Ocular myasthenia: diagnosis, treatment, and pathogenesis.
Although myasthenia gravis (MG) is often considered the best-understood autoimmune disorder and effective treatments have controlled life-threatening complications, the pathogenesis of ocular myasthenia (OM) remains enigmatic, and its clinical consequences offer therapeutic challenges. About half of patients with MG present with visual complaints of droopy eyelids or double vision, and many will remain with purely ocular muscle weakness without generalized weakness, defined as OM. OM may be confused with disorders of the brainstem, ocular motor nerves, and eye muscles. Frustrating for the clinician, confirmatory tests such as the edrophonium test, serum acetylcholine receptor antibodies, and standard electrodiagnostic evaluations may fail to positively identify the clinical suspicion of OM. Patients may derive relief from nonpharmacologic interventions and cholinesterase inhibitors, but most will desire better symptom control with corticosteroids or need other immunosuppression. Early corticosteroid therapy may reduce the probability of generalization of the disease. The reasons for ocular muscle involvement by OM include physiologic and cellular properties of the ocular motor system and the unique immunology of OM, which, when better understood, will lead to novel treatments. OM is a challenging disorder for the clinician and scientist, with both learning from the other for the betterment of the patient. The future requires answers to why the ocular muscles are so frequently involved by MG, whether the generalization of the disease may be limited by early corticosteroid treatment, and what treatment options may be developed which will improve symptoms without long-term complications.


Metabolic outcomes of gastric bypass.
Gastric bypass surgery may be the most successful treatment for morbid obesity. However, postoperative patients are susceptible to deficiencies of several nutrients, including iron, vitamin B(12), and folate. Careful monitoring and supplementation are recommended to prevent negative outcomes of nutrient deficiencies. Metabolic benefits, on the other hand, include improvements in glycemic control and biochemical risk factors for cardiovascular disease. Pursuing surgery as an option for treating morbid obesity requires long-term dedication from the patient and the healthcare team.


Specific brainstem neurons switch each other into pacemaker mode to drive movement by activating NMDA receptors.
Rhythmic activity is central to brain function. In the vertebrate CNS, the neuronal circuits for breathing and locomotion involve inhibition and also neurons acting as pacemakers, but identifying the neurons responsible has proven difficult. By studying simple hatchling Xenopus laevis tadpoles, we have already identified a population of electrically coupled hindbrain neurons (dINs) that drive swimming. During rhythm generation, dINs release glutamate to excite each other and activate NMDA receptors (NMDARs). The resulting depolarization enables a network mechanism for swimming rhythm generation that depends on reciprocal inhibition between antagonistic right and left sides. Surprisingly, a surgically isolated hemi-CNS without inhibition can still generate swimming-like rhythms. We have now discovered that activation of NMDARs transforms dINs, which normally fire singly to current injection, into pacemakers firing within the normal swimming frequency range (10-25 Hz). When dIN firing is blocked pharmacologically, this NMDAR activation produces 10 Hz membrane potential oscillations that persist when electrical coupling is blocked but not when the voltage-dependent gating of NMDARs by Mg²+ is removed. The NMDA-induced oscillations and pacemaker firing at swimming frequency are unique to the dIN population and do not occur in other spinal neurons. We conclude that NMDAR-mediated self-resetting switches critical neurons that drive swimming into pacemaker mode only during locomotion where it provides an additional, parallel mechanism for rhythm generation. This allows rhythm generation in a half-CNS and raises the possibility that such concealed pacemaker properties may be present underlying rhythm generation in other vertebrate brain networks.


Parry-Romberg syndrome presenting with recurrent exotropia and torticollis.
Parry-Romberg syndrome, or progressive facial hemiatrophy, is a unilateral, slowly progressive atrophy that affects skin, subcutaneous tissues, muscles, and bones. The authors describe an 8-year-old girl with Parry-Romberg syndrome, amblyopia, recurrent exotropia, and torticollis, and stress that the association between this syndrome and amblyopia, recurrent exotropia, and torticollis should be recognized.


Salivary gland necrosis in dogs: a retrospective study of 19 cases.
Salivary gland necrosis has been described in dogs and is characterised by enlarged, hard, painful salivary glands, retching and vomiting or regurgitation. The cause has yet to be determined. A retrospective study of 19 dogs with the same clinical signs was undertaken for breed, age, gender, history and presenting signs, diagnostic evaluations and findings, treatment and outcome. An underlying association was identified in 16 of the 19 dogs. This included Spirocerca lupi infestation (seven dogs), megaoesophagus (three dogs) and oesophagitis, oesophageal diverticulum, giardiasis and suspected autoimmune sialadenitis. Almost all associated lesions involved the oesophagus. Where the associated disease was successfully treated, the salivary glands returned to normal and all clinical signs resolved. It is hypothesised that an afferent vagal reflex may be involved, and that the mechanism of disease is similar to the neural pathogenesis suggested for hypertrophic osteopathy; in this instance, the efferent targets are the salivary glands rather than the limbs.


Metabolic Disorders in HIV-Infected Adolescents Receiving Protease Inhibitors.
Protease inhibitor (PI) may cause abnormal glucose metabolism, abnormal lipid metabolism, and metabolic syndrome in HIV-infected adults but less well studied in Asian adolescents. This cross-sectional study evaluated anthropometric factors, oral glucose tolerance test, and lipid profiles of perinatally HIV-infected Thai adolescents who had received PI-based antiretroviral therapy for at least 6 months. Eighty adolescents were enrolled [median (IQR) age 16.7 (14.6-18.0) years, 42 males]. Metabolic syndrome, prediabetes, and type 2 diabetes mellitus (T2DM) were found in 8 (10%), 17 (22.1%), and 3 (3.8%) adolescents, respectively. Dyslipidemia was found in 56 (70%) adolescents, with hypertriglyceridemia being the most common type. In multivariate analysis, presence of lipohypertrophy (OR: 25.7, 95% CI: 3.2-202.8; p = 0.002) and longer duration of PI use (OR: 1.04, 95% CI: 1.00-1.08; p = 0.023) were associated with metabolic syndrome. Obesity (OR: 7.71, 95% CI: 1.36-43.7; p = 0.021), presence of lipohypertrophy (OR: 62.9, 95% CI: 4.97-795.6; p = 0.001), and exposure to stavudine for ≥6 months (OR: 8.18, 95% CI: 1.37-48.7; p = 0.021) were associated with prediabetes/T2DM, while exposure to tenofovir for ≥6 months reduced the risk (OR: 0.17, 95% CI: 0.04-0.78; p = 0.022). Metabolic disorders were commonly found in adolescents receiving PI. Careful monitoring and early intervention to modify cardiovascular risk should be systematically implemented in this population particularly those with exposure to stavudine.


Assessment for benign paroxysmal positional vertigo in medical patients admitted with falls in a district general hospital.
Having benign paroxysmal positional vertigo (BPPV) puts patients at a significantly higher risk of falling. It is poorly recognised and diagnosis is frequently delayed. BPPV has been studied in outpatient settings, but there have been no studies looking at the prevalence in patients admitted with falls. This study aims to establish how common BPPV is in these patients.For a 4-month period, patients admitted on an unselected medical take were screened for an admission precipitated by a fall. Patients who consented were assessed for BPPV using the Dix-Hallpike manoeuvre. Patients who tested positive were treated using the Epley manoeuvre. The assessments were carried out by specialist physiotherapists who were experienced at assessing and diagnosing patients with peripheral vestibular disorders. Out of the 111 patients initially identified, 37 (33%) were considered to be appropriate and consented to be part of the study. Of these, 20 patients (54%) had a positive Dix-Hallpike manoeuvre.Of the patients included in the study, over half tested positive for BPPV. This merits further study. Potentially, there is a proportion of patients admitted with falls who have an easily treatable contributing factor that is not being identified with standard practice.


Seacole award winners for 2014 announced.
SIX NURSES developing innovative projects to reduce health inequalities among black and minority ethnic (BME) communities have received grants at the 2014 Mary Seacole Leadership and Development Awards.


Ectopic hepatocellular carcinoma in the adrenal gland with inferior vena cava thrombosis and right atrial extension.
Intravascular tumor extension in the inferior vena cava (IVC) is known to occur with abdominal tumors, such as renal cell, hepatocellular, adrenal cell carcinoma, and Wilm's tumor. We encountered a 53-year-old male patient presenting with pulmonary embolism and a right atrial mass with imaging evidence of an adrenal tumor extending into the IVC, up to the right atrium. The patient underwent surgery for the resection of the tumor using cardiopulmonary bypass by a team of cardiothoracic surgeons and urologists. Histology identified the tumor as hepatocellular carcinoma, which developed as ectopic hepatic tissue in the right adrenal gland.


Meaning of Ki related to touch in caring.
In an attempt to identify the concept of Ki related to touch within the context of caring, and further, to provide specific information that may lead to culturally sensitive nursing intervention for the population who relate the concept of Ki to touch in a caring situation, a qualitative analysis was planned and carried out. Data was collected using interactive interviews with 19 health care professionals, 4 alternative therapists, 10 inpatients, and 13 healthy adults, and analyzed by the latent content analysis. Ki, the interactive energy flow, and touch, the activator of Ki flow, were postulated from six categories of perceived meanings of Ki related to touch.


Toward five-part differential of leukocytes based on electrical impedances of single cells and neural network.
The five-part differential of leukocytes plays key roles in the diagnosis of a variety of diseases and is realized by optical examinations of single cells, which is prone to various artifacts due to chemical treatments. The classification of leukocytes based on electrical impedances without cell treatments has not been demonstrated because of limitations in approaches of impedance acquisition and data processing. In this study, based on treatment-free single-cell impedance profiles collected from impedance flow cytometry leveraging constriction microchannels, two types of neural pattern recognition were conducted for comparisons with the purpose of realizing the five-part differential of leukocytes. In the first approach, 30 features from impedance profiles were defined manually and extracted automatically, and then a feedforward neural network was conducted, producing a classification accuracy of 84.9% in the five-part leukocyte differential. In the second approach, a customized recurrent neural network was developed to process impedance profiles directly and based on deep learning, a classification accuracy of 97.5% in the five-part leukocyte differential was reported. These results validated the feasibility of the five-part leukocyte differential based on label-free impedance profiles of single cells and thus provide a new perspective of differentiating white blood cells based on impedance flow cytometry.


