A method for identifying places in rural America at risk of not being able to support adequate health services.
Public policymakers and their advisers struggle with the problem of specifying criteria by which health care providers in rural areas are eligible for special consideration in payment policies and for special grant programs. A means of designating places can provide a basis for assistance and can help target public resources for any providers who deliver services in those places. This paper provides the details underlying a place-based approach to identifying rural areas that are at risk for not being able to provide requisite health services. A population size criterion is utilized first to eliminate metropolitan areas and other large agglomerations from consideration. Any territory not included in a place of 3500 or more people, including a 25-mile buffer around that place, is a priori considered to be at risk. All places, including buffers, that have populations between 3500 and 100,000 are further analyzed using population compositional data and principal components analysis. In 10 states and 24 bordering states selected for developing and testing the method, there were 1907 block groups outside the boundaries of any place with a population of at least 3500. In addition, the analysis suggested that 66 out of 236 places and buffers with populations between 3500 and 100,000 also should be classified as vulnerable. The results are discussed in regard to how a place-based approach can advance the study of rural health needs. By focusing on the needs of the people residing in a defined area, as determined from the aggregate characteristics of the population, a model is generated that can be used to predict special circumstances confronting any service provider. The public policy implications of the findings are also considered. Special payment policies could be written on the basis of place instead of provider characteristics, and grant programs providing technical assistance could be targeted to places of greatest need.


Associations of perceived neighborhood environment and physical activity with metabolic syndrome among Mexican-Americans adults: a cross sectional examination.
This secondary data analysis examined associations among perceived neighborhood environmental factors, physical activity (PA), and the presence of metabolic syndrome (MS) in Mexican-American (MA) adults. Seventy-five MA adults (mean age of 37.9 ± 9.3 years) provided anthropometric, biomarker, and survey data. The Neighborhood Scales Questionnaire evaluated six perceived neighborhood factors: walking environment, aesthetic quality, safety, violence, social cohesion, and activities with neighbors. The Rapid Assessment of PA questionnaire assessed PA. MS was determined according to ATP III criteria. PA was significantly associated with MS (OR = .338, CI .204-.738). Neighborhood factors of safety (B = .255, p = .024), walking environment (B = .384, p = .001), and social cohesion (B = .230, p = .043) were positively associated with PA. No other neighborhood factors were significantly related to PA. Analyses examining whether neighborhood factors moderated the relationship between PA and MS were not significant.


[Trend in the emergence of flea imagoes from cocoons in the nests of a mountain gopher (Spermophilus musicus) in the central Caucasian highland natural focus of plague].
The results of observations of a trend in the emergence of flea imagoes from cocoons in the nests of mountain gopher (Spermophilus musicus) (Elbrus region) confirm that the dominant species: Citellophilus tesquorum elbrusensis and Ctenophthalmus golovi golovi have two generations. Emergence of first-generation imagoes from cocoons is recorded in July-August in the nests where the grophers constantly inhabit in May-June. These are brood-rearing and other summer nests and, to a lesser degree, former wintering ones. Hatching of the bulk of second-generation flea imagoes is observed in the nests constantly inhabited by grophers in July-August (these are nests made from summer holes and renovable wintering nests). The onset of emergence of second-generation imagoes from cocoons in both flea species is noted in September; some specimens hibernate in the cocoons, by emerging from them next April.


The Effect of Botulinum Toxin A on Ischemia-Reperfusion Injury in a Rat Model.
While studies using various materials to overcome ischemia-reperfusion (IR) injury are becoming increasingly common, studies on the effects of botulinum toxin A (BoTA) on IR injury in musculocutaneous flaps are still limited. The purpose of this study was to examine our hypotheses that BoTA provide protection of musculocutaneous flap from ischemia-reperfusion injury. Five days after pretreatment injection (BoTA versus normal saline), a right superior musculocutaneous flap (6 × 1.5 cm in size) was made. Ischemia was created by a tourniquet strictly wrapping the pedicle containing skin and muscle for 8 h. After ischemia, the tourniquet was cut, and the musculocutaneous flap was reperfused. The overall survival percentage of flap after 8 h of pedicle clamping followed by reperfusion was 87.32 ± 3.67% in the control group versus 95.64 ± 3.25% in the BoTA group (p < 0.001). The BoTA group had higher expression of CD34, HIF-1α, VEGF, and NF-kB comparing to control group in qRT-PCR analysis. In this study, we found that local BoTA preconditioning yielded significant protection against IR injury in a rat musculocutaneous flap model.


[Intraventricular application of opiates using implantable pump systems].
Intraventricular catheters and implanted morphium pumps make it possible to effectively treat patients with severe pain from malignant growths. The surgical procedure for our special field is explained in a short summary.


Countering resistance to protected-area extension.
The establishment of protected areas is a critical strategy for conserving biodiversity. Key policy directives like the Aichi targets seek to expand protected areas to 17% of Earth's land surface, with calls by some conservation biologists for much more. However, in places such as the United States, Germany, and Australia, attempts to increase protected areas are meeting strong resistance from communities, industry groups, and governments. We examined case studies of such resistance in Victoria, Australia, Bavaria, Germany, and Florida, United States. We considered 4 ways to tackle this problem. First, broaden the case for protected areas beyond nature conservation to include economic, human health, and other benefits, and translate these into a persuasive business case for protected areas. Second, better communicate the conservation values of protected areas. This should include highlighting how many species, communities, and ecosystems have been conserved by protected areas and the counterfactual (i.e., what would have been lost without protected area establishment). Third, consider zoning of activities to ensure the maintenance of effective management. Finally, remind citizens to think about conservation when they vote, including holding politicians accountable for their environmental promises. Without tackling resistance to expanding the protected estate, it will be impossible to reach conservation targets, and this will undermine attempts to stem the global extinction crisis.


Contact isolation is a risk factor for venous thromboembolism in trauma patients.
Contact isolation (CI) is a series of precautions used to prevent the transmission of medically significant infectious pathogens in the health care setting. Our institution's implementation of CI includes limiting patient movement to the assigned room. Our objective was to define the association between CI and venous thromboembolism (VTE) at our Level I trauma center. Our institution's prospective trauma database was retrospectively queried for all patients admitted to the trauma service between January 1, 2011, and December 31, 2012. Data including demographics, Injury Severity Score (ISS), preexisting medical conditions, injury type, and VTE development were collected. CI status data were obtained from our institution's infection control database. χ2 was used to examine the unadjusted relationship between CI status and VTE. As the groups were not equivalent, logistic regression was then used to examine the relationship between CI and VTE while adjusting for relevant covariates including sex, age, ISS, and comorbidities. Of the 4,423 trauma patients admitted during the study period, 4,318 (97.6%) had complete records and were included in subsequent analyses. A total of 249 (5.8%) of the patients were on CI. VTE occurred in 44 patients (17.7%) on CI versus 141 patients (3.5%) who were not isolated (p < 0.0001; odds ratio, 6.0; 95% confidence interval, 4.1-8.6). With the use of lasso [least absolute shrinkage and selection operator] regression to adjust for patient risk factors, this relationship remained highly significant (p < 0.0001; odds ratio, 2.61; 95% confidence interval, 1.7-4.0). CI, ISS, hospital length of stay, and cardiac comorbidity were associated with VTE. After adjustment for other risk factors, CI remained most strongly associated with VTE. Although any medical intervention may come with unintended consequences, the risks and benefits of CI in this population need to be reevaluated. Further study is planned to identify opportunities to mitigate this increased VTE risk. Prognostic/epidemiologic study, level III; therapeutic study, level IV.


Therapeutic Effect of Exosomes Derived From Stem Cells in Spinal Cord Injury: A Systematic Review Based on Animal Studies.
A systematic review of the role of stem cell-derived exosomes in repairing spinal cord injury (SCI) and the existing problems in animal experiments to provide a reference for better animal experiments and clinical studies in the future. Three electronic databases, namely PubMed, Web of Science, and Ovid-Embase were searched. The studies were retrieved from inception to October 2021. Two researchers independently screened the literature, extracted data, and evaluated the methodological quality based on the inclusion criteria. Thirty-two studies were incorporated into the final analyses. Exosomes derived from stem cells could not only significantly improve the motor function of animals with SCI, but also significantly increase the expression of anti-inflammatory factors IL-4 and IL-10 and anti-apoptotic protein Bcl-2, while significantly lowering the pro-inflammatory factor IL-1β and TNF-α and the expression of the apoptotic protein BAX. However, the mechanism of exosome-mediated SCI repair, as well as the best source and dosage remain unknown. In addition, there are still some issues with the design, implementation, and reporting of animal experiments in the included studies. Therefore, future research should further standardize the implementation and reporting of animal studies and fully explore the best strategies for exosomes to repair SCI so as to promote the translation of preclinical research results to clinical research better and faster.


Structure of motor endplates in the different fiber types of vertebrate skeletal muscles.
The number and localization of vertebrate motor endplates on the muscle fiber, and their structure, vary according to phylum and species, and among the different fiber types in a given species. Vertebrate skeletal muscle fibers are classified into two major groups: the twitch (fast) and the slow (tonic) fibers. The twitch fiber has straight Z-lines and a well developed T-SR system, and is singly innervated with en plaque (plate-like) type motor endplate. The twitch fibers are further subdivided into three types: the red (mitochondria-rich), intermediate (mitochondria-moderate) and white (mitochondria-poor) fibers. The motor endplate of the white fiber is large and has a complicated structure, that of the red fiber is small and less complicated, and that of the intermediate fiber possesses intermediate characteristics. The slow fiber has zigzag Z-lines and poorly developed sarcoplasmic reticulum (SR), and is multiply innervated with en grappe (grape-like) type motor endplates. The morphological features of the motor endplate in each of these fiber types of the mammalian, avian, reptilian, amphibian, and fish skeletal muscles are reviewed. Special emphasis has been placed on the three-dimensional structure of the motor endplates of the different fiber types as observed by high-resolution scanning electron microscopy.


