Competence to consent to treatment of geriatric patients: judgements of physicians, family members and the vignette method.
In absence of a gold standard of methods to assess competence, three judgements of competency of geriatric patients are evaluated: the judgements of a physician, the judgement of a family member, and the judgement of an instrument. Competence of 80 geriatric patients was judged both by a physician and a family member. Decision making capacity was assessed with a vignette. A vignette describes a treatment choice, after which the following abilities are evaluated: evidencing a choice, understanding, reasoning and appreciating a situation. Cognitive functioning was measured with the Mini-Mental State Examination. Most of the geriatric patients were judged competent by all three methods. Disagreement between the three judgements was found for 25 patients. Agreement about incompetence was only reached for one patient. Physicians appeared to be most lenient in their incompetency judgement: only three patients were judged incompetent. These patients scored significantly lower than competent patients on cognitive functioning, the decisional ability of understanding, and the total vignette score. Family members appeared to be most stringent in their judgement: they considered 22 patients incompetent. Incompetent patients scored significantly lower than competent patients on cognitive functioning, reasoning and the total vignette score. The disagreement between the judgements suggests a difference in factors given emphasis by the three methods. The finding that both the judgement of physicians and family members are associated with the assessment of the vignette, suggests that the vignette method has more than a legal theoretical base and is associated with daily life experience and knowledge as well. Physicians can be helped to assess competence by the vignette method to evaluate decisional abilities and by family members who can provide more information about patients' values.


Aortic obstruction: anatomy and echocardiography.
Echocardiography is a valuable non-invasive technique for identifying the site and type of aortic obstruction. Knowledge of the morphological details of each type of obstruction is the basis for correct interpretation of the diagnostic images and clinical decisions. This study was undertaken to correlate the echocardiographic images with anatomic specimens of equivalent valvular and supravalvular aortic obstruction. Specimens were part of the collection of the Department of Embryology. Fifty six patients were studied, and forty specimens with aortic obstruction were analyzed. Echocardiographic characteristics: Thirty one (55.3%) patients were women and twenty five (44.7%) men. Valvular aortic obstruction was found in Thirty six patients (64.3 %) and supravalvular aortic obstruction in twenty (35.7%). Anatomic characteristics: Of the forty specimens examined, twenty one (52.5%) had valvular aortic obstruction and nineteen (47.5%) supravalvular aortic obstruction. The anatomoechocardiographic correlation clearly showed that the anatomic findings of the specimen hearts and aortas corresponded to echocardiographic images of valvular and supravalvular aortic obstruction and provided solid corroboration of echocardiographic diagnoses.


HPV infection and 5mC/5hmC epigenetic markers in penile squamous cell carcinoma: new insights into prognostics.
Penile cancer is one of the most aggressive male tumors. Although it is preventable, the main etiologic causes are lifestyle behaviors and viral infection, such as human papillomavirus (HPV). Long-term epigenetic changes due to environmental factors change cell fate and promote carcinogenesis, being an important marker of prognosis. We evaluated epidemiological aspects of penile squamous cell carcinoma (SCC) and the prevalence of HPV infection using high-risk HPV (hrHPV) and p16INK4A expression of 224 participants. Global DNA methylation was evaluated through 5-methylcytosine (5mC) and 5-hydroxymethylcytosine (5hmC). The incidence of HPV was 53.2% for hrHPV and 22.32% for p16INK4a. hrHPV was not related to systemic or lymph node metastasis and locoregional recurrence, nor influenced the survival rate. P16INK4a seems to be a protective factor for death, which does not affect metastasis or tumor recurrence. Lymph node and systemic metastases and locoregional recurrence increase the risk of death. An increased 5mC mark was observed in penile SCC regardless of HPV infection. However, there is a reduction of the 5hmC mark for p16INK4a + (P = 0.024). Increased 5mC/5hmC ratio (> 1) was observed in 94.2% of penile SCC, irrespective of HPV infection. Despite the increase in 5mC, it seems not to affect the survival rate (HR = 1.06; 95% CI 0.33-3.38). P16INK4a seems to be a good prognosis marker for penile SCC and the increase in 5mC, an epigenetic mark of genomic stability, may support tumor progression leading to poor prognosis.


A phase 3 study of induction treatment with concurrent chemoradiotherapy versus chemotherapy before surgery in patients with pathologically confirmed N2 stage IIIA nonsmall cell lung cancer (WJTOG9903).
This study sought to ascertain whether induction-concurrent radiotherapy added to chemotherapy could improve the survival of patients undergoing surgery for stage IIIA N2 nonsmall cell lung cancer (NSCLC). Patients with pathologically proven N2 disease were randomized to receive either induction chemotherapy (docetaxel 60 mg/m(2) and carboplatin AUC [area under the receiver operating characteristic curve] = 5 for 2 cycles) plus concurrent radiation therapy (40 Gy) followed by surgery (CRS arm) or induction chemotherapy followed by surgery (CS arm). They subsequently underwent pulmonary resection when possible. Sixty patients were randomly assigned between December 2000 and August 2005. The study was prematurely terminated in January 2006 because of slow accrual. The most common toxicity was grade 3 or 4 leukopenia in 92.9% of patients in the CRS arm and 46.4% in the CS arm. Induction therapy was generally well tolerated, and there were no treatment-related deaths in either arm. Downstaging in the CS arm and CRS arm was 21% and 40%, respectively. The progression-free survival (PFS) and overall survival (OS) in the CS arm were 9.7 months and 29.9 months (PFS, hazard ratio [HR] = 0.68, P = .187), and those in the CRS arm were 12.4 months and 39.6 months (OS, HR = 0.77, P = .397), respectively. The PFS with and without downstaging was 55.0 and 9.4 months, respectively (HR = 3.39, P = .001). The OS with and without downstaging was 63.3 and 29.5 months, respectively (HR = 2.62, P = .021). The addition of radiotherapy to induction chemotherapy conferred better local control without significant adverse events. Tumor downstaging is important for prolonging the OS in patients with stage IIIA (N2) NSCLC.


Therapeutic options in an era of decreasing antimicrobial susceptibility.
Antimicrobial resistance among human pathogens has evolved to the multidrug-resistant phase. Consequently, preserving antimicrobial efficacy is now an important clinical consideration when selecting an agent for therapy. A new, in vitro measure of potency called the mutant prevention concentration (MPC) allows clinicians to select antibacterials on the basis of an agent's ability to restrict the selection of resistant mutants. With some pathogens, C-8-methoxy fluoroquinolones are expected to be quite effective at restricting the selection of resistance because the value of MPC is below the human serum drug concentration achieved with standard doses. Clinical trials are now needed to determine how well preclinical profiles of these drugs correlate with the prevention of resistance.


Interactions of Li, Ca, and Al with aromatic carbon materials: an ab initio study.
The interactions of benzene (C6H6), naphthalene (C10H8), and perinaphthene (C13H9) with metal atoms (Li, Ca, and Al) were studied using second-order Møller-Plesset perturbation theory. By analyzing the frontier molecular orbitals, geometric structures, binding energies, and charge transfers, it was found that these metal atoms can bond strongly with C13H9, but can only bond weakly with C6H6 and C10H8. The bonding nature between a metal atom and C13H9 at their ground state depends significantly on the valence orbital of the metal atom and the pi-bonding distribution of the aromatic hydrocarbons. The spindly shaped 3p valence orbital of an Al atom results in the deviation of the adsorption site to the edge of C13H9, whereas the ball-shaped 2s/4s valence orbitals of a Li and a Ca atom facilitate their overlap with the second lowest unoccupied molecular orbital of C13H9. Further, Hartree-Fock and density-functional theory methods were demonstrated generally to be unreliable in describing the interactions of metal atoms with these pi systems.


Co-Adsorptive Removal of Creatinine and Urea by a Three-Component Dual-Layer Hollow Fiber Membrane.
The development of wearable artificial kidney demands an efficient dialysate recovery, which relies upon the adsorption process. This study proposes a solution to solve the problem of competitive adsorption between the uremic toxins by employing two adsorptive components in a membrane separation process. Dual-layer hollow fiber (DLHF) membranes, which are composed of a polysulfone (PSf)/activated carbon (AC) inner layer and a PSf/poly(methyl methacrylate) (PMMA) outer layer, were prepared for co-adsorptive removal of creatinine and urea from aqueous solution. The DLHF membranes were characterized in terms of morphological, physicochemical, water transport, and creatinine adsorption properties. The membrane was then subjected to an ultrafiltration adsorption study for performance evaluation. The incorporation of AC in membrane, as confirmed by microscopic and surface analyses, has improved the pure water flux up to 25.2 L/(m2 h). A membrane with optimum AC loading (9 wt %) demonstrated the highest maximum creatinine adsorption capacity (86.2 mg/g) based on the Langmuir adsorption isotherm model. In the ultrafiltration adsorption experiment, the membrane removed creatinine and urea with a combined average percent removal of 29.3%. Moreover, the membrane exhibited creatinine and urea uptake recoveries of 98.8 and 81.2%, respectively. The combined action of PMMA and AC in the PSf DLHF membrane has made the adsorption of multiple uremic toxins possible during dialysate recovery.


Living Conditions as a Driving Factor in Persistent Methicillin-resistant Staphylococcus aureus Colonization Among HIV-infected Youth.
Methicillin-resistant Staphylococcus aureus (MRSA) colonization has been linked to HIV-related sexual and social behaviors. MRSA risk factors may be different for HIV-infected children, adolescents and young adults. We investigated the association of MRSA colonization, persistent colonization and genotypes with potential risk factors among HIV-infected youth. For this case-control study, patients 24 years of age or younger attending 2 HIV reference centers were recruited from February to August 2012 and followed for 1 year. Nasal swabs were collected at enrollment and every 3 months. MRSA clones were characterized by staphylococcal chromosomal cassette mec typing, spa typing and multilocus sequence typing. We compared MRSA colonization and persistent colonization with patient demographic and clinical characteristics. Among 117 participants, MRSA colonization frequency (calculated for each collection based on the number of positive cultures per patient) was 12.8% at the first collection. The average MRSA colonization frequency was 10.4%. Our results showed 11.1% were persistent carriers (subjects with more than 1 positive culture in at least 3). Crowding was the only factor associated with MRSA colonization (P = 0.018). Persistent carriers had significantly higher (4.2 times) odds of living in a crowded household (95% confidence interval-1.1-16.2). We observed high genetic diversity among MRSA isolates, with t002/ST5 and t318/ST30 being the most frequent. MRSA colonization among HIV-infected youth is more closely related to living in a low-income or slum community than to HIV-related clinical factors. High genetic MRSA isolate diversity in our population suggests frequent transmission.


