Effects of the twin-arginine translocase on the structure and antimicrobial susceptibility of Escherichia coli biofilms.
In this descriptive study, we used Escherichia coli twin-arginine translocase (tat) mutants to distinguish antibiotic tolerance from the formation of mature biofilm structure. Biofilm formation by wild-type and deltatat strains of E. coli was evaluated using viable cell counts, scanning electron microscopy, and confocal laser-scanning microscopy. Escherichia coli deltatat mutants had an impaired ability to form biofilms when grown in rich or minimal media. These mutants produced disorganized layers and cell aggregates with significantly decreased cell density relative to the wild-type strain. In contrast, wild-type E. coli grown under similar test conditions formed highly structured, surface-adherent communities. We thus determined if this decreased biofilm formation by E. coli deltatat mutants may result in lowered tolerance to antimicrobials. When grown in rich media, planktonic deltatat mutants were hypersensitive to some metals, detergents, and antibiotics. However, the corresponding biofilms were about as resilient as the wild-type strain. In contrast, both planktonic cells and biofilms of the deltatatABC strain grown in minimal media were hypersensitive to many antimicrobials. Remarkably, these biofilms remained up to 365 times more tolerant to beta-lactams than corresponding planktonic cells. Our data suggest that the twin-arginine translocase may play a contributing role in the antimicrobial tolerance, structural organization, and formation of mature E. coli biofilms under nutrient-limited conditions. However, the high tolerance of the deltatatABC strain to bactericidal concentrations of antimicrobials indicates that mature biofilm structure may not be required for surface-adherent E. coli to survive exposure to these lethal factors.


Genotoxic assessment of calcium hypochlorite and Strychnos potatorum Linn. seeds-two commonly used water purifying agents.
The role of water in our daily lives cannot be highlighted enough, and ensuring the availability of pure water is an urgent need. Bleaching powder (calcium hypochlorite) and Strychnos potatorum Linn. seeds are commonly used in water purification as a disinfectant and anticoagulant, respectively, yet their safety levels have not been analyzed so far. Hence, a genotoxic assessment was conducted using Allium cepa chromosome aberration assay. Reduction in mitotic index and increase in abnormality percentage was observed for both, but this effect was dose dependent. All values were statistically significant at p<0.05%. Bleaching powder was found to be cytotoxic and genotoxic compared with the control. Abnormality percentage was found to be significantly high when compared with the positive control. Chromosome aberrations like binucleate condition, micronuclei formation, stickiness, and lesions could only be observed in root meristems treated with positive control and bleaching powder. The seeds of S. potatorum expressed mild cytotoxicity, but the genotoxic effect was found to be negligible when compared with positive control. Other chromosome aberrations observed included chromosome bridges, c-metaphases, chromosome laggards, shift in microtubule organizing centre, polyploidy, early movement of chromosomes, vagrant chromosomes, as well as diagonal, disturbed, and scattered arrangement of chromosomes. Thus, the genotoxic effect of bleaching powder warns people to use a safer choice of S. potatorum in water purification, whenever possible, as in the condition of muddy, coagulated water.


Evaluating the relationship between citation set size, team size and screening methods used in systematic reviews: a cross-sectional study.
Standard practice for conducting systematic reviews (SRs) is time consuming and involves the study team screening hundreds or thousands of citations. As the volume of medical literature grows, the citation set sizes and corresponding screening efforts increase. While larger team size and alternate screening methods have the potential to reduce workload and decrease SR completion times, it is unknown whether investigators adapt team size or methods in response to citation set sizes. Using a cross-sectional design, we sought to understand how citation set size impacts (1) the total number of authors or individuals contributing to screening and (2) screening methods. MEDLINE was searched in April 2019 for SRs on any health topic. A total of 1880 unique publications were identified and sorted into five citation set size categories (after deduplication): < 1,000, 1,001-2,500, 2,501-5,000, 5,001-10,000, and > 10,000. A random sample of 259 SRs were selected (~ 50 per category) for data extraction and analysis. With the exception of the pairwise t test comparing the under 1000 and over 10,000 categories (median 5 vs. 6, p = 0.049) no statistically significant relationship was evident between author number and citation set size. While visual inspection was suggestive, statistical testing did not consistently identify a relationship between citation set size and number of screeners (title-abstract, full text) or data extractors. However, logistic regression identified investigators were significantly more likely to deviate from gold-standard screening methods (i.e. independent duplicate screening) with larger citation sets. For every doubling of citation size, the odds of using gold-standard screening decreased by 15 and 20% at title-abstract and full text review, respectively. Finally, few SRs reported using crowdsourcing (n = 2) or computer-assisted screening (n = 1). Large citation set sizes present a challenge to SR teams, especially when faced with time-sensitive health policy questions. Our study suggests that with increasing citation set size, authors are less likely to adhere to gold-standard screening methods. It is possible that adjunct screening methods, such as crowdsourcing (large team) and computer-assisted technologies, may provide a viable solution for authors to complete their SRs in a timely manner.


The saboteurs of Britain's opiate policy: overprescribing physicians or American-style "junkies"?
In the 1950s a new deviant drug user, the American-style "junkie", appeared in the United Kingdom. Previous discussions of this subculture have not raised the issue of how it came to be patterned on a foreign model, rather than evolving as a domestic deviant style. A number of overprescribing physicians who nourished the new subculture by their generous prescribing practices provided the impetus for changes in British drug policy. It is argued that these "overprescribers" were the creation of the new generation of heroin users, as well as their creators.


Social Anxiety and Biased Recall of Positive Information: It's Not the Content, It's the Valence.
Cognitive theorists hypothesize that individuals with social anxiety are prone to memory biases such that event recall becomes more negative over time. With few exceptions, studies have focused primarily on changes in negative self-judgments. The current study examined whether memory for positive social events is also subject to recall bias. Undergraduate participants (N = 138) engaged in an unexpected public speaking task and received standardized positive or neutral feedback on their performance. They rated their memory of the received feedback following a 5-minute delay and again 1 week later. Results revealed that higher scores on social anxiety symptoms predicted significant reductions in the recalled valence of positive feedback over time, whereas no changes were observed for neutral feedback. The results suggest that social anxiety may lead to erosion in memory of positive events.


Mental health and psychosocial characteristics of breast augmentation patients.
Cosmetic breast surgery experience and a wide range of mental health, psychosocial, and sociodemographic variables were assessed in the population-based Norwegian Mother and Child Cohort Study (N = 78,252). Breast augmentation patients reported elevated mental health problems. Factors in the domains of physical appearance, drug use, relationships, and exposure to abuse were all related to breast augmentation. Adjusting for such factors reduced the relationships between breast augmentation surgery and all mental health problems to non-significance. Results indicate that the increased prevalence of mental health problems among breast augmentation patients has to be understood from multiple perspectives involving several psychosocial domains.


Writing a technical note.
A technical note is a short article giving a brief description of a specific development, technique or procedure, or it may describe a modification of an existing technique, procedure or device applicable to medicine. The technique, procedure or device described should have practical value and should contribute to clinical diagnosis or management. It could also present a software tool, or an experimental or computational method. Technical notes are variously referred to as technical innovations or technical developments. The main criteria for publication will be the novelty of concepts involved, the validity of the technique and its potential for clinical applications.


Cognition and emotion: a plea for theory.
Research on cognition and emotion during the past 30 years has made reasonable progress in theory, methods and empirical research. New theories of the cognition-emotion relation have been proposed, emotion research has become more interdisciplinary, and improved methods of emotion measurement have been developed. On the empirical side, the main achievement of the past 30 years is seen to consist in the reduction of the set of serious contenders for a theory of emotions. Still, several important issues are not fully resolved, including the computational implementation of appraisal processes, the nature of emotions, and the link between emotions and actions. Also, quantitative theories of the cognition-emotion relation need to be refined and tested, and improved theories of the link between emotions and bodily and facial expressions need to be developed. To counter the dangers of theoretical fragmentation and knowledge loss, more efforts should be devoted to the analysis, reconstruction, comparison and integration of important theories and hypotheses in the field of emotion, as well as to the systematization of arguments in favor and against these theories and hypotheses.


The use of control - the actions of informal carers on those at risk from falling at home. A qualitative study.
To explore the experiences of informal carers who provide care for frail, older adults who are at risk from falling in their own home. Frail, older adults who fall present a significant challenge for their careers and the health and social care services that support them. Falls can often mean long stays in acute hospital facilities or admission to care homes. Research studies have often investigated the cause and effect of falls in relation to risk, but there has been a limited amount of insight into how informal carers manage those who are at risk from falling in their own home. A qualitative study that used thematic analysis was adopted. Ten informal carers participated in the study. Data were collected via one to one, semi structured interviews in the care recipient's home from February to May 2019. The study applied the COREQ research checklist. Findings highlight that informal carers believed that once a fall had occurred, further falls were inevitable and that falls prevention interventions were of little value. To prevent falls, informal carers would restrict the activity of the care recipient as well as controlling both the environment and the care recipient's movements. A better understanding of the use of control and monitoring of care recipients by informal carers is important. This knowledge will enable the delivery of falls prevention interventions for the frail, adult population that are effective, appropriate and promote the delivery of evidence-based care.


A retrospective analysis from a single center for 60 COVID-19 patients with asymptomatic, mild to moderate, and severe conditions in Wuxi, China.
The aim of this study was to retrospectively analyze the clinical data of COVID-19 patients with different severity during February 2020 in Wuxi, China.The present retrospective study included a total of 60 cases who were diagnosed as COVID-19 patients and hospitalized in the Wuxi Fifth People's Hospital during February 2020 to March 2020. Among all patients 14 cases were asymptomatic, 25 cases were with mild stage, 13 cases were with moderate stage, and 8 cases were with severe stage. Basic clinical data as well as clinical characteristics, including temperature, respiratory rate, heart rate, blood gas analysis data, whole blood test data, and the prognosis condition, were collected and analyzed. Statistical analysis was conducted in different severity stage patients.Among the patients, the median temperature gradually increased from the asymptomatic to the severe patients and the median age increased from the mild to the severe patients with statistical difference. The hospitalization duration was the highest in severe patients. Higher heart rate, as well as lower oxygen partial pressure and oxygenation index were observed in severe patients than the other groups. Besides, higher CRP and globulin levels after admission were found in severe patients, and were gradually increased from the asymptomatic patients to the severe patients. On the contrary, the lymphocyte ratio and count was significant lower in severe patients. We also observed higher D-Dimer levels in the severe patients and the difference was statistical. Among all patients, 2 cases (3.33%) died and other patients were all cured after treatment.Statistical difference was mainly found mainly in age, hospitalization duration, temperature, CRP levels, O2 partial pressure and oxygenation index, globulin, lymphocyte ratio, and D-Dimer in patients with different severity. The higher CRP levels, lower O2 partial pressure and oxygenation index, higher globulin, lower lymphocyte ratio, and higher D-Dimer might be associated with the patients' severity.