Mucoadhesive bilayered tablets for buccal sustained release of flurbiprofen.
The aim of this work was the design of sustained-release mucoadhesive bilayered tablets, using mixtures of mucoadhesive polymers and an inorganic matrix (hydrotalcite), for the topical administration of flurbiprofen in the oral cavity. The first layer, responsible for the tablet retention on the mucosa, was prepared by compression of a cellulose derivative and polyacrylic derivative blend. The second layer, responsible for buccal drug delivery, was obtained by compression of a mixture of the same (first layer) mucoadhesive polymers and hydrotalcite containing flurbiprofen. Nonmedicated tablets were evaluated in terms of swelling, mucosal adhesion, and organoleptic characteristics; in vitro and in vivo release studies of flurbiprofen-loaded tablets were performed as well. The best results were obtained from the tablets containing 20 mg of flurbiprofen, which allowed a good anti-inflammatory sustained release in the buccal cavity for 12 hours, ensuring efficacious salivary concentrations, and led to no irritation. This mucoadhesive formulation offers many advantages over buccal lozenges because it allows for reduction in daily administrations and daily drug dosage and is suitable for the treatment of irritation, pain, and discomfort associated with gingivitis, sore throats, laryngopharyngitis, cold, and periodontal surgery. Moreover, it adheres well to the gum and is simple to apply, which means that patient compliance is improved.


Active Trigger Points in the Cervical Musculature Determine the Altered Activation of Superficial Neck and Extensor Muscles in Women With Migraine.
Previous studies have demonstrated the presence of active trigger points (TrPs) in women with migraine reproducing their headache attacks. No study has investigated whether these TrPs can alter cervical muscle function in migraine. Our objective was to analyze differences in the activation of superficial neck flexor and extensor muscles in women with migraine considering the presence of active TrPs in the splenius capitis (SC), the upper trapezius (UT), and the sternocleidomastoid (SCM) muscles. Surface electromyography (EMG) was recorded from the superficial flexors (SCM and anterior scalene) and the extensor (SC, UT) muscles bilaterally as participants performed a staged task of cranio-cervical flexion (CCF; 5 contractions representing a progressive increase in CCF range of motion) in 70 women with migraine. They were stratified according to the presence or the absence of active TrPs in the SCM, the SC, or the UT musculature. A comparison of EMG normalized root mean square (RMS) values was conducted with a 2×5 analysis of covariance with the task level as the within-subject variable, group stratified by active TrPs as the between-subjects variable and the presence of neck pain as a covariable. All patients exhibited active TrPs in their cervical muscles, which reproduced their migraine. Women with migraine exhibiting active TrPs in the SCM (P<0.01), the UT (P<0.05), or the SC (P<0.05) muscles had lower normalized RMS values of their superficial neck flexors than those without active TrPs in the same muscles. In addition, individuals exhibiting active TrPs in the SC and the UT (both, P<0.05) muscles had higher normalized RMS values in the SC muscle than those without active TrPs in the same muscles. The presence of active TrPs in the cervical musculature determines an altered activation of superficial neck and extensor muscles during low-load, isometric CCF contractions in women with migraine.


Pharmacological modifications of the sodium channels of frog nerve.
Voltage clamp measurements on myelinated nerve fibers show that tetrodotoxin, saxitoxin, and DDT specifically affect the sodium channels of the membrane. Tetrodotoxin and saxitoxin render the sodium channels impermeable to Na ions and to Li ions and probably prevent the opening of individual sodium channels when one toxin molecule binds to a channel. The apparent dissociation constant of the inhibitory complex is about 1 nM for the cationic forms of both toxins. The zwitter ionic forms are much less potent. On the other hand, DDT causes a fraction of the sodium channels that open during a depolarization to remain open for a longer time than is normal. The effect cannot be described as a specific change in sodium inactivation or as a specific change in sodium activation, for both processes continue to govern the opening of the sodium channels and neither process is able to close the channels. The effects of DDT are very similar to those of veratrine.


[Soluble IL-2 receptor levels in rheumatic diseases].
We measured soluble interleukin-2 receptors (sIL-2R) in plasma and/or joint fluid (JF) from patients with rheumatoid arthritis (RA: 16 patients), Sjögren's syndrome (SS: 24 patients) and Behçet's disease (BD: 23 patients). Plasma sIL-2R levels were significantly higher in RA patients (956 +/- 994 U/ml, p < 0.01) and SS patients (1025 +/- 1112 U/ml, p < 0.01) than 20 healthy subjects (338 +/- 159 U/ml), but not significantly increased in BD patients (408 +/- 329 U/ml). sIL-2R levels higher than the mean of healthy subjects +2 standard deviations were observed in 3 BD patients (13.0%), 7 RA patients (43.8%) and 10 SS patients (41.7%). sIL-2R levels positively correlated with erythrocyte sedimentation rates and C-reactive protein levels in RA patients, or IgM levels in SS. There was no significant correlation between plasma sIL-2R levels and disease activity, clinical symptoms, or other laboratory parameters in BD patients. However, sIL-2R concentrations in the JF from 4 BD patients (1644 +/- 198 U/ml: p < 0.05) or 16 RA patients (3946 +/- 5424 U/ml: p < 0.01) were significantly higher than corresponding plasma sIL-2R concentrations. Above results indicate that lymphocytes are being activated in patients with RA or SS and in the inflammatory lesions of BD patients, while the whole immunologic activation are relatively lower in BD than RA and SS.


15-Hydroxyprostaglandin dehydrogenase is a target of hepatocyte nuclear factor 3beta and a tumor suppressor in lung cancer.
The forkhead transcription factor hepatocyte nuclear factor 3beta (HNF3beta) is essential in foregut development and the regulation of lung-specific genes. HNF3beta expression leads to growth arrest and apoptosis in lung cancer cells and HNF3beta is a candidate tumor suppressor in lung cancer. In a transcriptional profiling study using a conditional cell line system, we now identify 15-PGDH as one of the major genes induced by HNF3beta expression. 15-PGDH is a critical metabolic enzyme of proliferative prostaglandins, an antagonist to cyclooxygenase-2 and a tumor suppressor in colon cancer. We confirmed the regulation of 15-PGDH expression by HNF3beta in a number of systems and showed direct binding of HNF3beta to 15-PGDH promoter elements. Western blotting of lung cancer cell lines and immunohistochemical examination of human lung cancer tissues found loss of 15-PGDH expression in approximately 65% of lung cancers. Further studies using in vitro cell-based assays and in vivo xenograft tumorigenesis assays showed a lack of in vitro but significant in vivo tumor suppressor activity of 15-PGDH via an antiangiogenic mechanism analogous to its role in colon cancer. In summary, we identify 15-PGDH as a direct downstream effector of HNF3beta and show that 15-PGDH acts as a tumor suppressor in lung cancer.


Modification of the Ribosome and the Translational Machinery during Reduced Growth Due to Environmental Stress.
Escherichia coli strains normally used under laboratory conditions have been selected for maximum growth rates and require maximum translation efficiency. Recent studies have shed light on the structural and functional changes undergone by the translational machinery in E. coli during heat and cold shock and upon entry into stationary phase. In these situations both the composition and the partitioning of this machinery into the different pools of cellular ribosomes are modified. As a result, the translational capacity of the cell is dramatically altered. This review provides a comprehensive account of these modifications, regardless of whether or not their underlying mechanisms and their effects on cellular physiology are known. Not only is the composition of the ribosome modified upon entry into stationary phase, but the modification of other components of the translational machinery, such as elongation factor Tu (EFTu) and tRNAs, has also been observed. Hibernation-promoting factor (HPF), paralog protein Y (PY), and ribosome modulation factor (RMF) may also be related to the general protection against environmental stress observed in stationary-phase E. coli cells, a role that would not be revealed necessarily by the viability assays. Even for the best-characterized ribosome-associated factors induced under stress (RMF, PY, and initiation factors), we are far from a complete understanding of their modes of action.


Hypoxia-induced VEGF and collagen I expressions are associated with angiogenesis and fibrogenesis in experimental cirrhosis.
Cirrhosis consists of hepatocyte nodules surrounded by a highly vascularized fibrous tissue. We previously showed that the development of biliary cirrhosis in the rat is associated with the occurrence of hepatocellular hypoxia and the induction of hepatic angiogenesis. We herein examined the occurrence of hypoxia in an experimental model of diethylnitrosamine (DEN)-induced cirrhosis. We also determined whether hypoxia directly affects the expression of vascular endothelial growth factor (VEGF), of VEGF receptors (Flt-1, Flk-1), and of type I and type IV collagens in activated hepatic stellate cells (HSCs) and the expression of VEGF in hepatocytes. Our results show that in DEN-treated rats, although the progression of liver fibrosis is associated with hepatocellular hypoxia and angiogenesis, VEGF and Flt-1 expressions in the liver are increased and correlated with the density of microvessels. In vitro, hypoxia induces the expression of VEGF, Flt-1, and type I collagen in activated HSCs and that of VEGF in hepatocytes. In addition, we show that hypoxia-induced type I collagen expression in HSCs may occur independently of transforming growth factor beta1 (TGF-beta1) overexpression. In conclusion, the present study provides further evidence that hepatocellular hypoxia and angiogenesis progress together with fibrogenesis after liver injury and that hypoxia directly contributes to the progression of liver fibrosis.


Nucleotides, Nucleosides, and Nucleobases.
We review literature on the metabolism of ribo- and deoxyribonucleotides, nucleosides, and nucleobases in Escherichia coli and Salmonella,including biosynthesis, degradation, interconversion, and transport. Emphasis is placed on enzymology and regulation of the pathways, at both the level of gene expression and the control of enzyme activity. The paper begins with an overview of the reactions that form and break the N-glycosyl bond, which binds the nucleobase to the ribosyl moiety in nucleotides and nucleosides, and the enzymes involved in the interconversion of the different phosphorylated states of the nucleotides. Next, the de novo pathways for purine and pyrimidine nucleotide biosynthesis are discussed in detail.Finally, the conversion of nucleosides and nucleobases to nucleotides, i.e.,the salvage reactions, are described. The formation of deoxyribonucleotides is discussed, with emphasis on ribonucleotidereductase and pathways involved in fomation of dUMP. At the end, we discuss transport systems for nucleosides and nucleobases and also pathways for breakdown of the nucleobases.


