Application of IRI Visualization to Terahertz Vibrational Spectroscopy of Hydroxybenzoic Acid Isomers.
The characteristic absorption spectra of three positional isomers of hydroxybenzoic acid are measured using a terahertz time-domain spectroscopy system (THz-TDS) in the 0.6-2.0 THz region at room temperature. Significant differences in their terahertz spectra are discovered, which indicates that THz-TDS is an effective means to identify positional isomers. In order to simulate their spectra, the seven molecular clusters of 2-, 3-, and 4-hydroxybenzoic acid (2-, 3-, and 4-HA) are calculated using the DFT-D3 method. Additionally, the potential energy distribution (PED) method is used to analyze their vibration modes. The analysis indicates that the vibration modes of 2-HA are mainly out-of-plane angle bending and bond angle bend in plane. The vibration modes of 3-HA are mainly bond length stretch and dihedral angle torsion. The vibration modes of 4-HA are mainly bond angle bend in plane and dihedral angle torsion. Interaction region indicator (IRI) analysis is used to visualize the location and type of intermolecular interactions in 2-, 3-, and 4-HA crystals. The results show that the weak interaction type of 2-, 3-, and 4-HA is dominated by van der Waals (vdW) interaction. Therefore, we can confirm that terahertz spectroscopy detection technology can be used as an effective means to identify structural isomers and detect the intermolecular interactions in these crystals. In addition, it can explain the absorption mechanism of terahertz waves interacting with matter.


Racial-Ethnic Differences in Fall Prevalence among Older Women: A Cross-Sectional Survey Study.
Falls are the leading cause of hip fracture in older women, with important public health implications. Fall risk increases with age and other clinical factors, and varies by race/ethnicity. International studies suggest that fall risk is lower in Asians, although data are limited in U.S. This study examines racial/ethnic differences in fall prevalence among older U.S. women within a large integrated healthcare delivery system. This cross-sectional study used data from 6277 women ages 65-90 who responded to the 2008 or 2011 Kaiser Permanente Northern California Member Health Survey (KPNC-MHS). The KPNC-MHS is a mailed questionnaire sent to a random sample of adult members stratified by age, gender, and geographic location, representing a population estimate of >200,000 women age ≥65 years. Age, race/ethnicity, self-reported health status, presence of diabetes, arthritis or prior stroke, mobility limitations and number of falls in the past year were obtained from the KPNC-MHS. The independent association of race/ethnicity and recent falls was examined, adjusting for known risk factors. The weighted sample was 76.7% non-Hispanic white, 6.2% Hispanic, 6.8% black and 10.3% Asian. Over 20% reported having fallen during the past year (28.5% non-Hispanic white, 27.8% Hispanic, 23.4% black and 20.1% Asian). Older age was associated with greater fall risk, as was having diabetes (OR 1.24, CI 1.03-1.48), prior stroke (OR 1.51, CI 1.09-2.07), arthritis (OR 1.61, CI 1.39-1.85) and mobility limitations (OR 2.82, CI 2.34-3.39), adjusted for age. Compared to whites, Asian (OR 0.64, CI 0.50-0.81) and black (OR 0.73, CI 0.55-0.95) women were much less likely to have ≥1 fall in the past year, adjusting for age, comorbidities, mobility limitation and poor health status. Asians were also less likely to have ≥2 falls (OR 0.62, CI 0.43-0.88). Among older women, the risk of having a recent fall was substantially lower for black and Asian women when compared to white women. This may contribute to their lower rates of hip fracture. Future studies should examine cultural and behavioral factors that contribute to these observed racial/ethnic differences in fall risk among U.S. women.


Comprehensive Survey of Machine Learning Systems for COVID-19 Detection.
The last two years are considered the most crucial and critical period of the COVID-19 pandemic affecting most life aspects worldwide. This virus spreads quickly within a short period, increasing the fatality rate associated with the virus. From a clinical perspective, several diagnosis methods are carried out for early detection to avoid virus propagation. However, the capabilities of these methods are limited and have various associated challenges. Consequently, many studies have been performed for COVID-19 automated detection without involving manual intervention and allowing an accurate and fast decision. As is the case with other diseases and medical issues, Artificial Intelligence (AI) provides the medical community with potential technical solutions that help doctors and radiologists diagnose based on chest images. In this paper, a comprehensive review of the mentioned AI-based detection solution proposals is conducted. More than 200 papers are reviewed and analyzed, and 145 articles have been extensively examined to specify the proposed AI mechanisms with chest medical images. A comprehensive examination of the associated advantages and shortcomings is illustrated and summarized. Several findings are concluded as a result of a deep analysis of all the previous works using machine learning for COVID-19 detection, segmentation, and classification.


Comparative structure and physicochemical properties of Ilpumbyeo, a high-quality japonica rice, and its mutant, Suweon 464.
A new rice mutant Suweon 464 (S-464) derived from a high-quality rice, Ilpumbyeo (IP), revealed a striking difference in cooking quality from IP. The physicochemical properties of S-464 and IP were compared. S-464 was unusually high in amylose and fiber contents, had B-type crystallinity of starch, and had a markedly lower proportion of short chains in the distribution of glucan-chain fractions of debranched starch as compared with IP. Scanning electron microscopy revealed that starch granules of S-464 were much smaller in size than those of IP and that many of them were not separated from amyloplasts. The physicochemical properties of S-464 would contribute to poor gelatinization, lower swelling power, higher hardness, and less stickiness when cooked. Although S-464 may not be desirable for cooked rice, the mutant could be an excellent candidate for other processed food products on the basis of its unusual properties of starch and high fiber, protein, and lipid contents.


[Patient's information and announcement of a serious disease].
The announcement of a serious disease to a patient and an adequate information are never easy. Some physicians are more comfortable than others. However, some knowledges on usual reactions of patients and on new rules could be useful. The complete information of the patient is a duty with regard to the law, although it could be facultative in some rare circumstances. The medical confidence has to be respected with all persons, even among close relations of the patient. It is not contradictory with a therapeutic alliance with these close relations. The announcement must be provided by the doctor who first suggested the diagnosis. An anxious reaction is normal. Mechanisms of defence, appropriate or not, are developed by the patient. Nonetheless, precise information seems to be less anxiogenic than non resolved questions. Fears of some physicians, who avoid information, often appear linked to their own anxiety. Nevertheless, good information is associated with adequate words and adequate choice of news. There is need to evaluate knowledges of the patient on his/her disease. Complete and adequate information must be associated with an early psychological (and sometimes social) help. It appears necessary for well-being of the patient but also maybe for his/her prognosis.


[Penile fracture with associated urethra lesion: case report and bibliographic review].
Penile fracture is a rare lesion that occurs almost exclusively during erection. This lesion may be associated with rupture of the urethra in 20-30% of the cases. We describe a case that has been treated at our institution and review the literature. A-42-year-old patient suffered fracture of penis, with urethral section, during sexual intercourse. The patient underwent surgical exploration, the lesions of the corporal bodies and urethra were identified. Both lesions were repaired. patient's recovery was satisfactory without complications or esthetical or functional sequelae. Penile fracture with urethral section is an exceptional disease, the most frequent cause of which in occident is violent sexual activity. For diagnosis it is necessary in most cases a correct anamnesis and physical examination. Early surgical approach and closure of the albuginea's lesion and repair of the urethral lesion is the best way of treatment.


Dosage effect of cisatracurium on intubation and intraoperative neuromonitoring during thyroidectomy: a randomized controlled trial.
Intraoperative neuromonitoring (IONM) reduces the risk of recurrent laryngeal nerve (RLN) injury during thyroid surgery. However, the use of neuromuscular blocking agents (NMBAs), which are essential to improve intubation conditions, may hinder the electromyographic response during IONM. The aim of this prospective, double-blind, randomized controlled trial was to explore the optimal dosage of cisatracurium to produce adequate muscle relaxation for tracheal intubation without significantly affecting evoked potentials of IONM during thyroidectomy. Patients undergoing thyroidectomy with IONM in our institution, with an American Society of Anesthesiologists grade of I-II, aged 18-75 years, and with a body mass index below 32 kg/m2 were enrolled and randomly assigned (by random numbers) to receive 1× (group C1) or 2× (group C2) the effective dose (ED95) of cisatracurium for tracheal intubation. The patients, surgeons, and anesthesiologists in charge were blinded to group assignment. Anesthesia was induced with sufentanil, propofol, and cisatracurium (0.05 mg/kgin group C1, 0.1 mg/kg in group C2). Ease of intubation was evaluated with the intubation condition score (Cooper score) and the intubation difficulty scale (IDS). Amplitudes of evoked potentials during intermittent IONM were compared between groups. The primary outcomes were the Cooper score, the IDS score, and the evoked potentials of IONM. Fifty-three patients were randomized from October 2019 to November 2020, and 52 were analyzed (with 26 patients in each group). The Cooper score was significantly lower in group C1 [median, 8.0 (interquartile range, 7.0-8.3)] than in group C2 [9.0 (9.0-9.0), P<0.001]. The rate of difficult laryngoscopy without external laryngeal pressure was significantly higher in group C1 than in group C2 (61.5% vs. 11.5%, P<0.001). More patients in group C1 required assistance to complete tracheal intubation (16 vs. 4, P=0.001). The IDS score was significantly higher in group C1 [3.0 (0.0-4.0) vs. 1.0 (0.0-1.0), P=0.045]. There were no significant differences between groups in amplitudes of evoked potentials. No serious adverse events were observed. A dose of 2× ED95 of cisatracurium provided better intubation conditions and easier tracheal intubation than 1× ED95, without disturbing IONM. Chinese Clinical Trial Registry (No. ChiCTR1900022884).


Central cardiovascular dynamics of ducks.
Blood pressures and flows have been recorded from the heart and arterial arches of ducks in order to present a complete picture of central hemodynamics in an avian species. An attempt has also been made to define the characteristics of the avian central circulation in terms of either "windkessel", or wave-transmission models. Mean arterial pressure (143 plus or minus 2.2 mmHg) and cardiac output (219 plus or minus 7ml/kg per min) were high compared with those of similarly sized mammals, although therewas no evidence of elevated pulmonary pressures, perhaps because of the unusual structure of the avian lung. Only 25% of the total systemic flow was distributed by the aorta, the remainder supplying the wing, flight muscles, and head via the brachiocephalic arteries. The contours of central pressure and flow waves ressembled those recorded inmammal except that significant circulation impedance modulus graphs indicated that resistance to pulsatile flow fell sharply to a minimum of 1/30th the DC value at 9-12 Hz. Flow led pressure at frequencies below 9-12Hz and pressure led flow at higherfrequencies. Impedance modulus in the pulmonary circulation fell to one-half the DC value and remained constant over a wide range of frequencies with pressure and flow being in a phase at all frequencies. Aortic pulse wave velocity varied with position inthe aorta as did the pressure pulse profile: these factors obviously limit the applicability of a windkessel model to the avian circulation.


