Effect of postoperative epidural analgesia on surgical outcome.
Pain relief allowing sufficient mobilization after major surgical procedures can only be achieved by continuous epidural analgesia with local anesthetics, which also reduces the stress response to surgery. However, the role of postoperative epidural analgesia on postoperative morbidity is controversial. We therefore update the effects of postoperative analgesia on surgical outcome. After major abdominal surgery, postoperative epidural analgesia with local anesthetics significantly reduces postoperative ileus and pulmonary complications while effects on cardiac morbidity are debatable. Continuous epidural analgesia significantly lowers the risk of thromboembolic complications after lower body procedures, while no effect is seen after major abdominal surgery. Unfortunately, many studies have inadequate study design, with use of lumbar epidural analgesia for abdominal procedures, or the epidural regimen does not contain a sufficient amount of local anesthetics. Future evaluation of the effects of epidural analgesia on postoperative outcome also requires integration of epidural analgesia within a multimodal rehabilitation programme.


Details of Single-Molecule Force Spectroscopy Data Decoded by a Network-Based Automatic Clustering Algorithm.
Atomic force microscopy-single-molecule force spectroscopy (AFM-SMFS) is a powerful methodology to probe intermolecular and intramolecular interactions in biological systems because of its operability in physiological conditions, facile and rapid sample preparation, versatile molecular manipulation, and combined functionality with high-resolution imaging. Since a huge number of AFM-SMFS force-distance curves are collected to avoid human bias and errors and to save time, numerous algorithms have been developed to analyze the AFM-SMFS curves. Nevertheless, there is still a need to develop new algorithms for the analysis of AFM-SMFS data since the current algorithms cannot specify an unbinding force to a corresponding/each binding site due to the lack of networking functionality to model the relationship between the unbinding forces. To address this challenge, herein, we develop an unsupervised method, i.e., a network-based automatic clustering algorithm (NASA), to decode the details of specific molecules, e.g., the unbinding force of each binding site, given the input of AFM-SMFS curves. Using the interaction of heparan sulfate (HS)-antithrombin (AT) on different endothelial cell surfaces as a model system, we demonstrate that NASA is able to automatically detect the peak and calculate the unbinding force. More importantly, NASA successfully identifies three unbinding force clusters, which could belong to three different binding sites, for both Ext1f/f and Ndst1f/f cell lines. NASA has great potential to be applied either readily or slightly modified to other AFM-based SMFS measurements that result in "saw-tooth"-shaped force-distance curves showing jumps related to the force unbinding, such as antibody-antigen interaction and DNA-protein interaction.


Inverted flap technique for a large traumatic macular hole with choroidal rupture and subretinal hemorrhage.
Large traumatic macular holes (TMHs) tend to be irregular and have a variable predictability. The inverted flap technique makes use of remnants of internal limiting membrane (ILM) at the periphery of the MH. The peeled-off ILM contains Müller cell fragments which can induce gliosis and help in closure of MH. We operated on a case of large TMH (~899 μ minimum linear diameter) with choroidal rupture and subretinal hemorrhage in a young female with the inverted flap technique of ILM peeling and observed successful closure of the MH. The excellent anatomical and surgical results achieved in our case seem to suggest this to be a safe and effective surgical manoeuvre for such cases.


Growth, microstructure, and infrared-ultraviolet optical conductivity of La(0.5)Sr(0.5)CoO(3) nanocrystalline films on silicon substrates by pulsed laser deposition.
La(0.5)Sr(0.5)CoO(3) (LSCO) nanocrystalline (nc) films have been directly grown on silicon wafers under different substrate temperatures by pulsed laser deposition. The X-ray diffraction analysis indicate that the films are polycrystalline with the pure perovskite phase at higher substrate temperatures. The columnar growth formation with the nanocrystalline structure in the films has been confirmed by microscopy experiments. Infrared-ultraviolet optical properties of the LSCO films have been investigated with the aid of spectroscopic ellipsometry (SE). Dielectric function in the photon energy range of 1.1-3.1 eV (400-1100 nm) has been extracted by reproducing the experimental data with a Lorentz oscillator model. It is found that the real part is decreased from 4.7 to -0.7 at the near-infrared region with increasing substrate temperature. The optical conductivity shows a different variation trend for the lower and higher growth temperatures, respectively. Note that the films deposited above 650 degrees C exhibit the well-defined metallic phase behavior. The discrepancies could be mainly ascribed to different crystalline structure and surface morphology. The present results may be crucial for future applications of ferromagnetic-based optoelectronic and spin-electronic devices.


Three-dimensional hysterosonography for the study of endometrial tumors: comparison with conventional transvaginal sonography, hysterosalpingography, and hysteroscopy.
We studied endometrial thickness and homogeneity in 36 patients with postmenopausal bleeding using three-dimensional ultrasound following distention of the uterine cavity with a sterile saline solution (3D-SHSG). Results with 3D-SHSG were compared with findings using transvaginal sonography, transvaginal sonohysterography, transvaginal color Doppler, and hysteroscopy. Sixteen patients (including three on tamoxifen) were undergoing hormone therapy at the time when they were studied. Visualization of the uterine cavity and of endometrial thickness was better with 3D-SHSG than with any of the other ultrasound techniques. The results with 3D-SHSG corresponded to the findings observed with hysteroscopy. Three-dimensional SHSG seems to improve ultrasound determination of myometrial and cervical invasion in cases of endometrial adenocarcinoma.


The prognostic significance of lymph node size in node-positive colon cancer.
To (i) show the outcome benefits of enlarged lymph nodes in node-positive colon cancer cases, as it was shown previously in negative node cases; (ii) disprove the stage migration theory and (iii) list the factors affecting lymph node size and yield. A retrospective study including 234 node-positive colon cancer cases was scheduled and performed. All recovered lymph nodes (6969) from 234 cases were microscopically examined in regard to (a) lymph node size (b) presence of metastasis (c) extent of intra-nodal metastasis. On the basis of resulting data, a statistical analysis was performed. Metastases occurred in all size categories, though more often in larger lymph nodes. Fifty-one percent of all metastasised nodes were 2 to 6 mm in size. Approximately half of all nodes >10 mm were microscopically free of cancer. Cases with a small lymph node metastasis to lymph node size ratio (MSR) had a better prognosis than others: 85 months (95% CI: 72-97) vs. 67 months (95% CI: 47-88), p <0.001 (mean, overall survival). To differentiate between cases with the same ratio but different absolute lymph nodes sizes, we divided the cases into two groups that differed in their number of moderate to large lymph nodes. The group with more moderate to large lymph nodes showed a clear outcome benefit: 104 months (95% CI: 86-122) vs. 66 months (95% CI: 54-77), p = 0.014 (mean, overall survival). Metastasised lymph nodes affect all size categories, and large lymph nodes are not always metastasised. The combination of enlarged lymph nodes and a small lymph node metastasis to lymph node size ratio (MSR) is associated with a better prognosis than others. When enlarged lymph nodes were considered as surrogate markers of an effective local immune response due to nodal hyperplasia, the immune system could be seen as the confounder affecting both lymph node size and prognosis. Our results are pointing in this direction and, along with other reasons, are challenging the stage migration theory.


Persistent activation of interlinked type 2 airway epithelial gene networks in sputum-derived cells from aeroallergen-sensitized symptomatic asthmatics.
Atopic asthma is a persistent disease characterized by intermittent wheeze and progressive loss of lung function. The disease is thought to be driven primarily by chronic aeroallergen-induced type 2-associated inflammation. However, the vast majority of atopics do not develop asthma despite ongoing aeroallergen exposure, suggesting additional mechanisms operate in conjunction with type 2 immunity to drive asthma pathogenesis. We employed RNA-Seq profiling of sputum-derived cells to identify gene networks operative at baseline in house dust mite-sensitized (HDMS) subjects with/without wheezing history that are characteristic of the ongoing asthmatic state. The expression of type 2 effectors (IL-5, IL-13) was equivalent in both cohorts of subjects. However, in HDMS-wheezers they were associated with upregulation of two coexpression modules comprising multiple type 2- and epithelial-associated genes. The first module was interlinked by the hubs EGFR, ERBB2, CDH1 and IL-13. The second module was associated with CDHR3 and mucociliary clearance genes. Our findings provide new insight into the molecular mechanisms operative at baseline in the airway mucosa in atopic asthmatics undergoing natural aeroallergen exposure, and suggest that susceptibility to asthma amongst these subjects involves complex interactions between type 2- and epithelial-associated gene networks, which are not operative in equivalently sensitized/exposed atopic non-asthmatics.


The non-identity problem and genetic harms -- the case of wrongful handicaps.
The Human Genome Project will produce information permitting increasing opportunities to prevent genetically transmitted harms, most of which will be compatible with a life worth living, through avoiding conception or terminating a pregnancy. Failure to prevent these harms when it is possible for parents to do so without substantial burdens or costs to themselves or others are what I call "wrongful handicaps". Derek Parfit has developed a systematic difficulty for any such cases being wrongs -- when the harm could be prevented only by preventing the existence of the individual who would have a worthwhile life even with the handicap, then bringing him into existence with the handicap does not make him worse off and so does not wrong him. I argue that a non "person-affecting" principle requiring the avoidance of suffering and limited opportunity correctly accounts for cases of wrongful handicaps without requiring that the individuals with the handicap have been made worse off and therefore wronged. It is an advantage, not a difficulty, of this account that it does not imply that the person with the handicap has been wronged or is a victim with a special moral complaint.


Adaptive Finite-Time Controller Design for T-S Fuzzy Systems.
This paper studies the adaptive finite-time stabilization problem for a class of nonlinear systems described by Takagi-Sugeno (T-S) fuzzy dynamic models with parametric uncertainties. A novel adaptive state feedback control scheme for the T-S fuzzy systems is proposed, and the scheme is developed based on finite-time Lyapunov theorem and adaptive backstepping-like method. Augmented dynamics are introduced in the design of finite-time stabilization controllers to construct suitable finite-time Lyapunov functions. It is shown that finite-time convergence of the closed-loop adaptive control system can be achieved, and the potential controller singularity problem caused by the augmented dynamics can be avoided. In addition, constructive procedures to obtain such an adaptive finite-time controller are given. Convergence time as a transient performance specification is also taken into account, and a finite upper bound on the convergence time is estimated. Finally, two numerical examples are provided to illustrate the effectiveness and practicality of the proposed adaptive control approach.


