor potential vanilloid type 1 (TRPV1) receptor, induces meningeal vasodilatation, a significant component of neurogenic inflammation, through the release of calcitonin gene-related peptide (CGRP). This study examines the effects of streptozotocin-induced diabetes on TRPV1 receptor-mediated neurogenic sensory vasodilatation, CGRP release and nerve fiber density in the rat dura mater. In a cranial window preparation, epidural application of capsaicin (10(-7) M) produced distinct vasodilatory responses in control animals as measured by laser Doppler flowmetry. In diabetic rats, capsaicin-induced vasodilatation was reduced or even abolished 6, but not 2 or 4 weeks after diabetes induction. In contrast, vasoconstriction, a non-neurogenic response to capsaicin at a higher concentration (10(-5) M), was not altered in diabetic rats. The vasodilatory effects of histamine (10(-5) M), acetylcholine (10(-4) M) and CGRP (10(-5) M) were similar in control, diabetic and insulin-treated diabetic animals. In diabetic rats, a significant decrease in the capsaicin-evoked release of CGRP and reduction in the density of TRPV1-immunoreactive (IR) nerves were demonstrated. Treatment of the diabetic rats with insulin restored both the vasodilatory response and the capsaicin-induced CGRP release toward control values. In conclusion, this study revealed a marked impairment of meningeal TRPV1-IR nerves in streptozotocin diabetic rats by showing reduced neurogenic sensory vasodilatation, decreased capsaicin-evoked CGRP release and reduction in the number of TRPV1-IR nerve fibers of the dura mater. The findings suggest that capsaicin-sensitive afferents may play an important role in meningeal nociceptor function and their dysfunction, e.g. due to a limited removal of inflammatory mediators and/or tissue metabolites from the meningeal tissue, may contribute to the enhanced incidence of headaches in diabetics.


Pediatric clinical faculty structure and teaching hospital function.
An organization of clinical faculty has been formed at Rainbow Babies and Childrens Hospital, Cleveland, Ohio, to help coordinate the mutual goals but sometimes conflicting needs of practicing pediatricians and a teaching hospital. The organization has been active in developing and conducting educational experiences for students, house officers, and practitioners. It has contributed to efforts to improve ambulatory and inpatient care. Collaborative clinical research projects involving practitioners and academicians are planned. We know of no other existing similar organization. We propose that other institutions with similar needs consider this mechanism to help improve their academic and patient care programs.


[Experience in the management of acute superior mesenteric artery ischemia].
To study the management of acute superior mesenteric artery (SMA) ischemia and to improve its prognosis. The clinical data of 37 patients treated from January 1996 to August 2007 was retrospectively reviewed. Of the cases, 19 (51.4%) patients were diagnosed with acute SMA embolism, 15 (40.5%) with acute SMA thrombosis, 2 (5.4%) with spontaneous isolated dissection of SMA and 1 (2.7%) with SMA aneurysm. Nineteen (51.4%) patients were misdiagnosed in emergency. Eighteen (48.6%) patients died in the hospital, and most of them died of severe infection and multiple organ failure. Three cases of the survived 19 patients experienced severe complications (2 with short gut syndrome, 1 with cerebral hemorrhage). Nine cases were followed-up for a mean period of 15 months, and 5 died during that term. Acute SMA ischemia has multiple etiological factors. Early intervention can improve the prognosis.


[Mental fatigue - possible explanations, diagnostic methods and possible treatments].
Mental fatigue or brain fatigue is a pathological and disabling symptom with diminished mental energy. It can be a long-lasting consequence after trauma or disease affecting the brain. The person can do most things in the moment and can be perceived as completely healthy, but the mental energy is insufficient over time and affects the ability to work and participate in social activities. After a conversation, for example, the person can be completely drained of energy and the recovery time is disproportionally long. Here we describe the phenomenon of mental fatigue, provide an explanatory model for how the condition can arise, point out diagnostic methods and possible treatments, which are currently in the research stage but may be implemented in healthcare within the foreseeable future.


Nonossifying fibroma accompanied by pathological fracture in a 12-year-old runner.
Resident's case problem. Nonossifying fibroma (NOF) is the most common fibrous bone lesion in children. The lesion is usually asymptomatic, and rarely leads to pathological fractures. We present the case of a 12-year-old boy who appeared to be normally developed but had a pathological insufficiency fracture associated with NOF in the distal femur. He was a member of a track athletics club and ran more than 5 km every day. Seven weeks prior to the initial evaluation he felt discomfort in the left distal thigh when running and felt pain upon knee flexion. The amount of discomfort increased gradually and he began to experience pain while running 4 weeks prior to his initial evaluation. At the time of the initial evaluation, he had tenderness over the distal thigh region and there was increased pain with weight bearing. Plain radiographs showed an irregular, well-defined cortical bone lesion, suggesting NOF, with vague increased density in the bone marrow across the femur and periosteal new bone, suggesting a fracture. Computed tomography confirmed a linear fracture with increased density across the femur leading to the cortical lesion. In the process of differential diagnosis osteosarcoma, or Ewing sarcoma, and bone/joint infection were ruled out using magnetic resonance imaging. The final diagnosis based upon the images and clinical course was pathological insufficiency fracture associated with NOF. The patient was treated with initial avoidance of weight bearing using 2 crutches for ambulation, followed by progressive weight bearing over a period of 5 weeks. Active range of motion of the knee joint was allowed. Three months after onset (5 weeks after the initial evaluation), the patient had normal gait without pain, whereupon the patient resumed his sport activities, beginning with jogging. Although pathological fractures secondary to NOF in the femur are rare, NOF can cause pathological insufficiency fractures in athletes, even if the lesion is confined and small. The current case is a reminder of such a possibility. This case also provides a time course as a reference for the rehabilitation of patients in similar cases. Diagnosis, level 4.