Current perioperative practice in Canadian vascular surgery.
The Enhanced Recovery After Surgery (ERAS) Society has set out to improve patient recovery by developing evidence-based perioperative practices. Many institutions and other specialties have begun to apply their principles with great success; however, ERAS principles focus mostly on general surgery, and their applicability to other specialties, such as vascular surgery, is less clear. We sought to investigate the current standard of perioperative care in Canadian vascular surgery by assessing surgeons' perceptions of evidence supporting ERAS practices, identifying barriers to aligning them and identifying aspects of perioperative care that require research specific to vascular surgery before they could be broadly applied. We administered an online survey with 26 questions to all Canadian Society for Vascular Surgery members. Respondents varied largely in perioperative practice, most notably in the use of nasogastric tubes, Foley catheters and neck drains. Familiarity with supporting evidence was poor. Approximately half (44%) of respondents were not familiar with contrary evidence, while those who were often perceived institutional barriers to change. Finally, one-third (30%) of respondents felt that relevant evidence did not exist to support changing their practice. The variability of perioperative practice in Canadian vascular surgery is likely due to multiple factors, including a lack of specific evidence. Further research in areas of perioperative vascular care where the current standard of practice varies most greatly may help improve recovery after vascular surgery in Canada over simply adopting existing ERAS principles.


[Clinical analysis of multiple primary carcinomas in colorectal cancer patients].
To explore the prevalence, clinical features and prognosis of multiple primary neoplasms in patients with colorectal carcinoma (CRC). Data of colorectal cancer patients admitted to our hospital from June 1994 to June 2002 were analyzed retrospectively. Patients were divided into multiple-cancer group (MCG) and single- cancer group (SCG). Clinical features and prognosis were compared between two groups. The incidence of multiple cancers was 7.4 % (83/ 1125). Forty- seven patients had multiple colorectal cancers metachronous CRC(S) in 12 and synchronous CRC(S) in 35. Thirty- six patients 5 patients with synchronous cancers had malignant tumors outside colorectal tract,12 of whom were gastric carcinomas. No significant differences were found between MCG and SCG regarding gender, onset age, Dukes stage and differentiation of index CRC. Cancer family history (P=0.002) and colorectal adenoma (P=0.036) were significantly more common in MCG than those in SCG. The local recurrence or distant metastasis in MCG was significantly higher than that in SCG (P=0.047), though there was no significant difference in survival between the two groups. Forty- one percent of index tumors were located in right colon in MCG, significantly higher than that in SCG (P=0.048). The secondary tumors were mainly adenoma cancerization in MCG. Cancer family history and colorectal adenoma seems to be at high risk for developing multiple cancers in CRC patients. Gastric cancer and colorectal adenoma cancerization were common secondary tumors of multiple primary neoplasms in patients with colorectal carcinoma.


A theoretical study on the palladium-catalyzed oxidative carbocyclization-alkoxycarbonylation of bisallenes to construct seven-membered carbocycles assisted by olefins.
The reaction mechanisms of the Pd(ii)-catalyzed oxidative carbocyclization-alkoxycarbonylation of bisallenes to construct seven-membered carbocycles have been theoretically investigated with the aid of density functional theory (DFT) calculations. Our calculation results account for the experimental fact that the product should be the seven-membered carbocycle P1 instead of the spiro-type product P2. Our calculations indicate that CO coordination should occur prior to the ring closing step, which determines the regioselectivity. Through investigating the corresponding natural bond orbital (NBO) charges, we find that an electron withdrawing carbonyl group would decrease the electron density and lower the activation barrier. Therefore, the regioselectivity is dominated by the electronic effect.


Transcranial duplex ultrasound: experience with contrast enhancing agents.
Transcranial duplex real time sonography (TCCS) is a non-invasive imaging modality that allows repetitive examinations of central nervous system vascular and parenchymal anatomy; a broad spectrum of cerebral pathology may be disclosed: vascular changes include ischemic and hemorrhagic stroke, arteriosclerotic vascular degeneration, arteno-venous malformations and aneurysms, as well as neoplastic and degenerative parenchymal disorders. Imaging was performed with a duplex ultrasound system, employing a 2.25 resp. 2.0 MHz phased-array transducer. Imaging was achieved through the acoustic bone window of the temporal bone and through the foramen magnum. For three-dimensional image reconstruction a mechanical position sensor and online video grabbing was applied. To evaluate the potential of a transpulmonary stable ultrasound contrast enhancing agent we used galactose-based SH U 508 A (Levovist, Schering, Berlin) with 1 to 6 i.v. injections per patient in a phase 2/3 clinical protocol. The signal to noise ratio is significantly improved; the Doppler signal intensity is increased by approx. 25 dB. Levovist was well tolerated and no adverse events occurred, approx. 30% of patients had a sensation of heat and slight pain at the injection site during and shortly after the injection. With the increase in signal intensity, the complete circle of Willis, the peripheral arterial branches, the vertebro-basilar system and the basal venous system may be depicted. In addition, tumour parenchyma vascularisation may be detected, as well as improved delineation of arteriovenous malformations and aneurysms. Three dimensional image reconstruction may represent a novel option in contrast enhanced transcranial duplex imaging including additional information about 3D structure and continuity.


Public perceptions of the transmission of pandemic influenza A/H1N1 2009 from pigs and pork products in Australia.
A cross-sectional study was conducted at the height of the pandemic influenza H1N1/09 outbreak in Australia in 2009. The objectives of the study were to evaluate public perceptions about transmission and prevention of the disease, to understand their concerns and preparedness to cope with the disease, and to investigate drivers influencing their behaviour. A questionnaire was designed and administered to 510 customers visiting 15 butcher shops in the Greater Sydney region between 26th June and 2nd August 2009. Data were analysed to estimate the proportion of people with certain perceptions and to evaluate the influence of these perceptions on two binary outcome variables: (1) whether or not people believed that avoiding pork would protect them from contracting H1N1/09, and (2) whether or not they actually made some changes to pork consumption after the outbreak. A majority of the respondents had perceptions based on fact about transmission and prevention of H1N1/09. As many as 96.8% of the respondents believed that washing their hands frequently was likely to protect them from contracting H1N1/09. Similarly, most believed that they could contract H1N1/09 by travelling on public transport with a sick person present (94.1%), by shaking hands with a sick person (89.2%), or by attending a community gathering (73.7%). Women were more likely than men to have factual perceptions about protective behaviours. Misconceptions regarding transmission of the disease were evident, with 21.7% believing that avoiding eating pork could protect them against H1N1/09, 11.1% believing that they could contract H1N1/09 by drinking tap water, 22.8% by handling uncooked pork meat and 15.6% by eating cooked pork. Approximately one third of respondents believed that working in a pig farm or an abattoir increased their likelihood of contracting H1N1/09 (36.9% and 32.3%, respectively). Younger people (<35 years old) were more likely to have these misconceptions than older people. Reduction in consumption of pork, ham or bacon was significantly associated with misconceptions regarding the risk of contracting H1N1/09 from eating pig meat products. It is recommended that in the event of a future disease emergency, communication activities providing factual information and targeting younger people should be used.


Nutrition and cancer risk: an overview.
The role of diet in cancer is a major public health issue Foods associated with a low risk of cancer are those typically included in the so-called Mediterranean diet, which is also associated with low mortality rates from cardiovascular disease. Implementing such a diet would involve increasing the consumption of fruits, vegetables, cereals, whole-grain foods and fish, while reducing the intake of refined carbohydrates and red meat. In addition, olive oil should replace saturated fats. Omega-3 fatty acids found in fish inhibit the growth in vitro of colon, breast and prostate cancers. Fibre can bind bile acids, which produce carcinogenic metabolites, and fermented fibre produces volatile fatty acids that can protect against colon cancer. It has been hypothesized that the anti-cancer actions of olive oil may relate to the ability of its mono-unsaturated fatty acid, oleic acid, to regulate oncogenes.


Culture of rabbit zygotes into blastocysts in protein-free medium with one to twenty per cent oxygen.
Embryos were collected from superovulated Dutch rabbits 19 h after injection of LH and insemination. The embryos were at the one-cell stage at that time and those judged to be normal by the absence of granular cytoplasm and regular shape were distributed randomly within donors into culture dishes containing 500 microliters of a macromolecule-free medium consisting of RPMI-1640 and low glucose Dulbecco's modified Eagle's medium, 1:1, without a cover of oil. In Expt 1, O2 concentrations of 5, 10 and 15%, with 5% CO2 plus 90, 85 and 80% N2, respectively, were tested. In Expt 2, O2 concentrations of 1, 5 and 20% were combined with 5% CO2 and the remaining gas was N2. After 84 h in culture at 39 degrees C, embryos were examined for stage of development and stained with Hoechst 33342 so that the number of cells could be counted. In Expt 1, the proportion of embryos reaching the hatching blastocyst stage after 84 h in culture in 5, 10 and 15% O2 was 48, 38 and 21%, (P < 0.01) and the cell number per embryo averaged 258, 226 and 188, respectively (P < 0.01). In Expt 2, the proportion of hatching embryos after 84 h in culture in 1, 5 and 20% O2 was 67, 72 and 29% (P < 0.01), respectively. Cell numbers in the 1 and 5% O2 concentrations were higher than in the 20% O2 concentration (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)


New insight on the Xq28 association with systemic sclerosis.
To evaluate whether the systemic sclerosis (SSc)-associated IRAK1 non-synonymous single-nucleotide polymorphism rs1059702 is responsible for the Xq28 association with SSc or whether there are other independent signals in the nearby methyl-CpG-binding protein 2 gene (MECP2). We analysed a total of 3065 women with SSc and 2630 unaffected controls from five independent Caucasian cohorts. Four tag single-nucleotide polymorphisms of MECP2 (rs3027935, rs17435, rs5987201 and rs5945175) and the IRAK1 variant rs1059702 were genotyped using TaqMan predesigned assays. A meta-analysis including all cohorts was performed to test the overall effect of these Xq28 polymorphisms on SSc. IRAK1 rs1059702 and MECP2 rs17435 were associated specifically with diffuse cutaneous SSc (PFDR=4.12×10(-3), OR=1.27, 95% CI 1.09 to 1.47, and PFDR=5.26×10(-4), OR=1.30, 95% CI 1.14 to 1.48, respectively), but conditional logistic regression analysis showed that the association of IRAK1 rs1059702 with this subtype was explained by that of MECP2 rs17435. On the other hand, IRAK1 rs1059702 was consistently associated with presence of pulmonary fibrosis (PF), because statistical significance was observed when comparing SSc patients PF+ versus controls (PFDR=0.039, OR=1.30, 95% CI 1.07 to 1.58) and SSc patients PF+ versus SSc patients PF- (p=0.025, OR=1.26, 95% CI 1.03 to 1.55). Our data clearly suggest the existence of two independent signals within the Xq28 region, one located in IRAK1 related to PF and another in MECP2 related to diffuse cutaneous SSc, indicating that both genes may have an impact on the clinical outcome of the disease.