Decreased allergy incidence in children supplemented with E. coli O83:K24:H31 and its possible modes of action.
The growing knowledge of the key role of microbiota in the maturation of neonatal immune system suggests that manipulation of microbiota could be exploited in hampering allergy development. In this study, Escherichia coli O83:K24:H31 (EcO83) was administered to newborns that were followed prospectively. Several immunological characteristics (cytokines, specific IgE, total T regulatory cells (Treg) and subpopulation of natural Treg (nTreg) and induced Treg (iTreg)) were tested in peripheral blood of 8-year-old children. Incidence of allergic disease was decreased in EcO83 supplemented children and significantly elevated levels of IL-10 and IFN-ɣ were detected in serum of EcO83 supplemented children. Probiotic supplementation did not influence the numbers of the total Treg population but their functional capacity (intracellular expression of IL-10) was significantly increased in children supplemented with EcO83 in comparison to non-supplemented children. Morover, decreased proportion of iTreg was present in peripheral blood of non-supplemented in comparison to EcO83 supplemented children. Finally, stimulation of cord blood cells with EcO83 promoted both gene expression and secretion of IL-10 and IFN-ɣ suggesting that beneficial effect of EcO83 in prevention of allergy development could be mediated by promotion of regulatory responses (by IL-10) and Th1 immune response (by IFN-ɣ).


[Right heart failure in a patient with unexplained tricuspid regurgitation and a rare congenital heart disease].
We report the case of a 63-year-old woman admitted to the intensive care unit because of acute decompensated right heart failure. Transthoracic and transesophageal echocardiography revealed severe right ventricular dysfunction with severe tricuspid regurgitation of unknown origin and a large membrane running from the inferior vena cava to the interatrial septum with significant diastolic transmembrane gradient, consistent with the diagnosis of cor triatriatum dexter. The clinical interest of our findings relies on the coexistence of multiple diseases, which actually contributed in a different but synergistic manner to right heart failure.


Visible light driven type II heterostructures and their enhanced photocatalysis properties: a review.
Considerable efforts have been devoted to enhancing the photocatalytic activity and solar energy utilization of photocatalysts. The fabrication of type II heterostructures plays an important role in photocatalysts modification and has been extensively studied. In this review, we briefly trace the application of type II heterostructured semiconductors in the area of environmental remediation and water splitting, summarize major fabrication methods, describe some of the progress and resulting achievements, and discuss the future prospects. The scope of this review covers a variety of type II heterostructures, focusing particularly on TiO2 and ZnO based visible light driven type II 0D and 1D heterostructured photocatalysts. Some other low dimensional nanomaterials which have shown high-performance photocatalysis are also presented. We expect this review to provide a guideline for readers to gain a clear picture of fabrication and application of type II heterostructures.


Isolated unilateral thalamic venous infarct in a toddler.
Isolated deep cerebral venous thrombosis (CVT), especially involving only the right thalamus, is one of the rarest forms of intracranial venous thrombosis in a child. The anatomy and flow patterns of the deep cerebral venous system are complex and usually, the thrombosis of the internal cerebral veins (ICV) results in thalamic infarction bilaterally. The focal infections, thalamic tumours and vascular malformations may have overlapping clinicoradiological patterns. The treating team should be able to recognise the atypical phenotypes of the deep CVT at the earliest, which can facilitate apt treatment and obviate the need for unnecessary investigations and interventions. We present a rare case of an isolated right thalamic acute venous infarct secondary to bilateral ICV thrombosis in a toddler who was successfully managed by timely diagnosis and with only conservative therapy.


[Treatment of post-transplant glomerulonephritis].
The treatment of recurrent glomerulonephritis (GN) is often empirical. Plasmapheresis has received the largest consensus for the treatment of focal glomerular sclerosis (FGS), whether associated with cyclophosphamide and steroids or not. To be effective, such therapy needs to be started as quickly as possible after the onset of proteinuria, and prolonged for months when recovery is delayed. Plasmapheresis and cyclophosphamide have also been used to treat GNs with glomerular crescents. However, there has been no consensus on the efficacy of such therapy. The recently introduced rituximab is the most innovative drug but also the most experimental. So far, it has been used for the treatment of ANCA-associated vasculitis, FGS and membranous GN, with results that are still under debate. Cyclophosphamide has been used in patients with severe recurrent GN, but the anedoctal cases described prevent us from drawing any firm conclusions. Steroids have been used for the treatment of many recurrent GNs, but yet again, without any standard protocol. They have been used both in children with FGS and in adults with aggressive GN or severe proteinuria. Both ACE inhibitors and angiotensinreceptor blockers have been suggested as first-line therapy in recurrent GN with proteinuria. This therapy is safe and can be even more effective than others. Finally, it must be kept in mind that the addition of immunosuppression in transplant patients can dramatically increase the risk of infective complications. Moreover, recurrent GNs are often associated with chronic allograft diseases that can cause graft worsening independently of any therapy.


Developing consensus in identifying challenges of undergraduate orthodontic education in Malaysian public universities using e-Delphi.
The aim of the study was to seek consensus, identify and explore the challenges facing undergraduate orthodontic education and propose equitable solutions for overcoming the challenges amongst Malaysian public university dental schools. An iterative e-Delphi technique was employed as the method for gathering consensus on a range of topics found pertinent to affect orthodontic teaching and learning established through literature review. A total of ten expert panellists were recruited through a targeted invitation to the orthodontists from Malaysian public universities offering undergraduate dental education. The e-Delphi comprised of three rounds of anonymous e-survey. The consensus was sought for two open-ended and two closed-ended questions. The response rates for all the three rounds were 100 per cent. The total number of questions responded by the participants in all the three rounds was forty-four. Round one achieved consensus on two closed-ended questions. Round two achieved a consensus on twenty-eight out of thirty-four (82.35%) questions with round three achieving a consensus on four out of six (66.66%) questions. A 70% consensus was considered as the minimum level of agreement for all the rounds. In total, consensus and agreement were achieved on two closed-ended questions and twenty-nine items from the open-ended questions. The study was able to identify a range of issues affecting undergraduate orthodontic education with a good level of consensus using the e-Delphi technique highlighting the need for curriculum refinement. The study has, in addition, proposed tangible methods to enable such a change.


Hindlimb unloading induces a collagen isoform shift in the soleus muscle of the rat.
To determine whether hindlimb unloading (HU) alters the extracellular matrix of skeletal muscle, male Sprague-Dawley rats were subjected to 0 (n = 11), 1 (n = 11), 14 (n = 13), or 28 (n = 11) days of unloading. Remodeling of the soleus and plantaris muscles was examined biochemically for collagen abundance via measurement of hydroxyproline, and the percentage of cross-sectional area of collagen was determined histologically with picrosirius red staining. Total hydroxyproline content in the soleus and plantaris muscles was unaltered by HU at any time point. However, the relative proportions of type I collagen in the soleus muscle decreased relative to control (Con) with 14 and 28 days HU (Con 68 +/- 5%; 14 days HU 53 +/- 4%; 28 days HU 53 +/- 7%). Correspondingly, type III collagen increased in soleus muscle with 14 and 28 days HU (Con 32 +/- 5%; 14 days HU 47 +/- 4%; 28 days HU 48 +/- 7%). The proportion of type I muscle fibers in soleus muscle was diminished with HU (Con 96 +/- 2%; 14 days HU 86 +/- 1%; 28 days HU 83 +/- 1%), and the proportion of hybrid type I/IIB fibers increased (Con 0%; 14 days HU 8 +/- 2%; 28 days HU 14 +/- 2%). HU had no effect on the proportion of type I and III collagen or muscle fiber composition in plantaris muscle. The data demonstrate that HU induces a shift in the relative proportion of collagen isoform (type I to III) in the antigravity soleus muscle, which occurs concomitantly with a slow-to-fast myofiber transformation.


Field evaluation of selected cassava genotypes for cassava brown streak disease based on symptom expression and virus load.
Production of cassava (Manihot esculenta Crantz), a food security crop in sub-Saharan Africa, is threatened by the spread of cassava brown streak disease (CBSD) which manifests in part as a corky necrosis in the storage root. It is caused by either of two virus species, Cassava brown streak virus (CBSV) and Ugandan cassava brown streak virus (UCBSV), resulting in up to 100% yield loss in susceptible varieties. This study characterized the response of 11 cassava varieties according to CBSD symptom expression and relative CBSV and UCBSV load in a field trial in Uganda. Relative viral load was measured using quantitative RT-PCR using COX as an internal housekeeping gene. A complex situation was revealed with indications of different resistance mechanisms that restrict virus accumulation and symptom expression. Four response categories were defined. Symptom expression was not always positively correlated with virus load. Substantially different levels of the virus species were found in many genotypes suggesting either resistance to one virus species or the other, or some form of interaction, antagonism or competition between virus species. A substantial amount of research still needs to be undertaken to fully understand the mechanism and genetic bases of resistance. This information will be useful in informing breeding strategies and restricting virus spread.


A non-invasive chamber sampling technique for HPLC analysis of human epidermal urocanic acid isomers.
A new, non-invasive chamber sampling technique for HPLC analysis of human epidermal urocanic acid isomers is described. Easily processed samples are obtained in a rapid and non-invasive manner, without discomfort to the patient. HPLC data from chamber samples are reproducible, and recorded urocanic acid isomer levels are comparable to those measured in samples taken with tape stripping technique.


Clinical value of serum alkaline phosphatase isoenzyme estimations in the elderly.
The value of the estimation of liver and bone isoenzyme of alkaline phosphatase in a series of 500 admissions to a geriatric unit is described. A raised total alkaline phosphatase was found in 40 patients and this was due to raised levels of the bone isoenzyme in about two-thirds of these. Its value in diagnosis of treatable bone disease is emphasized.


Evaluating the Role of a Neurosurgery Consultation in Management of Pediatric Isolated Linear Skull Fractures.
The purpose of this study was to determine if a pediatric neurosurgical consultation for isolated linear skull fractures (ILSF) in pediatric patients with Glasgow Coma Scale (GCS) scores of ≥14 changed their management. A 10-year retrospective chart review at a Level 1 Pediatric Trauma Center was performed. Exclusion criteria were age > 18 years, open, depressed, or skull base fractures, pneumocephalus, poly-trauma, any hemorrhage (intraparenchymal, epidural, subdural, subarachnoid), cervical spine fractures, penetrating head trauma, and initial GCS scores ≤13. Primary outcomes were neurosurgery recommendations to change acuity of care, obtain additional imaging studies, and perform invasive procedures. Secondary outcomes were patient demographics, injury type, transfer status, admitting service, length of hospital stay, consult location, and clinical course. There were 127 cases of ILSF meeting study criteria with an average age of 2.36 years. Unilateral parietal bone fracture was the most common injury (46.5%). Falls were the most common mechanism (81.1%). All patients received pediatric neurosurgical consultations within 24 h of hospital arrival. There were no neurosurgical recommendations to obtain additional imaging studies, change acuity of care, or perform invasive procedures. Routine neurosurgical consultation in children with ILSF and GCS 14-15 does not appear to alter clinical management.