Cholestasis induces murine hepatocyte apoptosis and DNA synthesis with preservation of the immediate-early gene response.
Major hepatic resection in patients with unrelieved obstructive jaundice carries an increased risk of postoperative liver failure. We hypothesized that cholestasis induces hepatocyte apoptosis and impairs hepatic regeneration by inhibiting up-regulation of the known immediate-early response genes, nuclear factor kappa B (NF-kappaB) and activating protein-1 (AP-1). The aim of this study was to determine whether the immediate-early gene response in hepatic regeneration remains intact in extrahepatic cholestasis. Eight-week-old BALB/c mice underwent either sham operation (SO) or common bile duct ligation (BDL). Two-thirds partial hepatectomy (PH) was performed at 4 and 7 days, with remnant liver harvested 0, 15, 30, or 60 minutes after PH. Serum analysis for markers of cholestasis and histopathology was obtained. Proliferating cell nuclear antigen and terminal deoxyuridine triphosphate nick end labeling (TUNEL) immunohistochemistry for detection of DNA synthesis and apoptosis, respectively, was performed 4, 7, or 10 days after SO or BDL. Liver samples from 0, 15, 30, or 60 minutes after PH were analyzed for NF-kappaB and AP-1 DNA binding activity by using electrophoretic mobility shift assays. Increased serum bilirubin level and hematoxylin-eosin-stained liver sections confirmed cholestasis in BDL mice. BDL induced marked DNA synthesis and hepatocyte apoptosis in prehepatectomy liver at both 4 and 7 days. Substantially higher basal levels of both NF-kappaB and AP-1 binding activity were present in BDL compared with SO mice. Fold induction of NF-kappaB and AP-1, however, was similar between BDL and SO mice. Cholestasis induced hepatocyte DNA synthesis and apoptosis. Basal NF-kappaB and AP-1 DNA binding activity was increased in BDL mice, but fold induction of these immediate-early genes did not differ from controls. Although basal NF-kappaB and AP-1 DNA binding is increased in cholestasis, the immediate-early gene response to PH remains intact in BDL mice.


Comparison of 18F-FDG-PET/CT and 18F-FDG-PET/MR imaging in oncology: a systematic review.
The aim of this study was to systematically review the literature to evaluate the clinical performance of integrated 18F-FDG PET/MR as compared with 18F-FDG PET/CT in oncologic imaging. The literature was searched using MEDLINE and EMBASE via OVID. Studies comparing the diagnostic accuracy of integrated 18F-FDG PET/MR and 18F-FDG PET/CT in the diagnosis, staging/restaging, assessment of treatment response, or evaluation of metastasis in patients with suspected or diagnosed cancers were deemed eligible for inclusion. Risk of bias and applicability concerns were assessed using the QUADAS-2 tool. Twenty studies met the inclusion criteria. The overall quality of the studies was rated favorably with bias or applicability concerns in a few studies. Our review suggests that 18F-FDG PET/MR performs comparably to 18F-FDG PET/CT in the detection of local lymph node and distant metastases and superiorly in determining the local extent of tumor. SUV obtained from 18F-FDG PET/MR correlated highly with those obtained from 18F-FDG PET/CT. Based on early evidence, 18F-FDG PET/MR is comparable to 18F-FDG PET/CT in the clinical scenarios examined in this review. The potential for interchangeability of 18F-FDG PET/MR with 18F-FDG PET/CT will vary by indication and the body site that is being imaged, with PET scanners integrated with MRI predicted to provide greater detail in the evaluation of local tumor extent, where 18F-FDG PET/CT can be limited.


The effectiveness of microencapsulated sodium butyrate at reducing symptoms in patients with irritable bowel syndrome.
The aim of the study was to assess the effectiveness of a patented preparation of sodium butyrate in the triglyceride matrix at reducing clinical symptoms and improving quality of life in patients with irritable bowel syndrome (IBS). In this prospective multicenter clinical trial, we observed a total of 3000 non-hospitalized patients with confirmed IBS who were treated with sodium butyrate in a triglyceride matrix at a dosage of 150 mg twice a day for 12 weeks. The primary outcome was to evaluate the efficacy of sodium butyrate at reducing the severity of clinical symptoms and improving quality of life in patients with IBS. A total of 2990 complete surveys were collected. A statistically significant improvement in severity of abdominal pain was noticed (p < 0.001). Moreover, flatulence, diarrhea, constipation, urgent pressure for bowel movements, nausea, and vomiting decreased significantly (p < 0.001). Most of the respondents (93.90%) declared that they would continue the therapy and 88.9% would recommend using sodium butyrate to other IBS patients. Sodium butyrate in the triglyceride matrix, as a postbiotic substance, may be effective in relieving the symptoms of IBS by modifying the intestinal microbiota.


An Unusual Complex Posterolateral Osteoligamentous Injury of the Knee in an Adolescent.
We present an unusual and complex case of a 16-year-old adolescent male who injured his right knee and sustained combined avulsion injuries of posterior cruciate ligament (PCL) at the tibial insertion site, iliotibial band at lateral tibial condyle, and lateral collateral ligament (LCL) at femoral insertion site akin to osteoligamentous posterolateral corner injury. Anatomical reduction of the femoral LCL avulsion fragment was performed and fixed with a two 4-mm partially threaded cancellous screw. Iliotibial band avulsion was buttressed using Ellis t-plate and fixed with two 4-mm partially threaded cancellous screws. PCL avulsion fracture was conservatively treated owing to minimal displacement. At one-year follow-up, the patient was pain free with a range of motion of 0 to 150 degrees of flexion and had a pain free knee with no instability. Posterolateral corner injury in the patient was very significant as it involved LCL avulsion and iliotibial band avulsion, both of which are part of the posterolateral structures of the knee and also involve the growth plate. Fixation of the avulsion of Gerdy's tubercle with the buttress plate helps to provide additional stability to counteract the deforming forces of the iliotibial band. LCL is also the major stabilizer against varus forces, and hence fixation is required for stability while preventing growth disturbance. PCL avulsion can be treated conservatively in those patients where the fragment is undisplaced or minimally displaced. A good outcome can be achieved in skeletally immature patients who have osteoligamentous posterolateral corner injuries with associated avulsion fractures by using appropriate anatomical reduction and surgical fixation.


Treatment of non-Hodgkin's lymphomas in elderly patients.
The roles of evolving treatment strategies for non-Hodgkin's lymphomas (NHL) in elderly patients are still not well defined and their effects on the overall epidemiology of the disease are still not clear. Three questions arise when discussing the management of NHL in elderly patients. First, should older patients be treated with the same regimens usually administered to younger patients? Second, are health outcomes of elderly patients similar to those usually observed in young patients, particularly response rate and overall survival? Third, which strategies should be adopted to improve overall health outcomes? Periodic review of the literature and updated data on the management of NHL in elderly patients may provide an answer to all these queries. In essence, older patients must be treated with the same intensive approaches that are usually reserved for younger patients. The results reported in randomized controlled clinical trials are consistent with the capability of older patients to exhibit overall response rate, event-free survival, and overall survival similar to those observed in their younger counterparts. Combining chemotherapy and monoclonal antibodies seems to be the main optional strategy for better outcomes in elderly patients. In contrast, knowledge concerning the management of indolent lymphomas in elderly patients is still lacking, and available clinical data are limited in this setting, especially in patients with poor prognostic factors who may need an immediate therapeutic intervention.