Massive FungatingEwing's Sarcoma of Scapula Treated by Limb Salvage Surgery: A Case Report.
Ewing's sarcoma (ES) is a malignant tumor of the bone and soft tissue arising from the neuroectodermal cells. It commonly arises from the extremities of children and young adults and very rarely from flat bones like the scapula. Locally advanced disease with prior history of surgery and poor response to neoadjuvant chemotherapy in a bedridden patient is usually treated by forequarter amputation, considering the anatomical complexity of the shoulder girdle. A young adult diagnosed and previously operated for ES of the left scapula, presented to us with a massive fun gating mass over the left upper back, excruciating pain and inability to use the left upper limb. Limb salvage surgery was performed, followed by adjuvant radiotherapy, chemotherapy, and autologous stem-cell transplantation. The patient is disease free with a functional limb on 3 years of follow-up. ES of scapula is very rare. With meticulous surgery and multidisciplinary treatment approach, limb salvage can be achieved even in such advanced cases, thereby prolonging survival and providing better quality of life.


Comparative effects of chlordecone and mirex on rat cardiac ATPases and binding of 3H-catecholamines.
The effects of chlordecone and mirex on the rat myocardial ATPases and binding of 3H-dopamine and 3H-norepinephrine to the NAK-fraction were determined both by in vitro and in vivo treatment. The in vitro data showed that chlordecone significantly inhibited mitochondrial Mg2+ ATPase and Na+--K+ ATPase in a concentration dependent manner with ID50 values of 5 x 10(-8) and 2 x 10(-6) M, respectively. Mitrex, a close structural analog of chlordecone did not inhibit mitochondrial Mg2+ ATPase but inhibited about 15% of N+--K+ ATPase activity. Rats treated with symptomatogenic doses of chlordecone showed a marked and significant decrease of myocardial Na+--K+ ATPase and the residual Mg2+ ATPase activities. The decrease in the enzyme activities was dose dependent and significant. However, mirex treated rats showed a slight decrease in the myocardial Na+--K+ ATPase. The potency of chlordecone to inhibit the ATPase system was parallel to its ability to decrease the dopamine and norepinephrine binding of the myocardial NAK-fraction. Preincubation of the NAK-fraction with various concentrations of chlordecone resulted in a decreased binding of dopamine and norepinephrine. The decrease was significant and concentration dependent. Similar findings were observed in rats pretreated with chlordecone. Mirex did not show any effect, either in vitro or in vivo treatment, on the binding of dopamine or norepinephrine to the myocardial NAK-fraction. These results suggest that chlordecone may be altering the sodium pump activity by inhibiting both ATP hydrolysis and ATP synthesis and thus reducing other cellular events such as catecholamine uptake.


Improved long-term survival with subdural drains following evacuation of chronic subdural haematoma.
Chronic subdural haematoma (CSDH) is a common condition that is effectively managed by burrhole drainage but requires repeat surgery in a significant minority of patients. The Cambridge Chronic Subdural Haematoma Trial (CCSHT) was a randomised controlled study that showed placement of subdural drains for 48 h following burrhole evacuation significantly reduces the incidence of reoperation and improves survival at 6 months. The present study examined the long-term survival of the patients in the trial. In the original trial patients at a single neurosurgical centre from 2004-2007 were randomly assigned to receive a drain (n = 108) or no drain (n = 107) following burrhole drainage of CSDH. We ascertained whether the trial patients were alive in February 2016-a minimum of 8 years following enrollment-via the UK NHS tracing service. Survival was compared between the trial groups and against expected survival for the UK general population matched for age and sex. At 5 years following surgery the drain group continued to have significantly better survival than the no drain patients (p = 0.027), but this was no longer apparent at 10 years. Survival of patients in the drain group did not differ significantly from that of the general population whereas patients who did not receive a drain had significantly lower survival than expected (p = 0.0006). Subdural drains following CSDH evacuation are associated with improved long-term survival, which appears similar to that expected for the general population of the same age and sex. All patients having burrhole CSDH evacuation should receive a drain as standard practice unless specifically contraindicated.


Serum calcium and magnesium levels in women presenting with pre-eclampsia and pregnancy-induced hypertension: a case-control study in the Cape Coast metropolis, Ghana.
Hypertensive disorders of pregnancy are important causes of morbidity and mortality. The levels of calcium (Ca2+) and magnesium (Mg2+) in pregnancy may implicate their possible role in pregnancy-induced hypertension. This study assessed serum Ca2+ and Mg2+ levels in women with PIH (pregnancy-induced hypertension) and PE (pre-eclampsia), compared to that in normal pregnancy. This case-control study was conducted on 380 pregnant women (≥20 weeks gestation) receiving antenatal care at three hospitals in the Cape Coast metropolis, Ghana. This comprised 120 women with PIH, 100 women with PE and 160 healthy, age-matched pregnant women (controls). Demographic, anthropometric, clinical and obstetric data were gathered using an interview-based questionnaire. Venous blood samples were drawn for the estimation of calcium and magnesium. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly raised in women with PIH (p < 0.0001) and PE (p < 0.0001). Women with hypertensive disorders (PE and PIH) had significantly lower serum calcium and magnesium levels than those in the control group (p < 0.0001 each). Of those with PIH, SBP correlated positively with BMI (r = 0.575, p < 0.01) and Ca2+ correlated positively with Mg2+ (r = 0.494, p < 0.01). This was similar amongst the PE group for SBP and BMI as well as for Ca2+and Mg2+ but was not significant. Multivariate analysis showed that women aged ≥40 years were at a significant risk of developing PIH (OR = 2.14, p = 0.000). In this study population, serum calcium and magnesium levels are lower in PIH and PE than in normal pregnancy. Mineral supplementation during the antenatal period may influence significantly, the occurrence of hypertensive disorders in pregnancy.


Life in the Aftermath of Mass Extinctions.
The vast majority of species that have ever lived went extinct sometime other than during one of the great mass extinction events. In spite of this, mass extinctions are thought to have outsized effects on the evolutionary history of life. While part of this effect is certainly due to the extinction itself, I here consider how the aftermaths of mass extinctions might contribute to the evolutionary importance of such events. Following the mass loss of taxa from the fossil record are prolonged intervals of ecological upheaval that create a selective regime unique to those times. The pacing and duration of ecosystem change during extinction aftermaths suggests strong ties between the biosphere and geosphere, and a previously undescribed macroevolutionary driver - earth system succession. Earth system succession occurs when global environmental or biotic change, as occurs across extinction boundaries, pushes the biosphere and geosphere out of equilibrium. As species and ecosystems re-evolve in the aftermath, they change global biogeochemical cycles - and in turn, species and ecosystems - over timescales typical of the geosphere, often many thousands to millions of years. Earth system succession provides a general explanation for the pattern and timing of ecological and evolutionary change in the fossil record. Importantly, it also suggests that a speed limit might exist for the pace of global biotic change after massive disturbance - a limit set by geosphere-biosphere interactions. For mass extinctions, earth system succession may drive the ever-changing ecological stage on which species evolve, restructuring ecosystems and setting long-term evolutionary trajectories as they do.


Value of metabolic parameters in distinguishing primary mediastinal lymphomas from thymic epithelial tumors.
Objective: A high rate of unnecessary thymectomies has been reported. This study aimed to distinguish primary mediastinal lymphomas (PMLs) from thymic epithelial tumors (TETs) by evaluating volumetric and metabolic parameters with 18F-FDG PET/CT. Methods: A total of 136 patients who were pathologically diagnosed with TETs or PMLs were enrolled, and 18F-FDG PET/CT was performed before therapy. Volumetric parameters, including the mean SUV (SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and SUVmax, were determined and compared between the 2 subtypes. The diagnostic performance of these parameters was evaluated with receiver operating characteristic (ROC) curve analysis. Results: All parameters significantly differed between patients with PMLs and TETs. Patients with lymphomas were younger and had higher SUVmean, SUVmax, TLG, and MTV values than patients with TETs. The MTV and TLG values had similar diagnostic performance. ROC analysis indicated that the areas under the curves of the SUVmean and SUVmax values performed similarly (approximately 0.76) in differentiating patients with PMLs from TETs, and both values were better than the MTV and TLG values. When age was included with the SUVmax in differentiating TETs from PMLs, the AUC was 0.91, and the sensitivity and specificity increased to 80% and 93%, respectively. Conclusions: The SUVmax and volumetric parameters of 18F-FDG PET/CT can be used to distinguish patients with PMLs versus TETs, and thus may aid in preventing unnecessary thymectomies or other invasive operations.


Heterogeneity of hemodynamic parameters in untreated primary hypertension, and individualization of antihypertensive therapy based on noninvasive hemodynamic measurements.
Noninvasive measurement of hemodynamic parameter was undertaken in 240 patients with untreated primary hypertension using impedance cardiography (ICG) in outpatient clinics. High output was defined as a cardiac index (CI) >3.6 L/minute/m(2) and high resistance was defined as the total peripheral resistance index (TPRI) >2700 dyne·s·m(2)/cm(5). Of all patients, 67% had high-resistance hypertension (high TPRI with normal or low CI), and 16% had high-output hypertension (high CI with normal TPRI). Treatment with β-blockers for high-output hypertension and with calcium channel blockers for high-resistance hypertension reduced blood pressure equally, and restored normal hemodynamic balance, as reported in studies using invasive monitoring methods. These findings suggest that it is appropriate to use noninvasive ICG measurements to guide antihypertensive therapy. Multivariate analysis showed that female gender, tachycardia, and low body mass index (BMI) were associated with high-output hypertension, but age was not. Heterogeneity of hemodynamic parameters is thought to be one of the reasons why the efficacies of antihypertensive agents differ between patients. It may be feasible to predict which antihypertensive agent would be the most effective for a particular patient based on hemodynamic measurements or combination of gender, heart rate, and BMI.