[Risks and perspectives of drug dependence. Catamnestic results in 100 opiate addicts during the access years 1969-1974].
The further development of 100 young drug addicts of the opiate type (72 males, 28 females) who had been medically assessed by court or police order between 1969 and 1974 was evaluated over 10 to 15 years. Until the end of 1983 20 clients had died, 14 males and 6 females. The state of the survivors was separated into 5 categories according to drug dependency, rate of delinquency and assurance of income. 39 clients were free from injectable drugs. The abstinence rate was equal in males and females. The major part of these abstinent clients was fully rehabilitated, drug-independent for years, not delinquent and integrated into work. A minor part depended on external help. Three clients were not able to earn a living. Half of the 80 survivors had to be considered at risk. International comparison shows that the increased mortality among opiate addicts is only slightly different among western industrial nations. Perspectives of survivors are also similar. Despite different treatment and intervention strategies the abstinence ratio approaches 40% after the 30th year of life with an increasing tendency with increase of age. As the now already older clients usually decline in-patient care, however accept out-patient help promoting rehabilitation successfully ("path of rehabilitation"), promotion of ambulatory care decisively involving doctors is urgently required.


Analysis of Healing Effect of Alginate Sulfate Hydrogel Dressing Containing Antimicrobial Peptide on Wound Infection Caused by Methicillin-Resistant Staphylococcus aureus.
Wound infections caused by methicillin-resistant Staphylococcus aureus are a health problem worldwide; therefore, it is necessary to develop new antimicrobial compounds. Considering broad-spectrum antimicrobial activity and low probability of drug resistance to peptides, applications these peptides are being studied extensively. In this study, to control drug release over time, an alginate sulfate-based hydrogel impregnated with the CM11 peptide as the antimicrobial agent was developed, and its healing effects were tested on skin infections caused by methicillin-resistant S. aureus strains in a mouse model. Minimum inhibitory and minimum bactericidal concentrations of the CM11 peptide and alginate hydrogel in combination with the peptide were determined. Forty mice were divided into 4 groups: 1 group as a negative control (without treatment; however, 5 mice received hydrogel dressing without peptide), 1 group as a positive control (2% mupirocin treatment), and 2 groups as test groups. To establish skin infection, 200 μL of bacterial suspension with 3 × 10(8) CFU/mL concentration was subcutaneously injected in the scapular region of the mice. On the basis of the in vitro minimal bactericidal concentration of the alginate hydrogel containing peptide for 15 clinical isolates, hydrogel containing 128 mg/L of peptide was used for wound dressing over an 8-day period. The highest and lowest numbers of wounds were observed on day 2 in the negative and positive control groups, respectively. During the 8-day period, the positive control and hydrogel containing peptide treatment groups showed similar levels of wound healing. This study showed that compared to standard drug treatment, treatment with hydrogel containing peptide had substantial antibacterial effects on S. aureus wound infections in mice.


Evaluation of TCOM/HBOT practice guideline for the treatment of foot burns occurring in diabetic patients.
A multidisciplinary team developed an evidence-based guideline for the management of foot burns occurring in diabetic patients that included transcutaneous oxygen measurements (TCOM) and application of hyperbaric oxygen therapy (HBOT) to selected patients. This report represents an evaluation of preliminary TCOM/HBOT data. This is a retrospective review of patients with diabetes mellitus (DM) who were admitted to a single American Burn Association (ABA) verified burn center for the treatment of foot burns. Patients were treated via the guideline if they were over the age of 16, admitted for the initial care of burns involving the feet between 4/01/2012 and 7/22/2013, and had a known or new diagnosis of DM. Eighteen patients were treated according to the guideline, 14 men and 4 women. Average age was 54 years+14.78. Average BMI was 30.63+6.34. Median burn size was 0.88% TBSA (median partial thickness of 1% and median full thickness of 0.5%). The average HbA1c was 9.08+2.42. Seven patients received pre-operative HBOT, two received post-operative HBOT and three patients healed their wounds with HBOT alone. Average hospital length of stay was 13.39 days+9.94 and was significantly longer for the group receiving HBOT. Admission HbA1c was not a predictor of the need for HBOT. While TCOM/HBOT therapy has not been widely applied to the management of diabetic foot burns, the use of an evidence-based guideline incorporating TCOM/HBOT can provide a systematic way to evaluate the patients' microcirculation and ability to heal burns of the foot. The incorporation of TCOM determination and application of HBOT in selected patients with DM and burns of the feet warrant continued study.


Myoglobin and troponin concentrations are increased in early stage deep tissue injury.
Pressure-induced deep tissue injury is a form of pressure ulcer which is difficult to detect and diagnose at an early stage, before the wound has severely progressed and becomes visible at the skin surface. At the present time, no such detection technique is available. To test the hypothesis that muscle damage biomarkers can be indicative of the development of deep tissue injury after sustained mechanical loading, an indentation test was performed for 2 h on the tibialis anterior muscle of rats. Myoglobin and troponin were analysed in blood plasma and urine over a period of 5 days. The damage as detected by the biomarkers was compared to damage as observed with T2 MRI to validate the response. We found that myoglobin and troponin levels in blood increased due to the damage. Myoglobin was also increased in urine. The amount of damage observed with MRI immediately after loading had a strong correlation with the maximal biomarker levels: troponin in blood rs = 0.94; myoglobin in blood rs = 0.75; and myoglobin in urine rs = 0.57. This study suggests that muscle damage markers measured in blood and urine could serve as early diagnosis for pressure induced deep tissue injury.


Client satisfaction with rural substance abuse case management services.
Although many substance abuse organizations offer case management services, little is known about clients' satisfaction as consumers of case management services. The purpose of this study was to evaluate consumer preferences regarding the delivery of case management services in a rural substance abuse treatment program. For this study, 120 clients (30 in each of four research conditions) were interviewed about their experiences in the Iowa Case Management Project (ICMP), a field-based clinical trial evaluating a strengths-based model of case management for rural clients in drug abuse treatment. A mixed-method approach evaluated clients' responses from a semistructured interview. Most clients preferred meeting with their case manager in their own home. Clients also stated that they preferred specific characteristics of case management services-namely, convenience, privacy, comfort, and accessibility. Finally, clients wanted more time with their case managers over time. Although clients in drug treatment are not often considered as consumers, we found that client satisfaction with case management services could be studied and that clients appreciated being asked about their experiences. By targeting perceived and actual barriers to meeting with case managers (e.g., availability of transportation), service utilization by clients may be increased along with overall satisfaction.


Cultured human endothelial cells display an antigen that is recognized by certain human anti-chromatin autoantibodies.
Certain human anti-nucleosome autoantibodies cross-reacted specifically with an antigen on the surface of human vascular endothelial cells. This was shown by two different techniques. First, antibodies eluted from the surface of cultured endothelial cells bound to cell nuclei; this binding was inhibited by soluble mononucleosomes. Second, X-ANA, specifically isolated by their affinity to polynucleosomes, stained the plasma membranes of single cell suspensions of endothelial cells in the indirect immunofluorescence test. Several lines of evidence excluded Fc receptor-mediated binding of Ig to the cells. Thus, plasma membranes of vascular endothelial cells and chromatin bear an antigen that is serologically related.


A novel semi-automated method of tracking fetal movements.
We have designed software that can "look" at recorded ultrasound sequences. We analyzed fifteen video sequences representing recorded ultrasound scans of nine fetuses. Our method requires a small amount of user labelled pixels for processing the first frame. These initialize GrowCut, a background removal algorithm, which was used for separating the fetus from its surrounding environment (segmentation). For each subsequent frame, user input is no longer necessary as some of the pixels will inherit labels from the previously processed frame. This results in our software's ability to track movement. Two sonographers rated the results of our computer's 'vision' on a scale from 1 (poor fit) to 10 (excellent fit). They assessed tracking accuracy for the entire video as well as segmentation accuracy (the ability to identify fetus from non-fetus) for every 100th processed frame. There was no appreciable deterioration in the software's ability to track the fetus over time.


Predictive values, sensitivity and specificity of abdominal fluid variables in determining the need for surgery in horses with an acute abdominal crisis.
To determine the predictive values, sensitivity and specificity of abdominal fluid variables associated with the need for surgery in horses with an acute abdominal crisis. Retrospective study. Two-hundred and thirty-six horses examined for signs of abdominal pain between January 1993 and June 1999. Breed, age and gender of the horse and colour, total protein concentration and total nucleated cell count of an abdominal fluid sample were recorded. Colour of the abdominal fluid was classified as normal if it was yellow and transparent. Turbid fluid or fluid that was serosanguinous or other colours was classified as abnormal. Protein concentration < or = 20 g/L and a total nucleated cell count < or = 5 x 10(9) cells/L were considered normal and values above these were considered abnormal. An abdominal fluid sample was classified as abnormal if one or more of the three variables were considered abnormal. Cases were defined as surgical when lesions identified at surgery or necropsy examination would not have resolved with medical treatment alone. Cases were defined as medical in horses that survived without surgical intervention, and those with a lesion found at surgery or necropsy that would have resolved with medical treatment alone. A third category was identified during the study as those diagnosed with Actinobacillus equuli--induced peritonitis. These horses were included in the study but not in the data analysis. The association between the sensitivity, specificity and positive and negative predictive value of colour, total protein, and total nucleated cell count in the abdominal fluid and the need for surgery was calculated. There were 100 females and 136 males of mixed breeds, ranging from 3 days to 26 years of age that had an abdominocentesis performed during the specified period. There were 97 horses with a lesion classified as surgical, 91 horses with a lesion classified as medical and 48 horses with a diagnosis of A equuli-induced peritonitis. Colour of the abdominal fluid was recorded in all horses, protein concentration was recorded in 194 horses and total nucleated cell count was recorded in 179 horses. Abnormal abdominal fluid colour had a sensitivity, specificity, positive and negative predictive value of 92%, 74%, 79% and 89% respectively, associated with the need for surgery. Sensitivity, specificity, positive and negative predictive values for a serosanguinous abdominal fluid sample associated with the need for surgery were 48%, 99%, 98% and 64% respectively. Abnormal abdominal fluid protein concentration had a sensitivity, specificity, positive and negative predictive value of 86%, 75%, 77% and 85% respectively, associated with the need for surgery. The sensitivity, specificity, positive and negative predictive value associated with the need for surgery in horses with an abnormal total nucleated cell count in the abdominal fluid were 59%, 75%, 67% and 67%, respectively. An abdominal fluid sample classified as abnormal had a sensitivity, specificity, positive and negative predictive value of 92%, 74%, 79% and 89% respectively, associated with the need for surgery. Results of this study suggest that abdominal fluid sample analysis contributes to the decision to proceed to surgery, but is not a diagnostic panacea. Colour and protein concentration of abdominal fluid were the most useful variables in abdominal fluid for differentiating medical and surgical lesions. Colour and protein had a greater value in horses with a disease likely to respond to medical treatment (negative predictive value) than those with a lesion requiring surgery (positive predictive value) except when the fluid was serosanguinous. Abdominal fluid colour and protein are clinically relevant and easily measured in the field, providing immediate information without the need for sophisticated laboratory techniques.