[Edwardsellia tarda septicemia in chronic lymphoid leukemia].
Edwardsiella tarda is a Gram negative bacilli. At least 300 cases have been reported in the literature. Here we report a new case of Edwardsiella tarda septicemia in an immunocompromised patient with chronic lymphocytic leukemia. Chief infections associated with this bacterium include bacterial gastroenteritis and septicemia with fatal evolution in 50% of cases. Risk factors associated with Edwardsiella tarda infections include exposure to aquatic environments and exotic animals. Although studies indicate that this bacterium is susceptible to most commonly prescribed antibiotics, it is interesting to note that in our case, Edwardsiella tarda was resistant to numerous beta-lactamins.


Complete primary structure of the major component myoglobin of California gray whale (Eschrichtius gibbosus).
The complete primary structure of the major component myoglobin from the California gray whale, Eschrichtius gibbosus, was determined by specific cleavage of the protein to obtain large peptides for degradation by the automatic sequenator. Cleavage at the two methionine residues of the apomyoglobin with cyanogen bromide and at the three arginine residues of the methyl acetimidated protein with trypsin resulted in three and four easily separable peptides, respectively, which when sequenced accounted for 85% of the primary structure. The remainder of the covalent structure was obtained by further digestion of the central cyanogen bromide peptide with trypsin and S. aureus strain V8 protease. This protein differs from that of the sperm whale, Physeter catodon, at 12 positions, from that of the common porpoise, Phocoena phocoena, and the Black Sea dolphin, Delphinus delphis, at 14 positions, and from that of the Amazon River dolphin, Inia geoffrensis, at 7 positions. All substitutions observed in this sequence fit easily into the tertiary structure of sperm whale myoglobin.


Application of a new expert system for the structure elucidation of natural products from their 1D and 2D NMR data.
Described herein are applications of the latest version of the StrucEluc expert software system, enhanced to use 2D NMR data, to the structure elucidation of 60 recently isolated natural products. In this study, selected molecules containing between 15 and 65 skeletal atoms and having molecular masses ranging from 200 to 900 amu have been investigated. The correct structure was determined unambiguously for 58 of these molecules. The structures for 75% of the data sets were determined in less than one minute, while 90% of the analyses required no more than 30 minutes. The strategy of structure elucidation by this expert system is described, and several examples are discussed. These illustrate that StrucEluc is a powerful and versatile analytical tool for the structure elucidation of natural products.


Effect of underground urban structures on eutrophic coastal environment.
The NIES Integrated Catchment-based Eco-hydrology (NICE) model was expanded to include the density current and solute-transport process of groundwater in the Kanto Plain and to incorporate the effects of water table and tidal fluctuations around the eutrophic Tokyo Bay, Japan (NICE-SEA). The simulation reproduced excellently the observed values of river discharge and groundwater level in the catchment. The simulated groundwater level shows a minus value (below the sea level) around the Tokyo metropolitan area because of excessive withdrawal around the urban area in the past. The model shows that the underground urban structures, sewage pipes, seashore concrete dikes, and embankments have changed the hydrologic cycle in the catchment and the nutrient supply to Tokyo Bay. In particular, the groundwater flow is interrupted and the phase is delayed, resulting in an increase in the groundwater level, and a decrease of groundwater seepage into Tokyo Bay. Furthermore, we propose four types of political scenario for provisioning human ecosystem service (ES) sites to promote infiltration. The simulated result forecasts that the groundwater level increases predominantly at a maximum value exceeding 40 cm in a scenario for farmland and productive green areas and that the level recovers in some parts of the urban area. This phenomenon is related to the cut-off of groundwater flow by underground urban structures and the sewer leakage into the aquifer, which also influences the decrease of submarine groundwater discharge around the western side of Tokyo Bay.


Genetics of Unilateral and Bilateral Age-Related Macular Degeneration Severity Stages.
Age-related macular degeneration (AMD) is a common disease causing visual impairment and blindness. Various gene variants are strongly associated with late stage AMD, but little is known about the genetics of early forms of the disease. This study evaluated associations of genetic factors and different AMD stages depending on unilateral and bilateral disease severity. In this case-control study, participants were assigned to nine AMD severity stages based on the characteristics of each eye. 18 single nucleotide polymorphisms (SNPs) were genotyped and attempted to correlate with AMD severity stages by uni- and multivariate logistic regression analyses and trend analyses. Area under the receiver operating characteristic curves (AUC) were calculated. Of 3444 individuals 1673 were controls, 379 had early AMD, 333 had intermediate AMD and 989 showed late AMD stages. With increasing severity of disease and bilateralism more SNPs with significant associations were found. Odds ratios, especially for the main risk polymorphisms in ARMS2 (rs10490924) and CFH (rs1061170), gained with increasing disease severity and bilateralism (exemplarily: rs1061170: unilateral early AMD: OR = 1.18; bilateral early AMD: OR = 1.20; unilateral intermediate AMD: OR = 1.28; bilateral intermediate AMD: OR = 1.39, unilateral geographic atrophy (GA): OR = 1.50; bilateral GA: OR = 1.71). Trend analyses showed p<0.0001 for ARMS2 (rs10490924) and for CFH (rs1061170), respectively. AUC of risk models for various AMD severity stages was lowest for unilateral early AMD (AUC = 0.629) and showed higher values in more severely and bilaterally affected individuals being highest for late AMD with GA in one eye and neovascular AMD in the other eye (AUC = 0.957). The association of known genetic risk factors with AMD became stronger with increasing disease severity, which also led to an increasing discriminative ability of AMD cases and controls. Genetic predisposition was also associated with the disease severity of the fellow-eye, highlighting the importance of both eyes in AMD patients.


The nucleotide sequences of the initiator transfer RNAs from bean cytoplasm and chloroplasts.
The initiator tRNAsMet from the cytoplasm and chloroplasts of Phaseolus vulgaris have been purified and sequenced. The sequence of bean cytoplasmic initiator tRNAiMet is : pA-U-C-A-G-A-G-U-m1G-m2G-C-G-C-A-G-C-G-G-A-A-G-C-G-U-m2G-G-U-G-G-G2-C-C-C-A-U-t6A-A-C-C-C-A-C-A-G-m7G-D-m5C-C-C-A-G-G-A-psi-C-G-m1A-A-A-C-C-U-Gm-G-C-U-C-U-G-A-U-A-C-C-AOH. The sequence of bean cytoplasmic tRNAiMet is almost identical to that of wheat germ and shows a high degree of homology with other cytoplasmic initiator tRNAs. The sequence of bean chloroplast initiator tRNAfMet is : pC-G-C-G-G-A-G-U-A-G-A-G-C-A-A-C-U-U-Gm-G-D-A-G-C-U-C-G-C-A-A-G-G-C-U-C-A-U-A-A-C-C-U-U-G-A-A-m7G-acp3U-U-A-C-G-G-G-T-psi-C-A-A-A-U-C-C-C-G-U-C-U-C-C-G-C-A-A- C-C-AOH. Bean chloroplast initiator tRNAfMet sequence shows procaryotic characteristics at the 5' end of the acceptor stem and in the TpsiC loop, but also contains some distinctive features.


Machine Learning-Based Analysis of MR Multiparametric Radiomics for the Subtype Classification of Breast Cancer.
Objective: To investigate whether machine learning analysis of multiparametric MR radiomics can help classify immunohistochemical (IHC) subtypes of breast cancer. Study design: One hundred and thirty-four consecutive patients with pathologically-proven invasive ductal carcinoma were retrospectively analyzed. A total of 2,498 features were extracted from the DCE and DWI images, together with the new calculated images, including DCE images changing over six time points (DCEsequential) and DWI images changing over three b-values (DWIsequential). We proposed a novel two-stage feature selection method combining traditional statistics and machine learning-based methods. The accuracies of the 4-IHC classification and triple negative (TN) vs. non-TN cancers were assessed. Results: For the 4-IHC classification task, the best accuracy of 72.4% was achieved based on linear discriminant analysis (LDA) or subspace discrimination of assembled learning in conjunction with 20 selected features, and only small dependent emphasis of Kendall-tau-b for sequential features, based on the DWIsequential with the LDA model, yielding an accuracy of 53.7%. The linear support vector machine (SVM) and medium k-nearest neighbor using eight features yielded the highest accuracy of 91.0% for comparing TN to non-TN cancers, and the maximum variance for DWIsequential alone, together with a linear SVM model, achieved an accuracy of 83.6%. Conclusions: Whole-tumor radiomics on MR multiparametric images, DCE images changing over time points, and DWI images changing over different b-values provide a non-invasive analytical approach for breast cancer subtype classification and TN cancer identification.


[Indications and limits of nerve block techniques].
Repetitive nerve blocks as a monotherapeutic treatment are loosing importance in the therapy of chronic pain. Such invasive methods for pain reduction are just one strategy in the interdisciplinary and multimodal planning of pain therapy. They are mostly used in special indications, e.g. reflex sympathetic dystrophy neurolysis in S3-S5 localized cancer pain. Premises for an invasive pain therapy are the patient's knowledge and agreement concerning this method. Furthermore, it is necessary for the physician to know the typical complications of the invasive treatment and to be able to manage them. It is recommended to document the pain course.


Clinical practice guidelines for depression.
The Ministry of Health Clinical Practice Guidelines for Depression were prepared and distributed to all doctors in Singapore in early 2004. This article highlights salient points and discusses pharmacotherapy, psychotherapy and psychoeducation in managing cases of depression. Assessment of suicide risk is elaborated upon, although this was not discussed in the guidelines. The learning points will be enhanced if this article is reviewed together with the Ministry of Health Clinical Practice Guidelines.