Influence of Feeding Practices on Malnutrition in Haitian Infants and Young Children.
Infant malnutrition remains an important cause of death and disability, and Haiti has the highest prevalence in the Americas. Therefore, preventive strategies are needed. Our aims were (1) To assess the prevalence of malnutrition among young children seen at a health center in Haiti; (2) Examine adherence to infant feeding practices recommended by the World Health Organization (WHO) and the association to nutritional status. This cross-sectional study recruited children from the Saint Espri Health Center in Port Au Prince in 2014. We recorded feeding practices, socio-demographic data, and anthropometric measurements (WHO-2006). We evaluated 278 infants and children younger than two years old, aged 8.08 ± 6.5 months, 53.2% female. 18.35% were underweight (weight/age <-2 SD); 13.31% stunted (length/age <-2 SD), and 13.67% had moderate or severe wasting (weight/length <-2 SD). Malnutrition was associated with male gender, older age, lower maternal education level, and greater numbers of siblings (Chi², p < 0.05). Adherence to recommended breastfeeding practices was 11.8-97.9%, and to complementary feeding practices was 9.7-90.3%. Adherence was associated with a lower prevalence of malnutrition. Prevalence of infant and young child malnutrition in this population is high. Adherence to WHO-recommended feeding practices was associated with a better nutritional status.


Clinicopathological Characteristics, Treatment, and Prognosis of 21 Patients with Primary Gastric Squamous Cell Carcinoma.
We performed a retrospective analysis of 21 patients with primary gastric squamous cell carcinoma (PGSCC) who were admitted to our hospital from October 2008 to October 2014. The median age was 67 years and male predominance was observed, the most common tumor locations were the upper third of the stomach, most of the clinical manifestations were identical to those of other types of gastric tumors, and the tumor cells had positive immunoreactivity for p63 and CK5/6. In terms of treatments, surgery (R0 resection) is the main treatment; the effect of other treatments is unclear. The median survival time for the surgery group and nonsurgery group was 46 and 4.5 months, respectively. Probably due to limited number of cases, no significant difference in median survival time was observed between the surgery alone group and the surgery plus adjuvant therapy group (46 versus 51 months, P = 0.310). A standard chemotherapy regimen for this disease has not yet been established; the choice of its chemotherapy regimens tends to follow the principle of the treatment of gastric adenocarcinoma or esophageal cancer. PGSCC generally had a poor prognosis, and early detection, early diagnosis, and early surgical treatment are beneficial to patients.


[The pharmacist Léopold Mathet and the photography].
From 1872 and during half-century , the pharmacist Léopold Mathet (1850-1922) was interested in theoretical and practical faces of photography whose he was a talented popularizer by means of his many books and publications. He specially got enthusiastic over colour photography by additive trichromy and he made sensitized plates including polychromatic net which, as early as 1904, he achieved successfully fine colour photographs.


Papillon-Lefèvre Syndrome and Basal Cell Carcinoma: A Case Study.
Papillon-Lefèvre syndrome (PLS) is a rare autosomal recessive disorder characterized by palmoplantar keratoderma and early-onset periodontitis. It was first described by Papillon and Lefèvre in 1924. PLS is caused by mutations in the cathepsin-C (CTSC) gene. The development of malignant skin neoplasms in PLS patients is extremely rare. To date, there have been two cases of malignant melanoma (MM) in PLS patients reported in international journals. Further, only one case of squamous cell carcinoma (SCC) has been reported in PLS patients. To the best of our knowledge, no cases with basal cell carcinoma in PLS patients have been reported in literature. Thus, we report a case of a 55-year-old male from Arabic Saudi with PLS and basal cell carcinoma. The patient was homozygous for a G-to-C substitution at the nucleotide position 815 (CTSC, c.815G>Cp.(Arg272Pro), which is a pathogenic variant. Since this is not the first case of skin cancer in PLS patients, we are supporting the possibility that cathepsin-C play a role in cancer development.


High mortality after ALPPS for perihilar cholangiocarcinoma: case-control analysis including the first series from the international ALPPS registry.
Resection of perihilar cholangiocarcinoma (PHC) entails high-risk surgery with postoperative mortality reported up to 18%, even in specialized centers. The aim of this study was to compare outcomes of PHC patients who underwent associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) to patients who underwent resection without ALPPS. All patients who underwent ALPPS for PHC were identified from the international ALPPS registry and matched controls were selected from a standard resection cohort from two centers based on future remnant liver size. Outcomes included morbidity, mortality, and overall survival. ALPPS for PHC was associated with 48% (14/29) 90-day mortality. 90-day mortality was 13% in 257 patients who underwent major liver resection for PHC without ALPPS. The 29 ALPPS patients were matched to 29 patients resected without ALPPS, with similar future liver remnant volume (P = 0.480). Mortality in the matched control group was 24% (P = 0.100) and median OS was 27 months, comparted to 6 months after ALPPS (P = 0.064). Outcomes of ALPPS for PHC appear inferior compared to standard extended resections in high-risk patients. Therefore, portal vein embolization should remain the preferred method to increase future remnant liver volume in patients with PHC. ALPPS is not recommended for PHC.


Peri-articular histiocytic sarcoma and previous joint disease in Bernese Mountain Dogs.
Peri-articular histiocytic sarcoma (PAHS) occurs in dogs, including Bernese Mountain Dogs (BMD). An etiologic relationship with previous joint disease has not been documented. Peri-articular histiocytic sarcoma in BMD will be more frequently encountered around previously diseased joints compared with normal joints. 920 European BMD. A retrospective study, in which data were obtained through an Internet questionnaire and from 2 veterinary pathology laboratories. Archived samples of hematoxylin-eosin (H&E) staining diagnosed PAHS and synovial cell sarcoma (SCS) were immunolabeled with CD18 and pancytokeratin. Descriptive, comparative, and actuarial statistics comprise the data analysis. All primary synovial tumors were identified as PAHS based on their morphology, positive CD18, and negative pancytokeratin labeling. Joint disease was diagnosed in 226 BMD, of which 15 developed PAHS in a previously diseased joint and 3 in a nondiseased joint. Of the remaining 694 BMD without joint disease, 9 developed PAHS. The odds ratio for a dog with previous joint disease developing PAHS is calculated as 5.4 (95% CI: 2.3-12.5; P < .0001) compared with no previous joint problem. A significant association between previous joint disease and PAHS in the same joint was demonstrated for the left elbow (P = .016), right elbow (P = .006), right shoulder (P = .047), left and right stifle (P < .001), and left carpal joint (P = .010). The results of this study suggest a relation between previous joint disease and the development of PAHS in the same joint of European BMD. Owners of BMD should monitor dogs for peri-articular swellings, particularly around previously diseased joints.


Acute post-traumatic diabetes insipidus: treatment with continuous intravenous vasopressin.
A young male presented within hours after closed head injury with hypotension, tachycardia, and polyuria. A diagnosis of post-traumatic diabetes insipidus was made. Although a rare entity, the rapid diagnosis of diabetes insipidus and early treatment with vasopressin may have been life-saving in this case. A detailed approach for treatment with continuous intravenous vasopressin may be the most accurate and efficient method of managing acute onset diabetes insipidus, especially in the hemodynamically compromised patient. This will allow for a controlled fluid management in order to achieve hemodynamic stability and prevent aggravation of cerebral edema.


[Ernst Friedrich Gurlt (1794-1882)].
Ernst Friedrich Gurlt (1794-1882) is the founder of the comparative veterinary anatomy on a solid scientific basis. The integration of the human being into the comparative study and the continuous linkage between human anatomy and veterinary anatomy feature him in the same time as a distinguished pioneer of the comparative anatomy. Beside this, Gurlt has merits in physiology and post mortem anatomy. This publication contains a short life story and a laudation of the work of Ernst Friedrich Gurlt, which was active at the Veterinary School at Berlin more than a half century, from 1819 to 1870.


The effect of 3D hydrogel scaffold modulus on osteoblast differentiation and mineralization revealed by combinatorial screening.
Cells are known to sense and respond to the physical properties of their environment and those of tissue scaffolds. Optimizing these cell-material interactions is critical in tissue engineering. In this work, a simple and inexpensive combinatorial platform was developed to rapidly screen three-dimensional (3D) tissue scaffolds and was applied to screen the effect of scaffold properties for tissue engineering of bone. Differentiation of osteoblasts was examined in poly(ethylene glycol) hydrogel gradients spanning a 30-fold range in compressive modulus ( approximately 10 kPa to approximately 300 kPa). Results demonstrate that material properties (gel stiffness) of scaffolds can be leveraged to induce cell differentiation in 3D culture as an alternative to biochemical cues such as soluble supplements, immobilized biomolecules and vectors, which are often expensive, labile and potentially carcinogenic. Gel moduli of approximately 225 kPa and higher enhanced osteogenesis. Furthermore, it is proposed that material-induced cell differentiation can be modulated to engineer seamless tissue interfaces between mineralized bone tissue and softer tissues such as ligaments and tendons. This work presents a combinatorial method to screen biological response to 3D hydrogel scaffolds that more closely mimics the 3D environment experienced by cells in vivo.


A Selectfluor-promoted oxidative reaction of disulfides and amines: access to sulfinamides.
An unprecedented transition-metal-free oxidative reaction of disulfides and amines with Selectfluor as a mild oxidant under aerobic conditions was developed. This reaction was conducted under mild conditions and tolerated a wide range of coupling partners including disulfides and amines, affording the corresponding sulfinamide products in good chemical yields. Furthermore, this reaction could be used in gram-scale synthesis. This reaction enriches the research content of Selectfluor and provides a valuable vista for the convenient synthesis of sulfinamides.


Animal model for chronic massive rotator cuff tear: behavioural and histologic analysis.
Massive rotator cuff tears (MRCT) are usually chronic lesions that present associated degenerative changes of the myotendinous unit that have been implicated in limitations for surgical repair. In order to develop effective therapies, it is important to establish animal models that mimic the hallmarks of the injury itself. Therefore, in the present work, we aimed to (1) optimize a rodent animal model of MRCT that closely reproduces the fatty infiltration of the cuff muscles seen in humans and (2) describe the effects of unilateral or bilateral lesion in terms of histology and behaviour. Massive tear was defined as two rotator cuff tendons-supraspinatus and infraspinatus-section. Twenty-one Wistar rats were randomly assigned to four groups: bilateral lesion (five animals), right-sided unilateral lesion (five animals), left-sided unilateral lesion (five animals) and control (six animals). Behaviour was analyzed with open field and staircase test, 16 weeks after lesion. After that, animals were killed, and the supraspinatus and infraspinatus muscles were processed. Histologic analysis revealed adipocytes, fatty infiltration and atrophy in the injured side with a greater consistency of these degenerative changes in the bilateral lesion group. Behaviour analysis revealed a significant functional impairment of the fine motor control of the forepaw analyzed in staircase test where the number of eaten pellets was significantly higher in sham animals (sham = 7 ± 5.0; left unilateral = 2.6 ± 3.0; right unilateral = 0 ± 0; and bilateral = 0 ± 0, p < 0.05). A trend to reach a lower level of steps, in more injured animals, was also observed (sham animals = 3 ± 1.6 > left unilateral = 2 ± 2.1 > right unilateral = 0.8 ± 1.3 > bilateral = 0.8 ± 1.1). The present study has been able to establish an animal model that disclosed the hallmarks of MRCT. This can now be used as a valuable, cost-effective, pre-clinical instrument to assist in the development of advanced tissue engineered strategies. Moreover, this animal model overcomes some of the limitations of those that have been reported so far and thus represents a more reliable source for the assessment of future therapeutic strategies with potential clinical relevance.