An Easy-to-Implement Risk Score for Targeted Hepatitis C Virus Testing in the General Population.
Despite the effectiveness of available treatments, hepatitis C virus (HCV) remains a major public health problem, mainly due to the high percentage of undiagnosed individuals. We aim to create an easy-to-implement risk score to facilitate targeted HCV testing in the general population. This is a substudy derived from a prospective study in primary care in Madrid (Spain). Participants completed a 21-question risk assessment questionnaire, followed by HCV testing for those with at least one positive response and those >50 years of age, even if they did not answer positively. We used the population >50 years of age to fit a logistic regression model to create a score predicting the risk of a positive test result. We then performed a sensitivity analysis by applying the score obtained to the population <50 years of age, to assess its diagnostic accuracy. Data collected from 2,302 participants were included in the analysis. The prevalence of HCV infection was 1.3%. Five items were selected, showing a C-statistic of 0.896, i.e., male sex, Eastern European origin, use of intravenous drugs, self-perceived risk of acquired HCV infection, and past hepatitis or unexplained liver disease. The sensitivity was 98%, and the negative likelihood ratio was 0.05 for participants with scores of 0 (49.8% in our sample), ruling out HCV infection with high probability. We obtained similar estimates in the population <50 years of age. This tool achieved high diagnostic accuracy to target HCV testing. This could help optimize resources when universal screening is not feasible. IMPORTANCE Despite the highly effective treatments currently available, HCV remains one of the major public health problems related to an infectious agent, mainly because a high percentage of individuals remain undiagnosed. Universal screening has been proposed as a way to end this epidemic; however, it is not feasible in all settings due to different implementation barriers. With this work, we aim to collaborate in improving the diagnosis of HCV infection by creating a simple 5-item score that rules out HCV infection with a very high probability. Almost one-half of the participants in our sample did not present any affirmative answers to these questions, and their probability of being infected was close to 0%. This tool could be a useful strategy and could be considered a cost-effective alternative to optimize resources when universal screening is not feasible.


Surgical approach of ectopic maxillary third molar avulsion: Systematic review and meta-analysis.
Ectopic maxillary third molars (EMTM) are extracted mainly by the Caldwell-Luc technique but also by nasal endoscopy. There is currently no consensus on the treatment of this eruption and its management is heterogeneous and multidisciplinary. Two literature searches were performed with no time restrictions via Pubmed. In the first, we used the keywords "ectopic AND third molar" and in the second the keywords "dentigerous cyst AND ectopic third molar". For both articles, epidemiological, symptomatic, radiological and surgical data were recorded. Overall, 33 eligible articles were identified involving 39 cases of EMTM. 79% of patients were symptomatic. 87% of the teeth were associated with a dental cyst. In only 13% of cases was the location of the tooth in the sinus specified in the three planes of the space. Surgery was performed in 77% of patients by the Caldwell-Luc technique, by nasal endoscopy in 10% and by the Le Fort I approach in 3%. The indications for avulsion of EMTM are symptomatic patients or asymptomatic patients with an associated cyst. The intra-sinusal location of the tooth is not a factor in the choice of technique used, which depends rather on the individual skills of the surgeon. Although for a trained operator the Le Fort I osteotomy is an easy procedure, its interest in the treatment of EMTM is limited owing to the rare but potentially severe complications involved.


Cardiac responses to drugs at the extremes of age.
Although current knowledge concerning drug responsiveness in the human heart is still deficient at both extremes of age, i.e. in the fetus and the elderly, new information is beginning to emerge. Pharmacodynamic studies have provided a fairly comprehensive picture of the appearance and maturation of the automatic receptors, and also of the emergence and development of sympathetic-adrenergic and parasympathetic-cholinergic mechanisms in the prenatal human heart. A timetable can now be drawn up for the earliest detection of intrinsic responsiveness to numerous adrenergic and cholinergic agonists and antagonists, and to inotropic and antiarrhythmic drugs in the human embryonic and fetal heart. Information on the antenatal cardiac pharmacodynamics of antiarrhythmics and inotropic drugs is mostly confined to some of the classical remedies, so that a systematic study of the effects of the various newer drugs is warranted. As legal abortions yield prenatal hearts only in very limited numbers, human embryonic and fetal cardiac tissue and cell cultures could also be used for such research under both physiological and pathological conditions, such as hypoxia or simulated ischemia. Since the sporadic data available on the transplacental efficacy of maternally administered cardioactive agents are encouraging, extensive clinical investigation into the pharmacological control of intrauterine cardiac arrhythmias and heart failure, based on new, high-resolution fetal echocardiographic techniques to monitor the success of drug therapy at the various stages of prenatal development, is also a stimulating challenge. In the elderly human heart, pharmacodynamically-based alterations in responsiveness to drugs have so far been conclusively proven for adrenergic agents.(ABSTRACT TRUNCATED AT 250 WORDS)


Toll-like receptor 9 negatively related to clinical outcome of AML patients.
Acute myeloid leukemia (AML) can modulate toll-like receptor-9 (TLR9) expression and activation. This study was conducted to elucidate the expression of TLR9 in AML patients and its relation to the prognosis of the disease. The study included 40 newly diagnosed AML patients managed in the hospital in addition to 20 sex and age matched normal volunteers as control. TLR9 expression assay was conducted on peripheral blood samples of AML cases before the start of treatment as well as the controls by immunophenotyping. TLR9 expression was ranging from 0.10 to 2.40% in AML patients with higher expression among the control, ranging from 0.94 to 8.25%. The median TLR9 expression in AML patients was significantly lower with advanced cytogenetic risk score. It is not significantly differing in relation to patients' sex, age group, and FAB type of AML. However, significant lower median expression was found in relation to clinical outcome. TLR9 expression ≤ 1% showed lower median overall survival time when compared to those with > 1% expression. This study concluded that AML patients express TLR9 in leukemic cells with very low percentage. This expression was negatively related to the clinical outcome.


The function of the plant cell wall in plant-microbe interactions.
The plant cell wall is an interface of plant-microbe interactions. The ability of microbes to decompose cell wall polysaccharides contributes to microbial pathogenicity. Plants have evolved mechanisms to prevent cell wall degradation. However, the role of the cell wall in plant-microbe interactions is not well understood. Here, we discuss four functions of the plant cell wall-physical defence, storage of antimicrobial compounds, production of cell wall-derived elicitors, and provision of carbon sources-in the context of plant-microbe interactions. In addition, we discuss the four families of cell surface receptors associated with plant cell walls (malectin-like receptor kinase family, wall-associated kinase family, leucine-rich repeat receptor-like kinase family, and lysin motif receptor-like kinase family) that have been the subject of several important studies in recent years. This review summarises the findings on both plant cell wall and plant immunity, improving our understanding and may provide impetus to various researchers.


[Transpupillary thermotherapy in age-related macular degeneration. Preliminary results].
To evaluate anatomical and functional results of transpupillary thermotherapy (TTT) in age-related macular degeneration (ARMD) with a chorioid neovascular membrane (CNVM). TTT was performed by means of a diode laser (Iris Medical Oculight Six) in 38 eyes of 35 patients aged 46-93 years, mean 70.6 years. Ocult CNVM was treated in 34 eyes, classical CNVM in 4 eyes. In TTT we applied 1 to 5 points (on average 1.9 spot) and used a laser beam with a diameter of 0.5-3 mm (mean width 1.61 mm). In 10 eyes with occult CNVM (29%) TTT was repeated after 1-6 months. The patients were followed up after TTT for 6-18 months on average for 9.5 months. The final visual acuity (VA) improved after TTT in two eyes (5.3%), remained unchanged in 22 eyes (57.9%) and deteriorated in 14 eyes (36.8%). The mean VA after TTT declined from 0.23 to 0.17. Biomicroscopic manifestations of exudation disappeared or receded in 29 eyes with occult CNVM (85.3%) and in 3 eyes with classical CNVM (75%). Fluoroangiographic examination revealed a reduced or absent extravasation of the dye in 24 eyes with occult CNVM (70.5%) and in 3 eyes with classical CNVM (75%). Optic coherent tomography confirmed regression of exudative changes and the development of a chorioretinal scar in 23 eyes with occult CNVM (67.6%) and 3 eyes with classical CNVM (75%). TTT is a new potential therapy of ACMD with CNVM. It is indicated in particular in occult CNVM. It can be however used also in classical CNVM. TTT is not economically pretentious and can be used also in other than large clinical departments. It is important to test the possibilities and limitations of TTT on a large number of patients and assess its position among other therapeutic procedures.


