Acquaintance of dental implants as a treatment modality in edentulous states among health workers in Aseer Province, KSA.
To identify the acquaintance of dental implant (DI) as a treatment modality in edentulous states among health workers in the Aseer region and also to assess the level of understanding about DI among them. A questionnaire set of 18 questions was used for 500 health workers from the concerned area about DI. Questionnaire set basically consists of questions to assess the attitude, perception, and knowledge among them about DI. The data collected and association with the factors were tested for significance using the Chi-square test and P < 0.05 was considered statistically significant. The response rate was 89%. More than 75% were aware of DI, but only 50% of the total respondents were knowing about the difference between the DI, fixed prosthesis, and removable prosthesis. Of the latter, 47.4% have suggested implants for patients and about 55% respondents were agreeing to get DI done for themselves. Dental health care workers have more knowledge than the medical health workers, and the difference was found to be statistically significant. Of respondents, >90% were willing to know more about DI. The practice of implant dentistry is growing in the Aseer region. However, general health workers are not fully aware of proper DI information. In addition, all the efforts should be made to include basic implant education in all the branches of health sciences and the CDE program should be conducted regularly to enhance the knowledge, so that correct information can be channelized to the patients.


Characterization of N- and O-glycopeptides of recombinant human erythropoietins as potential biomarkers for doping analysis by means of microscale sample purification combined with MALDI-TOF and quadrupole IT/RTOF mass spectrometry.
The structural characterization of the O- and N-glycan structures of three different commercially available recombinant human erythropoietins (rhEPOs) is represented by means of a microscale sample purification using ZipTip technology and MALDI-TOF and MALDI low-energy CID MS. Glycopeptides were released from rhEPO samples by a differential endoproteolytic digestion to obtain site-specific glycosylation patterns. Mass accuracies in the range of +/- 0.04% obtained by the high-resolution TOF instrument allowed an unambiguous assignment of N-glycan structures via glycan database software. Furthermore, the O-glycan structures were directly analyzed on the glycopeptide level by MS/MS experiments. Principally, site-specific glycosylation was found to be very similar for the three different rhEPOs (EPO-alpha, EPO-beta, and novel erythropoiesis stimulating protein (NESP)) but exhibiting quantitative differences in distinct O- and N-glycan moieties. Significant differences were found in the degree of sialylation and acetylation. Especially, a considerable degree of variation of the O-acetylation of sialic acid residues could be realized on the glycan structures of O- and N-glycopeptides, whereas EPO-alpha and EPO-beta could be clearly differentiated from NESP solely on the O-glycopeptide level.


[The behaviour of creatine phosphokinase in serum after the intramuscular injection of a Tetracyclin preparation (author's transl)].
The single intramuscular injection of 275 mg Rolitetracyclin (Reverin) led to a rise in serum creatine phosphokinase in 11 out of 20 heart healthy patients, 7 cases with values over 100 mU/ml. In sane cases the initial values had still not been reached 72 hours after injection. With Rolitetracyclin given intravenously the creatine phosphokinase values do not alter, as with an isotonic Na-Cl solution given intramuscularly. A rise in the serum creatine phosphokinase was seen in 2 out of 6 cases after an intramuscular injection of Oxytetracyclin (Terramycin -Depot). One is not dealing with a reaction which is typical only to Rolitetracyclin. The cause is thought to be the setting free of enzymes through the musclelesions. The results underline the sensitivity of and problems involved with creatine phosphokinase in the diagnosis of heart-infarction.


Unilateral expiratory airflow obstruction during forced exhalation.
We present a case of unilateral airflow obstruction during forced exhalations. The patient presented with episodic dyspnea and wheezing, particularly when he lay in the right lateral decubitus position. Spirometry revealed symmetric, marked reductions in forced expiratory volume in the first second and forced vital capacity values, while plethysmography demonstrated a near-normal total lung capacity. Bronchoscopy revealed a polypoid lesion in the right main bronchus, of which biopsy specimens demonstrated adenoid cystic carcinoma. Following a right pneumonectomy, total lung capacity was markedly reduced; interestingly, however, spirometry was essentially unchanged. This case is an elegant illustration of the effects of respiratory maneuvers and body position on airway caliber.


Plasma concentrations of alpha-human atrial natriuretic polypeptide and cyclic GMP in patients with heart disease.
Plasma concentrations of immunoreactive alpha-human atrial natriuretic polypeptide (i alpha-hANP) and cyclic guanosine monophosphate (cGMP) were measured in 70 patients with heart disease. Plasma concentrations of i alpha-hANP were directly related to the severity of heart disease (F = 29.61, p less than 0.001). Plasma concentrations of i alpha-hANP were well correlated with pulmonary capillary wedge pressure (PCWP; r = 0.64, p less than 0.001), mean pulmonary arterial pressure (PAP; r = 0.62, p less than 0.001), and mean right atrial pressure (RAP; r = 0.75, p less than 0.001). Plasma concentrations of cGMP were also directly related to the severity of heart disease (F = 13.61, p less than 0.001) and highly correlated with plasma concentrations of i alpha-hANP (r = 0.73, p less than 0.001). Plasma concentrations of cGMP were also closely correlated with PCWP (r = 0.69, p less than 0.001), mean PAP (r = 0.61, p less than 0.001), and mean RAP (r = 0.60, p less than 0.001). The i alpha-hANP concentrations of plasma samples obtained from the coronary sinus were approximately fourfold higher than those of samples obtained from the pulmonary artery, whereas cGMP concentrations were comparable in plasma samples obtained from either site. Elevation of cGMP concentrations following intravenous infusion of synthetic alpha-hANP was comparable in plasma samples obtained from the coronary sinus and the pulmonary artery. These findings suggest that elevated plasma concentrations of i alpha-hANP in cardiac patients result from an increase in the secretion of ANPs, which is probably accelerated by elevation of right or left atrial pressure, and that plasma concentrations of cGMP reflect circulating levels of alpha-hANP.


[Reorientation osteotomy of the trapezial saddle].
At its early stage, the thumb TM osteo-arthritis is occasionally painful during some activities and there are mainly radiological signs, only visible on specific views and with maximum amplitudes. They are the first metacarpal base imperfect reintegration in the trapezium saddle in ante-position and an increased slope angle of 140 degrees. So, the "slippery saddle" of the trapezium induces a metacarpal base subluxation. The goal of the proposed technique is to correct the orientation of the trapezial saddle. The slope angle must return to its normal value of about 125 degrees, thanks to an opening wedge osteotomy into the trapezium, completed with a bony wedge insertion. Proposed for the first time in 1983, and used only once by Dr. Heim, this technique was "rediscovered" recently and used on five patients in ten years. It is easy to do, the only complication being two post-operative radial nerve sensitive branch neuromas. In six cases on seven, the pain disappeared, even if the osteo-arthritis was evolving for the two former cases. The functional recovery was total and the patients were satisfied in most of the cases. In spite of this short series, this technique is worth being used for the early stage of thumb osteo-arthritis, eventually combined with others techniques like tenotomy of the Abductor pollicis longus accessories or different types of ligamentoplasties. It is, in any case, more logical than the first metacarpal osteotomy.


The Influence of Steel Fiber Tensile Strengths and Aspect Ratios on the Fracture Properties of High-Strength Concrete.
Steel fiber embedded in concrete serves to reduce crack development and prevent crack growth at the macroscopic level of the concrete matrix. Steel fiber-reinforced concrete (SFRC) with high compressive concrete strength is affected primarily by the dimensions, shape, content, aspect ratio, and tensile strength of the embedded steel fiber. In this study, double-ended hook steel fiber was used in SFRC with a concrete compressive strength of 80 MPa. This fiber was used for the study variables with two aspect ratios (64, 80) and tensile strength values up to 1600 MPa. The flexural performance of the SFRC specimens was evaluated using crack mouth open displacement tests, and the test results were compared with code provisions. A modified reinforcement index was also used to quantify the flexural performance based on comparisons with fracture energy.


[Metabolic defects with hypoketotic hypoglycemia].
Metabolic defects resulting in hypoketotic hypoglycemia can lead to hepato-encephalopathy and can be lethal. Recognition of the association of hypoglycemia with hypoketonemia is essential for efficient diagnostic and therapeutic procedures. The pattern of urinary excretion of organic acids is useful in differential diagnosis between the possible metabolic defects, viz. carnitine deficiency, carnitine palmitoyl transferase deficiency, medium-chain, long-chain and multiple acyl-CoA dehydrogenase deficiencies, and HMG-CoA lyase deficiency. These (except for carnitine deficiency) can be confirmed by enzyme activity measurements in cultured fibroblasts and tissue biopsies and prenatally. Treatment is available for all of them except some cases of multiple acyl-CoA dehydrogenase deficiency. Genetic counselling of the families must be based on a precise biochemical diagnosis.


First Line of Defense: The Vital Role of Family Medicine Physicians in Preventing Acute Mesenteric Ischemia in High-Risk Patients.
Acute mesenteric ischemia (AMI) is a life-threatening condition with a high mortality rate despite surgical interventions. Morbidity and mortality are especially high in those with risk factors, which include diabetes mellitus (DM), hypertension (HTN), coronary artery disease, recent myocardial infarction, and rheumatic autoimmune diseases, among others. We present the case of a 70-year-old Caucasian woman diagnosed with AMI. The patient presented acutely to the emergency department after nine episodes of vomiting and was admitted to the surgical floor the same day for an emergent exploratory laparotomy. She presented acutely with an atypical presentation and without any progressive symptoms, despite various comorbidities. This patient was classified as "very high risk", but she had not been on any medications or monitored for any of her comorbidities. We highlight the essential and multifaceted role of family medicine physicians, also known as primary care physicians (PCPs), in the prevention of bowel ischemia and recommend the use of routine outpatient monitoring with clinical examination, blood testing, and imaging. These, along with a high index of suspicion, have clinical utility in preventing hospitalization, surgical intervention (bowel resection), and other serious sequelae of AMI. Timely detection, management, and specialist referrals from a family medicine physician can lower the overall burden on healthcare resources and personnel.