Green synthesis and characterization of silver nanoparticles using Artemisia absinthium aqueous extract--A comprehensive study.
Unlike chemical synthesis, biological synthesis of nanoparticles is gaining tremendous interest, and plant extracts are preferred over other biological sources due to their ample availability and wide array of reducing metabolites. In this project, we investigated the reducing potential of aqueous extract of Artemisia absinthium L. for synthesizing silver nanoparticles (AgNPs). Optimal synthesis of AgNPs with desirable physical and biological properties was investigated using ultra violet-visible spectroscopy (UV-vis), dynamic light scattering (DLS), transmission electron microscopy (TEM) and energy-dispersive X-ray analysis (EDX). To determine their appropriate concentrations for AgNP synthesis, two-fold dilutions of silver nitrate (20 to 0.62 mM) and aqueous plant extract (100 to 0.79 mg ml(-1)) were reacted. The results showed that silver nitrate (2mM) and plant extract (10 mg ml(-1)) mixed in different ratios significantly affected size, stability and yield of AgNPs. Extract to AgNO3 ratio of 6:4v/v resulted in the highest conversion efficiency of AgNO3 to AgNPs, with the particles in average size range of less than 100 nm. Furthermore, the direct imaging of synthesized AgNPs by TEM revealed polydispersed particles in the size range of 5 to 20 nm. Similarly, nanoparticles with the characteristic peak of silver were observed with EDX. This study presents a comprehensive investigation of the differential behavior of plant extract and AgNO3 to synthesize biologically stable AgNPs.


Reduced interferon-gamma secretion in neonates and subsequent atopy.
Low interferon-gamma (IFN-gamma) secretion has been found in individuals with active atopic disease. Whether this is a cause or result of the disease process is uncertain. Cord blood IFN-gamma secretion was examined in 35 neonates who were then prospectively followed up for 1 year for the development of atopic disease. Infants who developed either symptoms of atopic disease or a positive IgE-mediated skin prick test at 12 months of age produced significantly less IFN-gamma at birth compared with those who did not (p = 0.005). This reduced secretion of IFN-gamma at birth indicates that the defect in interferon secretion is a primary component of the atopic state rather than an effect of the disease process.


Coherent Vibrational Dynamics of Au144(SC8H9)60 Nanoclusters.
The coherent vibrational dynamics of Au144(SC8H9)60, obtained from femtosecond time-resolved transient absorption spectroscopy, are described. Two acoustic modes were identified and assigned, including 2.0 THz breathing and 0.7 THz quadrupolar vibrations. These assignments are consistent with predictions using classical mechanics models, indicating that bulk models accurately describe the vibrational properties of Au144(SC8H9)60. Coherent phonon signals were persistent for up to 3 ps, indicating energy dissipation by the nanocluster was the primary dephasing channel. The initial excitation phases of the breathing and quadrupolar modes were π-phase-shifted, reflecting differences in the displacive nuclear motion of the vibrations. The combined agreement of the vibrational frequencies, relative phases, and decoherence times supported predictions based on classical models. The vibrational frequencies were insensitive to silver substitution for gold but did show increased inhomogeneous damping of the coherent phonons. The ability to predict the vibrational properties of metal nanoclusters can have an impact on nanoresonator and mass sensing technologies.


[Simultaneous determination of five flavonoid compounds in leaves of Adinandra nitida by HPLC-PAD].
To established a novel HPLC-PAD method for the simultaneous determination of five compounds (camellianin A, camellianin B, apigenin, quercitrin, epicatechin) in leaves of Adinandra nitida. These compounds were effectively separated on a reversed-phase C18 column (4.6 mm x 250 mm, 10 microm) with the column temperature at 25 degrees C. The mobile phase was composed of 0.1% aqueous formic acid and methanol. The flow rate was 1.0 mL x min(-1), the detection wavelength was set at 280 nm before 15 min for detecting epicatechin and at 262 nm from 15 to 40 min for detecting the rest four compounds. All the linearities were good (r > 0.9991) within their test ranges. The established method showed good precision with overall intra-day and interday RSD values less than 3.33% and 3.2%, respectively. The average recoveries were in the range of 96.08% to 100.30% with RSD from 2.0% to 4.0%. The limits of detection (LOD) and quantification (LOQ) in the range of ranged from 0.9 to 5.6 ng and 3.0 to 19.0 ng, respectively. This established method can be applied to evaluate the intrinsic quality of the leaves of A. nitida.


Recent Advances in Anodes for Microbial Fuel Cells: An Overview.
The recycling and treatment of wastewater using microbial fuel cells (MFCs) has been attracting significant attention as a way to control energy crises and water pollution simultaneously. Despite all efforts, MFCs are unable to produce high energy or efficiently treat pollutants due to several issues, one being the anode's material. The anode is one of the most important parts of an MFC. Recently, different types of anode materials have been developed to improve the removal rate of pollutants and the efficiency of energy production. In MFCs, carbon-based materials have been employed as the most commonly preferred anode material. An extensive range of potentials are presently available for use in the fabrication of anode materials and can considerably minimize the current challenges, such as the need for high quality materials and their costs. The fabrication of an anode using biomass waste is an ideal approach to address the present issues and increase the working efficiency of MFCs. Furthermore, the current challenges and future perspectives of anode materials are briefly discussed.


Risk Factors for Postoperative Morbidity After Totally Robotic Gastric Bypass in 302 Consecutive Patients.
Totally robotic gastric bypass (robotic Roux-en-Y gastric bypass, R-RYGBP) has been adopted in some centers on the basis of large retrospective studies. In view of some data showing higher morbidity and higher costs, some authors have considered that robotic gastric bypass may no longer be justified with the existing system. Although low postoperative complication rates after R-RYGBP have been reported, risk factors for postoperative morbidity have never been evaluated. The goal of this study was to identify risk factors for postoperative morbidity after R-RYGBP. A retrospective analysis of a prospectively maintained database was performed and included 302 consecutive patients after R-RYGBP performed between 2007 and 2013. This subset of patients represented 34 % of all gastric bypass procedures performed during this study period. Univariate and multivariate analyses were performed in order to identify risk factors for postoperative overall morbidity (Clavien scores 1-4 versus 0) and major morbidity (Clavien score ≥3 versus 0-1-2). Postoperative morbidity and mortality rates were 24.4 and 0.6 %, respectively. In multivariate analysis, independent risk factors for overall morbidity were American Society of Anesthesiologists (ASA) score ≥3 (odds ratio (OR) 2.0) and previous bariatric surgery (revisional gastric bypass) (OR 2.0). Independent risk factors for major morbidity (Clavien ≥3) were previous bariatric surgery (revisional gastric bypass) (OR 3.7), low preoperative hematocrit level (OR 0.9), and revisional gastric bypass procedure with concomitant gastric banding removal (OR 5.7). R-RYGBP is prone to increased complications in the setting of a high preoperative ASA score and revisional surgery. This should be taken into consideration by clinicians when evaluating R-RYGBP.


