The chemotherapy of rodent malaria, XXII. The value of drug-resistant strains of P. berghei in screening for blood schizontocidal activity.
Data are provided on the activity of a variety of antimalarial drugs against drug-sensitive and drug-resistant lines of Plasmodium berghei in albino mice. Parallel data for the response of the drug-sensitive parasites to these compounds in vitro indicate whether the drugs have a chloroquine-like or quinine-like type of action, or neither. The value of this test system for drug evaluation is debated. It is concluded that the in vivo tests do provide a valuable indication of the potential use of a compound against drug-resistant malaria parasites of man. The tests may also provide a good indication of the future value of new compounds against strains of parasites that are already resistant to chloroquine. Where necessary, steps should be taken to protect promising new compounds.


Developmental changes in hepatic esterase activity towards chloramphenicol succinate and its Michaelis-Menten constant of liver, kidney and lung in human.
The hepatic esterase activities towards chloramphenicol succinate were determined in the tissues from 45 human subjects, including 18 electively aborted fetuses, 5 premature and 8 full-term newborn babies, 8 infants and 6 adults. The enzyme activities in the tissues from the fetuses and neonates were significantly lower compared with those obtained from the infants and adults. This suggests that the activity showed postnatal development. Kinetic studies of the esterase activity revealed that hepatic Km values were similar to those of the lung, but renal Km values were about 3 times higher than those of the liver and lung. In each organ, no age-related changes in Km values were observed. However, all the Vmax values in each organ showed developmental increases. Therefore, the liver plays the most important role in hydrolysis of chloramphenicol succinate when the weight of the organ is taken into consideration.


Identification of the substrate-binding sites of 2'-5'-oligoadenylate synthetase.
2'-5'-Oligoadenylate synthetases are interferon-induced enzymes that upon activation by double-stranded RNA polymerize ATP to 2'-5'-linked oligoadenylates. In our continuing effort to understand the mechanism of catalysis by these enzymes, we used photo affinity cross-linking and peptide mapping to identify the substrate-binding sites of the P69 isozyme of human 2'-5'-oligoadenylate synthetases. Radiolabeled azido 2'-5'-oligoadenylate dimers were enzymatically synthesized and used as ligands for cross-linking to the P69 protein by exposure to ultraviolet light. The radiolabeled protein was digested with trypsin, and two ligand-cross-linked peptides were purified by immobilized aluminum affinity chromatography followed by reverse phase high pressure liquid chromatography. The peptides were identified by mass spectrometry and peptide sequencing and were found to correspond to residues 420-425 and 539-547 of P69. To examine the functional importance of the cross-linking sites, specific residues in the two peptides were mutated. When residues in the two sites were mutated individually, ligand cross-linking was selectively eliminated at the mutated site, and the enzyme activity was lost almost completely. Using substrates that can serve either as a donor or as an acceptor but not both, we could identify one of the sites as the acceptor and the other as the donor site.


Toward a 1,4-Diphosphinine-Based Molecular CPS-Ternary Compound.
Synthesis of the tricyclic 1,3-dithiole-2-thione-derived 1,4-dihydro-1,4-diphosphinine is presented using a base-induced ring formation protocol and chloro(diethylamino)(1,3-dithiole-2-thion-4-yl)phosphane as the starting point. P-oxidation reactions of dihydrodiphosphinine by chalcogens led to bis(P-oxide), bis(P-sulfide), or bis(P-selenide), respectively; all tricyclic compounds were obtained as cis/trans mixtures. 1,4-Dihydro-1,4-diphosphinine was converted into 1,4-dichloro-1,4-dihydro-1,4-diphosphinine. This compound is almost insoluble in organic solvents, furnished selectively the trans-bis(amino) derivative upon a 2-fold P-substitution reaction with the weak nucleophile potassium bis(trimethylsilyl)amide, and reacted also with alcohols ROH (R = nBu, iPr, tBu) to give cis/trans mixtures of the corresponding bis(alkoxy) derivatives. Furthermore, the dichloro derivative could be reduced to a 1,4-diphosphinine using PnBu3, but, unfortunately, the stubbornly insoluble product could be neither purified nor crystallized. Despite this, we achieved a thermal [4 + 2] cycloaddition reaction of this first CPS-ternary compound with diethylacetylene dicarboxylate to obtain the corresponding diphosphabarrelene, thus providing indirect evidence for the aromatic tricyclic diphosphinine. Detailed density functional theory studies on the formation of 1,4-diphosphinine provided insights into formation pathways as well as NMR, IR, and UV/vis data.