Genome-wide screening using automated fluorescent genotyping to detect cryptic cytogenetic abnormalities in children with idiopathic syndromic mental retardation.
Mental retardation (MR) is the most common developmental disability, affecting approximately 2% of the population. The causes of MR are diverse and poorly understood, but chromosomal rearrangements account for 4-28% of cases, and duplications/deletions smaller than 5 Mb are known to cause syndromic MR. We have previously developed a strategy based on automated fluorescent microsatellite genotyping to test for telomere integrity. This strategy detected about 10% of cryptic subtelomeric rearrangements in patients with idiopathic syndromic MR. Because telomere screening is a first step toward the goal of analyzing the entire genome for chromosomal rearrangements in MR, we have extended our strategy to 400 markers evenly distributed along the chromosomes to detect interstitial anomalies. Among 97 individuals tested, three anomalies were found: two deletions (one in three siblings) and one parental disomy. These results emphasize the value of a genome-wide microsatellite scan for the detection of interstitial aberrations and demonstrate that automated genotyping is a sensitive method that not only detects small interstitial rearrangements and their parental origin but also provides a unique opportunity to detect uniparental disomies. This study will hopefully contribute to the delineation of new contiguous gene syndromes and the identification of new imprinted regions.


Palladium-catalyzed carbonylative coupling of (2-azaaryl)methyl anion equivalents with (hetero)aryl bromides.
Conditions for the palladium-catalyzed coupling of (2-pyridyl)acetones with aryl bromides have been developed. Followed by an acid-promoted deacetylation step, the desired 1-(het)aryl-2-(2-pyridyl)ethanones were obtained in good to excellent yields with high functional group tolerance. Test reactions revealed that both the addition of MgCl2 and a specifically positioned heteroatom in the heteroaromatic ring were crucial for product formation indicating the importance of a chelated intermediate in the reaction mechanism. The reaction conditions proved suitable for a number of 5- and 6-membered heteroaromatic starting materials affording all products in good yields. The utility of the obtained 1-(het)aryl-2-(2-pyridyl)ethanones was demonstrated by the straightforward synthesis of several multiaromatic derivatives in only few additional steps.


Environmental and individual influences on Australian young adults' likelihood of attending university: a follow-up study.
In this longitudinal study, which is a follow-up analysis of a previous investigation (K. Marjoribanks, 2002a), the author examined environmental and individual influences on the likelihood of Australian young adults attending university. Participants were 5,181 Anglo-Australian (parents born in Australia, English was the language of the family), 460 Asian, 699 English (parents born in England), 746 European, and 163 Middle Eastern students (M age = 14.7 years, when the study began). The analyses indicated that Asian, European, and Middle Eastern young adults were more likely to attend university than were young adults from Anglo-Australian and English families, and young women had higher odds of attending university than did young men. Family social status variations in the likelihood of university attendance could be explained by differences in individual characteristics and proximal learning environments. Adolescents' individual characteristics and proximal learning environments combined to have a large independent association with the decision to attend university.


Heparanase induced by advanced glycation end products (AGEs) promotes macrophage migration involving RAGE and PI3K/AKT pathway.
Advanced glycation end products (AGEs), inflammatory-associated macrophage migration and accumulation are crucial for initiation and progression of diabetic vascular complication. Enzymatic activity of heparanase (HPA) is implicated strongly in dissemination of metastatic tumor cells and cells of the immune system. In addition, HPA enhances the phosphorylation of selected signaling molecules including AKT pathway independent of enzymatic activity. However, virtually nothing is presently known the role of HPA during macrophage migration exposed to AGEs involving signal pathway. These studies were carried out in Ana-1 macrophages. Macrophage viability was measured by MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assays. HPA and AKT protein expression in macrophages are analysed by Western blotting and HPA mRNA expression by real time quantitative RT-PCR. Release of HPA was determined by ELISA. Macrophage migration was assessed by Transwell assays. HPA protein and mRNA were found to be increased significantly in AGEs-treated macrophages. Pretreatment with anti-HPA antibody which recognizes the nonenzymatic terminal of HPA prevented AGEs-induced AKT phosphorylation and macrophage migration. LY294002 (PI3k/AKT inhibitor) inhibited AGEs-induced macrophage migration. Furthermore, pretreatment with anti-receptor for advanced glycation end products (RAGE) antibody attenuated AGEs-induced HPA expression, AKT phosphorylation and macrophage migration. These data indicate that AGEs-induced macrophage migration is dependent on HPA involving RAGE-HPA-PI3K/AKT pathway. The nonenzymatic activity of HPA may play a key role in AGEs-induced macrophage migration associated with inflammation in diabetic vascular complication.


Intramolecular electronic energy transfer in bichromophoric macrocyclic complexes.
Efficient intramolecular electronic energy transfer (EET) has been demonstrated for three novel bichromophoric compounds utilizing a macrocyclic spacer as the bridge between the electronic energy donor and acceptor fragments. As their free base forms, emission from the electronically excited donor is absent and the acceptor emission is reductively quenched via photoinduced oxidation of proximate amine lone pairs. As their Zn(II) complexes, excitation of the donor results in sensitization of the electronic acceptor emission.


The effectiveness of rotating versus single course antibiotics for small intestinal bacterial overgrowth.
Small intestinal bacterial overgrowth treatment is usually based on antibiotics with no guidelines available. This study aimed to investigate the efficacy of different antibiotics to treat small intestinal bacterial overgrowth. Consecutive patients referred to our tertiary center and diagnosed with intestinal bacterial overgrowth were retrospectively included. Patients were diagnosed using a 75 g glucose breath test. Patients were treated either with a single antibiotic (quinolone or azole) or rotating antibiotics (quinolone and azole, one after the other) for 10 consecutive days per month for 3 months. A negative glucose breath test after antibiotic treatment was considered as remission. Quality of life (GIQLI) and gastrointestinal severity (IBS-SSS) were assessed before and after antibiotic treatment. Symptomatic evaluation was realized in simple blind of glucose breath test result: patients were unaware of their results. Between August 2005 and February 2020, 223 patients were included in the analysis (female 79.8%, mean age 50.2 ± 15.7 years). Remission was observed in 119 patients (53.4%) after one course of antibiotics and was more frequent in patients receiving rotating antibiotics than in patients receiving a single antibiotic (70.0% vs. 50.8%, p = 0.050). Remission was associated with a significant improvement in quality of life (p = 0.035) and in bloating (p = 0.004). In this study, the treatment of small intestinal bacterial overgrowth using rotating antibiotics was more effective than treatment using a single course of antibiotic. Remission was associated with improvement in both quality of life and bloating.


Three-Dimensional Imaging Improves Accuracy in Clip Sizing During Thoracoscopic Left Atrial Appendage Exclusion.
The AtriClip is an epicardially applied occlusion device for the left atrial appendage. Accurate sizing and placement of the device is essential to its success. We describe the use of 3-dimensional computed tomography imaging to aid in accurate sizing of the AtriClip device during thoracoscopic surgical ablation. This technique reduces the risk of improper sizing of the device and thus mitigates the risk of malpositioning and potential damage or compression to surrounding structures such as the circumflex coronary artery.


Detection of Acute Changes in Left Ventricular Function by Myocardial Deformation Analysis after Excessive Alcohol Ingestion.
The effects of acute excessive alcohol ingestion on echocardiographic parameters of left ventricular (LV) function are unclear. One hundred ninety-nine healthy subjects (44 ± 5 years, 71% male) were prospectively examined within 6 hours after excessive alcohol ingestion as well as after 4 weeks with strict alcohol abstinence. Echocardiography was performed at baseline and follow-up for conventional parameters (left ventricular ejection fraction [LVEF], transmitral E and A Doppler flow velocities, E/A ratio, tissue Doppler velocity lateral and septal (é), E/é ratio, deceleration time of E, and isovolumic relaxation time) and myocardial deformation data (such as global radial and global and layer-specific circumferential [endo and epi global CS] and longitudinal [endo and epi global LS] strain). Multivariate regression was used to assess the impact of independent variables on echocardiographic parameters. Alcohol levels were 1.2 ± 0.3 g/L at the time of drinking cessation. After alcohol ingestion endo CS (30% ± 2% vs 37% ± 3%, P = .008) and endo LS (27% ± 4% vs 33% ± 3%, P = .002) were significantly lower at baseline versus follow-up. Blood pressure, LVEF and heart rate, and other echocardiographic parameters did not differ between the two examinations. Alcohol levels were modestly, negatively associated with change in endo CS and endo LS (r = -0.54, 95% CI, -0.63 to -0.43, P < .001; and r = -0.26, 95% CI, -0.39 to -0.14; P < .003, respectively). Alcohol levels were the strongest predictor for endo CS (β = -4.84; 95% CI, -6.31 to -3.37) and endo LS (β = -2.50; 95% CI, -4.32 to -0.68). Acute alcohol ingestion effects endocardial CS and LS, suggesting an acute and transient toxic effect on myocardial deformation, an effect that remains undetected by conventional echocardiographic parameters. The current findings may help clinicians to gain more understanding into the mechanism of developing an alcohol cardiomyopathy and to detect early persistent alcohol-induced myocardial disturbances for an effective therapy in time to prevent harm.


Short-term effects of right-left heart sequential cardiac resynchronization in patients with heart failure, chronic atrial fibrillation, and atrioventricular nodal block.
Single-site ventricular pacing in patients with heart failure, atrial fibrillation, and severe atrioventricular (AV) nodal block risks the generation of discoordinate contraction. Whether altering the site of stimulation can offset this detrimental effect and what role sequential right ventricular-left ventricular (RV-LV) stimulation might play in such patients remain unknown. Nine subjects with heart failure (ejection fraction, 14% to 30%), atrial fibrillation, and AV block were studied by pressure-volume analysis. Ventricular stimulation was applied to the RV (apex and outflow tract), LV free wall, and biventricular (BiV) at 80 and 120 bpm. BiV improved systolic function more than either site alone (dP/dt(max), 810+/-83, 924+/-98, 983+/-102 mm Hg/s for RV, LV, BiV, respectively; P<0.05), although LV pacing was significantly better than RV pacing. However, only BiV improved diastolic function (isovolumic relaxation) over RV or LV alone. Similar results were obtained for both heart rates. RV pacing site did not alter the BiV effect, and concomitant stimulation of both RV sites did not improve function over each alone. Finally, varying RV-LV delay revealed optimal responses with simultaneous pacing. Simultaneous BiV pacing acutely enhances both systolic and diastolic function over single-site RV or LV pacing in congestive heart failure patients with atrial fibrillation and advanced AV block. Sequential RV-LV stimulation offers minimal benefit on average and should perhaps be considered only in targeted subsets such as nonresponding patients.