Social and physical environments as a source of individual variation in the rewarding effects of testosterone in male California mice (Peromyscus californicus).
Despite extensive research revealing the occurrence of testosterone (T) pulses following social encounters, it is unclear how they lead to varied behavioral responses. We investigated the influence of residency (home versus unfamiliar environment) and social/sexual experience (pair-bonded, isolated or housed with siblings) on the plasticity of T's rewarding effects by measuring the development of conditioned place preferences (CPPs), a classical paradigm used to measure the rewarding properties of drugs. For pair-bonded males, T-induced CPPs were only produced in the environment wherein the social/sexual experience was accrued and residency status had been achieved. For isolated males, the T-induced CPPs only occurred when the environment was unfamiliar. For males housed with a male sibling, the T-induced CPPs were prevented in both the home and unfamiliar chambers. Our results reveal the plasticity of T's rewarding effects, and suggest that the behavioral functions of T-pulses can vary based on social/sexual experience and the environment in which residency was established. The formation of CPPs or reward-like properties of drugs and natural compounds can therefore exhibit malleability based on past experience and the current environment.


Fluorescent labelling of Escherichia coli ribosomal sulfhydryl groups.
The reactivity of the sulfhydryl groups of Escherichia coli ribosome has been investigated using a fluorescent label. Under denaturing conditions, all the --SH groups can be titrated. In the native form of the ribosome, six and less than one labels can be respectively conjugated to the 30-S and 50-S subparticles without loss of activity for poly(U)-dependent polyphenylalanine synthesis. The most reactive thiol groups belong to proteins S1, S12, S18, S21. The binding of mRNA plus tRNA to the 70-S ribosomes affects the spectroscopic properties of the labels showing that conformational changes are induced by these interactions. Furthermore, the treatment of these complexes by the labelling agent demonstrates that the --SH group belonging to protein S1 is partially protected whereas other thiol groups located on the 50-S subparticle become reactive.


Association of heme oxygenase-1 polymorphisms with cancer risk: A systematic review and meta-analysis.
Observational studies have recently focused on the association between heme oxygenase-1 (HMOX1) gene promoter polymorphisms and cancer risk. However, conflicting results have been obtained. To derive a precise estimate of the association, a systematic review and meta-analysis were conducted. This study followed the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses. PubMed, Medline, Embase and Web of Knowledge were systematically searched for relevant studies. Summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for the allelic and genotypic comparisons according to the homozygous, heterozygous, dominant, and recessive genetic models. Between-study heterogeneity was quantified through I2 statistics, and publication bias was appraised by using funnel plots. Sensitivity analyses were conducted to evaluate the robustness of the meta-analysis findings. Meta-analysis of 9 studies involving 2491 cases and 3380 controls did not reveal any significant association of the HMOX-1 (GT)n and 413A>T polymorphisms with cancer risk. Stratified analysis by ethnicity showed a statistically significant association between (GT)n repeat length variant and susceptibility to cancer for the heterozygous genetic model among Asian populations (OR=1.42, 95% CI: 1.04-1.95, Pheterogeneity=0.218), which is a robust finding according to sensitivity analysis. Funnel plot inspection did not reveal any publication bias. In conclusion, this study comprehensively examined the available literature on the association of HMOX-1 (GT)n and 413A>T polymorphisms with cancer risk. Meta-analysis results suggest (GT)n repeat length polymorphism as a potential susceptibility variant for cancer in Asians. Additional large-scale and well-designed studies are needed to confirm these results.


Sickle cell anemia: conclusions from a forensic case report of a young African woman who died after anesthesia.
A 20-year old African woman underwent anesthesia for interruption of an unwanted pregnancy. As a consequence of the anesthesia, she went into coma because of an as yet unknown and untested homozygotic state of sickle cell anemia. Her vital functions were maintained for more than 1 year by intensive medicine, but she died finally in multiorgan failure and aspiration pneumonia. Because of the complications under anesthesia and the missing preanesthetic test for hemoglobinopathy, autopsy was conducted in the forensic medicine department and not in the department of pathology. The sickle cell disease was diagnosed by electrophoresis of the blood, by molecular detection of mutation in the hemoglobin gene, as well as by postmortem light and electron microscopy. Sickle cells were found in capillaries of brain, liver, lung, bone marrow, and spleen. Electrophoretic analysis revealed 80.2% HbS in addition to 3.2% HbA2 and 16.6% HbF, whereas no HbA0 could be detected in blood, confirming the homozygosity of sickle cell anemia. Because of sickle cell crisis, occluded blood vessels, and severe brain cortex necrosis, the patient died in spite of reanimation and intensive medicine. This case demonstrates that it is still important to realize the possibility of this disease and diagnostic obstacles even in regions where its manifestation is not endemic, as in Northern and Central Europe.


Topical glyceryl trinitrate for the treatment of tendinopathies: a systematic review.
To produce a best evidence synthesis of the clinical effects of topical glyceryl trinitrate (GTN) in the treatment of tendinopathies. A systematic review of published randomised controlled trials (RCTs) of the use of GTN in patients with tendinopathy. MEDLINE, Embase, Scopus and CINAHL from database inception to January 2018. We examined RCTs comparing the effects of topical GTN with either placebo or other treatments on tendinopathy. Overall quality of each eligible study was determined based on a combined assessment of internal validity, external validity and precision. The level of evidence for each assessed parameter was rated based on the system by van Tulder et al. A total of 10 eligible RCTs were identified including patients with tendinopathy of the rotator cuff (n=4), wrist extensors (n=3), Achilles (n=2) and patellar (n=1) tendons. For all tendinopathies, improvements in pain were significant when comparing GTN versus placebo in the short term (<8 weeks; poor evidence). Significant improvements in midterm outcomes for treatment with GTN versus placebo included the following: patient satisfaction (strong evidence); chances of being asymptomatic with activities of daily living (strong evidence); range of movement (moderate evidence); strength (moderate evidence); pain (at night and with activity; poor evidence) and local tenderness (poor evidence). Patients treated with topical GTN reported a higher incidence of headaches than those who received placebo (moderate evidence). Treatment of tendinopathies with topical GTN for up to 6 months appears to be superior to placebo and may therefore be a useful adjunct to the treating healthcare professions.


Nurse-Administered Hand Massage: Integration Into an Infusion Suite's Standard of Care .
Nurse-delivered hand massage is a safe and effective intervention that has potential for positively affecting nursing and patient outcomes. . Nurses in a National Cancer Institute-designated academic health center outpatient chemotherapy infusion suite were taught how to administer a hand massage to strengthen the nurse-patient relationship and improve patient experience, comfort, satisfaction, stress, and anxiety. . A pre-/postimplementation group comparison design was used. Patients in both groups completed self-reported measures of stress, comfort, satisfaction, and anxiety. Nurses completed Likert-type scales pre- and postimplementation on the perceived benefits of hand massage to the patient and nursing practice, impact on patient anxiety, and preparation in providing a hand massage. . A positive trend was seen in all indicators. Patients who received a hand massage had a statistically significant improvement in comfort (p = 0.025) compared to those who did not. A statistically significant improvement was seen in all nurse indicators pre- to postimplementation.


Stent technology in ischemic stroke.
Atherosclerotic disease of the cerebral vasculature is a major cause of stroke worldwide. Atherosclerosis that is refractory to best medical management may require revascularization. In these instances, endovascular treatment provides a popular and safe alternative to open surgical techniques. The authors provide an overview of stent technology in the treatment of ischemic stroke, discussing the major studies evaluating stenting for extracranial carotid artery, vertebral artery, and intracranial atherosclerotic disease. The authors describe the commonly used stents with respect to their individual characteristics and technical limitations. Current and future developments in stent technology are also discussed, with areas for further innovation and clinical research.


Pseudomonas aeruginosa exotoxin A and keratitis in mice.
To determine the importance of Pseudomonas aeruginosa exotoxin A (ETA) as a virulence factor in corneal disease. Isogenic mutants deficient in ETA were constructed in P. aeruginosa strains PAO1 and ATCC 19660 by allelic exchange and then evaluated for virulence in a mouse model of bacterial keratitis. The effect of ETA on adherence to scarified corneal epithelium was assessed in an in vitro organ culture model. Mutants of either P. aeruginosa PAO1 or 19660, deficient in ETA, adhered to wounded corneal tissue and initiated ocular disease similar to that in wild-type strains. However, in contrast to wild-type strains, ETA mutants were quickly cleared from the eye, inflammation diminished, and the cornea healed. Although ETA has no effect on the ability of P. aeruginosa to adhere to corneal wounds or to initiate Pseudomonas keratitis, it is crucial for the organism to persist in the eye and ultimately cause disease.


Palindromic octa- and dodecanucleotides containing 2'-deoxytubercidin: synthesis, hairpin formation, and recognition by the endodeoxyribonuclease EcoRI.
Octa- and dodecanucleotides containing 2'-deoxytubericidin within the endodeoxyribonuclease EcoRI recognition fragment d(GAATTC) have been prepared by solid-phase synthesis. Whereas octamers as well as dodecamers with a "random" flanking region formed duplexes in aqueous solution, the dodecamer d(CGCGAATTCGCG) and isosterically modified oligomers thereof showed a strong tendency of hairpin formation. Due to this, cleavage with the endodeoxyribonuclease EcoRI was strongly decreased. In contrast, d(GTAGAATTCTAC) was easily cleaved by the enzyme. Single replacement of one of the dA residues by 2'-deoxytubercidin within the recognition sequence decreased the cleavage velocity but retained specificity. Twofold modification prevents cleavage of the oligomer. This implies that both N-7 purine nitrogens are proton acceptor sites for the endodeoxyribonuclease EcoRI.


