A reduced abbreviated indirect calorimetry protocol is clinically acceptable for use in spontaneously breathing patients with traumatic brain injury.
A steady state should be established when using indirect calorimetry to assess resting energy expenditure, reduce error, and improve the validity of the measurement. Steady-state criteria are often rigorous and difficult to achieve in hospitalized patients, particularly in patients recovering from traumatic brain injury. This study aimed to assess whether reducing the timeframe for steady-state conditions to 2, 3, or 4 minutes when using indirect calorimetry was significantly different from the widely accepted 5-minute steady-state protocol in patients recovering from traumatic brain injury. Indirect calorimetry using an open-circuit calorimeter was used to measure resting energy expenditure in 20 spontaneously breathing patients with traumatic brain injury. Each patient underwent repeated measurements once per day at various stages of his or her recovery. Bland-Altman methods comparison was used for statistical analysis. In total, 124 measurements were recorded, of which 59% met 5-minute, 70% met 4-minute, 76% met 3-minute, and 84% met 2-minute steady-state conditions. Mean within-patient coefficient of variation was 13% (range, 0%-35%). Agreement at the +/-10% level using Bland-Altman plots was 100% for a 4-minute steady-state protocol, 96% for a 3-minute protocol, and 90% using a 2-minute protocol. A 4-minute or 3-minute abbreviated steady-state indirect calorimetry protocol is clinically acceptable to measure resting energy expenditure in spontaneously breathing patients with a traumatic brain injury.


Effects of transgenic expression of Brevibacterium linens methionine gamma lyase (MGL) on accumulation of Tylenchulus semipenetrans and key aminoacid contents in Carrizo citrange.
Carrizo transgenic plants overexpressing methionine-gamma-lyase produced dimethyl sulfide. The transgenic plants displayed more resistance to nematode attacks (Tylenculus semipenetrans) and may represent an innovative strategy for nematode control. Tylenchulus semipenetrans is a nematode pest of many citrus varieties that causes extensive damage to commercial crops worldwide. Carrizo citrange vr. (Citrus sinensis L. Usb × Poncirus trifoliate L. Raf) plants overexpressing Brevibacterium linens methionine-gamma-lyase (BlMGL) produced the sulfur volatile compound dimethyl sulfide (DMS). The aim of this work was to determine if transgenic citrus plants expressing BlMGL showed increased tolerance to T. semipenetrans infestation and to determine the effect on the content of key amino acids. While transgenic lines emitted dimethyl sulfide from leaves and roots, no sulfur-containing volatiles were detectable in wild-type Carrizo in the same tissues. Significant changes detected some key amino acids from leaves of transgenic plants such as aspartate, lysine, glycine, leucine and threonine with no changes in the amounts of methionine and α-ketobutyrate. In roots only glycine showed significant changes across all transgenic lines in comparison to wild-type plants. Transgenic plants expressing BlMGL and emitting DMS had less T. semipenetrans aggregation and more biomass than infected WT control plants, indicating that they may represent an innovative management alternative to pesticide/nematicide-based remedies.


Vertebral Fracture in an Elderly Golfer.
Golf is one of the most popular sports among seniors. Here, we report the case of a 76-year-old woman who developed a vertebral fracture while playing golf. The patient had been suffering from leg pain for several years but developed sudden back pain after her golf swing. Because magnetic resonance imaging demonstrated a new vertebral fracture of the L1 vertebral body and canal stenosis at the L4/5 level, she successfully underwent L1 vertebroplasty and L4/5 decompression. For older golfers, a classical swing that twists the pelvis and shoulders at the same time may be recommended.


Heightened interference on implicit, but not explicit, tests of negative transfer: evidence from patients with unilateral temporal lobe lesions and normal old people.
The present research investigated alternative explanations of heightened interference in AB-AC learning in individuals with memory loss related to medial temporal lobe dysfunction. In Experiment 1, patients with left or right temporal lobectomy and control subjects were administered the standard AB-AC test. Relative to the other groups, left temporal patients exhibited significant negative transfer that was characterized by large numbers of response intrusion errors. In Experiment 2, groups of community-dwelling old and young adults were administered the standard test and an implicit version in which, during AC testing, subjects were instructed to provide the first word that comes to mind in response to stimulus words. There were no differences between groups on either version. Of particular interest was that both groups made significantly more intrusion errors on the implicit test and did not differ on this measure. It was concluded that exaggerated interference in AB-AC learning, as reflected by response intrusion errors, is related to the use of implicit memory processes rather than a failure of inhibitory mechanisms. Memory-impaired individuals, who have a selective loss of explicit memory, are vulnerable on this task because they rely excessively on implicit memory processes.


Streptococcal toxic shock syndrome: report of two cases.
Two Japanese cases of streptococcal toxic shock syndrome (STSS) are reported. The first patient was a 45-year-old male who developed necrotizing fasciitis and myositis of the left thigh, refractory hypotension, hepatic dysfunction and acute renal failure; the patient died despite treatment. Streptococcus pyogenes was isolated from the inflamed fascia. The second patient was a 69-year-old female who had coagulopathy, polymyositis and hepatic function abnormality. Streptococcus pyogenes was isolated from blood culture. She was immediately placed on high-dose ampicillin as well as other supportive measures, and she survived.


Cost-effectiveness of transcatheter edge-to-edge repair in secondary mitral regurgitation.
Transcatheter edge-to-edge mitral valve repair (TMVr) improves symptoms and survival for patients with heart failure with reduced left ventricular ejection fraction (HFrEF) and severe secondary mitral regurgitation despite guideline-recommended medical therapy (GRMT). Whether TMVr is cost-effective from a UK National Health Service (NHS) perspective is unknown. We used patient-level data from the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) trial to perform a cost-effectiveness analysis of TMVr +GRMT versus GRMT alone from an NHS perspective. Costs for the TMVr procedure were based on standard English tariffs and device costs. Subsequent costs were estimated based on data acquired during the trial. Health utilities were estimated using the Short-Form 6-Dimension Health Survey. Costs for the index procedural hospitalisation were £18 781, of which £16 218 were for the TMVr device. Over 2-year follow-up, TMVr reduced subsequent costs compared with GRMT (£10 944 vs £14 932, p=0.006), driven mainly by reductions in heart failure hospitalisations; nonetheless, total 2-year costs remained higher with TMVr (£29 165 vs £14 932, p<0.001). When survival, health utilities and costs were projected over a lifetime, TMVr was projected to increase life expectancy by 1.57 years and quality-adjusted life expectancy by 1.12 quality-adjusted life-years (QALYs) at an incremental cost of £21 980, resulting in an incremental cost-effectiveness ratio (ICER) of £23 270 per QALY gained (after discounting). If the benefits of TMVr observed in the first 2 years were maintained without attenuation, the ICER improved to £12 494 per QALY. For patients with HFrEF and severe secondary mitral regurgitation similar to those enrolled in COAPT, TMVr increases life expectancy and quality-adjusted life expectancy compared with GRMT at an ICER that represents good value from an NHS perspective.


Distribution of organobrominated and organochlorinated contaminants in Belgian human adipose tissue.
We have measured the levels of flame retardants, polybrominated diphenyl ethers (PBDEs), in 20 recent human adipose tissues from Belgium and compared them to other organohalogen compounds such as polychlorinated biphenyls (PCBs), hexachlorobenzene, 2,2-bis(4-chlorophenyl)-1,1,1-trichloroethane (p,p'-DDT), and its metabolite, 2,2-bis(4-chlorophenyl)-1,1-dichloroethylene (p,p'-DDE). After Soxhlet extraction and cleanup on acidified silica solid-phase extraction cartridges, analysis was achieved by capillary gas chromatography/electron impact mass spectrometry. The method allowed the determination of 5 PBDE and 35 PCB congeners. Concentrations of PBDEs (sum of congeners IUPAC Nos. 28, 47, 99, 100, and 153) ranged between 2.2 and 11.7 ng/g lipid weight and were on the lower end of reported PBDE concentrations in European countries. The median value for the sum of PCBs (35 congeners) was 841 ng/g lipid weight and ranged from 286 to 1802 ng/g lipid weight. The median value for the sum of DDTs (calculated from p,p'-DDE and p,p'-DDT) was 290 ng/g lipid weight and ranged from 47 to 2802 ng/g lipid weight. The sum of PCBs showed a good correlation with the sum of DDTs (r=0.77, P<0.05), while the correlation with the sum of PBDEs was weaker (r=0.56, P<0.05). No age dependency was found for PBDEs (r=0.09), while PCBs and DDTs showed higher correlation coefficients with age (r=0.59 and 0.40, respectively, P<0.05).


The impact of brush cytology from endoscopic retrograde cholangiopancreatography (ERCP) on patient management at a UK teaching hospital.
Patients with suspected pancreaticobiliary cancers frequently undergo endoscopic retrograde cholangiopancreatography (ERCP) to obtain brush cytology for confirmatory diagnosis. The outcome of this often leads to the management of the patient and can avoid more invasive investigations. There is a wide range of sensitivities and specificities reported in the literature. To determine the accuracy of the brush cytology obtained at ERCP by performing a retrospective audit of all patients admitted to Guy's and St. Thomas' Hospital for ERCP during 2008-2013. Also, to evaluate the impact of cytology results on patient care following ERCP. Data were collected from 4 January 2008 to 27 December 2013. This involved analysing EndoSoft (the in-house software for endoscopic data entry), Pathnet (the pathology database) and Electronic Patient Records. 162 patients underwent brush cytology during ERCP. 58 patients had positive cytology. With intention-to-treat analysis, sensitivity was 54.7%, specificity was 100.0% and negative predictive value was 53.9% with a positive predictive value of 100%. Patients with a positive brush cytology result required fewer investigations compared with patients with a negative cytology result. Our results compare favourably with previous studies in the field. Brush cytology has been ignored in recent times due to perceived poor results and efficacy. Our audit shows that it can reduce the number of investigations required to reach a diagnosis of malignancy and so is a valuable tool in the diagnosis of pancreaticobiliary malignancies. However, better guidance on preparation of samples for cytology is needed to reduce the number of insufficient samples.