An active enzyme constructed from a 9-amino acid alphabet.
Nature employs a set of 20 amino acids to produce a repertoire of protein structures endowed with sophisticated functions. Here, we combined design and selection to create an enzyme composed entirely from a set of only 9 amino acids that can rescue auxotrophic cells lacking chorismate mutase. The simplified protein captures key structural features of its natural counterpart but appears to be somewhat less stable and more flexible. The potential of a dramatically reduced amino acid alphabet to produce an active catalyst supports the notion that primordial enzymes may have possessed low amino acid diversity and suggests that combinatorial engineering strategies, such as the one used here, may be generally applied to create enzymes with novel structures and functions.


Effect of Leaves of Caesalpinia decapetala on Oxidative Stability of Oil-in-Water Emulsions.
Caesalpinia decapetala (Roth) Alston (Fabaceae) (CD) is used in folk medicine to prevent colds and treat bronchitis. This plant has antitumor and antioxidant activity. The antioxidant effects of an extract from Caesalpinia decapetala (Fabaceae) were assessed by storage of model food oil-in-water emulsions with analysis of primary and secondary oxidation products. The antioxidant capacity of the plant extract was evaluated by the diphenylpicrylhydrazyl (DPPH), Trolox equivalent antioxidant capacity (TEAC), oxygen radical absorbance capacity (ORAC) and ferric reducing antioxidant power (FRAP) assays and by electron paramagnetic resonance (EPR) spectroscopy. Lyophilized extracts of CD were added at concentrations of 0.002%, 0.02% and 0.2% into oil-in-water emulsions, which were stored for 30 days at 33 ± 1 °C, and then, oxidative stability was evaluated. The CD extract had high antioxidant activity (700 ± 70 µmol Trolox/g dry plant for the ORAC assay), mainly due to its phenolic components: gallic acid, quercetin, catechin, 4-hydroxybenzoic acid and p-coumaric acid. At a concentration of 0.2%, the extract significantly reduced the oxidative deterioration of oil-in-water emulsions. The results of the present study show the possibility of utilizing CD as a promising source of natural antioxidants for retarding lipid oxidation in the food and cosmetic industries.


Youth psychotherapy change trajectories and outcomes in usual care: Community mental health versus managed care settings.
The authors compared symptom change trajectories and treatment outcome categories in children and adolescents receiving routine outpatient mental health services in a public community mental health system and a private managed care organization. Archival longitudinal outcome data from parents completing the Youth Outcome Questionnaire (Y-OQ) were retrieved for children and adolescents (4-17 years old) served in a community mental health system (n = 936, mean age = 12 years, 40% girls or young women, 28% from families of color) and a managed care organization (n = 3,075, mean age = 13 years, 45% girls or young women, race and ethnicity not reported). The authors analyzed Y-OQ data using multilevel modeling and partial proportional odds modeling to test for differences in change trajectories and final outcomes across the 2 service settings. Although initial symptom level was comparable across the 2 settings, the rate of change was significantly steeper for cases in the managed care setting. In addition, 24% of cases in the community mental health setting demonstrated a significant increase in symptoms over the course of treatment, compared with 14% of cases in the managed care setting. These results emphasize the need for increased attention to negative outcomes in routine mental health services and provide a stronger foundation for identifying youth cases at risk for treatment failure. In addition, given the overall differences observed across treatment settings for average rate of change and deterioration rates, results suggest that setting-specific model heuristics should be used for identifying cases at risk for negative outcomes.


Effects of nitrogen plasma treatment on the surface characteristics of olive stone-based activated carbon.
Nitrogen plasma treatment (NPT) of activated carbon (AC) at different conditions was carried out to introduce nitrogen-containing groups onto olive stone-activated carbon (OSAC) surfaces. Textural characteristics of raw and irradiated samples were analyzed by N2 and CO2 adsorption. Surface chemical functional groups were analyzed by X-ray photoelectron spectrometry (XPS) and Fourier Transformed Infrared spectroscopy. The results showed that after NPT, the surface textural properties of irradiated OSAC were slightly damaged, and a gradual decrease in surface area and pore volume was observed during the irradiation. XPS revealed that NPT could change the distribution of oxygen functional groups on the OSAC surface and there were more nitrogen atoms incorporated into the aromatic ring. A tentative explanation for the modification process is proposed. Phenol adsorption was enhanced from 110 mg/g for untreated AC to 635 mg/g for 30-min plasma-treated OSAC.


Chondroblastoma of the Distal Femur in an Adolescent.
An 11-year-old female was referred to physical therapy due to a 3-month history of right medial knee pain. The patient's medical diagnosis was Osgood-Schlatter disease, based on radiographs obtained at the initial pediatrician consultation. An MRI scan was obtained 2 weeks after starting physical therapy and revealed a bony lesion near the medial condyle of the right femur and damage to medial joint structures. Pathology after open biopsy and curettage of the lesion revealed a chondroblastoma. J Orthop Sports Phys Ther 2020;50(5):275. doi:10.2519/jospt.2020.9021.


Knee orthosis with variable stiffness and damping that simulates hemiparetic gait.
Individuals with unilateral stroke have neuromuscular weakness or paralysis on one side of the body caused by some muscles disengaging and others overexciting. Hyperextension of the knee joint and complete lack of plantar flexion of the ankle joint are common symptoms of stroke. This paper focuses on the creation and implementation of a small, lightweight, and adjustable orthotic device to be positioned around the knee of an able-bodied person to simulate hemiparetic gait. Force and range of motion data from able-bodied subjects fitted with the orthosis, inducing hemiparetic gait, was collected using the Computer Assisted Rehabilitation ENvironment (CAREN) system. The four parameters that the design focused on are damping, catch, hysteresis, and stiffness. The main goal of the project was to discern whether this device could be utilized as a viable research instrument to simulate hemiparetic gait. It was hypothesized that the device has the potential to be utilized in the future as a rehabilitation device for people with stroke since it has been designed to induce larger knee flexion as an after effect. A comparison between how the dominant leg was affected by the orthosis and how the non-dominant leg was affected was investigated as well. The results show that the device affected the velocities, knee angles, and force profiles of the subject's gait.


Light- and nucleotide-dependent increase in apparent viscosity in a suspension of retinal disks.
Light triggers the cyclic nucleotide cascade in photoreceptor disk membranes. We report here that light-induced changes in the apparent viscosity of disk membrane suspensions can also be observed using either native disk membranes or washed membranes reconstituted with G protein and PDE. The viscosity changes are light- and GTP-dependent and require the presence of G protein and PDE. The magnitude of the viscosity change increases with increasing membrane concentration. Under the same conditions in which light elicits a change in viscosity, we observe a large increase in light scattering by the disk membrane suspension.


Heterozygous gain of function variants in a critical region of RNF13 cause congenital microcephaly, epileptic encephalopathy, blindness, and failure to thrive.
Missense variants in the RNF13 gene have been previously known to cause congenital microcephaly, epileptic encephalopathy, blindness, and failure to thrive through a gain-of-function disease mechanism. Here, we identify a nonsense variant, expected to result in protein truncation, in a similarly affected patient. We show that this nonsense variant, residing in the terminal exon, is likely to escape nonsense-mediated decay while removing a critical region for protein function, thus resulting in a gain-of-function effect. We review the literature and disease databases and identify several other affected individuals with overlapping phenotypes carrying distinct truncating variants in the terminal exon upstream of the putative critical region. Furthermore, we analyze truncating variants from the general population, namely, the Genome Aggregation Database (gnomAD), and provide additional evidence supporting our hypothesis, and ruling out haploinsufficiency as an alternative disease mechanism. In summary, our case report, literature review, and analysis of disease and population databases strongly support the hypothesis that heterozygous gain-of-function variants in a critical region of RNF13 cause congenital microcephaly, epileptic encephalopathy, blindness, and failure to thrive.


HMPAO SPET does not distinguish obsessive-compulsive and tic syndromes in families multiply affected with Gilles de la Tourette's syndrome.
Gilles de la Tourette's syndrome (GTS) is a familial neuropsychiatric disorder characterized by tics and obsessive-compulsive behaviours (OCB). Previous HMPAO SPET studies of subjects with GTS have shown hypoperfusion of striatal and frontal areas. Studies of patients with primary obsessive-compulsive disorder have shown, in contrast, hyperperfusion of similar areas. Twenty subjects from five families affected by GTS, including individuals with OCB but no tics, were examined using HMPAO SPET. There were abnormalities of regional cerebral perfusion in individuals with GTS, OCB and tics. Hypoperfusion was in striatal, frontal and temporal areas. There was no hyperperfusion. Regional cerebral blood flow patterns in individuals with OCB in families affected by GTS are comparable to their relatives with GTS and differ from individuals with primary OCD in the absence of a family history of tic disorders.


Inability to demonstrate lytic antibodies to autologous leukaemia cells in the sera from remission patients with acute myelogenous leukaemia treated with active specific immunotherapy.
The sera from seven patients with acute myelogenous leukaemia (AML) who had achieved a clinical remission and who were being maintained by weekly immunotherapy using irradiated allogeneic AML cells and BCG, were examined for the presence of antibodies which were lytic to autologous AML cells using either a complement- or cell-dependent assay. The AML cells had been stored at --179 degrees C and put into a short-term tissue culture prior to testing. At no time during the period of remission or relapse could cytotoxic activity to the autologous cells be detected, although all of the sera had lytic antibodies for some allogenic leukaemia cells. We concluded that the patients were capable of raising lytic antibodies to histocompatibility antigens but did not raise comparable lytic antibodies directed against a leukaemia-specific membrane antigen.


Efficacy of thyroid scintigraphy in the diagnosis of intrathoracic goiter.
For evaluation of the usefulness of thyroid scintigraphy in the diagnosis of intrathoracic goiter, we analyzed the results of radionuclide thyroid scintigraphy in 54 consecutive cases with suspected upper mediastinal masses. Intrathoracic goiters were found in 42. The sensitivity, specificity, and accuracy of the scintigraphy for intrathoracic goiter were 93% (39/42), 100% (12/12), and 94% (51/54), respectively. Scintigraphic morphology, scanning technique, and pitfalls are discussed. The results show that most intrathoracic goiters do have thyroid function and that radioiodine scintigraphy is a definitive and cost-effective diagnostic procedure for this disease.