[Research in synthesis of bioactive peptide RGD and the method for its grafting on PET surface].
The aim of this experiment is to graft synthesizing Arg-Gly-Asp peptides (RGD) on the surface of polymer materials, combine endothelial cells with its special site, enhance the adhesion of endothelial cells on the surface, promote the blood compatibility of the biomaterials. Carboxy group (-COOH) was grafted on the materials surface by ultraviolet (UV) radiation, and the RGD serial obtained by liquid phase synthesis was successfully grafted on the disposed materials by chemical reaction. The endothelialization experiment was made also. The grafting results were measured by X-ray photoelectron spectroscopy (XPS), and endothelialization was observed using optical microscope and scanning electron microscope (SEM). The results indicated that the method improves the effect of materials endothelialization. The experiment has made successful use of UV grafting and chemical coupling methods to graft bioactive RGD onto PET film surface. This is a new method of grafting bioactive peptide.


Advanced methodologies for cocrystal synthesis.
Pharmaceutical cocrystals are multicomponent systems composed of two or more molecules and held together by H-bonding. Currently, cocrystals provide exciting opportunities in the pharmaceutical industry for the development and manufacturing of new medicines by improving poor physical properties of Active Pharmaceutical Ingredients (APIs) such as processability, solubility, stability and bioavailability. According to the recent reclassification, cocrystals are considered as drug polymorph rather a new API which has a significant impact on drug development, regulatory submissions and intellectual property protection. This review summarizes recent trends and advances in synthesis, manufacturing and scale - up of cocrystals. The operational principles of several cocrystals manufacturing technologies are discussed including their advantages and disadvantages in terms of crystal quality, purity stability, throughput and limitations in large scale production.


Automated scoring of lymphocyte micronuclei by the MetaSystems Metafer image cytometry system and its application in studies of human mutagen sensitivity and biodosimetry of genotoxin exposure.
Automated image analysis scoring of micronuclei (MN) in cells can facilitate the objective and rapid measurement of genetic damage in mammalian and human cells. This approach was repeatedly developed and tested over the past two decades but none of the systems were sufficiently robust for routine analysis of MN until recently. New methodological, hardware and software developments have now allowed more advanced systems to become available. This mini-review presents the current stage of development and validation of the Metasystems Metafer MNScore system for automated image analysis scoring of MN in cytokinesis-blocked binucleated lymphocytes, which is the best-established method for studying MN formation in humans. The results and experience of users of this system from 2004 until today are reviewed in this paper. Significant achievements in the application of this method in research related to mutagen sensitivity phenotype in cancer risk, radiation biodosimetry and biomonitoring studies of air pollution (enriched by new data) are described. Advantages as well as limitations of automated image analysis in comparison with traditional visual analysis are discussed. The current increased use of the Metasystems Metafer MNScore system in various studies and the growing number of publications based on automated image analysis scoring of MN is promising for the ongoing and future application of this approach.


Three's a crowd - stabilisation, structure, and applications of DNA triplexes.
DNA is a strikingly flexible molecule and can form a variety of secondary structures, including the triple helix, which is the subject of this review. The DNA triplex may be formed naturally, during homologous recombination, or can be formed by the introduction of a synthetic triplex forming oligonucleotide (TFO) to a DNA duplex. As the TFO will bind to the duplex with sequence specificity, there is significant interest in developing TFOs with potential therapeutic applications, including using TFOs as a delivery mechanism for compounds able to modify or damage DNA. However, to combine triplexes with functionalised compounds, a full understanding of triplex structure and chemical modification strategies, which may increase triplex stability or in vivo degradation, is essential - these areas will be discussed in this review. Ruthenium polypyridyl complexes, which are able to photooxidise DNA and act as luminescent DNA probes, may serve as a suitable photophysical payload for a TFO system and the developments in this area in the context of DNA triplexes will also be reviewed.


Effect of 8-week frequency-specific electrical muscle stimulation combined with resistance exercise training on muscle mass, strength, and body composition in men and women: a feasibility and safety study.
In recent years, electrical muscle stimulation (EMS) devices have been developed as a complementary training technique that is novel, attractive, and time-saving for physical fitness and rehabilitation. While it is known that EMS training can improve muscle mass and strength, most studies have focused on the elderly or specific patient populations. The aim of this study was to investigate the effects of frequency-specific EMS combined with resistance exercise training for 8 weeks on muscle mass, strength, power, body composition, and parameters related to exercise fatigue. Additionally, we aimed to evaluate the feasibility and safety of EMS as an exercise aid to improve body composition. We recruited 14 male and 14 female subjects who were randomly assigned to two groups with gender parity (seven male and seven female/group): (1) no EMS group (age: 21.6 ± 1.7; height: 168.8 ± 11.8 cm; weight: 64.2 ± 14.4 kg) and (2) daily EMS group (age: 21.8 ± 2.0; height: 167.8 ± 9.9 cm; weight: 68.5 ± 15.5 kg). The two groups of subjects were very similar with no significant difference. Blood biochemical routine analysis was performed every 4 weeks from pre-intervention to post-intervention, and body composition, muscle strength, and explosive power were evaluated 8 weeks before and after the intervention. We also performed an exercise challenge analysis of fatigue biochemical indicators after 8 weeks of intervention. Our results showed that resistance exercise training combined with daily EMS significantly improved muscle mass (p = 0.002) and strength (left, p = 0.007; right, p = 0.002) and significantly reduced body fat (p < 0.001) than the no EMS group. However, there was no significant advantage for biochemical parameters of fatigue and lower body power. In summary, our study demonstrates that 8 weeks of continuous resistance training combined with daily upper body, lower body, and abdominal EMS training can significantly improve muscle mass and upper body muscle strength performance, as well as significantly reduce body fat percentage in healthy subjects.


[Long-term results of hepaticojejunostomy in high iatrogenic strictures of the extrahepatic biliary tract].
The authors evaluated the long-term results (after 1-3 and 4-11 years) of hepaticojejunostomies Roux-Y made in high strictures of the common bile duct which developed after iatrogenic lesions of the biliary pathways during cholecystectomy (n = 31). Excellent long-term result were recorded in 27%, satisfactory results in 65% and unsatisfactory results in 8% of the operated patients. The authors emphasize factors which influence the long-term patency of hepaticojejunostomy (mucosal-mucosal technique of anastomosis, transanastomotic drainage).


Signal transduction pathways activated in endothelial cells following infection with Chlamydia pneumoniae.
Chlamydia pneumoniae is an important respiratory pathogen. Recently, its presence has been demonstrated in atherosclerotic lesions. In this study, we characterized C. pneumoniae-mediated activation of endothelial cells and demonstrated an enhanced expression of endothelial adhesion molecules followed by subsequent rolling, adhesion, and transmigration of leukocytes (monocytes, granulocytes). These effects were blocked by mAbs against endothelial and/or leukocyte adhesion molecules (beta1 and beta2 integrins). Additionally, activation of different signal transduction pathways in C. pneumoniae-infected endothelial cells was shown: protein tyrosine phosphorylation, up-regulation of phosphorylated p42/p44 mitogen-activated protein kinase, and NF-kappaB activation/translocation occurred within 10-15 min. Increased mRNA and surface expression of E-selectin, ICAM-1, and VCAM-1 were noted within hours. Thus, C. pneumoniae triggers a cascade of events that could lead to endothelial activation, inflammation, and thrombosis, which in turn may result in or may promote atherosclerosis.


Juvenile-onset distal myopathy in Rottweiler dogs.
Two juvenile Rottweiler siblings were presented with the complaint of decreased activity and various postural abnormalities, including plantigrade and palmigrade stance and splayed forepaw digits. The neurologic examinations were otherwise normal. Electromyography revealed rare fibrillation potentials and positive sharp waves. Motor nerve conduction velocities were normal, whereas compound muscle action potentials from the interosseous muscles were decreased. These findings were consistent with a primary myopathy. A 3rd pup from a different litter and a 4th pup from a litter with 3 of 8 affected dogs had similar clinical presentations. Histopathologic changes in fresh-frozen muscle biopsy samples were similar in all pups and consisted of myofiber atrophy with mild myonecrosis, endomysial fibrosis and replacement of muscle with fatty tissue. These changes were more severe in distal muscles than in proximal muscles. Plasma carnitine concentrations (total and free) were decreased in all pups. Muscle carnitine concentrations (total and free) were decreased in 3 of 4 pups and the least affected pup had a borderline low free muscle carnitine concentration. Abnormalities involving major metabolic pathways were not found on quantification of organic and amino acids. Dystrophin immunocytochemistry was normal in 2 dogs tested. Distal myopathies in humans are classified under the dystrophic group of muscle disorders. These 4 cases represent a form of muscular dystrophy apparently not previously reported in dogs.


Movement and segregation of kinetochores experimentally detached from mammalian chromosomes.
The kinetochore is a specialized structure at the centromere of eukaryotic chromosomes that attaches chromosomes to the mitotic spindle. Recently, several lines of evidence have suggested that kinetochores may have more than a passive role in the movement of chromosomes during mitosis and meiosis. Kinetochores seem to attract and 'capture' microtubules that grow from the spindle poles and microtubules may lengthen or shorten by the addition or subtraction of tubulin subunits at their kinetochore-associated ends. An attractive hypothesis is that kinetochores function as 'self-contained engines running on a microtubule track'. Here, we show that kinetochores can be experimentally detached from chromosomes when caffeine is applied to Chinese hamster ovary cells that are arrested in the G1/S phase of the cell cycle. The detached kinetochore fragments can still interact with spindle microtubules and complete all the mitotic movements in the absence of other chromosomal components. As these cells enter mitosis before DNA synthesis is completed, chromosome replication need not be a prerequisite for the pairing, alignment and segregation of kinetochores.