Changes in Chenopodium rubrum seeds with aging.
We studied antioxidative system, germination, growth, and flowering in vitro in Chenopodium rubrum seeds of different ages. Peroxidase, superoxide dismutase, and catalase activity, as well as glutathione status, were determined in 2.5-h imbibed seeds. Germination was tested under controlled conditions. Growth and flowering of plants were tested in vitro. The enzyme activities and glutathione content were higher in younger seeds. Germination declines with seed age. Plants derived from older seeds were smaller, and flowering percentage was lower compared to plants derived from younger seeds. Gibberellic acid reduced the difference in growth and flowering between plants derived from seeds different in age.


Microgravity elicits reproducible alterations in cytoskeletal and metabolic gene and protein expression in space-flown Caenorhabditis elegans.
Although muscle atrophy is a serious problem during spaceflight, little is known about the sequence of molecular events leading to atrophy in response to microgravity. We carried out a spaceflight experiment using Caenorhabditis elegans onboard the Japanese Experiment Module of the International Space Station. Worms were synchronously cultured in liquid media with bacterial food for 4 days under microgravity or on a 1-G centrifuge. Worms were visually observed for health and movement and then frozen. Upon return, we analyzed global gene and protein expression using DNA microarrays and mass spectrometry. Body length and fat accumulation were also analyzed. We found that in worms grown from the L1 larval stage to adulthood under microgravity, both gene and protein expression levels for muscular thick filaments, cytoskeletal elements, and mitochondrial metabolic enzymes decreased relative to parallel cultures on the 1-G centrifuge (95% confidence interval (P⩽0.05)). In addition, altered movement and decreased body length and fat accumulation were observed in the microgravity-cultured worms relative to the 1-G cultured worms. These results suggest protein expression changes that may account for the progressive muscular atrophy observed in astronauts.


Narratives as Borders: Using an Adapted Narrative Approach to Understand the Retelling of the Physical Narratives of Trauma by Karen Women With Refugee Status Resettled in the United States.
The refugee narrative spans time, geography, and generations, enfolding the complexity of constructing identities through displacement and migration. Through adapted narrative analysis, we examined the physical narratives of war trauma which a sample of Karen refugee women constructed, as they claimed their experiences of war trauma and torture in interview discussions. We employed an adapted narrative method relevant to the analysis of field texts to interpret the remembering and retelling of trauma narratives. This method helped to elicit positional identities and physical/sensory memories that were prominent in women's experiences and to contextualized concurrently collected quantitative data. Accounts revealed key constructs relevant to the narrative function and orientation of the narratives: remembering childhood, being a mother, embodiment of trauma.


Resilience model for parents of children with cancer in mainland China-An exploratory study.
Parents have psychosocial functions that are critical for the entire family. Therefore, when their child is diagnosed with cancer, it is important that they exhibit resilience, which is the ability to preserve their emotional and physical well-being in the face of stress. The Resilience Model for Parents of Children with Cancer (RMP-CC) was developed to increase our understanding of how resilience is positively and negatively affected by protective and risk factors, respectively, in Chinese parents with children diagnosed with cancer. To evaluate the RMP-CC, the latent psychosocial variables and demographics of 229 parents were evaluated using exploratory structural equation modeling (SEM) and logistic regression. The majority of goodness-of-fit indices indicate that the SEM of RMP-CC was a good model with a high level of variance in resilience (58%). Logistic regression revealed that two demographics, educational level and clinical classification of cancer, accounted for 12% of this variance. Our results indicate that RMP-CC is an effective structure by which to develop mainland Chinese parent-focused interventions that are grounded in the experiences of the parents as caregivers of children who have been diagnosed with cancer. RMP-CC allows for a better understanding of what these parents experience while their children undergo treatment. Further studies will be needed to confirm the efficiency of the current structure, and would assist in further refinement of its clinical applications.


An empowerment program to enhance women's ability to prevent and control malaria in the community, Chiang Mai Province, Thailand.
Paulo Freire's theory was modified to empower a women's group in Chiang Mai Province, Thailand, to prevent and control malaria. This study conducted an intervention in Mueang Na Wan Village, Mueang Na Sub-district, Chiang Dao District, Chiang Mai Province, where 45 women were systematically recruited into the study cohort. Navail Village was selected as a control village because it resembled the intervention village. The empowerment program emphasized enhancement of malaria preventive levels, using insecticide-treated bed nets, self-esteem, and self confidence expectation to prevent and control malaria. Intensive training was conducted and activities performed among the women's group, with 10 participatory meetings in all. Data collection was conducted for the pre-test in month 1, and post-intervention in months 3, 6, 9, and 12. The qualitative methods used were focus-group discussions, non-participant observations, and in-depth interviews with housewives, their husbands, and youths at risk for malaria. The results showed that, post-intervention, there were significantly increased levels for malaria preventive behaviors, behaviors of using insecticide-treated nets, self-esteem, and self confidence expectations, in the intervention village compared with the control village. Insecticide-treated net usage and insecticide-treated net usage behaviors increased in the intervention village more than before and more than that in the control village. The women's group in the intervention village created the following plans, which were crucial to malaria prevention: (1) a family protection plan, (2) providing malaria education to community members, (3) a mosquito-control campaign, (4) scaling-up insecticide-impregnated bed nets, and (5) malaria control among foreign laborers. Finally, the empowered women's group performed sustainable activities. Between malaria-prevention activities, they conducted a joint program to raise income for their families.


Feasibility and outcomes of endovascular embolization of cerebral arteriovenous malformations at a low-volume centre.
Herein, we report our initial experience with the endovascular management of cerebral arteriovenous malformations (AVMs) using the liquid embolic agent Onyx and n-butyl cyanoacrylate for AVM embolization. We reviewed data from 15 patients with brain AVMs, who were observed at our endovascular facility from January 2008 to July 2011. All cases were embolized with Onyx and/or n-butyl cyanoacrylate. There were 8 women and 7 men with a mean age of 27.2 years (range 17-43 years). The clinical presentations included intracerebral haemorrhage (n = 7), seizures (n = 4), headache (n = 2), and focal neurological deficits (n = 2); according to the Spetzler-Martin classification (Spetzler R and Martin N (1986) J NeurosurgV65 446-83), 8 AVMs were grades I-II, 5 were grade III, and 2 were grades IV-V. A total of 31 embolization procedures were performed in 15 patients, and 44 feeding pedicles were embolized, ranging from 1 to 5 per patient, with an average size reduction of 70% (median 75%, range 40-100%). Total obliteration was achieved for 3 AVMs (20%) (2 patients had single feeders and 1 patient had double feeders), and a partial embolization was achieved in 12 patients (80%). The procedure was related to a permanent disabling morbidity in one patient (6.6%), and no mortalities occurred. The outcome of (AVM) embolization in our centre is comparable to the reported outcome in other larger-volume centres. The feasibility and safety of AVM embolization in our low-volume centre are similar to the outcomes reported at high-volume centre.


Effects of extraction method and storage of dry tissue on marine lipids and fatty acids.
Various protocols are currently used to study marine lipids, but there is a growing interest in working on dry samples that are easier to transport. However, reference protocols are still lacking for dry samples. In order to make recommendations on this use, lipid classes and fatty acids (FA) obtained from six analytical protocols using two different tissue states (dry vs wet) and three extraction methods (automat vs manual potter vs leaving the solvent to work on tissue) were compared. Three dry storage modes of tissue (freezer vs gas nitrogen vs dry room) during one and three months were also compared. These comparisons were made on seven marine species with different lipid profiles, including fishes, crustaceans and mollusks. Lipid classes and FA obtained from wet and dry tissues were similar, but they were affected by the extraction methods. Regardless of tissue state, "Leave to work" methods obtained the highest lipid quantities, followed by manual potter and automat methods (ca. 90% and 80% of "Leave to work" methods, respectively). Linear relationships allowed correction for lipid classes and FA concentrations obtained from different protocols. The repeatability of all protocols still needs to be improved, especially for fish species. Increasing the replicate number for each sample might be an indirect way to improve lipid quantification. Our results show that storing dry tissues in the freezer for more than one month was associated with a decrease in lipids, which is also observed for other storage methods. For qualitative studies of FA (expressed in %), a three-month storage of dry tissue in freezer did not affect the relative composition of species/tissues with a lipid content below 20% of dry weight.


Fibroblast Growth Factor 7 Regulates Proliferation and Decidualization of Human Endometrial Stromal Cells via ERK and JNK Pathway in an Autocrine Manner.
Decidualization is an essential activity of the endometrium in pregnancy, but the molecular mechanisms involving the initiation and maintenance have not yet been clarified. In the present study, we examined the expression of fibroblast growth factor 7 (FGF7) in endometria, normal decidua, and abortion decidua from miscarriage by immunohistochemistry. We analyzed the expression of FGF7 and FGFR2 and the levels of phosphorylated extracellular signal-regulated kinases (ERKs), c-Jun N-terminal kinase (JNK) in endometrial stromal cells (ESCs), and decidual stromal cells (DSCs) from early pregnancy or miscarriage by In-Cell Western assay. The effect of FGF7 on the proliferation of decidualized ESCs was determined by bromodeoxyuridine proliferation assay. Our results show that the expression of FGF7 protein in the normal decidua is obviously higher than that of the endometrium and the abortion decidua, and the expression of FGF7 in the abortion decidua was still higher than that in the endometrium. The FGF7 expression in ESCs is significantly increased after stimulation with a combination of progesterone and 17β-estradiol or 8-bromoadenosine 3',5'-cyclic monophosphate for 12 days. The expression of FGF7 and FGFR2 and the levels of phosphorylated ERK and JNK in DSCs from normal decidua are markedly higher compared with that in ESCs from the endometrium, and the DSCs from abortion decidua had lower expression than DSCs from normal decidua but still higher than ESCs from the endometrium. Our results suggest that FGF7 may stimulate ESCs proliferation and insulin-like growth factor-binding protein 1 and prolactin expressions through ERK and JNK signal pathways in an autocrine manner.