[Effects of soluble M-CSF receptor on differentiation of umbilical cord blood-derived myelomonocytic hematopoietic precursors in mesenchymal stem cell microenvironment].
To investigate the effects of soluble M-CSF receptor (sMR) on proliferation and differentiation of hematopoietic precursors derived from umbilical cord blood in mesenchymal stem cell (MSC) microenvironment. In group of cytokine (CK) + sMR, MSCs were used as feeder cells, mononuclear cells (MNCs) from cord blood were expanded in MSC microenvironment in presence of SCF, Flt3L, TPO, IL-6 and sMR. In CK control group, no sMR was added. MNC counting and colony forming cell (CFC) culture were performed at week 1, 2, 3 and 4. 1) The number of MNCs increased rapidly in both group CK and group CK + sMR (108.47 -fold and 120.67 -fold, respectively, P > 0.05). 2) CFC increased, peaked at week 3(38.1 x 10(3)) and declined rapidly at week 4(18.1 x 10(3)) in group CK, but still increased in group CK + sMR at week 4 (84 x 10(3)), the total number of CFC was higher in group CK + sMR than in group CK at week 3 and week 4 (P <0.01). 3) The erythroid CFC peaked at week 1 (5891.2 and 5635.6 for groups CK and CK + sMR, respectively), then dropped rapidly and to zero at week 3, in both group CK and group CK + sMR (P > 0. 05). 4) Myeloid CFC expanded continuously and peaked at week 3 (31.5 x 10(3)), then declined at week 4 (18.3 x 10(3)) in group CK; but still increased at week 4(80.8 x 10(3)) in group CK + sMR, being higher than that in group CK at week 3 and week 4 (P <0.01). sMR can inhibit the differentiation of cord blood hematopoietic precursors expanded in MSC microenvironment, but the inhibition exerts only on myelomonocytic but not on erythroid precursors.


Synthesis of amidinohydrazones and evaluation of their inhibitory effect towards aldosterone synthase (CYP11B2) and the formation of selected steroids.
The synthesis and biological evaluation of a series of amidinohydrazones (3a-h, 6a-c, 8 and 9) as potential nonsteroidal inhibitors of aldosterone synthase (CYP11B2) are described. The compounds were tested in vitro using CYP11B2-expressing fission yeast; they showed only marginal inhibitory effect. Compound 6c was evaluated for its effect on the formation of aldosterone, cortisol, androstenedione, and DHEA in the adrenocortical tumor cell line NCI-H295R. It exhibited no significant effect on the production of these products.


Implementation of an image guided intensity-modulated protocol for post-prostatectomy radiotherapy: planning data and acute toxicity outcomes.
There is substantial interest in implementation of image-guided intensity-modulated radiotherapy (IG-IMRT) in the post-prostatectomy setting. We describe our implementation of IG-IMRT, and examine how often published organ-at-risk (OAR) constraints were met. Furthermore, we evaluate the incidence of acute genitourinary and gastrointestinal toxicities when patients were treated according to our protocol. Patients were eligible if they received post-prostatectomy radiotherapy (PPRT). Planning data were collected prospectively, and toxicity assessments were collected before, during and after treatment. Seventy-five eligible patients received either 64 Gy (19%) or 66 Gy (81%) in a single phase to the prostate bed. Suggested rectal dose-constraints of V40Gy < 60% and V60Gy < 40% were met in 64 (85%) and 75 (100%) patients, respectively. IMRT-specific rectal dose-constraints of V40Gy < 35% and V65Gy < 17% were achieved in 5 (7%) and 57 (76%) of patients. Bladder dose-constraint (V50Gy < 50%) was met in 58 (77%) patients. Two patients (3%) experienced new grade 3 genitourinary toxicity and one patient (1%) experienced new grade 3 gastroinestinal toxicity. All grade 3 toxicities had improved by 3-month review. Overall deterioration in urinary and gastrointestinal symptoms occurred in 33 (44%) and 35 (47%) of patients respectively. We report on our implementation of PPRT which takes into account nationally adopted guidelines, with a margin reduction supported by use of daily image guidance. Non-IMRT OAR constraints were met in most cases. IMRT-specific constraints were less often achieved despite margin reductions, suggesting the need for review of guidelines. Severe toxicity was rare, and most patients did not experience deterioration in urinary or bowel function attributable to radiotherapy.


Radiation dose reduction at MDCT with iterative reconstruction for prenatal diagnosis of skeletal dysplasia: preliminary study using normal fetal specimens.
The purpose of this study was to investigate to what degree the radiation dose can be reduced without affecting the ability to evaluate normal fetal bones at MDCT with iterative reconstruction. Fifteen normal fetal specimens immersed in containers (30- and 35-cm diameter) were scanned with a 64-MDCT scanner, with tube voltage of 100 kVp and tube current of 600, 300, 150, 100, and 50 mA. Images were subjected to adaptive statistical iterative reconstruction (ASIR). The fetal dose was measured using glass dosimeters. We calculated the relative ratio of the dose at 600 mA. Image quality was evaluated on maximum-intensity-projection and volume-rendering images. Two radiologists recorded the visualization scores of five regions. Images at 600 mA were considered to be standard. With the 30-cm-diameter container, the fetal dose was 10.15 mGy (relative ratio, 100%) at a tube current of 600, 51% at 300, 25% at 150, 17% at 100, and 9% at 50 mA. With the 35-cm-diameter container the fetal dose was 10.01 mGy (relative ratio, 100%) at 600, 47% at 300, 24% at 150, 17% at 100, and 8% at 50 mA. Visual evaluation showed that in both containers, with ASIR 90%, there was a statistically significant difference between 50-and 600-mA images (p<0.01) but not between 600-mA images and those acquired at 100, 150, and 300 mA (p=0.08-1.00). The fetal radiation dose for the evaluation of normal fetal bones can be reduced by 83% with ASIR 90%.


Association between symptoms of chronic venous disease in the lower extremities and cardiovascular risk factors in middle-aged women.
The association between chronic venous disease (CVD) and atherosclerosis has been intensively investigated. Because data regarding cardiovascular disease in women are sparse, we evaluated the potential association between the symptoms of CVD and cardiovascular risk factors including markers of preclinical atherosclerosis in middle-aged women. A questionnaire for chronic lower limb venous insufficiency was completed by 902 women, aged 45-54 years, from the general population. At the same time, all women were examined for the presence of cardiovascular risk factors, including the ankle/brachial systolic blood pressure index (ABI) and carotid intima media thickness of the common carotid arteries measured by ultrasound. Differences in cardiovascular risk factors and markers of preclinical atherosclerosis between women with and without symptoms of CVD were evaluated. Symptoms (cramps, aching, edema, disturbance of sleep) suggestive of CVD in the lower extremities were reported by 606 (67.2%) women and 114 (12.6%) reported that those symptoms were severe enough to limit their usual daily activities. A higher prevalence of ABI of less than 0.91 was observed in women with any (P=0.005) or severe (P=0.029) CVD symptoms. A significantly higher prevalence of the following were observed in women with any or severe CVD symptoms: coronary artery disease, history of diabetes mellitus, increased body mass index, waist circumference, serum triglycerides, serum C-reactive protein and lower serum HDL cholesterol. CVD symptoms were strongly associated with a higher prevalence of pathological values of ABI and several other manageable cardiovascular risk factors. These findings support the data that chronic venous disease might also indicate increased risk for atherosclerosis.


Release of gliotransmitters through astroglial connexin 43 hemichannels is necessary for fear memory consolidation in the basolateral amygdala.
Recent in vitro evidence indicates that astrocytes can modulate synaptic plasticity by releasing neuroactive substances (gliotransmitters). However, whether gliotransmitter release from astrocytes is necessary for higher brain function in vivo, particularly for memory, as well as the contribution of connexin (Cx) hemichannels to gliotransmitter release, remain elusive. Here, we microinfused into the rat basolateral amygdala (BLA) TAT-Cx43L2, a peptide that selectively inhibits Cx43-hemichannel opening while maintaining synaptic transmission or interastrocyte gap junctional communication. In vivo blockade of Cx43 hemichannels during memory consolidation induced amnesia for auditory fear conditioning, as assessed 24 h after training, without affecting short-term memory, locomotion, or shock reactivity. The amnesic effect was transitory, specific for memory consolidation, and was confirmed after microinfusion of Gap27, another Cx43-hemichannel blocker. Learning capacity was recovered after coinfusion of TAT-Cx43L2 and a mixture of putative gliotransmitters (glutamate, glutamine, lactate, d-serine, glycine, and ATP). We propose that gliotransmitter release from astrocytes through Cx43 hemichannels is necessary for fear memory consolidation at the BLA. Thus, the present study is the first to demonstrate a physiological role for astroglial Cx43 hemichannels in brain function, making these channels a novel pharmacological target for the treatment of psychiatric disorders, including post-traumatic stress disorder.


Comparison of transvaginal sonography with endometrial biopsy in asymptomatic postmenopausal women.
The purpose of this study was to compare TVS with endometrial biopsy as a screening technique in asymptomatic postmenopausal women. Asymptomatic postmenopausal women were recruited by newspaper advertisement. Each study patient was subjected to pelvic examination and TVS followed by endometrial biopsy. Patients with suspected endometrial abnormalities by TVS (normal by endometrial biopsy) were evaluated further with hysteroscopy with biopsy or D&C or both. Eight patients were identified as having abnormalities by TVS, only one of whom had abnormalities by initial endometrial biopsy. Two patients were identified as having abnormalities by endometrial biopsy and normal by TVS. Further evaluation of the seven patients identified as having abnormalities by TVS (normal by endometrial biopsy) documented all seven patients as having abnormalities. The total yield of abnormalities with TVS was 16% (eight of 50 patients). The total yield of abnormalities with endometrial biopsy was 6% (three of 50 patients). The sensitivity of TVS in identifying endometrial abnormalities was 80% (eight of 10), while endometrial biopsy was only 30% (three of 10). TVS was more sensitive in detecting endometrial abnormalities, including endometrial hyperplasia, than was endometrial biopsy. The use of endometrial biopsy as a screening technique in asymptomatic postmenopausal patients is questioned.


[Study strategies on medicinal properties of foreign medicine introduced to traditional Chinese medicine].
The Silk Road and the Maritime Silk Road were the important accesses for the exchanges of herbal medicine between the primary traditional medical systems in the ancient world,which also are the strategic links between the areas with herbal medicine widely used and the most active markets for herbs at present. This article focuses on the foreign medicinal resources introduced to traditional Chinese medicine( TCM) in China. As new resources of Chinese Materia Medica( CMM),the four basic conditions should be required,which are the clear origin,the safety and effectiveness in clinical,the efficacy and properties described with theory of TCM.Medicinal property is the key scientific problem of foreign medicinal resources introduced to TCM. The research strategies include three aspects. Medicinal properties of foreign medicinal resources will be deduced and analyzed across multiple medical systems by solving the difference depending on finding the similarities of traditional medical systems. The medicinal properties-efficacies of foreign medicinal resources will be identified by identifying Xiang and selecting similar CMM. And Xiang-properties-efficacies of foreign medicinal resources will be researched under formulae environment using medicinal properties.