Body weight dynamics and their association with physical function and mortality in older adults: the Cardiovascular Health Study.
To estimate the associations of weight dynamics with physical functioning and mortality in older adults. Longitudinal cohort study using prospectively collected data on weight, physical function, and health status in four U.S. Communities in the Cardiovascular Health Study. Included were 3,278 participants (2,013 women and 541 African Americans), aged 65 or older at enrollment, who had at least five weight measurements. Weight was measured at annual clinic visits between 1992 and 1999, and summary measures of mean weight, coefficient of variation, average annual weight change, and episodes of loss and gain (cycling) were calculated. Participants were followed from 1999 to 2006 for activities of daily living (ADL) difficulty, incident mobility limitations, and mortality. Higher mean weight, weight variability, and weight cycling increased the risk of new onset of ADL difficulties and mobility limitations. After adjustment for risk factors, the hazard ratio (95% confidence interval) for weight cycling for incident ADL impairment was 1.28 (1.12, 1.47), similar to that for several comorbidities in our model, including cancer and diabetes. Lower weight, weight loss, higher variability, and weight cycling were all risk factors for mortality, after adjustment for demographic risk factors, height, self-report health status, and comorbidities. Variations in weight are important indicators of future physical limitations and mortality in the elderly and may reflect difficulties in maintaining homeostasis throughout older ages. Monitoring the weight of an older person for fluctuations or episodes of both loss and gain is an important aspect of geriatric care.


Gender distinction in neural discrimination of sex pheromones in the olfactory bulb of crucian carp, Carassius carassius.
Studies on projection of the sensory neurons onto the olfactory bulb in fish have revealed a clear subdivision into spatially different areas that each responded specifically to different classes of odorants. Amino acids induce activity in the lateral part, bile salts induce activity in the medial part, and alarm substances induce activity in the posterior part of the medial olfactory bulb. In the present study, we demonstrate a new feature of the bulbar chemotopy showing that neurons specifically sensitive to sex pheromones are located in a central part of the ventral olfactory bulb in crucian carp. Extensive single-unit recordings were made from these neurons, stimulating with four sex pheromones, 17,20beta-dihydroxy-4-pregnen-3-one, 17,20beta-dihydroxy-4-pregnen-3-one-20-sulfate, androstenedione, and prostaglandin F(2alpha), known to induce specific reproductive behaviors in males of carp fish. All substances were applied separately to the sensory epithelium at a concentration of 10(-9) M. Of the 297 neurons recorded in males, the majority (236 or 79.5%) responded exclusively to one of the four sex pheromones and thus showed a high specificity. Of the 96 neurons recorded from the olfactory bulb in females, only 1 unit showed such a specific activation. These findings reflect remarkable differences between males and females in the discriminatory power of the olfactory neurons toward these sex pheromones. The gender differences are discussed in relation to behavior studies, expression of olfactory receptors, and the convergence of sensory neurons onto the secondary neurons in the olfactory bulb.


Impact of postoperative pancreatic fistula on long-term oncologic outcomes after pancreatic resection.
The short-term morbidity associated with post-operative pancreatic fistula (POPF) is well established, however data regarding the long-term impact are lacking. We aim to characterize long-term oncologic outcomes of POPF after pancreatic resection through a single institution, retrospective study of pancreatic resections performed for adenocarcinoma from 2009 to 2016. Kaplan-Meier survival analysis, logistic regression, and multivariate analysis (MVA) were used to evaluate impact of POPF on overall survival (OS), disease free survival (DFS), and receipt of adjuvant chemotherapy (AC). 767 patients were included. 82 (10.6%) developed grade B (n = 67) or C (n = 15) POPF. Grade C POPF resulted in decreased OS when compared to no POPF (20.22 vs 26.33 months, p = 0.027) and to grade B POPF (20.22 vs. 26.87 months, p = 0.049). POPF patients were less likely to receive AC than those without POPF (59.5% vs 74.9%, p = 0.003) and grade C POPF were less likely to receive AC than all others (26.7% vs 74.2%, p = 0.0001). POPF patients are less likely to receive AC and more likely to have delay in time to AC. These factors are exacerbated in grade C POPF and likely contribute to decreased OS. These findings validate the clinical significance of the ISGPF definition of POPF.


Independent Evaluation of Medical-Grade Bioresorbable Filaments for Fused Deposition Modelling/Fused Filament Fabrication of Tissue Engineered Constructs.
Three-dimensional printing/additive manufacturing (3DP/AM) for tissue engineering and regenerative medicine (TE/RM) applications is a multifaceted research area encompassing biology, material science, engineering, and the clinical sciences. Although being quite mature as a research area, only a handful of clinical cases have been reported and even fewer commercial products have made it to the market. The regulatory pathway and costs associated with the introduction of bioresorbable materials for TE/RM have proven difficult to overcome, but greater access to 3DP/AM has spurred interest in the processing and availability of existing and new bioresorbable materials. For this purpose, herein, we introduce a series of medical-grade filaments for fused deposition modelling/fused filament fabrication (FDM/FFF) based on established and Federal Drug Administration (FDA)-approved polymers. Manufacturability, mechanical characterization, and accelerated degradation studies have been conducted to evaluate the suitability of each material for TE/RM applications. The comparative data serves to introduce these materials, as well as a benchmark to evaluate their potential in hard and soft tissue engineering from a physicochemical perspective.


Distal Internal Maxillary Artery Occlusion with Palatal Necrosis following Cheek Injection with Calcium Hydroxylapatite.
Accidental intravascular injection of cosmetic fillers resulting in dermal infarction represents one of the most feared complications in aesthetic medicine. Despite the infrequency of these injuries, the rapid rise in filler use has caused a sudden increase in the incidence of filler-induced skin necrosis. Because the complex vascular anatomy of the face subserves a wide range of cutaneous and mucosal tissues, it has been surmised that occult injuries affecting the oronasal cavities could occur as a result of accidental intravascular injection of dermal fillers. We report an instance of ischemic skin injury of the infraorbital territory of the face with hemi-palatal mucosal necrosis secondary to vascular occlusion with calcium hydroxylapatite.


Outcome after primary and secondary replacement for subcapital fracture of the hip in 10 264 patients.
Between 1999 and 2005, 10 264 patients who had undergone total hip replacement (THR) for subcapital fracture of the hip were compared with 76 520 in whom THR had been performed for other reasons. All the cases were identified through the Swedish Hip Arthroplasty Register. The THRs performed as primary treatment for fracture were also compared with those done after failure of internal fixation. After seven years the rate of revision was higher in THR after fracture (4.4% vs 2.9%). Dislocation and periprosthetic fracture were the most common causes of revision. The risk was higher in men than in women. The type of femoral component and the surgical approach influenced the risk. After correction for gender, type of component and the surgical approach the revision rates were similar in the primary and secondary fracture THR groups. Total hip replacement is therefore a safe method for both the primary and secondary management of fracture of the hip.


Multitasking strategies make the difference: Separating processing-code resources boosts multitasking efficiency when individuals prefer to interleave tasks in free concurrent dual tasking.
Previous research has shown that individuals differ with respect to their preferred strategies in self-organized multitasking: They either prefer to work on one task for long sequences before switching to another (blocking), prefer to switch repeatedly after short sequences (switching), or prefer to respond almost simultaneously after processing the stimuli of two concurrently visible tasks (response grouping). In two experiments, we tested to what extent the choice of strategy and related differences in multitasking efficiency were affected by the between-resource competition (Wickens, 2002) of two tasks to be performed concurrently in a self-organized manner. All participants performed a set of dual tasks that differed with respect to the kind of stimuli (verbal vs. spatial) and/or responses (manual vs. vocal). The choice of strategy was hardly affected as most individuals persisted in their response strategy independent of the degree of resource competition. However, the efficiency of individuals preferring a switching or response-grouping strategy increased especially when the reduction in resource competition was response related (manual vs. vocal), leading even to considerable dual-tasking benefits under these circumstances. In contrast, individuals who preferred to block their responses did not achieve any considerable benefits (or costs) with either of the different dual tasks. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


[The apoptosis in the course of experimental infection with T. pseudospiralis in mice].
The apoptosis in the course of experimental infection with T. pseudospiralis in mice. The level of apoptic cells in the lamina propria of the mucosa of the jejunum and in the masseter muscle in the mice infected with 200 larvae T. pseudospiralis was observed. Cryostat preparations made from jejunum and muscle samples on 7, 14, 21, 28, 60, 180 and 360 day post infection (dpi), were examined employing the TUNNEL method with the use of "In situ Cell Death Detection KIT Fluorescein" of Roche. The number of apoptic cells in the lamina propria of jejunum started to increase as early as on 7 dpi. The highest number of the apoptic cells, on an average - 56,4 in the crypta-villus unit, was recorded on 28 dpi, whereas the return to the standard level took place only 360 dpi. The level of the apoptic cells in the masseter muscle was the highest on 28 and 60 dpi, which constituted some 30% of all the cells of infiltration.


Added Value of Subtraction SPECT/CT in Dual-Isotope Parathyroid Scintigraphy.
Adding subtraction single-photon emission computed tomography/computed tomography (SPECT/CT) to dual isotope (I-123 and Tc-99m-sestamibi) subtraction parathyroid scintigraphy is not widely implemented. We aimed to assess the added value of dual isotope subtraction SPECT/CT over single isotope SPECT/CT as an adjunct to dual isotope planar pinhole subtraction scintigraphy. Parathyroid scintigraphies from 106 patients with an estimated total of 415 parathyroid glands who (1) were diagnosed with primary hyperparathyroidism, (2) underwent dual isotope subtraction scintigraphy in the Department of Nuclear Medicine, Gentofte Hospital, Denmark throughout 2017 and (3) underwent subsequent parathyroidectomy, were included. The original dual isotope planar pinhole subtraction plus dual isotope subtraction SPECT/CT (dual/dual method) exams were retrospectively re-evaluated using only Tc-99m-sestamibi SPECT/CT (dual/single method). Statistics were calculated per parathyroid. Surgical results confirmed by pathology served as reference standard. The dual/dual method had higher sensitivity than the dual/single method (82% (95%CI 74%-88%) vs. 69% (95%CI 60%-77%)) while specificity, positive and negative predictive values (PPV and NPV) were similar (specificity 96% vs. 93%, PPV's 87% vs. 82% and NPV's 89% vs. 93%). Reader confidence was higher when employing the dual/dual method (p = 0.001). The dual/dual method can be considered superior to the dual/single method in the preoperative imaging in primary hyperparathyroidism.


Oligodendroglioma arising in a sacrococcygeal immature teratoma.
Tumors of neuroepithelial origin are extremely rare in teratoma and tend to be derived from glial or primitive neuroectodermal cells. We describe a case of 2- month-old baby girl with an oligodendroglioma arising in an immature teratoma of the sacrococcygeal region. Histologically, the tumor was identical in appearance to low grade oligodendroglioma within the adult brain. Because immature teratoma was grade II, the patient received adjuvant chemotherapy. The patient died of progression of the intra-abdominal tumor 6 months after surgical excision. The authors believe this to be the first presentation in the world literature.