Plasmon resonant enhancement of carbon monoxide catalysis.
Irradiating gold nanoparticles at their plasmon resonance frequency creates immense plasmonic charge and high temperatures, which can be used to drive catalytic reactions. By integrating strongly plasmonic nanoparticles with strongly catalytic metal oxides, significant enhancements in the catalytic activity can be achieved. Here, we study the plasmonically driven catalytic conversion of CO to CO(2) by irradiating Au nanoparticle/Fe(2)O(3) composites. The reaction rate of this composite greatly exceeds that of the Au nanoparticles or Fe(2)O(3) alone, indicating that this reaction is not driven solely by the thermal (plasmonic) heating of the gold nanoparticles but relies intimately on the interaction of these two materials. A comparison of the plasmonically driven catalytic reaction rate with that obtained under uniform heating shows an enhancement of at least 2 orders of magnitude.


HLA-DQA1*0101 haplotypes and disease outcome in early onset pauciarticular juvenile rheumatoid arthritis.
To further investigate a clinical impression that patients with early onset pauciarticular juvenile rheumatoid arthritis (EOPA-JRA) who carry HLA-DQw1 have more severe arthritis, we subtyped HLA-DQw1 in American midwestern patients with EOPA-JRA. The HLA-DQA1*0101 subtype was present in 10 of 19 patients who developed persistent polyarticular erosive disease compared with 18 of 92 healthy controls (chi 2 = 9.13, p = 0.003, RR = 4.6), and occurred more frequently in this polyarticular group than in patients without polyarticular erosive disease (chi 2 = 4.11, p = 0.040, RR = 3.0). The presence of HLA-DQA1*0101 was significantly lower in patients with chronic iridocyclitis than in patients without chronic iridocyclitis (chi 2 = 7.07, p = 0.008, RR = 0.21). In HLA-DQA1*0101 positive patients, DNA sequences of the beta-1 domain of the HLA-DQ alpha and HLA-DQ beta genes (HLA-DQA1*0101, HLA-DQB1*0501 and HLA-DQB1*0503) were identical to those in controls. In this midwestern EOPA-JRA population, HLA-DQA1*0101 or genes in linkage disequilibrium with it, are associated with a cohort of patients with EOPA-JRA with distinct clinical characteristics.


Novel Tu translation elongation factor, mitochondrial (TUFM) homozygous variant in a consanguineous family with premature ovarian insufficiency.
Premature ovarian insufficiency (POI) is a clinical syndrome of ovarian dysfunction characterized by cessation of menstruation occurring before the age of 40 years. The genetic causes of idiopathic POI remain unclear. Here we recruited a POI patient from a consanguineous family to screen for potential pathogenic variants associated with POI. Genetic variants of the pedigree were screened using whole-exome sequencing analysis and validated through direct Sanger sequencing. A homozygous variant in TUFM (c.524G>C: p.Gly175Ala) was identified in this family. TUFM (Tu translation elongation factor, mitochondrial) is a nuclear-encoded mitochondrial protein translation elongation factor that plays a critical role in maintaining normal mitochondrial function. The variant position was highly conserved among species and predicted to be disease causing. Our in vitro functional studies demonstrated that this variant causes decreased TUFM protein expression, leading to mitochondrial dysfunction and impaired autophagy activation. Moreover, we found that mice with targeted Tufm variant recapitulated the phenotypes of human POI. Thus, this is the first report of a homozygous pathogenic TUFM variant in POI. Our findings highlighted the essential role of mitochondrial genes in folliculogenesis and ovarian function maintenance.


Data and methods to estimate fetal dose from fluoroscopically guided prophylactic hypogastric artery balloon occlusion.
To provide data for estimation of fetal radiation dose (DF) from prophylactic hypogastric artery balloon occlusion (HABO) procedures. The Monte-Carlo-N-particle (MCNP) transport code and mathematical phantoms representing a pregnant patient at the ninth month of gestation were employed. PA, RAO 20° and LAO 20° fluoroscopy projections of left and right internal iliac arteries were simulated. Projection-specific normalized fetal dose (NFD) data were produced for various beam qualities. The effects of projection angle, x-ray field location relative to the fetus, field size, maternal body size, and fetal size on NFD were investigated. Presented NFD values were compared to corresponding values derived using a physical anthropomorphic phantom simulating pregnancy at the third trimester and thermoluminescence dosimeters. NFD did not considerably vary when projection angle was altered by ±5°, whereas it was found to markedly depend on tube voltage, filtration, x-ray field location and size, and maternal body size. Differences in NFD < 7.5% were observed for naturally expected variations in fetal size. A difference of less than 13.5% was observed between NFD values estimated by MCNP and direct measurements. Data and methods provided allow for reliable estimation of radiation burden to the fetus from HABO.