[Rebound hypertension after controlled hypotension and its prevention by captopril].
In 27 patients undergoing ear, nose and throat surgery, the problem of post-hypotensive hypertension (rebound hypertension) following vasodilator-induced controlled hypotension was studied, together with prevention by the ACE inhibitor captopril. Hypotension was induced by sodium nitroprusside (SNP) in seven patients (group 1) and by nitroglycerin (NTG) in ten patients (group 3). Ten patients (group 2) received 25 mg captopril given orally, together with the preanaesthetic medication, as well as SNP. The degree and duration of the decrease in blood pressure did not differ significantly between groups. After discontinuation of the respective vasodilators, blood pressure had increased to above prehypotensive levels in both group 1 (SNP) and group 3 (NTG) 30 min afterward and, to a more marked extent, 60 min afterward. In these groups plasma renin activity (PRA) increased continuously during the hypotensive period up to 11.4 +/- 2.4 and 19.5 +/- 4.5 ng/ml/h, respectively, and had not yet reached its prehypotensive value 60 min after discontinuation. In group 2 (captopril/SNP) there was no overshoot hypertension on discontinuation of SNP, and the average infusion rate of SNP was reduced. PRA was markedly higher than in groups 1 and 3 (peak level 27.9 +/- 6.5 ng/ml/h) due to inhibition of the feedback mechanism in the renin-angiotensin system. From the results it may be concluded that both SNP and NTG can cause rebound hypertension, the extent of which depends on the level of hypotension previously achieved and the infusion rate of the vasodilator. Pretreatment with captopril prevents the rebound and reduces the dosage of vasodilator required and, therefore, may be considered an alternative to the well-documented beta-adrenergic blockers.


Natural LacI from E. coli yields faster response and higher level of expression than the LVA-tagged LacI.
The lac promoter is one of the most commonly used promoters for expression control of recombinant genes in E. coli. In the absence of galactosides, the lac promoter is repressed by its repressor protein LacI. Since the lac promoter is regulated by a repressor, overexpression of LacI is necessary for regulation when the promoter is introduced on a high-copy plasmid. For that purpose, a modified variant of LacI, a LVA-tagged LacI, was submitted to the Registry of Standard Biological Parts and has been used for more than 500 constructs since then. We have found, however, that natural LacI is superior to the LVA-tagged LacI as controller of expression.


Quantification of high-resolution (1)H NMR spectra from rat brain extracts.
Extracting quantitative information about absolute concentrations from high-resolution (1)H NMR spectra of complex mixtures such as brain extracts remains challenging. Partial overlap of resonances complicates integration, whereas simple line fitting algorithms cannot accommodate the spectral complexity of coupled spin systems. Here, it is shown that high-resolution (1)H NMR spectra of rat brain extracts from 11 distinct brain regions can be reproducibly quantified using a basis set of 29 compounds. The basis set is simulated with the density matrix formalism using complete prior knowledge of chemical shifts and scalar couplings. A crucial aspect to obtain reproducible results was the inclusion of a line shape distortion common among all 73 resonances of the 29 compounds. All metabolites could be quantified with <10% and <3% inter- and intrasubject variation, respectively.


Acoustic characteristics of the vowel systems of six regional varieties of American English.
Previous research by speech scientists on the acoustic characteristics of American English vowel systems has typically focused on a single regional variety, despite decades of sociolinguistic research demonstrating the extent of regional phonological variation in the United States. In the present study, acoustic measures of duration and first and second formant frequencies were obtained from five repetitions of 11 different vowels produced by 48 talkers representing both genders and six regional varieties of American English. Results revealed consistent variation due to region of origin, particularly with respect to the production of low vowels and high back vowels. The Northern talkers produced shifted low vowels consistent with the Northern Cities Chain Shift, the Southern talkers produced fronted back vowels consistent with the Southern Vowel Shift, and the New England, Midland, and Western talkers produced the low back vowel merger. These findings indicate that the vowel systems of American English are better characterized in terms of the region of origin of the talkers than in terms of a single set of idealized acoustic-phonetic baselines of "General" American English and provide benchmark data for six regional varieties.


The efficacy of local liposomal bupivacaine infiltration on pain and recovery after Total Joint Arthroplasty: A systematic review and meta-analysis of randomized controlled trials.
Total Joint Arthroplasty (TJA) is gradually emerging as the treatment of choice for end-stage osteoarthritis. In the past, Perioperative liposomal bupivacaine treatment is still a controversial subject in TJA. Therefore, we write this systematic review and meta-analysis to evaluate the efficacy of liposomal bupivacaine on pain and recovery after TJA. Embase, Pubmed, and Cochrane Library were comprehensively searched. Randomized controlled trials (RCTs), cohort studies were included in our meta-analysis. Twelve studies that compared liposomal bupivacaine groups with placebo groups were included in our meta-analysis. The research was reported according to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. RCTs were included in our meta-analysis. Our study demonstrated that liposomal bupivacaine group was as effective as the placebo group in term of VAS score at 24 h (P = .09), 48 h (P = .97); Postoperative nausea (P = .72); and LOS (0.27). There was significant difference in terms of total morphine consumption at 24 h (P < .0001), 48 h (P = .0008). Our meta-analysis demonstrated that liposomal bupivacaine has similar pain control and functional recovery after TJA which compared with the control group. However, we still need large sample size, high-quality studies to explore the relationship between complications and dose response to give the final conclusion.


The interferon-inducible p204 protein acts as a transcriptional coactivator of Cbfa1 and enhances osteoblast differentiation.
The differentiation of uncommitted mesenchymal cells into osteoblasts is a fundamental molecular event governing both embryonic development and bone repair. The bone morphogenetic proteins (BMPs) are important regulators of this process; they function by binding to cell surface receptors and signaling by means of Smad proteins. Core binding factor alpha-1 (Cbfa1), a member of the runt family of transcription factors, is an essential transcriptional regulator of osteoblast differentiation and bone formation, and this process is positively or negatively regulated by a variety of coactivators and corepressors. We report that p204, an interferon-inducible protein that was previously shown to inhibit cell proliferation and promote the differentiation of myoblasts to myotubes, is a novel regulator in the course of osteogenesis. p204 is expressed in embryonic osteoblasts and hypertrophic chondrocytes in the growth plate as well as in the calvaria osteoblasts of neonatal mice. Its level is increased in the course of the BMP-2-triggered osteoblast differentiation of pluripotent C2C12 cells. This increase is probably due to the activation of the gene encoding 204 (Ifi204) by Smad transcription factor, including Smad1, -4, and -5. Overexpression of p204 enhances the BMP-2-induced osteoblast differentiation in vitro, as revealed by elevated alkaline phosphatase activity and osteocalcin production. p204 acts as a cofactor of Cbfa1: 1) high levels of p204 augment, whereas the lowering of p204 level decreases, the Cbfa1-dependent transcription, and 2) p204 associates with Cbfa1 both in vitro and in vivo. Two nonoverlapping segments in p204 bind to Cbfa1, and the N-terminal 88-amino acid segment of Cbfa1 is required for binding to p204. p204, which is the first interferon-inducible protein found to associate with Cbfa1, functions as a novel regulator of osteoblast differentiation.


An unusual cause of lumbar discitis.
Case report. To identify an unusual cause of lumbar discitis. Discitis resulting from a foreign body has not been reported in the English-language literature. A case report is reviewed identifying the presence of this foreign object (titanium), erroneously implanted into the disc space at L5-S1. Imaging studies identify the location and surrounding reaction. The surgical exploration of this disc revealed an inflammatory response surrounding the disc with degeneration within the disc space. If this gynecologic procedure is performed using bone anchors, care must be take to ensure that the sacrum is identified before insertion.


Perforation of Malone antegrade continence enema: diagnosis and management.
Severe bowel dysfunction often accompanies neurogenic bladder, and Malone antegrade continence enema (MACE) procedures can lead to improvement in the quality of life of these patients. However, complications such as catheter false passage with subsequent intraperitoneal instillation of irrigation can lead to significant morbidity. We present our experience with the diagnosis and management of this condition. The records of all patients undergoing MACE procedures at pediatric institutions from 1989 to 2002 were retrospectively reviewed. The records of patients diagnosed with a perforation were assessed for presentation, initial imaging studies, management and outcomes. Of 187 consecutive patients treated with MACE procedures we identified 6 females and 1 male (3.7%). Mean patient age at initial surgery was 11.3 years. Of the 7 patients presented within 3 months of the initial surgery, 6 presented with abdominal pain after irrigation and 4 reported traumatic catheterization. Six patients had extravasation of contrast material on imaging studies. Two patients presented with peritonitis and underwent immediate laparotomy. In 5 patients endoscopy was performed with catheter placement which was then maintained for 6 weeks. After a mean followup of 4.7 years 4 patients have complete continence, 2 have a MACE button in place and 1 has mild fecal leakage. MACE procedures have a low incidence of conduit false passage and perforation. Prompt diagnosis and early intervention are crucial to management. Endoscopic evaluation with catheter placement can be helpful in preserving continence and decreasing morbidity.


Design and rationale for a real-world observational cohort of patients with nonalcoholic fatty liver disease: The TARGET-NASH study.
Nonalcoholic fatty liver disease (NAFLD) is highly prevalent and can lead to cirrhosis, hepatocellular carcinoma, and end-stage liver disease. NAFLD comprises the spectrum from simple steatosis (nonalcoholic fatty liver, NAFL), to steatosis with inflammation (nonalcoholic steatohepatitis, NASH). Current primary therapy recommended for NAFLD is weight loss induced by lifestyle modification. The difficulty in achieving this has led to robust pharmacological therapy development. While new drugs may show efficacy in selected phase II/III clinical trial populations, their real-world effectiveness is unknown. TARGET-NASH is a 5-year, longitudinal, observational study of patients with NAFLD designed to evaluate the effectiveness of clinical practice interventions and provide practical information unobtainable in registration trials. A biological specimen repository is included in TARGET-NASH for translational studies of genomics and biomarkers of disease activity. Patients are enrolling at adult and pediatric sites representing multiple specialties. All patients being managed for NAFLD are eligible, whereas those in other NASH registries or clinical trials will be excluded. Enrolled patients range in age from 6 and up and will have 3years of clinical data reviewed. Patient comorbidities, concomitant medications, disease progression and off-label interventions will be assessed, and adverse outcomes, monitored. Confirming the use, safety and effectiveness of NAFLD interventions in children and adults and establishing pragmatic methods of assessing disease progression under real-world conditions are key study outcomes. Ultimately, TARGET-NASH will establish a large, diverse registry of NAFLD patients at academic and community practices to be leveraged to improve health and reduce development of cirrhosis and hepatocellular carcinoma.