Engineering of Saccharomyces cerevisiae for the efficient co-utilization of glucose and xylose.
The rapid co-fermentation of both glucose and xylose is important for the efficient conversion of lignocellulose biomass into fuels and chemicals. Saccharomyces cerevisiae is considered to be a potential cell factory and has been used to produce various fuels and chemicals, but it cannot metabolize xylose, which has greatly limited the utilization of lignocellulose materials. Therefore, numerous studies have attempted to develop xylose fermenting strains in past decades. The simple introduction of the xylose metabolic pathway does not enable yeast to rapidly utilize xylose, and several limitations still need to be addressed, including glucose repression and slow xylose transport, cofactor imbalance in the xylose reductase/xylitol dehydrogenase pathway, functional expression of a heterologous xylose isomerase, the low efficiency of downstream pathways and low ethanol production. In this review, we will discuss strategies to overcome these limitations and the recent progress in engineering xylose fermenting S. cerevisiae strains.


Possibly carcinogenic HPV subtypes are a cause of HSIL and negative clinical HPV tests - A European prospective single center study.
To correlate p16ink4a positive cervical precancers of 388 consecutive patients from a single European center with the preceding clinical HPV-DNA and HPV E6/E7 mRNA screening test. 374/388 patients had a HSIL (CIN 2/3) and 14/388 AIS (6 pure and 8 combined AIS/HSIL). Lesional tissues of HSIL/AIS with negative Cobas and/or Aptima HPV tests underwent HPV genotyping with CHIPRON HPV 3.5 LCD-array. Selected cases were subjected to a cancer hot spot analysis. The Aptima test missed 10/388 (2.6%) and the Cobas test seven of 388 (1.8%) precancers associated HPV-HR. Both HPV tests were negative in 20/374 precancers (5.3%; 17 HSIL/CIN3, two HSIL/CIN2, one AIS). Due to insufficient DNA four of 20 double negative cases (three HSIL, one AIS) were not genotyped. In the remaining cases, two of 20 (10%) HSIL genotyping detected HR-HPV subtypes. 10/20 (50%) HSIL were associated with possibly carcinogenic and low risk HPV (four x HPV73, three x HPV 53, one x HPV 82, one x HPV 67 and one x HPV 6), all of which are not included in both HPV tests. Two of 20 (10%) HSIL were negative with all HPV tests; one of these HSIL had a somatic PIK3CA gene mutation and the other had a single nucleotide variant in the APC gene. Three of 20 HSIL (15%) were thin HSIL (≤9 cell layers thick). Possibly carcinogenic HPV subtypes not included in the clinical HPV tests may account for the small gap of missed HSIL in clinical HPV screening. True HPV negative HSIL are exceedingly rare. Expanding HPV testing to include more possibly carcinogenic HPV subtypes may further reduce cervical cancer.


DIFFERENTIAL SURVIVAL OF SEXUAL AND ASEXUAL POECILIOPSIS DURING ENVIRONMENTAL STRESS.
According to the Frozen Niche-Variation model, coexisting clones of an asexual species can freeze and faithfully replicate ecologically relevant genetic variability that segregates in the sexual ancestors. The present experiments with fish of the genus Poeciliopsis provide further evidence in support of this model. Sexual and clonal forms of Poeciliopsis live in the desert streams of Sonora, Mexico, and are exposed to environmental extremes ranging from flash floods to hot, desiccating, residual pools. We examined coexisting members of the monacha complex to see whether the fish types differed with respect to survival during stress and swimming endurance in an artificial flume. The two coexisting clones of the triploid gynogenetic fish P. 2 monacha-lucida differed dramatically: clone MML/II had the best survival during heat and cold stress and the worst survival during hypoxic stress, whereas clone MML/I had the best survival during hypoxic stress and the worst during heat stress. Poeciliopsis monacha, the sexual species with which these clones coexist, had intermediate survival during heat and hypoxic stress and very poor swimming endurance in the flume. The physiological differences seen in this study are consistent with the Frozen Niche-Variation model and provide some insights into environmental factors that affect the distribution and abundance of these fish.


Changes in cardiovascular risk factors among adolescents from 1995 to 2004 in the Republic of Karelia, Russia.
In Russia, cardiovascular mortality is among the highest in the world. Behaviours related to the development of cardiovascular disease are usually adopted in childhood and adolescence. Very little information exists on prevalence and trends of risk factors among Russian youth. This study aims to investigate changes in the prevalence of cardiovascular risk factors among adolescents in the Republic of Karelia, Russia, from 1995 to 2004. Cross-sectional surveys on chronic disease risk factors were carried out among 15-year-old adolescents in Pitkäranta region, in the Republic of Karelia. The surveys were conducted in all 10 secondary schools in the Pitkäranta region. All ninth-grade students in 1995 (N = 385, response rate 95%) and in 2004 (N = 395, response rate 85%) were included in the survey samples. Systolic blood pressure decreased statistically significantly among boys (from 119 to 116 mmHg). Diastolic blood pressure decreased statistically significantly among both girls (from 64 to 59 mmHg) and boys (from 62 to 59 mmHg). Total cholesterol increased statistically significantly only among girls (from 3.9 to 4.1 mmol/l). Body mass index did not exhibit any significant changes in both genders. Daily smoking rate doubled statistically significantly among girls from 7% to 15%. The study results show changes in the prevalence of cardiovascular disease risk factors among adolescents in the Republic of Karelia occurring over the last decade. Active measures need to be taken to prevent the increase in smoking prevalence, especially among girls, and to avert the unfavourable development of other risk factors in the future.


[Peculiar forms of benign tumors of the brain stem].
Three patients are described, who were treated because of tumors of the medulla oblongata, growing towards the lumen of the IV ventricle and into the subarachnoid space. In two cases clinical cure was achieved after partial removal of the tumor and radiotherapy. One of these patients 32 years after the operation is working as a librarian, the other one treated 25 years ago is also professionally active and has a 5-year old son. In the third case only fragments of the tumor were taken for histological examination but radiotherapy was not given in view of serious condition of the patient. The patient however improved and after 23 years he died suddenly from myocardial infarction. On the base of these cases and a survey of the world literature it may by supposed that there are two kinds of brain stem tumors differing in their clinical course and direction of growth. Type A develops in the transverse plane of the brain stem and along its longitudinal axis producing paralysis of cranial nerves, signs of damage to the long ascending and descending pathways and disturbances of equilibrium. Symptoms of intracranial hypertension appear late or not at all. Type B grows into the lumen of the fourth ventricle and subarachnoid space as well, without infiltrating the deep structures of the brain stem. Partial removal of the tumor followed by radiotherapy may give useful survival for many years and may be even permanent cure.


A novel iterative modified bicubic interpolation method enables high-contrast and high-resolution image generation for F-18 FDG-PET.
Positron emission tomography (PET) has become a useful and important technique in oncology. However, spatial resolution of PET is not high; therefore, small abnormalities can sometimes be overlooked with PET. To address this problem, we devised a novel algorithm, iterative modified bicubic interpolation method (IMBIM). IMBIM generates high resolution and -contrast image. The purpose of this study was to investigate the utility of IMBIM for clinical FDG positron emission tomography/X-ray computed tomography (PET/CT) imaging.We evaluated PET images from 1435 patients with malignant tumor and compared the contrast (uptake ratio of abnormal lesions to background) in high resolution image with the standard bicubic interpolation method (SBIM) and IMBIM. In addition to the contrast analysis, 340 out of 1435 patients were selected for visual evaluation by nuclear medicine physicians to investigate lesion detectability. Abnormal uptakes on the images were categorized as either absolutely abnormal or equivocal finding.The average of contrast with IMBIM was significantly higher than that with SBIM (P < .001). The improvements were prominent with large matrix sizes and small lesions. SBIM images showed abnormalities in 198 of 340 lesions (58.2%), while IMBIM indicated abnormalities in 312 (91.8%). There was statistically significant improvement in lesion detectability with IMBIM (P < .001).In conclusion, IMBIM generates high-resolution images with improved contrast and, therefore, may facilitate more accurate diagnoses in clinical practice.


Corneal thickness in eyes with diabetic and nondiabetic neovascularisation.
The corneal thickness was measured in 20 patients with ocular neovascularisation of diabetic and nondiabetic aetiology. Mean corneal thickness (+/- SD) was 0.561 mm (+/- 0.027) and 0.499 mm (+/- 0.029) in the diabetic (n = 11) and the nondiabetic groups (n = 9), respectively (2p less than 0.001). The increased corneal thickness in the diabetic group is comparable to that previously reported in diabetics with proliferative retinopathy. These results indicate that the increased corneal thickness found in diabetics is peculiar to the diabetic eye and not secondary to the process of ocular neovascularisation as such.


Vanillin biotechnology: the perspectives and future.
The biotechnological production of fragrances is a recent trend that has expanded rapidly in the last two decades. Vanillin is the second most popular flavoring agent after saffron and is extensively used in various applications, e.g., as a food additive in food and beverages and as a masking agent in various pharmaceutical formulations. It is also considered a valuable product for other applications, such as metal plating and the production of other flavoring agents, herbicides, ripening agents, antifoaming agents, and personal and home-use products (such as in deodorants, air fresheners, and floor-polishing agents). In general, three types of vanillin, namely natural, biotechnological, and chemical/synthetic, are available on the market. However, only natural and nature-identical (biotechnologically produced from ferulic acid only) vanillins are considered as food-grade additives by most food-safety control authorities worldwide. In the present review, we summarize recent trends in fermentation technology for vanillin production and discuss the importance of the choice of raw materials for the economically viable production of vanillin. We also describe the key enzymes used in the biotechnological production of vanillin as well as their underlying genes. Research to advance our understanding of the molecular regulation of different pathways involved in vanillin production from ferulic acid is still ongoing. The enhanced knowledge is expected to offer new opportunities for the application of metabolic engineering to optimize the production of nature-identical vanillin. © 2018 Society of Chemical Industry.


Scurvy mimicking systemic vasculitis.
An 91 years old woman was hospitalized because of lethargy, shortness of breath and diffuse subcutaneous hemorrhage of legs. Clinical features were consistent with the diagnosis of vasculitis with systemic involvement. However dermatologic characteristics of the legs, in association with malnutrition, suggested vitamin C deficiency which was confirmed by laboratory test. Ascorbic acid supplement dramatically improved her clinical symptoms. This case remarks how scurvy may mimmick a systemic vasculitis.