Controlled force measurements of gingival attachment level made with the Toronto automated probe using electronic guidance.
Precise reproduction of probe placement, probing force and probing angulation may influence the reliability of replicate gingival attachment level measurements (GAL). Reproducibility of GAL measurements was determined with the Toronto automated periodontal probe (TAPP) in which a novel electronic guidance system was incorporated to improve the precision of probing angulation. Bench testing of forces produced at the probe tip was performed with an electronic balance. Reproducibility and precision of force generation were tested in a variety of instrument configurations using laboratory models. The data indicated that highly precise and reproducible probing forces can be generated with the TAPP over a large (10 to 90 g) probing range. Instrument precision was +/- 0.27 mm when probing forces of 40-60 g were used. The guidance system provided accurate and reproducible measurements of the probe handle in both roll and pitch axes when compared with precisely machined wedges (R = 0.99, roll; R = 0.98, pitch). Deviation of probing angulation greater than 5 degrees on replicate measurements of GAL was associated with significant alterations in the location of circumferential probe placement and in the size of the difference between GAL measurements (delta GAL). Clinical assessment of probing angulation in 6 patients demonstrated that delta GAL was 0.40 +/- 0.05 mm when probing angulation deviation was less than 5 degrees but increased to 0.96 +/- 0.11 mm when deviations exceeded 5 degrees. Taken together, these data indicate that the regulation of probing angulation in clinical measurement of GAL with the TAPP is an important determinant of the reproducibility of periodontal probing.


Beneficial Effects of Spirulina Consumption on Brain Health.
Spirulina is a microscopic, filamentous cyanobacterium that grows in alkaline water bodies. It is extensively utilized as a nutraceutical food supplement all over the world due to its high levels of functional compounds, such as phycocyanins, phenols and polysaccharides, with anti-inflammatory, antioxidant, immunomodulating properties both in vivo and in vitro. Several scientific publications have suggested its positive effects in various pathologies such as cardiovascular diseases, hypercholesterolemia, hyperglycemia, obesity, hypertension, tumors and inflammatory diseases. Lately, different studies have demonstrated the neuroprotective role of Spirulina on the development of the neural system, senility and a number of pathological conditions, including neurological and neurodegenerative diseases. This review focuses on the role of Spirulina in the brain, highlighting how it exerts its beneficial anti-inflammatory and antioxidant effects, acting on glial cell activation, and in the prevention and/or progression of neurodegenerative diseases, in particular Parkinson's disease, Alzheimer's disease and Multiple Sclerosis; due to these properties, Spirulina could be considered a potential natural drug.


The impact of snake bite on household economy in Bangladesh.
The present study aims to assess the different types of costs for treatment of snake bite patients, to quantify household economic impact and to understand the coping mechanisms required to cover the costs for snake bite patients in Bangladesh. The patients admitted to four tertiary level hospitals in Bangladesh were interviewed using structured questionnaires including health-care-related expenditures and the way in which the expenditures were covered. Of the snakes which bit the patients, 54.2% were non-venomous, 45.8% were venomous and 42.2% of the patients were given polyvalent antivenom. The total expenditure related to snake bite varies from US$4 (US$1 = Taka 72) to US$2294 with a mean of US$124 and the mean income loss was US$93. Expenditure for venomous snake bite was US$231, which is about seven times higher than non-venomous snake bite (US$34). The treatment imposes a major economic burden on affected families, especially in venomous snake bite cases.


Systematization of the Introduction of IPV and Switch from tOPV to bOPV in the Americas.
The synchronized introduction of the inactivated polio vaccine (IPV) and the switch from trivalent oral polio vaccine (tOPV) to bivalent oral polio vaccine (bOPV) has constituted an effort without precedents, and with astonishing results. Within the established time frame, all countries in our region managed to carry out the decision, planning, and introduction of this vaccine and subsequent switch to their national immunization schedules.The purpose of this article is to systematize the process of IPV introduction and switch in Latin America and the Caribbean, which constitutes an important piece in the documentation of the polio legacy in the Americas. Regional level as well as country perspectives and viewpoints are described. Analyzing and summarizing the lessons learned from the introduction of IPV and the switch from tOPV to bOPV can be useful for the introduction of new vaccines in the Pan American Health Organization (PAHO) region and in other regions of the world, and to help our own region successfully carry out another synchronized vaccine introduction in the future, if necessary.


[Interaction between bovine serum albumin and umbelliferone with/without metal ions of Cu2+ or Zn2+].
The interaction between bovine serum albumin (BSA) a nd umbelliferone, an active component of Chinese herbs, with or without metal ions was investigated using fluorescence spectroscopy (FS) and UV. The experimental results showed that the umbelliferone molecules inserted into the hydrophobic pockets of BSA and quenched the intrinsic fluorescence of BSA by forming umbelliferone-BSA complex. The mechanism of fluorescence quenching was confirmed combining by both static quenching and nonradiative energy transferring. It was discovered that the apparent association constant (K(A)) increases in the presence of Cu2+ and Zn2+, whereas the spatial-distance (r) between umbelliferone molecule and fluorescent amino acid residues of the BSA and the binding sites (n) of umbelliferone molecules on BSA have no obviously change. Binding of umbelliferone molecules to BSA was a spontaneous supramolecular interaction in which entropy increased and Gibbs free energy decreaed. The interaction of the umbelliferone-BSA was driven mainly by electrostatic force which was enhanced by Cu2+ and Zn2+, thus the contribution of AH to AG increased in the presence of metal ions.


A Stabilization Group Approach for Heterogeneous Populations of Trauma Clients.
High prevalence and long-lasting implications of human-inflicted trauma call for effective treatment approaches reaching clients in need of trauma-specific treatment. Numerous approaches exist, but often with limited empirical support. There is also a tendency toward segregating treatment approaches depending on type of exposure history and presenting symptoms. This might exclude clients in need of trauma-specific treatment; therefore, treatment approaches that can reach more heterogeneous groups of clients are needed. In this article, a group-based treatment approach adjusted to include clients with a wide range of trauma-related problems and traumatic experiences will be presented. A brief outline of the approach is presented, together with the theoretical and empirical background, to facilitate implementation by practitioners and empirical testing.


Seasonal occurrence of Alternaria (1993- 2004) and Epicoccum (1994-2004) spores in Trieste (NE Italy).
Fungal spores are known to trigger allergic respiratory diseases. Very little is known about airborne fungal spore presence in Trieste. This paper reports the seasonal (June-October) Alternaria (1993-2004) and Epicoccum (1994-2004) spore concentrations during these years, using a Hirst sampler. Daily spore counts fluctuate considerably from one day to the next. Airborne spores of Alternaria and Epicoccum tend to display a similar temporal pattern, with the peak daily count occurring in late summer - early autumn; a shifted occurrence towards the early autumn of the maximum peaking day of Epicoccum was observed, compared to Alternaria, on average. A great variability in seasonal spore concentrations was also found throughout the years. Seasonal totals of 6,076 Alternaria spores and 2,796 Epicoccum spores were found over the examined years, on average. 2003 was an exceptionally high year for Alternaria with a seasonal total of 15,021 spores. Statistical analyses comparing daily spore counts with meteorological parameters were carried out. Weather variables have been shown to affect the spore concentrations in the air. Alternaria and Epicoccum respond in a similar way to meteorological factors. Daily spore levels showed a significant positive correlation with temperatures; weak significant negative correlations have been found with the other parameters.


Rationale and design for the CARDIOVIT Study (Cardiovit, Atherosclerotic vascular disease and hypeRhomocysteinemia: an epiDemiological study in Indians, additionally evaluating the effect of Oral VITamin supplementation).
Atherosclerotic vascular disease (AVD), including coronary heart disease (CHD), is on the rise in India. Mortality due to CHD is estimated to be 40% higher in Indian Asians compared with Europeans. Hyperhomocyst(e)inaemia (hypertHcy) is emerging as a novel independent risk factor for AVD. Moreover, there is increasing evidence of its association with CHD in subjects of Indian origin possibly because of inadequate folic acid and B(12) status. However, there is a lack of epidemiological data on its prevalence in Indians. A need to evaluate the optimum dose of folic acid required to reduce plasma homocyst(e)ine (tHcy) also exists. The CARDIOVIT study, divided into two stages, is designed to determine the prevalence and relevance of hypertHcy in Indian subjects and also evaluate the tHcy-lowering effect of a marketed multivitamin formulation (Cardiovit). Stage I is a cross-sectional epidemiological study to estimate the prevalence of hypertHcy in a randomly selected population in South India. We planned to screen 2000 subjects between 25 and 64 years of age for established risk factors; plasma tHcy levels will be estimated and the correlation of AVD with established risk factors, plasma tHcy and nutritional factors was evaluated. Subjects having tHcy levels > 12 micromol/L are recruited in Stage II; a randomized, three-arm, double-blind, double-dummy, placebo-controlled, parallel-group, comparative study designed to evaluate the tHcy-lowering effect of a multivitamin formulation containing 300 microg folic acid, 1 microg vitamin B(12) and 1.5 mg vitamin B(6), along with Vitamins A, C, E and selenium. Subjects will be randomized into three groups (n = 64 completed subjects each) and receive either two placebos, or one placebo and multivitamin, or two multivitamin tablets for 6 weeks. Serum vitamin B(12), serum and red cell folate are estimated at baseline and at 6 weeks. Descriptive, univariate analysis, multiple logistic regression model and appropriate statistical tests will be used to analyse the prevalence of hypertHcy, association with risk factors of AVD, efficacy and safety of the multivitamin formulation and other data per protocol. CARDIOVIT is one of the first and largest studies in India to provide insight into the prevalence of hypertHcy, its association with AVD and conventional risk factors and the role of multivitamins in reducing it.


[Regulatory framework of the new wage payment system in dentistry].
The paper presents the analysis of regulatory frameworks for wage payment system in federal, state and municipal dental clinics. The new wage payment system provided significant freedom for employers in payments size determination by regulation of basic, stimulating and compensative salary payoffs. The study highlights the need for scientific studies on dental care quality assessment criteria for wage payment system.


[Expression of major histocompatibility complex on human medulloblastoma cells].
Medulloblastoma is one of the most common malignant brain tumors in childhood. These cells are immature bipotential cells that could differentiate into both neuronal and glial cells. The authors established two human medulloblastoma cell lines. One was derived from a 2-year-old girl with cerebellar tumor (designated as ONS-76) and another was from a 9-year-old girl with metastatic tumor in the right frontal lobe (ONS-81). Immunohistochemical studies showed that both cell lines possessed 145 and 200 kDa neurofilament proteins and neuron-specific enolase, without glial fibrillary acidic protein and S-100 protein. It was shown that interferon gamma could enhance or induce the expression of the major histocompatibility complex (MHC) antigens which play a major role in immune response. Also shown for the first time was the expression of MHC class II antigens on human medulloblastoma (ONS-76 and 81) with neuronal differentiation.