[Preconception weight and perinatal health].
The health condition of a women relates closely to the health of her child and family members. The health of the mother is critical to her being able to conceive and give birth to healthy children and constructing a healthy lifestyle environment. Recent research has found a relationship between preconception weight and perinatal health. Abnormal weight (either overweight or underweight) was found to be the most prevalent of pre-pregnancy medical conditions studied. Therefore, the Center of Disease Control and Prevention in the United States has suggested that every woman should receive a preconception health assessment. Weight gain during pregnancy should be compared against preconception weight and body mass index. Following such a regimen can help improve maternal-infant perinatal health.


Effects of Spatial Expression of Activating Transcription Factor 4 on the Pathogenicity of Two Phenotypes of Bovine Viral Diarrhea Virus by Regulating the Endoplasmic Reticulum-Mediated Autophagy Process.
The endoplasmic reticulum (ER) stress response is a highly conserved stress-defense mechanism and activates the adaptive unfolded protein response (UPR) to mitigate imbalance. The ER stress-activated signaling pathways can also trigger autophagy to facilitate cellular repair. Bovine viral diarrhea virus (BVDV) utilizes the host cellular ER as the primary site of the life cycle. However, the interplay between cellular ER stress and BVDV replication remains unclear. This report reveals that cytopathic (cp) and noncytopathic (ncp) BVDV have distinct strategies to regulate UPR mechanisms and ER stress-mediated autophagy for their own benefit. Immunoblot analysis revealed that cp and ncp BVDV differentially regulated the abundance of ER chaperone GRP78 for viral replication, while the protein kinase RNA-like ER kinase (PERK)-eukaryotic translation initiation factor 2 subunit α (eIF2α)-activating transcription factor 4 (ATF4) pathway of the UPR was switched on at different stages of infection. Pretreatment with ER stress inducer promoted virion replication, but RNA interference (RNAi) knockdown of ATF4 in BVDV-infected cells significantly attenuated BVDV infectivity titers. More importantly, the effector ATF4 activated by cp BVDV infection translocated into the nucleus to mediate autophagy, but ATF4 was retained in the cytoplasm during ncp BVDV infection. In addition, we found that cp BVDV core protein was localized in the ER to induce ER stress-mediated autophagy. Overall, the potential therapeutic target ATF4 may contribute to the global eradication campaign of BVDV. IMPORTANCE The ER-tropic viruses hijack the host cellular ER as the replication platform of the life cycle, which can lead to strong ER stress. The UPR and related transcriptional cascades triggered by ER stress play a crucial role in viral replication and pathogenesis, but little is known about these underlying mechanisms. Here, we report that cytopathic and noncytopathic BVDV use different strategies to reprogram the cellular UPR and ER stress-mediated autophagy for their own advantage. The cytopathic BVDV unconventionally downregulated the expression level of GRP78, creating perfect conditions for self-replication via the UPR, and the noncytopathic BVDV retained ATF4 in the cytoplasm to provide an advantage for its persistent infection. Our findings provide new insights into exploring how BVDV and other ER-tropic viruses reprogram the UPR signaling pathway in the host cells for replication and reveal the attractive host target ATF4 for new antiviral agents.


Force transmission of one- and two-piece morse-taper oral implants: a nonlinear finite element analysis.
To compare force transmission behaviors of one-piece (1-P) and two-piece (2-P) morse-taper oral implants. A three-dimensional finite element model of a morse-taper oral implant and a solid abutment was constructed separately. The implant-abutment complex was embedded in a phi 1.5 cm x 1.5 cm acrylic resin cylinder. Vertical and oblique forces of 50 N and 100 N were applied on the abutment and solved by two different analyses. First, contact analysis was performed in the implant-abutment complex to evaluate a 2-P implant. Then, the components were bonded with a separation force of 10(20) N to analyze a 1-P implant. Von Mises stresses in the implant, principal stresses, and displacements in the resin were the same for both designs under vertical loading. Under oblique loading, principal stresses and displacement values in the resin were the same, but the magnitudes of Von Mises stresses were higher in the 2-P implant. The principal stress distributions around both implants in the acrylic bone were similar under both loading conditions. 2-P implants experience higher mechanical stress under oblique loading. Nevertheless, the 1-P- or 2-P morse-taper nature of an implant is not a decisive factor for the magnitude and distribution of stresses, and displacements in supporting tissues.


The evaluation of fetal interventricular septum with M-mode and spectral tissue Doppler imaging in gestational diabetes mellitus: a case-control study.
To demonstrate possible functional changes in the frequently affected fetal interventricular septum (IVS) with spectral tissue Doppler imaging (TDI) and M-mode imaging to compare gestational diabetes mellitus (GDM) and control groups. A total of 63 pregnant women with GDM, 30 on diet (A1 GDM) and 33 on treated with insulin (A2 GDM), and 63 healthy pregnant women randomly selected and matched to the case group in the control group were included. The GDM fetuses had significantly thickened IVS, increased early diastole (E'), atrial contraction (A'), systole (S'), higher myocardial performance index (MPI'), prolonged isovolumetric relaxation time (IVRT'), shortened ejection time (ET'), and decreased septal annular plane systolic excursion (SAPSE) than the controls. The A2 GDM group fetuses had significantly thickened IVS, increased S' and shortened ET' than the A1 GDM group. In the GDM group, we found a significantly positive low correlation between glycated hemoglobin levels and maternal serum fasting glucose and one-hour postprandial glucose with fetal IVS thickness. We demonstrated a significantly negative low correlation between maternal serum one-hour postprandial glucose, glycated hemoglobin levels, and gestational weight gain with fetal IVS ET'. Fetal IVS diastolic and systolic functions were altered in the GDM group compared to controls, and systolic functions were altered in A2 GDM compared to A1 GDM. This may alert clinicians to possible cardiovascular diseases in the postnatal life, and early preventive strategies and long-term lifestyle changes may provide protection in fetuses with GDM.


Genetic risk score constructed using 14 susceptibility alleles for type 2 diabetes is associated with the early onset of diabetes and may predict the future requirement of insulin injections among Japanese individuals.
We evaluated the clinical usefulness of a genetic risk score (GRS) based on 14 well-established variants for type 2 diabetes. We analyzed 14 SNPs at HHEX, CDKAL1, CDKN2B, SLC30A8, KCNJ11, IGF2BP2, PPARG, TCF7L2, FTO, KCNQ1, IRS-1, GCKR, UBE2E2, and C2CD4A/B in 1,487 Japanese individuals (724 patients with type 2 diabetes and 763 control subjects). A GRS was calculated according to the number of risk alleles by counting all 14 SNPs (T-GRS) as well as 11 SNPs related to β-cell function (β-GRS) and then assessing the association between each GRS and the clinical features. Among the 14 SNPs, 4 SNPs were significantly associated with type 2 diabetes in the present Japanese sample (P < 0.0036). The T-GRS was significantly associated with type 2 diabetes (P = 5.9 × 10(-21)). Among the subjects with type 2 diabetes, the β-GRS was associated with individuals receiving insulin therapy (β = 0.0131, SE = 0.006, P = 0.0431), age at diagnosis (β = -0.608, SE = 0.204, P = 0.0029), fasting serum C-peptide level (β = -0.032, SE = 0.0140, P = 0.022), and C-peptide index (β = -0.031, SE = 0.012, P = 0.0125). Our data suggest that the β-GRS is associated with reduced β-cell functions and may be useful for selecting patients who should receive more aggressive β-cell-preserving therapy.


Deferiprone and Gallium-Protoporphyrin Have the Capacity to Potentiate the Activity of Antibiotics in Staphylococcus aureus Small Colony Variants.
Small colony variants (SCVs) of bacteria like Staphylococcus aureus are characterized by a reduced colony size and are linked to increased antibiotic tolerance and resistance. Their altered expression of virulence factors, slow growing properties and their ability to form biofilms make the eradication of SCVs challenging. In the context of biofilm-related infectious diseases involving S. aureus SCVs, a therapy targeting bacterial iron metabolism was evaluated. The combination of the iron-chelator deferiprone (Def) and the heme-analog gallium-protoporphyrin (GaPP), in solution and incorporated in a surgical wound gel, was tested for activity against planktonic and sessile SCVs. To this end, the activity of Def-GaPP was assessed against planktonic S. aureus SCVs, as well as against in vitro and in vivo biofilms in the colony biofilm model, an artificial wound model and a Caenorhabditis elegans infection model. While Def alone failed to show substantial antibacterial activity, GaPP and the combination of Def-GaPP demonstrated concentration- and strain-dependent antibacterial properties. Specifically, the Def-GaPP combination significantly reduced the bacterial load in an artificial wound model and increased the survival of S. aureus SCV infected C. elegans. When Def-GaPP were combined with gentamicin or ciprofloxacin, the triple combinations exceeded the antibiofilm activity of the individual compounds in the colony biofilm model. In targeting bacterial iron metabolism, Def-GaPP showed significant activity against planktonic and sessile SCVs. Moreover, Def-GaPP could potentiate the activity of gentamicin and ciprofloxacin. Delivered in a wound healing gel, Def-GaPP showed promise as a new topical strategy against infections with S. aureus SCVs.