The Wetting Deformation Model of Rockfill and Its Two Methods for Simulating Rockfill Dam Collapse Settlement.
The wetting deformation of the upstream dam shell material during the impoundment of the core wall rockfill dam seriously affects the safety of the dam. Based on the proposed Ew - νw wetting model, this paper proposes its corresponding two methods to simulate the collapse settlement of the rockfill dam: the initial strain method and the initial stress method. By simulating the collapse settlement of the Guanyinyan core wall rockfill dam, it is found that the simulated result using the initial stress method is in good agreement with the field monitoring data, while the displacement simulated using the initial strain method is larger. The distribution of displacement contours simulated using the initial strain method is obviously inconsistent in the area where the wetting deformation occurs, and the simulation results of the initial stress method are more reasonable. With the rise in the water level, the wetting deformation of the upstream dam shell material causes the tensile stress zone at the top of the dam. Therefore, the wetting deformation is the direct cause of the crack at the top of the dam, and the initial stress method should be preferred in the simulation of the wetting deformation of rockfill materials.


Severity assessment of acute pancreatitis using CT severity index and modified CT severity index: Correlation with clinical outcomes and severity grading as per the Revised Atlanta Classification.
To assess the severity of acute pancreatitis (AP) using computed tomography (CT) severity index (CTSI) and modified CT severity index (MCTSI), to correlate with clinical outcome measures, and to assess concordance with severity grading, as per the revised Atlanta classification (RAC). In this prospective study approved by the Institutional Review Board (November 2014 to March 2016), sixty patients with AP (as per the RAC definition) underwent contrast-enhanced computed tomography (CECT) 5-11 days (median 6 days) after symptom onset. Two radiologists, blinded to clinical parameters, independently assessed CTSI and MCTSI (differences were resolved by consensus). Clinical outcome parameters included duration of stay in the hospital and intensive care unit (ICU), presence of persistent organ failure (OF), evidence of infection, need for intervention, and mortality. We included 60 cases [36 males, age range 19-65 (mean 37) years]. As per the RAC, 26 patients had mild AP, 12 moderately severe, and 22 severe AP. According to CTSI and MCTSI, mild, moderate, and severe cases were 27 (45%), 19 (31.7%), 14 (23.3%) and 24 (40%), 10 (16.7%), 26 (43.3%), respectively. MCTSI was concordant with the RAC grading in 54 (90.0%), CTSI was concordant in 47 (78.3%), and both were concordant in 43 (71.7%) cases. Area under the receiver-operating characteristic (ROC) curves (AUROC) was compared by the Hanley and McNeil method. Both CTSI and MCTSI were significantly associated with outcome parameters (P < 0.001), except duration of ICU stay. Sensitivity, specificity, positive predictive value (PPV), and accuracy of CTSI for detecting moderate/severe disease were 97.1%, 100%, 100%, and 98.3% respectively, and of MCTSI were 100%, 92.3%, 94.4%, and 96.7% respectively. Both CTSI and MCTSI showed significant correlation with clinical outcome parameters, and good concordance with RAC grading of severity. MCTSI showed a higher sensitivity but lower specificity than CTSI in differentiating mild from moderate/severe AP.


Effects of lactated Ringer's solutions on human leukocytes.
The standard lactated Ringer's (LR) solution contains racemic lactate, an equal mixture of D(-)- and L(+)-isomers. The aim of this study was to investigate whether racemic LR solution (containing both isomers, dl-LR) differs from LR containing L-isomer only (L-LR). Blood from 20 volunteers was incubated for 30 minutes with lactated Ringer's solutions containing the DL- or L-form of lactate, Hank's balanced salt solution, normal saline, and ketone Ringer's (lactate replaced with ketone bodies). Neutrophil "oxidative burst" was measured using flow cytometry. Gene expression of 23 genes associated with leukocyte function was determined with cDNA array technique. The arraying procedure was repeated four times to obtain four sets of data. Compared with the L-LR and ketone Ringer's, DL-LR causes an increased production of reactive oxygen species by neutrophils and affects expression of leukocyte genes known to be involved in inflammation, cell migration, and apoptosis. Lactated Ringer's solution in commonly used formulation (racemic mixture, DL-LR) influences neutrophil function and leukocyte gene expression.


Procaine, lidocaine, and hypothermia inhibit calcium paradox in glial cells.
The purpose of this study was to determine the effects of local anesthetics (lidocaine and procaine) and hypothermic perfusion on Na+/Ca2+ exchanger activity during reperfusion-induced calcium paradox in vitro. Hypothetically, this work provides a mechanism for reperfusion paradox injury in vitro that may relate to a variety of ischemic insults in vivo. Intracellular calcium ([Ca2+]i) in individual cells was measured using a fura-2 photometry system during protocols previously shown to dramatically and persistently increase [Ca2+]i in a manner that replicates certain phases of reperfusion injury in vivo. Our results suggest that short (< 5.0 min) exposure to hypocalcia prompts subsequent, potentially lethal, sodium-dependent calcium entry via the reverse phase of the Na+/Ca2+ exchanger. The local anesthetics lidocaine or procaine are able to block [Ca2+]i increases when added at the time of reperfusion. Furthermore, since [Ca2+]i is normally increased when local anesthetics are added by themselves, the results suggest that local anesthetics promote the forward mode of Na+/Ca2+ exchange (i.e., Na-dependent calcium removal) in addition to reverse Na+/Ca2+ exchanger blockade. Low temperature (18 degrees C) perfusion or reperfusion also affects exchanger dynamics and attenuates calcium entry during such protocols. These experiments further implicate the Na+/Ca2+ exchanger in reperfusion-mediated cell injury and provide potential ways to therapeutically modify such phenomena in vivo.


Synthesis of guaiacol-alpha-D: -glucoside and curcumin-bis-alpha-D: -glucoside by an amyloglucosidase from Rhizopus.
Guaiacol (2-methoxyphenol) and curcumin [1E,6E-1,7-di(4-hydroxy-3-methoxy-phenyl)-1,6-heptadiene-3,5-dione] were converted into their corresponding glucosides using glucose and an amyloglucosidase from Rhizopus. Guaiacol-alpha-D: -glucoside yields ranged from 3 to 52% with the highest at pH 7.0. Curcumin-bis-alpha-D: -glucoside yields ranged from 3 to 48% with the highest at pH 4.0 with 50% (w/w D: -glucose) of enzyme. The phenolic hydroxyl group of guaiacol and both phenolic hydroxyl groups of curcumin were glucosylated at the C1 carbon of alpha-D: -glucose indicating that the enzymatic reaction is stereospecific. Both guaiacol-alpha-D: -glucoside and curcumin-bis-alpha-D: -glucosides had antioxidant activities.


Pharmacotherapy for primary delusional jealousy, a retrospective observational study of 32 cases with Othello syndrome.
To determine whether primary delusional jealousy can be treated effectively with antipsychotics or antidepressants, and whether any clinical variables are associated with response to pharmacotherapy, we carried out a retrospective case series observational study by reviewing clinical records of patients with an International Classification of Disease, 9th ed., diagnostic code of 297 (delusional disorders) who were treated at the Department of Psychiatry of a university affiliated hospital from January 2010 to December 2015. Only those records showing obvious delusional jealousy not secondary to other medical conditions, dementia, or schizophrenia were scrutinized thoroughly with respect to types of pharmacotherapy, treatment response, and other demographic and clinical variables likely to be associated with clinical outcomes. All except one of 32 patients, 16 men and 16 women, between 37 and 79 (60.9±10.6) years of age, were treated with low-dose antipsychotics. The general response was favorable as 19 (59.4%) were rated as good and 13 as inadequate responders (seven partial and six limited). Compared with antipsychotic monotherapy, concomitant therapy with antidepressants had a higher rate of good response, although statistically insignificant (75 vs. 53%, P=0.21). Younger age (P=0.01) and presentation at the index visit with their suspected unfaithful spouse were associated with a good response (P=0.036); comorbidity with delusions other than the jealous type was associated with a poor response (P=0.006). The overall outcome for delusional jealousy looks promising if the patients can accept pharmacotherapy in an outpatient setting.


Childhood tuberculosis in Malawi: nationwide case-finding and treatment outcomes.
All 43 non-private hospitals (three central, 22 [corrected] district and 18 [corrected] mission) in Malawi that register and treat adult and paediatric TB cases. To assess the rate, pattern and treatment outcome of childhood TB case notifications in Malawi in 1998. Retrospective data collection using TB registers, treatment cards and information from health centre registers. Information was collected on number of cases, types of TB and treatment outcomes using standardised definitions. There were 22,982 cases of TB registered in Malawi in 1998, of whom 2,739 (11.9%) were children. Children accounted for 1.3% of all case notifications with smear-positive pulmonary TB (PTB), 21.3% with smear-negative PTB and 15.9% with extra-pulmonary TB (EPTB). Estimated rates of TB in children were 78/ 100,000 in those aged less than one year, 83/100,000 in those aged 1-4 years and 33/100,000 in those aged 5-14 years. A significantly higher proportion of TB cases was diagnosed in central hospitals. Only 45% of children completed treatment. There were high rates of death (17%), default (13%) and unknown treatment outcomes (21%). Treatment outcomes were worse in younger children and in children with smear-negative PTB. Treatment completion was best (76%) and death rates lowest (11%) for the 127 children with smear-positive PTB. Childhood TB is common in Malawi and treatment outcomes are poor. Research should be directed towards improved diagnosis and follow-up of children with TB, and the National TB Programme should support appropriate management of childhood contacts of smear positive PTB cases.


Doing the right thing for one's children: deciding whether to take the genetic test for Huntington's disease as a moral dilemma.
This is a qualitative examination of candidates' decision-making in relation to the genetic test for Huntington's disease. Semi-structured interviews were conducted with nine participants who were asked about factors influencing their decision whether to take up predictive genetic testing. Transcripts of interviews were subjected to interpretative phenomenological analysis to elicit emergent themes. A key factor for participants was to do the right thing for their children. Interestingly, this factor presents a moral dilemma to participants and can direct them either towards or away from testing. This article offers a detailed examination of how participants think through this dilemma.