Chemotherapeutic evaluation of 4-hydroxybenzylretinone (4-HBR), a nonhydrolyzable C-linked analog of N-(4-hydroxyphenyl) retinamide (4-HPR) against mammary carcinogenesis.
The antitumor effects of N-(4-hydroxyphenyl)retinamide (4-HPR), and its stable C-linked analog, 4-hydroxybenzylretinone (4-HBR) on the regression of established 7,12-dimethylbenz(a)anthracene(DMBA)-induced rat mammary tumors were compared. 4-HBR is a stable and nonhydroyzable derivative which cannot be converted in vivo to retinoic acid (RA). The results indicate that 4-HBR decreased mammary tumor volumes to the same extent as equimolar concentration (2 mmol/kg diet) of 4-HPR (-45% for 4-HBR vs. -42% for 4-HPR, p<0.01). Both 4-HPR and 4-HBR bind very poorly to nuclear retinoid receptors RARs and RXRs. The similarity of physicochemical properties of 4-HPR and 4-HBR as well as their equal antitumor potency suggests that 4-HPR like 4-HBR, is acting directly rather than through hydrolysis to free RA. Treatment with 4-HPR caused an almost 65% decrease in serum retinol levels. These results suggest that 4-HBR may have a significant chemotherapeutic advantage over 4-HPR, as the nonhydrolyzable analog may not cause night blindness which occurs as a significant side effect of 4-HPR usage.


[Biological stigmata of lead poisoning from water and their peculiarities. Application to the choice of diagnostic tests].
We have studied the diagnostic efficiency of some biological tests in 59 consecutive patients whom we suspected to be poisoned by lead from drinking water. This diagnosis was confirmed in 30 patients in whom EDTA-promoted urinary excretion of lead was greater than 800 micrograms/24 hr. The measurement of delta-ALA (delta-aminolevulinic acid) dehydrase was the most sensitive test (89.7 p. 100). Sensitivities of protoporphyrin blood level (64.7 p. 100), of serum lead level (46.2 p. 100), of the presence of erythrocytes with basophilic stippling in blood (44.4 p. 100) were lower. The determinations of urinary coproporphyrin and of delta-ALA levels in blood and urine had no practical diagnostic value. We conclude that the best screening test for the diagnosis of lead poisoning by drinking water is the measurement of delta-ALA dehydrase activity. An increase of the EDTA-promoted urinary excretion of lead is required for a final confirmation of the diagnosis.


Risk factors associated with venous thromboembolism in isolated blunt chest trauma.
Isolated chest trauma is not historically considered to be a major risk factor for venous thromboembolism (VTE). After blunt chest trauma, VTE may be underappreciated because pain, immobility, and inadequate prophylaxis as a result of hemorrhage risk may all increase the risk of VTE. This investigation determines the predictors and rate of VTE after isolated blunt chest trauma. A review of patients admitted to a Level I trauma center with chest trauma between 2007 and 2009 was performed. Demographics, injuries, VTE occurrence, prophylaxis, comorbidities, Injury Severity Score, intensive care unit/hospital length of stay, chest tube, and mechanical ventilation use were recorded. VTE rate was compared between those with isolated chest injury and those with chest injury plus extrathoracic injury. Predictors of VTE were determined with regression analysis. Three hundred seventy patients had isolated chest trauma. The incidence of VTE was 5.4 per cent (n = 20). The VTE rate in those with chest injury plus extrathoracic injury was not significantly different, 4.8 per cent (n = 56 of 1140, P = 0.58). Independent risk factors for VTE after isolated chest trauma were aortic injury (P < 0.01, odds ratio [OR], 47.7), mechanical ventilation (P < 0.01; OR, 6.8), more than seven rib fractures (P < 0.01; OR, 6.1), hemothorax (P < 0.05; OR, 3.9), hypercoagulable state (P < 0.05; OR, 6.3), and age older than 65 years (P < 0.05; OR, 1.03). Patients with the risk factors mentioned are at risk for VTE despite only having thoracic injury and might benefit from more aggressive surveillance and prophylaxis.


Blood platelet formation at a glance.
The main function of blood platelets is to ensure hemostasis and prevent hemorrhages. The 1011 platelets needed daily are produced in a well-orchestrated process. However, this process is not yet fully understood and in vitro platelet production is still inefficient. Platelets are produced in the bone marrow by megakaryocytes, highly specialized precursor cells that extend cytoplasmic projections called proplatelets (PPTs) through the endothelial barrier of sinusoid vessels. In this Cell Science at a Glance article and the accompanying poster we discuss the mechanisms and pathways involved in megakaryopoiesis and platelet formation processes. We especially address the - still underestimated - role of the microenvironment of the bone marrow, and present recent findings on how PPT extension in vivo differs from that in vitro and entails different mechanisms. Finally, we recapitulate old but recently revisited evidence that - although bone marrow does produce megakaryocytes and PPTs - remodeling and the release of bona fide platelets, mainly occur in the downstream microcirculation.


Association between periodontitis and severity of COVID-19 infection: A case-control study.
COVID-19 is associated with an exacerbated inflammatory response that can result in fatal outcomes. Systemic inflammation is also a main characteristic of periodontitis. Therefore, we investigated the association of periodontitis with COVID-19 complications. A case-control study was performed using the national electronic health records of the State of Qatar between February and July 2020. Cases were defined as patients who suffered COVID-19 complications (death, ICU admissions or assisted ventilation), and controls were COVID-19 patients discharged without major complications. Periodontal conditions were assessed using dental radiographs from the same database. Associations between periodontitis and COVID 19 complications were analysed using logistic regression models adjusted for demographic, medical and behaviour factors. In total, 568 patients were included. After adjusting for potential confounders, periodontitis was associated with COVID-19 complication including death (OR = 8.81, 95% CI 1.00-77.7), ICU admission (OR = 3.54, 95% CI 1.39-9.05) and need for assisted ventilation (OR = 4.57, 95% CI 1.19-17.4). Similarly, blood levels of white blood cells, D-dimer and C Reactive Protein were significantly higher in COVID-19 patients with periodontitis. Periodontitis was associated with higher risk of ICU admission, need for assisted ventilation and death of COVID-19 patients, and with increased blood levels of biomarkers linked to worse disease outcomes.


Comparison of the Accuracy of Maxillary Positioning With Interim Splints Versus Patient-Specific Guides and Plates in Executing a Virtual Bimaxillary Surgical Plan.
An extension of digital technology is to provide patient-specific hardware to reposition the first jaw in a bimaxillary case without the use of an intermediate splint. The purpose of our study was to determine if there were significant differences in maxillary repositioning using interim splints versus patient-specific guides and implants (PSIs) in executing a bimaxillary virtual surgical plan (VSP). This is a retrospective cohort study of patients who underwent bimaxillary orthognathic surgery with interim splints or PSIs planned with VSP at our institution. The difference in maxillary positions from the VSP to the postoperative cone-beam computed tomography (CBCT) was evaluated in both groups. The primary predictor variable was the method by which the maxilla was repositioned (interim splint vs PSI). The primary outcome variable was the postoperative 3D position of the maxillary incisors and right and left first molars in the anteroposterior, transverse, and vertical dimensions. Differences in the planned and postoperative positions of the above landmarks in all three planes of space between the two groups were statistically analyzed. A total of 82 patients were included. 13 patients had their maxillae repositioned with an interim splint between the unoperated mandible and the mobile maxilla, and 69 patients had their maxilla repositioned using custom drill/cutting guides and a PSI. The mean difference between the planned and actual position of the maxilla in the PSI group was smaller than in the splint group. In the PSI group alone, vertical changes were accurate whether the maxilla was being superiorly or inferiorly repositioned. The use of a PSI provides more accurate maxillary repositioning during bimaxillary surgery than the use of an interim splint.


Molecular mechanisms of corticosteroid resistance.
Most patients with asthma are successfully treated with conventional therapy. Nevertheless, there is a small proportion of asthmatic patients, including present cigarette smokers and former cigarette smokers, who fail to respond well to therapy with high-dose glucocorticoids (GCs) or with supplementary therapy. In addition, high doses of steroids have a minimal effect on the inexorable decline in lung function in COPD patients and only a small effect on reducing exacerbations. GC insensitivity, therefore, presents a profound management problem in these patients. GCs act by binding to a cytosolic GC receptor (GR), which is subsequently activated and is able to translocate to the nucleus. Once in the nucleus, the GR either binds to DNA and switches on the expression of antiinflammatory genes or acts indirectly to repress the activity of a number of distinct signaling pathways such as nuclear factor (NF)-kappaB and activator protein (AP)-1. This latter step requires the recruitment of corepressor molecules. Importantly, this latter interaction is mutually repressive in that high levels of NF-kappaB and AP-1 attenuate GR function. A failure to respond may therefore result from reduced GC binding to GR, reduced GR expression, enhanced activation of inflammatory pathways, or lack of corepressor activity. These events can be modulated by oxidative stress, T-helper type 2 cytokines, or high levels of inflammatory mediators, all of which may lead to a reduced clinical outcome. Understanding the molecular mechanisms of GR action, and inaction, may lead to the development of new antiinflammatory drugs or may reverse the relative steroid insensitivity that is characteristic of patients with these diseases.


Adenosine deaminase and tuberculous meningitis--a systematic review with meta-analysis.
Tuberculous meningitis (TBM) is a severe infection of the central nervous system, particularly in developing countries. Prompt diagnosis and treatment are necessary to decrease the high rates of disability and death associated with TBM. The diagnosis is often time and labour intensive; thus, a simple, accurate and rapid diagnostic test is needed. The adenosine deaminase (ADA) activity test is a rapid test that has been used for the diagnosis of the pleural, peritoneal and pericardial forms of tuberculosis. However, the usefulness of ADA in TBM is uncertain. The aim of this study was to evaluate ADA as a diagnostic test for TBM in a systematic review. A systematic search was performed of the medical literature (MEDLINE, LILACS, Web of Science and EMBASE). The ADA values from TBM cases and controls (diagnosed with other types of meningitis) were necessary to calculate the sensitivity and specificity. Out of a total of 522 studies, 13 were included in the meta-analysis (380 patients with TBM). The sensitivity, specificity and diagnostic odds ratios (DOR) were calculated based on arbitrary ADA cut-off values from 1 to 10 U/l. ADA values from 1 to 4 U/l (sensitivity >93% and specificity <80%) helped to exclude TBM; values between 4 and 8 U/l were insufficient to confirm or exclude the diagnosis of TBM (p = 0.07), and values >8 U/l (sensitivity <59% and specificity >96%) improved the diagnosis of TBM (p < 0.001). None of the cut-off values could be used to discriminate between TBM and bacterial meningitis. In conclusion, ADA cannot distinguish between bacterial meningitis and TBM, but using ranges of ADA values could be important to improve TBM diagnosis, particularly after bacterial meningitis has been ruled out. The different methods used to measure ADA and the heterogeneity of data do not allow standardization of this test as a routine.