Effects of high-dose ketoconazole and dexamethasone on ACTH-stimulated adrenal steroidogenesis in orchiectomized prostatic cancer patients.
The effects of high-dose ketoconazole (i.e. 400 mg every 8 h) therapy on adrenal steroidogenesis were investigated in 7 patients with advanced prostatic cancer who no longer responded to orchiectomy. An ACTH challenge was performed before and on days 14 and 28 of high-dose ketoconazole treatment. During the last 14 days, dexamethasone (0.5 mg twice daily) was administered together with ketoconazole. High-dose ketoconazole alone lowered the basal levels of the androgens by 49-66%. It almost completely inhibited their stimulation by ACTH, whereas plasma progesterone was doubled. Basal cortisol was only slightly lowered, but the response to ACTH stimulation was markedly blunted. Basal and stimulated plasma aldosterone remained unaffected. Both basal and stimulated 11-deoxycortisol, 11-deoxycorticosterone, and, to a lesser extent, corticosterone rose more markedly after ketoconazole than after placebo. The basal and stimulated plasma adrenal androgen levels were further reduced after combined ketoconazole-dexamethasone treatment, whereas plasma corticosterone, 11-deoxycortisol, and 11-deoxycorticosterone were lowered in the same way as cortisol. Aldosterone and progesterone profiles were similar to those observed under high-dose ketoconazole, but plasma 17 alpha-hydroxyprogesterone increased more markedly than after high-dose ketoconazole alone. These results demonstrate that high-dose ketoconazole lowers plasma androgen levels in orchiectomized patients and partly inhibits the gluco- and mineralocorticoid syntheses, especially after ACTH-stimulation. The addition of dexamethasone does not only correct the possible consequence of the impairment of the cortisol production by high-dose ketoconazole, but it further reduces the androgen levels and lowers the plasma concentrations of most precursors, for instance 11-deoxycorticosterone, which has some physiological mineralocorticoid activity.(ABSTRACT TRUNCATED AT 250 WORDS)


MECHANISM OF ACTION OF STAPHYLOCOCCAL ALPHA-HEMOLYSIN. I. SOME FACTORS INFLUENCING THE MEASUREMENT OF ALPHA-HEMOLYSIN.
Marucci, Americo A. (Upstate Medical Center, Syracuse, N.Y.). Mechanism of action of staphylococcal alpha-hemolysin. I. Some factors influencing the measurement of alpha-hemolysin. J. Bacteriol. 86:1182-1188. 1963.-A kinetic method for the accurate and reproducible measurement of the action of staphylococcal alpha-hemolysin on rabbit erythrocytes is described. The activity of the alpha-hemolysin depends upon the temperature used for measurement. At 37 C the hemolysin lyses cells faster, but it in turn is rather quickly inactivated. At 0 C there is no inactivation, but the rate of lysis is greatly decreased. There is no change in the activity with change in total reaction volume, providing that the concentrations of cells and hemolysin are kept constant. The fraction of rabbit red cells lysed by a given amount of hemolysin in a given time is constant and independent of the total number of cells in the reaction mixture.


VMF3o: the Vienna Mapping Functions for optical frequencies.
The troposphere is considered as one of the major error sources in space geodetic techniques. Thus, accurate troposphere delay models are essential to provide high-quality products, such as reference frames, satellite orbits, or Earth rotation parameters. In this paper, a new troposphere delay model for satellite laser ranging, the Vienna Mapping Functions 3 for optical frequencies (VMF3o), is introduced. The model parameters are derived from ray-traced delays generated by an in-house ray-tracing software. VMF3o comprises not only zenith delays and mapping functions, but also linear horizontal gradients, which are not part of the standard SLR analysis yet. The model parameters are dedicated to a signal wavelength of 532 nm. Since some SLR stations operate also with other wavelengths, VMF3o provides a correction formula to transform the model parameters to any requested wavelength between 350 and 1064 nm. A test demonstrates that the correction formula approximates slant delays calculated at different wavelengths very accurately. The remaining error for slant delays at a wavelength of 1064 nm adds up to only a few millimetres at 10 ∘ elevation angle. A comparison study of the modelled delays that are derived from VMF3o and ray-traced delays was carried out to examine the quality of the model approach. The remaining differences of modelled and ray-traced delays are expressed as mean absolute error. At 5 ∘ elevation angle, the mean absolute error is only a few millimetres. At 10 ∘ elevation angle, it is at the 1 mm level. The results of the comparison also reveal that introducing linear horizontal gradients reduces the mean absolute error by more than 80% for low elevation angles.


Ultraviolet radiation exposure, vitamin D, and cancer.
This paper reviews briefly the evidence for an association between various measures of UV radiation (UVR) exposure and the development of cancer. Issues such as data quality, study design, measurement variation, comparability of studies, and quantification of UV exposure in relation to skin cancer are discussed. A range of exposure, based on skin type, might be appropriate: from 5 min a day three times a week for light-skinned individuals and 10 min a day three times a week for darker-skinned individuals. These exposures translate into 13 h per year, for a light-skinned individual, leading to 650 h of exposure from birth to age 50.


Acute ethanol intoxication after consumption of hairspray.
A 61-year-old woman with a history of alcohol dependence came to the emergency department with ethanol intoxication. Her serum ethanol concentration was 322 mg/dl. When questioned, she admitted to consuming a 14-oz bottle of hairspray mixed with water because of its denatured alcohol content. The woman had used nonbeverage sources of alcohol on a regular basis for a number of years after learning of the practice from fellow attendees of Alcoholics Anonymous meetings. Her primary reason for this behavior was to hide her continued alcohol abuse from her family. She consumed hairspray that contained 50% denatured alcohol by volume; the amount she ingested was equal to 7 fluid oz of ethanol, the equivalent of 14 1.25-oz shots of 80-proof liquor. Her serum ethanol concentration was consistent with that predicted by pharmacokinetic equations based on the consumption of one bottle of hairspray. The hairspray product contained specially denatured alcohol 40-B, which consists of ethanol and small quantities of t-butyl alcohol and denatonium benzoate. Ethanol is the substance of primary toxicologic concern. Clinicians need to be aware that numerous nonbeverage sources of alcohol exist and should be considered when a patient presents with acute intoxication. The source and its components should be identified as soon as possible in order to assess other potential toxicities.


Benchmarking of copper(II) LFMM parameters for studying amyloid-β peptides.
Ligand field molecular mechanics (LFMM) parameters have been benchmarked for copper (II) bound to the amyloid-β1-16 peptide fragment. Several density functional theory (DFT) optimised small test models, representative of different possible copper coordination modes, have been used to test the accuracy of the LFMM copper bond lengths and angles, resulting in errors typically less than 0.1 Å and 5°. Ligand field molecular dynamics (LFMD) simulations have been carried out on the copper bound amyloid-β1-16 peptide and snapshots extracted from the subsequent trajectory. Snapshots have been optimised using DFT and the semi-empirical PM7 method resulting in good agreement against the LFMM calculated geometry. Analysis of substructures within snapshots shows that the larger contribution of geometrical difference, as measured by RMSD, lies within the peptide backbone, arising from differences in DFT and AMBER, and the copper coordination sphere is reproduced well by LFMM. PM7 performs excellently against LFMM with an average RMSD of 0.2 Å over 21 tested snapshots. Further analysis of the LFMD trajectory shows that copper bond lengths and angles have only small deviations from average values, with the exception of a carbonyl moiety from the N-terminus, which can act as a weakly bound fifth ligand.


[Laboratory procedures in adenoviruses. II. Sensitivity of various cell cultures as determined by endpoint titration (author's transl)].
The sensitivity of human embryonic kidney (HEK), human amnion (HAm) and HeLa cells for human adenoviruses was investigated by means of endpoint titrations of 13 prototype strains and numerous original specimens from patients. Prototypes and original specimens showed the same behavior. Adenoviruses of subgrouppp III produced nearly identical titers in all 3 cell cultures, while for subgroup I HAm cells showed a 10- to 100-fold lower titer. On the other hand, HAm cells are nearly as sensitive as HEK cells for type 8, whereas HeLa cells are less sensitive. For other viruses of subgroup II and for subgrou IV, HAm (for type 12 also HeLa) cells are less sensitive than HEK cells. Out of three HeLa cell strains tested the Bristol strain was inferior to the other two in its sensitivity. Concerning the speed of the CPE development, HEK cells are superior for all types, the difference being greatest for subgroup I towards HAm and HeLa and for type 8 towards HeLa cells. The length of incubation necessary for the appearance of CPE even with minimal amounts of virus is 40 days for type 8 in all kinds of cell cultures, whereas for adenoviruses of sub-groups I and III, which are predominantly isolated in the routine laboratory, 25 days for HEK and 30 days for HAm and HeLa cells may suffice in most cases. When endpoint titrations are compared with titers obtained by immunofluorescence, it appears that this technique may be applied as a screening method; thus long incubation periods of negative specimens can be saved. The amounts of infectious virus present in original specimens are reported; the highest quantity was found in specimens containing subgroup I viruses.


The addition of glutamic acid or protein to a threonine-deficient diet differentially affects growth performance and threonine dehydrogenase activity in fattening pigs.
The effects of dietary levels of threonine, protein (essential and nonessential amino acids) and glutamic acid (nonessential amino acid) on growth, food intake and threonine metabolism were studied in 54 fattening female pigs (Piétrain x Large White) from 40 to 100 kg live weight. Six experimental diets were compared using a 2 x 3 factorial design: two levels of threonine (0.42 and 0.52 g/100 g) corresponding to a limited and an adequate supply for growth, and three types of nitrogen supply: a basal diet supplying 12.6 g crude protein/100 g, a second diet providing additional protein to give a total supply of 15.6 g crude protein/100 g, and a third diet providing nonessential nitrogen in the form of L-glutamic acid to give the same total supply of 15.6 g crude protein/100 g diet. Protein addition to the basal diets did not modify growth performance but increased L-threonine-3-dehydrogenase (TDG) activity when pigs were fed the higher threonine diet. The addition of L-glutamic acid to the threonine-deficient diet improved growth performance, but there was no effect at the higher level of threonine. Glutamic acid increased TDG activity in pigs fed the low threonine diet. We conclude that glutamic acid may have a sparing effect on threonine when threonine is rate-limiting for protein deposition, but the mechanism of the interaction between the two amino acids remains unknown.


Skin injury prevalence and incidence in China: a multicentre investigation.
To quantify the prevalence and incidence of different skin injuries, pressure ulcers (PU), skin tears (ST) and incontinence-associated dermatitis (IAD) in China, and to identify their causes to aid prevention and control. A cross-sectional observational study was conducted across nine tertiary hospitals. Registered nurses were trained on a standard approach to injury assessment and examination. The study was carried out at the same time on the same day across the participating centres. Participating patients were examined for PU, ST or IAD. A total of 13,176 inpatients were assessed and 233 PU were identified, of which 126 occurred in hospitals, 99 cases at home and eight cases within community hospitals. In addition, there were 141 skin tears and 97 IADs. This study involved the largest number of hospitals, to date (in China). Therefore, the prevalence and rate of incidence of skin injury obtained in this study may represent a regional baseline in China.