Autotransplantation of a tooth using guided tissue regeneration.
Autotransplantation is an alternative treatment to replace missing or periodontally-involved hopeless teeth. A prerequisite for performing this procedure is having a recipient site with sufficient bone volume to support the transplant. Often, however, crestal bone resorption following tooth extraction or periodontitis results in a reduced alveolar ridge with inadequate dimensions to properly house the transplant. In these cases, the procedure is contraindicated. A case is presented in which the biologic principle of guided tissue regeneration was used to gain periodontal support around an autotransplanted 3rd molar. The results suggest the potential use of guided tissue regeneration in conjunction with autotransplantation. This may represent a new area in reconstructive dentistry.


[The effects of instruction about strategies for efficient calculation].
Calculation problems such as "12x7÷3" can be solved rapidly and easily by using certain techniques; we call these problems "efficient calculation problems." However, it has been pointed out that many students do not always solve them efficiently. In the present study, we examined the effects of an intervention on 35 seventh grade students (23 males, 12 females). The students were instructed to use an overview strategy that stated, "Think carefully about the whole expression", and were then taught three sub-strategies. The results showed that students solved similar problems efficiently after the intervention and the effects were preserved for five months.


Dimensions of oral-health-related quality of life.
Oral-health-related quality of life (OHRQoL) is expected to have multiple dimensions. It was the aim of this study to investigate the dimensional structure of OHRQoL measured by the Oral Health Impact Profile (German version) (OHIP-G) and to derive a summary score for the instrument. Subjects (N = 2050; age, 16-79 yrs) came from a national survey. We used rotated principal-components analysis to derive a summary score and to explore the dimensional structure of OHIP-G. The first principal component explained 50% of the variance in the data. The sum of OHIP-G item responses was highly associated with the first principal component (r = 0.99). This simple but informative OHIP-G summary score may indicate that simple sums are also potentially useful scores for other OHRQoL instruments. Four dimensions (psychosocial impact, orofacial pain, oral functions, appearance) were found. These OHIP-G dimensions may serve as a parsimonious set of OHRQoL dimensions in general.


Barriers and facilitative factors in the provision of first-responder services to persons bereaved following a drug-related death: A qualitative study.
Aim: To broaden our knowledge from the perspective of municipality first-responder services of what prevents and what facilitates the provision of professional assistance to the bereaved after a drug-related death during the acute phase. Method: A reflexive thematic analysis was applied in six focus group interviews with 27 first-responder personnel in Norway. Results: The acute phase presented a challenging and complex support situation. We identified two main barriers: failure to initiate services and difficulties meeting with bereaved persons who use drugs. Facilitative factors were associated with competence and proactive cooperation. We discuss the findings in light of associated stigma, disenfranchised grief and an ecological approach to public services. Conclusion: First-responder professionals must understand drug-related death as a potentially traumatising event and initiate the procedures set out in the national guidelines. To achieve this, first-responder health and welfare services must become more knowledgeable about drug-related loss and bereavement, acute grief reactions and the need for psychosocial follow-up.


Development of a disposable and highly sensitive paper-based immunosensor for early diagnosis of Asian soybean rust.
Soybean is one of the most important crops and plays a key role in the whole food chain production. Soybean crops are very susceptible to the fungus Phakopsora Pachyrhizi, the agent responsible by the Asian soybean rust. The spore of the fungus is easily disseminated by wind with adequate environment, leaf wetness, high humidity and temperatures, the crop can be totally lost within few days. A high sensitive, specific and easy test is the key for early diagnosing the soybean rust and therefore save the crop. Here we present a paper-based immunosensor for early stage diagnosis of soybean rust that can be performed by unskilled operators on-site. Nitrocellulose membrane was chosen as the substrate to stick the antigen due to its high binding properties. Polyclonal antibodies labeled with fluorescent nanoparticles were employed as the recognizers. An analytical curve with spiked samples shows a linear response range from 0.0032 to 3.2 μg/mL. This immunosensor presents a very low detection limit of 2.2 ng/mL, which corresponds approximately to 8-12 spores/mL. The paper-based sensor reachs the detection range of ELISA and PCR based test systems, and outranges the available commercial test kits by two order of magnitude. We believe this immunosensor has a great potential as a point-of-care device for the early diagnosis of Asian soybean rust.


Biosensors-Recent Advances and Future Challenges in Electrode Materials.
Electrochemical biosensors benefit from the simplicity, sensitivity, and rapid response of electroanalytical devices coupled with the selectivity of biorecognition molecules. The implementation of electrochemical biosensors in a clinical analysis can provide a sensitive and rapid response for the analysis of biomarkers, with the most successful being glucose sensors for diabetes patients. This review summarizes recent work on the use of structured materials such as nanoporous metals, graphene, carbon nanotubes, and ordered mesoporous carbon for biosensing applications. We also describe the use of additive manufacturing (AM) and review recent progress and challenges for the use of AM in biosensing applications.


Expression of cytokeratins in gliomas.
Metastatic carcinoma, which is a common malignant tumor seen in the central nervous system is often difficult to distinguish from glioblastoma multiforme. In general, neoplastic cells maintain fidelity in the expression of parent cell intermediate filament and immunohistochemistry remains the mainstay in diagnosis. A panel consisting of GFAP (usually positive for astrocytic tumors) and cytokeratin (usually positive for metastatic carcinomas) is most commonly used for this purpose. However, co-expression of two or more classes of intermediate filament proteins by neoplasms is a widespread phenomenon and there are reports of glial neoplasms expressing keratin markers. Our aims and objectives were to analyse the expression of both cytokeratin and GFAP in different glial tumors and metastatic carcinomas. Cases were collected for a period of two years. All the cases were diagnosed as primary or metastatic intracranial tumors. Formalin-fixed paraffin-embedded thin sections were taken on egg-albumin coated slides and immunostaining with GFAP and polyclonal cytokeratin was done. Forty-five tumors were analysed, including 35 glial neoplasms and 10 metastatic carcinomas of which 7 of the 32 astrocytic neoplasms (22%) showed focal immunoreactivity with pancytokeratin. All of the glial tumors but none of the metastatic carcinomas were positive with GFAP. So our conclusion was that co-expression of GFAP and CK is a fairly common phenomenon, especially in case of undifferentiated and high grade gliomas and this must be kept in mind while differentiating these cases from metastatic carcinoma, as CK positivity does not rule out the diagnosis of a glial neoplasm. Further studies with an expanded panel of CK is most useful for this.


PRGF Membrane with Tailored Optical Properties Preserves the Cytoprotective Effect of Plasma Rich in Growth Factors: In Vitro Model of Retinal Pigment Epithelial Cells.
The present study evaluates the ability of a novel plasma rich in growth factors (PRGF) membrane with improved optical properties to reduce oxidative stress in retinal pigment epithelial cells (ARPE-19 cells) exposed to blue light. PRGF was obtained from three healthy donors and divided into four main groups: (i) PRGF membrane (M-PRGF), (ii) PRGF supernatant (S-PRGF), (iii) platelet-poor plasma (PPP) membrane diluted 50% with S-PRGF (M-PPP 50%), and (iv) M-PPP 50% supernatant (S-PPP 50%). ARPE-19 cells were exposed to blue light and then incubated with the different PRGF-derived formulations or control for 24 and 48 h under blue light exposure. Mitochondrial and cell viability, reactive oxygen species (ROS) production, and heme oxygenase-1 (HO-1) and ZO-1 expression were evaluated. Mitochondrial viability and cell survival were significantly increased after treatment with the different PRGF-derived formulations. ROS synthesis and HO-1 expression were significantly reduced after cell treatment with any of the PRGF-derived formulations. Furthermore, the different PRGF-derived formulations significantly increased ZO-1 expression in ARPE-19 exposed to blue light. The new PRGF membrane with improved optical properties and its supernatant (M-PPP 50% and S-PPP 50%) protected and reversed blue light-induced oxidative stress in ARPE-19 cells at levels like those of a natural PRGF membrane and its supernatant.


Milestones in pathology-from histology to molecular biology.
Autopsy, histology and cytology have been and histology and cytology still are the main diagnostic tools in surgical pathology. During the last two decades molecular biology gradually has extended the diagnostic armamentarium. In tumor pathology molecular biology techniques are used to diagnose and subclassify tumors, predict response to therapies and identify therapeutic targets. Molecular pathology has evolved into a novel focus of clinical pathology and transforms the historically morphology based discipline. Traditional pathology and molecular pathology combine and guide tumor therapy.


Coronary Artery Disease Reporting and Data System (CAD-RADS) Adoption: Analysis of Local Trends in a Large Academic Medical Center.
To perform a retrospective review of Coronary Artery Disease Reporting and Data System (CAD-RADS) adoption at a high-volume cardiac CT service. In this retrospective study, the adoption of CAD-RADS in 6562 coronary CT angiography (CTA) reports from January 1, 2017, to February 13, 2020, was evaluated. Reports without CAD-RADS were classified as opt-outs or exceptions to CAD-RADS. CAD-RADS classifications were retrospectively assigned to the opt-outs and the clinical indications for coronary CTA. CAD-RADS scores were reported in 95% (6264 of 6562) of cases. Among the 5% (n = 298) of reports not reported according to CAD-RADS, 58% (n = 172) were considered opt-outs and 42% (n = 126) were exceptions. Cases with higher degree of stenosis, stents, and coronary artery bypass grafts (CABGs) occurred more often in opt-outs versus reports with CAD-RADS (odds ratio [OR], 8.3 [95% CI: 1.6, 42.1]; P < .001). The quarterly opt-out rate decreased over consecutive quarters in the 1st year (OR, 0.77 [95% CI: 0.61, 0.96]; P = .01), then stabilized. Quarterly opt-out rate for patients with stents decreased over time (OR, 0.82 [95% CI: 0.73, 0.92]; P = .008), as did the opt-out rates in patients with CABG (OR, 0.83 [95% CI: 0.76, 0.91]; P < .001). Exceptions (n = 126) included coronary dissections (44%), anomalous coronary arteries (41%), coronary artery aneurysms or pseudoaneurysms (10%), vasculitis (2%), stent complications (2%), and extrinsic compression of grafts (2%). CAD-RADS was adopted rapidly and widely. Readers opted out of its use most often in complex cases of CAD, and the most common exceptions were coronary dissections and anomalous coronary artery.Keywords: Coronary Arteries, CT Angiography© RSNA, 2021.