Ingested quercetin but not rutin increases accumulation of hepatic beta-carotene in BALB/c mice.
Beta-carotene is a carotenoid with a range of reported health benefits besides vitamin A activity. If the enzymatic conversion of beta-carotene to retinal is suppressed in the digestive tract, residual beta-carotene that reaches the tissues increases. We evaluated the function of quercetin and rutin (quercetin-3-rutinoside) to increase the accumulation of beta-carotene in vitro and in vivo in BALB/c mice. When the conversion of beta-carotene by a preparation of the murine small intestine was measured in vitro, the addition of quercetin or rutin considerably inhibited the conversion. When the levels of hepatic beta-carotene and retinoids were measured among three groups of mice fed a diet supplemented with beta-carotene plus quercetin or rutin or beta-carotene alone (four to six mice per group), quercetin increased the level of beta-carotene and decreased the level of retinol, whereas rutin did not. These results demonstrate that quercetin can suppress the conversion of beta-carotene which develops in the cytosol of small intestinal epithelial cells, and that rutin whose rutinose-moiety prevents being absorbed in the small intestine cannot suppress the conversion in vivo. This study offers a novel insight into the interaction between flavonoids and carotenoids with respect to the health benefits from the latter.


Do bus accidents cause nonepileptic seizures?: complex issues of medicolegal causation.
The question of causation is approached through a case description and analysis. An alternative perspective is discussed for addressing neuropsychiatric cases in the medicolegal context. Viewing medical litigation from the perspective of risk factors, timeline, and baseline may add clarity to the difficulty of understanding causation.


Physical mapping of large DNA by chromosome fragmentation.
A technique is described for physically positioning any cloned DNA on a native or artificial Saccharomyces cerevisiae chromosome. The technique involves splitting a chromosome at a specific site by transformation with short linear molecules containing the cloned DNA at one end and telomeric sequences at the other. Recombination between the end of the linear molecules and homologous chromosomal sequences gives rise to chromosome fragments comprising all sequences distal or proximal to the mapping site depending on the orientation of the cloned DNA. The recombinant products are recovered by screening for stabilization of a suppressor tRNA on the linear molecules using a colony color assay. The cloned DNA is positioned relative to the chromosome ends by sizing the chromosomal fragments using alternating contour-clamped homogeneous electric field gel electrophoresis. Application of this technique to organisms other than S. cerevisiae and to the analysis of exogenous DNA cloned in yeast is discussed.


[Microalbuminuria in essential hypertension: of limited value as an indicator of patients with a high risk for complications].
Microalbuminuria is usually defined as a urinary albumin excretion of 30-300 mg/24 h (i.e. 20-200 micrograms/min) measured, in view of the short-term variation of 15-30%, in at least 2 out of 3 urine samples. An alternative definition is: an albumin-creatinine ratio of 2-20 mg/mmol creatinine. Microalbuminuria is an indicator of an enhanced risk of chronic kidney failure and cardiovascular disease in diabetic patients and of cardiovascular disease in the elderly general population. It is not known whether these relationships exist in essential hypertension as well. In essential hypertension there is, however, a relationship between microalbuminuria and endothelial dysfunction, impaired regulation of renal haemodynamics and an increased risk of left ventricular hypertrophy and hypertensive retinopathy. By screening for microalbuminuria a group of patients can be distinguished who have a relatively high risk for the presence of complications of hypertension. It is not certain, however, that more intensive treatment of such patients (e.g. with ACE inhibitors) is useful. Consequently, for the time being, screening of patients with essential hypertension for microalbuminuria is of little practical importance.


[Evolution of diagnostic methods for cicatrical tracheal stenosis and tracheomalacia].
To analyze the role of ray functional computerized diagnostic technologies in assessment of the state of tracheal wall in cicatricial stenosis. We examined 45 patients with cicatricial tracheal stenosis during August 2013 -- March 2015. Fibrobronchoscopy, multislice computerized tomography, magnetic resonance imaging and lungs function examination were performed. For the first time dynamic (functional) CT and MRI were included in research algorithm. These techniques have not been used for cicatricial stenosis and tracheomalacia in our country until this moment. Circular resection with anastomosis was made in 38 patients and stage reconstructions were preferred in 7 cases. Last ones had advanced tracheomalacia on the background of cicatrical stenosis that forced to abandon from tracheal resection. So time to treatment and incidence of complications and recurrences were reduced and the results were improved. Endoscopy remains the main method of diagnosis of tracheal stenosis despite its invasiveness. Data of cicatrical transformation of tracheal wall per se can be obtained non-invasively using dynamic CT and MRI. These techniques help to identify or exclude tracheomalacia. They potentially complement fibrobronchoscopy and may be preferable to assess perioperative intramural pathological changes of the trachea.


The human bladder carcinoma cell line 5637 constitutively secretes functional cytokines.
We have studied cytokine secretion by the human bladder carcinoma cell line 5637 using growth factor-dependent cell line bioassays and specific ELISA. The 5637 cell line-conditioned medium (5637 CM) stimulated proliferation of human growth factor-dependent leukemia cell lines in a dose-dependent fashion. Quantitation by specific ELISA and by bioassays detected high amounts of G-CSF and GM-CSF and smaller quantities of IL-1beta, M-CSF and SCF in 5637 CM; the concentration of IL-3 was below the detection level of the ELISA, if present at all. The G-CSF and GM-CSF activities secreted by 5637 cells could be inhibited specifically by neutralizing anti-G-CSF and anti-GM-CSF antibodies. In conclusion, 5637 bladder carcinoma cells constitutively produce and secrete several functionally active cytokines; 5637 CM is a valuable, reliable and inexpensive source for cytokines, for instance for the culture of growth factor-responsive or -dependent hematopoietic primary cells and cell lines.


Laser-Fabricated Reduced Graphene Oxide Memristors.
Finding an inexpensive and scalable method for the mass production of memristors will be one of the key aspects for their implementation in end-user computing applications. Herein, we report pioneering research on the fabrication of laser-lithographed graphene oxide memristors. The devices have been surface-fabricated through a graphene oxide coating on a polyethylene terephthalate substrate followed by a localized laser-assisted photo-thermal partial reduction. When the laser fluence is appropriately tuned during the fabrication process, the devices present a characteristic pinched closed-loop in the current-voltage relation revealing the unique fingerprint of the memristive hysteresis. Combined structural and electrical experiments have been conducted to characterize the raw material and the devices that aim to establish a path for optimization. Electrical measurements have demonstrated a clear distinction between the resistive states, as well as stable memory performance, indicating the potential of laser-fabricated graphene oxide memristors in resistive switching applications.


Role of TNF-alpha in the induction of fungicidal activity of mouse peritoneal exudate cells against Cryptococcus neoformans by IL-12 and IL-18.
We have recently demonstrated that two IFN-gamma-inducing cytokines, interleukin (IL)-12 and IL-18, synergistically induced the fungicidal activity of mouse peritoneal exudate cells (PEC) against Cryptococcus neoformans through NK cell production of interferon (IFN)-gamma and nitric oxide (NO) synthesis. In the present study, we further dissected these effects by examining the involvement of tumor necrosis factor (TNF)-alpha in the induction of IL-12/IL-18-stimulated PEC fungicidal activity. The addition of neutralizing anti-TNF-alpha mAb significantly suppressed IL-12/IL-18-stimulated PEC anticryptococcal activity. This effect was ascribed to the inhibition of macrophage NO synthesis, but not of IFN-gamma production by NK cells, because the same treatment inhibited the former response, but not the latter one. On the other hand, combined treatment with IL-12 and IL-18 synergistically induced the production of TNF-alpha by PEC and this effect was almost completely abrogated by neutralizing anti-IFN-gamma mAb. The cell type producing TNF-alpha among PEC was mostly macrophage. TNF-alpha significantly promoted macrophage NO production and anticryptococcal activity induced by IFN-gamma, and furthermore anti-TNF-alpha mAb partially inhibited these responses. Considered together, our results indicated that TNF-alpha contributed to the potentiation of IL-12/IL-18-induced PEC fungicidal activity against C. neoformans through enhancement of IFN-gamma-induced production of NO by macrophages, but not through increased production of IFN-gamma by NK cells.


An examination of safety on laparoscopic surgery in patients with ventriculoperitoneal shunt by a CO2 reflux experiment.
When a patient with a ventriculoperitoneal shunt (VPS) undergoes laparoscopic surgery, there is the concern about possible problems with the shunt due to increased intra-abdominal pressure. We conducted a simplified reflux experiment on VPS valves to demonstrate safety. Each of five different VPS valves was connected via tubes to a glass vessel of our own making. Carbon-dioxide gas was consecutively insufflated into the vessel at 3-25 mm Hg pressure to determine whether reflux occurred when the valves and tubes were empty (opened test) and when filled with physiologic saline (closed test). Reflux occurred for two of five valves at an insufflation pressure of 5 mm Hg or more in the opened test, while not for any valves until 25 mm Hg in the closed test. In clinical settings, there would be no possibility of reflux under the pneumoperitoneum in VPS systems draining cerebrospinal fluid. Laparoscopic surgery in patients with VPS would be performed safely if characteristics of VPS valves are taken advantage of.


Microscope-Integrated OCT Feasibility and Utility With the EnFocus System in the DISCOVER Study.
To evaluate the feasibility and utility of a novel microscope-integrated intraoperative optical coherence tomography (OCT) system. The DISCOVER study is an investigational device study evaluating microscope-integrated intraoperative OCT systems for ophthalmic surgery. This report focuses on subjects imaged with the EnFocus prototype system (Leica Microsystems/Bioptigen, Morrisville, NC). OCT was performed at surgeon-directed milestones. Surgeons completed a questionnaire after each case to evaluate the impact of OCT on intraoperative management. Fifty eyes underwent imaging with the EnFocus system. Successful imaging was obtained in 46 of 50 eyes (92%). In eight cases (16%), surgical management was changed based on intraoperative OCT findings. In membrane peeling procedures, intraoperative OCT findings were discordant from the surgeon's initial impression in seven of 20 cases (35%). This study demonstrates the feasibility of microscope-integrated intraoperative OCT using the Bioptigen EnFocus system. Intraoperative OCT may provide surgeons with additional information that may influence surgical decision-making. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:216-222.].