FGD3 Gene as a New Prognostic Factor in Breast Cancer.
Despite the establishment of the traditional prognostic factors for breast cancer, patients belonging to the same histological and molecular subgroup often present quite different outcomes. Recently, the introduction of gene expression profiling, assessed by RT-qPCR and microarray DNA analysis, offered a view of the whole cell gene activity and the ability to identify new transcripts that are associated with outcome. This review aimed to gather all recent trials about new breast cancer prognostic factors, focusing on the most promising one, the FGD3 gene, and to discuss the real feasibility of a molecular approach in everyday clinical practice. In conclusion, all literature concerning this subject indicated that expression of the FGD3 gene is a strong marker of good prognosis in breast cancer patients and that immunohistochemistry represents an efficient, inexpensive, reproducible evaluation method, affordable also by small Institutions.


Suppression of vaccine responses by malaria: insignificant or overlooked?
Malaria is widely reported to suppress immune responses to heterologous antigens, including vaccines, but the evidence base for this assumption is patchy and confusing. Here we review the evidence for malaria-mediated suppression of responses to vaccination and conclude that: there is evidence of impairment of responses to heterologous polysaccharide antigens in children with clinical malaria or asymptomatic parasitemia; there is little evidence of impairment of responses to routine, protein-based childhood vaccine regimens; and the underlying mechanisms of impaired responsiveness, and especially of impaired responses to T-independent polysaccharide antigens, remain unclear. We suggest that, with the possible exception of vaccines against encapsulated bacteria, the benefits of postponing vaccination until a malaria infection has cleared are probably outweighed by the risk of missing opportunities to vaccinate hard-to-reach populations.


American cutaneous leishmaniasis in infancy and childhood.
Infant and young child skin diseases are among the most common features of morbidity throughout the tropics. Because the skin is directly exposed to the environment, it is considerably affected by climatic and local conditions such as vectors and microorganisms, as in the case of leishmaniasis. In America the observed magnitude of cutaneous leishmaniasis in children has led to the study of increased risk of exposure of this group due to the possibility of peri- and intradomiciliary transmission. The present review pretends to make a concrete approach all through the broad and main figures of this parasitic disease, including the clinical, physiopathological, epidemiological, diagnostic, and therapeutic aspects, in order to be used as a practical source of reference for pediatricians leading with tropical cutaneous pathology in the region.


[The prospects for the study of mosquito irritability to insecticides].
Mosquito irritability to insecticides was intensively studied abroad in the 40-ies and 60-ies. At present such studies are carried out mainly in the E. I. Martsynovskiĭ Institute of Medical Parasitology and Tropical Medicine. The article sums up the history of such studies and reviews the main results. A hypothesis of the mechanism of mosquito irritability to insecticides is outlined. It is emphasized that besides traditional monitoring in the population of carriers it is necessary to study thoroughly the physiology and genetics of irritability.


[Methodological evaluation of an enzyme-immunoassay for plasma Big-et-1 determination].
The evaluation of big-endothelin (ET)-1 plasmatic concentrations may serve as another noninvasive marker in patients with cardiovascular diseases, based on the assumption that it may reflect endothelin overproduction more accurately than circulating ET-1. For this reason the analytical performance of an immunoenzimatic assay for plasma Big-ET-1, with or without a preliminary step of extraction, was evaluated. Sensitivity for direct assay was 0.15+/-0.010 fmol/ml (n=27), inter-assay variability, evaluated at 2 different concentrations, resulted 2.5+/-0.062, CV%=5.6 (n=5) and 1.47+/-0.09 fmol/ml, CV%=12.8 (n=4), respectively, while intra-assay variability was 0.89+/-0.022 fmol/ml, CV%=5.6. Sensitivity for the assay with extraction resulted 0.71+/-0.104 (n=6) fmol/ml and intra-assay variability was 3.6+/-0.13 fmol/ml, CV=7.4% (n=4). The comparison between the 2 procedures, performed on 107 plasma samples at different peptide concentrations, showed a close agreement between the results of the 2 procedures for Big-ET-1 values higher than 1 fmol/ml. The main limitation of the direct assay is due to possible interference effects while the correct evaluation of extraction yield of the individual samples is the main drawback of the procedure with extraction. These effects become important when assaying samples with low levels of analyte. The direct assay of plasma Big-ET-1, easier to perform, more rapid and less expensive, could be the choice method.


Analysis of the spatial distribution of amyotrophic lateral sclerosis in Virginia.
Objective: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder that is usually fatal. Environmental exposures have been posited in the etiology of ALS, but few studies have modeled the spatial risk of ALS over large geographic areas. In this paper, our goal was to analyze the spatial distribution of ALS in Virginia and identify any areas with significantly elevated risk using Virginia ALS Association administrative data. Methods: We used Bayesian hierarchical spatial regression models to estimate the relative risk for ALS in Virginia census tracts, adjusting for several covariates posited to be associated with the disease. We used an intrinsic conditional autoregressive prior to allow for spatial correlation in the risk estimates and stabilize estimates over space. Results: Considerable variation in ALS risk existed across Virginia, with greater relative risk found in the central and western parts of the state. We identified significantly elevated relative risk in a number of census tracts. In particular, Henrico, Albemarle, and Botetourt counties all contained at least four census tracts with significantly elevated risk. Conclusions: We identified several areas with significantly elevated ALS risk across Virginia census tracts. These results can inform future studies of potential environmental triggers for the disease, whose etiology is still being understood.