Evaluation of four different methods to measure endothelium-dependent vasodilation in the human peripheral circulation.
At present, several techniques exist that claim to evaluate endothelium-dependent vasodilation (EDV) in the human peripheral circulation. The present study aims to evaluate the relationships between four of these techniques. A group of 24 young, healthy subjects underwent measurements of EDV and endothelium-independent vasodilation (EIDV) in predominately resistance vessels in the forearm using the invasive forearm technique with local infusion of methacholine and sodium nitroprusside, evaluation of flow-mediated vasodilation (FMD) in the conduit brachial artery measured by ultrasound, with or without the addition of ischaemic hand exercise, and evaluation of the reduction in the relative height of the inflection point of the radial pulse wave following beta(2)-adrenergic receptor stimulation. The reduction in the relative height of the inflection point following beta(2)-adrenergic receptor stimulation was significantly related to both EDV and EIDV in the forearm (r=-0.41 and r=-0.42 respectively; both P<0.05), but not to the EDV/EIDV ratio (r=-0.10). However, FMD, with or without the addition of ischaemic hand exercise, was not significantly related to the results obtained using the other two techniques (r=-0.18 to +0.13). In conclusion, the reduction in the relative height of the inflection point of the pulse wave following beta(2)-adrenergic receptor stimulation was related to both EDV and EIDV measured by the invasive forearm technique, indicating that the pulse wave technique does not measure EDV specifically. FMD in the brachial artery, with or without ischaemic hand exercise, was not significantly related to values obtained using the other two techniques, indicating that endothelial function differs between conduit and resistance arteries, and that both of these measurements should be evaluated in future studies.


Prevalence, Incidence, Prognosis, Early Stroke Risk, and Stroke-Related Prognostic Factors of Definite or Probable Transient Ischemic Attacks in China, 2013.
The epidemiological characteristics of transient ischemic attacks (TIAs) in China are unclear. In 2013, we conducted a nationally representative, door-to-door epidemiological survey on TIA in China using a complex, multistage, probability sampling design. Results showed that the weighted prevalence of TIA in China was 103.3 [95% confidence interval (CI): 83.9-127.2] per 100,000 in the population, 92.4 (75.0-113.8) per 100,000 among men, and 114.7 (87.2-151.0) per 100,000 among women. The weighted incidence of TIA was 23.9 (17.8-32.0) per 100,000 in the population, 21.3 (14.3-31.5) per 100,000 among men, and 26.6 (17.0-41.7) per 100,000 among women. No difference in average prognosis was found between TIA and stroke in the population. Weighted risk of stroke among TIA patients was 9.7% (6.5-14.3%), 11.1% (7.5-16.1%), and 12.3% (8.4-17.7%) at 2, 30, and 90 days, respectively. The risk of stroke was higher among male patients with a history of TIA than among female patients with a history of TIA (OR: 2.469; 95% CI: 1.172-5.201; P = 0.018), and higher among TIA patients with hypertension than among TIA patients without hypertension (OR: 2.671; 1.547-4.613; P < 0.001). It can be concluded that there are an estimated 1.35 million TIA patients nationwide, with 0.31 million new cases of TIA annually in China. TIA patients were not better managed prior to a stroke event. Early risk of stroke among TIA patients is high. Sex and hypertension may be stroke-associated prognostic factors among TIA patients. TIA clinics and surveillance should be integrated into the national health-care system.


CALCRL Gene is a Suitable Prognostic Factor in AML/ETO+ AML Patients.
The t(8 ; 21) translocation is the most common chromosomal abnormality in human acute myeloid leukemia (AML) subtype 2 (M2), which forms the AML/ETO fusion gene. However, AML/ETO alone does not necessarily cause leukemia. Other factors are thought to contribute to the disease. Calcitonin receptor-like (CALCRL), a G-protein-coupled neuropeptide receptor, is involved in various biological processes, such as colony formation and drug resistance. First, The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases were used to determine any differences in CALCRL expression in AML patients with and without AML/ETO and the prognostic significance of CALCRL expression in AML patients was further evaluated. Next, we detected the CALCRL expression level in 67 AML/ETO+ AML patients and 16 patients with nonmalignant hematological diseases using qRT-PCR and identified its prognostic relevance. Individuals in the group expressing low levels of CALCRL had a longer median survival time. In AML/ETO+ AML patients, higher mRNA levels of CALCRL were observed before treatment, which decreased after the complete remission that followed multiple chemotherapy sessions. Clinical features indicated that more patients in the CALCRLhigh group also had c-kit mutations compared with patients in other groups. Overall survival (OS) was longer in patients with lower levels of CALCRL expression, especially in patients with c-kit mutations or with more blast cells in bone marrow (BM). In addition, a longer OS was observed in the CALCRLlow group after hematopoietic stem cell transplantation (HSCT). This preliminary study indicates that CALCRL could serve as a suitable prognostic factor in AML/ETO+ AML patients.


Genetics and epigenetics of alcohol dependence.
Alcohol dependence is a severe and common disorder associated with high morbidity and mortality rates. Genetic as well as environmental factors are known to modulate susceptibility to alcohol dependence. There is a growing body of evidence suggesting that this interaction between the genome and the environment is mediated by epigenetic mechanisms, e.g. DNA methylation at CpG sites. Following an introduction of epigenetic regulation of gene transcription, this review will provide an overview over recent genetic and epigenetic findings in the context of alcohol dependence focusing on human studies. Finally, we will discuss the current limitations of epigenetic studies as well as the implications of genetic and epigenetic findings for the development of better treatment and prevention strategies.


Gender differences in patients with chronic fatigue syndrome.
To determine whether there are differences between men and women patients who have chronic fatigue syndrome (CFS) and, if so, to ascertain whether a gender-related pattern exists. A descriptive study of demographic, clinical, and psychosocial measures, the results of which were prospectively collected for patients who had CFS. A university-based referral clinic devoted to the evaluation and management of chronic fatigue. 348 CFS patients who had undergone complete medical evaluations. Clinical variables included symptoms, physical examination findings, and laboratory results. Psychosocial assessment consisted of a structured psychiatric interview, the Medical Outcomes Study Short-form General Health Survey to assess functional status, the General Health Questionnaire to ascertain psychological distress, the Multidimensional Health Locus of Control, and measures of attribution, social support, and coping. Overall, few gender-related differences were identified. Women had a higher frequency of tender or enlarged lymph nodes (60% versus 33%, p < or = 0.01) and fibromyalgia (36% versus 12%, p < or = 0.001) and lower scores on the physical functioning subscale of the Medical Outcomes Study Short-form General Health Survey (37.6 versus 52.2, p < 0.01); men more often had pharyngeal inflammation (42% versus 22%, p < or = 0.001) and reported a higher lifetime prevalence of alcoholism (20% versus 9%, p < or = 0.01). In general, demographic, clinical, and psychosocial factors do not distinguish men from women CFS patients.


Effect of inspiratory flow on methacholine challenge in children.
Regulation of inspiratory flow alters the outcomes of the methacholine (MHC) challenge in adults and cough receptor sensitivity in children. The effect of inspiratory flow on the reproducibility of the MHC challenge in children is unknown. The aim of this study was to evaluate the effect of inspiratory flow alteration on the repeatabilty of the MHC challenge in children with and without asthma. Twenty-five children undertook the MHC challenge on three different days by using a dosimeter connected to a setup that allowed regulation of inspiratory flow and pattern. Children were randomized to commence the challenges at 20 or 60 L/min, and the last challenge was performed at 20 L/min. The within-subject standard deviation, 95% range for change, and doubling dose for the differing inspiratory flow (20 vs. 60 L/min) was more than twice that of when inspiratory flow was maintained at 20 L/min for both occasions. The range of the "limits of agreement" of the Bland and Altman plot was smaller when inspiratory flow was constant. For short-term comparative individual studies in children, inspiratory flow should be regulated. Laboratories and research measuring change in airway hyperrepsonsiveness to MHC should determine and report reproducibility indices of the challenge so airway hyperresponsiveness changes can be interpreted meaningfully.


Predation of Ladybird Beetles (Coleoptera: Coccinellidae) by Amphibians.
Studies of predation of ladybird beetles (Coccinellidae) have focused on a limited number of predator taxa, such as birds and ants, while other potential predators have received limited attention. I here consider amphibians as predators of ladybirds. Published amphibian gut analyses show that ladybirds are quite often eaten by frogs and toads (Anura), with recorded frequencies reaching up to 15% of dietary items. Salamanders (Caudata) eat ladybirds less frequently, probably as their habits less often bring them into contact with the beetles. Amphibians do not appear to be deleteriously affected by the potentially toxic alkaloids that ladybirds possess. Amphibians, especially frogs and toads, use primarily prey movement as a release cue to attack their food; it is thus likely that their ability to discriminate against ladybirds and other chemically defended prey is limited. Because of this poor discriminatory power, amphibians have apparently evolved non-specific resistance to prey defensive chemicals, including ladybird alkaloids. Although amphibian-related ladybird mortality is limited, in certain habitats it could outweigh mortality from more frequently studied predators, notably birds. The gut analyses from the herpetological literature used in this study, suggest that in studying predation of insects, entomologists should consider specialized literature on other animal groups.


Role of nitric oxide in urinary bladder function: effect of L-arginine.
Evidence indicates that decreased blood flow to the bladder plays a major role in obstructive bladder dysfunction in the rabbit model of partial bladder outlet obstruction (PBOO), and that nitric oxide (NO) regulation of blood flow may be important in modulating the degree of obstructive bladder dysfunction. The specific aim of our study is to determine the effect of feeding rabbits a diet high in L-arginine on the response to PBOO. Sixteen male NZ White rabbits were separated into 4 groups of 4 each. The rabbits in groups 1 and 3 underwent PBOO. The rabbits in groups 2 and 4 were sham-operated. For 1 week prior to surgery, and 2 weeks postoperatively, each rabbit in groups 1 and 2 was put on a diet containing 7% arginine. Rabbits in groups 3 and 4 were on a normal diet (0.76% arginine). PBOO resulted in a greater increase in bladder weight in the control group than the arginine group. PBOO resulted in a greater decrease in compliance in the control group than the arginine group. The contractile responses to all agents in the arginine control group were greater than in the control normal diet group. PBOO resulted in a greater decrease in the response to field stimulation in the control group than in the arginine group. These studies clearly demonstrate that feeding rabbits a diet high in L-arginine was beneficial for the control rabbits, and reduced the level of dysfunctions following PBOO.