Effect of preoperative mild renal dysfunction on mortality and morbidity following valve cardiac surgery.
The objective of this study was to investigate the effect of preoperative mild renal dysfunction (RD) not requiring dialysis on mortality and morbidity after valve cardiac surgery (VCS). We studied 681 consecutive patients (2002-2006) who underwent valve cardiac surgery with or without coronary artery bypass graft (CABG). Preoperative RD was calculated with the abbreviated Modification of Diet in Renal Disease formula and was defined as a glomerular filtration rate <60 ml/min/1.73 m(2). Logistic regression analysis was used to assess the effect of preoperative renal dysfunction on operative and adverse outcomes. Two hundred and seven patients (30%) had preoperative mild RD. Patients with preoperative RD were older, had a higher rate of preoperative anaemia (43% vs. 25%, P<0.001) and more comorbidities. Patients with preoperative RD had worse outcomes with more reoperation (6.8% vs. 2.3%, P<0.001). Preoperative RD was significantly and independently associated with more red blood cell transfusions and longer hospital stay (median 9 vs. 8 days, P<0.001). Mortality was similar in both groups (3.4% vs. 2.3%, P=0.43). Preoperative mild renal dysfunction in patients undergoing cardiac valve surgery is an independent marker of postoperative morbidity.


Rare disease heralded by pulmonary manifestations: Avoiding pitfalls of an "asthma" label.
Pulmonary manifestations are seldom recognized as symptoms of storage disorders. The report describes the diagnostic journey in a 30-month-old male infant, born of a third-degree consanguineous marriage referred to our institute as severe persistent asthma. History revealed that the child had progressively worsening breathlessness and persistent dry cough not associated with fever but accompanied by weight loss. On physical examination, there was growth failure, respiratory distress, clubbing, hepatosplenomegaly, and occasional rhonchi. Blood gas revealed hypoxemia which improved with oxygen administration. Plain X-rays and high-resolution computed tomography of the chest showed perihilar alveolar infiltrates and patchy consolidation. The clinicoradiological features did not support a diagnosis of asthma but favored interstitial lung disease (ILD). Bronchoalveolar lavage was performed as a first-tier investigation. It showed periodic acid-Schiff-negative foamy macrophages. The clues of consanguinity, visceromegaly, ILD, and foamy macrophages in the bronchoalveolar fluid prompted consideration of lysosomal storage disorders as the likely etiology. Gaucher disease and Niemann-Pick disease A/B were ruled out by enzyme estimation. Niemann-Pick disease type C was suspected and confirmed by detecting a homozygous mutation in the NPC2 gene. This case serves to caution physicians against labeling breathlessness in every toddler as asthma. It emphasizes the importance of searching for tell-tale signs such as clubbing and extrapulmonary clues which point to a systemic disease such as lysosomal storage disorders as a primary etiology of chronic respiratory symptoms.


Noble-metal Ag nanoparticle chains: annealing Ag/Bi superlattice nanowires in vacuum.
One-dimensional noble-metal Ag nanoparticle chains have been prepared by electrodepositing Ag/Bi superlattice nanowires in a porous anodic alumina oxide (AAO) template and following an annealing process in vacuum. It is found that Bi, as a sacrificial metal, can be removed completely after annealing at 450 °C with a vacuum degree of 10(-5) Torr. The regulation of particle size, shape and interparticle spacing of Ag NP chains has been realized by adjusting the segment length of the Ag/Bi superlattice nanowires and the annealing condition. With an extension of the annealing time, it is observed that Ag particles display the transform trend from ellipsoid to sphere. Our findings could inspire further investigation on the design and fabrication of metal nanoparticle chains.


Central vasomotor failure in a patient with medulla arteriovenous fistula.
We report on the case of a 60-year-old man who suffered from hiccup, dysphagia and unsteady gait for three months. He was diagnosed with intracranial dural arteriovenous fistula in medulla with retrograde perimedullary vein drainage. He developed quadriplegia, persistent shock status and symptomatic bradycardia immediately after a conventional cerebral angiography study. After excluding cardiogenic, hypovolemic, anaphylactic and septic shock, central vasomotor failure caused by venous thrombosis of the lesion was considered. The patient's central vasomotor failure recovered after continuous dopamine infusion treatment for 42 days. We concluded that venous hypertension with venous thrombosis in rostral ventrolateral medulla (RVLM), a major vasomotor center in the brainstem, was the lesion site. In our case, vasomotor dysfunction caused by an RVLM lesion related to venous thrombosis is considered as causative.


Influence of provisional cements on ultimate bond strength of indirect composite restorations to dentin.
The aim of this study was to evaluate the effect of provisional cements on the adhesion of resin bonded indirect restorations and determine the best method for avoiding adverse effects. Forty-five bovine incisors were selected, and the enamel removed with a 600-grit SiC abrasive disk to expose superficial dentin. Provisional restorations of acrylic resin were cemented with three different provisional cements: calcium hydroxide cement, Dycal (HC); cement containing zinc oxide-eugenol, Provy (ZOE); zinc oxide eugenol-free cement, TempBond NE (ZNE). The specimens were stored at 100% humidity, 37 degrees C. Then provisional restorations were removed with: (1) hand scaler for 10 s; (2) pumice-water slurry for 10 s; (3) aluminum oxide sandblasting for 10 s. The indirect restorations were subsequently cemented with Single Bond and Rely-X ARC. The teeth were sectioned, 4 slices per tooth (n = 16), and each slice trimmed with a diamond bur to obtain an adhesion area of 1 mm2. The microtensile bond strength test was performed with a universal testing machine (Instron-4411) at a crosshead speed of 0.5 mm/min. The results were analyzed with ANOVA, followed by Tukey's test (p < 0.05). ANOVA showed significant differences in the interaction between provisional cement and dentin cleaning method; in general, aluminum oxide sandblasting provided the highest values of bond strength and calcium hydroxide the lowest. The type of provisional cement and its method of removal can affect the adhesion of resin-bonded indirect restorations.


Peptide-nucleic acid-modified ion-sensitive field-effect transistor-based biosensor for direct detection of DNA hybridization.
Here, we report the development of a peptide-nucleic acid (PNA)-modified ion-sensitive field-effect transistor (IS-FET)-based biosensor that takes advantage of the change in the surface potential upon hybridization of a negatively charged DNA. PNA was immobilized on a silicon nitride gate insulator by an addition reaction between a maleimide group introduced on the gate surface, the succinimide group of N-(6-maleimidocaproyloxy) succinimide, and the thiol group of the terminal cysteine in PNA. The surface was characterized after each step of the reaction by X-ray photoelectron spectroscopy analysis, and the kinetic analysis of the hybridization events was assessed by surface plasmon resonance. In addition, we measured the -potential before and after PNA-DNA hybridization in the presence of counterions to investigate the change in surface charge density at the surface-solution interface within the order of the Debye length. On the basis of the zeta-potential, the surface charge density, DeltaQ, calculated using the Grahame equation was approximately 4.0 x 10(-3) C/m2 and the estimated number of hybridized molecules was at least 1.7 x 10(11)/cm2. The I-V characteristics revealed that the PNA-DNA duplexes induce a positive shift in the threshold voltage, VT, and a decrease in the saturated drain current, ID. These results demonstrate that direct detection of DNA hybridization should be possible using a PNA-modified IS-FET-based biosensor. PNA is particularly advantageous for this system because it enables highly specific and selective binding at low ionic strength.


All-Inside Anterior Cruciate Ligament Reconstruction: A Review of Advance and Trends.
Anterior cruciate ligament (ACL) injury is a common disease in orthopedics and mostly occurs as a noncontact injury in athletes. Patients' knee joint stability, which is crucial to their athletic ability, cannot be restored through conservative treatment; it can only be restored through ACLR (ACL reconstruction) surgery. The surgical techniques of ACLR are constantly evolving, from bone tendon bone (BTB) grafting combined with interface screw fixation to hamstring tendon autograft or allogeneic tendon and of suspension device constructs. In particular, the currently prevalent all-inside technique featuring good cosmetic results and quick recovery of early functions not only ensures the stable fixation of grafts but also reduces surgical trauma. This review compares the advantages and disadvantages of different aspects of all-inside ACLR, including graft selection and preparation, bone socket reconstruction, fixation methods, and surgical technique effects and limitations. It has been found that the all-inside technique excels both anatomically and clinically but still requires further development. Besides, it has some limitations, and high-quality randomized controlled trials are still required to compare the long-term effects of the all-inside technique and other ACLR techniques.


MicroRNA-9501 inhibits breast cancer proliferation and metastasis through regulating Wnt/β-catenin pathway.
This research was designed to explore the expression characteristics of microRNA-9501 in breast cancer (BCa), and to further explore whether it can influence the development of BCa through the regulation of Wnt/β-Catenin pathway. QPCR was carried out to examine microRNA-9501 level in tumor tissue samples and paracancerous ones collected from 42 BCa patients, and the interplay between microRNA-9501 expression and the clinical indicators, as well as the prognosis of BCa patients were analyzed. In addition, we detected microRNA-9501 expression in BCa cell lines by qPCR. Subsequently, microRNA-9501 overexpression model was constructed in BCa cell lines MCF-7 and MDA-MB-231. Then, CCK-8, EdU, cell wound healing, as well as transwell assays, were carried out to evaluate the impact of microRNA-9501 on the biological functions of BCa cells. Finally, the Dual-Luciferase reporting test and tumor formation experiment in nude mice were conducted to further clarify the potential molecular mechanism. QPCR results indicated that microRNA-9501 level in tumor tissue specimens of BCa patients was remarkably higher than that in adjacent ones, and the difference was statistically significant. Compared with patients with high expression of microRNA-9501, patients with lowly-expressed microRNA-9501 had higher tumor stage, higher incidence of lymph node or distant metastasis, and lower overall survival rate. In addition, compared with control group, cells in microRNA-9501 overexpression group showed a significant decrease in proliferation rate, invasiveness, and migration ability. Meanwhile, luciferase reporting assay revealed that overexpression of β-Catenin remarkably attenuated the luciferase activity of the vector containing wild-type microRNA-9501 sequences, further demonstrating that microRNA-9501 can be targeted by β-Catenin. Meanwhile, qPCR revealed a negative association between β-Catenin and microRNA-9501 in BCa tissues. Finally, tumor-bearing experiments in nude mice also demonstrated that microRNA-9501 may suppress the malignant growth of breast tumor. MicroRNA-9501 expression was found remarkably decreased in BCa tissues and cell lines, which was closely relevant to the pathological stage, metastasis incidence, and prognosis of BCa patients. In addition, microRNA-9501 may suppress the malignant progression of BCa via modulating Wnt/β-Catenin path-way.