Vinculin is proteolyzed by calpain during platelet aggregation: 95 kDa cleavage fragment associates with the platelet cytoskeleton.
The focal adhesion protein vinculin contributes to cell attachment and spreading through strengthening of mechanical interactions between cell cytoskeletal proteins and surface membrane glycoproteins. To investigate whether vinculin proteolysis plays a role in the influence vinculin exerts on the cytoskeleton, we studied the fate of vinculin in activated and aggregating platelets by Western blot analysis of the platelet lysate and the cytoskeletal fractions of differentially activated platelets. Vinculin was proteolyzed into at least three fragments (the major one being approximately 95 kDa) within 5 min of platelet activation with thrombin or calcium ionophore. The 95 kDa vinculin fragment shifted cellular compartments from the membrane skeletal fraction to the cortical cytoskeletal fraction of lysed platelets in a platelet aggregation-dependent manner. Vinculin cleavage was inhibited by calpeptin and E64d, indicating that the enzyme responsible for vinculin proteolysis is calpain. These calpain inhibitors also inhibited the translocation of full-length vinculin to the cytoskeleton. We conclude that cleavage of vinculin and association of vinculin cleavage fragment(s) with the platelet cytoskeleton is an activation response that may be important in the cytoskeletal remodeling of aggregating platelets.


Apelin induces vascular smooth muscle cells migration via a PI3K/Akt/FoxO3a/MMP-2 pathway.
Apelin is an adipokine that has a critical role in the development of atherosclerosis, which may offer potential for therapy. Because migration of vascular smooth muscle cells (VSMCs) is a key event in the development of atherosclerosis, understanding its effect on the atherosclerotic vasculature is needed. Here we investigated the effect of apelin on VSMC migration and the possible signaling mechanism. In cultured rat VSMCs, apelin dose- and time-dependently promoted VSMC migration. Apelin increased the phosphorylation of Akt, whereas LY294002, an inhibitor of phosphatidylinositol 3-kinase (PI3K), and an Akt1/2 kinase inhibitor blocked the apelin-induced VSMC migration. Apelin dose-dependently induced phosphorylation of Forkhead box O3a (FoxO3a) and promoted its translocation from the nucleus to cytoplasm, which were blocked by LY294002 and Akt1/2 kinase inhibitor. Furthermore, apelin increased matrix metalloproteinase 2 (MMP-2) expression and gelatinolytic activity. Overexpression of a constitutively active, phosphorylation-resistant mutant, TM-FoxO3a, in VSMCs abrogated the effect of apelin on MMP-2 expression and VSMC migration. ARP101, an inhibitor of MMP-2, suppressed apelin-induced VSMC migration. Moreover, the levels of apelin, phosphorylated Akt, FoxO3a, and MMP-2 were higher in human carotid-artery atherosclerotic plaque than in adjacent normal vessels. We demonstrate that PI3K/Akt/FoxO3a signaling may be involved in apelin inducing VSMC migration. Phosphorylation of FoxO3a plays a central role in mediating the apelin-induced MMP-2 activation and VSMC migration.


[Re-coronary artery bypass grafting for anomalous origin of left coronary artery from pulmonary artery (Bland-White-Garland syndrome) after operation in infancy: a case of 18-year follow-up].
Anomalous origin of the left coronary artery from the pulmonary artery is a very rare congenital malformation. Re-coronary artery bypass grafting was performed in a 18-year-old man who had received coronary artery reconstruction with a homologous saphenous vein (from his mother) at 7-months old. After the first operation, clinical course was uneventful, but the patient became symptomatic because of effort angina at age 15. The electrocardiogram showed abnormal ST segments in Lead V2-5 and abnormal T waves in Lead V5-6. Coronary arteriography revealed that saphenous vein graft was occluded. The left internal thoracic artery (LITA) was anastomosed to the left anterior descending artery and a two coronary system was established. Postoperative angiography revealed that LITA was patent, and relief of angina was obtained.


Ultrasound-guided spectral photoacoustic imaging of hemoglobin oxygenation during development.
Few technologies are capable of imaging in vivo function during development. In this study, we have implemented spectral photoacoustic imaging to estimate tissue oxygenation longitudinally in pregnant mice. We used the spectral photoacoustic signal to estimate hemoglobin oxygen saturation within intact, in vivo mouse concepti from developmental day (E) 8.5 to E16.5-a first step towards functional imaging of the maternal-fetal environment. Future work will apply these methods to compare longitudinal functional changes during normal vs abnormal development of embryos, fetuses, and placentas.


A second lysine-specific serine protease from Lysobacter sp. strain IB-9374.
A second lysyl endopeptidase gene (lepB) was found immediately upstream of the previously isolated lepA gene encoding a highly active lysyl endopeptidase in Lysobacter genomic DNA. The lepB gene consists of 2,034 nucleotides coding for a protein of 678 amino acids. Amino acid sequence alignment between the lepA and lepB gene products (LepA and LepB) revealed that the LepB precursor protein is composed of a prepeptide (20 amino acids [aa]), a propeptide (184 aa), a mature enzyme (274 aa), and a C-terminal extension peptide (200 aa). The mature enzyme region exhibited 72% sequence identity to its LepA counterpart and conserved all essential amino acids constituting the catalytic triad and the primary determining site for lysine specificity. The lepB gene encoding the propeptide and mature-enzyme portions was overexpressed in Escherichia coli, and the inclusion body produced generated active LepB through appropriate refolding and processing. The purified enzyme, a mature 274-aa lysine-specific endopeptidase, was less active and more sensitive to both temperature and denaturation with urea, guanidine hydrochloride, or sodium dodecyl sulfate than LepA. LepA-based modeling implies that LepB can fold into essentially the same three-dimensional structure as LepA by placing a peptide segment, composed of several inserted amino acids found only in LepB, outside the molecule and that the Tyr169 side chain occupies the site in which the indole ring of Trp169, a built-in modulator for unique peptidase functions of LepA, resides. The results suggest that LepB is an isozyme of LepA and probably has a tertiary structure quite similar to it.


Efficacy of intrathecal baclofen therapy in children with intractable spastic cerebral palsy: a randomised controlled trial.
Intractable spasticity can be treated effectively with continuous infusion of intrathecal baclofen. Because evidence for its use in the treatment of children with spastic cerebral palsy is lacking, we conducted a randomised controlled trial. To test whether continuous infusion of intrathecal baclofen is effective in comparison with standard treatment only. Seventeen children, aged 13.2 (SD 2.8) years, with intractable spastic cerebral palsy were randomised to receive a Synchromed pump for continuous infusion of intrathecal baclofen after either 1 month (CITB group) or 6 months (Control group). Primary outcomes were the 6-month-change scores on the 0-10 visual analogue scale for individually formulated problems and the caregiver assistance scale of the Pediatric Evaluation of Disability Inventory self-care domain. One of the secondary outcome measures was health related quality of life as measured with the Child Health Questionnaire-PF50. Nine children were randomly assigned to the CITB group and eight to the Control group. The visual analogue scale for individual problems improved with 4.0 (SD 1.7) in the CITB group and changed with -0.2 (SD 1.3) in the Control group (p=0.001). Pediatric Evaluation of Disability Inventory scores did not change significantly. The Child Health Questionnaire-PF50 6-month-change score significantly differed in favour of the CITB group for the domains of bodily pain/discomfort (p=0.014), mental health (p=0.045), psychosocial status (p=0.027) and parents' personal time limitation (p=0.043). The results of this randomised controlled trial establish continuous infusion of intrathecal baclofen to be effective in carefully selected children with problems caused by intractable spastic cerebral palsy.


Xenon-related analgesia: a new target for pain treatment.
The noble gas xenon has been known for >50 years in the field of anesthesia with an emerging series of favorable features; several clinical and preclinical studies performed over the last years reveal a renewed interest because they substantially agree on attributing relevant analgesic properties to xenon. The main mechanism of action is the inhibition of N-methyl-D-aspartate receptors of glutamate; it involves the blocking of painful stimuli transmissions from peripheral tissues to the brain and it also avoids the development of pain hypersensitivity. Therefore, this mechanism is responsible for the inhibition of pain transmission at spinal and supraspinal levels, as well as the cortical level. In all these levels of pain pathways, as the development of hyperalgesia is possible, xenon efficacy can also be based on the blocking of these processes. Several forms of pain share such mechanisms in their maintenance, and xenon can be successfully used at low dosages, which have no effects on vital parameters. The literature shows that analgesic features could also emerge outside the field of anesthesia; thus, this could permit xenon to have a larger usage according to local availability.


Charge transfer dissociation of phosphocholines: gas-phase ion/ion reactions between helium cations and phospholipid cations.
Phospholipid cations formed by electrospray ionization were subjected to excitation and fragmentation by a beam of 6 keV helium cations in a process termed charge transfer dissociation (CTD). The resulting fragmentation pattern in CTD is different from that of conventional collision-induced dissociation, but analogous to that of metastable atom-activated dissociation and electron-induced dissociation. Like collision-induced dissociation, CTD yields product ions indicative of acyl chain lengths and degrees of unsaturation in the fatty acyl moieties but also provides additional structural diagnostic information, such as double bond position. Although CTD has not been tested on a larger lipid sample pool, the extent of structural information obtained demonstrates that CTD is a useful tool for lipid structure characterization, and a potentially useful tool in future lipidomics workflows. CTD is relatively unique in that it can produce a relatively strong series of 2+ product ions with enhanced abundance at the double bond position. The generally low signal-to-noise ratios and spectral complexity of CTD make it less appealing than OzID or other radical-induced methods for the lipids studies here, but improvements in CTD efficiency could make CTD more appealing in the future. Copyright © 2017 John Wiley & Sons, Ltd.


Sigma receptors suppress multiple aspects of microglial activation.
During brain injury, microglia become activated and migrate to areas of degenerating neurons. These microglia release proinflammatory cytokines and reactive oxygen species causing additional neuronal death. Microglia express high levels of sigma receptors, however, the function of these receptors in microglia and how they may affect the activation of these cells remain poorly understood. Using primary rat microglial cultures, it was found that sigma receptor activation suppresses the ability of microglia to rearrange their actin cytoskeleton, migrate, and release cytokines in response to the activators adenosine triphosphate (ATP), monocyte chemoattractant protein 1 (MCP-1), and lipopolysaccharide (LPS). Next, the role of sigma receptors in the regulation of calcium signaling during microglial activation was explored. Calcium fluorometry experiments in vitro show that stimulation of sigma receptors suppressed both transient and sustained intracellular calcium elevations associated with the microglial response to these activators. Further experiments showed that sigma receptors suppress microglial activation by interfering with increases in intracellular calcium. In addition, sigma receptor activation also prevented membrane ruffling in a calcium-independent manner, indicating that sigma receptors regulate the function of microglia via multiple mechanisms.