[Clinical value of arterial stiffness assessment on risk prediction of vascular stiffness in the octogenarian elderly].
Objective: This study aimed to analyze clinical factors related to arterial stiffening and establish a risk prediction nomogram of arterial stiffening in the octogenarian(≥80 years). Methods: This study was a retrospective cross-sectional study, which enrolled the octogenarian elderly who underwent physical examination and secondary prevention intervention in the outpatient department of Chinese People's Liberation Army General Hospital from April 2022 to August 2022. Clinical data including demographics, biochemical indicators and medical history were collected. Brachial-ankle pulse wave velocity (baPWV) was detected during the clinical visit. Participants were divided into the control group (baPWV≤1 800 cm/s) and vascular sclerosis group (baPWV>1 800 cm/s). The risk factors of arterial stiffness were analyzed by univariate and logistic regression analysis, and the nomogram model was constructed by R programming language. The predictive effect of the nomogram model was evaluated by the receiver operating characteristic curve (ROC). Results: The median age of the 525 participants was 87.0 (82.0, 92.0) years, 504 (96.0%) were male, 82 in the control group, 443 in the vascular sclerosis group. The baPWV, age, systolic blood pressure, mean arterial pressure and diastolic blood pressure were significantly lower in the control group than those in the vascular sclerosis group (all P<0.05). Logistic regression analysis showed that high-density lipoprotein cholesterol, alanine aminotransferase and amylase were protective factors, and alkaline phosphatase and creatinine were risk factors of arterial stiffening (all P<0.05). The combined nomogram model scores including age, mean arterial pressure and the above five laboratory indicators indicated that mean arterial pressure and serum creatinine levels were strongly correlated with vascular sclerosis. The ROC curve suggested that the nomogram model had good prediction ability. Conclusions: Age, mean arterial pressure, high-density lipoprotein cholesterol, alanine aminotransferase, alkaline phosphatase, amylase and creatinine are independently determinants for increased vascular stiffness. The combined prediction model in this study can provide reference for individualized clinical risk prediction of vascular sclerosis in the octogenarian elderly.


High-power near-concentric Fabry-Perot cavity for phase contrast electron microscopy.
Transmission electron microscopy (TEM) of vitrified biological macromolecules (cryo-EM) is limited by the weak phase contrast signal that is available from such samples. Using a phase plate would thus substantially improve the signal-to-noise ratio. We have previously demonstrated the use of a high-power Fabry-Perot cavity as a phase plate for TEM. We now report improvements to our laser cavity that allow us to achieve record continuous wave intensities of over 450 GW/cm2, sufficient to produce the optimal 90° phase shift for 300 keV electrons. In addition, we have performed the first cryo-EM reconstruction using a laser phase plate, demonstrating that the stability of this laser phase plate is sufficient for use during standard cryo-EM data collection.


Palladium-catalyzed unactivated β-methylene C(sp(3))-H bond alkenylation of aliphatic amides and its application in a sequential C(sp(3))-H/C(sp(2))-H bond alkenylation.
A palladium(II)-catalyzed β-methylene C(sp(3))-H bond alkenylation of acyclic aliphatic amides with alkenyl halides has been developed. Both (E)-olefins and (Z)-olefins can be readily accessed using this method and a possible (Z)/(E)-olefin isomerization pathway is proposed. A solvent effect-promoted sequential C(sp(3))-H bond alkenylation and C(sp(2))-H bond alkenylation was also studied, and can provide a convenient route to novel diene compounds.


Structure and stability of the organo-noble gas molecules XNgCCX and XNgCCNgX (Ng = Kr, Ar; X = F, Cl).
Density functional theory (B3LYP) and ab initio theory [second-order Møller-Plesset perturbation theory (MP2) and coupled-cluster theory including single, double, and quasiperturbative triple excitations (CCSD(T))] have been used in combination with the standard and augmented correlation consistent basis sets (cc-pVnZ and aug-cc-pVnZ, where n = D, T, and Q) to investigate potential new noble gas compounds. Two classes of molecules were studied: XNgCCNgX and XNgCCX, where Ng = Kr and Ar and X = F and Cl. These molecules were characterized by finding the ground-state structures and calculating the relative energies, charge distributions, and vibrational frequencies. In addition, transition-state structures were also determined and decomposition pathways were identified through intrinsic reaction coordinate calculations.


Influences of donepezil on cardiovascular system--possible therapeutic benefits for heart failure--donepezil cardiac test registry (DOCTER) study.
To study prospectively influences of donepezil, an acetylcholinesterase inhibitor against Alzheimer disease, on cardiovascular system, we evaluated cardiovascular changes occurring during new initialized treatment with donepezil in 49 dementia patients over 6 months. No patient suffered from cardiovascular events. In clinical changes between baseline and the first evaluation after donepezil treatment, heart rate and plasma brain natriuretic peptide (BNP) levels as a marker for heart failure did not change (BNP: 59.62 ± 62.71 pg/mL at baseline to 53.18 ± 42.34 pg/mL at first evaluation; P = 0.262). We further examined plasma BNP levels in 2 groups into which the patients were divided at baseline according to the cut-off plasma BNP level of 60 pg/mL. In patients with high level of BNP, the BNP levels decreased after administration of donepezil (116.39 ± 76.58 pg/mL at baseline to 82.24 ± 46.64 pg/mL at first evaluation; P = 0.011) with the tendency to be reduced in the follow-up period. BNP did not change in patients with low level of BNP. Donepezil seemed to be safe in patients with dementia without symptomatic heart disease and significantly decreased plasma BNP levels in patients with subclinical chronic heart failure.


How does the addition of steric hindrance to a typical N-heterocyclic carbene ligand affect catalytic activity in olefin metathesis?
Density functional theory (DFT) calculations were used to predict and rationalize the effect of the modification of the structure of the prototype 1,3-bis(2,6-diisopropylphenyl)imidazol-2-ylidene) N-heterocyclic carbene (NHC) ligand. The modification consists in the substitution of the methyl groups of ortho isopropyl substituent with phenyl groups, and here we plan to describe how such significant changes affect the metal environment and therefore the related catalytic behaviour. Bearing in mind that there is a significant structural difference between both ligands in different olefin metathesis reactions, here by means of DFT we characterize where the NHC ligand plays a more active role and where it is a simple spectator, or at least its modification does not significantly change its catalytic role/performance.


Comparative gastrointestinal morphology of Tachyoryctes splendens (Rüppell, 1835) and Heliophobius emini, (Noack, 1894) two species of East African mole-rats.
Tachyoryctes splendens (Northeast African mole-rat) and Heliophobius emini (Emin's mole-rat) are two African mole-rats that represent separate allopatric rodent families namely Spalacidae and Bathyergidae respectively. While these species consume a similar diet of underground plant storage organs such as roots and tubers, T. splendens has been reported to additionally consume small amounts of aerial foliage. This study aims to provide detailed gross morphological and histological morphometric analyses of the gastrointestinal tract (GIT) of these two subterranean species. The formalin fixed gastrointestinal tracts of T. splendens (n = 9) and H. emini (n = 6) were photographed, weighed and measured. The length and basal surface areas were calculated for each anatomically distinct region. Representative histological samples were prepared and stained using Hematoxylin and Eosin. Microscopic luminal measurements were used to calculate a surface enlargement factor and the luminal surface area of each region. Tachyoryctes splendens had a large double chambered hemi-glandular stomach with a macroscopically visible transition from keratinized stratified squamous epithelium to glandular epithelium. The cecum was large and the luminal surface revealed a single spiral fold. The ascending colon of T. splendens was arranged in a spiral, with two centripetal and two centrifugal windings. The descending colon was arranged in a single parallel loop, similar to H. emini. A narrow colonic groove was accompanied by V-shaped folds on either side. Heliophobius emini had a simple glandular stomach, a large, haustrated cecum that displayed a cecal appendix and the descending colon was arranged in a single parallel loop. The internal aspect of the colon revealed a wide colonic groove extending from the ceco-colic junction to distal colon. As both species originate from a similar geographical region and ingest very similar diets, it is likely that the differences in the GIT morphology are attributed to phylogeny as the species represent two different families of mole-rats.


Expression and Activity of the Transcription Factor CCAAT/Enhancer-Binding Protein β (C/EBPβ) Is Regulated by Specific Pulse-Modulated Radio Frequencies in Oligodendroglial Cells.
The rapid growth of wireless electronic devices has raised concerns about the harmful effects of leaked electromagnetic radiation (EMR) on human health. Even though numerous studies have been carried out to explore the biological effects of EMR, no clear conclusions have been drawn about the effect of radio frequency (RF) EMR on oligodendrocytes. To this end, we exposed oligodendroglia and three other types of brain cells to 2.4 GHz EMR for 6 or 48 h at an average input power of 1 W in either a continuous wave (CW-RF) or a pulse-modulated wave (PW-RF, 50 Hz pulse frequency, 1/3 duty cycle) pattern. RNA sequencing, RT-qPCR, and Western blot were used to examine the expression of C/EBPβ and its related genes. Multiple reaction monitoring (MRM) was used to examine the levels of expression of C/EBPβ-interacting proteins. Our results showed that PW-RF EMR significantly increased the mRNA level of C/EBPβ in oligodendroglia but not in other types of cells. In addition, the expression of three isoforms and several interacting proteins and targeted genes of C/EBPβ were markedly changed after 6-h PW-RF but not CW-RF. Our results indicated that RF EMR regulated the expression and functions of C/EBPβ in a waveform- and cell-type-dependent manner.


A Bayesian approach to study design and analysis with type I error rate control for response variables of mixed types.
There has been increased interest in the design and analysis of studies consisting of multiple response variables of mixed types. For example, in clinical trials, it is desirable to establish efficacy for a treatment effect in primary and secondary outcomes. In this article, we develop Bayesian approaches for hypothesis testing and study planning for data consisting of multiple response variables of mixed types with covariates. We assume that the responses are correlated via a Gaussian copula, and that the model for each response is, marginally, a generalized linear model (GLM). Taking a fully Bayesian approach, the proposed method enables inference based on the joint posterior distribution of the parameters. Under some mild conditions, we show that the joint distribution of the posterior probabilities under any Bayesian analysis converges to a Gaussian copula distribution as the sample size tends to infinity. Using this result, we develop an approach to control the type I error rate under multiple testing. Simulation results indicate that the method is more powerful than conducting marginal regression models and correcting for multiplicity using the Bonferroni-Holm Method. We also develop a Bayesian approach to sample size determination in the presence of response variables of mixed types, extending the concept of probability of success (POS) to multiple response variables of mixed types.