Comparative anatomy of the floral elaiophore in representatives of the newly re-circumscribed Gomesa and Oncidium clades (Orchidaceae: Oncidiinae).
Recently, molecular approaches have been used to investigate the phylogeny of Oncidiinae. This has resulted in the transfer of taxa previously considered to be species of Oncidium Sw. into Gomesa R. Br. and the re-circumscription of both genera. In this study, the structure of the floral elaiophore (oil gland) is described and compared for Gomesa echinata (Barb. Rodr.) M.W. Chase & N.H. Williams, G. ranifera (Lindl.) M.W. Chase & N.H. Williams, Oncidium amazonicum (Schltr.) M.W. Chase & N.H. Williams and O. oxyceras (Königer & J.G. Weinm.) M.W. Chase & N.H. Williams in order to determine whether phylogenetic revision is supported by differences in its anatomy. The floral elaiophore structure was examined and compared at three developmental stages (closed bud, first day of anthesis and final stage of anthesis) for all four species using light microscopy, fluorescence microscopy, scanning electron microscopy, transmission electron microscopy and histochemistry. In all species investigated, the floral elaiophore occurs on the labellar callus and is of the epithelial type, comprising cuboidal to palisade-like, secretory epidermal cells and a layer of sub-epidermal cells, both tissues enclosing ground parenchyma supplied with collateral vascular bundles and containing idioblasts, often with raphides or phenolic contents. A bi-layered cuticle comprising an outer, lamellate and an inner, reticulate layer is present, and sub-cuticular accumulation of secreted material results in distension of the cuticle. Secretion-filled cavities are present at anthesis in the elaiophore cell walls and, in most species, the outer, tangential walls of the elaiophore have small, peg-like projections that protrude into the cytoplasm. In all taxa examined, the elaiophore organelle complement, especially the smooth endoplasmic reticulum (SER), is typical of lipid-secreting cells. In terms of location, morphology, anatomy and ultrastructure, the floral elaiophores of both Gomesa and Oncidium species examined are very similar, and distinction between these genera is not possible based on elaiophore features alone. Furthermore, many of these elaiophore characters are shared with representatives of other clades of Oncidiinae, including the Ornithocephalus clade. Consequently, elaiophores are considered homoplasious and of limited value in investigating the phylogeny of this subtribe.


Chaperone-like activity of protein disulfide isomerase in the refolding of a protein with no disulfide bonds.
D-Glyceraldehyde-3-phosphate dehydrogenase (GAP-DH) is a protein containing no disulfide bonds; the guanidine HCl-denatured enzyme shows only a limited extent of refolding and reactivation upon dilution, and the enzyme is particularly prone to aggregation during the dilution process. With increasing GAPDH concentration, reactivation decreases and aggregation increases. The presence of protein disulfide isomerase in the dilution mixture markedly increases reactivation of GAPDH and at the same time prevents the aggregation of GAPDH as shown by light-scattering measurements. It is suggested that upon dilution, denatured GAPDH is faced with two competing processes of correct folding and assembly to yield the native enzyme and non-productive association of the partially refolded species to form aggregates. Independent of the isomerase activity as no disulfide bond is present in GAPDH, protein disulfide isomerase assists the refolding of GAPDH to its active state by suppressing aggregation in a way closely similar to the action of chaperones.


Neonatal respiratory distress syndrome and underlying mechanisms in cloned cattle.
Neonatal respiratory distress is a major mortality factor in cloned animals, but the pathogenesis of this disease is rarely investigated. In this study, four neonatal cloned cattle, born after full-term gestation, exhibited symptoms of neonatal respiratory distress syndrome (NRDS), which included symptoms of hyaline membrane disease as well as disordered surfactant homeostasis in their collapsed lungs. No differences in DNA methylation or histone modifications correlated with the suppressed SPB and SPC transcription observed in the cloned cattle group (p > 0.05), whereas TTF-1 occupancy at SPB and SPC promoter regions in cloned cattle was significantly reduced to 24% and 20% that of normal lungs, respectively (SPB, p < 0.05; SPC, p < 0.01). Decreased TTF1 expression, dysregulation of SPB and SPC transcription by TTF-1, and disordered proteolytic processing of Surfactant protein B precursor together potentially contribute to the disruption of surfactant homeostasis and NRDS in bovine clones. Elucidation of the associated mechanisms should facilitate the development of novel preventive or therapeutic strategies to reduce the mortality rate of cloned animals and to improve the efficiency of SCNT technology.


Incidence of Device-Detected Atrial Fibrillation and Long-Term Outcomes in Patients With Hypertrophic Cardiomyopathy.
Atrial fibrillation (AF) is a common complication of hypertrophic cardiomyopathy (HC) and associated with adverse clinical outcomes, such as thromboembolisms. Cardiac implantable electronic devices (CIEDs) enable early detection of AF. The aim of this study was to assess the incidence of device-detected AF and the impact on long-term outcomes in patients with HC. The cohort consisted of 132 patients (63% men, mean age 52 ± 16 years) with a diagnosis of HC and a CIED. Follow-up started at the date of CIED implantation to assess the incidence of device-detected AF. Patients with persistent AF at the time of implantation were excluded from the analysis of the incidence of AF. End points were all-cause and cardiac mortality, device-detected AF, and thromboembolism (stroke, transient ischemic attack, or peripheral arterial embolism). In total, 114 patients were in sinus rhythm at time of CIED implantation. During the median 2.8 (interquartile range 1.2 to 5.4) years of follow-up, device-detected AF occurred in 29 patients (25%), resulting in an annual incidence of 7.0%/year. Device-detected AF led to a change in the clinical management in 22 patients (76%). Anticoagulation therapy was started in 13 (45%), antiarrhythmic medication in 9 (31%), and electrical cardioversion in 8 (28%) patients. Six patients (5%) suffered a thromboembolic complication. All-cause mortality was 27 (20%), and cardiac mortality was 21 (16%). A history of AF at time of implantation was an independent predictor of cardiac death (hazard ratio 4.7, p = 0.003). In conclusion, the incidence of device-detected AF in patients with HC was 7.0%/year, leading to a change in clinical management in the majority (76%) of cases to reduce the risk of thromboembolic complications. These findings stress the importance of AF detection in HC and advocate vigilant interrogation of the device.


Characteristics of patients found not to have multiple sclerosis.
Of 400 consecutive patients referred to Dalhousie University's multiple sclerosis research unit 52 (13%) were found not to have multiple sclerosis. Forty-one (79%) of the patients were female and 11 (21%) were male. About half of the patients had raised the suspicion of multiple sclerosis, and about half had either a medical background or a close association with a patient with the disease. Although in many cases a diagnosis was made at the initial visit, in difficult cases the most effective diagnostic technique was repeated assessment of the patient over a long period. It is important to keep an open mind when assessing patients suspected of having multiple sclerosis and to apply the recognized criteria for diagnosis of the disease.


Comparable Consistency, Coherence, and Commonality of Measures of Cognitive Functioning Across Adulthood.
Increased age is associated with lower scores in many cognitive tests, but interpretation of those results is based on the assumption that the measurement at different ages is equivalent, such that the differences reflect quantitative rather than qualitative changes. The assumption of measurement equivalence was investigated by comparing adult age differences in the relations among alternative versions of the same tests, among different tests of the same ability, and among different cognitive abilities. Results from three independent data sets revealed that only modest age differences were apparent at each level, which implies that cognitive abilities have similar measurement properties at different ages in adulthood.


[Tuberculosis of the prostate].
Genitourinary tract is the second most common site where extrapulmonary tuberculosis (TB) occurs. Genitourinary TB is notable for a latent clinical course and difficult diagnosis. The paper presents clinical observations of two patients treated in a urology department of a general public hospital. One of them was diagnosed with tuberculosis of the prostate, MTB+. In the other, TB of the prostate was suspected based on pathologic assessment of the surgical specimen after surgery for prostate cancer.


Ethical dilemmas of medically unexplained symptoms.
Medically unexplained symptoms (MUS) are common across health settings. These are defined as "physical symptoms that prompt sufferer to seek healthcare but remain unexplained after an appropriate medical evaluation". Expectedly, MUS are often associated with significant health-seeking behaviours that add to the burden on health resources.


[Schizophrenia in the light of the evolutionary theories].
The aim of the article was to review the hypotheses of schizophrenia in the light of the evolutionary theory. The authors distinguished adaptationist and non-adaptationist hypotheses concerning the evolutionary underpinnings of schizophrenia. The adaptationist hypotheses are firmly based on notions of adaptation, natural selection and proximate and ultimate causes. The standard hypotheses of this sort proposed by Steven and Price as well as by Pollimeni and Reiss were discussed. Also, the other similar conceptions originated from McGuire and Troisi and proposed by David Horrobin were presented of which the latter is especially promising and worth further investigating. The non-adaptationistic authors criticised many assumptions of the adapationist program i.e. too broad use of term "adaptation" in the area of human behaviour or the very idea of proximate and ultimate causes. Unlike the adaptionists, they focus their attention on other aspects of the evolutionary processes i.e. the role of the mutation and also they are searching in a much intensive way than their opponents for verification of the hypotheses based on the empirical evidence. The theories developed by Crow and by Yeo were listed among the non-adaptationistic ones and presented.


[Long-term results of functional surgery for attic cholesteatoma].
We evaluated the long-term results of functional surgery for attic cholesteatoma. In this study, we presented the results of 81 patients (42 males 39 females; mean age 34 years; range 8 to 59 years) who underwent functional surgical techniques for attic cholesteatomas between January 1992 and January 1998. All the patients were followed-up for at least five years. For eradication of attic cholesteatoma, canal wall-down technique tympanoplasty was required in the majority of the patients. After surgery there was a statistically significant hearing improvement in all but four cases. In the postoperative period, residual cholesteatoma and graft perforation were found in five and six patients, respectively. Two patients required revision meatoplasty for problems related with cavity clearance. Apart from satisfactory hearing improvement with functional surgery, a successful self-clearance was obtained in mastoid cavities with saucerization and meatoplasty. Canal wall-down tympanoplasty is associated with very low incidences of residual or recurrent cholesteatoma in the majority of patients.