Origin of tunable photoluminescence from graphene quantum dots synthesized via pulsed laser ablation.
A one-step synthesis of graphene quantum dots (GQDs) has been implemented using pulsed laser ablation (PLA) with carboxyl-functionalized multiwalled carbon nanotubes (MWCNTs). The synthesized GQDs with an average size smaller than 3 nm were obtained by the fragmentation of MWCNTs via oxidative cutting. The GQDs can generate tunable photoluminescence (PL) ranging from green to blue by controlling the PLA time. The PL spectrum (decay time) of the green GQDs remains unchanged under different excitation energies (emission energies), while that of the blue GQDs correlates with the excitation energy (emission energy). On the basis of the pH and temperature dependence of PL, we suggest that the localized intrinsic states associated with the sp(2) nanodomains and delocalized extrinsic states embedded on the GQD surface are responsible for blue and green emission in GQDs, respectively.


Comparative study of embedding methods.
Embedding experimental data is a common first step in many forms of dynamical analysis. The choice of appropriate embedding parameters (dimension and lag) is crucial to the success of the subsequent analysis. We argue here that the optimal embedding of a time series cannot be determined by criteria based solely on the time series itself. Therefore we base our analysis on an examination of systems that have explicit analytic representations. A comparison of analytically obtained results with those obtained by an examination of the corresponding time series provides a means of assessing the comparative success of different embedding criteria. The assessment also includes measures of robustness to noise. The limitations of this study are explicitly delineated. While bearing these limitations in mind, we conclude that for the examples considered here, the best identification of the embedding dimension was achieved with a global false nearest neighbors argument, and the best value of lag was identified by the mutual information function.


Evaluating the Performance of Pre-Trained Convolutional Neural Network for Audio Classification on Embedded Systems for Anomaly Detection in Smart Cities.
Environmental Sound Recognition (ESR) plays a crucial role in smart cities by accurately categorizing audio using well-trained Machine Learning (ML) classifiers. This application is particularly valuable for cities that analyzed environmental sounds to gain insight and data. However, deploying deep learning (DL) models on resource-constrained embedded devices, such as Raspberry Pi (RPi) or Tensor Processing Units (TPUs), poses challenges. In this work, an evaluation of an existing pre-trained model for deployment on Raspberry Pi (RPi) and TPU platforms other than a laptop is proposed. We explored the impact of the retraining parameters and compared the sound classification performance across three datasets: ESC-10, BDLib, and Urban Sound. Our results demonstrate the effectiveness of the pre-trained model for transfer learning in embedded systems. On laptops, the accuracy rates reached 96.6% for ESC-10, 100% for BDLib, and 99% for Urban Sound. On RPi, the accuracy rates were 96.4% for ESC-10, 100% for BDLib, and 95.3% for Urban Sound, while on RPi with Coral TPU, the rates were 95.7% for ESC-10, 100% for BDLib and 95.4% for the Urban Sound. Utilizing pre-trained models reduces the computational requirements, enabling faster inference. Leveraging pre-trained models in embedded systems accelerates the development, deployment, and performance of various real-time applications.


Implantation of oral squamous cell carcinoma at the site of a percutaneous endoscopic gastrostomy: a case report.
A 55-year-old man had an operation and radiotherapy for a squamous cell carcinoma of the oral cavity and developed a metastatic deposit at the site of a percutaneous endoscopic gastrostomy, with no other evidence of systemic spread. Treatment of the metastasis was by neo-adjuvant chemotherapy with cisplatin and 5-fluorouracil (5-FU) followed by en bloc resection of the stomal recurrence on the anterior abdominal wall. There has been no evidence of recurrence to date. Only 17 other cases of metastasis to this site from a primary tumour in the upper aerodigestive tract have been reported. We review the relevant publications and discuss the techniques, complications and possible mechanisms of spread and their implications for the use of percutaneous endoscopic gastrostomy in head and neck cancer surgery.


Therapeutic efficacy of sulfadoxine-pyrimethamine and amodiaquine among children with uncomplicated Plasmodium falciparum malaria in Zanzibar, Tanzania.
The efficacy of sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ) was assessed at Kivunge and Micheweni in Zanzibar, Tanzania, in 2001. The main objective was to obtain baseline data after observations of high levels of chloroquine treatment failures. Children (6-59 months) were randomized to receive either drug. At Kivunge, SP and AQ were given to 64 and 63 cases, while for Micheweni, 61 and 70 cases were treated. Main findings were overall high rates (> 90%) of adequate clinical response (ACR) with AQ. A lower ACR was seen in the SP group at Kivunge (87.1%) compared with Micheweni (94.8%). Furthermore, in the ACR group, 16.7% AQ parasitological resistance (RI-RIII) was encountered at Kivunge. Most of the cases of SP parasitological resistance (14.5%; RI/RII) were seen at Micheweni. Notwithstanding this, the overall treatment failure was only 9.2% with SP and 5.5% with AQ. The Zanzibar Ministry of Health has since reviewed its antimalarial drug policy.


Intravascular ultrasound.
Intravascular ultrasound imaging, in which a catheter-based miniature sonographic transducer is introduced into vessels, provides high-resolution, cross-sectional, real-time imaging of the vessel wall and lumen. It has been found to be useful as both a diagnostic and therapeutic adjunct in the evaluation and management of various arterial and venous disorders. Used in conjunction with other imaging modalities, such as conventional angiography, spiral computed tomography, and magnetic resonance angiography, it has the potential to increase the accuracy of percutaneous interventions and device sizing.


Identification of key pathways and genes in endometrial cancer using bioinformatics analyses.
Endometrial cancer (EC) is one of the most common gynecological cancer types worldwide. However, to the best of our knowledge, its underlying mechanisms remain unknown. The current study downloaded three mRNA and microRNA (miRNA) datasets of EC and normal tissue samples, GSE17025, GSE63678 and GSE35794, from the Gene Expression Omnibus to identify differentially expressed genes (DEGs) and miRNAs (DEMs) in EC tumor tissues. The DEGs and DEMs were then validated using data from The Cancer Genome Atlas and subjected to gene ontology and Kyoto Encyclopedia of Genes and Genomes pathway analysis. STRING and Cytoscape were used to construct a protein-protein interaction network and the prognostic effects of the hub genes were analyzed. Finally, miRecords was used to predict DEM targets and an miRNA-gene network was constructed. A total of 160 DEGs were identified, of which 51 genes were highly expressed and 100 DEGs were discovered from the PPI network. Three overlapping genes between the DEGs and the DEM targets, BIRC5, CENPF and HJURP, were associated with significantly worse overall survival of patients with EC. A number of DEGs were enriched in cell cycle, human T-lymphotropic virus infection and cancer-associated pathways. A total of 20 DEMs and 29 miRNA gene pairs were identified. In conclusion, the identified DEGs, DEMs and pathways in EC may provide new insights into understanding the underlying molecular mechanisms that facilitate EC tumorigenesis and progression.


CD169-mediated restrictive SARS-CoV-2 infection of macrophages induces pro-inflammatory responses.
Exacerbated and persistent innate immune response marked by pro-inflammatory cytokine expression is thought to be a major driver of chronic COVID-19 pathology. Although macrophages are not the primary target cells of SARS-CoV-2 infection in humans, viral RNA and antigens in activated monocytes and macrophages have been detected in post-mortem samples, and dysfunctional monocytes and macrophages have been hypothesized to contribute to a protracted hyper-inflammatory state in COVID-19 patients. In this study, we demonstrate that CD169, a myeloid cell specific I-type lectin, facilitated ACE2-independent SARS-CoV-2 fusion and entry in macrophages. CD169-mediated SARS-CoV-2 entry in macrophages resulted in expression of viral genomic and subgenomic RNAs with minimal viral protein expression and no infectious viral particle release, suggesting a post-entry restriction of the SARS-CoV-2 replication cycle. Intriguingly this post-entry replication block was alleviated by exogenous ACE2 expression in macrophages. Restricted expression of viral genomic and subgenomic RNA in CD169+ macrophages elicited a pro-inflammatory cytokine expression (TNFα, IL-6 and IL-1β) in a RIG-I, MDA-5 and MAVS-dependent manner, which was suppressed by remdesivir treatment. These findings suggest that de novo expression of SARS-CoV-2 RNA in macrophages contributes to the pro-inflammatory cytokine signature and that blocking CD169-mediated ACE2 independent infection and subsequent activation of macrophages by viral RNA might alleviate COVID-19-associated hyperinflammatory response.


Neuroimaging Evaluation for First Attack of Unprovoked Nonfebrile Seizure in Pediatrics: When to Order?
To assess the value of neuroimaging studies in evaluating pediatric patients presenting with a first attack of nonfebrile seizure. We reviewed the medical records of pediatric patients aged 28 days to 12 years who were admitted between 1 January and 31 December 2013 with a first attack of unprovoked, afebrile seizure. These patients had undergone neuroimaging studies. The exclusion criterion was patients with known predisposing conditions for seizure. The computed tomography (CT) scan and magnetic resonance imaging (MRI) results were either normal or abnormal, and the abnormal ones were further classified into clinically insignificant or significant. Descriptive analysis was performed to summarize the data. Fifty children were identified with a mean age of 5.2 ± 3.8 years. Of the 50 subjects, 29 (58.0%) were males and 21 (42.0%) were females. Sixteen patients (32.0%) had abnormal neuroimaging studies (CT scan, MRI or both); however, only 1 was considered to have a clinically significant abnormality, later diagnosed as Moyamoya disease. In this study, the neuroimaging studies were found not to be useful in evaluating pediatric patients presenting with a first attack of unprovoked, nonfebrile seizures.


Continuing care beyond the hospital walls and onto the streets.
Trauma center nurses joined forces with their city's leaders and organizations to address juvenile violence and crime. Metropolitan Partners Against Crime's primary initiatives focus on overcoming race, class and gender variances and establishing community awareness programs.


Income-related inequality in mental health in Britain: the concentration index approach.
Reduction of health inequalities is a major policy goal in the UK. While there is general recognition of the disadvantaged position of people with mental health problems, the extent of inequality, particularly the association with socio-economic characteristics, has not been widely studied. We aimed to measure income-related inequality in the distribution of psychiatric disorders and to compare with inequality in other health domains. The concentration index (CI) approach was used to examine income-related inequality in mental health using data from the Psychiatric Morbidity Survey 2000 for Britain. There is marked inequality unfavourable to lower income groups with respect to mental health disorders. The extent of inequality increases with the severity of problems, with the greatest inequality observed for psychosis. Income-related inequality for psychiatric disorders is higher than for general health in the UK. Standardized CIs suggest that these inequalities are not due to the demographic composition of the income quintiles. Income-related inequalities exist in mental health in Britain. As much of the observed inequality is probably due to factors associated with income and not due to the demographic composition of the income quintiles, it may be that these inequalities are potentially 'avoidable'.