Gas Leakage Source Detection for Li-Ion Batteries by Distributed Sensor Array.
Lithium-based batteries operation is related to some safety risks of dangerous flaming, integrity destruction, or even explosion. Gas leakage is an early and reliable indicator for such irreversible malfunctioning of electrical accumulators. Often, accurate gas emission source location sensing is difficult especially in heavy operational conditions, related to temperature changes, vibrations, movements, accelerations, etc. In this paper we propose a gas detection system, with catalytic type sensor array, and a numerical reconstruction method for precise gas emission source location inside the battery pack. The detection system employs a distributed array of CO sensors. Proposed sensor array configurations significantly reduce the number of sensing nodes inside the battery pack and fewer sensors than the protected battery elements are used. This way, data acquisition process by sensor nodes is also simplified. Several array configurations are considered according to their measurement efficiency and accuracy. Reconstruction algorithm is based on fast interpolation technique very suitable for real-time data processing. Estimation of reconstruction method accuracy is made by computational model of the gas diffusion inside the pack.


Regulation of iron assimilation: nucleotide sequence analysis of an iron-regulated promoter from a fluorescent pseudomonad.
An iron-regulated promoter was cloned on a 2.1 kb Bg/II fragment from Pseudomonas sp. strain M114 and fused to the lacZ reporter gene. Iron-regulated lacZ expression from the resulting construct (pSP1) in strain M114 was mediated via the Fur-like repressor which also regulates siderophore production in this strain. A 390 bp StuI-PstI internal fragment contained the necessary information for iron-regulated promoter expression. This fragment was sequenced and the initiation point for transcription was determined by primer extension analysis. The region directly upstream of the transcription start point contained no significant homology to known promoter consensus sequences. However the -16 to -25 bp region contained homology to four other iron-regulated pseudomonad promoters. Deletion of bases downstream from the transcriptional start did not affect the iron-regulated expression of the promoter. The -37 and -43 bp regions exhibited some homology to the 19 bp Escherichia coli Fur-binding consensus sequence. When expressed in E. coli (via a cloned transacting factor from strain M114) lacZ expression from pSP1 was found to be regulated by iron. A region of greater than 77 bases but less than 131 upstream from the transcriptional start was found to be necessary for promoter activity, further suggesting that a transcriptional activator may be required for expression.


Strain-induced ferroelectricity in simple rocksalt binary oxides.
Using first-principles density functional calculations, we show that ferroelectricity can be induced in simple alkaline-earth-metal binary oxides such as barium oxide (BaO) using appropriate epitaxial strains. Going beyond the fundamental discovery, we highlight that the functional properties (polarization, dielectric constant, and piezoelectric response) of such strained binary oxides are comparable in magnitude to those of typical ferroelectric perovskite oxides, making them of direct interest for applications. Finally, we show that magnetic binary oxides such as EuO, with the same rocksalt structure, behave similarly to the alkaline-earth-metal oxides, suggesting a route to new multiferroics combining ferroelectric and magnetic properties.


Comparative potency of tactile, auditory, and visual stimulus repetition in eliciting activated forebrain EEG in the rabbit.
The experiments addressed the question of whether certain modalities of stimulation are more effective in eliciting immobility-related, atropine-sensitive neocortical low-voltage fast activity and hippocampal rhythmical slow activity from the rabbit. More pronounced activation and less pronounced habituation followed tactile than auditory and visual stimulation. On the basis of these results, and other studies, it is suggested that atropine-sensitive electroencephalographic activity may be importantly involved in the central programming, initiation, and guidance of movement.