The value of epithelial membrane antigen in the diagnosis of ovarian tumors.
The value of epithelial membrane antigen (EMA) in the diagnosis of ovarian tumors was investigated using an indirect immunoperoxidase staining technique on 91 histologic sections (88 tumors and 3 normal tissues) and 39 ascitic fluid smears (28 from patients with epithelial ovarian tumors and 11 from cases of myoma uteri). The rate of positive EMA staining was highest in malignant tumors (89.2%), second highest in tumors of low malignant potential (33.3%) and lowest in benign tumors (25.0%); normal ovarian tissues were negative for EMA. Of the malignant tumors, all 48 serous cystadenocarcinomas (100%) and 18 of 26 mucinous cystadenocarcinomas (69.2%) stained positively for EMA. In serous cystadenocarcinomas, the EMA staining was mainly localized on the luminal membrane of cells in well-differentiated tumors, but appeared on the entire cell surface and cytoplasm of cells in poorly differentiated tumors. The results of EMA staining on ascitic fluid smears were almost the same as the results for the histologic sections. The intensity and the localization of EMA staining were related to the grade of malignancy in these ovarian tumors. In comparison with staining for other antigens (carcinoembryonic antigen, CA-125 and human keratin protein), EMA was found to be one of the most sensitive markers for the diagnosis of ovarian cancer.


Reconstitution, activities, and structure of the eukaryotic RNA exosome.
The RNA exosome is a multisubunit 3' to 5' exoribonuclease complex that participates in degradation and processing of cellular RNA. To determine the activities and structure of the eukaryotic exosome, we report the reconstitution of 9-subunit exosomes from yeast and human and reconstitution of 10- and 11-subunit exosomes from yeast. Comparative biochemical analysis between purified subunits and reconstituted exosomes using AU-rich, polyadenylated (poly[A]), generic, and structured RNA substrates reveals processive phosphorolytic activities for human Rrp41/Rrp45 and the 9-subunit human exosome, processive hydrolytic activities for yeast Rrp44 and the yeast 10-subunit exosome, distributive hydrolytic activities for Rrp6, and processive and distributive hydrolytic activities for the yeast 11-subunit exosome. To elucidate the architecture of a eukaryotic exosome, its conserved surfaces, and the structural basis for RNA decay, we report the X-ray structure determination for the 286 kDa nine-subunit human exosome at 3.35 A.


Neuraminidase production by Candida albicans.
A Candida albicans strain G42, isolated from a vaginal infection, was demonstrated to produce neuraminidase in culture filtrates with activity for N-acyl-neuraminic acid glycoprotein from bovine submaxillary gland, and human erythrocytes as substrates. Incubation of viable cells from G42 with human group O Rh(+) erythrocytes released N-acetyl-neuraminic acid in a time-dependent manner. Thirty-two clinical isolates of C albicans were studied for neuraminidase production. Enzyme activity was found in culture filtrates from five strains.It would appear important from these data to determine whether the production of neuraminidase by C albicans can be correlated with pathogenicity.


Calcium-dependent effect of gentamicin on glucose formation in isolated rabbit kidney-cortex tubules.
In contrast to the inhibition by gentamicin of glucose production from propionate, pyruvate and lactate in renal tubules incubated at 2.5 mM Ca2+, this antibiotic does not affect gluconeogenesis from propionate and lactate, and significantly stimulates this process from other substrates at 0.5 mM Ca2+. This may be due to the gentamicin-induced increase of the cytosolic manganese content (from 1.7 to 2.7 nmol/mg protein), resulting in a stimulation of cytosolic phosphoenolpyruvate carboxykinase activity. At 2.5 mM Ca2+ the cytosolic Mn content (2.7 nmol/mg protein) seems to be high enough to accomplish activation of the enzyme.


Impact of ionic and nanoparticle speciation states of silver on light harnessing photosynthetic events in Spirodela polyrhiza.
Owing to wide range of applications, nanotechnology is growing expeditiously. Likely negative impact of nanoparticles (NPs), which are inevitably released into our surroundings, on living organisms is of growing concern. Findings presented here are outcome of investigations carried out to evaluate the impact of ionic and NP speciation states of silver on light harnessing photosynthetic events in Spirodela polyrhiza fronds. Fronds exposed to ionic speciation state showed significant decline in PS (photosystem) II efficiency (Fv/Fm; variable fluorescence/maximal fluorescence), while those exposed to silver nanoparticles (Ag-NPs) showed marginal decline. Accordingly, decline in amplitude of Chl a fluorescence transients was sharper in fronds treated with Ag+ than those treated with Ag-NPs. Of the various phases Chl a fluorescence transient, J-I phase [which reflects reduction of plastoquinone (PQ) pool] was most sensitive to both Ag+ and Ag-NPs. Phenomenological yield models, built using Biolyzer software, revealed that fronds exposed to Ag+ possessed significantly lower potential to trap and harness absorbed light energy for photochemical reactions than those exposed to Ag-NPs. Accordingly, dissipation of absorbed light energy as heat was significantly higher in fronds exposed to Ag+ than those exposed to Ag-NPs. These findings revealed that NP speciation state of silver is significantly less toxic to light harnessing photosynthetic machinery of S. polyrhiza, compared to ionic speciation state.


Structure Characterization and Properties of K-Containing Copper Hexacyanoferrate.
Copper hexacyanoferrate, Cu(II)[Fe(III)(CN)6]2/3·nH2O, was synthesized, and varied amounts of K(+) ions were inserted via reduction by K2S2O3 (aq). Ideally, the reaction can be written as Cu(II)[Fe(III)(CN)6]2/3·nH2O + 2x/3K(+) + 2x/3e(-) ↔ K2x/3Cu(II)[Fe(II)xFe(III)1-x(CN)6]2/3·nH2O. Infrared, Raman, and Mössbauer spectroscopy studies show that Fe(III) is continuously reduced to Fe(II) with increasing x, accompanied by a decrease of the a-axis of the cubic Fm3̅m unit cell. Elemental analysis of K by inductively coupled plasma shows that the insertion only begins when a significant fraction, ∼20% of the Fe(III), has already been reduced. Thermogravimetric analysis shows a fast exchange of water with ambient atmosphere and a total weight loss of ∼26 wt % upon heating to 180 °C, above which the structure starts to decompose. The crystal structures of Cu(II)[Fe(III)(CN)6]2/3·nH2O and K2/3Cu[Fe(CN)6]2/3·nH2O were refined using synchrotron X-ray powder diffraction data. In both, one-third of the Fe(CN)6 groups are vacant, and the octahedron around Cu(II) is completed by water molecules. In the two structures, difference Fourier maps reveal three additional zeolitic water sites (8c, 32f, and 48g) in the center of the cavities formed by the -Cu-N-C-Fe- framework. The K-containing compound shows an increased electron density at two of these sites (32f and 48g), indicating them to be the preferred positions for the K(+) ions.


A technique for sequential segmental neuromuscular stimulation with closed loop feedback control.
In dynamic myoplasty, dysfunctional muscle is assisted or replaced with skeletal muscle from a donor site. Electrical stimulation is commonly used to train and animate the skeletal muscle to perform its new task. Due to simultaneous tetanic contractions of the entire myoplasty, muscles are deprived of perfusion and fatigue rapidly, causing long-term problems such as excessive scarring and muscle ischemia. Sequential stimulation contracts part of the muscle while other parts rest, thus significantly improving blood perfusion. However, the muscle still fatigues. In this article, we report a test of the feasibility of using closed-loop control to economize the contractions of the sequentially stimulated myoplasty. A simple stimulation algorithm was developed and tested on a sequentially stimulated neo-sphincter designed from a canine gracilis muscle. Pressure generated in the lumen of the myoplasty neo-sphincter was used as feedback to regulate the stimulation signal via three control parameters, thereby optimizing the performance of the myoplasty. Additionally, we investigated and compared the efficiency of amplitude and frequency modulation techniques. Closed-loop feedback enabled us to maintain target pressures within 10% deviation using amplitude modulation and optimized control parameters (correction frequency = 4 Hz, correction threshold = 4%, and transition time = 0.3 s). The large-scale stimulation/feedback setup was unfit for chronic experimentation, but can be used as a blueprint for a small-scale version to unveil the theoretical benefits of closed-loop control in chronic experimentation.


Namibia's path toward malaria elimination: a case study of malaria strategies and costs along the northern border.
Low malaria transmission in Namibia suggests that elimination is possible, but the risk of imported malaria from Angola remains a challenge. This case study reviews the early transition of a program shift from malaria control to elimination in three northern regions of Namibia that comprise the Trans-Kunene Malaria Initiative (TKMI): Kunene, Omusati, and Ohangwena. Thirty-four key informant interviews were conducted and epidemiological and intervention data were assembled for 1995 to 2013. Malaria expenditure records were collected for each region for 2009, 2010, and 2011, representing the start of the transition from control to elimination. Interviews and expenditure data were analyzed across activity and expenditure type. Incidence has declined in all regions since 2004; cases are concentrated in the border zone. Expenditures in the three study regions have declined, from an average of $6.10 per person at risk per year in 2009 to an average of $3.61 in 2011. The proportion of spending allocated for diagnosis and treatment declined while that for vector control increased. Indoor residual spraying is the main intervention, but coverage varies, related to acceptability, mobility, accessibility, insecticide stockouts and staff shortages. Bed net distribution was scaled up beginning in 2005, assisted by NGO partners in later years, but coverage was highly variable. Distribution of rapid diagnostic tests in 2005 resulted in more accurate diagnosis and can help explain the large decline in cases beginning in 2006; however, challenges in personnel training and supervision remained during the expenditure study period of 2009 to 2011. In addition to allocating sufficient human resources to vector control activities, developing a greater emphasis on surveillance will be central to the ongoing program shift from control to elimination, particularly in light of the malaria importation challenges experienced in the northern border regions. While overall program resources may continue on a downward trajectory, the program will be well positioned to actively eliminate the remaining foci of malaria if greater resources are allocated toward surveillance efforts.


[Dynamic Material Flow Analysis of Perfluorooctane Sulfonate in China: 1985-2019].
Perfluorooctane sulfonates (PFOS) are regarded as a category of chemicals with persistence, bioaccumulation, and toxicity. Understanding dynamic flows, stocks, and emissions of PFOS on a macro spatial and temporal scale can help provide a scientific basis for their sound management. In this work, a dynamic material flow analysis (d-MFA) model was built to characterize and analyze the cycles of PFOS in mainland China over the period 1985-2019. Flows, stocks, and environmental emissions were calculated and the sensitivity and uncertainty of the results were then analyzed. Results show that domestic production was the primary source of PFOS in China, most of which was flowed to the domestic market in the form of final products, with the remainder exported to international markets; soil and water were the main sinks of PFOS in China, with emissions from the usage stage contributing the largest portion (103 tons in 2019). The number of inflows and outflows were relatively low before 2000, but gradually increased until 2009 when the relevant convention was issued. Since 2005, in-use stocks and emissions of PFOS have grown yearly. In addition, stocks in landfill have been climbing since 1985. End-of-life management was still dominated by traditional methods, such as landfill and incineration, while there was a trend towards green treatments. This study can provide basic data and theoretical support for the sound management of PFOS in China.