[Results of the Czech National Breast Cancer screening programme].
Breast cancer screening based on mammography is an effective tool for lowering mortality rates from this disease. The organised and nationwide Breast Cancer Screening Programme has been underway in the Czech Republic since 2002. Monitoring of the programme is based on data from the Czech National Cancer Registry (CNCR), Breast Cancer Screening Registry, and the Czech National Reference Centre (CNRC). These data sources make it possible to evaluate early performance indicators according to international standards, and to monitor the cancer burden in the Czech population. The CNRC data allow us to document the high validity of the available data as well as to map non-organised mammography examinations (so-called opportunistic screening). Until the mid-1990s, breast cancer incidence and mortality rates saw a slight but continuous increase. In the last 15 years, however, incidence rates have grown more substantially; by contrast, mortality rates have stalled and even started to decline since the 2000s. In the mid-1990s, the proportion of cancers diagnosed at stage I was below 20%; this situation has dramatically improved since then, as more than 40% cases of breast cancer were diagnosed at stage I in 2011. Breast cancer screening coverage currently amounts to 50%; this value reached a plateau in the period 2007-2008, and unfortunately has not shown any further significant increase. Over the last few decades, the breast cancer burden among the Czech population has been significantly reduced - despite the growing incidence rates, mortality rates have decreased, which can be largely attributed to earlier detection of breast cancer based on the screening programme. Further improvements in the programmes effectiveness can only be achieved if the population coverage becomes higher; the programme of personalised invitations to mammography examinations, which was introduced in early 2014, should contribute to the accomplishment of this goal.


Health Promotion Behaviors and Psychosocial Factors Among Middle-Aged Women in Saudi Arabia.
Middle-aged women experience several changes that can affect their biological and psychosocial health. A healthy lifestyle is a fundamental requirement for achieving optimal health. To examine the impact of psychosocial factors on health promotion behaviors among middle-aged women in Saudi Arabia. A cross-sectional, descriptive, correlational study design was used. One hundred and eighteen middle-aged women completed the demographic questionnaire, Stunkard Figure Rating Scale, Perceived Stress Scale, and Health-Promoting Lifestyle Profile-II from September 2, 2020 to February 15, 2021. Multiple regression analysis was performed to estimate the impact of psychosocial factors on health promotion behaviors. Participants "sometimes" engaged in health promotion behaviors. Spiritual growth scored the highest, whereas physical exercise scored the lowest. Most of the participants were dissatisfied with their body image and reported moderate levels of perceived stress. The participants were more likely to report a preferred body image that was smaller than their perceived body image. Perceived stress and body image were significantly correlated with the total score for health promotion behaviors. Perceived stress level, age, and menopause status were significant predictors of health promotion behaviors. The model significantly predicted all the health promotion behavior subscales, excluding nutrition. There were relationships between certain psychosocial predictors and health-promoting behaviors. This study can guide healthcare professionals in promoting middle adult women's adoption of health-promoting behaviors. More research can be conducted in Saudi Arabia to understand the health promotion behaviors of middle-aged women.


Effects of lip-closing training on maximum voluntary lip-closing force during lip pursing in healthy young adults.
To investigate the effect of lip-closing training, the time-course of multidirectional lip-closing forces during training was evaluated. The subjects were healthy young adults with no systemic disease. Ten subjects each were allocated to the training and non-training (control) groups. The subjects were instructed to use a lip muscle strength fixation device (M Patakara) for lip-closing training. Regarding closing the upper and lower lips against this force for 3 min as one task, the subjects were instructed to perform three tasks a day for 4 weeks. The multidirectional lip-closing forces were measured before, during and after training every week. In the control group, the forces were measured under the same schedule without training. After the initiation of training, the total lip-closing force significantly increased at 3 and 4 weeks in the training group compared with that in the control group (P = 0·003 at 3 weeks, P < 0·001 at 4 weeks). After the completion of training, the force decreased from 1 week and no significant difference from the control group was noted. When the lip-closing force was evaluated by direction, significant increases in the upward and downward directions were noted in the training group compared with those in the control group (P = 0·034 at 3 weeks for upwards; P = 0·027 at 4 weeks for downwards). Quantitative analysis confirmed that lip-closing training enhanced the lip-closing force regionally.


Cataract surgical training in Europe: European Board of Ophthalmology survey.
To survey recently graduated European ophthalmologists concerning cataract surgery (CS) training opportunities. Countries affiliated to the European Board of Ophthalmology (EBO). Cross-sectional study of anonymous survey results. A 23-question online survey was emailed to candidates who sat the EBO Diploma Examination as residents between 2018 and 2022. 821 ophthalmologists from 30 countries completed the survey. The mean residency duration was 4.73 (SD 0.9) years. The mean reported number of entire CS procedures performed was 80.7 (SD 100.6) at the end of residency, but more than 25% of respondents (n = 210) had received no live CS training during their residency. The self-confidence (scale, 1 to 10) to perform a simple case or challenging case, manage posterior capsular rupture, and realize a corneal stitch were rated 4.1, 3.2, 4.2, 2.4, respectively. We observed extensive variation in clinical exposure to CS and self-reported confidence to perform CS between European trainees. Females reported a mean of 18% fewer entire procedures than their male colleagues and were also less confident in their surgical skills (P < .05). Trainees in residency programs longer than 5 years performed fewer procedures and were less confident than trainees in residences of shorter duration (P < .001). The importance of fellowships to complete surgical education was rated 7.7 out of 10. CS training across European countries lacks harmony. Female ophthalmology trainees continue, as in other specialties, to experience apparent gender bias. European level recommendations seem necessary to raise and harmonize competency-based CS training programs and promote post-residency fellowship training programs.


Comprehensive preoperative psychological assessment of breast cancer patients.
In the context of the traumas suffered by patients following the oncological diagnosis and the expectation of the surgical intervention, it is important to unitary and multidimensional identify the psychological status, using a single interview structured to cover these psychological vulnerabilities. The overall psychological picture can help the psycho-oncologist to adapt his psychotherapeutic interventions to relieve the stress caused by the oncological diagnosis and specific treatment. 58 patients with a breast cancer diagnosis and 61 patients with breast lumps diagnosis who were waiting for the histopathological result, received several scales for assessing emotional distress, the level self-esteem, depression, anxiety and cognitive dysfunctions levels. The analysis of the answers led to the multidimensional identification of differences between the two categories of patients and establishing correlations between personality traits and the development of certain psychological changes. Statistically significant differences (p < 0.05) were observed between patients with breast cancer and those with breast lumps awaiting histopathological diagnosis, in the areas of self-esteem, depression and cognitive schemas. Diagnosed patients have predominantly dysfunctional attitudes such as negative emotions and cognitive schemas related to catastrophe and self-deprecation, while undiagnosed patients, have cognitive schemas related to low tolerance for frustration and absolutist requirements and lower dysfunctional attitudes. A global assessment with a single psychological tool can capture the overall picture of the cancer patient, including possible triggers and maintenance of symptoms, with the psychological consequences of the disease that are reflected somatically, as well as predisposing factors in the history that generates these feelings.


A double-blind clinical comparison of two dosage schedules of cefatrizine in children.
A double-blind, randomized clinical trial was carried out to compare the effectiveness of twice daily versus once daily administration of the cephalosporin, cefatrizine, in paediatric outpatients with bacterial infection of the respiratory tract. Thirty children were studied, aged 7 years 2 months (range, 4-12 years). They were given 75 mg/kg.day cefatrizine either once daily or twice daily at 12 h intervals for 8 days. Fever, clinical symptoms, bacterial eradication and overall tolerance were evaluated. No significant differences were observed between once daily or twice daily administration. This is in agreement with other studies carried out on adults. It is concluded that cefatrizine may be given to paediatric out-patients for the treatment of bacterial infection of the respiratory tract only once daily with good clinical and overall results.


Autophagy in cultured murine neurons infected with equid herpesvirus 1.
In this study we investigated the relationship of equid herpesvirus 1 (EHV-1) infection to autophagy in primary culture of murine neurons. Infection with both Jan-E and Rac-H strains of EHV-1 resulted in the formation of autophagosomes in the cytoplasm during early stages of infection, while in late stages of infection autophagosomes were mainly concentrated around the nucleus what suggests the induction of nuclear envelope-derived autophagy (NEDA). No significant effect of an authophagy inhibitor-chloroquine on final virus titers demonstrated that autophagy is not essential for EHV-1 replication.


Nail resembling cutaneous horn occurring after acral bone loss.
A patient with leprosy and an anesthetic left hand noted a hornlike nail on his index finger after recurrent trauma and infection had resulted in acral bone loss. This case illustrates the importance of an intact terminal phalanx in the formation of a normal nail plate.


Considering Retention and Curricula in Reframing Pharmacy Enrollment Challenges.
Enrollment in pharmacy education has been a topic of extensive discussions as the number of applications has declined. Some pharmacy programs have either not met enrollment goals or decreased incoming class sizes. This Commentary poses two questions that we must ask ourselves as an Academy. First, is it possible to realistically do more to recruit our way out of this situation in the next three to five years and beyond. Second, how, if possible, will pharmacy colleges and schools avoid the significant and transformative forces that could impact higher education in the future. Forces that are impacting higher education include changing demographics, transitioning from an industrial-based economy to a knowledge-based economy, and the continuing advances in technology with increased globalization as a component of all three of these forces. To address these questions, the concepts of student retention and success as well as considerations for reframing current curricular and pedagogical models and beliefs are challenged. In that pharmacy enrollment challenges are not likely to be easily resolved in the next few years, the Academy must place additional emphasis on issues related to student success and the design of our educational models and programs.