Meal Frequency and Timing Are Associated with Changes in Body Mass Index in Adventist Health Study 2.
Background: Scientific evidence for the optimal number, timing, and size of meals is lacking.Objective: We investigated the relation between meal frequency and timing and changes in body mass index (BMI) in the Adventist Health Study 2 (AHS-2), a relatively healthy North American cohort.Methods: The analysis used data from 50,660 adult members aged ≥30 y of Seventh-day Adventist churches in the United States and Canada (mean ± SD follow-up: 7.42 ± 1.23 y). The number of meals per day, length of overnight fast, consumption of breakfast, and timing of the largest meal were exposure variables. The primary outcome was change in BMI per year. Linear regression analyses (stratified on baseline BMI) were adjusted for important demographic and lifestyle factors.Results: Subjects who ate 1 or 2 meals/d had a reduction in BMI per year (in kg · m-2 · y-1) (-0.035; 95% CI: -0.065, -0.004 and -0.029; 95% CI: -0.041, -0.017, respectively) compared with those who ate 3 meals/d. On the other hand, eating >3 meals/d (snacking) was associated with a relative increase in BMI (P < 0.001). Correspondingly, the BMI of subjects who had a long overnight fast (≥18 h) decreased compared with those who had a medium overnight fast (12-17 h) (P < 0.001). Breakfast eaters (-0.029; 95% CI: -0.047, -0.012; P < 0.001) experienced a decreased BMI compared with breakfast skippers. Relative to subjects who ate their largest meal at dinner, those who consumed breakfast as the largest meal experienced a significant decrease in BMI (-0.038; 95% CI: -0.048, -0.028), and those who consumed a big lunch experienced a smaller but still significant decrease in BMI than did those who ate their largest meal at dinner.Conclusions: Our results suggest that in relatively healthy adults, eating less frequently, no snacking, consuming breakfast, and eating the largest meal in the morning may be effective methods for preventing long-term weight gain. Eating breakfast and lunch 5-6 h apart and making the overnight fast last 18-19 h may be a useful practical strategy.


Comorbidity in multiple sclerosis: implications for patient care.
Most efforts aimed at understanding the notable heterogeneity of outcomes in multiple sclerosis (MS) have focused on disease-specific factors, such as symptoms at initial presentation, initial relapse rate, and age at symptom onset. These factors, however, explain relatively little of the heterogeneity of disease outcomes. Owing to the high prevalence of comorbidity in MS and the potential for its prevention or treatment, comorbidity is of rising interest as a factor that could explain the heterogeneity of outcomes. A rapidly growing body of evidence suggests that comorbidity adversely affects outcomes throughout the disease course in MS, including diagnostic delays from symptom onset, disability at diagnosis and subsequent progression, cognition, mortality, and health-related quality of life. Therefore, clinicians need to incorporate the prevention and management of comorbidity when treating patients with MS, but managing comorbidities in MS successfully may require the adoption of new collaborative models of care.


Association of Comorbid Conditions with Six-month Survival and Disease Outcome in Patients of Necroinflammatory Otitis Externa.
To determine association of gender, causative organisms, control of diabetes, facial paralysis, infectious agent, and hearing loss with disease outcome, in terms of six-month improvement of symptoms, static condition or expiry of patients presenting with necroinflammatory otitis externa (NOE). Descriptive study. ENT Department in collaboration with Pathology Department, KEMU/Mayo Hospital, Lahore from 2016 to 2019. Methodology: Patients with NOE were inducted. Studied variables included age at presentation, gender, diabetes, glycated hemoglobin (HbA1c) levels, comorbid conditions, facial nerve involvement, hearing loss, CT and biopsy findings, and causative organisms; and their association with outcome was observed with significance at p<0.05. Out of 28 patients, there were 17 males (60.7%) and 11 females (39.3%). Association between gender and survival showed that 41.2% (7) males and 27.3% (3) females survived; and 23.5% (4) males and 1 (9.1%) female expired within six months of diagnosis. Thinning of temporal bone (2/5=40%) was common among the expired patients. Twenty percent (1/5) patients diagnosed with squamous cell carcinoma and 80% (4/5)with granulation tissue (GT) expired (p=0.543) All ten patients (100%) that improved had mild to moderate hearing loss (p <0.001). Among expired group, 80% (4/5) had HBA1c of more than 7 and 20% (1/5) had good control of diabetes. Aspergillus (2/5=40%) and Pseudomonas (1/5=20%) were the commonest among expired patients; Staphylococcus (6/10=60%) and Pseudomonas (3/10=30%) infections were more frequent among the survived (p=0.005). Previously pseudomonal infection was described as the only causative agent of NOE. This study showed a rising community-acquired disease with Staphylococcus aureus 6/10 (60%) and Pseudomonas 3/10 (30%) infection. Fungal infection is associated with poor survival and death, thus requiring aggressive management. Thinning of temporal bone on CT, uncontrolled diabetes, sever hearing loss and facial paralysis score V/VI were associated with poor outcome of disease. Key Words: Necroinflammatory otitis externa, Pseudomonas aeruginosa. Diabetes, Hearing loss, Facial paralysis, Temporal bone thinning, CT scan.


Object color affects identification and repetition priming.
We investigated the influence of color on the identification of both non-studied and studied objects. Participants studied black and white and color photos of common objects and memory was assessed with an identification test. Consistent with our meta-analysis of prior research, we found that objects were easier to identify from color than from black and white photos. We also found substantial priming in all conditions, and study-to-test changes in an object's color reduced the magnitude of priming. Color-specific priming effects were large for color-complex objects, but minimal for color-simple objects. The pattern and magnitude of priming effects was not influenced either by the extent to which an object always appears in the same color (i.e., whether a color is symptomatic of an object) or by the object's origin (natural versus fabricated). We discuss the implications of our findings for theoretical accounts of object perception and repetition priming.


Fast scale-invariant lateral lumbar vertebrae detection and segmentation in X-ray images.
Fully automatic localization of lumbar vertebrae from clinical X-ray images is very challenging due to the variation of X-ray quality, scale, contrast, number of visible vertebrae, etc. To overcome these challenges, we present a novel framework, where we accelerate a scale-invariant object detection method using Support Vector Machines (SVM) trained on Histogram of Oriented Gradients (HOG) features and segmenting a fine vertebra contour using Gradient Vector Flow (GVF) based snake model. Support Vector Machines trained on HOG features are now an object detection standard in many perception fields and have demonstrated good performance on medical images as well. However, the computational complexity and lack of robustness brought by rescaling the original images have prevented its applicability. The proposed multistage detection framework uses lower-level detection result to determine the rescaling regions to reduce the region of interest, thereby decreasing the execution time. We further refine the detection result by segmenting the contour of vertebra using GVF snake, where we use edge detection techniques to increase the robustness of the GVF snake. Finally, we experimentally demonstrate the effectiveness of this framework using a large set of clinical X-ray images.


Special care dentistry: how prepared are we?
To assess and evaluate the confidence of the undergraduate dental team in Irish dental schools regarding their training in the field of special care dentistry (SCD). A questionnaire was distributed amongst the undergraduate dental teams within Cork University Dental School and Hospital (CUDSH) and Dublin Dental University Hospital (DDUH). The data were analysed to assess for differences between the median responses of the various groups. A total of 139 students participated in the study; 82 from DDUH (59 dental science students, seven dental hygiene students and 16 dental nursing students) and 57 from CUDSH (43 dental science students and 14 dental hygiene students). Twenty-two per cent (n = 30) of respondents agreed that their training had been sufficient in providing treatment or assistance for patients requiring SCD. Seventy-five per cent agreed that more emphasis should be placed on clinical training in SCD (n = 76). Thirty-one per cent of students anticipated a high level of confidence in treating patients requiring SCD upon graduation (n = 43), with dental science students feeling the least prepared amongst the dental team. Confidence levels of the undergraduate dental team were low with regard to SCD. The existing hands-on clinical training in SCD was deemed insufficient by the respondents. Students believed more emphasis should be placed on SCD training in the undergraduate curriculum.