Dietary L-lysine deficiency increases stress-induced anxiety and fecal excretion in rats.
Little is known about the psychobehavioral consequences of a dietary deficiency of the amino acid, L-lysine. This report demonstrates that a 4-d long L-lysine deficiency in rats interfered with the normal circadian release of the neurotransmitter serotonin, but not dopamine, measured by in vivo microdialysis in the central nucleus of the amygdala. L-Lysine deficiency was induced by feeding rats a L-lysine-deficient diet. Controls were pair-fed a L-lysine-sufficient diet. Footshock stress-induced anxiety, measured in an elevated plus-maze paradigm, and wrap-restraint stress-stimulated fecal excretion were significantly greater in the L-lysine-deficient rats than in the controls. We conclude that a severe deficiency of dietary L-lysine enhances serotonin release in the amygdala, with subsequent changes in psychobehavioral responses to stress.


Complement components, complement activation, and acute phase response in systemic lupus erythematosus.
The investigation concerned 33 systemic lupus erythematosus (SLE) patients assigned to three groups representing mild SLE, more severe extra renal SLE, and SLE with significant renal involvement. In patients with extrarenal disease, the inflammatory plasma protein response was often pronounced during exacerbation, as evidenced by markedly increased concentrations of C-reactive protein (CRP), alpha 1-antichymotrypsin, alpha 1-antitrypsin, and orosomucoid. CRP responses were rare in patients with renal involvement, despite the increased concentrations of other acute-phase reactants in some of these patients. Superimposed bacterial infections were not clearly distinguished by raised CRP concentrations. The classical pathway of complement was activated in all patients during exacerbation, as indicated by increased concentrations of C1r-C1s-C1 inactivator complexes and C2a fragments. C1, C2, and probably also C3 activation varied according to the amounts of circulating C1q-binding immune complexes, as measured by solid-phase assay. Manifest hypocomplementemia was usually associated with glomerulonephritis. Participation of complement components in the inflammatory plasma protein response apparently counteracted the development of hypocomplementemia in many patients with extrarenal SLE. Circulating C3d was detected in all patients during exacerbation of renal disease and in most patients with severe extrarenal manifestations. Inverse relationships were found between immunochemical C2 concentrations and the percentage of cleaved C2 and between C3 and C3d. There was no appreciable consumption of factors B and D and properdin of the alternative pathway in the patients. High concentrations of factor D, a low molecular weight protein, were exclusively found in patients with renal involvement and could be ascribed to retention due to reduced glomerular filtration.


Involvement of Asn-293 in stereospecific agonist recognition and in activation of the beta 2-adrenergic receptor.
To investigate the molecular mechanism for stereospecific binding of agonists to beta 2-adrenergic receptors we used receptor models to identify potential binding sites for the beta-OH-group of the ligand, which defines the chiral center. Ser-165, located in transmembrane helix IV, and Asn-293, situated in the upper half of transmembrane helix VI, were identified as potential binding sites. Mutation of Ser-165 to Ala did not change the binding of either isoproterenol isomer as revealed after transient expression in human embryonic kidney (HEK)-293 cells. In contrast, a receptor mutant in which Asn-293 was replaced by Leu showed substantial loss of stereospecific isoproterenol binding. Adenylyl cyclase stimulation by this mutant after stable expression in CHO cells confirmed the substantial loss of stereospecificity for isoproterenol. In a series of agonists the loss of affinity in the Leu-293 mutant receptor was strongly correlated with the intrinsic activity of the compounds. Full agonists showed a 10-30-fold affinity loss, whereas partial agonists had almost the same affinity for both receptors. Stereospecific recognition of antagonists was unaltered in the Leu-293 mutant receptor. These data indicate a relationship between stereospecificity and intrinsic activity of agonists and suggest that Asn-293 is important for both properties of the agonist-receptor interaction.


Mauriac syndrome in a child with a positive antinuclear antibody screen.
A 17-year-old male with type 1 diabetes mellitus (T1DM) presented to clinic with elevated transaminases and a positive antinuclear antibody (ANA) screen. Due to concern for autoimmune hepatitis, a liver biopsy was performed which revealed Mauriac syndrome. This case report is the second known description of a child with Mauriac syndrome presenting with positive autoimmune markers.


Proliferative response of human acute myeloid leukemia cells and normal marrow enriched progenitor cells to human recombinant growth factors IL-3, GM-CSF and G-CSF alone and in combination.
The effects of human recombinant colony-stimulating factors (r-CSFs), interleukin 3 (IL-3), granulocyte-macrophage colony-stimulating factor (GM-CSF) and granulocyte colony-stimulating factor (G-CSF) on inducing the growth of colonies derived from patients with acute myeloid leukemia (AML) (CFU-L) were investigated and compared to the proliferative response of CFU-GM derived from highly enriched normal blast cell populations. The effects of GM-CSF and IL-3 alone were similar. Both only minimally stimulated normal colonies derived from CFU-GM when compared to stimulation with MoCM (a mean of 28% of the total colonies and 17% of the colonies greater than 100 cells obtained with MoCM). Similarly, the number of leukemic colonies was substantially less than with MoCM (less than 30% of MoCM) in all but 3/10 AML patients and both were only able to significantly stimulate CFU-L derived colonies greater than 50 cells from 2/10 patients. G-CSF alone stimulated some CFU-L derived colony growth in 9/10 patients but the number stimulated was minimal relative to MoCM in five of the patients and significant stimulation of colonies greater than 50 cells occurred in only one patient. The mean number of normal CFU-GM derived colonies stimulated by G-CSF was 41% of the total colonies and 34% of the colonies greater than 100 cells generated by MoCM. The combination of G-CSF with GM-CSF and G-CSF with IL-3 resulted in a synergistic or additive increase in the number of CFU-L in 5/10 and 7/10 patients, respectively, and a synergistic increase in the size of CFU-L in 5/10. The same combinations resulted in a significant synergistic effect on size of normal CFU-GM derived colonies. There was no evidence of a synergistic increase in the number or size of CFU-L and CFU-GM derived colonies stimulated with GM-CSF in combination with IL-3. In addition, a combination of all three (G-CSF + GM-CSF + IL-3) did not enhance the effect of G-CSF + GM-CSF or G-CSF + IL-3. These results suggest that there is significant heterogeneity among AML patients in the pattern of responsiveness of the leukemic cells to the recombinant growth factors. In addition, their responsiveness does not significantly differ from that of normal progenitors. In view of the current clinical trials with r-CSFs and cytotoxic drugs in AML patients, this issue is important and worthy of further investigation.(ABSTRACT TRUNCATED AT 400 WORDS)


Immobilization of TiO2 nanofibers on reduced graphene sheets: Novel strategy in electrospinning.
A simple and efficient approach is developed to immobilize TiO2 nanofibers onto reduced graphene oxide (RGO) sheets. Here, TiO2 nanofiber-intercalated RGO sheets are readily produced by two-step procedure involving the use of electrospinning process to fabricate TiO2 precursor containing polymeric fibers on the surface of GO sheets, followed by simultaneous TiO2 nanofibers formation and GO reduction by calcinations. GO sheets deposited on the collector during electrospinning/electrospray can act as substrate on to which TiO2 precursor containing polymer nanofibers can be deposited which give TiO2 NFs doped RGO sheets on calcinations. Formation of corrugated structure cavities of graphene sheets decorated with TiO2 nanofibers on their surface demonstrates that our method constitutes an alternative top-down strategy toward fabricating verities of nanofiber-decorated graphene sheets. It was found that the synthesized TiO2/RGO composite revealed a remarkable increased in photocatalytic activity compared to pristine TiO2 nanofibers. Therefore, engineering of TiO2 nanofiber-intercalated RGO sheets using proposed facile technique can be considered a promising method for catalytic and other applications.


Effect of process conditions on the growth of three-dimensional dermal-equivalent tissue obtained by microtissue precursor assembly.
Bottom-up approach is an appealing strategy to build complex three-dimensional (3D) viable tissues in vitro starting from microtissue precursors (μTP). In this work we biofabricated a thick dermal-like tissue by sequentially combining two steps: a μTPs production and assembly followed by tissue maturation in a purpose-built bioreactor. The μTPs were produced by first seeding bovine primary fibroblasts on gelatine microparticles and then cultivating them in stirring conditions until a thick layer of ~80 μm of de novo synthesized extracellular matrix uniformly covered the microparticle surface. The μTPs were then loaded into a cylindrical chamber (2 mm in depth and 35 mm in diameter) and let to maturate and assemble into a 3D viable biohybrid tissue under specific fluid flow conditions. Several combinations of perfusion and/or tangential fluid flow were applied and their effect on the tissue formation and maturation was assessed. Results show that structural composition and mechanical features of the final 3D bioengineered tissue are strongly affected by the hydrodynamic environment and demonstrate that by optimizing culture conditions a 3D viable tissue with properties similar to that of native derma could be produced.


Cloning embryos by nuclear transfer.
Nuclear transfer has been used to study the differentiation process in embryogenesis, as well as a method to produce multiple identical individuals. When nuclei are transferred to activated, enucleated oocytes the nuclei swell in diameter, synthesize DNA, acquire cytoplasmic proteins and release nuclear proteins. This protein exchange is thought to result in specific genomic modifications resulting in the transferred nucleus behaving as a zygotic nucleus. The limitations of development observed with relatively differentiated nuclei are thought to result from asynchronies in the length of the cell cycle between the donor cell and the recipient cytoplasm, as well as insufficient genomic modifications. This results in incomplete DNA synthesis and incomplete reprogramming before the first cell division. These nuclear modifications are discussed with data from amphibians and mammals.