[Prognostic factors in neuroblastoma in children].
The results of clinico-morphological studies of 152 cases of neuroblastoma are presented. Neuroblastoma should be regarded as a tumor in which the following patterns may be distinguished: sympatogonioma (2.6%), sympatoblastoma -1 (38.8%), sympatoblastoma -2 (15.2%), ganglioneuroblastomia (41.4%), and combined ganglioneuroblastoma (2%). Mean two-year survival rate was 40.2%. Such factors as patient's by the time of tumor detection, radical surgery and excision of primary neoplasm in patients with metastases were found to improve the prognosis. The two-year survival rates in sympatoblastoma -1, sympatoblastoma -2 and ganglioneuroblastoma were 19.6, 50, and 72%, respectively.


A benchtop shock physics laboratory: Ultrafast laser driven shock spectroscopy and interferometry methods.
Common Ti:sapphire chirped pulse amplified laser systems can be readily adapted to be both a generator of adjustable pressure shock waves and a source for multiple probes of the ensuing ultrafast shock dynamics. In this paper, we detail experimental considerations for optimizing the shock generation, interferometric characterization, and spectroscopic probing of shock dynamics with visible and mid-infrared transient absorption. While we have reported results using these techniques elsewhere, here we detail how the spectroscopies are integrated with the shock and interferometry experiment. The interferometric characterization uses information from beams at multiple polarizations and angles of incidence combined with thin film equations and shock dynamics to determine the shock velocity, particle velocity, and shocked refractive index. Visible transient absorption spectroscopy uses a white light supercontinuum in a reflection geometry, synchronized to the shock wave, to time resolve shock-induced changes in visible absorption such as changes to electronic structure or strongly absorbing products and intermediates due to reaction. Mid-infrared transient absorption spectroscopy uses two color filamentation supercontinuum generation combined with a simple thermal imaging microbolometer spectrometer to enable broadband single shot detection of changes in the vibrational spectra. These methods are demonstrated here in the study of shock dynamics at stresses from 5 to 30 GPa in organic materials and from a few GPa to >70 GPa in metals with spatial resolution of a few micrometers and temporal resolution of a few picoseconds. This experiment would be possible to replicate in any ultrafast laser laboratory containing a single bench top commercial chirped pulse amplification laser system.


Quantifying the robustness of a chaotic system.
As a way to quantify the robustness of a chaotic system, a scheme is proposed to determine the extent to which the parameters of the system can be altered before the probability of destroying the chaos exceeds 50%. The calculation uses a Monte-Carlo method and is applied to several common dissipative chaotic maps and flows with varying numbers of parameters.


Host factors in the susceptibility of rheumatic patients to streptococcal infections.
In children and adolescents who each had at least one previous episode of rheumatic fever and who were not maintaining effective anti-streptococcal prophylaxis, the attack rates of subsequent streptococcal infections declined with advancing age, but were unaffected by gender, cardiac status, or multiplicity of antecedent rheumatic episodes. The rate of rheumatic recurrence per streptococcal infection fell with advancing age, but rose with increasing amounts of cardiac damage and with multiplicity of previous rheumatic attacks. The results suggest that the underlying clinical features of the host have a greater effect on the rheumatogenicity of an acquired streptococcal infection than on the ability to avoid the infection.


The position of the Regulatory Authorities.
Statements produced by the Regulatory Authorities have impacted significantly on the practice of Menopausal Medicine. The advice that the lowest dose of hormone therapy should be given for the shortest possible time and that hormone therapy should no longer be a first-line treatment for osteoporosis has lead to a major shift in prescribing practice. Since these statements have such an enormous impact, this presentation will consider further the background to the authorities and the mechanism by which their decisions were reached.


Antagonism of GPR4 with NE 52-QQ57 and the Suppression of AGE-Induced Degradation of Type II Collagen in Human Chondrocytes.
Osteoarthritis (OA) is a common degenerative joint disease for which an effective therapeutic strategy has not yet been established. AGEs are widely recognized as a contributor to OA pathogenesis. GPR4, a recently discovered proton-sensing transmembrane receptor, has been shown to possess a wide range of physiological functions. However, the potential role of this receptor in chondrocytes and the pathogenesis of OA is unclear. In the present study, we investigated the potential of GPR4 to modulate the effects of advanced glycation end products (AGEs) in SW1353 human chondrocytes. First, we demonstrate that GPR4 is fairly expressed in SW1353 chondrocytes and that exposure to AGEs increases the expression of this transmembrane receptor. Second, we found that antagonism of GPR4 with NE 52-QQ57 significantly inhibited the AGE-induced increased expression of several key inflammatory cytokines and signaling molecules, including tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6, inducible nitric oxide synthase (iNOS), nitric oxide (NO), cyclooxygenase 2 (COX2), and prostaglandin E2 (PGE2). We also found that antagonisn of GPR4 had a remarkable ability to rescue type II collagen from AGE-induced degradation by inhibiting the expression of matrix metalloproteinase (MMP)-3 and MMP-13. As a key pro-inflammatory signaling pathway, we further tested the effect of GPR4 antagonism on the activation of nuclear factor-κB (NF-κB) and found that NF-κB activation was indeed suppressed, thereby indicating that the NF-κB signaling pathway may mediate the effects of GPR4 antagonism described above. These findings provide a basis for further research into the role of GPR4 -mediated signaling in OA.


Exhaled breath analysis in obstructive sleep apnea.
Breath analysis is a novel application that can be used for non-invasive metabolic phenotyping and identification of disease specific breath patterns. Obstructive sleep apnea (OSA) is highly prevalent and has diverse metabolic and cardiovascular consequences, many of them incompletely understood. Areas covered: This review systematically summarizes the current evidence from breath metabolomics using immunoassays of breath condensate, off-line mass spectrometry as well as real-time analysis by electronic sensors and by untargeted mass spectrometry, and discusses the challenges and perspectives of breath analysis in OSA. Expert commentary: Analysis of exhaled breath is an innovative approach that is likely to provide profound insights into the metabolomics of OSA and its consequences and might facilitate diagnosis and therapy monitoring.


Recording characteristics of the surface EMG electrodes.
Routine motor nerve conduction studies are conducted using surface EMG electrodes. Most techniques of estimating the number of motor units (MUs) are based on surface EMG recordings. Therefore, it is important to assess the uptake area of these electrodes. We recorded surface EMG motor unit action potentials (SMUAPs) from the biceps muscle of normal subjects. The SMUAP amplitude fell from 42 microV for the superficially located MUs (i.e., within 10 mm of skin surface) to 11 microV for the deep MUs (i.e., more than 20 mm from the skin surface). We infer that the pickup radius of the surface electrode is less than 20 mm. The implications of the limited uptake area of the surface electrodes to the analysis of compound muscle action potentials, estimation of the number of MUs, and the surface EMG recordings are discussed.


Computing Functional Brain Connectivity in Neurological Disorders: Efficient Processing and Retrieval of Electrophysiological Signal Data.
Brain functional network connectivity is an important measure for characterizing changes in a variety of neurological disorders, for example Alzheimer's Disease, Parkinson Disease, and Epilepsy. Epilepsy is a serious neurological disorder affecting more than 50 million persons worldwide with severe impact on the quality of life of patients and their family members due to recurrent seizures. More than 30% of epilepsy patients are refractive to pharmacotherapy and are considered for resection to disrupt epilepsy seizure networks. However, 20-50% of these patients continue to have seizures after surgery. Therefore, there is a critical need to gain new insights into the characteristics of epilepsy seizure networks involving one of more brain regions and accurately delineate epileptogenic zone as a target for surgery. Although there is growing availability of large volume of high resolution stereotactic electroencephalogram (SEEG) data recorded from intracranial electrodes during presurgical evaluation of patients, there are significant informatics challenges associated with processing and analyzing this large signal dataset for characterizing epilepsy seizure networks. In this paper, we describe the development and application of a high-performance indexing structure for efficient retrieval of large-scale SEEG signal data to compute seizure network patterns corresponding to brain functional connectivity networks. This novel Neuro-Integrative Connectivity (NIC) search and retrieval method has been developed by extending the red-black tree index model together with an efficient lookup algorithm. We systematically perform a comparative evaluation of the proposed NIC index using de-identified SEEG data from a patient with temporal lobe epilepsy to retrieve segments of signal data corresponding to multiple seizure events and demonstrate the significant advantages of the NIC index as compared to existing methods. This new NIC Index enables faster computation of brain functional connectivity measures in epilepsy patients for large-scale network analysis and potentially provide new insights into the organization as well as evolution of seizure networks in epilepsy patients.


Preparation and characterization of monodisperse microcapsules with alginate and bentonite via external gelation technique encapsulating Pseudomonas putida Rs-198.
This paper evaluated the external gelation technique for preparing microcapsules. The microcapsules were consisted of Pseudomonas putida Rs-198 (Rs-198) core and sodium alginate (NaAlg)-bentonite (Bent) shell. Different emulsification rotation speeds and core/shell ratios were used to prepare the microcapsules of each formulation. The near-spherical microcapsules were monodisperse with a mean diameter of 25-100 μm and wrinkled surfaces. Fourier transform infrared spectrophotometry (FTIR) and thermogravimetric analysis (TGA) revealed the physical mixture of the wall material and the superior thermal stability of the microcapsules. Percentage yield, water content, and encapsulation efficiency were evaluated and correlated with the changes in emulsification rotation speed and core/shell ratio. In vitro release experiments demonstrated that 60% of the bacteria were released from the NaAlg-Bent microcapsules within three days. Considerably better survival was observed for encapsulated cells compared to free cells, especially in pH 4.0 and 10.0. In summary, the desired properties of microcapsules can be obtained by external gelation technique and the microcapsules on the bacteria had a good protective effect.