Antibacterial Additives in Epoxy Resin-Based Root Canal Sealers: A Focused Review.
Dental materials used in root canal treatment have undergone substantial improvements over the past decade. However, one area that still remains to be addressed is the ability of root canal fillings to effectively entomb, kill bacteria, and prevent the formation of a biofilm, all of which will prevent reinfection of the root canal system. Thus far, no published review has analysed the literature on antimicrobial additives to root canal sealers and their influence on physicochemical properties. The aim of this paper was to systematically review the current literature on antimicrobial additives in root canal sealers, their anti-fouling effects, and influence on physicochemical properties. A systematic search was performed in two databases (PubMed and Scopus) to identify studies that investigated the effect of antimicrobial additives in epoxy resin-based root canal sealers. The nature of additives, their antimicrobial effects, methods of antimicrobial testing are critically discussed. The effects on sealer properties have also been reviewed. A total of 31 research papers were reviewed in this work. A variety of antimicrobial agents have been evaluated as additives to epoxy resin-based sealers, including quaternary ammonium compounds, chlorhexidine, calcium hydroxide, iodoform, natural extracts, antibiotics, antifungal drugs, and antimicrobial agent-functionalised nanoparticles. Antimicrobial additives generally improved the antimicrobial effect of epoxy resin-based sealers mainly without deteriorating the physicochemical properties, which mostly remained in accordance with ISO and ANSI/ADA specifications.


Multimodal convergence within the intraparietal sulcus of the macaque monkey.
The parietal cortex is highly multimodal and plays a key role in the processing of objects and actions in space, both in human and nonhuman primates. Despite the accumulated knowledge in both species, we lack the following: (1) a general description of the multisensory convergence in this cortical region to situate sparser lesion and electrophysiological recording studies; and (2) a way to compare and extrapolate monkey data to human results. Here, we use functional magnetic resonance imaging (fMRI) in the monkey to provide a bridge between human and monkey studies. We focus on the intraparietal sulcus (IPS) and specifically probe its involvement in the processing of visual, tactile, and auditory moving stimuli around and toward the face. We describe three major findings: (1) the visual and tactile modalities are strongly represented and activate mostly nonoverlapping sectors within the IPS. The visual domain occupies its posterior two-thirds and the tactile modality its anterior one-third. The auditory modality is much less represented, mostly on the medial IPS bank. (2) Processing of the movement component of sensory stimuli is specific to the fundus of the IPS and coincides with the anatomical definition of monkey ventral intraparietal area (VIP). (3) A cortical sector within VIP processes movement around and toward the face independently of the sensory modality. This amodal representation of movement may be a key component in the construction of peripersonal space. Overall, our observations highlight strong homologies between macaque and human VIP organization.


Negotiating the complexities of exocrine and endocrine dysfunction in chronic pancreatitis.
Chronic pancreatitis is a chronic inflammatory disease of the pancreas characterised by irreversible morphological change and typically causing pain and/or permanent loss of function. This progressive, irreversible disease results in destruction of healthy pancreatic tissue and the development of fibrous scar tissue. Gradual loss of exocrine and endocrine function follows, along with clinical manifestations such as steatorrhoea, abdominal pain and diabetes. Nutrition in chronic pancreatitis has been described as a problem area and, until recently, there was little research on the topic. It is often asserted that >90 % of the pancreas must be damaged before exocrine insufficiency occurs; however, an exploration of the original studies from the 1970s found that the data do not support this assertion. The management of steatorrhoea with pancreatic enzyme replacement therapy is the mainstay of nutritional management, and early identification and treatment is a key. The presence of steatorrhoea, coupled with poor dietary intake (due to intractable abdominal pain, gastrointestinal side effects and often alcoholism) renders the chronic pancreatitis patients at considerable risk for undernutrition, muscle depletion and fat-soluble vitamin deficiency. Premature osteoporosis/osteopenia afflicts two-thirds of patients as a consequence of poor dietary intake of calcium and vitamin D, low physical activity, low sunlight exposure, heavy smoking, as well as chronic low-grade inflammation. Bone metabolism studies show increased bone formation as well as bone resorption in chronic pancreatitis, indicating that bone turnover is abnormally high. Loss of the pancreatic islet cells occurs later in the disease process as the endocrine cells are diffusely distributed throughout the pancreatic parenchyma. Patients may develop type 3c (pancreatogenic) diabetes, which is complicated by concurrent decreased glucagon secretion, and hence an increased risk of hypoglycaemia. Diabetes control is further complicated by poor diet, malabsorption and (for some) alcoholism, and therefore those with type 3c diabetes have clinical characteristics and therapeutic goals that are different from that of type 1 and type 2 diabetes patients. This review describes emerging research and clinical guidelines for nutrition in chronic pancreatitis.