Proteolytic cleavage of the cell surface protein p160 is required for detachment of the fertilization envelope in the sea urchin.
Sea urchin eggs secrete a serine protease activity, CGSP1, at fertilization that is essential for the block to polyspermy. Several targets of this proteolytic activity on the plasma membrane were identified here using a cell surface biotinylation approach. Amino acid microsequencing of one of these proteins led to the identification of a 4.75-kb cDNA clone from a Strongylocentrotus purpuratus ovary cDNA library that encodes a 160-kDa protein called p160. This protein contains five CUB domains and a putative transmembrane domain suggesting that p160 is an integral membrane protein with protein-protein interaction motifs facing the extracellular matrix of the egg. Whole-mount immunolocalization studies demonstrate that p160 is on the surface of the egg, enriched at the tips of microvilli. The protein is removed at fertilization in a protease-dependent manner, and functional assays suggest that p160 serves to link the plasma membrane to the vitelline layer until fertilization. Thus, p160 is a key candidate for a vitelline-layer linker protein, the selective proteolysis of which functions in the block to polyspermy in the sea urchin egg.


Primary hyperparathyroidism in pregnancy. A report of two cases.
Primary hyperparathyroidism in pregnancy is an uncommon event, with approximately 100 reported cases in the literature. Two cases illustrate the common problems in diagnosing this disease in pregnancy and indicate that surgery should be considered the primary modality of treatment. These two are the 24th and 25th cases of surgery for primary hyperparathyroidism in pregnancy reported in the literature.


Spontaneous activity in denervated mouse diaphragm muscle.
Intracellular electrodes were used to study the discrete depolarizations which trigger fibrillation potentials in chronically denervated mouse diaphragm muscles. Provided that the muscles were perfused on both sides spontaneous activity was maintained in vitro. 2. Discrete spontaneous depolarizations, present only in the centre of the muscle, were recorded from the third day of denervation reaching a maximum in prevalence 9-12 days after sectioning the nerve. These potentials had random occurrence and nearly constant amplitude and frequency within a fibre, dependence of amplitude and frequency on membrane potential, and low temperature dependence. 3. The spontaneous activity was enhanced and could be initiated in previously quiescent fibres by lowering the external Ca concentration. The activity was reduced by increasing external Ca and was abolished at 15mM-[Ca] 0. Tetrodotoxin (10-(7)M) blocked spontaneous activity. 4. The spontaneous activity was enhanced by the catecholamines isoprenaline and adrenaline (0.5-10 mug/ml.). This effect of isoprenaline was accompanied by an increase in the rate of rise and the amount of overshoot of the action potential. 5. Ouabain (10-(6)-10-(4)M) of K+-free solutions reversibly blocked spontaneous activity. Ouabain (10-(4)M) reduced the rate of rise and the amount of overshoot of the action potential. 6. Detubulation of muscle fibres with glycerol of the presence of hypertonic solutions abolished spontaneous activity which could not be restarted by reducing Ca or by the addition of isoprenaline. 7. The results support the suggestion that the spontaneous discrete depolarizations which give rise to fibrillation potentials in denervated muscle result from regenerative sodium conductance increases within the transverse tubular system of the muscle fibres. Catecholamines and ouabain could affect this activity either directly, through an action on membrane excitability, or indirectly via the Na+-K+ pump.


Necrotizing fasciitis with mediastinitis following snakebite envenomation.
Snakebite envenomation is a life-threatening injury and a neglected public health issue in Africa. We report the case of a child that presented 6 days following a forearm snakebite with compartment syndrome and necrotizing fasciitis of the upper limb extending to the neck and chest who developed mediastinitis. She underwent multiple surgical debridements and the mediastinitis was managed non-surgically with antibiotics and postural drainage leading to recovery. The wounds were later grafted and the child discharged. Extension of necrotizing fasciitis from the limbs to the chest wall with development of mediastinitis is extremely rare with one previous case reported in a woman with poorly controlled diabetes mellitus on immunosuppressive therapy. We report this case due to its unusual presentation with no previous reports found on the development of mediastinitis following snakebite. In conclusion, physicians should have a high index of suspicion for mediastinitis in patients with necrotizing fasciitis extending to the neck and chest following snakebite.


Tight cohesion between glycolipid membranes results from balanced water-headgroup interactions.
Membrane systems that naturally occur as densely packed membrane stacks contain high amounts of glycolipids whose saccharide headgroups display multiple small electric dipoles in the form of hydroxyl groups. Experimentally, the hydration repulsion between glycolipid membranes is of much shorter range than that between zwitterionic phospholipids whose headgroups are dominated by a single large dipole. Using solvent-explicit molecular dynamics simulations, here we reproduce the experimentally observed, different pressure-versus-distance curves of phospholipid and glycolipid membrane stacks and show that the water uptake into the latter is solely driven by the hydrogen bond balance involved in non-ideal water/sugar mixing. Water structuring effects and lipid configurational perturbations, responsible for the longer-range repulsion between phospholipid membranes, are inoperative for the glycolipids. Our results explain the tight cohesion between glycolipid membranes at their swelling limit, which we here determine by neutron diffraction, and their unique interaction characteristics, which are essential for the biogenesis of photosynthetic membranes.


[Immune responses in broncho-pulmonary cancer].
The anti-tumoral immune response is essentially cellular and numerous studies have been conducted with the aim of augmenting it from the therapeutic aspect. Activation of the immune system has been reported in the early stages of bronchial carcinoma. On the other hand numerous studies have demonstrated a degree of immuno-suppression in patients with advanced cancer prior to any immuno-suppressant treatment, particularly an alteration of cell mediated immunity. The presence of white cells, infiltrating the tumour is an indication of an active host response to the tumour. Several para-neoplastic syndromes associated with the presence of auto-antibodies have been described, particularly in small cell bronchial carcinoma. Other antibodies not associated with para-neoplastic syndromes have also been found, principally directed against the tumour suppressant gene P53. Non-specific active immuno-therapy (BCG, interferons, interleukins.), passive immuno-therapy (monoclonal antibodies) and adoptive immuno-therapy have been studied for many years without encouraging results. Specific active immuno-therapy (anti-tumour vaccines and gene therapy) is the route being most actively explored at present. Correct targeting of patients likely to benefit from immuno-therapy, specificity and effectiveness of the agents, the expression of transfected genes and the risk of infection and dissemination during clinical trials are all problems currently under investigation. Manipulations of the immune response have been and are being undertaken with the aim of improving its effectiveness. Anti-tumour vaccines and gene therapy are the routes most studied.


Skeletal muscle adaptations consequent to long-term heavy resistance exercise.
Heavy resistance training is associated with increased body weight, lean body mass, and muscle cross-sectional area. The increased muscle cross-sectional area is mainly brought about by hypertrophy of individual muscle fibers. There is a greater increase in the area of fast twitch fibers compared to slow twitch fibers. In addition, long-term heavy resistance training may produce fiber proliferation. Mitochondrial volume density decreases in proportion to muscle hypertrophy in response to training. Typically, no capillary neoformation occurs during strength training. Therefore, capillary density decreases consequent to heavy resistance training. It appears, though, that bodybuilders, relying on a high repetition training system, in contrast to Olympic weight- and power lifters, display a small increase in number of capillaries per fiber. Enzyme activities, reflecting oxidative potential; decrease during long-term heavy resistance training, resulting in muscle hypertrophy. Although glycogen storage capacity is enhanced in strength trained athletes, enzyme activities reflecting anaerobic metabolism do not increase in response to heavy resistance exercise.


[The prehospital phase of patients with suspected acute myocardial infarct: results of the Oltner Cardiac Emergency Study].
Early reperfusion in acute myocardial infarction has been shown to reduce myocardial damage and to improve prognosis. The goals of this study, the Olten Cardiac Emergency Study, were to identify the factors, related to the patients or to the emergency medical services, which influenced pre-hospital delay in patients with symptoms suggestive of acute myocardial infarction. From November 1, 1992, to June 15, 1993, all the events occurring between symptom onset and hospital discharge where analyzed for 341 such patients who were cared for by the emergency networks connected with the Cantonal Hospital, Olten: in addition, follow-up at 3 months was obtained on all patients discharged alive. Of the 341 patients, 14 (4.1%) died out of the hospital. The final diagnoses of the 327 patients admitted to the emergency department were: acute myocardial infarction 18.3%; unstable angina 10.1%; stable angina 3.4%; non-ischemic cardiac diseases 29.4%; other non-cardiac diseases 38.8%. Mean delay between symptom onset and arrival at the hospital was 8 h 55 min (median delay 4 h 10 min); for patients with a final diagnosis of acute myocardial infarction, mean delay was 9 h 43 min (median delay 5 h 10 min). Patient delay was surprisingly long and represented 70.4% of the total pre-hospital delay; 56.6% of the patients did not realize that their symptoms were serious and only 47.1% (and 68.3% of the patients with acute myocardial infarction) came to the hospital by ambulance. These long pre-hospital delays were responsible for the low (13.3%) thrombolysis rate of patients with acute myocardial infarction. We conclude that pre-hospital delay was much too long in our population. Improvements can only be achieved through patient education and better efficiency of emergency networks. Our findings underline the need for public education campaigns on heart attacks.


T-cell lymphoma in the CNS: clinical and pathologic features.
T-cell lymphoma may involve the CNS as either a primary or secondary neoplasm. This report describes 8 patients with either primary or secondary T-cell malignancies in the CNS. Five patients presented with symptoms and signs of CNS disease that included seizures, visual impairment, cranial nerve palsies, sensory and motor deficits, gait ataxia, and paraparesis. Three of them had primary parenchymal CNS lymphoma, and 2 had epidural lymphoma that originated in adjacent bone marrow. Three patients were neurologically asymptomatic, but had leptomeningeal tumor and focal parenchymal infiltration at postmortem examination. Histologically, 4 lymphomas were large cell, 3 were mixed large and small cell, and 1 could not be classified by the working formulation for non-Hodgkin's lymphomas. The clinical and pathologic manifestations of T-cell lymphoma in the CNS may be diverse. This report demonstrates that neurologic abnormalities may be the presenting signs of either primary CNS or systemic T-cell lymphoma.