Inter-limb asymmetries and kicking limb preference in English premier league soccer players.
The aims of this study were: (1) to quantify interlimb asymmetries in EPL soccer players in the context of kicking limb preference and (2) to establish the relationship between interlimb asymmetries and measures of physical performance. Twenty-two players (age: 21.8 ± 4.4 years) from an EPL club performed a running gait assessment (20 km/h) and unilateral countermovement jumps, a CoD assessment (modified 505 test), and an isokinetic knee extension/flexion protocol using each leg. Asymmetries were quantified using the percentage difference method and Pearson's correlations were used to quantify the association between variables. Players displayed the greatest level of asymmetry in isokinetic strength measures (5.9-12.7%) and lower levels of asymmetry in gait (1.6-7.7%), jump (0.9-7.0%) and CoD (1.9-3.5%) assessments. The influence of the preferred kicking limb was most evident in the isokinetic assessment with the players showing dominance in the preferred limb for knee flexor strength and in the non-preferred limb for knee extensor strength. These manifested in the asymmetry values calculated for the hamstring:quadricep (H:Q) ratios at 60°/s (8.80 ± 7.82%) and 240°/s (11.22 ± 7.04%) and in the functional H:Q ratio (12.67 ± 8.25%). The asymmetry values for peak extensor moment at 240°/s showed a significant correlation (ρ = -0.55, p = 0.034) with 10 m time in the CoD assessment. These findings provide benchmark asymmetry data for soccer practitioners and reveal that kicking limb preferences may bring about interlimb differences in the H:Q ratio which raises important considerations in the design of testing batteries and injury reduction interventions.


Late hemotoxicity following North American rattlesnake envenomation treated with crotalidae immune F(ab')2 (equine) antivenom and crotalidae immune polyvalent Fab (ovine) antivenom reported to the North American Snakebite Sub-registry.
Late hemotoxicity is common following rattlesnake envenomation treated with crotalidae immune polyvalent Fab (ovine) (FabAV). Initial clinical trials showed crotalidae immune F(ab')2 (equine) (Fab2AV) to be superior to FabAV in preventing late hemotoxicity, but this effect has not been demonstrated in broader populations. This study investigated late hemotoxicity in patients receiving Fab2AV or FabAV after rattlesnake envenomation. This is a retrospective analysis of prospectively collected data from patients with snakebite reported to the ToxIC North American Snakebite Registry (NASBR) between January 1, 2019, and December 31, 2020. Inclusion criteria were rattlesnake envenomation and administration of antivenom. Patients were excluded if they received more than one type of antivenom. The primary outcome was occurrence of late hemotoxicity (platelets ≤120 k/mm3 or fibrinogen ≤170 mg/dL) in patients receiving Fab2AV and FabAV. Data collected included demographics, envenomation characteristics, laboratory values, and treatment administered. Statistics including t-test and Fisher's exact test were used. A total of 201 rattlesnake envenomated patients receiving antivenom were reported to the NASBR in the study period; 144 were included. 49 received Fab2AV alone, 45 received FabAV alone and 50 received both antivenoms. Baseline patient and envenomation characteristics were similar between the groups. Late hemotoxicity occurred in 2/49 patients in the Fab2AV group (4% (95% CI 0.7-12.6)) and in 19/45 patients in the FabAV group (42% (95% CI 28.4-59.0); absolute risk reduction 39.1% (95% CI 21.2-46.2) (p = 0.001). On follow up, 0 patients (0%) receiving Fab2AV were retreated with antivenom; 4 patients (9%) receiving FabAV were retreated (p = 0.049). In the North American Snakebite Registry, late hemotoxicity was less common in rattlesnake envenomated patients treated with Fab2AV compared to FabAV.


Malignant melanoma of the lacrimal sac.
Although malignancies of the lacrimal sac are rare, malignant melanoma of the lacrimal sac is an exceedingly rare occurrence. Patients with abnormalities of the nasolacrimal system may come to otolaryngologists for evaluation. Treatment of lacrimal sac malignancies will necessitate consultation of a head and neck surgeon. The triad of symptoms commonly found in these patients includes epiphora, bloody reflux from the lacrimal punctum, and a medial canthal mass. Early local recurrence occurs frequently. Radical surgical treatment, including wide-field en bloc resection of the entire nasolacrimal system, affords the best protection against local recurrence and provides the best opportunity for enhanced patient survival. Adjunctive therapy in this disorder remains controversial.


Animal models of germinal matrix hemorrhage.
Germinal matrix hemorrhage refers to bleeding that arises from the subependymal (or periventricular) germinal region of the immature brain. Clinical studies have shown that infants who experience germinal matrix hemorrhage can develop hydrocephalus or suffer from long-term neurologic dysfunction, including cerebral palsy, seizures, and learning disabilities. Understanding the causative factors and the pathogenesis of subsequent brain damage is important if germinal matrix hemorrhage is to be prevented or treated. Appropriate animal models are necessary to achieve this understanding. A number of animal species, including mice, rats, rabbits, sheep, pigs, dogs, cats, and primates, have been used to model germinal matrix hemorrhage. This literature review critically evaluates the animal models of germinal matrix hemorrhage. Each model has its own advantages and disadvantages; no single model is suitable for the study of all aspects of brain damage.


Lower urinary tract symptoms in young men: videourodynamic findings and correlation with noninvasive measures.
In a prospective manner we sought to determine the cause of lower urinary tract symptoms in young men and whether noninvasive testing and symptoms scores are useful in deciding which patients to evaluate with videourodynamics. We evaluated 85 men 18 to 45 years old with lower urinary tract symptoms. Patients with a history of known neurological disease or urethral stricture were excluded from the study. Patients were evaluated with the American Urological Association (AUA) symptom index, noninvasive uroflowmetry post-void residual and videourodynamics, and classified by specific urodynamic diagnoses. Noninvasive uroflowmetry (normal versus abnormal), post-void residual and AUA symptom index (total, voiding and storage scores) were evaluated as predictors of urodynamic abnormalities. Mean patient age was 35.1 (range 18 to 45) and mean symptom duration was 53.8 months. Mean AUA scores were total 19.3, voiding 10.8 and storage 8.5. Videourodynamic diagnoses were primary bladder neck obstruction in 40 (47%) cases, dysfunctional voiding in 12 (14%), impaired contractility in 8 (9%), sensory urgency in 7 (8%), detrusor instability alone in 5 (6%), detrusor instability and impaired contractility in 1 (1%), external detrusor-sphincter dyssynergia in 1 (1%) and normal in 5 (6%). Of these patients, 9 could not void during urodynamics and in 6 (7%) no urodynamic diagnosis was made. Videourodynamics were not considered helpful in patients with a normal or nondiagnostic study or sensory urgency only (group 1) but were helpful or diagnostic in the remaining patients (group 2). Only 5 of 18 patients (28%) in group 1 had an abnormal uroflow compared to 56 of 67 (84%) in group 2 (p <0.0001). Mean post-void residual volumes were not different between the 2 groups (40.3 versus 40.0 ml.). Mean total and storage symptom scores were also not different between the 2 groups but voiding scores were significantly higher in group 2 (11.5 versus 8.3, p <0.03). Lower urinary tract symptoms in young men have a variety of underlying causes. Videourodynamics is an extremely helpful diagnostic test especially in men with abnormal uroflow and high voiding scores.


The effects of exercise stress testing, diurnal variation and temporal decline on circulating progenitor cells.
Endothelial damage/dysfunction is involved in numerous cardiovascular disease processes. Given that the mature endothelial cells have limited capacity for self regeneration, circulating progenitor cells (CPCs) may modulate the balance between vascular damage and regeneration. The three aims of the present study were 1) to define the influence of exercise treadmill testing (ETT) on peripheral CPC levels; 2) to assess the diurnal variation of CPC counts; and 3) to investigate the rate of temporal decline in CPCs once ex vivo . The dynamics of CPC count changes following an ETT were assessed on consecutive 20 patients referred to our 'rapid-access' chest pain clinic (70% male, age 69.9 +/- 7.8) with venous blood samples taken pre-exercise, immediately post-exercise and at 30 minutes post-exercise. Diurnal variation in CPCs was assessed in 13 stable in-hospital patients (46% male, age 69.1 +/- 7.5 years) with blood samples were taken five times every 6 hours. To investigate the temporal decline, blood samples from 12 patients (58.3% male, age 69.9 +/- 7.9 years) were reprocessed for CPC counts at 4 hours and at 24 hours after sample collection. Plasma levels of von Willebrand factor (vWf) and soluble E-selectin (sE-selectin) were assessed by ELISA. CPCs were enumerated with flow cytometry as CD34+, CD133+, CD45dim events. Exercise led to significant increases in vWF and sE-selectin levels, but no significant influence on CPC counts were observed. Baseline CPC numbers demonstrated a negative correlation with vWf (r=-0.551, p=0.012) and sE-selectin levels (r=-0.494, p=0.027). CPC counts showed a significant diurnal variation, being significantly higher at 12 a.m. compared to 12 p.m. (p=0.046) and 6 p.m. (p=0.023). A 4 hour delay in sample preparation did not affect CPCs counts, but there was a significant decline in CPC recovery when sample processing was delayed by 24 hours (p<0.05). Routine exercise stress testing does not significantly affect CPC counts. Peripheral CPC levels showed a significant diurnal variation. Delays in sample preparation for CPC counts should be avoided as they may influence the accuracy of the test by resulting in a significant decline in CPC recovery. Thus, various factors may affect accuracy of CPC enumeration that may limit their role as a reliable clinical marker and biomarker of endothelial damage.


The effects of pravastatin on hyperlipidemia in renal transplant recipients.
Hyperlipidemia may be one of the risk factors in the development of atherosclerotic disease in renal transplant recipients. In the present study, 24 kidney recipients with hyperlipidemia were treated with an HMG-CoA reductase inhibitor, pravastatin (10 mg/day). All recipients had been treated with cyclosporine (CsA), azathioprine (Az), and prednisolone (Pred). The mean total cholesterol (T-chol) level decreased from 323 +/- 7.4 to 261 +/- 7.9 mg/dl at one month after starting treatment (P less than 0.01) and this level did not change during treatment for further 6 months. The mean LDL cholesterol level was also decreased from 205.9 +/- 11.2 to 118.7 +/- 8.1 mg/dl at 3 months after starting treatment (P less than 0.01). On the other hand, pravastatin did not affect the levels of HDL-cholesterol and triglycerides. Pravastatin did not show any effects on the white blood cell, monocyte, and lymphocyte counts, or the hemoglobin concentration (NS). One patient displayed a slight elevation of aspartate aminotransferase and alanine aminotransferase levels, but this was not sufficient to cease treatment. Pravastatin did not adversely affect the renal function or creatinine phosphokinase (CPK) levels. Two recipients developed nausea and vomiting and their treatment was stopped. Pravastatin appears to be a safe and efficacious method of treating hyperlipidemia in renal transplant recipients.