Intra-observer reliability and agreement of manual and digital orthodontic model analysis.
Digital orthodontic model analysis is gaining acceptance in orthodontics, but its reliability is dependent on the digitalisation hardware and software used. We thus investigated intra-observer reliability and agreement / conformity of a particular digital model analysis work-flow in relation to traditional manual plaster model analysis. Forty-eight plaster casts of the upper/lower dentition were collected. Virtual models were obtained with orthoX®scan (Dentaurum) and analysed with ivoris®analyze3D (Computer konkret). Manual model analyses were done with a dial caliper (0.1 mm). Common parameters were measured on each plaster cast and its virtual counterpart five times each by an experienced observer. We assessed intra-observer reliability within method (ICC), agreement/conformity between methods (Bland-Altman analyses and Lin's concordance correlation), and changing bias (regression analyses). Intra-observer reliability was substantial within each method (ICC ≥ 0.7), except for five manual outcomes (12.8 per cent). Bias between methods was statistically significant, but less than 0.5 mm for 87.2 per cent of the outcomes. In general, larger tooth sizes were measured digitally. Total difference maxilla and mandible had wide limits of agreement (-3.25/6.15 and -2.31/4.57 mm), but bias between methods was mostly smaller than intra-observer variation within each method with substantial conformity of manual and digital measurements in general. No changing bias was detected. Although both work-flows were reliable, the investigated digital work-flow proved to be more reliable and yielded on average larger tooth sizes. Averaged differences between methods were within 0.5 mm for directly measured outcomes but wide ranges are expected for some computed space parameters due to cumulative error.


Bizarre Parosteal Osteochondromatous Proliferation (Nora's Lesion) of the Hand: A Report of Two Atypical Cases.
Bizarre parosteal osteochondromatous proliferation (BPOP), also called Nora's lesion, is an unusual, benign, bony lesion frequently found in the hand. Originally, two of the key radiological features used to describe such lesions were: (1) a lack of corticomedullar continuity and (2) an origin from the periosteal aspect of an intact cortex. The authors present 2 unique cases of histologically proven BPOP in which the integrity of the cortex was affected. In the first case there was medullary continuity, and in the second case there was saucerization of the underlying cortical bone. The authors support that simple X-ray evaluation is insufficient to diagnose BPOP in atypical cases. Careful axial CT scanning or MRI may prove helpful. Taking into account these new notions, histopathology gains greater importance as a diagnostic tool for this particular group of entities.


An ecological approach to breastfeeding.
Current numbers of breast-feeding mothers are well below Healthy People 2010 goals of 75% in the early postpartum period, 50% at 6 months, and 25% at 1 year. A promising line of research is the use of an ecological model for breastfeeding that includes factors traditionally examined in breastfeeding (mother/infant and family) as well as mesosystem and exosystem sources of influence on families (healthcare delivery system, community, and societal/cultural). A telephone survey was conducted with 95 primiparous, postpartum women using closed and open-ended items. Content analysis was used with the transcribed comments from these telephone interviews, to test the fit of a preexisting ecological model for breastfeeding. The comments of postpartum women provided a rich source of information about the many mother-infant, family, healthcare delivery system, community, and societal/cultural factors that influence breastfeeding. These all fit the ecological breast-feeding model proposed. Efforts to improve rates of breastfeeding in this country to meet year 2010 goals must consider the many contextual factors that influence feeding. Interventions to promote breastfeeding should exceed the individual level, and occur at many layers simultaneously. The ecological model provides direction for the multiple interventions needed to increase rates and duration of breastfeeding.


Experimentally induced diabetes causes glial activation, glutamate toxicity and cellular damage leading to changes in motor function.
Behavioral impairments are the most empirical consequence of diabetes mellitus documented in both humans and animal models, but the underlying causes are still poorly understood. As the cerebellum plays a major role in coordination and execution of the motor functions, we investigated the possible involvement of glial activation, cellular degeneration and glutamate transportation in the cerebellum of rats, rendered diabetic by a single injection of streptozotocin (STZ; 45 mg/kg body weight; intraperitoneally). Motor function alterations were studied using Rotarod test (motor coordination) and grip strength (muscle activity) at 2nd, 4th, 6th, 8th, 10th, and 12th week post-diabetic confirmation. Scenario of glial (astroglia and microglia) activation, cell death and glutamate transportation was gaged using immunohistochemistry, histological study and image analysis. Cellular degeneration was clearly demarcated in the diabetic cerebellum. Glial cells were showing sequential and marked activation following diabetes in terms of both morphology and cell number. Bergmann glial cells were hypertrophied and distorted. Active caspase-3 positive apoptotic cells were profoundly present in all three cerebellar layers. Reduced co-labeling of GLT-1 and GFAP revealed the altered glutamate transportation in cerebellum following diabetes. These results, exclusively derived from histology, immunohistochemistry and cellular quantification, provide first insight over the associative reciprocity between the glial activation, cellular degeneration and reduced glutamate transportation, which presumably lead to the behavioral alterations following STZ-induced diabetes.


HIV-1 superinfection and viral diversity.
Sequential acquisition of viral variants, or HIV-1 superinfection, has been proposed to explain the high fractions of recombinant viruses observed in some geographical regions, but only a few cases of superinfection in humans have been reported. Animal models suggest that susceptibility to superinfection may be restricted to a short period of time after initial infection, possibly due to maturation of broad antiviral immune responses. A mathematical model involving a system of differential equations was developed to identify transmission and superinfection patterns that would lead to the observed global patterns of viral diversity. Requirements for a high prevalence of infections involving recombinant viruses include high viral infectivity, the presence of highly sexually active core groups, and introduction of divergent viruses early in the epidemic spread of HIV-1. Restricted superinfection could explain the persistent predominance of single virus subtypes in regions with well-established HIV-1 epidemics. The rate of recombination within individuals was not strongly related to recombinant fractions in populations. HIV-1 superinfection restricted to early HIV-1 infection could account for the high fraction of recombinant virus infections observed in populations. The relationship between recombination in cellular infections and recombinant fractions in populations is complex and depends on epidemiological factors and biological factors that can be modeled.


[Assay of erythropoietin in serum with short term enzyme linked immunosorbent assay method--the clinical significance: Part 2--:Relation to serum iron, UIBC and ferritin in renal failure and hematological disorders].
With a newly developed short term enzyme linked immunosorbent assay kit (TOYOBO Co.), in which 2 kinds of anti-EPO monoclonal antibodies were used, we assayed EPO concentration in sera from patients with renal failure and hematological disorders. In this report, the EPO data were analysed in relation to serum iron concentrations, with ferritin and UIBC. In the patients with renal failure, there was no significant correlation between EPO concentration and serum iron, ferritin, nor UIBC concentration. On the other hand, in the patients with hematological disorders, there were two types. One was in patients with iron deficiency anemia, whose serum EPO was negatively correlated to serum iron (r = -0.64) and ferritin (r = -0.59), but positively related to UIBC (r = 0.27). The another was the pattern in patients with aplastic anemia, leukemia and MDS, whose serum EPO positively correlated to iron and ferritin but negatively correlated to UIBC. In the patients with aplastic anemia serum EPO had good correlation to serum iron (r = 0.62), ferritin (r = 0.60) and UIBC (r = -0.46). The relationship of EPO to iron in the patients with leukemia (r = 0.54), and EPO to ferritin in the patients with MDS (r = 0.42) show significantly positive correlation coefficient.(ABSTRACT TRUNCATED AT 250 WORDS)


Specific and non-specific suppressor cell activity in NZB mice.
Non-specific and specific suppressor cell activity has been examined in both young and old NZB mice and compared to normal CBA mice. Both young and old NZB mice are shown to be able to generate antigen non-specific and specific suppressor cells in response to Con A and rat RBC respectively. In addition, antigen-specific suppressor cells which suppress the experimental induction of red cell autoantibodies do not influence the spontaneous development or course of autoimmune haemolytic anaemia. Subsequent experiments showed that this is probably due to differences in specificity of induced and spontaneous autoantibodies.


Treatment of Depersonalization Disorder With Repetitive Transcranial Magnetic Stimulation.
High frequency repetitive transcranial magnetic stimulation (rTMS) was approved by the US Food and Drug Administration in 2008 to treat major depressive disorder in those who did not respond to at least 1 antidepressant trial. Previous studies have shown that both high frequency rTMS to the left dorsolateral prefrontal cortex (DLPFC) and low frequency rTMS to the right DLPFC have antidepressant efficacy in treatment-resistant depression. Although rTMS has been widely used in the treatment of depression, very few studies of rTMS in patients with depersonalization disorder (DPD) have been published so far. DPD involves persistent or recurrent experiences of unreality and feelings of detachment causing distress or functional impairment while insight remains intact. The prevalence of DPD is approximately 1% to 2%. Studies of the pharmacological treatment of DPD are limited, and medications have proven to be of limited benefit. We present the case of a 30-year-old man with major depressive disorder and DPD who did not respond to pharmacotherapy. After the patient was treated with low frequency rTMS to the right DLPFC followed by high frequency rTMS to the left DLPFC, there was a significant reduction in his depersonalization symptoms. Given its effectiveness in our patient, the use of both low frequency rTMS to the right DLPFC and high frequency rTMS to the left DLPFC for treatment of DPD should be further explored.


γ-Aminobutyric acid plays a key role in alleviating Glomerella leaf spot in apples.
The fungal disease Glomerella leaf spot (GLS) seriously impacts apple production. As a nonprotein amino acid, γ-aminobutyric acid (GABA) is widely involved in biotic and abiotic stresses. However, it is not clear whether GABA is involved in a plant's response to GLS, nor is its molecular mechanism understood. Here, we found that exogenous GABA could significantly alleviate GLS, reduce lesion lengths, and increase antioxidant capacity. MdGAD1 was identified as a possible key gene for GABA synthesis in apple. Further analysis indicated that MdGAD1 promoted antioxidant capacity to improve apple GLS resistance in transgenic apple calli and leaves. Yeast one-hybrid analysis identified the transcription factor MdWRKY33 upstream of MdGAD1. Electrophoretic mobility shift assay, β-glucuronidase activity, and luciferase activity further supported that MdWRKY33 bound directly to the promoter of MdGAD1. The content of GABA and the transcription level of MdGAD1 in the MdWRKY33 transgenic calli were higher than that of the wild type. When MdWRKY33 transgenic calli and leaves were inoculated with GLS, MdWKRY33 positively regulated resistance to GLS. These results explained the positive regulatory effects of GABA on apple GLS and provided insight into the metabolic regulatory network of GABA.