Surviving cave bats: auditory and behavioural defences in the Australian noctuid moth, Speiredonia spectans.
The Australian noctuid moth, Speiredonia spectans shares its subterranean day roosts (caves and abandoned mines) with insectivorous bats, some of which prey upon it. The capacity of this moth to survive is assumed to arise from its ability to listen for the bats' echolocation calls and take evasive action; however, the auditory characteristics of this moth or any tropically distributed Australian moth have never been examined. We investigated the ears of S. spectans and determined that they are among the most sensitive ever described for a noctuid moth. Using playbacks of cave-recorded bats, we determined that S. spectans is able to detect most of the calls of two co-habiting bats, Rhinolophus megaphyllus and Miniopterus australis, whose echolocation calls are dominated by frequencies ranging from 60 to 79 kHz. Video-recorded observations of this roost site show that S. spectans adjusts its flight activity to avoid bats but this defence may delay the normal emergence of the moths and leave some 'pinned down' in the roosts for the entire night. At a different day roost, we observed the auditory responses of one moth to the exceptionally high echolocation frequencies (150-160 kHz) of the bat Hipposideros ater and determined that S. spectans is unable to detect most of its calls. We suggest that this auditory constraint, in addition to the greater flight manoeuvrability of H. ater, renders S. spectans vulnerable to predation by this bat to the point of excluding the moth from day roosts where the bat occurs.


Palisaded encapsulated neuroma on the lower lip: a case report.
Palisading encapsulated neuroma is a rare, benign, cutaneous nerve sheath tumor. It usually occurs as an asymptomatic solitary skin-colored papule and commonly affects the nose and cheeks. Sometimes, it involves other sites, including the shoulder, upper arm, and trunk, but rarely involves the oral mucosa, including that of the lip. In our case, a 63-year-old female patient complained of a pinkish rubbery nodule on her lower lip. Histopathologic examination demonstrated a well-circumscribed nodule encapsulated by connective tissue stroma in the dermis. The nodule consisted of palisading spindle-shaped tumor cells with wavy and basophilic nuclei. The cells were arranged in streaming fascicles with multiple clefts and were strongly positive for S-100 proteins. To our knowledge, only three cases of palisading encapsulated neuroma on the lower lip have been reported in the Korean literature. Herein, we report a rare case of an oral palisaded encapsulated neuroma.


A reliable and rapid method for molecular detection of malarial parasites using microwave irradiation and loop mediated isothermal amplification.
Improved living conditions together with appropriate diagnosis can reduce avoidable malarial deaths substantially. Microscopy remains the gold standard in the diagnosis of malaria. However, rapid molecular diagnostic tests (RmDT) are becoming increasingly important and will, most likely, be the diagnostic techniques of choice in the next years. In this study, a rapid and reliable nucleic acid extraction procedure from human blood and malarial parasites using microwave irradiation as a promising platform is described. In addition, a tailored loop mediated isothermal amplification (LAMP) methodology that utilizes hydroxynaphthol blue (HNB) and Bst 2.0 DNA polymerases in molecular detection of malarial parasites is described. Following microwave irradiation for DNA isolation, conventional PCR assays were able to detect up to five malaria parasites/μl. The LAMP methodology described here was capable to detect as low as one Plasmodium falciparum parasite/μl after DNA extraction by microwave irradiation. A turnover time of 45 minutes from nucleic acid extraction to final visual read-out was achieved. The described procedure offers a cheap, simple and fast method of molecular detection of malaria parasites. This test can easily be performed in basic laboratories. The methodology has been validated as a proof of concept and has specifically be developed for use at low-resource settings. Such RmDTs may aid health providers to make timely therapeutic interventions in malaria endemic regions.


Bacteremia in children: an outpatient clinical review.
In a 20-month period, 1,783 children seen in the pediatric outpatient department had blood cultures performed and 117 (6.5%) of these children had bacteremia. Two thirds of the isolates were Diplococcus pneumoniae and Hemophilus influenzae b. Ninety-three percent of children with H. influenzae b bacteremia and 20% of children with pneumococcal bacteremia had soft tissue involvement at the initial visit. Most children with positive blood cultures (102) were previously well and beyond the newborn period and many (46) had seemingly trivial illnesses initially: upper respiratory tract infection, fever of unknown origin, otitis media, and diarrhea. In the absence of soft tissue infection, the latter three diagnoses correlated best with bloodstream invasion. Nineteen children had persistent bacteremia and five developed soft tissue complications not noted initially. Two factors, age between 7 and 24 months and temperature between 39.4 and 40.6 C, showed increased specificity for bacteremia but were sensitive only for pneumococcal disease. A temperature larger than or equal to 40.5 C showed more specificity for bacteremia than lesser fevers. A white blood cell count greater than 20,000/cu mm was poorly sensitive, and pulmonary infiltrates were neither specific nor sensitive for positive blood cultures. Five bacteremic children had aseptic lymphocytosis in the cerebrospinal fluid. Two days of intravenous antibiotic therapy and eight days of oral therapy were adequate for pneumococcal bacteremia without soft tissue involvement. This therapy may not be without soft tissue involvement. This therapy may not be ideal, however, since other routes and duration of therapy were not evaluated.


[Secondary active-evolutive cavitary pulmonary tuberculosis of the apicodorsal segment of the left upper lobe associated with bronchial tuberculosis and bronchial geotrichosis].
A case of active pulmonary secondary tuberculosis associated with bronchial tuberculosis and bronchial geotrichosis is presented. This association is infrequent. Favoring factors: local and general immunodepression (recurrent infection with pyogenic germs, rubella, neutropenia, aggressive antibiotherapy, iron deficiency). The diagnosis was based mainly on the bacteriological sputum examination for bK (smear and culture) and the mycologic examination (smear and culture) of the bronchial aspiration, identifying Geotrichum candidum. The treatment consisted of antituberculous and antimycotic drugs, bronchodilators, bronchial aspirations and local endoscopic administration of antimycotic drugs.


Asymmetric total synthesis of (+)-fusarisetin A via the intramolecular Pauson-Khand reaction.
An asymmetic total synthesis of (+)-fusarisetin A has been achieved. The essential to our strategy was the application of the intramolecular Pauson-Khand reaction for the stereoselective construction of the trans-decalin subunit of (+)-fusarisetin A with a unique C16 quarternary chiral center. The developed chemistry offers an alternative to the IMDA reaction that has been used for fusarisetin A, and is applicable to analogue synthesis for biological evaluation.


Polar pollutants entry into the water cycle by municipal wastewater: a European perspective.
The effluents of eight municipal wastewater treatment plants (WWTP) in Western Europe were analyzed by liquid-chromatography-mass spectrometry for the occurrence of 36 polar pollutants, comprising household and industrial chemicals, pharmaceuticals, and personal care products. In a long-term study of the effluents of three WWTP over 10 months, sulfophenyl carboxylates and ethylene diamino tetraacetate (EDTA) were detected above 10 microg/L on average, while benzotriazoles, benzothiazole-2-sulfonate, diclofenac, and carbamazepine showed mean concentrations of 1-10 microg/L, followed by some flame retardants, naphthalene disulfonates, and personal care products in the range of 0.1-1 microg/L. Half of the determined compounds were not significantly removed in tertiary wastewater treatment. By dividing the effluent concentration of a compound by its relative removal in WWTP a water cycle spreading index (WCSI) was calculated for each compound. We propose that this index provides a measure for the potential of a polar compound to spread along a partially closed water cycle after discharge with municipal wastewater and to occur in raw waters used for drinking water production. Polar pollutants in surface water samples of different catchments showed increasing concentration for compounds with increasing WCSI.


Pregnant at work: time for prenatal care providers to act.
Fifty years ago, when a woman became pregnant, she was expected to stop working. Today, however, most women who work are the primary, sole, or co-breadwinner for their families, and their earnings during pregnancy are often essential to their families' economic well-being. Medical data about working during pregnancy are sparse but generally show that both low-risk and high-risk women can tolerate work-related duties well, although some work accommodations (eg, providing a chair for sitting, allowing snacks, or modifying the work schedule) may be necessary. However, some employers refuse to accommodate pregnant women who need adjustments. This can result in a woman being forced to make the choice between working without accommodations and losing her income and health insurance or even her job. Prenatal care providers can play an important role by implementing changes in their own practice, shaping public policy, and conducting research to increase protections for pregnant women and to ensure that they receive medically recommended accommodations while continuing to earn income for their growing families.


[Coexistence of azygous pericallosal artery with aneurysm].
The authors describe three cases of successfully surgically treated of aneurysms of the brain associated with absence of one pericallosal artery. Despite the rarity of such anomaly these cases are important in view of a possible damage to the only remaining pericallosal artery.


Recurrent abdominal pain: gaining control of the symptom.
The treatment of recurrent abdominal pain without organic cause requires that the families involved change their focus from organic to emotional issues. This is done during a family conference with the pediatrician, in which a positive approach to the problem is outlined. Following such a plan avoids the pitfalls of continuing an inappropriate and organically oriented response to the family's needs and also avoids threatening the family with emotionally charged personal needs too soon. When the transition period is successfully negotiated, the child's symptoms often are alleviated without further psychological intervention. In cases where further psychiatric intervention is indicated, a foundation has been laid for successful treatment. Nineteen patients have been successfully treated either by the pediatrician alone or have successfully begun psychotherapy, thus preventing unnecessary medical tests and further "doctor shopping", which characteristically accompanies such cases.