Mass spectrometry-based methods to study protein architecture and dynamics.
Mass spectrometry is now an indispensable tool in the armamentarium of molecular biophysics, where it is used for tasks ranging from protein sequencing and mapping of post-translational modifications to studies of higher order structure, conformational dynamics, and interactions of proteins with small molecule ligands and other biopolymers. This mini-review highlights several popular mass spectrometry-based tools that are now commonly used for structural studies of proteins beyond their covalent structure with a particular emphasis on hydrogen exchange and direct electrospray ionization mass spectrometry.


Preemptive analgesia in dental implant surgery: A systematic review and meta-analysis of randomized controlled trials.
To assess the effectiveness of preemptive analgesia in dental implant surgery in randomized controlled trials (RCTs). The present study was conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and registered in PROSPERO database CRD42020168757. A search without restrictions regarding language or date of publication was conducted in six databases and gray literature. A random effect meta-analysis compared the efficacy of preemptive analgesia compared to placebo through pooled OR and 95%CI. The interpretation of results followed the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach together with the magnitude of the effect according to GRADE guidelines. Four studies were included in the review and three were incorporated into the meta-analysis. All studies demonstrated that preemptive analgesia contributed to a significant improvement in the postoperative pain control. However, the overall pooled standard mean difference (SMD) showed that preemptive analgesia had small effects compared to placebo in reducing pain (SMD: -0.45; IC: -0.83; -0.08) with low certainty of the evidence. Our meta-analysis showed that the magnitude of the effect was bigger six to eight hours after the surgery (large effect), compared to the time of one to two hours after the surgery (small effect). Preemptive analgesia may have a positive effect in reducing pain compared to not using preemptive medication, but the evidence is very uncertain.


Serologic Evidence of Various Arboviruses Detected in White-Tailed Deer (Odocoileus virginianus) in the United States.
White-tailed deer (Odocoileus virginianus) are an abundant mammal with a wide geographic distribution in the United States, which make them good sentinels for monitoring arboviral activity across the country. Exposure to various arboviruses has been detected in white-tailed deer, typically in conjunction with another diagnostic finding. To better assess the exposure of white-tailed deer to seven arboviruses, we tested 1,508 sera collected from 2010 to 2016 for antibodies to eastern equine encephalitis (2.5%), Powassan (4.2%), St. Louis encephalitis, (3.7%), West Nile (6.0%), Maguari (19.4%), La Crosse (30.3%), and bluetongue (7.8%) viruses. At least one arbovirus was detected in 51.3%, and exposure to more than one arbovirus was identified in 17.6% of the white-tailed deer sampled.


Cultural competence skills in a dental curriculum: A review.
This study aimed to analyse and evaluate the extent of transcultural content in the current curricula of the Doctor of Dental Surgery (DDS), Bachelor of Oral Health (BOH) and Master of Nursing Science (MNSc) courses at the University of Melbourne. The study was conducted in two phases: a quantitative review and assessment of the current DDS, BOH and MNSc curricula at the University of Melbourne, and interviews with various staff from the University of Melbourne who were responsible for curriculum development for these courses. Staff from the DDS, BOH and MNSc courses concurred on the importance of transcultural skills, the necessity of covering cultural issues relevant to the main ethnic groups in Australia, obstacles faced and the lack of evaluation methods for cultural competency. The nursing curriculum had the most extensive coverage of transcultural content throughout both years of the course (total 71 formal contact hours; mean 36 formal contact hours per year). In contrast, modules on transcultural skills were limited to the first two of the 3-year BOH course (54 hours; 18 hours) and only the first of the 4-year dental curriculum (40 hours; 10 hours). The DDS course showed less time devoted to formal teaching of these concepts compared to the nursing and BOH courses despite showing a noticeable improvement from a previous assessment conducted in 2006. It is hoped that the DDS course continues to further increase the transcultural content and find ways to incorporate more transcultural education.


Effect of early luteal phase administration of a single dose mifepristone on immunohistochemical distribution of interleukin 1 alpha (IL-1 alpha) and transforming growth factor beta 1 (TGF-beta 1) in mid-luteal phase ovary of the rhesus monkey.
A single low dose administration of a high affinity anti-progestin agent like mifepristone during the early luteal phase inhibits blastocyst implantation in human and non-human primates. Though it has been observed that luteal phase serum concentrations of estradiol and progesterone were not affected by the application of anti-nidatory dose of early luteal phase mifepristone suggesting that ovarian steroidogenic function is not compromised, it is nevertheless possible that ovarian physiology at the local tissue level is affected in this treatment schedule. In the present study, healthy, mature, proven fertile female rhesus monkeys were divided into two groups. Group 2 animals were treated with a single dose of mifepristone (2 mg/kg body weight), while group 1 animals were injected with vehicle (1:4 benzoyl benzoate: olive oil, v/v, s.c.) on day 2 post-ovulation. The morphological examination including that of vascularity, as well as, histometric determination of profiles of immunopositivity for IL-1alpha and TGF-beta1 in stromal, follicular and luteal compartments of mid-luteal phase ovaries from animals with or without a single, anti-nidatory dose of mifepristone applied on day 2 after ovulation failed to reveal any significant change between the two groups. Thus, it appears that early luteal phase administration of a single antinidatory dose of mifepristone does not affect the ovarian physiology in the treatment cycle.


Research on Electric Field-Induced Catalysis Using Single-Molecule Electrical Measurement.
The role of catalysis in controlling chemical reactions is crucial. As an important external stimulus regulatory tool, electric field (EF) catalysis enables further possibilities for chemical reaction regulation. To date, the regulation mechanism of electric fields and electrons on chemical reactions has been modeled. The electric field at the single-molecule electronic scale provides a powerful theoretical weapon to explore the dynamics of individual chemical reactions. The combination of electric fields and single-molecule electronic techniques not only uncovers new principles but also results in the regulation of chemical reactions at the single-molecule scale. This perspective focuses on the recent electric field-catalyzed, single-molecule chemical reactions and assembly, and highlights promising outlooks for future work in single-molecule catalysis.


On-chip high-speed optical detection based on an optical rectification scheme in silicon plasmonic platform.
We theoretically investigate the nonlinear optical rectification (OR) process induced in a silicon plasmonic slot waveguide (PSW) with an electro-optic polymer infiltrated into the slot. An electrical signal is generated between the two metal slabs when an intensity-modulated optical signal is injected into the PSW. Optimization of the geometrical parameters is performed to obtain the highest OR efficiency. Specifically, a voltage responsivity over 1V/W and a normalized OR efficiency of 2.25 × 10(-4)W(-1) are predicted in a compact PSW with active size of 50nm × 90nm × 22.4μm for a modulation speed of 400GHz. The OR efficiency is further increased when introducing the electrically induced OR contribution. The OR characterizes a relatively flat response for a wide range of optical wavelengths from 1.25μm to 1.7μm and supports a RF cut-off frequency up to 800 GHz. This efficient OR process paves a new way for realization of high-speed broadband optical detection and demodulation in silicon chips.


Morphological and physical properties of kefiran-whey protein isolate bionanocomposite films reinforced with Al2O3 nanoparticles.
Considering environmental pollution caused by the non-biodegradable polymers used in food packaging, developing and enhancing the properties of biodegradable films seem to be necessary. For this aim, in the present study, kefiran-whey protein isolate bionanocomposite films were prepared and the impact of different concentrations (1, 3 and 5% w/w) of Al2O3 (alumina) nanoparticles on their physical, morphological, thermal and mechanical properties was studied. Based on the obtained results, an increase in the nanoparticles content led to a significant decrease (p < 0.05) in the water vapor permeability, moisture absorption, moisture content, and water solubility. Scanning electron microscope images showed a homogeneous structure, confirming the good dispersion of alumina nanoparticles with smooth surface up to concentration of 3%. In addition, both thermal stability and mechanical properties of the films were improved by the increased concentrations of alumina. The results of X-ray diffraction indicated that the intensity of the crystalline peaks of film increased with the addition of Al2O3 to kefiran-whey protein isolate matrix. By considering all results, the concentration of 3% was proposed as the appropriate concentration of Al2O3 for the nano-reinforcement of kefiran-whey protein isolate bionanocomposites.


[Pregnancy outcomes in women with gestational diabetes: specific subgroups might require increased attention].
To compare peri-partal parameters between two groups of pregnant women - with and without gestational diabetes mellitus (GDM), to correlate degree of glucose abnormality with incidence of peri-partal morbidity and, finally, to analyse the potential effect of comorbidities (i.e. obesity, hypertension, thyreopathy, polycystic ovary syndrome, trombophylia, anemia, allergy, smoking) on pregnancy outcomes. Epidemiological observational "case-control" study. Department of Obstetric and Gynaecology, Faculty Hospital Brno; Department of Internal Medicine, Diabetes Centre, Faculty Hospital Brno; Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno. The study comprised 432 pregnant women (364 with GDM diagnosis, 68 healthy controls) followed during a period 2011-2013. GDM was diagnosed by oral glucose tolerance test in 24-28th week of gestation (by fasting plasma glucose >5,6 mmol/l or >8,8 mmol/l in 60th min or >7,8 mmol/l in 120th min post-75g glucose load). Following peri-partal parameters were studied: ultrasonographic examination before delivery, a date of delivery, length of childbirth, induction, perinatal complications, post-delivery complications, section, abnormity in pH, base excess, Apgar score, birth weight. Subjects with GDM had significantly increased rate of labour induction compared to healthy controls (P = 0.0035, chi-square test). Subgroup of GDM women classified as having a higher risk for adverse perinatal outcomes by a definition of Czech Obstetric and Gynaecology Society had significantly more labour inductions, more sections and instrumental deliveries. New-borns of those mothers had significantly more common worse perinatal outcomes (Apgar score and macrosomia). Based on our data risk stratification of GDM subjects according to Czech Obstetric and Gynaecology Society appears relevant and justified.