Clear cell (glycogen rich) gastric adenocarcinoma: a distinct tubulo-papillary variant with a predilection for the cardia/gastro-oesophageal region.
To explore the clinicopathological and immunohistochemical profile of clear cell gastric cancers with a tubulo-papillary pattern. Twelve cases of clear cell gastric cancer (containing a minimum of 10% of clear cells) were studied. The cases were stained with: CK7, CK20, CEA, AFP, cyclin D1, E-cadherin and CDX-2. There were nine males and three females with an age range of 62 to 82 years (mean 71.4 years). Ten cases were located in the gastric cardia with extension into the gastro-oesophageal junction and two were in the pylorus/pre-pyloric area. Tumours ranged from 2 to 9 cm (mean 4.5 cm), nine were polypoid, exophytic grossly and all had a tubulo-papillary histological pattern. Five cases contained intracytoplasmic hyaline globules. Lymph node involvement was present in eight cases. Eight cases were CK7 positive, four were CK20 positive and all 12 were CEA, cyclin D1, E-cadherin and CDX-2 positive. All cases were AFP negative. Five patients had recurrence and/or metastasis within 6 months. Clear cell gastric cancers have a predilection for the gastro-oesophageal junction, are polypoid, have a tubulopapillary pattern, and show over-expression of cyclin D1 but normal E-cadherin.


Transcriptomic analysis of spinal cord regeneration after injury in Cynops orientalis.
Cynops orientalis (C. orientalis) has a pronounced ability to regenerate its spinal cord after injury. Thus, exploring the molecular mechanism of this process could provide new approaches for promoting mammalian spinal cord regeneration. In this study, we established a model of spinal cord thoracic transection injury in C. orientalis, which is an endemic species in China. We performed RNA sequencing of the contused axolotl spinal cord at two early time points after spinal cord injury - during the very acute stage (4 days) and the subacute stage (7 days) - and identified differentially expressed genes; additionally, we performed Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses, at each time point. Transcriptome sequencing showed that 13,059 genes were differentially expressed during C. orientalis spinal cord regeneration compared with uninjured animals, among which 4273 were continuously down-regulated and 1564 were continuously up-regulated. Down-regulated genes were most enriched in the Gene Ontology term "multicellular organismal process" and in the ribosome pathway at 10 days following spinal cord injury. We found that multiple genes associated with energy metabolism were down-regulated and multiple genes associated with the lysosome were up-regulated after spinal cord injury, indicating the importance of low metabolic activity during wound healing. Immune response-associated pathways were activated during the early acute phase (4 days), while the expression of extracellular matrix proteins such as glycosaminoglycan and collagen, as well as tight junction proteins, was lower at 10 days post-spinal cord injury than 4 days post-spinal cord injury. However, compared with 4 days post-injury, at 10 days post-injury neuroactive ligand-receptor interactions were no longer down-regulated, up-regulated differentially expressed genes were enriched in pathways associated with cancer and the cell cycle, and SHH, VIM, and Sox2 were prominently up-regulated. Immunofluorescence staining showed that glial fibrillary acidic protein was up-regulated in axolotl ependymoglial cells after injury, similar to what is observed in mammalian astrocytes after spinal cord injury, even though axolotls do not form a glial scar during regeneration. We suggest that low intracellular energy production could slow the rapid amplification of ependymoglial cells, thereby inhibiting reactive gliosis, at early stages after spinal cord injury. Extracellular matrix degradation slows cellular responses, represses the expression of neurogenic genes, and reactivates a transcriptional program similar to that of embryonic neuroepithelial cells. These ependymoglial cells act as neural stem cells: they migrate and proliferate to repair the lesion and then differentiate to replace lost glial cells and neurons. This provides the regenerative microenvironment that allows axon growth after injury.


Routine Assessment of Health Impacts of Local Transportation Plans: A Case Study From the City of Los Angeles.
To determine the health impacts of three future scenarios of travel behavior by mode for the City of Los Angeles, California, and to provide specific recommendations for how to conduct health impact assessments of local transportation plans on a more routine basis. We used the Integrated Transportation and Health Impact Model to assess the health impacts of the Los Angeles Mobility Plan 2035 by using environmental impact report data on miles traveled by mode under alternative implementation scenarios as inputs. The Integrated Transportation and Health Impact Model links region-wide changes in travel behavior to population exposures to physical activity, air pollution, and traffic collisions and associated health outcomes and costs. The largest impacts were on cardiovascular disease through increases in physical activity. Reductions in air pollution-related illnesses were more modest. Traffic injuries and deaths increased across all scenarios but were greatly reduced through targeted roadway safety enhancements accounted for outside the model. By establishing miles travelled as the metric for transportation impacts of statewide and regional plans, states can leverage existing data sources to more routinely consider health impacts as part of environmental impact reports. While not insurmountable, challenges remain regarding the incorporation of land use and roadway safety strategies into health impact estimates.


Dynamic transcription and expression patterns of KIF3A and KIF3B genes during spermiogenesis in the shrimp, Palaemon carincauda.
Spermiogenesis is a highly ordered and complex process in the male germ cell differentiation. The microtubule-based motor proteins KIF3A and KIF3B are required for the progression of the stages of spermiogenesis. In this study, the main goal was to determine whether KIF3A and KIF3B have a key role in spermiogenesis in Palaemon carincauda. The complete cDNA of KIF3A/3B from the testis of P. carincauda was cloned by using PCR and rapid amplification of cDNA ends (RACE). The predicted secondary and tertiary structures of KIF3A/3B contained three domains which were the: a) head region, b) stalk region, and c) tail region. Real-time quantitative PCR (qPCR) results revealed that KIF3A and KIF3B mRNAs were obtained for all the tissues examined, with the greatest gene expression in the testis. In situ hybridization indicated the KIF3A and KIF3B mRNAs were distributed in the periphery of the nuclear in the early spermatid of spermiogenesis. In the middle and late spermatid stages, KIF3A and KIF3B mRNAs were gradually upregulated and assembled to one side where acrosome biogenesis begins. In the mature sperm, KIF3A and KIF3B mRNAs were distributed in the acrosome cap and spike. Immunofluorescence studies indicated that KIF3A, tubulin, mitochondria, and Golgi were co-localized in different stages during spermiogenesis in P. carincauda. The temporal and spatial gene expression dynamics of KIF3A/3B indicate that KIF3A and KIF3B proteins may be involved in acrosome formation and nucleus shaping. Moreover, these proteins can transport the mitochondria and Golgi that facilitate acrosome formation in P. carincauda.


Molluscum contagiosum in immunocompromised patients: AIDS presenting as molluscum contagiosum in a patient with psoriasis on biologic therapy.
Molluscum contagiosum (MC) is a common, self-limited cutaneous infection in immunocompetent individuals. However, in immunocompromised individuals the infection often has an atypical presentation and can be difficult to eradicate, making both the diagnosis and treatment challenging. Due to advancements in the management of patients with human immunodeficiency virus (HIV) and cancer, there is a growing population of immunosuppressed individuals, signaling the need for dermatologists to recognize and manage related skin diseases. We present a case of an atypical MC eruption in a patient on biologic therapy for psoriasis and an unrecognized underlying HIV infection, followed by a current review of the presentation and treatment of MC in various immunosuppressed states. With a growing population of immunosuppressed patients, it is important to recognize MC as a potential indicator of underlying immunosuppression. Testing for HIV should be offered to any patient starting immunosuppressive therapy such as biologic agents.


DNA Chaos Blend to Secure Medical Privacy.
In this technological era, it is highly essential to protect the digital medical data from the fraud and forgery as they are transmitted over the public channel. Also with the increased data traffic, it is hard to transmit the entire bulky medical data. New methods have come into the scene to reduce the traffic while maintaining the sufficient level of security. Partial encryption is one of the methods which selectively encrypt the bulky medical image. Meanwhile, if the same medical image is needed to be reused for another diagnosis, then it is recommended to protect the entire medical image. This paper proposes a hybrid encryption scheme based on deoxyribo nucleic acid and chaotic maps, which can be adaptable for both selective and full medical image encryption. The proposed algorithm uses multiple chaotic maps in single process to generate the highly random keys for encrypting the color digital imaging and communications in medicine image. The algorithm comprises three phases, namely, permutation, encoding, and diffusion. In all the phases, the selection of specific rule set depends on the key sequences produced from the combined chaotic system. Experimental results are carried out to validate the resistance of the developed algorithm toward statistical, differential, and brute force attacks.


Clinical guidelines, defensive medicine, and the physician between the two.
In this article, we study the use of the American Academy of Otolaryngology-Head and Neck Surgery recommendations regarding coagulation screening tests before tonsillectomy and adenoidectomy by ear, nose, and throat (ENT) physicians in Israel and offer insights into the reasons for accepting/declining this recommendation. During April and May 2002, 309 self-administered questionnaires were sent to all ENT physician members of the Israeli Society of Otolaryngology-Head and Neck Surgery. Physicians answered questions regarding demographic data, their habits of preoperative laboratory and imaging tests before tonsillectomy and adenoidectomy, and the reasons for performing these tests. One hundred ninety-six (63.4% compliance rate) physicians responded to the survey. One hundred fifty-four (78.6% of the responding physicians) do not follow guideline recommendations and ask their otherwise healthy patients to undergo prothrombin time/partial thromboplastin time (PT/PTT) tests before tonsillectomy and adenoidectomy. Common practice in their departments was the leading reasoning for preoperative PT/PTT testing for 101 (51.5%) physicians. Eighty-nine physicians (45.4%) specifically stated that the reason for this behavior is defensive medicine, thirty-two physicians (16.3%) stated that the reason for those tests is hospital requirements, and literature recommendation was the reason in 24 (12.2%), followed by personal experience for 11 physicians (5.6%). Most ENT physicians in Israel do not follow clinical guidelines and perform unnecessary coagulation tests before tonsillectomy and adenoidectomy. More studies are needed to find ways to change physicians' behavior regarding preoperative tests.