Association between self-rated health and incident severe hypertension among men: a population-based cohort study.
Self-rated health (SRH) is a consistent predictor of cardiovascular disease and mortality. However, the intermediate biological mechanisms behind this association are not clear. We examined the longitudinal relationship between SRH and incident severe hypertension. We studied a population-based cohort of 1,298 participants (mean age 62.5 years, range 49-84 years), at the baseline examination (1992-1994) residing in the Blue Mountains region, west of Sydney, Australia, and re-examined after five years (1997-1999). Main outcome-of-interest was incident severe hypertension (systolic blood pressure [BP] 160 mmHg or above, diastolic BP 100 mmHg or above, or a combination of self-reported hypertension diagnosis and use of antihypertensive medications) among baseline individuals without severe hypertension. Among men, those with fair/poor SRH had significantly higher odds of incident severe hypertension, compared to individuals with excellent SRH. Multivariable odds-ratio (OR) (95 percent confidence intervals [CI]) comparing fair/poor SRH to excellent SRH was 1.93 (1.04-3.56) (p-trend was 0.03). This association was not observed in women comparing fair/poor SRH to excellent SRH: OR 0.96, 95 percent CI 0.57-1.62 (p-trend was 0.70). Subgroup analyses stratified by age, smoking, body mass index, diabetes mellitus and BP categories, supported this male gender-specific pattern of association. This data suggests an association between poor SRH and incident hypertension among men, but not among women. These results suggest that at least part of the previously-reported association between poor SRH and mortality may be mediated by its relation to incident severe hypertension.


Domain catalyzed chemical reactions: a molecular dynamics simulation of isomerization kinetics.
The model for domain catalyzed isomerization kinetics in condensed fluids is applied for a diluted mixture of a chiral solute with a consolute temperature. The solution is quench to phase separation at temperatures below the consolute temperature. The droplet coalescence enhances the isomerization kinetics due to the substantial excess pressure inside the small droplets given by the Laplace equation. The domain catalyzed isomerization kinetics breaks the symmetry, and the droplets end with only one dominating species. We argue that D-glyceraldehyde which is only moderately solvable in water and which has played a crucial role in the evolution is a candidate for the stereo specific ordering in bio-organic matter.


Dephasing and diffusion on the alveolar surface.
We propose a surface model of spin dephasing in lung tissue that includes both susceptibility and diffusion effects to provide a closed-form solution of the Bloch-Torrey equation on the alveolar surface. The nonlocal susceptibility effects of the model are validated against numerical simulations of spin dephasing in a realistic lung tissue geometry acquired from synchotron-based μCT data sets of mouse lung tissue, and against simulations in the well-known Wigner-Seitz model geometry. The free induction decay is obtained in dependence on microscopic tissue parameters and agrees very well with in vivo lung measurements at 1.5 Tesla to allow a quantification of the local mean alveolar radius. Our results are therefore potentially relevant for the clinical diagnosis and therapy of pulmonary diseases.


Improvement of Pain and Function After Use of a Topical Pain Relieving Patch: Results of the RELIEF Study.
Pain is the most common reason for patients to consult primary care providers. Identification of effective treatments with minimal adverse events is critical to safer opioid-sparing and multi-modal approaches to pain treatment. Topical analgesic patches target medication to peripheral sites of pain while potentially avoiding adverse effects associated with systemic medications. Opioids, prescription nonsteroidal anti-inflammatory drugs, and over-the-counter oral medications are associated with systemic toxicities, increasing morbidity and mortality. This study evaluated a topical analgesic pain-relieving patch in reducing pain severity and improving function in patients with mild to moderate arthritic, neurological, or musculoskeletal pain. This Institutional Review Board-approved study evaluated the effectiveness of a topical pain-relieving patch in reducing Brief Pain Inventory (BPI) scores in patients. The treatment group (TG) (n=152) received patches for 14 days. A control group (CG) (n=47) did not receive the patch. After day 14, 34 CG patients crossed over to treatment (CROSSG) with the patch. Surveys were administered to patients at baseline and 14 days to assess changes in pain severity and interference. Changes in oral pain medication use, side effects, and satisfaction use were also assessed. Paired data were collected in the CG, TG and CROSSG. At day 14, TG pain severity score and pain interference score decreased (49% and 58.1%, respectively). Pain severity and interference scores decreased less in the CG (12.3% and 14.8%, respectively). In the study, 60.5% of the TG were using concomitant oral pain medications "a lot less", and 90.8% were very/extremely satisfied with the patch. CROSSG patients showed similar reductions in pain severity and interference scores after patch treatment. No side effects of treatment were reported. Results indicate that this topical analgesic pain-relieving patch can reduce BPI pain severity and interference scores in adult patients with mild to moderate arthritic, neurological, and musculoskeletal pain and should be considered as a treatment option.


Neurogenin3 activation is not sufficient to direct duct-to-beta cell transdifferentiation in the adult pancreas.
It remains controversial whether adult pancreatic ducts harbor facultative beta cell progenitors. Because neurogenin3 (Ngn3) is a key determinant of pancreatic endocrine cell neogenesis during embryogenesis, many studies have also relied upon Ngn3 expression as evidence of beta cell neogenesis in adults. Recently, however, Ngn3 as a marker of adult beta cell neogenesis has been called into question by reports of Ngn3 expression in fully-developed beta cells. Nevertheless, direct evidence as to whether Ngn3 activation in adult pancreatic duct cells may lead to duct-to-beta cell transdifferentiation is lacking. Here we studied two models of Ngn3 activation in adult pancreatic duct cells (low-dose alloxan treatment and pancreatic duct ligation) and lineage-traced Ngn3-activated duct cells by labeling them through intraductal infusion with a cell-tagging dye, CFDA-SE No dye-labeled beta cells were found during the follow-up in either model, suggesting that activation of Ngn3 in duct cells is not sufficient to direct their transdifferentiation into beta cells. Therefore, Ngn3 activation in duct cells is not a signature for adult beta cell neogenesis.