Characterization of eosinophil cell activation by peptides. Differential effects of substance P, melittin, and FMET-Leu-Phe.
The ability of three different peptides, substance P (SP), FMLP and melittin, to activate eosinophils purified from the peritoneal cavity of human serum-treated guinea pigs was investigated. Degranulation (eosinophil peroxidase, EPO), oxidative burst (O2-), [Ca2+]i mobilization, and arachidonic acid metabolism (thromboxane B2, TXB2) were used as indices of eosinophil activation. SP (100 nM to 100 microM), FMLP (1 to 100 microM) and melittin (10 nM to 100 microM) induced EPO release but only FMLP (1 to 100 microM) led to an elevation of [Ca2+]i. The melittin- and SP-induced EPO secretion occurred at both cytotoxic and noncytotoxic concentrations as assessed by lactate dehydrogenase release. In addition, the effect of SP was not inhibited by the SP analogue (D-Pro4, D-Trp7,9,10)SP(4-11) and SP failed to promote the generation and subsequent release of TXA2. In contrast, FMLP (10 to 100 microM) stimulated the release of TXB2 from guinea pig eosinophils that was selectively inhibited by pretreatment of the cells with BOC-FMLP. On an equimolar basis (1 microM), melittin was approximately fivefold more active at promoting TXB2 release than FMLP. The results indicate that eosinophils respond to the three peptides, SP, melittin, and FMLP in differential fashion. We conclude that activation of guinea pig eosinophils by FMLP is likely to be receptor-mediated whereas the actions of SP and melittin may act through nonspecific peptide-membrane phospholipid interactions.


Modifying Robusta coffee aroma by green bean chemical pre-treatment.
Green Robusta beans were subjected to pre-treatment with the aim of reducing the perceived aroma difference between Arabica and Robusta coffee. Treatment was a short soaking procedure with varying concentrations of acetic acid (up to 5%). Samples were subjected to thermal treatment (roasted) and ground to a standardised particle size distribution. Aroma compounds were evaluated by headspace analysis using solid-phase microextraction and gas chromatography-mass spectrometry. Pre-treatment significantly affected aroma formation during roasting and resulted in a modified level of pyrazines, furanic compounds and sulfur-containing compounds (p < 0.05). Principal component analysis illustrated that the aroma profile of the pre-treated Robusta coffee was closer to the target Arabica coffee after roasting. Sensory results confirmed that the aroma of the 2% acetic acid pre-treated Robusta brew was similar to Arabica; the maximum inclusion level of Robusta coffee in a blend could be increased from 20% to 80%.


A single-centre retrospective review of unilateral and bilateral Dysport injections in adductor spasmodic dysphonia.
We reviewed the results and side-effect profile of the Dysport preparation of botulinum toxin A (BTA) in the management of the adductor spasmodic dysphonia. We performed 272 injection episodes in 68 patients, 42 (62%) female, 26 (38%) male. A total of 116 of these injections were unilateral, and 156 were bilateral; 94% of the injections were considered to have been successful with a voice score of 2 or higher. The mean duration of effect (injection intervals) was 128.8 days in the unilateral cohort and 118.7 days in the bilateral (P > 0.05). We injected a relatively lower dose of BTA for unilateral injection episodes in our institution compared to those reported by others to produce comparable results and side-effect profiles.


The developmental and environmental regulation of gravitropic setpoint angle in Arabidopsis and bean.
Root and shoot branches are major determinants of plant form and critical for the effective capture of resources below and above ground. These branches are often maintained at specific angles with respect to gravity, known as gravitropic set point angles (GSAs). We have previously shown that the mechanism permitting the maintenance of non-vertical GSAs is highly auxin-dependent and here we investigate the developmental and environmental regulation of root and shoot branch GSA. We show that nitrogen and phosphorous deficiency have opposing, auxin signalling-dependent effects on lateral root GSA in Arabidopsis: while low nitrate induces less vertical lateral root GSA, phosphate deficiency results in a more vertical lateral root growth angle, a finding that contrasts with the previously reported growth angle response of bean adventitious roots. We find that this root-class-specific discrepancy in GSA response to low phosphorus is mirrored by similar differences in growth angle response to auxin treatment between these root types. Finally we show that both shaded, low red/far-red light conditions and high temperature induce more vertical growth in Arabidopsis shoot branches. We discuss the significance of these findings in the context of efforts to improve crop performance via the manipulation of root and shoot branch growth angle.


Borderline personality disorder and the MMPI.
Fourteen patients diagnosed as borderline on the basis of the Diagnostic Interview for Borderlines obtained a mean group profile of 8-2-7 similar in configuration, but more elevated than that obtained by a group of 7 diagnostically heterogeneous controls. The borderline patients manifested significantly greater hypochondriasis, depression and hysteria, slightly more schizotypal features, a more deviant self-presentation, and lesser defensiveness. However, considerable heterogeneity in symptomatology was found within the borderline subsample. Further, clinical scales comprised of a higher proportion of relatively subtle and presumably less structured items did not discriminate borderline from control patients more effectively than did those scales made up of a lower proportion of such items. The results offer partial support for the construct validity of the borderline syndrome and for the usefulness of the MMPI in differentiating it from other psychiatric disorders.


[Microvascular tissue transplantation of the ear, nose and throat].
Free tissue transfers are a versatile method of reconstruction in head and neck surgery. In the pharynx and oral cavity the functional result dictates the choice of flap. For these sites thin and pliant fasciocutaneous flaps are ideal tissue transfers, and we favour the radial forearm flap which is raised from the distal volar forearm. This flap is easy to dissect and the donor defect, which is grafted with split skin, does not inconvenience the patient. For reconstruction of thicker defects we prefer bulky myocutaneous flaps such as the latissimus dorsi, which has a reliable pedicle of adequate length. The rectus abdominis flap, if taken with peritoneum, is useful for reconstruction of large cheek defects involving all layers; the peritoneum replaces the oral mucosa. For hypopharyngeal reconstruction the free jejunal loop has advantages compared with local skin or myocutaneous flaps, since it is a one-stage procedure with a low rate of post-operative fistulae. In some cases of reconstruction of the oral cavity and oropharynx we have used a jejunal patch, but in general we prefer the radial forearm flap, since it is more resistant to mechanical trauma. The advantage of a free tissue transfer is its excellent blood supply, which makes it possible to apply these flaps in irradiated and infected tissue. It is important in microvascular tissue transfer to choose an appropriate flap for the size and depth of the resection. It is only necessary to be familiar with those transfers most commonly used in this region.


How to Reduce Mental Health Burden in Health Care Workers During COVID-19?-A Scoping Review of Guideline Recommendations.
The COVID-19 pandemic has posed an unprecedented demand and a huge burden for healthcare workers (HCWs) worldwide, with alarming reports of heightened mental health problems. To counteract these mental health challenges, guidelines and recommendations for the support of HCWs during the COVID-19 pandemic have been published. With this scoping review and guideline evaluation, we aim to provide a critical overview of these guidelines and recommendations and to guide policy makers in establishing respective surveillance and care programs. In summary, 41 articles were included in this review which were published between April 2020 and May 2021. Across all articles, the guidelines and recommendations could be clustered into four main categories: "Social/structural support," "Work environment," "Communication/Information," "Mental health support." Although there was substantial agreement across articles about the recommendations given, empirical evidence on the effectiveness of these recommendations is still lacking. Moreover, most recommendations were developed without involving different members of the target group (HCWs) or other involved stakeholders. Strategies to detect potential barriers and to implement these guidelines in clinical practice are lacking.


Erythroid hypoplasia. An unusual presentation of childhood acute lymphocytic leukemia.
A 3-year-old girl had pancytopenia and bone marrow erythroid hypoplasia. The pancytopenia resolved without therapy, but the erythroid hypoplasia persisted for four months in spite of a five-week course of corticosteroid therapy. She responded briefly when androgens were added to the corticosteroid regimen, but within three weeks of stopping therapy she developed acute lymphocytic leukemia. The differential diagnosis of RBC aplasia in childhood is discussed. To our knowledge, this is the first case reported with erythroid hypoplasia as a prodrome of acute lymphocytic leukemia of childhood.


New insight into the structures and formation of anthocyanic vacuolar inclusions in flower petals.
Although the biosynthetic pathways for anthocyanins and their regulation have been well studied, the mechanism of anthocyanin accumulation in the cell is still poorly understood. Different models have been proposed to explain the transport of anthocyanins from biosynthetic sites to the central vacuole, but cellular and subcellular information is still lacking for reconciliation of different lines of evidence in various anthocyanin sequestration studies. Here, we used light and electron microscopy to investigate the structures and the formation of anthocyanic vacuolar inclusions (AVIs) in lisianthus (Eustoma grandiflorum) petals. AVIs in the epidermal cells of different regions of the petal were investigated. Three different forms of AVIs were observed: vesicle-like, rod-like and irregular shaped. In all cases, EM examinations showed no membrane encompassing the AVI. Instead, the AVI itself consisted of membranous and thread structures throughout. Light and EM microscopy analyses demonstrated that anthocyanins accumulated as vesicle-like bodies in the cytoplasm, which themselves were contained in prevacuolar compartments (PVCs). The vesicle-like bodies seemed to be transported into the central vacuole through the merging of the PVCs and the central vacuole in the epidermal cells. These anthocyanin-containing vesicle-like bodies were subsequently ruptured to form threads in the vacuole. The ultimate irregular AVIs in the cells possessed a very condensed inner and relatively loose outer structure. Our results strongly suggest the existence of mass transport for anthocyanins from biosynthetic sites in the cytoplasm to the central vacuole. Anthocyanin-containing PVCs are important intracellular vesicles during the anthocyanin sequestration to the central vacuole and these specific PVCs are likely derived directly from endoplasmic reticulum (ER) in a similar manner to the transport vesicles of vacuolar storage proteins. The membrane-like and thread structures of AVIs point to the involvement of intravacuolar membranes and/or anthocyanin intermolecular association in the central vacuole.