Feedback on audit and action planning for dental caries control: a qualitative study to investigate the acceptability among interdisciplinary pediatric dental care teams.
American Indian and Alaska Native children suffer from the poorest oral health of all populational groups in the United States. Evidence-based practices (EBP) for caries control are well established, but systematically implementing such practices have proven difficult. Audit and feedback with goal setting, and action planning to implement these EBPs have not been tested or adapted for Alaska Native healthcare settings. The aim of this study was to investigate acceptability and perceived feasibility of an audit and feedback intervention for pediatric dental caries control among dental providers and patient stakeholders. The pilot program was implemented in two dental clinics from a tribal healthcare consortium in Alaska. Key-informant interviews were conducted to investigate the contextual, organizational, and behavioral facilitators and barriers to the implementation and expansion of the program. Interview transcripts were analyzed by two researchers using thematic analysis. Eight key informants were interviewed twice (during and after the intervention period), and one once, for a total of 17 interviews. Patient stakeholders were not interviewed due to COVID-19 pandemic clinic closures and social isolation mandates. Three principal themes emerged: a positive organizational climate and culture fostered the acceptability of the program, the positive impacts of the program observed in the pediatric dental teams and the organization, and the challenges to implement the program including understanding the data reports, trusting the accuracy of the data, and competing priorities. The intervention of audit and feedback with goal setting and action planning was well accepted and perceived as feasible by the study participants given the financial and human resources provided by the research project. This qualitative study can inform the design and evaluation of process-oriented implementation strategies geared towards decreasing health inequities and improving health outcomes, such as dental caries in American Indian and Alaska Native children and adolescents.


Low recurrence of syncope in patients with inducible sustained ventricular tachyarrhythmias treated with an implantable cardioverter-defibrillator.
To determine the effectiveness of the implantable cardioverter defibrillator (ICD) in preventing recurrence of syncope in patients with structural heart disease, previously unexplained syncope and inducible ventricular arrhythmias. Thirty-eight patients with syncope, structural heart disease and inducible arrhythmias had an ICD implanted. All ICDs delivered antitachycardia pacing and shocks of adjusted energy. Detection and therapy were programmed according to uniform criteria. The mean age of the patients was 63+/-11 years and most of them were male (36/38). After a mean follow-up of 28+/-15 (4-61) months, six patients died and one underwent heart transplantation. Syncope recurred in three patients, but in none of them was it caused by an arrhythmic event. In 18 patients, 113 episodes of ventricular tachycardia/ventricular fibrillation were detected and appropriately treated by the ICD. The mean time from implant until first appropriate therapy was 18+/-14 months. The actuarial probability of receiving appropriate therapy was 20% and 42% at 12 and 24 months, respectively. In patients with unexplained syncope, structural heart disease and inducible arrhythmias, ICD prevents syncope associated with arrhythmic events. Frequent effective use of antitachycardia pacing and shocks of adjusted energy seem essential to this aim.


Validation of biokinetic models of Cs and I using their daily dietary intakes and organ contents in an adult Indian population.
The daily dietary intakes and total contents of Cs and I in skeletal muscle and thyroid, respectively, for an average Indian adult were estimated by determining their concentrations in the total cooked diet and tissue samples using instrumental neutron activation analysis. These data were then used to predict the biological half-lives of Cs and I and their radioactive counterparts for the Reference Indian Man. The predicted biological half-lives of Cs and I for Reference Indian Man were found to be comparable with the reported values for the ICRP Reference Man.


Frequent aberrant p53 and Fhit expression in endoscopically resected superficial hypopharyngeal cancer and esophageal cancer.
In the last decade, the incidence rate of detection rate of superficial head, neck and esophageal squamous cell carcinomas has increased with the development of endoscopic imaging techniques. These cancers are thought to arise independently subsequent to tissue exposure to a common carcinogen e.g. alcohol or tobacco. This phenomenon has been termed field cancerization. To determine the molecular background of the development of hypopharyngeal squamous cell carcinomas (HPSCCs) and double esophageal squamous cell carcinomas (DESCCs), the present study immunohistochemically assessed tumor-related protein expression [p53, Fhit (fragile histidine triad), E-cadherin and activation-induced cytidine deaminase (AID)], and subsequently determined the correlation between protein expression and clinicopathological data. Tumor specimens of 9 HPSCCs and 9 DESCCs were endoscopically obtained from 8 patients with HPSCC. The 9 DESCCs, including 5 synchronous and 4 metachronous lesions, were all obtained from four patients with HPSCC. The overexpression of p53 and loss of Fhit expression was immunohistochemically detected in 8 (88.9%) and 8 (88.9%) of the 9 HPSCCs and in 8 (88.9%) and 8 (88.9%) of the 9 DESCCs, respectively, which demonstrated the high frequency of such expression. Additionally, 7 out of 9 HPSCCs, and 7 out of 9 DESCCs demonstrated aberrant expression of p53 and Fhit. The rate of aberrant AID and E-cadherin expression was 67 and 44% in HPSCCs and 44 and 44% in DESCC, respectively. These results suggested that aberrant p53 and Fhit expression was involved in the development of HPSCC and their DESCC, and that their expression may be used for the prediction of DESCC development in patients with HPSCC, thereby acting as a biomarker of field cancerization.


Plasma resistin levels associate with risk for hypertension among nondiabetic women.
Emerging evidence suggests a role for resistin in inflammation and vascular dysfunction, which may contribute to the pathogenesis of hypertension, but the association between resistin levels and incident hypertension is unknown. We examined the association between plasma resistin levels and the risk for incident hypertension among 872 women without a history of hypertension or diabetes from the Nurses' Health Study. We identified 361 incident cases of hypertension during 14 years of follow-up. After adjustment for potential confounders, resistin levels in the highest tertile conferred a 75% higher risk for hypertension than the lowest tertile (relative risk [RR] 1.75; 95% confidence interval [CI] 1.19 to 2.56). Further adjustment for other adipokines did not change the RR substantially. In stratified analysis, resistin levels in the highest tertile significantly increased the risk for hypertension among women aged >or=55 years (adjusted RR 2.40; 95% CI 1.55 to 3.73) but not among women aged <55 years (adjusted RR 0.64; 95% CI 0.25 to 1.62). In a subset analysis of 362 women who also had measurements of inflammatory and endothelial biomarkers, plasma resistin levels significantly correlated with IL-6, soluble TNF receptor 2, intercellular adhesion molecule 1, vascular adhesion molecule 1, and E-selectin after controlling for age and body mass index. After further adjustment for these biomarkers and C-reactive protein, resistin levels remained significantly associated with incident hypertension. In conclusion, higher plasma resistin levels independently associate with an increased risk for incident hypertension among women without diabetes.


Radiographic positioning test format for programs using an energized x-ray laboratory.
As a means of evaluating student performance in the clinical setting, three major areas of testing have been identified: (1) time required to position the patient for any given examination, (2) procedure performance, and (3) ability to evaluate the finished radiograph as to its diagnostic quality. The testing format developed at the University of Nevada, Las Vegas, is used to examine the student as he performs in an energized laboratory. This format, based on criteria the student knows in advance, increased the objectivity of the instructor giving the examination.


Glutamate Neurotransmission in Rodent Models of Traumatic Brain Injury.
Traumatic brain injury (TBI) is a leading cause of death and disability in people younger than 45 and is a significant public health concern. In addition to primary mechanical damage to cells and tissue, TBI involves additional molecular mechanisms of injury, termed secondary injury, that continue to evolve over hours, days, weeks, and beyond. The trajectory of recovery after TBI is highly unpredictable and in many cases results in chronic cognitive and behavioral changes. Acutely after TBI, there is an unregulated release of glutamate that cannot be buffered or cleared effectively, resulting in damaging levels of glutamate in the extracellular space. This initial loss of glutamate homeostasis may initiate additional changes in glutamate regulation. The excitatory amino acid transporters (EAATs) are expressed on both neurons and glia and are the principal mechanism for maintaining extracellular glutamate levels. Diffusion of glutamate outside the synapse due to impaired uptake may lead to increased extrasynaptic glutamate signaling, secondary injury through activation of cell death pathways, and loss of fidelity and specificity of synaptic transmission. Coordination of glutamate release and uptake is critical to regulating synaptic strength, long-term potentiation and depression, and cognitive processes. In this review, we will discuss dysregulation of extracellular glutamate and glutamate uptake in the acute stage of TBI and how failure to resolve acute disruptions in glutamate homeostatic mechanisms may play a causal role in chronic cognitive symptoms after TBI.


Local optical density of states in finite crystals of plane scatterers.
Spontaneous emission rates in a dielectric structure are position dependent and proportional to the local optical density of states. The latter can be calculated when the Green function is known. In our scalar formalism, we model dielectric slabs as infinitely thin planes and use the T-matrix formalism of multiple-scattering theory to find an exact analytical expression for the Green function of a dielectric mirror of arbitrary number of unit cells N. All the propagating and guided modes of the structure are found. There are at most N guided modes and their dispersion relations are studied. The guided modes appear around frequencies corresponding to the first stop band in normal direction. Local densities of propagating and guided modes are presented, also for frequencies where the layered structure acts as an omnidirectional mirror.


Haemorrhage due to renal angiomatosis. Case report.
Severe haemorrhage after an uncomplicated pyelolithotomy in a young women was found to be caused by multiple, unilateral haemangiomas. The diagnosis was made at angiography prior to the subsequent nephrectomy.


Comparison of Troponin I levels versus myocardial dysfunction on prognosis in sepsis.
In the context of sepsis, we tested the relationship between echocardiographic findings and Troponin, and their impact on prognosis. In this prospective study, we enrolled 325 septic patients (41% with shock), not mechanically ventilated, between October, 2012 and June, 2019 among those admitted to our High-Dependency Unit. By echocardiography within 24 h from the admission, sepsis-induced myocardial dysfunction (SIMD) was defined as left ventricular (LV) systolic dysfunction (speckle-tracking-based global longitudinal peak systolic strain, GLS, > - 14%) and/or right ventricular (RV) systolic dysfunction (Tricuspid Annular Plane Systolic Excursion, TAPSE < 16 mm). Troponin I levels were measured upon admission (T0) and after 24 h (T1); it was considered normal if > 0.1 ng/mL. Mortality was assessed at day-7 and day-28 end-points. One-hundred and forty-two patients had normal Troponin level at T0 and T1 (G1), 69 had abnormal levels at T0 or T1 (G2) and 114 showed abnormal Troponin levels at both T0 and T1 (G3). Compared to G1, patients in G3 had worse LV and RV systolic function (GLS - 11.6 ± 3.4% vs - 14.0 ± 3.5%, p < 0.001; TAPSE 18 ± 0.5 vs 19 ± 0.5 mm, p = 0.047) and greater day-28 (34% vs 20%, p = 0.015) mortality. In a Cox survival analysis including age, Troponin and SOFA score, mortality was predicted by the presence of SIMD (RR 3.24, 95% CI 1.72-6.11, p < 0.001) with no contribution of abnormal Troponin level. While abnormal Troponin levels were associated with SIMD diagnosed by echocardiography, only the presence of SIMD predicted the short- and medium-term mortality rate, without an independent contribution of increased Troponin levels.