Interaction between microbiome and host genetics in psoriatic arthritis.
Psoriatic arthritis (PsA) is a chronic inflammatory joint disease, seen in combination with psoriasis. Both genetic and environmental factors are responsible for the development of PsA, however little is known about the different weight of these two distinctive components in the pathogenesis of the disease. Genomic variability in PsA is associated with the disease and/or some peculiar clinical phenotypes. Candidate genes involved are crucial in inflammation, immune system, and epithelial permeability. Moreover, the genesis and regulation of inflammation are influenced by the composition of the human intestinal microbiome that is able to modulate both mucosal and systemic immune system. It is possible that pro-inflammatory responses initiated in gut mucosa could contribute to the induction and progression of autoimmune conditions. Given such premises, the aim of this review is to summarize immune-mediated response and specific bacterial changes in the composition of fecal microbiota in PsA patients and to analyze the relationships between bacterial changes, immune system, and host genetic background.


Mode of Action Analyses of Neferine, a Bisbenzylisoquinoline Alkaloid of Lotus (Nelumbo nucifera) against Multidrug-Resistant Tumor Cells.
Neferine, a bisbenzylisoquinoline alkaloid isolated from the green seed embryos of Lotus (Nelumbo nucifera Gaertn), has been previously shown to have various anti-cancer effects. In the present study, we evaluated the effect of neferine in terms of P-glycoprotein (P-gp) inhibition via in vitro cytotoxicity assays, R123 uptake assays in drug-resistant cancer cells, in silico molecular docking analysis on human P-gp and in silico absorption, distribution, metabolism, and excretion (ADME), quantitative structure activity relationships (QSAR) and toxicity analyses. Lipinski rule of five were mainly considered for the ADME evaluation and the preset descriptors including number of hydrogen bond donor, acceptor, hERG IC50, logp, logD were considered for the QSAR analyses. Neferine revealed higher toxicity toward paclitaxel- and doxorubicin-resistant breast, lung or colon cancer cells, implying collateral sensitivity of these cells toward neferine. Increased R123 uptake was observed in a comparable manner to the control P-gp inhibitor, verapamil. Molecular docking analyses revealed that neferine still interacts with P-gp, even if R123 was pre-bound. Bioinformatical ADME and toxicity analyses revealed that neferine possesses the druggability parameters with no predicted toxicity. In conclusion, neferine may allocate the P-gp drug-binding pocket and prevent R123 binding in agreement with P-gp inhibition experiments, where neferine increased R123 uptake.


Ureteric bupivicaine infusion for loin pain haematuria syndrome.
Loin pain haematuria syndrome is a common problem with complications including opiate dependence. Morbidity treatments include intra-ureteric capsaicin infusion, nephrectomy, autotransplantation and nephrolysis. We explored the use of flexible cystoscopic infusion of intra-ureteric bupivicaine. Patients presenting with chronic loin pain underwent urological and nephrological evaluation. Bupivicaine (0.5%, 20 ml) was infused via an intra-ureteric catheter under flexible cystoscopic guidance. Repeat infusions were offered if indicated. Sixteen of 17 patients with 1-year follow-up responded and were satisfied. Twelve of these required repeat infusions (mean, 2.9 infusions). The procedures were well tolerated by all patients without adverse effects. Intra-ureteric bupivicaine infusion has a place in the management of patients with chronic renal pain. It offers a minimally invasive alternative to other treatments. This procedure warrants further investigation within a randomised, controlled trial setting.


Role of the AP-5 adaptor protein complex in late endosome-to-Golgi retrieval.
The AP-5 adaptor protein complex is presumed to function in membrane traffic, but so far nothing is known about its pathway or its cargo. We have used CRISPR-Cas9 to knock out the AP-5 ζ subunit gene, AP5Z1, in HeLa cells, and then analysed the phenotype by subcellular fractionation profiling and quantitative mass spectrometry. The retromer complex had an altered steady-state distribution in the knockout cells, and several Golgi proteins, including GOLIM4 and GOLM1, were depleted from vesicle-enriched fractions. Immunolocalisation showed that loss of AP-5 led to impaired retrieval of the cation-independent mannose 6-phosphate receptor (CIMPR), GOLIM4, and GOLM1 from endosomes back to the Golgi region. Knocking down the retromer complex exacerbated this phenotype. Both the CIMPR and sortilin interacted with the AP-5-associated protein SPG15 in pull-down assays, and we propose that sortilin may act as a link between Golgi proteins and the AP-5/SPG11/SPG15 complex. Together, our findings suggest that AP-5 functions in a novel sorting step out of late endosomes, acting as a backup pathway for retromer. This provides a mechanistic explanation for why mutations in AP-5/SPG11/SPG15 cause cells to accumulate aberrant endolysosomes, and highlights the role of endosome/lysosome dysfunction in the pathology of hereditary spastic paraplegia and other neurodegenerative disorders.


Link-Information Augmented Twin Autoencoders for Network Denoising.
Removing noisy links from an observed network is a task commonly required for preprocessing real-world network data. However, containing both noisy and clean links, the observed network cannot be treated as a trustworthy information source for supervised learning. Therefore, it is necessary but also technically challenging to detect noisy links in the context of data contamination. To address this issue, in the present article, a two-phased computational model is proposed, called link-information augmented twin autoencoders, which is able to deal with: 1) link information augmentation; 2) link-level contrastive denoising; 3) link information correction. Extensive experiments on six real-world networks verify that the proposed model outperforms other comparable methods in removing noisy links from the observed network so as to recover the real network from the corrupted one very accurately. Extended analyses also provide interpretable evidence to support the superiority of the proposed model for the task of network denoising.


Does Patient Sex Affect the Rate of Mortality and Complications After Spine Surgery? A Systematic Review.
Available studies disagree regarding the influence of patient sex on mortality and complications after spine surgery. We sought to conduct a systematic review and pool the results of existing research to better understand this issue. We performed a systematic review to address two questions: (1) Does sex (male versus female) influence mortality after spine surgery? (2) Does sex impact the development of postoperative complications after spine surgery? This systematic review was performed through a query of PubMed using a structured search algorithm. Additional queries of Embase, SCOPUS, Web of Science, and the tables of contents of orthopaedic and neurosurgical journals were also conducted using search terms such as "sex factors", "male or female", "risk factors", and "spine surgery". Selected papers were independently abstracted by three of the authors (AJS, ENR, EIW) and pooling was performed. Our literature search returned 720 studies, of which 99 underwent full review. Of these, 50 were selected for final abstraction. The Cochrane Q test was used to assess study heterogeneity; significant study heterogeneity was present and so a random-effects model was used. A Harbord test was used to evaluate for the presence of publication bias; this analysis found no statistically significant evidence of publication bias. Males were at increased odds of mortality after spine surgery (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.35-1.97; p<0.001). No differences between the sexes were identified for the odds of complications (OR, 1.04; 95% CI, 0.95-1.13; p=0.42). Our results determined that males were at elevated odds of mortality but not of complications after spine surgery. These results should be used to inform preoperative discussion and decision-making at the time of surgical consent. Future work should be directed at determining the underlying factors responsible for increased mortality among males and prospective studies specifically designed to evaluate sex-based differences in outcomes after spine surgery. Level III, therapeutic study.