Large-area, high-quality monolayer graphene from polystyrene at atmospheric pressure.
Graphene films have been attracting great interest owing to their unique physical properties. In this paper, we develop an efficient method to prepare large-area monolayer graphene (97.5% coverage) by atmospheric pressure chemical vapor deposition on Cu foils using polystyrene in a short time (3 min). Raman spectroscopy, transmission electron microscopy and scanning electron microscopy are employed to confirm the thickness and uniformity of the graphene films. Graphene films on glass substrates show high optical transmittance and electrical conductivity. Magnetic transport studies demonstrate that the as-grown monolayer graphene exhibits a high carrier mobility of 3395 cm2 V-1 s-1 at 25 K. On the basis of the analysis, it is concluded that our method is a simple, safe and versatile approach for the synthesis of monolayer graphene.


An independent race model involving an abort and re-plan strategy explains reach redirecting movements during planning and execution.
Although race models have been extensively used to study inhibitory control, the mechanisms that enable change of reach plans in the context of race models remain unexplored. We used a redirect task in which targets occasionally changed their locations to study the control of reaching movements during movement planning and execution phases. We tested nine different race model architectures that could explain the redirect behavior of reaching movements. We show that an independent GO-STOP-GO model that reflects a plan-abort-re-plan strategy involving non-interacting elements successfully explained the various behavioral measures such as the compensation function and the pattern of error response reaction times. By extending the same race model to the execution phase, we could explain the extent and the pattern of hypometric trials. Interestingly, the race model also provided evidence that redirecting a movement during planning and execution shared the same inhibitory mechanism. Taken together, this study demonstrates the applicability of an independent race model to understand the computational mechanisms underlying the control of reach movements.


[The conceptualization of nursing in the Italian literature: an integrative analysis to inform theory development].
Nursing theories are essential for orienting nursing practice. To date, three models for nursing practice have been developed in Italy. In addition, significant epistemological reflections have been published, sparking a rich professional debate regarding the theoretical foundations of nursing in Italy. However, conceptual models from other countries are often still used, despite many difficulties associated with applying them in practice. In order to investigate and redress this 'theoretical gap' and related implications for intervention, three scoping reviews of the Italian nursing literature were conducted to examine three categories of nursing knowledge: (a) nursing practice in Italy; (b) the basic nursing concepts of person, health, environment and nursing; and (c) regulatory/normative statements regarding what nursing practice should be in Italy. The purpose of this investigation was to identify how nursing is conceptualized in the Italian literature through an integrative narrative analysis of three scoping reviews. The Scoping Review according to the recommendations published by Arksey and O'Malley and subsequently implemented by Levac et al. has been selected as the optimal methodology for mapping nursing knowledge. At the end of the reviews carried out to answer the three research questions, the researchers integrated the results by conducting a coding of the results. The narrative synthesis highlighted a systemic conception of persons in their social context, 'incorporated' within relational systems. Persons are imagined as active agents with self-determination toward promoting their own health. Health, derived from levels of equilibrium between multiple systemic components and based on the person's holistic view, is a fundamental right and a collective social interest. Maintaining or promoting a person's health requires careful consideration of all these constitutive and integral elements. The nursing process is implemented through technical acts as well as relational and caring skills. Professional autonomy, influenced by clinical and organizational contexts, is expressed in collaboration with other professionals who contribute to the healthcare process. The results of this integrative narrative analysis suggest the need for a holistic vision of persons, with an active role in their health management, indissociable from the system of relationships in which this is contextualized, within which nurses are embedded. In light of the results of our investigation, the promotion of a conceptualization of nursing based on the centrality of the person-social relational system and on the active role of persons that nurses work with, this could guide approaches used in nursing education and administration. This could help enhance care provided by nurses and persons' participation in decisions regarding their own health.


Management and control of isotonic contraction generated stress: evaluation of masseter muscle deformation pattern by means of ecography.
The objective of the following study is to observe the behavior of the six layers of the masseter during an isometric contraction at maximum exertion with the deformation pattern analysis method. This study has been conducted by use of an ultrasound machine (MicrUs ext-1H Telemed Medical Systems Milano) and a linear probe (L12-5l40S-3 5-12 MHz 40 mm) which allowed us to record a video (DCM) comprised of 45 frames per second. The probe was fixed to a brace and the patient was asked to clench their teeth as hard as possible, obtain the muscle's maximum exertion, for 5 seconds three times, with 30 seconds intervals in between. Both right and left masseter muscles were analyzed. Then we applied to the resulting video a software (Mudy 18.104.22.168 AMID Sulmona Italy) for the analysis of muscle deformation patterns (contraction, dilatation, cross-plane, vertical strain, horizontal strain, vertical shear, horizontal shear, horizontal displacement, vertical displacement). The number of videos of masseter muscles in contraction at maximum exertion due to dental clenching made during this research is around 12,000. Out of these we chose 1,200 videos which examine 200 patients (100 females, 100 males). The analysis of the deformation patterns of the masseter allows us to observe how the six layers of the muscle have different and specific functions each, which vary depending on the applied force (application point, magnitude and direction) so that we find it impossible to assign to one of the three sections of the muscle a mechanical predominance. Therefore it appears that the three parts of the muscle have specific and synergistic tasks.


MOLECULAR GENETICS OF ADAPTATION IN AN EXPERIMENTAL MODEL OF COOPERATION.
The evolution of cooperation was studied in an empirical system utilizing a parasitic bacteriophage (f1) and a bacterial host. Infected cells were propagated by serial passage so that a phage could increase its representation among infected hosts only by enhancing the rate of growth of its host. Loss of infectivity was therefore without selective penalty, and phage benevolence could potentially evolve through a variety of genetic changes. The infected hosts evolved to grow faster over the course of the study, but the genetic bases of this phenotypic change were more difficult to anticipate. Two fundamentally different types of genetic changes in the phage were revealed. One involved the loss of some phage genes, resulting in a noninfectious plasmid that continued to replicate via the parental phage replicon. The second change involved integration of the phage genome into host DNA by a process that, at low frequency, could be reversed to produce infectious phage particles. Integration is a previously unknown property of wild-type f1, and in the system studied, may have resulted from the use of a phage bearing an insert containing nonfunctional DNA. The evolution of this novel function apparently depended only on the presence of a small region in the phage genome that provided some homology to the host DNA, with the host providing all necessary functions. Although f1 is one of the simplest phages known, these observations suggest that host-parasite interactions of the filamentous phages are more complicated than previously thought. More generally, the f1 system offers a useful model for many problems concerning the genetic basis of adaptation.


Pharmacists' perception of educational material to improve patient safety: A cross-sectional study on practices and awareness in Germany.
Educational material (EM) addresses particular safety information of medicinal products to healthcare professionals and patients. Since 2016, German national competent authorities label approved EM with a Blue Hand symbol. However, data is scarce regarding its usability as a safety communication tool in pharmacies to improve patient safety. The purpose of this study is to investigate for the first time pharmacists' awareness and perception of EM in the setting of community and hospital pharmacies in Germany.The Drug Commission of German Pharmacists surveyed its nationwide network of 677 community and 51 hospital reference pharmacies, to investigate their awareness and perception of EM. The survey was conducted between January 16 and February 10, 2020 using SurveyMonkey. Data were analyzed using Microsoft Excel.A total of 373 community and 32 hospital pharmacists participated; response rates were 55.1% and 62.8%, respectively. Overall, 320 (85.8%) community and all hospital pharmacists confirmed awareness of EM. Community and hospital pharmacists fully (n = 172, 46.9% and n = 9, 28.1%) or rather (n = 109, 29.7% and n = 10, 31.3%) agreed that EM for healthcare professionals is suitable to reduce risks of medicinal products. Moreover, 237 (64.7%) community and 17 (53.1%) hospital pharmacists confirmed to inform patients or care facilities about EM. Asking pharmacists on their personal perception of EM, the refinement of readability and accessibility was indicated.Pharmacists confirm awareness of EM and its suitability as a safety communication tool. However, from a pharmacists' perspective, the applicability and readability of EM still needs further adjustment to improve patient safety.


Assessment for the minimal invasiveness of laparoscopic liver resection by interleukin-6 and thrombospondin-1.
Laparoscopic surgery has been introduced as a minimally invasive technique for the treatment of various field. However, there are few reports that have scientifically investigated the minimally invasive nature of laparoscopic liver resection (LLR). To investigate whether LLR is scientifically less invasive than open liver resection. During December 2011 to April 2015, blood samples were obtained from 30 patients who treated with laparoscopic (n = 10, 33%) or open (n = 20, 67%) partial liver resection for liver tumor. The levels of serum interleukin-6 (IL-6) and plasma thrombospondin-1 (TSP-1) were measured using ELISA kit at four time points including preoperative, immediate after operation, postoperative day 1 (POD1) and POD3. Then, we investigated the impact of the operative approaches during partial hepatectomy on the clinical time course including IL-6 and TSP-1. Serum level of IL-6 on POD1 in laparoscopic hepatectomy was significantly lower than those in open hepatectomy (8.7 vs 30.3 pg/mL, respectively) (P = 0.003). Plasma level of TSP-1 on POD3 in laparoscopic hepatectomy was significantly higher than those in open hepatectomy (1704.0 vs 548.3 ng/mL, respectively) (P = 0.009), and have already recovered to preoperative level in laparoscopic approach. In patients with higher IL-6 Levels on POD1, plasma level of TSP-1 on POD3 was significantly lower than those in patients with lower IL-6 Levels on POD1. Multivariate analysis showed that open approach was the only independent factor related to higher level of IL-6 on POD1 [odds ratio (OR), 7.48; 95% confidence interval (CI): 1.28-63.3; P = 0.02]. Furthermore, the higher level of serum IL-6 on POD1 was significantly associated with lower level of plasm TSP-1 on POD3 (OR, 5.32; 95%CI: 1.08-32.2; P = 0.04) in multivariate analysis. In partial hepatectomy, laparoscopic approach might be minimally invasive surgery with less IL-6 production compared to open approach.