Attitudes and knowledge levels of nurses and residents caring for adolescents with an eating disorder.
Although the vast majority of youths with an eating disorder (ED) are treated as outpatients, some require treatment in an inpatient unit. The purpose of this study was to determine the attitudes of nurses and pediatric residents towards adolescents and young adults with ED. Nursing questionnaires were distributed through a nurse manager and resident questionnaires were distributed in coordination with the chief residents. A total of 82 individuals (32 nurses and 50 pediatric residents) completed the survey. Only two nurses and six residents had not worked with a patient with an ED in the previous year. The vast majority of nurses and residents recognized that fear of gaining weight, refusal to maintain body weight and, disturbed body image were frequent signs occurring in patients with an ED. Both nurses and residents believed that emotional problems, influence of friends and family, family pressure, influence of the media, and being self-induced were the most likely causes of EDs. Genetics and influence of other medical problems were deemed less likely causes. The majority of residents identified having different rules for different patients and poor communication as factors that make it difficult to take care of ED patients. More than half of all nurses and residents (58.2%) thought that ED patients were responsible for their disease "always" or "in most cases". Residents (68.8%) were more likely than nurses (45.2%) to frequently feel frustrated with ED patients (χ2, p<0.0370). Adolescents with an ED provide a unique challenge to nurses and residents caring for them.


Supporting antidepressant discontinuation using mindfulness plus monitoring versus monitoring alone: A cluster randomized trial in general practice.
Discontinuing antidepressant medication (ADM) can be challenging for patients and clinicians. In the current study we investigated if Mindfulness-Based Cognitive Therapy (MBCT) added to supported protocolized discontinuation (SPD) is more effective than SPD alone to help patients discontinue ADM. This study describes a prospective, cluster-randomized controlled trial (completed). From 151 invited primary care practices in the Netherlands, 36 (24%) were willing to participate and randomly allocated to SPD+MBCT (k = 20) or SPD (k = 16). Adults using ADM > 9 months were invited by GPs to discuss tapering, followed by either MBCT+SPD, or SPD alone. Exclusion criteria included current psychiatric treatment; substance use disorder; non-psychiatric indication for ADM; attended MBCT within past 5 years; cognitive barriers. From the approximately 3000 invited patients, 276 responded, 119 participated in the interventions and 92 completed all assessments. All patients were offered a decision aid and a personalized tapering schedule (with GP). MBCT consisted of eight group sessions of 2.5 hours and one full day of practice. SPD was optional and consisted of consultations with a mental health assistant. Patients were assessed at baseline and 6, 9 and 12 months follow-up, non-blinded. In line with our protocol, primary outcome was full discontinuation of ADM within 6 months. Secondary outcomes were depression, anxiety, withdrawal symptoms, rumination, well-being, mindfulness skills, and self-compassion. Patients allocated to SPD + MBCT (n = 73) were not significantly more successful in discontinuing (44%) than those allocated to SPD (n = 46; 33%), OR 1.60, 95% CI 0.73 to 3.49, p = .24, number needed to treat = 9. Only 20/73 allocated to MBCT (27%) completed MBCT. No serious adverse events were reported. In conclusion, we were unable to demonstrate a significant benefit of adding MBCT to SPD to support discontinuation in general practice. Actual participation in patient-tailored interventions was low, both for practices and for patients. (Trial registration: ClinicalTrials.gov PRS ID: NCT03361514 registered December 2017).


Combined exposure to fine particulate matter and high glucose aggravates endothelial damage by increasing inflammation and mitophagy: the involvement of vitamin D.
Cardiovascular diseases (CVDs) are related to particulate matter (PM2.5) exposure. Researchers have not clearly determined whether hyperglycemia, a hallmark of diabetes, exacerbates PM2.5-induced endothelial damage. Thus, this study aimed to investigate the combined effects of PM2.5 and high glucose on endothelial damage. Here, we treated human umbilical vein endothelial cells (HUVECs) with 30 mM high glucose and 50 μg/mL PM (HG + PM) to simulate endothelial cells exposed to hyperglycemia and air pollution. First, we showed that HUVECs exposed to PM under high glucose conditions exhibited significant increases in cell damage and apoptosis compared with HUVECs exposed to PM or HG alone. In addition, PM significantly increased the production of reactive oxygen species (ROS) in HUVECs and mitochondria treated with HG and decreased the expression of superoxide dismutase 1 (SOD1), a free radical scavenging enzyme. The coexposure group exhibited significantly increased ROS production in cells and mitochondria, a lower mitochondrial membrane potential, and increased levels of the autophagy-related proteins p62, microtubule-associated protein 1 light chain 3β (LC3B), and mitophagy-related protein BCL2 interacting protein 3 (Bnip3). Moreover, autophagosome-like structures were observed in the HG + PM group using transmission electron microscopy. The expression of intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) were also increased through the JNK/p38 signaling pathway in the HG + PM group. As a ROS scavenger, vitamin D treatment effectively protected cells under HG and PM conditions by increasing cell viability, reducing mitochondrial ROS production, and suppressing the formation of mitophagy and inflammation. Furthermore, diabetes was induced in mice by administering streptozotocin (STZ). Mice were treated with PM by intratracheal injection. Vitamin D effectively alleviated oxidative stress, mitophagy, and inflammation in the aortas of mice treated with STZ and PM. Taken together, simultaneous exposure to PM and high glucose exerts significant harmful effects on endothelial cells by inducing ROS production, mitophagy, and inflammation, while vitamin D reverses these effects.


Impact of Cassia Bark Consumption on Glucose and Lipid Control in Type 2 Diabetes: An Updated Systematic Review and Meta-Analysis.
Control of diabetes is a constant challenge and natural remedies are being searched along with modern medicine. The effectiveness of cinnamon in managing it lacks consensus. Besides this, earlier trials had a variant in the type of product they used, quantity, duration, the form of molecules, etc. So, we aimed to measure the impact of cassia ground bark powder consumption, 1-2 gm/day for 90 days, in lowering plasma glucose and lipids among those with type 2 diabetes. The authors searched the PubMed, Medline, Embase, CINAHL, Clinical Key, Ovid, and Scopus databases and the Cochrane Central Register (last search December 30, 2020) with the MeSH terms and keywords of cinnamon, cassia cinnamon, Chinese cinnamon, and type 2 diabetes mellitus to conclude the effects of cassia cinnamon on diabetes based on the evidence of human clinical trials that reported at least one of the following: glycosylated hemoglobin (HbA1C), fasting blood glucose, total cholesterol, triglycerides, low-density lipoprotein (LDL), and high-density lipoprotein (HDL). Weighted mean differences were calculated by using the random-effect model of RevMan software (The Cochrane Collaboration, London, UK), and the pooled analysis found an insignificant reduction of the outcome variable (p>0.05).


Effect of prestrain on martensitic transformation in a Ti46.4Ni47.6Nb6.0 superelastic alloy and its application to medical stents.
The effect of applied strain on martensitic transformation in a superelastic Ti(46.4)Ni(47.6)Nb(6.0) alloy at room temperature was investigated by tensile tests, differential scanning calorimetry measurements, and X-ray diffraction. Reverse transformation starting (A(s)) and finishing (A(f)) temperatures increased with the application of tensile-strain over 13%, the undeformed specimen showing A(s) = -29.2 degrees C and A(f) = 17.9 degrees C, while the 13% predeformed alloy exhibited A(s) = 37.1 degrees C and A(f) = 40.2 degrees C. Furthermore, the values of the A(s) and A(f) for the predeformed alloy almost recovered to those of the undeformed alloy when heated to about 42 degrees C and then showed superelasticity again at room temperature. This characteristic is significant for application in sensors, actuators, and medical devices. Especially, medical stents with such qualities show promise as a new class of self-expandable stents with both excellent mountability and deliverability.


How colonization bottlenecks, tissue niches, and transmission strategies shape protozoan infections.
Protozoan pathogens such as Plasmodium spp., Leishmania spp., Toxoplasma gondii, and Trypanosoma spp. are often associated with high-mortality, acute and chronic diseases of global health concern. For transmission and immune evasion, protozoans have evolved diverse strategies to interact with a range of host tissue environments. These interactions are linked to disease pathology, yet our understanding of the association between parasite colonization and host homeostatic disruption is limited. Recently developed techniques for cellular barcoding have the potential to uncover the biology regulating parasite transmission, dissemination, and the stability of infection. Understanding bottlenecks to infection and the in vivo tissue niches that facilitate chronic infection and spread has the potential to reveal new aspects of parasite biology.


[Phagocytic activity of isolated perfused liver of rats of different ages. Biochemical and structural studies following perfusion with Cu-ceruloplasmin].
The phagocytic activity of young and old isolated perfused rat livers was measured referred to a glycoprotein (Cu-coeruloplasmin). It was shown that the phagocytic activity of the old rat liver is significantly higher than that of the young rat liver. There was no age-dependent difference of the parameters of liver function GOT, GPT, Kt and the quotients beta-OH-Butyric acid/Acetoacetate and lactate/butyrate.


Multiple atraumatic osteoporotic vertebral fractures in an adolescent with suprasellar germinoma: a case report.
We present the case of a patient with multiple atraumatic osteoporotic vertebral fractures in an adolescent with suprasellar germinoma and also review of relevant literature. The patient suffered from a rare adolescent brain tumour with common complications which are often overlooked and give rise to significant morbidity. Suprasellar germinoma is an intracranial neoplasm, that in addition to its rarity, has variable clinical presentation. Despite appropriate treatment and good outcome, tumour related morbidity is still of concern for these patients. Secondary osteoporosis, suprasellar germinoma, panhypopituitarism.


The impact of states' small group health insurance reforms on uninsurance rates.
The impact of states' small group market reforms on uninsurance rates was examined. Reform status was quantified on five reform dimensions: Access Improvement, Premium Reduction, Premium Differential Reduction, Continuity of Coverage, and Enhancing Valued Plan Features. These reform indices were calculated based on actuarial judgment of the market impact potential of each regulation. Regression analysis showed no association between uninsurance rates and the depth of reforms on any dimension, while controlling for income, foreign-born population, black population, and employment in the smallest businesses. Possible reasons for the lack of impact are discussed.