CCR9 Expressing T Helper and T Follicular Helper Cells Exhibit Site-Specific Identities During Inflammatory Disease.
CD4+ T helper (Th) cells that express the gut homing chemokine receptor CCR9 are increased in the peripheral blood of patients with inflammatory bowel disease and Sjögren's syndrome and in the inflamed lesions of autoimmune diseases that affect the accessory organs of the digestive system. However, despite the important role of the GIT in both immunity and autoimmunity, the nature of CCR9-expressing cells in GIT lymphoid organs and their role in chronic inflammatory diseases remains unknown. In this study, we analyzed the characteristics of CCR9+ Th and T follicular helper (Tfh) cells in GIT associated lymphoid tissues in health, chronic inflammation and autoimmunity. Our findings reveal an association between the transcriptome and phenotype of CCR9+ Th in the pancreas and CCR9+ Tfh cells from GIT-associated lymphoid tissues. GIT CCR9+ Tfh cells exhibited characteristics, including a Th17-like transcriptome and production of effector cytokines, which indicated a microenvironment-specific signature. Both CCR9+ Tfh cells and CCR9+ Th cells from GIT-associated lymphoid tissues migrated to the pancreas. The expression of CCR9 was important for migration of both subsets to the pancreas, but Tfh cells that accumulated in the pancreas had downmodulated expression of CXCR5. Taken together, the findings provide evidence that CCR9+ Tfh cells and Th cells from the GIT exhibit plasticity and can accumulate in distal accessory organs of the digestive system where they may participate in autoimmunity.


[The infection rates of echinococcosis and cysticercosis in agricultural animals in the Orenburg Region].
The infection rates of echinococcosis and cysticercosis in cattle and pigs were studied in the Orenburg Region. Those of echinococcosis remained high (the extensiveness of invasion increased from 6.7 to 23.8%, as shown by the 1996-2001 data) despite a considerable reduction in the animal numbers in the 1990s. The infection rate of cysticercosis in the cattle with cysticercosis was much lower (the extensiveness of invasion increased from 0.12 to 0.27% over this period). The lowest infection rate was established for porcine cysticercosis (the extensiveness of invasion was 0.1%).


Photoreceptor Mediated Plant Growth Responses: Implications for Photoreceptor Engineering toward Improved Performance in Crops.
Rising temperatures during growing seasons coupled with altered precipitation rates presents a challenging task of improving crop productivity for overcoming such altered weather patterns and cater to a growing population. Light is a critical environmental factor that exerts a powerful influence on plant growth and development ranging from seed germination to flowering and fruiting. Higher plants utilize a suite of complex photoreceptor proteins to perceive surrounding red/far-red (phytochromes), blue/UV-A (cryptochromes, phototropins, ZTL/FKF1/LKP2), and UV-B light (UVR8). While genomic studies have also shown that light induces extensive reprogramming of gene expression patterns in plants, molecular genetic studies have shown that manipulation of one or more photoreceptors can result in modification of agronomically beneficial traits. Such information can assist researchers to engineer photoreceptors via genome editing technologies to alter expression or even sensitivity thresholds of native photoreceptors for targeting aspects of plant growth that can confer superior agronomic value to the engineered crops. Here we summarize the agronomically important plant growth processes influenced by photoreceptors in crop species, alongwith the functional interactions between different photoreceptors and phytohormones in regulating these responses. We also discuss the potential utility of synthetic biology approaches in photobiology for improving agronomically beneficial traits of crop plants by engineering designer photoreceptors.


Ultrafast dynamics of exciton fission in polycrystalline pentacene.
We use ultrafast transient absorption spectroscopy with sub-20 fs time resolution and broad spectral coverage to directly probe the process of exciton fission in polycrystalline thin films of pentacene. We observe that the overwhelming majority of initially photogenerated singlet excitons evolve into triplet excitons on an ∼80 fs time scale independent of the excitation wavelength. This implies that exciton fission occurs at a rate comparable to phonon-mediated exciton localization processes and may proceed directly from the initial, delocalized, state. The singlet population is identified due to the brief presence of stimulated emission, which is emitted at wavelengths which vary with the photon energy of the excitation pulse, a violation of Kasha's Rule that confirms that the lowest-lying singlet state is extremely short-lived. This direct demonstration that triplet generation is both rapid and efficient establishes multiple exciton generation by exciton fission as an attractive route to increased efficiency in organic solar cells.


A comparative study of the cytogenetic and antineoplasmatic effects induced by carboplatin in combination with niacin in human lymphocytes in vitro and in Ehrlich ascites tumor cells in vivo.
Enhanced sister chromatid exchange (SCE) levels and cell division delays were observed when cultured human lymphocytes treated with carboplatin (cPt) were exposed to niacin. Cytogenetic damage was also observed by cPt when Ehrlich ascites tumor (EAT) cells were exposed in vivo to nontoxic concentrations of niacin. One hour before intraperitoneal injection of 5-bromodeoxyuridine, adsorbed to activated charcoal, EAT-bearing mice treated intraperitoneally with cPt appeared to have a dose-dependent increase in SCEs and cell division delays. Niacin increased the survival time of the EAT-bearing mice treated with cPt and markedly reduced the ascitic volume. Therefore the in vivo antitumor effect of cPt in conjunction with niacin appears to correlate well with the in vitro or in vivo synergistic effects on cytogenetic damage caused by the combined cPt plus Niacin treatment upon human lymphocytes or EAT cells, respectively.


Lipoprotein(a) concentrations and apolipoprotein(a) isoform distribution in a Zimbabwean population.
To determine serum lipoprotein(a)[Lp(a)] concentrations and apolipoprotein(a)[apo(a)] phenotypes in a Zimbabwean population. Cross sectional study. Blood Transfusion Services, Harare, Zimbabwe. 84 black and 40 white blood donors. Lp(a) concentrations and apo(a) phenotypes. The mean and median values for Lp(a) concentrations were 506 and 350 mg/L for the black subjects and 278 and 142 mg/L for the white subjects (p < 0.005). The frequency distributions of Lp(a) concentrations for both populations were skewed to the right. The frequency distribution of apo(a) size, expressed as the number of kringle IV repeats, was determined. Comparison of the frequency distribution plots showed very similar isoform distributions between the two groups. The documented inverse relationship between apo(a) size and Lp(a) concentration was observed in the white population. The Lp(a) levels in the black population were two to three fold higher than in the white population whilst no differences in apo(a) phenotype distribution were noted. This suggests that environmental and metabolic factors may be responsible for the elevated Lp(a) levels observed in blacks. Thus different pathological thresholds may have to be established for elevated serum Lp(a) levels to be used as a risk marker for coronary heart disease in black populations.


Lack of association between interferon-gamma receptor-1 polymorphism and pulmonary TB in Iranian population sample.
Tuberculosis is one of the most common infectious diseases in the world. In recent years, genetically approach has been developed. One of the interesting gene for investigator is IFN-gammaR1. Determination of susceptibility to tuberculosis with polymorphism of IFN-gammaR1 gene. Study was prospective case-control. Fifty patients with smear positive tuberculosis have been chosen randomly. They were matched with 54 healthy controls with no history of TB. Polymorphism at 395 codon of IFN-gammaR1 gene was detected with Newport method. Data were analysed with SPSS version 11. Mean age of patients and control were 55+/-20 and 53+/-13.5 years, respectively. Demographic characteristic had no difference within two groups. One patient in case group had heterozygote mutation at IFN-gammaR1 gene. In control group there were no mutations. Genetically susceptibility to TB is not in 395 colon of IFN-gammaR1 in Iranian TB sample and polymorphism of this loci has occur in 2% of TB patients and 0.96% of total study population.


Positive change with Ménière's disease.
The aims of this study were twofold: to determine in what way people with a non-fatal chronic illness experience positive change after the onset of their illness, and to determine whether comparing with other people with Ménière's disease influenced perceiving this change. Using a longitudinal method, questionnaires were administered at baseline and at ten-month follow-up. At both time points 301 people with Ménière's disease completed the Posttraumatic Growth Inventory and at baseline they also completed questionnaires measuring, demographic variables, disease severity, psychological variables (self-esteem, perceived control, and optimism), and social comparison variables. People with Ménière's disease in this study perceived positive change. Greater positive change was perceived on the domain of 'appreciation of life,' followed by 'relating to others,' 'personal strength,' 'new possibilities,' and 'spiritual change'. In addition, more change was perceived at follow-up than at baseline. Social comparison was associated with perceiving change at both time points. People with Ménière's disease do perceive positive change. Perceiving change is an on-going process for people with Ménière's disease, as they perceived more change over time. Social comparison was related to the perception of change, in particular, to the perception of growth in personal strength.


[HedgeHog inhibitor targeted therapy for periocular basal cell carcinoma: a case report].
A female patient, 87 years old, presented with an irregular swelling in the left medial canthus for 7 years. Due to the patient's poor general condition, radical surgery was not considered appropriate. Surgical biopsy confirmed periocular basal cell carcinoma of the left medial canthus. The patient was administered oral HedgeHog inhibitor targeted therapy for 6 months, resulting in approximately 90% reduction in tumor size. The patient's condition improved, and the tumor remained stable during the course of follow-up.


DCT Regularized Extreme Visual Recovery.
Here we study the extreme visual recovery problem, in which over 90% of pixel values in a given image are missing. Existing low rank-based algorithms are only effective for recovering data with at most 90% missing values. Thus, we exploit visual data's smoothness property to help solve this challenging extreme visual recovery problem. Based on the discrete cosine transform (DCT), we propose a novel DCT regularizer that involves all pixels and produces smooth estimations in any view. Our theoretical analysis shows that the total variation regularizer, which only achieves local smoothness, is a special case of the proposed DCT regularizer. We also develop a new visual recovery algorithm by minimizing the DCT regularizer and nuclear norm to achieve a more visually pleasing estimation. Experimental results on a benchmark image data set demonstrate that the proposed approach is superior to the state-of-the-art methods in terms of peak signal-to-noise ratio and structural similarity.