Clam bioaccumulation of Alkylphenols and Polyciclic aromatic hydrocarbons in the Venice lagoon under different pressures.
Biota-Sediment Accumulation Factors (BSAFs) of nonylphenols (NPs) and polycyclic aromatic hydrocarbons (PAHs) in Ruditapes philippinarum from the Venice Lagoon (Italy) were determined with the aim to verify whether the routine biomonitoring studies are reliable in contaminated sites. Clams and sediments were collected in field campaigns (October 2003 to June 2004) in three sites of the Venice Lagoon. Results showed that Marghera and Campalto sediments were more contaminated by NPs and PAHs than Poveglia. Different trends were observed in the contamination of clams with the highest BSAFs found at Poveglia. BSAF trend appeared to be inversely related to the contaminant pressure on the sites. These results suggest that clam bioaccumulation is not always representative of the chemical pressure on aquatic biota. The direct correlation between sediment and biota concentrations in contaminated sites can be lost as a function of the site-specific conditions such as sediment toxicity and food availability.


Description of Mexican Cleft Surgeons' Experience With Foreign Surgical Volunteer Missions in Mexico.
Mexican cleft surgeons provide multidisciplinary comprehensive cleft lip and palate care to children in Mexico. Many Mexican cleft surgeons have extensive experience with foreign, visiting surgeons. The purpose of this study was to characterize Mexican cleft surgeons' domestic and volunteer practice and to learn more about Mexican cleft surgeons' experience with visiting surgeons. A cross-sectional validated e-mail survey tool was sent to Mexican cleft surgeons through 2 Mexican plastic surgery societies and the Asociación Mexicana de Labio y Paladar Hendido y Anomalías Craneofaciales, the national cleft palate society that includes plastic and maxillofacial surgeons who specialize in cleft surgery. We utilized validated survey methodology, including neutral fact-based questions and repeated e-mails to survey nonresponders to maximize validity of statistical data; response rate was 30.6% (n = 81). Mexican cleft surgeons performed, on average, 37.7 primary palate repairs per year with an overall complication rate of 2.5%; 34.6% (n = 28) of respondents had direct experience with patients operated on by visiting surgeons; 53.6% of these respondents performed corrective surgery because of complications from visiting surgeons. Respondents rated 48% of the functional outcomes of visiting surgeons as "acceptable," whereas 43% rated aesthetic outcomes of visiting surgeons as "poor"; 73.3% of respondents were never paid for the corrective surgeries they performed. Thirty-three percent of Mexican cleft surgeons believe that there is a role for educational collaboration with visiting surgeons. Mexican cleft surgeons have a high volume of primary cleft palate repairs in their domestic practice with good outcomes. Visiting surgeons may play an important role in Mexican cleft care through educational collaborations that complement the strengths of Mexican cleft surgeons.


[125I] 3-quinuclidinyl 4-iodobenzilate: a high affinity, high specific activity radioligand for the M1 and M2-acetylcholine receptors.
We have prepared a radioiodinated ligand which binds with high affinity to the muscarinic acetylcholine receptor (m-AChR). A derivative of 3-quinuclidinyl benzilate, [125I] labeled (R) 1-aza-bicyclo(2.2.2)oct-3-yl (R,S)-alpha-hydroxy-alpha-(4-[125I]iodophenyl)phenyl acetate (4- IQNB ) exhibits an affinity for the m-AChR from corpus striatum higher than that of (R) [3H] QNB. Additionally, [125I] 4- IQNB exhibits receptor selectivity for the M1 receptor since the affinity for the receptor from dog and rat heart is lower than that using dog or rat corpus striatum.


Trauma Arrest and Spinal Injury in a 3-Year-Old Girl.
Management of an acutely injured pediatric patient with multiple traumas is a common challenge facing clinicians in pediatric emergency care. Blunt trauma is more common in the pediatric population with motor vehicle accidents being the most common cause of injury. Spinal injury, especially in young children, is only seen in 1% to 2% of cases and can be lethal. It is incumbent upon clinicians to be able to meet the challenges of patient management including airway management, providing hemodynamic support, and addressing potentially reversible causes of arrest while recognizing presenting symptoms of spinal injury. This case presents a child in trauma arrest after a motor vehicle crash requiring advanced interventions, diagnostics, and support. Her clinical course is described and reveals a complete distraction of the cervical and thoracic spine. This case illustrates pathology and management along with the importance of proper management and interventions by pediatric emergency clinicians to manage the patient and attempt to maximize the patient's outcome.


Byzantine medical manuscripts: towards a new catalogue, with a specimen for an annotated checklist of manuscripts based on an index of Diels' Catalogue.
Greek manuscripts containing medical texts were inventoried at the beginning of the 20th century by a team of philologists under the direction of Hermann Diels. The resulting catalogue, however useful it was when new and still is today, needs to be updated not only because some manuscripts have been destroyed, certain collections and single items have changed location, new shelfmark systems have been sometimes adopted and cataloguing has made substantial progress, but also because in Diels' time the concept of ancient medicine was limited, the method used in compiling data was not standardized and, in a time of manual recording and handling of information, mistakes could not be avoided. The present article is an introduction to a new catalogue of Greek medical manuscripts. In the first part, it surveys the history of the heuristic and cataloguing of Greek medical manuscripts from the 16th century forward; in the second part, it highlights the problems in Diels' catalogue and describes the genesis and methods of the new catalogue, together with the plan for its completion; and in the third part, it provides a sample of such a new catalogue, with a list of the Greek medical manuscripts in the libraries of the United Kingdom and Ireland.


Effects of Tribulus terrestris saponins on exercise performance in overtraining rats and the underlying mechanisms.
The objective of this study was to determine the effects of Tribulus terrestris L. (TT) saponins on exercise performance and the underlying mechanisms. A rat overtraining model was established and animals were treated with TT extracts (120 mg/kg body mass) 30 min before each training session. Serum levels of testosterone and corticosterone and levels of androgen receptor (AR) and insulin growth factor-1 receptor (IGF-1R) in the liver, gastrocnemius, and soleus were determined by ELISA and Western blot. Treatment of rats with TT saponins significantly improved the performance of the overtraining rats, reflected by the extension of time to exhaustion, with a concomitant increase in body mass, relative mass, and protein levels of gastrocnemius. Overtraining alone induced a significant decrease in the serum level of testosterone. In contrast, treatment with TT saponins dramatically increased the serum level of testosterone in overtraining rats to about 150% of control and 216% of overtraining groups, respectively. In addition, TT saponins resulted in a further significant increase in AR in gastrocnemius and significantly suppressed the overtraining-induced increase in IGF-1R in the liver. These results indicated that TT saponins increased performance, body mass, and gastrocnemius mass of rats undergoing overtraining, which might be attributed to the changes in androgen-AR axis and IGF-1R signaling.


Failure of epidural analgesia to modify postoperative depression of delayed hypersensitivity.
Delayed hypersensitivity to four common antigens was assessed in 32 patients undergoing major abdominal surgery randomly allocated to either general anesthesia (fentanyl + O2/N2O + postoperative pain relief with systemic opiates) or general anaesthesia + epidural analgesia (local anaesthetics + morphine) continued for 72 h. Skin-test responses were performed 2 days before surgery and 1 day after surgery and compared to a similar retesting schedule in 16 comparable non-operative control patients. Cumulated mean skin-test responses increased from 1290 to 2330 mm2 (P less than 0.0001) during retesting in the non-operative control group. In contrast, mean skin-test responses in patients operated during general anaesthesia + systemic opiates for postoperative pain relief fell from 1422 to 1227 mm2 (P = 0.3) and in patients receiving epidural analgesia from 1228 to 890 mm2 (P = 0.06), without statistically significant differences between these two groups (P greater than 0.5). Thus, surgery leads to depression of delayed hypersensitivity and this impairment in immunofunction is not modified by an epidural analgesic regimen providing adequate pain relief.


Self-Transcendence, Sexual Desire, and Sexual Frequency.
Self-forgetfulness is a facet of self-transcendence characterized by tendency to experience altered states of consciousness. We examined associations of self-forgetfulness with sexual desire and frequency. Two hundred sixty-one Portuguese men and women completed the self-forgetfulness subscale of the Temperament and Character Inventory-Revised, a measure of openness to experience, and a questionnaire on desired and actual frequency of vaginal intercourse, noncoital sex, and masturbation in the past month. In simple and partial correlations controlling for openness to experience and relationship status, women's self-forgetfulness correlated with desired frequency of intercourse and noncoital sex. For men, self-forgetfulness correlated with actual frequency of intercourse and noncoital sex.


Rapidly separating dissolving microneedles with sustained-release colchicine and stabilized uricase for simplified long-term gout management.
Despite growing prevalence and incidence, the management of gout remains suboptimal. The intermittent nature of the gout makes the long-term urate-lowering therapy (ULT) particularly important for gout management. However, patients are reluctant to take medication day after day to manage incurable occasional gout flares, and suffer from possible long-term toxicity. Therefore, a safe and easy-to-operate drug delivery system with simple preparation for the long-term management of gout is very necessary. Here, a chitosan-containing sustained-release microneedle system co-loaded with colchicine and uricase liposomes were fabricated to achieve this goal. This microneedle system was confirmed to successfully deliver the drug to the skin and maintain a one-week drug retention. Furthermore, its powerful therapeutic potency to manage gout was investigated in both acute gouty and chronic gouty models. Besides, the drug co-delivery system could help avoid long-term daily oral colchicine, a drug with a narrow therapeutic index. This system also avoids mass injection of uricase by improving its stability, enhancing the clinical application value of uricase. In general, this two-drug system reduces the dosage of uricase and colchicine and improves the patient's compliance, which has a strong clinical translation.


Development of a technique for improving coefficient of variation of CaSO4:Dy teflon-based TLD personnel monitoring system in low-dose region.
In view of the importance of zero-dose background (null signal) in influencing the coefficient of variation in low-dose region, a technique for the estimation of the same from composite (gross) signal is developed for CaSO4:Dy-based personnel monitoring system being used in India. The technique is based on simple analysis of glow curves (GCs) of unexposed and exposed dosemeters, evolution of trend/model for the zero-dose curves, generation of simulation protocol for individual zero-dose curves, establishment of characteristics of GCs of exposed dosemeters and finally preparation of an algorithm to segregate the components from composite signal. The technique offers the separation of real-time background and gives superior results over other method of approximation of the background. The results also prove efficiency of the empirical trending and simulation protocol of background GCs. The proposed technique can be implemented in routine monitoring without any extra man hours and reader time.