Effects of release factor context at UAA codons in Escherichia coli.
In Escherichia coli, nonsense suppression at UAA codons is governed by the competition between a suppressor tRNA and the translational release factors RF1 and RF2. We have employed plasmids carrying the genes for RF1 and RF2 to measure release factor preference at UAA codons at 13 different sites in the lacI gene. We show here that the activity of RF1 and RF2 varies according to messenger context. RF1 is favored at UAA codons which are efficiently suppressed. RF2 is preferred at poorly suppressed sites.


Stability Study of Sunscreens with Free and Encapsulated UV Filters Contained in Plastic Packaging.
Sunscreens play a fundamental role in skin cancer prevention and in protection against photo-aging. UV filters are often photo-unstable, especially in relation to their vehicles and, being lipophilic substances, they are able to interact with plastic packaging. Finally, UV filter stability can be significantly affected by the routine use of the product at high temperatures. This work aims to study the stability of sunscreen formulations in polyethylene packaging. Butyl methoxydibenzoylmethane and octocrylene, both in a free form and as encapsulated filters were chosen as UV filters. Stability evaluations were performed both in the packaging and on the formulations. Moreover, a further two non-destructive techniques, near-infrared (NIR) spectroscopy and a multiple light scattering technique, were also used to evaluate the stability of the formulation. Results demonstrated clearly that all of the pack underwent significant changes in its elastic/plastic behavior and in external color after solar irradiation. From the evaluation of the extractable profile of untreated and treated packaging material an absorption of 2-phenoxyethanol and octocrylene were shown. In conclusion, the results highlighted clearly that a reduction of the UV filter in the formulation packed in high-density polyethylene/low-density polyethylene (HDPE/LDPE) material can occur over time, reducing the protective effect of the product when applied to the skin.


Efficacy of buccal versus intranasal route of administration of midazolam spray in behavior management of preschool dental patients.
To assess the efficacy of aerosolized midazolam, introduced through buccal versus intranasal mucosa in managing uncooperative children undergoing dental treatment. A crossover randomized controlled clinical trial included 36 children aged 3 to 5 years, rated I or II according to the Frankl scale and ASA I or II. Each child fulfilled the requirement of having a dental condition that needed treatment in two dental settings. They were randomly assigned to one of two groups; either buccal or intranasal aerosolized midazolam was administered at the first visit. The alternate route was implemented with a 1-week washout period in the second visit. Drug acceptance and time until optimum sedation were measured. Crying, sleeping, head resistance, and child overall behavior were assessed using modified Houpt scale. In total, 34 patients (95 %) were drowsy on optimum sedation. There was a statistically higher acceptance of buccal midazolam (P < .001). Onset of optimum sedation was more rapid for the intranasal group, with a mean of 15.50 ± 4.226 minutes (P < .001), while in the buccal group the mean was 22.97 ± 4.582 minutes. No statistical differences were recorded between the two groups in all behavior rating scales, except for crying where the intranasal group was statistically higher (P = .010). Regarding the overall behavior, there was no significant difference recorded between the two groups (P = .204). Aerosolized buccal midazolam was more tolerated by the patients. However, intranasal aerosolized midazolam had a more rapid onset of sedation. Both buccal and intranasal administrations of aerosolized midazolam are safe and effective.


Immune-mediated inner ear disease and parvovirus B19.
Human parvovirus B19 (HP-B19), the etiologic agent of the common childhood illness erythema infectiosum, has been implicated in systemic immune disorders. Patients presenting with sensorineural hearing loss and/or dizziness, not readily categorized, were evaluated for immune-mediated inner ear disease. Appropriate serologic studies including parvovirus B19 antibody titers were conducted. Thirty patients with suspected immune-mediated inner ear disease were treated with corticosteroid trial for 5 to 7 days, then reexamined with repeat audiogram and/or vestibular testing. Seventeen patients with clinical response were treated with long-term corticosteroids and cyclophosphamide. Six patients had positive HP-B19 immunoglobulin M (IgM) titers and 8 patients had positive parvovirus immunoglobulin G (IgG) titers. All 14 patients responded to therapy. Parvovirus B19, therefore, is a possible etiology of immune-mediated inner ear disease.


Avascular necrosis of the femoral head due to low-dose corticosteroid used in a patient with panhypopituitarism: A case report and literature review.
Osteonecrosis, commonly known as avascular necrosis (AVN) of bone, is one of the universally recognized side effects of high-dose steroids and commonly involves femur head leading to significant morbidity. However, the development of AVN in the femoral head due to low-dose oral corticosteroid therapy in a short time is a rare occurrence. Management by stopping corticosteroid treatment can be challenging in many cases due to the adrenal crisis. Glucocorticoids may have to be continued in the lowest possible dose using a physiological preparation, such as hydrocortisone, when the stoppage is not possible. In this article, we report a 34-year-old male patient with hypopituitarism who developed bilateral AVN while receiving a mild physiological replacement oral prednisolone dose for only three years for secondary adrenal insufficiency of hypopituitarism after transsphenoidal surgery. The patient was switched to hydrocortisone and underwent core decompressive surgery resulting in a reduction of hip pain and improvement. The case report intends to highlight the occurrence of AVN of the femur even with a very low dose of corticosteroid used for the treatment of panhypopituitarism. Avascular necrosis should be considered in the differential diagnosis in patients with hip pain, even in low-dose steroid use because early diagnosis is essential to prevent progression, collapse, and eventually the need for hip replacement in AVN.


The past and the future of Alzheimer's disease CSF biomarkers-a journey toward validated biochemical tests covering the whole spectrum of molecular events.
This paper gives a short review on cerebrospinal fluid (CSF) biomarkers for Alzheimer's disease (AD), from early developments to high-precision validated assays on fully automated lab analyzers. We also discuss developments on novel biomarkers, such as synaptic proteins and Aβ oligomers. Our vision for the future is that assaying a set of biomarkers in a single CSF tube can monitor the whole spectrum of AD molecular pathogenic events. CSF biomarkers will have a central position not only for clinical diagnosis, but also for the understanding of the sequence of molecular events in the pathogenic process underlying AD and as tools to monitor the effects of novel drug candidates targeting these different mechanisms.


Personal style and hearing aid fitting.
Why do I have to drag information out of some patients? Why is another patient so talkative? Why didn't this patient like the XYZ 2002 digital hearing aid when she had the same degree, type, and configuration of hearing impairment as the patient I successfully fit last month? Could the answer be as basic as a difference in personality?


What is the factor that most influences QOL among rheumatoid arthritis patients?
Abstract We attempted to elucidate the factors which affect the quality of life (QOL) among patients with rheumatoid arthritis (RA). Ninety-five patients who satisfied the American Rheumatism Association criteria for RA were asked to fill in a modified arthritis impact measurement scale, version 2 (AIMS2) and complete a Lorish's face scale (FS) test. The same questionnaire and FS test were completed by 75 healthy persons as controls. We used Lorish's FS for our assessment of QOL. The investigation was undertaken to analyze the relationship between FS and each item on the questionnaire. For average FS score, there was no significant difference between the RA group and the controls. However, RA group scores covered a wider range than those of the controls. From the correlation analysis, physical stress, pain factors, and some of the activities of daily living (ADL) factors showed a strong correlation with FS. ADL factors which strongly correlated with FS were those related to activities of the lower limbs. Other ADL factors were moderately correlated with FS. Socioeconomic factors were not significantly correlated with FS. There was no significant difference between the QOL of RA patients and that of healthy controls. The QOL was correlated with pain and stress factors rather than with ADL factors among patients with RA.


What's New in Bipolar TURP for Surgical Management of BPH?
Transurethral resection of the prostate (TURP) is still considered the gold standard for male lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH), but new methods like bipolar TURP became a real treatment alternative. Bipolar resection presents many option for the effective resection of the prostate: the most similar with m-TURP is represented by the loop resection, then transurethral vaporisation of the prostate (B-TUVP) which is derived from plasmakinetic B-TURP and the enucleation, which is among open prosta tectomy or holmium laser, the first choice of surgical treatment in men with a substantially enlarged prostate and moderate-to-severe LUTS. There was no statistical difference observed between M-TURP and B-TURP in the parameters of surgery time, catheterization time, PSA drop, peak flow improvement (Qmax), occurrence of urinary retention, and IPSS and quality of life (QoL) scores. On the other hand, B-TURP proved to be superior to M-TURP in relation to hospitalization time, blood transfusion rate, post-TURP syndrome, serum sodium rate and lower occurrence of urethral stenosis. when is about the cost of the procedure, a meta-analysis on 24 from the most relevant publications in the last 20 years, revealed that the TURis system demon strates equivalent efficacy versus MTURP, In conclusion, it could be observed nowadays that bipolar-TURP represents a viable alternative to M-TURP in patients with moderate to-severe LUTS secondary to BPO, with similar efficacy but lower peri-operative morbidity.


[Inhibiting effects of TFPI-2 recombinant adenovirus on invasion of laryngeal squamous carcinoma].
To study the effects of adenovirus-mediated tissue factor pathway inhibitor-2 gene on the invasion of laryngeal squamous cancer. Ad-TFPI-2 was transfected into laryngeal squamous cancer (Hep-2) cell. Western-blot was used to test the TFPI-2 protein expression and Boyden Chamber experiment was used to examine the invasive ability of Hep-2 cells. Furthermore, the Ad-TFPI-2 infected Hep-2 cells were subcutaneously inoculated in nude mice and the tumor formation capability were observed. Ad-TFPI-2 was identified correctly by endonuclease and sequencing and the virus titer was 2.8 x 10(13) PFU/L. In the Hep-2 cells of treated group, the TFPI-2 protein expression was increased while the invasive capability was descent. The tumor formation capability was also decreased in the treated group nude mouse model. TFPI-2 recombinant adenovirus can effectively inhibit the invasive capability of laryngeal squamous cancer.