Antigen biochips verify and extend the scope of antibody detection in Lyme borreliosis.
The antibody response of serum IgM and IgG of patients with neuroborreliosis and erythema migrans of Lyme borreliosis (LB) was examined against a 41-kDa flagellar antigen and an 8-mer synthetic OspC8 peptide (VAESPKKP) derived from the C-terminus of outer surface protein C (OspC) from Borrelia garinii. We developed a streptavidin-modified biochip-based immunodiagnosis and compared it with conventional methods such as enzyme-linked immunosorbent assay (ELISA) and Western blot (WB). The diagnostic sensitivity of the coated biochips was demonstrated to be identical, and the results of conventional assays such as ELISA and WB were confirmed. Flagellar antigens lead to better diagnosis because of a higher discriminative value. By contrast, OspC8, a peptide derived from the outer surface antigen, is less sensitive to identify immunity in LB. The inferior antigenicity of OspC8 may be due to epitope masking. Overall, this system is open to simultaneously analyze a larger family of peptides differing in length. Thus, an array approach is generally more advantageous to extend the pattern of antigens to be tested for antigenicity in LB. Serial analysis during ongoing disease may be valuable to learn more about the course of the disease and intermittent reactivation of infection. Protein biochip as a potential substitution of ELISA and WB method offers the opportunity to study serum immunity in a multiplicity of patients simultaneously.


Thiol ester-linked p-coumaric acid as a new photoactive prosthetic group in a protein with rhodopsin-like photochemistry.
A number of Eubacteria contain a photoactive yellow protein which has a photosensory function in negative phototaxis. It has been proposed that the cofactor responsible for the intense yellow color of this protein is retinal [McRee, D. E., et al. (1989) Proc. Natl. Acad. Sci. U.S.A. 86, 6533-6537]. This would make it the first eubacterial rhodopsin. Here we report the chemical structure of this chromophoric group to be p-coumaric acid, which is covalently bound to a unique cysteine in the apoprotein via a thiol ester bond, and thus not retinal. This makes PYP the first example of a protein containing p-coumaric acid, a metabolite previously found only in plants, as a prosthetic group and establishes the photoactive yellow proteins as a new type of photochemically active receptor molecule.


The lipid-poor hemangioma: an investigation into the behavior of the "atypical" hemangioma.
Most vertebral hemangiomas contain high signal intensity on T1-weighted MRI images. Atypical vertebral hemangiomas, which are defined as showing low-signal intensity on T1-weighted images, have been described as lesions which are prone to aggressive behavior. This study was performed to assess behavior of atypical hemangiomas. Thoracic and lumbar spine MRI reports for the year 2012 were reviewed for diagnosis of atypical hemangioma. Images were reviewed by two independent observers, and cases which showed atypical vertebral hemangioma, and had imaging or clinical follow-up, were included in our study. Thirty atypical hemangiomas which had follow-up data were identified out of 2784 thoracic and lumbar MR examinations performed during 2012 at a single institution. Imaging follow-up was available for 23 lesions (mean follow-up 32 months), while there was clinical follow-up for the remaining seven lesions (mean 43.6 months). Twenty-two lesions were stable on imaging, while one demonstrated significant growth over approximately 6 years, developing MRI signal characteristics of a typical hemangioma. Eleven lesions had CT scans showing typical features of hemangioma. Two of the index lesions could not be identified on follow-up CT examinations, which showed normal-appearing spines. The remaining seven lesions were followed clinically; none of the patients reported symptoms in the region of the index lesions. Atypical hemangiomas are uncommon lesions. The cases in our population did not show aggressive behavior. A more appropriate designation for these lesions may be lipid-poor hemangioma, to distinguish them from aggressive hemangiomas.


Factors influencing the performance of volunteers who provide physical activity in middle schools.
Increasing physical activity among youth represents a national health goal, and using volunteer activity providers at schools offers one possible solution. This paper describes results from a program to recruit volunteer physical activity providers in middle schools. Twenty-one volunteers provided 850 physical activity hours at seven schools, including 575 activity sessions and 7,186 student contacts. Volunteers who received incentives offered more minutes of activity, conducted more activity sessions, reached a greater number of students, and logged more student-minutes of physical activity than those who received none. Male volunteers provided more activity minutes than female volunteers, but females were marginally more successful in engaging female students. Results can help guide schools to more effectively increase student physical activity throughout the school day.


Thoracoscopic thymectomy is a feasible and less invasive alternative for the surgical treatment of large thymomas.
Thoracoscopic surgery is widely used for the surgical treatment of thymoma. However, large-sized thymomas are typically treated using open surgery. This study evaluated the feasibility of performing thoracoscopic thymectomy (TT) for thymoma ≥50 mm. A retrospective review was conducted on 135 patients who underwent TT or open thymectomy (OT) for Masaoka stage I-IVa thymoma between 1996 and 2014. Patients were first divided into two groups based on thymoma size: thymoma ≥50 mm and thymoma <50 mm groups. There was no significant difference in the 5-year disease-free survival (DFS) between the groups ( P = 0.5352). Patients in the thymoma ≥50 mm group were further subdivided into TT and OT groups. The length of postoperative hospital stay was significantly shorter in the TT group than in the OT group (5 vs 14 days, P < 0.0001), with significantly fewer postoperative complications (6 patients vs 14 patients, P = 0.0008). There was no significant difference in the 5-year DFS between patients with thymoma ≥50 mm in the TT and OT groups ( P = 0.3501). Finally, patients undergoing TT were further subdivided into thymoma ≥50 mm and thymoma <50 mm groups and, no significant difference in the 5-year DFS was found between these groups ( P = 0.6661). Masaoka stages III-IV, but not thymoma size, were an independent prognostic factor for DFS. These results demonstrate the decreased invasiveness and feasibility of TT for large-sized thymomas.


Pd-Catalyzed Activation of Carbon-Carbon Bonds in Hydroxymethylfurfural Derivatives.
Palladium-catalyzed activation of C-C bonds in organic molecules is a powerful tool for the synthesis of value-added compounds. 5-Hydroxymethylfurfural (HMF) derivatives are a promising class of biomass-derived chemicals that have received considerable attention due to their potential applications in the synthesis of biologically active molecules and materials. However, the selective activation of unstrained C-C bonds is a challenging task, mainly due to their relatively high bond dissociation energies. Herein, we report a palladium-catalyzed method for the efficient C-C bond activation of HMF derivatives, enabling their arylation with iodobenzenes. Mechanistic studies, including reaction-profile analysis, competition experiments and head-space IR spectroscopy suggest a decarboxylative mechanism.


Pronounced structural similarities between the small subunit ribosomal RNA genes of wheat mitochondria and Escherichia coli.
We present here the nucleotide sequence of the small subunit (18S) rRNA gene from wheat mitochondria. Aside from five discrete variable domains, this gene and the analogous (16S) rRNA gene in Escherichia coli show essentially a one-to-one correspondence in their potential secondary structures, with regions accounting for 86% of the bacterial 16S rRNA having a strict secondary structure counterpart in the mitochondrial 18S rRNA. Primary sequence identity between the two rRNAs ranges from 73% to 85% (76% overall) within regions of conserved secondary structure. Within a smaller secondary structure core common to all small subunit rRNAs, the wheat mitochondrial sequence shares substantially more primary sequence identity with the E. coli (eubacterial) sequence (88%) than with the small subunit rRNA sequences of Halobacterium volcanii (an archaebacterium) (71%) or Xenopus laevis cytoplasm (61%). Moreover, the wheat mitochondrial sequence contains a very high proportion of certain lineage-specific residues that distinguish eubacterial/plastid 16S rRNAs from archaebacterial 16S and eukaryotic cytoplasmic 18S rRNAs. These data establish that the ancestry of the wheat mitochondrial 18S rRNA gene can be traced directly and specifically to the eubacterial primary kingdom, and the data provide compelling support for a relatively recent xenogenous (endosymbiotic) origin of plant mitochondria from eubacteria-like organisms.


Caring and curing: Considering the effects of hepatitis C pharmaceuticalisation in relation to non-clinical treatment outcomes.
The development of simplified and effective hepatitis C (HCV) pharmaceuticals enables treatment scale up among the most marginalised. This potentiates a promise of viral elimination at the population level but also individual level clinical and non-clinical benefits. Reports of transformative non-clinical outcomes, such as changes in self-worth and substance use, are primarily associated with arduous interferon-based treatments that necessitate intensive care relationships. We consider the implications of simplified treatment provision in the era of direct acting antivirals (DAAs) for the realisation of non-clinical benefits. We draw on qualitative data from ethnographic observations and longitudinal interviews with people receiving (n = 22) and providing (n = 10) HCV treatment in London during a transition in HCV biomedicine. First generation DAAs in conjunction with interferon were standard of care for most of this time, with the promise of simplified treatment provision on the horizon. Patient accounts of care accentuate the transformative value of interferon-based HCV treatment derived through non-clinical benefits linked to identity and lifestyle change. Such care is constituted as extending beyond the virus and its biomedical effects, with nurse specialists positioned as vital to this care being realised. Provider accounts emphasise the increased pharmaceuticalisation of HCV treatment; whereby care shifts from the facilitation of therapeutic relationships to pharmaceutical access. HCV care in the interferon-era affords identity transformations for those receiving and providing treatment. Biomedical promise linked to the increasing pharmaceuticalisation of HCV treatment has disruptive potential, shifting how care is practised and potentially the realisation of non-clinical treatment outcomes.


[G-proteins coupled receptors].
The superfamily of G protein-coupled receptors plays a major role in the transmission and amplification of extracellular stimuli. These membrane receptors have a common structure made of a single polypeptide chain including seven transmembrane spanning domains. The comparison of amino acid sequences of the various G protein-coupled receptors reveals several conserved amino acids and regions playing a key role in ligand binding, G protein coupling, and activation of intracellular second messengers. Mutations of amino acid sequences of seven transmembrane domain receptors and their coupled G proteins are responsible for various human diseases including certain kinds of cancer.


Kosovo's Experience for Children with Feeding Difficulties after Cardiac Surgery for Congenital Heart Defect.
A feeding disorder in infancy and during childhood is a complex condition involving different symptoms such as food refusal and faddiest, both leading to a decreased food intake. We aimed to assess the prevalence and predictor factors of feeding difficulties in children who underwent cardiac open heart surgery in neonatal period and infancy. We address selected nutritional and caloric requirements for children after cardiac surgery and explore nutritional interdependence with other system functions. This was a retrospective study in a tertiary referral hospital, and prior approval from the institutional ethics committee was obtained. Information for 78 children (42 male and 36 female) was taken from patients charts. Data were analysed with descriptive statistics and logistic regression. From a cohort of analysed children with feeding problems we have occurred in 23% of such cases. At the time of the study, refusal to eat or poor appetite was reported as a significant problem in 19 children and subnormal height and weight were recorded in 11 children. Early neonatal intervention and reoperation were identified as risk factors for latter feeding difficulties or inadequate intake. Children with feeding problems also tended to eat less than children without feeding problems. There was a trend towards more feeding problems in patients with chromosomal abnormalities or other associated anomalies. Feeding disorder is often and a frequent long-term sequel in children after neonatal or early infancy heart surgery. Patients with chromosomal and associated anomalies who underwent multiple cardiac surgeries are at risk of developing feeding difficulties.