A chief safety officer as the driver and guardian of a great safety rating.
If the Pharmaceutical Industry were to align to broad metrics that objectively state each product's "Safety Rating" two things would happen. First, Life Sciences companies would refocus dramatically on safety (followed by outcomes). Second, companies that have the highest aggregate "Safety Rating" would enjoy a significant competitive advantage. To achieve and maintain a high safety rating, the role of Safety officer needs to be elevated to the C-Suite.


Studies on papillary function and effect of prifinium bromide and other antispasmodics on motility of the papillary region (sphincter of Oddi) in humans.
We determined endoscopically the motility of the papillary region in humans, using a pressure sensor devised in our department. The subjects were 184 patients with various diseases. Prifinium bromide and four other antispasmodics were given to 60 of the 184 patients, and their effects were investigated. In 41 (85%) of the 48 patients with chronic gastritis, regular wave patterns were noted. In 35 (85%) of the 41 patients with diseases of the biliary tract and papillary region, in nine (82%) of the 11 patients with pancreatic diseases, and in six (67%) of the nine patients with liver diseases, irregular wave patterns were observed. It was postulated that a high incidence of papillary dysfunction accompanies biliary and pancreatic diseases. Additionally, it was concluded that prifinium bromide has as potent an effect on motility of the papillary region as does a massive dose (40 mg) of hyoscine N-butylbromide.


Activity of Trichoderma asperellum Strain ICC 012 and Trichoderma gamsii Strain ICC 080 Toward Diseases of Esca Complex and Associated Pathogens.
Grapevine trunk diseases are widespread in all grape-growing countries. The diseases included in the Esca complex of diseases are particularly common in European vineyards. Their distinctive foliar symptoms are well known to be associated not only with losses in quantity, as with all grapevine wood diseases, but also with losses in the quality of the crop. Protection of pruning wounds is known to reduce infections in artificial inoculations and, to some extent, reduce the external leaf symptoms. The application of biological control agents in the field is typically started at the first appearance of symptoms. In this article, the two strains belonging to two different species, Trichoderma asperellum ICC 012 and T. gamsii ICC 080, which are present in a commercial formulation, were tested in vitro, in vivo in artificial inoculation, and in the field in long-term experiments where the wounds on four young asymptomatic vineyards were protected since 1 or 2 years after planting. The in vitro trials highlighted the different temperature requirements of the two strains, the direct mycoparasitizing activity of T. asperellum, and the indirect activity shown by both Trichoderma strains. The in vivo trials confirmed the ability of the two strains to reduce the colonization following artificial inoculations with the high, unnatural concentration of spores used in artificial infections, even if with variable efficacy, and with long persistence as they could be reisolated 7 months post-application. The preventive applications carried out over 9 years showed a very high reduction in symptom development in the treated vines, on annual and cumulated incidence and on the death of vines, with disease reduction varying from 66 to almost 90%. Early and annual application of protection to the pruning wounds appears to be the best method for reducing damages caused by grapevine leaf stripe disease (a disease of the Esca complex of diseases). Trichoderma appears to offer an efficient, environmentally friendly, and long-lasting protection in the presence of a natural inoculum concentration.


Evaluation of Targeted Agents for Advanced and Unresectable Hepatocellular Carcinoma: A Network Meta-Analysis.
Objective: To evaluate different targeted anticancer agents for patients with advanced or unresectable hepatocellular carcinoma (HCC) based on network meta-analysis. Methods: Literature retrieval was conducted in globally recognized databases, namely, MEDLINE, PMC, EMBASE and Cochrane Central to find relevant randomized controlled trials (RCTs). Relative parametric data, including overall survival (OS), progression-free survival (PFS) and adverse event (AE), were quantitatively pooled and estimated based on the Bayesian theorem. The values of the surface under the cumulative ranking (SUCRA) probabilities regarding each parameter were calculated and ranked. Node-splitting analysis was performed to test the inconsistency of the main results, and publication bias was assessed by examining funnel-plot symmetry. Results: After a detailed review, 31 RCTs containing 20 different agents or combinations were finally included for network meta-analysis. For patients without previously systematic treatments, lenvatinib had the best clinical effects on OS (SUCRA, 0.22), and apatinib was superior regarding PFS (SUCRA, 0.41) and AE (SUCRA, 0.15). For patients who received previously targeted agents therapies, regorafenib exhibited the superior clinical effects on OS (SUCRA, 0.42) and PFS (SUCRA, 0.30), while codrituzumab showed the greatest safety benefit on AE (SUCRA, 0.75). Moreover, node-splitting analysis and funnel-plot symmetries illustrated no inconsistency or obvious publication bias in the current study. Conclusions: According to current evidence, lenvatinib and apatinib had superior clinical effects for patients without previously systematic treatments, and regorafenib seemed to be more suitable for patients with previously targeted agent therapies. However, our conclusions still need more statistical validations, and more high-quality trials are expected.


A systematic review of different jump-landing variables in relation to injuries.
Injuries of the lower extremity tend to be associated with jump-landing movements. This review provides an overview of the kinematic variables and malalignments during jump-landing, which could be attributed to overuse or acute injury occurrence. We searched ISI Web of Knowledge, SPORTDiscus, PubMed, EMBASE and SCOPUS for all studies, published before October 2012, which looked at the relation between kinematic risk factors and malalignments of jump-landing and injuries. An article was included 1) if the article was an observational, retrospective or prospective study; 2) if the article investigated the relationship between injuries and the visible and easily measurable kinematic variables or malalignments of the jump-landing technique; 3) if the article met a predefined quality cut-off score. Ten studies met all inclusion criteria. Literature shows that several kinematic factors are related to lower acute and overuse injuries. A stiffer jump-landing technique is a risk factor in the development of overuse injuries and acute injuries. This is caused by less active motion in the lower extremity joints and by the increased valgus position of the knee during the jump-landing maneuver which creates an unfavorable alignment of the lower extremity. A valgus position of the knee during landing was also a predictor of acute lower extremity injuries. Future intervention programs should focus on the jump-landing technique and the performance of the athlete.


In vitro cytotoxicity of cadmium microparticles for rabbit pulmonary alveolar macrophages.
A cytotoxic effect of cadmium monoxide microparticles on rabbit pulmonary alveolar macrophages was observed in vitro from 1 to 2 microg of metal cadmium per million cells (and per milliliter of incubation medium). This threshold was close to the one observed with lead microparticles, which in addition appeared to have a faster cytotoxic action. On the other hand, cadmium microparticles inhaled in vivo are known to be much more toxic to the respiratory system and much more slowly cleared from it than lead particles. These contradictions can be partially explained by our observation that in vitro the ability of alveolar macrophages to phagocytize microparticles was significantly lower for cadmium monoxide than for lead monoxide microparticles.


Significant premaxillary augmentation.
Substantial premaxillary augmentation is necessary as an adjunctive treatment in most cleft rhinoplasties and in those patients exhibiting an acute nasolabial angle due to retrusion of the premaxila. We describe our technique of evaluation and treatment of this condition using a custom-carved piece of material made from a woven combination of Teflon and organic fibers (Proplast). Detailed technical illustrations as well as patient results are demonstrated. We have found this technique in our hands to be a simple, safe, and effective means of correction of significant premaxillary retrusion.


Button Gastrostomy Tubes for Pediatric Patients: A Tertiary Care Center Experience.
Out of 34 patients who underwent gastrostomy tube insertion, 30 patients had their long tube replaced by a button gastrostomy. Majority were males (N = 18, 60%). Prolonged nasogastric tube feeding was the main indication of referral (N = 17, 56%) followed by feed intolerance (N = 6, 17%) and gastroesophageal reflux disease (N = 5, 16%). The main underlying diseases at referral were neurological impairment (N = 19, 63%) and metabolic disorders (N = 4, 13%). There was no significant difference between patients with neurological disorders and other diseases in terms of gender, nationality, or age. Laparotomy with gastrostomy is the main approach used (N = 18, 60%). No reported complications of button tubes in 50% of the patients (N = 15). Prolonged nasogastric tube feeding is the main indication of referral for gastrostomy tube insertion. Neurological disorders are the main diagnosis for the cases operated upon. Laparotomy with gastrostomy is the procedure of choice at our center. Majority of patients had no reported complications of button tube replacement. These children are likely to benefit from the button tube with fewer complications.


Intake, digestibility, and rumen and metabolic characteristics of cattle fed low-quality tropical forage and supplemented with nitrogen and different levels of starch.
Effects of nitrogen supplementation associated with different levels of starch on voluntary intake, digestibility, and rumen and metabolic characteristics of cattle fed low-quality tropical forage (Brachiaria decumbens hay, 7.4% crude protein, CP) were evaluated using ruminal and abomasal cannulated steers. Five European×Zebu young bulls (186 kg body weight, BW) were distributed according to a 5×5 Latin square. The following treatments were evaluated: control, supplementation with 300 g CP/d (0:1), supplementation with 300 g starch/d and 300 g CP/d (1:1), supplementation with 600 g starch/d and 300 g CP/d (2:1), and supplementation with 900 g starch/d and 300 g CP/d (3:1). A mixture of nitrogenous compounds provided 1/3 from true protein (casein) and 2/3 from non-protein nitrogen (mixture of urea and ammonium sulphate, 9:1) was used as the nitrogen supplement. In order to supply energy a unique source of corn starch was used. Supplements increased (p<0.05) dry matter intake, but did not affect (p>0.05) forage intake. There was a cubic effect (p<0.05) of starch on voluntary intake. This was attributed to the highest forage intake (g/kg BW) when using the 2:1 starch:CP ratio. Supplements increased (p<0.05) organic matter (OM) digestibility, but did not affect (p>0.05) neutral detergent fibre corrected for ash and protein (NDFap) digestibility. There was a positive linear effect (p<0.05) of the amount of starch supplemented on OM digestibility. Total NDFap digestibility was not affected (p>0.05) by the amount of supplemental starch. Ruminal ammonia nitrogen concentrations were higher (p<0.05) in supplemented animals, however, a negative linear effect (p<0.05) of amount of starch was observed. Supplements increased (p<0.05) the nitrogen balance (NB) and efficiency of nitrogen utilization. These effects were attributed to increased body anabolism, supported by higher (p<0.05) serum concentration of insulin-like growth factor 1. Increasing the amount of starch tended (p<0.06) to linearly increase the NB. In spite of this, there was a highest NB value for the 2:1 starch:CP ratio amongst the treatments with supplementation. Nitrogen supplementation in cattle fed low-quality tropical forage increases nitrogen retention in the animal's body. An additional supply of starch increases nitrogen retention by increasing energy availability for both rumen and animal metabolism.