Correlation of middle meatus and ethmoid sinus microbiology in patients with chronic sinusitis.
Empirical antibiotics constitute the cornerstone of medical therapy for chronic sinusitis due to difficulties of obtaining cultures from the paranasal sinuses. Indirect isolation of the pathogenic microorganisms outside the paranasal sinuses with a non-invasive method may enable administration of specific antibiotics. In this prospective study, we obtained cultures from the middle meatus and ethmoid sinuses of 193 sides from 127 patients who had undergone FESS for chronic sinusitis with a method that minimizes the risk of nasal contamination. The same bacterial species were isolated from both the ethmoid sinus and middle meatus in 59.3% of the cultures. There was no bacterial growth in either site in 32.3% of the cultures. The overall correlation rate of middle meatus and ethmoid sinus cultures was estimated to be 91.6%. In conclusion, middle meatal cultures can be used for the isolation of pathogenic microorganisms indirectly, while administration of specific antibiotics can be possible according to the results of these cultures.


THE RELATIVE CONTRIBUTIONS OF TIME AND EGGS TO THE COST OF REPRODUCTION.
Whether the trade-off between current and future reproduction in insect parasitoids is mediated by the costs of time or eggs remains an issue of contention. Life-history models predict that parasitoids have some risk of exhausting their lifetime supply of oocytes. I develop a simple conceptual model that assesses the relative contributions of time and eggs to the cost of reproduction by placing them in a common currency: foregone future fitness returns. Although rates of egg limitation observed in nature are modest, eggs still often make the dominant contribution to the overall cost of oviposition. Therefore, models of parasitoid reproduction must recognize the costliness of both time and eggs.


Regulation of glutamine synthetase. VI. Interactions of inhibitors for Bacillus licheniformis glutamine synthetase.
The relationships of five feedback inhibitors for the Bacillus licheniformis glutamine synthetase were investigated. The inhibitors were distinguishable by differences in their competitive relationship for the substrates of the enzyme. Mixtures of l-glutamine and adenosine-5'-monophosphate (AMP) or histidine and AMP caused synergistic inhibition of glutamine synthesis. Histidine, alanine, and glycine acted antagonistically toward the l-glutamine inhibition. Alanine acted antagonistically toward the glycine and histidine inhibitions. Independence of inhibitory action was observed with the other pairs of effectors. Possible mechanisms by which the inhibitors may interact to control glutamine synthesis are discussed. The low rate of catalysis of the glutamyl transfer reaction by the B. licheniformis glutamine synthetase can be attributed to the fact that l-glutamine serves both as a substrate and an inhibitor for the enzyme. Effectors which act antagonistically toward the l-glutamine inhibition stimulated glutamotransferase activity. The stimulation was not observed when d-glutamine was used as substrate for the glutamyl transfer reaction.


Characterized dispersive wave-form of evoked compound muscle action potential in the localized ulnar nerve neuropathy.
Disorder of the ulnar nerve with continuity around the elbow is known to be a neuropathy produced by long lasting compression, friction or traction. Forty-four patients with clinical diagnosis of ulnar nerve neuropathy were examined by means of motor nerve conduction study and induced electromyography. Compound muscle action potentials (CMAPs) from hand muscle were evoked by stimulating many points proximal and distal to the elbow and analysis of CMAP was performed. In mild grade of nerve lesion, dispersive wave-form with the extension of its duration was elicited by only stimulating proximal points to the elbow. It was also found that conduction velocity is delayed only over the short distance across the elbow. Thus an initial stage of nerve lesion has a tendency of dysfunctioning of conductivity restricted in only affected portion. CMAP patterns are classified into four groups in comparison with the progress of clinical signs of the disease. This classification can be utilized for the evaluation of the progress of ulnar nerve lesion.


The use of biological grafts for reconstruction of the inferior vena cava is a safe and valid alternative: results in 32 patients in a single institution.
Resection and reconstruction of the inferior vena cava (IVC) is occasionally required in the surgical treatment of intra-abdominal tumours. IVC reconstruction can be performed with biological or synthetic graft material, with most centres preferring synthetic grafts. In spite of the potential advantages of biological grafts in terms of handling characteristics, and safety, very limited data are available about their use in patients requiring an IVC resection. Medical records of 32 patients who underwent an IVC resection and reconstruction from 1990 and 2011 with autogenous peritoneo-fascial (N = 22) and bovine pericardial (N = 10) grafts were reviewed. A tangential resection with patch repair was performed in 10 patients, whereas in the remaining 22 it was necessary to resect and replace a segment or all of the retrohepatic IVC. A concomitant liver resection was performed in 14 patients, nephrectomy in 10 and pancreaticoduodenectomy in 2 patients. There were no acute or late complications related to graft thrombosis or infection. Three patients died as a consequence of multi-organ failure. Overall survival at 1 and 5 years was 78% and 48%, respectively. The preferential use of synthetic grafts in IVC replacement is not evidence based. Selection of an appropriate prosthetic graft for IVC reconstruction should be based on the safety and its handling features. The use of biological grafts for IVC repair is a valid alternative to current synthetic materials and may in fact be superior in terms of biocompatability, ease of handling, reduced rate of infection and improved long-term patency without permanent anticoagulation.


Genome sequence of the Asian Tiger mosquito, Aedes albopictus, reveals insights into its biology, genetics, and evolution.
The Asian tiger mosquito, Aedes albopictus, is a highly successful invasive species that transmits a number of human viral diseases, including dengue and Chikungunya fevers. This species has a large genome with significant population-based size variation. The complete genome sequence was determined for the Foshan strain, an established laboratory colony derived from wild mosquitoes from southeastern China, a region within the historical range of the origin of the species. The genome comprises 1,967 Mb, the largest mosquito genome sequenced to date, and its size results principally from an abundance of repetitive DNA classes. In addition, expansions of the numbers of members in gene families involved in insecticide-resistance mechanisms, diapause, sex determination, immunity, and olfaction also contribute to the larger size. Portions of integrated flavivirus-like genomes support a shared evolutionary history of association of these viruses with their vector. The large genome repertory may contribute to the adaptability and success of Ae. albopictus as an invasive species.