Background-free in vivo time domain optical molecular imaging using colloidal quantum dots.
The interest in optical molecular imaging of small animals in vivo has been steadily increased in the last two decades as it is being adopted by not only academic laboratories but also the biotechnical and pharmaceutical industries. In this Spotlight paper, the elements for in vivo optical molecular imaging are briefly reviewed, including contrast agents, i.e., various fluorescent reporters, and the most commonly used technologies to detect the reporters. The challenges particularly for in vivo fluorescence imaging are discussed and solutions to overcome the said-challenges are presented. An advanced imaging technique, in vivo fluorescence lifetime imaging, is introduced together with a few application examples. Taking advantage of the long fluorescence lifetime of quantum dots, a method to achieve background-free in vivo fluorescence small animal imaging is demonstrated.


Arthrodesis for Treatment of Intra-Articular Synovial Cysts of the Hallux Interphalangeal Joint.
Synovial cysts are benign tissue masses that develop near joints and tendons as a result of fluid leakage. They can be difficult to eradicate, and adjacent tendon and joint surfaces can complicate their treatment. We retrospectively analyzed the data from 4 consecutive patients who had undergone hallux interphalangeal fusion from January 2009 to December 2010. Of the 4 patients, 3 were male and 1 was female, with a mean age of 55 ± 22 (range 26 to 79) years. These 4 patients had developed painful interphalangeal arthritis with radiographic cystic changes of 1 to 4 years' duration. All patients were treated at a single facility, with surgical fixation of the joint performed by insertion of a single 4.3-mm headless lag screw across the interphalangeal joint. A final postoperative follow-up examination was performed at 22 ± 7 (range 14 to 30) months postoperatively. The mean American Orthopaedic Foot and Ankle Society hallux functional scores increased significantly from 70.8 ± 6.1 preoperatively to 90.5 ± 5.2 postoperatively (p < .01). No complications were observed, and complete interphalangeal joint fusion was observed at a mean of 9.2 ± 1.2 weeks. In conclusion, these preliminary data suggest that arthrodesis is an alternative effective treatment of symptomatic synovial cyst formation localized to the hallux interphalangeal joint.


The Effects of Maximal Intensity Exercise on Cognitive Performance in Children.
High intensity physical exercise has previously been found to lead to a decline in cognitive performance of adults. The aim of this study was to determine the effects of maximal intensity exercise on cognitive performance of children. Using a repeated-measures design, 20 children and adolescents aged 8-17 years completed a battery of tests measuring memory and attention. Forward and Backward Digit Span tests, the Rey Auditory-Verbal Learning Test (RAVLT) and the Digit Symbol Substitution Test (DSST) were performed at baseline, immediately after, and one hour after a maximal cardiopulmonary exercise test. Forward and Backward Digit Span scores significantly improved post-recovery compared with baseline measurements. There was a significant decrease in RAVLT scores post-exercise, which returned to baseline values after recovery. The DSST test scores were mildly elevated from post-exercise to after recovery. Maximal intensity exercise in children and adolescents may result in both beneficial and detrimental cognitive effects, including transient impairment in verbal learning. Cognitive functions applying short term memory improve following a recovery period. Parents, educators and coaches should consider these changes in memory and attention following high-intensity exercise activities in children.


Membrane protein preparation for TROSY NMR screening.
The first steps toward undertaking an NMR structural study of a new protein is very often to purify the protein and then to acquire an HSQC or TROSY NMR spectrum, the quality of which is used to assess the feasibility of an NMR-based structural determination. Relatively few integral membrane proteins (IMPs) have been subjected even to this very preliminary stage of NMR analysis. Here, NMR feasibility testing methods are outlined that are tailored for hexahistidine-tagged IMPs that have been expressed in Escherichia coli. Generally applicable protocols are presented for expression testing, purification, and NMR sample preparation. A 2D TROSY pulse sequence that has been optimized for use with IMPs is also presented.


Spinal GABAergic disinhibition allows microglial activation mediating the development of nociplastic pain in male mice.
Previously we developed a murine model in which postinjury stimulation of an injured area triggers a transition to a nociplastic pain state manifesting as persistent mechanical hypersensitivity outside of the previously injured area. This hypersensitivity was maintained by sex-specific mechanisms; specifically, activated spinal microglia maintained the hypersensitivity only in males. Here we investigated whether spinal microglia drive the transition from acute injury-induced pain to nociplastic pain in males, and if so, how they are activated by normally innocuous stimulation after peripheral injury. Using intraplantar capsaicin injection as an acute peripheral injury and vibration of the injured paw as postinjury stimulation, we found that inhibition of spinal microglia prevents the vibration-induced transition to a nociplastic pain state. The transition was mediated by the ATP-P2X4 pathway, but not BDNF-TrkB signaling. Intrathecally injected GABA receptor agonists after intraplantar capsaicin injection prevented the vibration-induced transition to a nociplastic pain state. Conversely, in the absence of intraplantar capsaicin injection, intrathecally injected GABA receptor antagonists allowed the vibration stimulation of a normal paw to trigger the transition to a spinal microglia-mediated nociplastic pain state only in males. At the spinal level, TNF-α, IL-1β, and IL-6, but not prostaglandins, contributed to the maintenance of the nociplastic pain state in males. These results demonstrate that in males, the transition from acute injury-induced pain to nociplastic pain is driven by spinal microglia causing neuroinflammation and that peripheral injury-induced spinal GABAergic disinhibition is pivotal for normally innocuous stimulation to activate spinal microglia.


Solvated ensemble averaging in the calculation of partial atomic charges.
In the calculation of partial atomic charges, for use in molecular mechanics or dynamics simulations, it is common practice to select only a single conformation for the molecule of interest. For molecules that contain rotatable bonds, it is preferable to compute the charges from several relevant conformations. We present here results from a charge derivation protocol that determines the partial charges by averaging charges computed for conformations selected from explicitly solvated MD simulations, performed under periodic boundary conditions. This approach leads to partial charges that are weighted by a realistic population of conformations and that are suitable for condensed phase simulations. This protocol can, in principle, be applied to any class of molecule and to nonaqueous solvation. Carbohydrates contain numerous hydroxyl groups that exist in an ensemble of orientations in solution, and in this report we apply ensemble averaging to a series of methyl glycosides. We report the extent to which ensemble averaging leads to charge convergence among the various monosaccharides and among the constituent atoms within a given monosaccharide. Due to the large number of conformations (200) in our ensembles, we are able to compute statistically relevant standard deviations for the partial charges. An analysis of the standard deviations allows us to assess the extent to which equivalent atom types may, nevertheless, require unique partial charges. The configurations of the hydroxyl groups exert considerable influence on internal energies, and the limits of ensemble averaged charges are discussed in terms of these properties.


Trends of influenza B during the 2010-2016 seasons in 2 regions of north and south Italy: The impact of the vaccine mismatch on influenza immunisation strategy.
Influenza A and B viruses are responsible for respiratory infections, representing globally seasonal threats to human health. The 2 viral types often co-circulate and influenza B plays an important role in the spread of infection. A 6-year retrospective surveillance study was conducted between 2010 and 2016 in 2 large administrative regions of Italy, located in the north (Liguria) and in the south (Sicily) of the country, to describe the burden and epidemiology of both B/Victoria and B/Yamagata lineages in different healthcare settings. Influenza B viruses were detected in 5 of 6 seasonal outbreaks, exceeding influenza A during the season 2012-2013. Most of influenza B infections were found in children aged ≤ 14 y and significant differences were observed in the age-groups infected by the different lineages. B/Victoria strains prevailed in younger population than B/Yamagata, but also were more frequently found in the community setting. Conversely, B/Yamagata viruses were prevalent among hospitalized cases suggesting their potential role in the development of more severe disease. The relative proportions of viral lineages varied from year to year, resulting in different lineage-level mismatch for the B component of trivalent influenza vaccine. Our findings confirmed the need for continuous virological surveillance of seasonal epidemics and bring attention to the adoption of universal influenza immunization program in the childhood. The use of tetravalent vaccine formulations may be useful to improve the prevention and control of the influenza burden in general population.


Pharmacotherapeutic management of pediatric gliomas : current and upcoming strategies.
Primary glial brain tumors account for the majority of primary brain tumors in children. They are classified as low-grade gliomas (LGG) or high-grade gliomas (HGG), based on specific pathologic characteristics of the tumor, resulting in disparate clinical prognoses. Surgery is a mainstay of treatment for HGG, although it is not curative, and adjuvant therapy is required. Temozolomide, an oral imidazotetrazine prodrug, while considered standard of care for adult HGG, has not shown the same degree of benefit in the treatment of pediatric HGG. There are significant biologic differences that exist between adult and pediatric HGG, and targets specifically aimed at the biology in the pediatric population are required. Novel and specific therapies currently being investigated for pediatric HGG include small molecule inhibitors of epidermal growth factor receptor, platelet-derived growth factor receptor, histone deacetylase, the RAS/AKT pathway, telomerase, integrin, insulin-like growth factor receptor, and γ-secretase. Surgery is also the mainstay for LGG. There are defined front-line, multiagent chemotherapy regimens, but there are few proven second-line chemotherapy options for refractory patients. Approaches such as the inhibition of the mammalian target of rapamycin pathway, inhibition of MEK1 and 2, as well as BRAF, are discussed. Further research is required to understand the biology of pediatric gliomas as well as the use of molecularly targeted agents, especially in patients with surgically unresectable tumors.


Induced aniseikonia diminishes binocular contrast sensitivity and binocular summation.
To study the effect on binocular contrast sensitivity and binocular summation of aniseikonia induced by size (afocal) lenses. In 18 young emmetropic observers, the monocular and binocular contrast sensitivity function was measured under normal conditions and after inducing different degrees of aniseikonia (2%, 3%, and 5% and for 6 observers, 8%) in the right eye. The spatial frequencies tested were 2.4, 3.7, 6.0, 9.2, 12, 15, 20, and 24 cpd. The results reveal a significant decline in binocular contrast sensitivity and binocular summation for 5% aniseikonia, this decline being more pronounced for intermediate and high spatial frequencies. These results, together with others on different binocular functions, show the importance of aniseikonia in binocular vision. On this basis, we recommend that aniseikonia be considered in surgical processes such as cataract and refractive surgery, whereby aniseikonia could be induced and binocular performance subsequently diminished.