The Gogi (word-meaning) syndrome with impaired kanji processing: alexia with agraphia.
Two cases, one with probable Pick's disease and one with herpes simplex encephalitis, are presented, focusing on Gogi (word-meaning) aphasia-like syndrome as their salient clinical feature. Their aphasic symptoms were characterized by impaired kanji processing and preserved kana processing in writing and oral reading known as a defining feature of Gogi aphasia, but little evidence of so-called "phonetic use of kanji in writing" and "confusion between on- and kun-readings of kanji in oral reading" often observed in Gogi aphasia. Systematic neuropsychological test batteries administered to them showed that the selective impairment of kanji processing did not always arise from a disturbance of a specific ability known to be essential to Gogi aphasia (i.e., failure in comprehending the semantic content of spoken and written language), but rather from an amnestic disruption in the ability to access the correct orthographic and phonological forms of kanji words. This selective impairment of kanji processing may be compatible with "alexia with agraphia of kanji," recently known to be attributable to left posterotemporal lesions. These results suggest that Gogi aphasia (or similar syndromes) is not necessarily a real syndrome but a polytypic constellation of symptoms.


Endogenous islet uncoupling protein-2 expression and loss of glucose homeostasis in ob/ob mice.
We hypothesized that the loss of glucose homeostasis in ob/ob mice is associated with upregulation of islet uncoupling protein-2 (UCP2) expression, leading to impaired glucose-stimulated insulin secretion (GSIS). Changes in glucose homeostasis in lean and ob/ob mice from 5 to 16 weeks were assessed by fasting blood glucose, plasma insulin, oral glucose tolerance, and tissue insulin sensitivity. In vitro GSIS and ATP content were assayed in isolated islets, while UCP2 expression was determined by quantitative real-time PCR and immunoblotting. Short-term reduction of UCP2 expression was achieved through transfection of islets with specific small interfering RNA. Insulin resistance was detected in 5-week-old ob/ob mice, but GSIS and blood glucose levels remained normal. By 8 weeks of age, ob/ob mice displayed fasting hyperglycemia, hyperinsulinemia and glucose intolerance, and also had elevated non-esterified fatty acid concentration in plasma. In vitro, GSIS and ATP generation were impaired in ob/ob islets. Islet UCP2 expression was elevated at 5 and 8 weeks of age. Short-term knockdown of islet UCP2 increased GSIS in islets of lean mice, but had no effect in islets from ob/ob mice. Loss of glucose homeostasis and impairment of insulin secretion from isolated islets at 8 weeks in ob/ob mice is preceded by an increase in UCP2 expression in islets. Moreover, the glucolipotoxic conditions observed are predicted to increase UCP2 activity, contributing to lower islet ATP and GSIS.


Connections between postparotid terminal branches of the facial nerve: An immunohistochemistry study.
It has been assumed that connections between the postparotid terminal branches of the facial nerve are purely motor. However, the nature of their fibers remains unexplored. The aim of this study is to determine whether these connections comprise motor fibers exclusively. In total 17 connections between terminal facial nerve branches were obtained from 13 different facial nerves. Choline acetyltransferase antibody (ChAT) was used to stain the fibers in the connections and determine whether or not all of them were motor. All connections contained ChAT positive and negative fibers. The average number of fibers overall was 287 (84-587) and the average proportion of positive fibers was 63% (37.7%-91.5%). In 29% of the nerves, >75% of the fibers were ChAT+ (strongly positive); in 52.94%, 50%-75% were ChAT+ (intermediately positive); and in 17.65%, <50% were ChAT+ (weakly positive). Fibers traveling inside the postparotid terminal cranial nerve VII branch connections are not exclusively motor.


Moderators of School Intervention Outcomes for Children with Autism Spectrum Disorder.
A prior cluster randomized controlled trial (RCT) compared outcomes for a comprehensive school intervention (schoolMAX) to typical educational programming (services-as-usual [SAU]) for 103 children with autism spectrum disorder (ASD) without intellectual disability. The schoolMAX intervention was superior to SAU in improving social-cognitive understanding (emotion-recognition), social/social-communication skills, and ASD-related impairment (symptoms). In the current study, a range of demographic, clinical, and school variables were tested as potential moderators of treatment outcomes from the prior RCT. Moderation effects were not evident in demographics, child IQ, language, or ASD diagnostic symptoms, or school SES. Baseline externalizing symptoms moderated the outcome of social-cognitive understanding and adaptive skills moderated the outcome of ASD-related symptoms (no other comorbid symptoms or adaptive skills ratings moderated outcomes on the three measures). Overall, findings suggest that the main effects of treatment were, with two exceptions, unaffected by third variables.


Differences in potentiation of melanoma growth by absorbable and nonabsorbable suture.
This study demonstrates that various suture materials have different influences on tumor take and growth. When used in an area containing 10(5) or greater tumor cells, all suture types studied potentiated tumor growth. At subclinical tumor cell doses- that is, 1,000 or fewer cells that do not normally grow to a clinically detectable tumor- silk and steel increased tumor occurrence. In comparison, monofilament nylon, polyglycolic acid, and chromic suture did not potentiate tumor growth. This phenomenon of increased tumor growth associated with certain suture types appears to be related to the physical characteristics of the suture involved, although the interaction of the chemical breakdown products of the suture material with the local tumor cells is under investigation. The type of suture material used may play a significant role in the subsequent development of local recurrence of cancer.


Solution and solid-phase halogen and C-H hydrogen bonding to perrhenate.
(1)H NMR spectroscopic and X-ray crystallographic investigations of a 1,3-bis(4-ethynyl-3-iodopyridinium)benzene scaffold with perrhenate reveal strong halogen bonding in solution, and bidentate association in the solid state. A nearly isostructural host molecule demonstrates significant C-H hydrogen bonding to perrhenate in the same phases.


CO2 Laser Fabrication of PMMA Microfluidic Double T-Junction Device with Modified Inlet-Angle for Cost-Effective PCR Application.
The formation of uniform droplets and the control of their size, shape and monodispersity are of utmost importance in droplet-based microfluidic systems. The size of the droplets is precisely tuned by the channel geometry, the surface interfacial tension, the shear force and fluid velocity. In addition, the fabrication technique and selection of materials are essential to reduce the fabrication cost and time. In this paper, for reducing the fabrication cost Polymethyl methacrylate (PMMA) sheet is used with direct write laser technique by VERSA CO2 laser VLS3.5. This laser writing technique gives minimum channel width of about 160   μ m , which limit miniaturizing the droplet. To overcome this, modification on double T-junction (DTJ) channel geometry has been done by modifying the channel inlets angles. First, a two-dimensional (2D) simulation has been done to study the effect of the new channel geometry modification on droplet size, droplets distribution inside the channel, and its throughput. The fabricated modified DTJ gives the minimum droplet diameter of 39 ± 2   μ m , while DTJ channel produced droplet diameter of 48 ± 4   μ m at the same conditions. Moreover, the modified double T-junction (MDTJ) decreases the variation in droplets diameter at the same flow rates by 4.5 - 13 % than DTJ. This low variation in the droplet diameter is suitable for repeatability of the DNA detection results. The MDTJ also enhanced the droplet generation frequency by 8 - 25 % more than the DTJ channel. The uniformity of droplet distribution inside the channel was enhanced by 3 - 20 % compared to the DTJ channel geometry. This fabrication technique eliminates the need for a photomask and cleanroom environment in addition shortening the cost and time. It takes only 20   min for fabrication. The minimum generated droplet diameter is within 40   μ m with more than 1000 droplets per second (at 10   mL / h . oil flow rate). The device is a high-throughput and low-cost micro-droplet formation aimed to be as a front-end to a dynamic droplet digital PCR (ddPCR) platform for use in resource-limited environment.


Choline alleviated perinatal fluoride exposure-induced learning and memory impairment through α4β2 nAChRs and α7 nAChRs in offspring mice.
Fluoride pollution is widely present in the living environment. As a critical period of brain development, the perinatal period is extremely vulnerable to fluoride. Studies have found that choline can protect the brain's memory and enhance the ability to focus. However, the effect of choline on perinatal fluoride-induced nerve damage remains unclear. Therefore, 32 Kunming newly conceived female mice and their offspring mice were randomly divided into control, NaF, LC + NaF, and HC + NaF groups, and the HE staining, Y-maze test, RT-PCR, western blotting, immunohistochemistry, etc. were used in this study. The results showed that fluoride decreased the brain organ coefficients and brain protein content (p < 0.05, p < 0.01), and caused histomorphological damage in the hippocampus and cortex, which suggested that fluoride affected the development of the brain and damaged the brain. Moreover, the results of the Y-maze test showed that fluoride increased the number of learning days, error reaction time, and total reaction time, and decreased the AchE activity in the brain (p < 0.05, p < 0.01), which indicated that fluoride reduced the learning and memory ability of the mice. Besides, the results showed that fluoride decreased the mRNA and protein expression levels of α4β2 nAChRs and α7 nAChRs in the hippocampus and cortex (p < 0.05, p < 0.01). However, perinatal choline supplementation reversed the aforementioned fluoride-induced changes. In short, these results demonstrated that choline alleviated perinatal fluoride-induced learning and memory impairment, which will provide a rationale for the mitigation and prevention of fluoride-induced brain damage.


Androgen-deprivation therapy and diabetes control among diabetic men with prostate cancer.
Androgen-deprivation therapy (ADT) for prostate cancer (PCa) is associated with decreased insulin sensitivity and increased diabetes risk among nondiabetic men. Few data are available about the effects of ADT on diabetes control among men with diabetes. We examined care for men who had diabetes at the time of PCa diagnosis to assess the effect of ADT on diabetes control, as measured by hemoglobin A1c (HbA1c) levels and the intensification of diabetes pharmacotherapy. This was an observational cohort study using US Department of Veterans Affairs registry data and administrative data to assess HbA1c levels and intensification of diabetes pharmacotherapy among 2237 pairs of propensity-matched men with PCa and diabetes who were or were not treated with ADT. We calculated the difference in difference of HbA1c levels at baseline and at 1 and 2 yr in the two groups, compared using a paired Student t test. We used a Cox proportional hazards model to estimate time to intensification of diabetes pharmacotherapy. The mean HbA1c at baseline was 7.24 (standard error [SE]: 0.05) for the ADT group and 7.24 (SE: 0.04) for the no-ADT group. HbA1c increased at 1 yr for men treated with ADT to 7.38 (SE: 0.04) and decreased among men not treated with ADT to 7.14 (SE: 0.04), for a difference in differences of +0.24 (p=0.008). Results were similar at 2 yr (p=0.03). The worsening HbA1c control occurred despite ADT being associated with an increased hazard of addition of diabetes medication (adjusted hazard ratio: 1.20; 95% confidence interval, 1.09-1.32). The limitation of this study was that it was observational and relied on administrative data. ADT is associated with worsening of diabetes control and increases in HbA1c levels despite the use of additional diabetes medications.