Characterization of novel intragenotype recombination events among norovirus pandemic GII.4 variants.
Recently, there has been an increase in the number of children hospitalized due to norovirus infection in Brazil. This is due both to the occurrence of more severe norovirus-related gastroenteritis cases after the introduction of the rotavirus vaccine and an increase in the tools for the detection of the disease. This pathogen is transmitted by the fecal-oral route, and the illness is characterized by diarrhea, vomiting, nausea and abdominal cramps. The genome of the virus is organized into three open reading frames showing strong mutation rates. Additionally, homologous recombination events, which can increase the virulence of the virus and lead to genotyping mistakes in molecular epidemiological studies, frequently occur. The purpose of this study was to describe two recombination events among different GII.4 variants that infected children who were hospitalized for severe acute gastroenteritis during distinct periods of time in Belém, Brazil. The recombination among the variants US95_96/Kaiso_2003 and Den Haag_2006b/Yerseke_2006a were observed in May 2003 and February 2009, respectively. In both cases, the association between the dominant variant at that point in time and another that was circulating at a low frequency in the population of Belém was demonstrated. Interestingly, the position of the breakpoint of the recombination event in the genome was the polymerase gene and was located at the nucleotide positions 4.834 and 5.002, which is an unusual location for the occurrence of recombination as other studies have previously reported the junction region as a breakpoint. In this study, both recombinant variant strains were related to severe cases of diarrhea that lead to hospitalization, demonstrating the viral evolution of GII.4 in response to selective pressures, which ultimately lead to the emergence of novel viral types in the pediatric population. The cases discussed here reinforce the need for continuous norovirus surveillance. To our knowledge, these two GII.4 variant recombinations have not yet been previously described.


Female bladder exstrophy: report of 2 unique cases and review of the literature.
Bladder exstrophy is a rare lower urinary tract malformation that occurs less frequently in women than in men. We report 2 cases of bladder exstrophy occurring in women. One patient was an adult with congenital bladder exstrophy; the patient's bladder wall flap was used to reconstruct the neourethra after the bladder was closed using a conventional procedure. The other patient experienced lower abdominal trauma that led to widespread loss of skin and subcutaneous tissue, exposing the bladder in the lower abdominal wall. In this patient, a pedicled gracilis muscle flap was used to close the abdominal wall after the closure of the bladder. To our knowledge, the first is the fifth reported case of bladder exstrophy in an adult woman and the latter is the first reported case of bladder exstrophy caused by trauma. Both patients showed good outcomes after undergoing surgical treatment.


[The "Alphabetical Dioscorides" (a propos the Codex Vindobonensis Med. gr. 1)].
The Greek "Alphabetical Dioscorides" of the Codex Vindobonensis (Viennese Codex) is above all a bibliographic work, remarkably illustrated, intended to show gratitude to an eminent person. It comprises exclusively currently-available plants which might be used by people of a cultivated milieu, who, not having studied medicine, would like to cure relatively benign illnesses while limiting any recourse to exotic drugs. On the contrary, the Latin Alphabaeticals from the eleventh century and the centuries following, as well as the Greek Alphabeticals of the Renaissance, cover all the drugs in the Materia medica and respond to the desire to quickly find the pharmacologic properties of medicinal herbs introduced into prescriptions which might be formulated by physicians.


A Longitudinal Study of Acculturation in Context and Cardiovascular Health and Their Effects on Cognition Among Older Latino Adults.
Background We previously outlined the importance of considering acculturation within the context of older Latino adults' lived experience (ie, acculturation in context) to better capture contributors to cognitive aging. We now examine this conceptual framework as related to level of and change in cardiovascular health, and whether cardiovascular health modifies previously documented associations of acculturation in context with cognition. Methods and Results Acculturation in context data from 192 Latino participants without dementia at baseline (age ~70 years) were compiled into 3 separate composite scores: acculturation-related (nativity, language-, and social-based preferences), contextually related socioenvironmental (experiences of discrimination, social isolation, social networks), and familism-related (Latino-centric family ethos). A modified American Heart Association's Life's Simple 7 (mLS7; ie, smoking, physical activity, body mass index, blood pressure, total cholesterol, blood glucose) was used to measure cardiovascular health. Mixed effects regressions simultaneously tested the association of all 3 composite scores with total mLS7 adjusting for confounders. Separate models tested whether mLS7 modified associations of the 3 composite scores and cognition. The contextually related socioenvironmental composite score reflecting higher discrimination, higher social isolation, and smaller social networks (estimate=0.22, SE=0.10, P=0.02) and the familism score (estimate=0.16, SE=0.07, P=0.02) both significantly associated with change in total mLS7. The acculturation-related composite was not significantly associated with change in mLS7. No composite was significantly associated with level of mLS7. Total mLS7, however, significantly modified associations between the acculturation-related composite and change in working memory (estimate=-0.02, SE=0.01, P=0.043). Conclusions Acculturation within the context of older Latino adults' lived experience is important for maintaining cardiovascular health, relationships that also affect domain-specific cognitive decline.


Genetic evidence for a mammalian retromer complex containing sorting nexins 1 and 2.
We have previously shown that the putative mammalian retromer components sorting nexins 1 and 2 (Snx1 and Snx2) result in embryonic lethality when simultaneously targeted for deletion in mice, whereas others have shown that Hbeta58 (also known as mVps26), another retromer component, results in similar lethality when targeted for deletion. In the current study, we address the genetic interaction of these mammalian retromer components in mice. Our findings reveal a functional interaction between Hbeta58, SNX1, and SNX2 and strongly suggest that SNX2 plays a more critical role than SNX1 in retromer activity during embryonic development. This genetic evidence supports the existence of mammalian retromer complexes containing SNX1 and SNX2 and identifies SNX2 as an important mediator of retromer biology. Moreover, we find that mammalian retromer complexes containing SNX1 and SNX2 have an essential role in embryonic development that is independent of cation-independent mannose 6-phosphate receptor trafficking.


Homicides among 15-19-year-old males--United States, 1963-1991.
In 1991, nearly half (13,122 [49%]) of the 26,513 homicide victims in the United States were males aged 15-34 years. In addition, among males in this age group, homicide accounted for 18% of all deaths and was the second leading cause of death (Table 1). During 1963-1991, the pattern of homicide rates changed substantially; the change was greatest for males aged 15-19 years, for whom rates increased substantially (Figure 1). This report summarizes these trends and presents strategies for violence prevention and intervention.


Effects of perfluorohexane vapor in the treatment of experimental lung injury.
We investigated the effects of vaporized perfluorohexane (PFH) on pulmonary vascular tone, pulmonary vascular resistance and peak inspiratory pressure as well as lipid mediator formation in the treatment of calcium ionophore induced lung injury in a model of the isolated perfused and ventilated rabbit lungs. Lung injury was induced in isolated perfused and ventilated rabbit lungs by calcium ionophore A23187. Lungs were treated with either 4.5 vol.% (4.5 vol.% PFH; n = 6) or 18 vol.% (18 vol.% PFH; n = 6) PFH. Six lungs remained untreated (Control). In addition 5 lungs (PFH-sham) remained uninjured receiving 18 vol.% PFH only. Mean pulmonary artery pressure (mPAP), peak inspiratory pressure (P(max)), and lung weight (weight) were monitored for 120 min. Experiments were terminated before when the increase in lung weight exceeded 40 g. Perfusate samples were taken at regular intervals for analysis of TXB(2), 6-keto-PGF(1) and LTB(4). Controls reached the study end point significantly earlier than both PFH groups. Significant differences were found for a weight gain of 10 g and 20 g between the control and the 4.5 vol.% PFH and the 18 vol.% PFH. Differences in mPAP were more pronounced in the 4.5 vol.% PFH. However increases in P(max) were more marked in 4.5 vol.% PFH. TXA(2)-, PGI(2)-, and LTB(4)-levels were significantly lower in PFH groups. Uninjured lungs remained unaffected by the presence of 18 vol.% PFH. Inflammatory lung injury was attenuated by the treatment with 4.5 vol.% PFH and 18 vol.% PFH vapor in the isolated perfused rabbit lung. Therapeutic effects were more pronounced with a concentration of 4.5 vol.% PFH.


Impact of intravascular hemolysis in malaria on liver dysfunction: involvement of hepatic free heme overload, NF-κB activation, and neutrophil infiltration.
We have investigated the impact of persistent intravascular hemolysis on liver dysfunction using the mouse malaria model. Intravascular hemolysis showed a positive correlation with liver damage along with the increased accumulation of free heme and reactive oxidants in liver. Hepatocytes overinduced heme oxygenase-1 (HO-1) to catabolize free heme in building up defense against this pro-oxidant milieu. However, in a condition of persistent free heme overload in malaria, the overactivity of HO-1 resulted in continuous transient generation of free iron to favor production of reactive oxidants as evident from 2',7'-dichlorofluorescein fluorescence studies. Electrophoretic mobility shift assay documented the activation of NF-κB, which in turn up-regulated intercellular adhesion molecule 1 as evident from chromatin immunoprecipitation studies. NF-κB activation also induced vascular cell adhesion molecule 1, keratinocyte chemoattractant, and macrophage inflammatory protein 2, which favored neutrophil extravasation and adhesion in liver. The infiltration of neutrophils correlated positively with the severity of hemolysis, and neutrophil depletion significantly prevented liver damage. The data further documented the elevation of serum TNFα in infected mice, and the treatment of anti-TNFα antibodies also significantly prevented neutrophil infiltration and liver injury. Deferoxamine, which chelates iron, interacts with free heme and bears antioxidant properties that prevented oxidative stress, NF-κB activation, neutrophil infiltration, hepatocyte apoptosis, and liver damage. Furthermore, the administration of N-acetylcysteine also prevented NF-κB activation, neutrophil infiltration, hepatocyte apoptosis, and liver damage. Thus, hepatic free heme accumulation, TNFα release, oxidative stress, and NF-κB activation established a link to favor neutrophil infiltration in inducing liver damage during hemolytic conditions in malaria.