Control of the bronchial tone.
The tone of airway smooth muscle is the functional expression of a dynamic equilibrium between various excitatory and inhibitory mechanisms. On the excitatory side, the vagal reflex mechanism, mainly activated by central airway irritant receptors, is the most important. Bronchial epithelium plays a pivotal role in the regulation of the responsiveness of these receptors. Cholinergic responses of the bronchial muscle are mediated by muscarinic (M2) receptors. On the inhibitory side, the main mechanism is the adrenergic one: beta 2-receptors are mainly stimulated by circulating adrenaline. A dense population of beta 2-receptors has recently been observed in bronchial epithelium. Nonadrenergic-noncholinergic mechanisms--both excitatory and inhibitory--participate in the regulation of bronchial motor tone, but their role in man is still to be defined. Nonsteroidal anti-inflammatory drugs do not modify bronchial motor tone; thus, in this respect, at least in physiological conditions, a modulatory function of the prostaglandin system can be excluded. Probably the same applies to leukotrienes, but for a definite answer, specific antagonists are needed.


Philanthropic endowments in general internal medicine.
We performed two surveys to uncover the status of philanthropic endowments in general internal medicine divisions. The initial survey of U.S. medical school departments of medicine found that only 14.1% of general internal medicine divisions hold endowments versus 21.9% of all other divisions, and that endowment sources for general medicine are atypical. The second survey of successfully endowed divisions found that sympathetic administrators and active pursuit of endowments were associated with endowment success. Aggressive pursuit of endowments, publicizing successes of general medicine, and consideration of endowment sources noted in this study are recommended to improve philanthropic contributions to general internal medicine.


Role of maternal corticosterone in the development and maturation of the aminoacidergic systems of the rat brain.
Previous studies have suggested an important role for maternal glucocorticoids in the development of the aminoacidergic systems of the rat brain. This study examines the effect of metyrapone (2-methyl-1,2-di-3-pyridyl-1-propanone), i.p.-administered to gestating mothers, on the maturation of the aminoacidergic systems of their offsprings' brains. gamma-Aminobutyric acid (GABA) and glutamate concentrations were determined in male and female offspring at postnatal days (PN) 23 and 90 in four brain areas: the hippocampus, hypothalamus, striatum and cortex. The activity of glutamic acid decarboxylase (GAD), the most important enzyme in the synthesis of GABA, was also analysed. The results show that a reduction in maternal corticosterone during gestation leads to a reduced GABAergic content in all brain areas studied at PN23; permanent organizational changes occurred in the cortex, striatum and hypothalamus. Maternal metyrapone treatment also affected the development of the glutamatergic systems, females being more affected than males at both PN23 and PN90 particularly in the hypothalamus and cortex. The metyrapone treatment produced no changes in GAD activity at PN23, but induced an important increase in this activity at PN90.


Influences of topical cyclopentolate on anterior chamber parameters with a dual-Scheimpflug analyzer in healthy children.
To evaluate the changes of anterior segment parameters following the topical instillation of cyclopentolate hydrochloride 1% with the Galilei dual-Scheimpflug analyzer (GSA) (Ziemer Ophthalmology Co., Port, Switzerland) in healthy children. Fifty children (29 boys, 21 girls) were evaluated before and 60 minutes after instillation of three drops of 1% cyclopentolate hydrochloride using the GSA. The measurements before and after cycloplegia, including anterior chamber depth (ACD), anterior chamber angle (ACA), anterior chamber volume (ACV), central corneal thickness (CCT), and pupil size, were evaluated using the paired t test. The mean age of the patients was 10.27 ± 3.32 years (range: 5 to 15 years). Measurements between the two sessions were significantly different for all parameters (P < .05), except for CCT (P > .05). The GSA demonstrated a statistically significant increase in ACD, ACV, ACA, and pupil size following the topical application of cyclopentolate hydrochloride 1%. These results should be considered during biometric measurement and refractive surgery planning.


Scheduled intermittent hospitalization for psychiatric patients.
The effect of scheduled intermittent hospitalization on the hospital utilization, community adjustment, and self-esteem of persons with serious and persistent mental illness was examined in an experimental study. Fifty-seven male veterans, aged 65 or younger, with a primary axis I psychiatric diagnosis who were frequent utilizers of inpatient care over the previous two years were randomly assigned to two groups. Patients in the experimental group were prescheduled for four hospital admissions, each lasting nine to 11 days, per year for two years. Patients in the control group had traditional access to hospital care. Psychiatric bed days, community adjustment, and self-esteem were assessed during and after the intervention. No differences between the groups on demographic or clinical variables were detected at study entry. The experimental group showed improvement in self-esteem, affect, and complaints of physical symptoms at one year. No statistically significant differences between groups were found in hospital utilization, financial management, substance abuse, or psychological well-being at one year. Scheduled intermittent hospitalization may be an appropriate and promising alternative to traditional care for revolving-door patients. This intervention could maintain patients at a higher level of wellness than traditional care and reduce the recurrence of the crises that precipitate hospitalization.


Replication and exploratory analysis of 24 candidate risk polymorphisms for neural tube defects.
Neural tube defects (NTDs), which are among the most common congenital malformations, are influenced by environmental and genetic factors. Low maternal folate is the strongest known contributing factor, making variants in genes in the folate metabolic pathway attractive candidates for NTD risk. Multiple studies have identified nominally significant allelic associations with NTDs. We tested whether associations detected in a large Irish cohort could be replicated in an independent population. Replication tests of 24 nominally significant NTD associations were performed in racially/ethnically matched populations. Family-based tests of fifteen nominally significant single nucleotide polymorphisms (SNPs) were repeated in a cohort of NTD trios (530 cases and their parents) from the United Kingdom, and case-control tests of nine nominally significant SNPs were repeated in a cohort (190 cases, 941 controls) from New York State (NYS). Secondary hypotheses involved evaluating the latter set of nine SNPs for NTD association using alternate case-control models and NTD groupings in white, African American and Hispanic cohorts from NYS. Of the 24 SNPs tested for replication, ADA rs452159 and MTR rs10925260 were significantly associated with isolated NTDs. Of the secondary tests performed, ARID1A rs11247593 was associated with NTDs in whites, and ALDH1A2 rs7169289 was associated with isolated NTDs in African Americans. We report a number of associations between SNP genotypes and neural tube defects. These associations were nominally significant before correction for multiple hypothesis testing. These corrections are highly conservative for association studies of untested hypotheses, and may be too conservative for replication studies. We therefore believe the true effect of these four nominally significant SNPs on NTD risk will be more definitively determined by further study in other populations, and eventual meta-analysis.


Multiscale analysis of information dynamics for linear multivariate processes.
In the study of complex physical and physiological systems represented by multivariate time series, an issue of great interest is the description of the system dynamics over a range of different temporal scales. While information-theoretic approaches to the multiscale analysis of complex dynamics are being increasingly used, the theoretical properties of the applied measures are poorly understood. This study introduces for the first time a framework for the analytical computation of information dynamics for linear multivariate stochastic processes explored at different time scales. After showing that the multiscale processing of a vector autoregressive (VAR) process introduces a moving average (MA) component, we describe how to represent the resulting VARMA process using statespace (SS) models and how to exploit the SS model parameters to compute analytical measures of information storage and information transfer for the original and rescaled processes. The framework is then used to quantify multiscale information dynamics for simulated unidirectionally and bidirectionally coupled VAR processes, showing that rescaling may lead to insightful patterns of information storage and transfer but also to potentially misleading behaviors.


An Embedded, Eight Channel, Noise Canceling, Wireless, Wearable sEMG Data Acquisition System With Adaptive Muscle Contraction Detection.
Wearable technology has gained increasing popularity in the applications of healthcare, sports science, and biomedical engineering in recent years. Because of its convenient nature, the wearable technology is particularly useful in the acquisition of the physiological signals. Specifically, the (surface electromyography) sEMG systems, which measure the muscle activation potentials, greatly benefit from this technology in both clinical and industrial applications. However, the current wearable sEMG systems have several drawbacks including inefficient noise cancellation, insufficient measurement quality, and difficult integration to customized applications. Additionally, none of these sEMG data acquisition systems can detect sEMG signals (i.e., contractions), which provides a valuable environment for further studies such as human machine interaction, gesture recognition, and fatigue tracking. To this end, we introduce an embedded, eight channel, noise canceling, wireless, wearable sEMG data acquisition system with adaptive muscle contraction detection. Our design consists of two stages, which are the sEMG sensors and the multichannel data acquisition unit. For the first stage, we propose a low cost, dry, and active sEMG sensor that captures the muscle activation potentials, a data acquisition unit that evaluates these captured multichannel sEMG signals and transmits them to a user interface. In the data acquisition unit, the sEMG signals are processed through embedded, adaptive methods in order to reject the power line noise and detect the muscle contractions. Through extensive experiments, we demonstrate that our sEMG sensor outperforms a widely used commercially available product and our data acquisition system achieves 4.583 dB SNR gain with accuracy in the detection of the contractions.


[Immunohistochemical study of Y hapten and carcinoembryonic antigen in rectal carcinoma].
The monoclonal antibodies C14 and C365 which define the Y hapten and specific carcinoembryonic antigen (CEA) were shown by ABC-immunohistochemical technique to stain positively the tissue sections in 48 of 56 cases (85.7%) of rectal carcinoma for Y hapten, in 51 cases (91%) for CEA, and 100% for both together. Cancer cells which expressed Y hapten were mainly distributed in the foreland and deep invading cancer tissue which showed high ability of malignant growth. Two patterns of localization on the cancer cells for Y hapten were found: local distribution in cytoplasmic Golgi region, similar to blood group antigens, and diffused distribution on the membrane and in the cytoplasm as CEA. Positive expression of Y hapten on the carcinoma associated with types of differentiation and Duke's pathology stages: highly expressed on the poorly differentiated cancer and in Duke's A and C stages (P less than 0.05). Phenotypes of Y hapten and CEA on metastatic cancer cells in lymph nodes and primary cancers were similar. Our findings indicate that the antibodies may be useful in immunodiagnosis and immunotherapy.