[Telmisartan reduces retina vessel endothelial cell apoptosis via upregulating retinal ACE2-Ang-(1-7)-Mas axis in spontaneous hypertensive rats].
To investigate the effects of angiotensin II (Ang II) antagonist telmisartan on retina vessel endothelial cell apoptosis and its impact on the ACE2-Ang-(1-7)-Mas axis in spontaneous hypertensive rats (SHR). Thirty-six SHR 16 week-old were randomly divided into 3 groups (n = 12 each): SHR, SHRT (telmisartan 10 mg · kg-1 · d-1 by gastric gavage) and SHRTA group (telmisartan 10 mg · kg-1 · d-1 by gastric gavage plus intravenous injection of A-779 0.5 mg · kg-1 · d-1), twelve WKY rats served as normotensive control group. Systolic blood pressure was measured at pre-treatment and 8 weeks later. After 8 weeks, rats were sacrificed, the expression of ACE2 and Mas in retina were analyzed by qRT-PCR, Western blot and Immunohistochemistry, the Ang-(1-7) concentration in serum was measured by ELISA. Specimens were obtained and stained by hematoxylin and eosin, and the morphology of retina vessel was observed. Apoptosis of vessel endothelial cells were determined by using terminal deoxynucleotidyl transferase mediated dUTP nick end labeling method. The systolic blood pressure of SHR, SHRT and SHRTA groups at baseline were significantly higher than age-matched WKY group (all P < 0.01). Eight weeks later, the systolic blood pressure group was significantly lower in SHRT group than in the SHR group (P < 0.01), this effect was partly reversed in SHRTA group. The retinal ACE2 mRNA and protein expression was significantly lower in SHR group than in WKY and SHRT groups (P < 0.01), which was similar between SHRT group and SHRTA group (P > 0.05). The retinal Mas mRNA and protein expression were significantly lower in SHR group compared to WKY and SHRT groups (all P < 0.01), which was significantly lower in SHRTA group than in the SHRT group (P < 0.05). ELISA results showed that serum Ang-(1-7) protein level was significantly lower in SHR group than in WKY group and SHRT group (both P < 0.05), which was lower in SHRTA group compared to SHRT group. Retinal vessel endothelial cell apoptosis was higher in SHR group than in WKY group, which could be reduced by cotreatment with telmisartan and this beneficial effect could be reversed by A-779. Telmisartan can reduce retinal vessel endothelial cell apoptosis via upregulating the ACE2-Ang-(1-7)-Mas axis.


'It's now time for me to speak out'.
Simon Innes, chief executive of CVS, shares his thoughts on vet salaries, recruitment challenges and his ambition for CVS global domination. By Adele Waters.


[A comparative study of celiprolol and nicardipine in stable angina of effort].
Seventeen patients with effort angina, a positive exercise test and at least one stenosed vessel in coronary angiography were studied. Following a crossover blind-design, each patient received at random either 400 mg/day oral celiprolol or 120 mg/day oral nicardipine. A treadmill exercise test and 24 hour Holter monitoring were accomplished at the end of each treatment period. Both drugs significantly prolonged exercise time and reduced maximum ST segment depression at similar stages of control testing. Nicardipine reduced resting diastolic blood pressure a mean of 18 mm Hg (p less than 0.005) and also systolic blood-pressure 11 mm Hg (p less than 0.005) while celiprolol only reduced systolic pressure 10 mm Hg (p less than 0.01). Resting heart-rate was lowered by celiprolol a mean of 9 beats/min (p less than 0.0001) while nicardipine slightly increased it. The double product at maximum effort decreased with celiprolol and increased with nicardipine. Six patients with 3 vessel disease continued having transient ischemic episodes during treatment with celiprolol and 5 had them with nicardipine. Both drugs were well tolerated by the patients. In conclusion celiprolol and nicardipine proved to be effective in the treatment of myocardial ischemia specially when coronary heart disease is not very advanced.


Antiphospholipid antibody-activated NETs exacerbate trophoblast and endothelial cell injury in obstetric antiphospholipid syndrome.
Despite the widespread use of antiplatelets and anticoagulants, women with antiphospholipid syndrome (APS) may face pregnancy complications associated with placental dysplasia. Neutrophil extracellular traps (NETs) are involved in the pathogenesis of many autoimmune diseases, including vascular APS; however, their role in obstetric APS is unclear. Herein, we investigated the role of NETs by quantifying cell-free DNA and NET marker levels. Live-cell imaging was used to visualize NET formation, and MAPK signalling pathway proteins were analysed. Cell migration, invasion and tube formation assays were performed to observe the effects of NETs on trophoblasts and human umbilical vein endothelial cells (HUVECs). The concentrations of cell-free DNA and NETs in sera of pregnant patients with APS were elevated compared with that of healthy controls (HCs) matched to gestational week. APS neutrophils were predisposed to spontaneous NET release and IgG purified from the patients (APS-IgG) induced neutrophils from HCs to release NETs. Additionally, APS-IgG NET induction was abolished with inhibitors of reactive oxygen species, AKT, p38 MAPK and ERK1/2. Moreover, NETs were detrimental to trophoblasts and HUVECs. In summary, APS-IgG-induced NET formation deserves further investigation as a potential novel therapeutic target in obstetrical APS.


Attilio Maseri.
Professor Attilio Maseri is a clinical investigator with a remarkable track record of innovative research who, by changing traditional paradigms, contributed to shape new diagnostic techniques in pathophysiologic thinking. His research has been characterized by challenging the generalizations of accepted "wisdom" which did not offer satisfactory explanations for the observations he made in his clinical practice. The results of his clinical investigations have contributed greatly to the opening of new avenues of research and patient management in the field of ischemic heart disease. His clinical and research experiences are catalogued in 740 pages of his single-authored textbook Ischemic Heart Disease. A Rational Basis for Clinical Practice and Clinical Research. This book chronicles Maseri's novel unifying vision of ischemic heart disease. In 2001, Professor Maseri left Catholic University in Rome to take on bigger challenges in Milan where he is now functioning as Professor of Cardiology at the University Vita-Salute San Raffaele and Director of the Cardio-Thoracic and Vascular Department of the San Raffaele Scientific Institute. His research interests include application of molecular biology, differential gene expression profiling, and clinical cardiovascular research such as molecular mechanisms of coronary instability and molecular mechanisms of negative and positive ventricular remodeling. Professor Attilio Maseri will be remembered as a thoughtful clinician, a mentor for many whose academic careers have blossomed, and a careful clinical investigator whose innovative research in ischemic heart disease will set the highest standards for those who follow in his giant footsteps. On a personal note, I first met Attilio Maseri, his wife Francesca, and their son Filippo at the 1976 Pisa conference. What transpired at that conference influenced my own career and stimulated my continued interest in ischemic heart disease as well as my enthusiasm for the international aspects of cardiovascular medicine. I consider myself fortunate to be a friend of Attilio Maseri and to have benefited from my associations with him, both professionally and personally.


[Etiology of tubulointerstitial nephritis].
Clinicomorphological manifestations of little-known forms of tubulointerstitial nephritis (TIN) are described. TIN development is considered in persons on prolonged antispasmodic therapy for epilepsy, in patients with HBS-antigen against a background of chronic hepatitis or liver cirrhosis, and in persons with chronic glomerulo- or pyelonephritis.


General phytoplasma detection by a q-PCR method using mycoplasma primers.
Phytoplasmas and mycoplasmas are bacteria belonging to the class Mollicutes. In this study, a fine tuning of quantitative polymerase chain reaction (qPCR) with a universal mycoplasma primer pair (GPO3F/MGSO) targeting the 16S rRNA gene was carried out on phytoplasmas. The dissociation curves of DNAs from Catharanthus roseus phytoplasma-infected micropropagated shoots and from phytoplasma field-infected plant samples showed a single peak at 82.5 °C (±0.5) specifically detecting phytoplasmas belonging to several ribosomal groups. Assay specificity was determined with DNA of selected bacteria: 'Candidatus Liberibacter solanacearum', Xylella fastidiosa, Ralstonia solanacearum and Clavibacter michiganensis. No amplification curves were observed with any of these tested bacteria except 'Ca. L. solanacearum' that was amplified with a melting temperature at 85 °C. Absolute quantification of phytoplasma titer was calculated using standard curves prepared from serial dilutions of plasmids containing the cloned fragment GPO3F/MGSO from European stone fruit yellows phytoplasma. Phytoplasma copy number ranged from 106 to 103 according with the sample. The sensitivity evaluated comparing plasmid serial dilutions resulted 10-6 for conventional PCR and 10-7 for qPCR. The latter method resulted therefore able to detect very low concentrations of phytoplasma in plant material.


Rough sets approach to analysis of data from peritoneal lavage in acute pancreatitis.
Two kinds of information systems composed of data from peritoneal lavage in acute pancreatitis are analysed with the concept of rough sets: system A, classifying patients described by pre-lavage attributes, and system B, classifying patients described by attributes of the course of the multistage lavage. The analysis tends to define subsets which are significant for high quality of classification. These attributes give the best description of the patient's state and are in the closest relationship with the time of lavage. The character of this relationship is shown by decision algorithms derived from decision tables representing the information system.


Towards an Earlier and Timely Diagnosis of Type 1 Diabetes: Is it Time to Change Criteria to Define Disease Onset?
Type 1 diabetes (T1D) is the immune-mediated form of diabetes requiring insulin treatment and affecting both children and adults. The incidence of T1D is increasing dramatically and has doubled in the past 2 decades. In the recent years, significant knowledge on the disease natural history has been gained and, nowadays, diabetes-related autoantibodies make T1D a predictable disease. Despite this great advance in the field of T1D, we still use diagnostic criteria defined by the American Diabetes Association (ADA) in 1997. In other autoimmune endocrine disorders (e.g., Hashimoto's thyroiditis and Addison's disease), that share several features with T1D, diagnosis is made early in the presence of circulating autoantibodies together with subclinical thyroid/adrenal functional impairment and treatments are often provided in the absence of a frank clinical glandular insufficiency. With this review, we propose to anticipate diagnosis also in T1D at the stage in which subjects have circulating multiple islet autoantibodies, are dysglycemic but are still insulin independent. We believe that anticipating T1D diagnosis can lead to better disease management and prevention of secondary complications but can also provide the possibility to perform earlier and likely more effective interventions for a disease that to date has proven controllable but still incurable.


Temporal bone malignancies involving the jugular foramen: diagnosis and management.
To describe the diagnosis, management and outcomes of temporal bone malignancies involving the jugular foramen. The charts of 12 patients with temporal bone malignancies involving the jugular foramen were reviewed and analyzed. The most frequent symptoms of temporal bone malignancies involving the jugular foramen were hearing loss (75%), otorrhea (66.67%) and otalgia (66.67%). In addition to the jugular foramen, the most invaded structure was the external auditory canal (91.67%), followed by the middle ear (75%) and facial nerve (58.33%). Four cases (33.33%) were misdiagnosed either with glomus jugulare tumor, Bell's palsy or chronic otitis media. Two patients underwent lateral temporal bone resection, whereas 10 patients underwent subtotal temporal bone resection. The mean follow-up time was 23.83 months (range, 2-85 months). The 2-year disease-free survival rate was 42.3%. Temporal bone malignancies involving the jugular foramen had a poor prognosis, especially in patients with squamous cell carcinoma. Misdiagnoses including glomus jugulare tumor, Bell's palsy and chronic otitis media were frequently encountered. Temporal bone malignancies involving the jugular foramen can be resected, and the choice of the surgical approach should be individualized.