Cerebral ganglioglioma with anaplastic oligodendroglial component.
We report an unusual and possibly unique example of cerebral ganglioglioma with an anaplastic oligodendroglial component. The latter was documented on both morphological and immunohistochemical grounds. Immunohistochemically, the anaplastic cells were strongly positive with the monoclonal antibody anti-Leu-7, while they lacked glial fibrillary acid protein, vimentin and neurofilaments.


[Pure laparoscopic DP-CAR procedure with portal vein resection].
To improve short- and long-term outcomes of locally advanced pancreatic body-tail cancer followed by major vessels invasion. A case report of pure laparoscopic DP-CAR procedure with portal vein resection for locally advanced pancreatic body-tail cancer followed by severe abdominal pain in a 49-year-old patient is presented. Liver or stomach ischemia was not observed. Portal wall resection wasn't associated with any complication and resulted R0-resection. Postoperative period was complicated by Grade B pancreatic fistula. Preoperative abdominal pain completely disappeared after surgery. Surgery time was 330 min, intraoperative blood loss - 300 ml. The patient is currently undergoing FOLFIRINOX adjuvant chemotherapy. CT in 90 days after surgery confirmed no progression of disease or liver/stomach blood supply congestion. Modern technologies provide the opportunity to perform pure laparoscopic advanced surgical procedures with major vessels resection. Pure laparoscopic DP-CAR procedure with portal vein resection is effective and safe procedure that can be performed with all principles of open surgery and is associated with acceptable short- and long-term results.


Sequence analysis of the 144-kilobase accessory plasmid pSmeSM11a, isolated from a dominant Sinorhizobium meliloti strain identified during a long-term field release experiment.
The genome of Sinorhizobium meliloti type strain Rm1021 consists of three replicons: the chromosome and two megaplasmids, pSymA and pSymB. Additionally, many indigenous S. meliloti strains possess one or more smaller plasmids, which represent the accessory genome of this species. Here we describe the complete nucleotide sequence of an accessory plasmid, designated pSmeSM11a, that was isolated from a dominant indigenous S. meliloti subpopulation in the context of a long-term field release experiment with genetically modified S. meliloti strains. Sequence analysis of plasmid pSmeSM11a revealed that it is 144,170 bp long and has a mean G+C content of 59.5 mol%. Annotation of the sequence resulted in a total of 160 coding sequences. Functional predictions could be made for 43% of the genes, whereas 57% of the genes encode hypothetical or unknown gene products. Two plasmid replication modules, one belonging to the repABC replicon family and the other belonging to the plasmid type A replicator region family, were identified. Plasmid pSmeSM11a contains a mobilization (mob) module composed of the type IV secretion system-related genes traG and traA and a putative mobC gene. A large continuous region that is about 42 kb long is very similar to a corresponding region located on S. meliloti Rm1021 megaplasmid pSymA. Single-base-pair deletions in the homologous regions are responsible for frameshifts that result in nonparalogous coding sequences. Plasmid pSmeSM11a carries additional copies of the nodulation genes nodP and nodQ that are responsible for Nod factor sulfation. Furthermore, a tauD gene encoding a putative taurine dioxygenase was identified on pSmeSM11a. An acdS gene located on pSmeSM11a is the first example of such a gene in S. meliloti. The deduced acdS gene product is able to deaminate 1-aminocyclopropane-1-carboxylate and is proposed to be involved in reducing the phytohormone ethylene, thus influencing nodulation events. The presence of numerous insertion sequences suggests that these elements mediated acquisition of accessory plasmid modules.


Awake Surgery for Local Recurrence of Brain Metastasis in the Precentral Gyrus After Fractionated Stereotactic Radiotherapy: A Technical Case Report.
To avoid permanent neurologic deficits and preserve brain function, intraoperative electrical stimulation mapping (IESM) is essential for surgical resection. A 59-year-old right-handed woman with ovarian cancer who had undergone stereotactic radiotherapy for brain metastasis two years before, was introduced due to progressive left upper paresis. Magnetic resonance imaging showed a recurrence of the lesion. We performed awake surgery using IESM. Thus, the sensorimotor site was elicited on the precentral and postcentral gyrus. However, IESM elicited no disturbance of motor function on the surface of the posterior part of the precentral gyrus. We made a safe corticotomy on it, and performed the resection of recurrent BM. Preserving the motor and sensory function, we achieved the resection of BM. After surgery, she experienced a significant improvement in motor function. IESM is a useful tool to make a safe approach via the precentral gyrus avoiding permanent sensorimotor deficits.


Time resolved plasma diagnostics for pulsed 2.45 GHz hydrogen discharges.
A review of the last ten years of advances in temporal resolved plasma diagnostics for pulsed operated 2.45 GHz microwave-driven hydrogen discharges is presented. Special attention has been paid to the study of breakdown and decay processes where some particular phenomena are explored for application in ion sources. Measurements of plasma temperature and density using vacuum ultraviolet spectroscopy, ultra-fast photography, and ion mass spectroscopy are performed in detail, including examples and results.


[Gastric metastasis from renal cell carcinoma 20 months after radical nephrectomy: a case report].
Metastatic lesions from renal cell carcinoma (RCC) commonly occur in the lung and bone, gastric metastasis has rarely been reported in the literature. We present herein a case of a man with gastric metastasis from RCC. A 49-year-old male was admitted to our hospital complaining of dyspnea on exercise. He had undergone right radical nephrectomy due to RCC two years ago (T3a NO MI), followed by postoperative immunotherapy with interferon-alpha and interleukin 2. Gastrointestinal endoscopy revealed a solitary polypoid lesion about 20 mm in diameter in the greater curvature of the middle gastric body. Endoscopic needle biopsy revealed poorly differentiated adenocarcinoma. Partial gastrectomy was performed and histologic examination of the resected specimen confirmed diagnosis of clear cell renal carcinoma. Metastasis of any cancer to the stomach is quite uncommon. In particular, gastric metastasis from RCC is extremely rare. To our knowledge, this is the 15th case of gastric metastasis from RCC reported in Japan.


Development and evaluation of an electronic guide for introductory microbiology skills.
To increase the quality of instruction, enhance student learning, and decrease laboratory time spent on laboratory safety, basic skills, and the use of equipment, we developed the Micro eGuide website. We compared the performance of students who used the Micro eGuide to students provided more traditional instruction in both an upper-level introductory microbiology course for biology majors and in a lower-division introductory microbiology course for nonmajors. Assessment of student learning included written pretests and posttests, practical testing of laboratory skills, and for the major's class, a review of poster presentations of independent projects. Students who used the Micro eGuide showed a statistically significant increase in performance on written examination in the introductory microbiology courses for both biology majors and nonmajors. Use of the Micro eGuide in the sophomore-level course for nonbiology majors resulted in a statistically significant improvement in laboratory skills. Though the increase in laboratory skills in the majors courses was not statistically significant, instructors were able to use the site as an effective learning source and decrease the time spent in class on topics covered in the Micro eGuide. While the number of student independent research projects was too small for statistical analysis on the quality of the poster presentations, the improvement in student attitude and the increase in the diversity in topics selected suggests that students using the Micro eGuide had increased comfort with microbiology and increased interest in exploring microbiology.


Comparative analysis of the efficacy of A1 adenosine receptor activation of Gi/o alpha G proteins following coexpression of receptor and G protein and expression of A1 adenosine receptor-Gi/o alpha fusion proteins.
HEK293T cells were transiently transfected to express either the human A1 adenosine receptor together with pertussis toxin-resistant cysteine-to-glycine forms of the alpha subunits of Gi1 (C351G), Gi2 (C352G), and Gi3 (C351G) and wild-type Go1alpha or fusion proteins comprising the A1 adenosine receptor and these Gi/o G proteins to compare A1 adenosine receptor agonist-mediated activation of these Gi family G proteins upon coexpression of individual Gi/o G proteins and receptor versus expression as receptor-G protein fusion proteins. Addition of the adenosine receptor agonist 5'-N-ethylcarboxamidoadenosine (NECA) to membranes of pertussis toxin-treated cells resulted in a concentration-dependent stimulation of [35S]GTPgammaS binding with comparable amounts of NECA required to produce half-maximal stimulation following transfection of A1 adenosine receptor and Gi/o G proteins either as fusion proteins or as separate polypeptides. However, the magnitude of agonist-mediated activation of GTPgammaS binding was greatly enhanced by expressing the A1 adenosine receptor and Gi family G proteins from chimaeric open reading frames. This observation was consistent following the study of more than 40 agonists. No preferential activation of any G protein was observed with more than 40 A1 receptor agonists following cotransfection of receptor with G protein or transfection of receptor-G protein fusion proteins. These studies demonstrate the utility of using fusion proteins to study receptor-G protein interaction, show that the A1 adenosine receptor couples equally well to the Gi/o G proteins Gi1alpha, G i2alpha, Gi3alpha, and Go1alpha, and demonstrate that for a range of agonists there is no selectivity for activation of any particular A1 adenosine receptor-Gi/o G protein combination.


Acute respiratory failure: a gender-based outcomes analysis.
To determine the influence of gender on patient outcomes and the delivery of medical care during mechanical ventilation for acute respiratory failure. A prospective cohort study. Medical intensive care unit of a university-affiliated urban teaching hospital. Three hundred twenty-one patients with acute respiratory failure requiring mechanical ventilation. Prospective patient surveillance and data collection. One hundred six patients (33.0%) died during hospitalization. No statistically significant difference in mortality rates was observed between male and female patients (36.1% versus 30.1%; P = .252). The duration of mechanical ventilation, intensive care unit length of stay, and hospital length of stay were also similar between men and women with acute respiratory failure. The presence of the acute respiratory distress syndrome (ARDS; adjusted odds ratio [AOR] = 3.65; 95% confidence interval [CI] = 2.34 to 5.71; P = .004), the number of acquired organ system derangements (AOR = 1.36; 95% CI = 1.20 to 1.53; P = .013), the predicted hospital mortality using acute physiology and chronic health evaluation (APACHE) II scores (AOR = 1.05; 95% CI = 1.04 to 1.05; P < .001), and patient age (AOR = 1.02; 95% CI = 1.01 to 1.03; P = .016) were found to be independent determinants of hospital mortality using multiple logistic regression analysis. These data suggest that important gender-specific differences in outcome do not occur among patients with respiratory failure requiring mechanical ventilation. Severity of illness, patient age, and acquired organ system derangements appear to be the most important determinants of mortality for patients with acute respiratory failure, regardless of patient gender.