Endoscopic third ventriculostomy in patients younger than 2 years: outcome analysis of 41 hydrocephalus cases.
The object of this study was to analyze the outcome of endoscopic third ventriculostomy (ETV) in patients under 2 years of age and investigate factors related to ETV success or failure in this patient population. The authors reviewed their experience in using endoscopic third ventriculostomy (ETV) in the treatment of 41 hydrocephalus patients younger than 2 years. The mean duration of follow-up was 45 months. The relationship between ETV efficacy and the following variables was analyzed: cause of hydrocephalus, level of CSF occlusion, primary versus secondary ETV, type of surgical procedure, head circumference, patient age at ETV, patient age at first manifestation of hydrocephalus, and anatomical features of the ventricle. Success of ETV was assessed based on the results of neurological examination and postoperative imaging during the follow-up period. The authors performed 32 primary ETVs and 10 secondary ETVs (ETV after hydrocephalus surgery) in 41 patients (a second ETV was performed in 1 patient). The success rates of primary and secondary ETV were 75.8 and 55.6%, respectively (no significant difference, p = 0.15). The ETV was clinically and radiologically successful in 30 (71.4%) of 42 procedures during a mean (+/- SD) follow-up period of 45.0 +/- 4.8 months (range 12-127 months). A negative relationship was found between success of ETV and the thickness of the floor of the third ventricle (the most effective procedures were those in which the floor of the ventricle was thinnest [p < 0.05]). There was a highly significant correlation between ETV success and prolapse of the ventricle floor (p < 0.001). Also, there was an inverse relationship between ventricle floor thickness and the width of the third ventricle (p < 0.005). In our group of patients there was significant correlation between ETV success and patient age at onset of hydrocephalus (the most effective procedures were in patients in whom signs of hydrocephalus first occurred after 1 month of age [p = 0.02]). Endoscopic third ventriculostomy was successful in 71.4% of procedures in children younger than 2 years and in 75.0% of procedures in infants. Success of ETV in children younger than 2 years depends not on the age of the patient or cause of hydrocephalus but on the thickness of the floor of the third ventricle and the patient's age at first manifestation of hydrocephalus.


[Effect of age on waiting time of emergency patients: a retrospective analysis of 219 299 patients in consecutive 2 years].
To evaluate whether patients aged over 70 years old is an independent predictor for prolonging the waiting time, and to know whether the population can be prioritized in the emergency grading system. A retrospective analysis was conducted. All the clinical data of adult visitors to the emergency department of the Third Affiliated Hospital of Sun Yat-sen University from January 1st in 2016 to December 31st in 2017 were collected. All the patients received four emergency first aid triages and treated according to the emergency classification results. The relevant data of selected patients were retrieved from the hospital information system (HIS) including gender, age, triage level, triage department, outpatient service and initial diagnosis time. According to the conclusion of pre-phase analysis that the patients over 65 years old was not associated with waiting time, all subjects were divided into ≥ 70 years old group and < 70 years old group for further analysis. The waiting time was defined as the difference in registration time and the initial diagnosis time, and the patients were divided into two groups according to whether it exceeded the target waiting time (TWT). TWT was considered as follows according to each emergency triage level: level I instantly, level II 10 minutes, level III 30 minutes, level IV 60 minutes (subacute patients) or 2-4 hours (non-urgent patients). The multivariable Logistic regression analysis was conducted to determine whether the factor that aged over 70 years old was an independent predictor for prolonging waiting time over TWT. There were 272 989 adult visits recorded totally, of which obstetrics and gynecology department visits, incomplete personnel information, invalid diagnosis (or no diagnosis), triage level I, abnormal waiting time (the waiting time exceeded 99% of the average waiting time of all samples) records were excluded. Finally, 219 299 emergency patients were enrolled, with 102 218 male and 117 081 female, which showed an average age of (35.86±15.81) years, 208 082 patients (94.9%) in < 70 years old group, and 11 217 (5.1%) in ≥ 70 years old group. Totally 191 588 patients (87.4%) were diagnosed within the TWT, and the number was 86.5% (9 701/11 217) in the ≥ 70 years old group. Multivariate Logistic regression analysis indicated that age under 70 years old was independently associated with an exceeded TWT [adjusted odds ratio (OR) = 1.106, 95% confidence interval (95%CI) = 1.041-1.176, P = 0.001]. Meanwhile, visits during the peak period or low triage level was also a risk factor of exceeded TWT. According to the Logistic regression analysis of different departments and removing other factors, in the emergency internal medicine with the most elderly patients, the probability of exceeded TWT in ≥ 70 years old group was lessened (adjusted OR = 1.203, 95%CI = 1.121-1.291, P < 0.001). In the emergency pre-grading system, the elderly aged (≥ 70 years old) was more likely to see a doctor in TWT than those under 70 years old, so they were easy to get priority treatment.


Effects of acute cervical stretching on arterial wall elastic properties.
Purpose: Acute (immediate) or regular (mid- or long-term) stretching increases arterial compliance and reduces arterial stiffness. Stretching is widely known to induce arterial functional factor changes, but it is unclear whether stretching alters arterial structural factors. Ultrasound shear wave elastography can quantify the distribution of tissue elastic properties as an index of arterial structural factors. This study thus aimed to examine the effects of acute cervical stretching on arterial wall tissue elastic properties. Methods: Seventeen healthy young adults participated in two different trials for 15 min in random order on separate days: a resting and sitting trial (CON) and a supervised cervical stretching trial (CS). In CS, subjects performed 10 different stretches. At each site, the stretch was held for 30 s followed by a 10-s relaxation period. In CON, subjects rested on a chair for 15 min. Results: After the experiment, carotid arterial compliance, assessed by combined ultrasound imaging and applanation tonometry, was significantly increased in CS, but not in CON. However, there was no significant change in tissue elasticity properties of the arterial wall in either trial, as assessed by ultrasound shear wave elastography. Conclusion: Acute cervical stretching significantly increased carotid artery compliance in young participants, but did not reduce elastic tissue properties (i.e., arterial structural factors) of the carotid artery wall. These results strongly suggest that changes in structural factors have little relation to stretching-induced acute increases in arterial compliance.


Peculiarities of sexual development and reproductive function in young women with childhood onset weight problems.
The risks of reproductive problems are higher in underweight and overweight or obese women, especially in case of rapid weight gain or loss. But evidence is inconsistent especially in relation to the effect of age of body weight changes. The aim of the study was detection of peculiarities of sexual development and reproductive function in underweight and overweight/obese females with childhood thinness or childhood obesity. 103 young females (48 - with low BMI, 55 - with high BMI) with different reproductive problems were examined prospectively. In all investigated patients full clinical examination was held, including body mass index (BMI), type of body fat distribution (waist-to-hip ratio), age of body weight changes, assessment of hirsutism, acne, stretch marks and hyperpigmentation, menstrual disturbances and fertility problems were recorded and gynecological ultrasound was performed. There was no difference established according to the age of menarche and types of menstrual disturbances between the groups of low BMI and high BMI females (p>.05). The correlation was established between the onset of menstrual disruption and progression of changes in body mass (R=.448, p=.005). Hirsutism, stretch marks and acantosis nigricans (hyperpigmentation) were exhibited significantly more frequently in the patients with high BMI (p<.05), whilst distribution of acne was almost the same in the study groups (p>.05). 74.5% of overweight and obese patients had upper body fat distribution (waist-to-hip ratio > 0.8), whilst underweight patients had mostly equal (66.7%) or lower body fat distribution (31.3%) (p=.000). Polycystic ovarian syndrome (PCOS) and metabolic syndrome (MS) was the most frequent in overweight and obese patients, whilst non-classical congenital adrenal hyperplasia (NCAH) and ovarian dysfunction prevailed in the underweight females (p<.05). Infertility was mostly observed in patients with high BMI (p<.05). In conclusion, the peculiarities of sexual development and menstrual function in young females with childhood thinness and obesity are related to their reproductive disorders, childhood BMI and progression of BMI changes.


In vitro characterization of the I-neb Adaptive Aerosol Delivery (AAD) system.
The in vitro characterization of device-related parameters such as the rate of aerosol output, total aerosol output, particle size, and fine particle fraction, is essential when assessing the potential performance of a nebulizer or making comparisons with other nebulizers as they are indicative of potential clinical performance. This article reviews a number of in vitro studies designed to characterize the I-neb Adaptive Aerosol Delivery (AAD) System in terms of drug delivery (particle size, residual, reproducibility, precise dose delivery, dose equivalence), in terms of drug-related performance (osmolality, surface tension, viscosity), and in terms of nebulizer orientation during operation. The results of the in vitro tests of drug delivery indicate that the I-neb AAD System is suitable for delivery of aqueous solutions by nebulization. The evaluation of equivalent doses between the I-neb AAD System (metered dose) and a conventional jet nebulizer (delivered dose), demonstrates that the amount of drug required to deliver the same dose is up to five times less with the I-neb AAD System due to the low residual and controlled drug delivery. The lack of change in osmolality during nebulization might be of importance as it presents an opportunity for delivery of drugs to patients with hyperreactive airways, or where a specific tonicity of the formulation is required. The physicochemical characteristics (surface tension, viscosity) of a number of drugs delivered with the I-neb AAD System highlights some of the demands created by existing and new drug formulations. Finally, the study of the impact of nebulizer orientation shows how important it is to also consider how the nebulizer will actually be physically used by the patient rather than solely under standard conditions used within the laboratory.


Subjective thermal strain impairs endurance performance in a temperate environment.
The aim of this study was to test the hypothesis that subjective thermal strain can reduce endurance performance independently from the general physiological strain normally associated with impaired endurance performance in the heat. In 20 °C and 44% relative humidity, 12 endurance-trained athletes (1♀ 11♂; mean ± SD; age: 27 ± 6 y; VO2max: 61 ± 6 ml/kg/min) performed a time to exhaustion (TTE) test in two different experimental conditions: with an electric heat pad applied to the subjects' upper back (HP) and control (CON: without heat pad). In both conditions, subjects cycled to volitional exhaustion at 70% of their VO2max. Cardiorespiratory, metabolic, thermoregulatory and perceptual responses were measured throughout the TTE test and compared at 0%, 50% and 100% isotime and at exhaustion. TTE was reduced by 9% in HP (2092 ± 305 s) compared to CON (2292 ± 344 s; p = .023). The main effect of condition on thermal discomfort at isotime (p = .002), the effect of condition on thermal sensation at 0% isotime (p = .004) and the condition by isotime interaction on rating of perceived exertion (p = .036) indicated higher subjective thermal strain in HP compared to CON. None of the measured cardiorespiratory, metabolic and thermoregulatory variables differed significantly between conditions. Our novel experimental manipulation (HP) was able to induce significant subjective thermal strain and reduce endurance performance in a temperate environment without inducing the general physiological strain normally associated with impaired endurance performance in the heat. These results suggest that subjective thermal strain is an important and independent mediator of the heat-induced impairment in endurance performance.


Older people's champion wins RCN award.
A senior nurse who has championed the care of older people was named RCN Wales Nurse of the Year for 2014 at a ceremony in Cardiff last week.