Pacemaker extrusion in a severely demented patient. Device reimplantation via the femoral approach.
Extrusion of the generator is an infrequent complication following pacemaker implantation. Occlusion or stenosis of the deep venous system is common in elderly patients and can cause significant difficulties in transvenous pacing. The present study reports a rare case of pacemaker extrusion in an elderly patient with an inaccessible upper extremities deep venous system, requiring device reimplantation via the femoral route.


siRNA knock down of casein kinase 2 increases force and cross-bridge cycling rates in vascular smooth muscle.
Contraction of smooth muscle involves myosin light chain (MLC) kinase catalyzed phosphorylation of the regulatory MLC, activation of myosin, and the development of force. However, this cannot account for all aspects of a smooth muscle contraction, suggesting that other regulatory mechanisms exist. One potentially important technique to study alternative sites of contractile regulation is the use of small interfering RNA (siRNA). The goal of this study was to determine whether siRNA technology can decrease the levels of a specific protein and allow for the determination of how that protein affects contractile regulation. To achieve this goal, we tested the hypothesis that casein kinase 2 (CK2) is part of the complex regulatory scheme present in vascular smooth muscle. Using intact strips of swine carotid artery, we determined that siRNA against CK2 produced a tissue that resulted in a approximately 60% knockdown after 4 days in organ culture. Intact strips of vascular tissue depleted of CK2 produced greater levels of force and exhibited an increased sensitivity to all stimuli tested. This was accompanied by an increase in cross-bridge cycling rates but not by a change in MLC phosphorylation levels. alpha-Toxin-permeabilized vascular tissue depleted of CK2 also showed an increased sensitivity to calcium compared with control tissues. Our results demonstrate that siRNA is a viable technique with which to study regulatory pathways in intact smooth muscle tissue. Our results also demonstrate that CK2 plays an important role in the mechanism(s) responsible for the development of force and cross-bridge cycling by a MLC phosphorylation-independent pathway.


Electron microscopic analysis of heat-induced leakage of polyphosphate from a phoU mutant of Escherichia coli.
Heat treatment is a simple technique for releasing polyphosphate (polyP) from microbial cells. We investigated the ultrastructural alterations of polyP granules (PPGs) in response to heat treatment at 70 degrees C using a polyP-accumulating phoU mutant of Escherichia coli as a model organism. Electron microscopic and energy-dispersive X-ray analysis suggested concurrent occurrence of PPG degradation and polyP release in the cytoplasm. PolyP is probably released by cytoplasmic extrusion through breaks in the cell envelope.


Approaches to reduce antibiotic resistance in the community.
During the last two decades, there has been an alarming worldwide increase of resistance to antibiotics of bacterial pathogens responsible for community-acquired infections. This dramatic evolution is generally attributed to the extensive use of antibiotics and the selective pressure on the bacterial strains. To decrease antibiotics resistance in the community, several approaches should be considered through: reducing unnecessary antibiotic prescriptions: inappropriate antibiotic treatments are becoming a major issue; however, few studies have shown a decrease of antibiotic resistance following a reduction of antibiotic use in the community;decreasing the prescriptions of the more selective antibiotic compounds for some bacterial species, eg macrolides and group A streptococcus (GAS), trimethoprim-sulfamethoxazole and pneumococcus; using an optimal dosage and duration of antibiotic regimens chosen; some studies have suggested that low dosage and long treatment duration could promote antibiotic resistance; and implementing the pneumococcal conjugate vaccines; several studies have shown a decline in the proportion of penicillin nonsusceptible Streptococcus pneumoniae isolated from invasive pneumococcal diseases or nasopharyngeal flora. The combination of these approaches, particularly the reduction of antibiotic use and pneumococcal immunization, could be synergistic.


Pancreatic neuroendocrine neoplasms: a current summary of diagnostic, prognostic, and differential diagnostic information.
Pancreatic endocrine tumors (PETs) continue to be challenging diagnostic and prognostic lesions in surgical pathology and clinical medicine. These neoplasms can be graded into 1 of 3 tiers, based on histologic characteristics in likeness to epithelial neuroendocrine tumors in other anatomic sites. However, grade 1 tumors are by far the most common and are the most difficult to prognosticate. The most helpful features by which to gauge the behavior of such lesions include size (3 cm or larger); mitotic activity (2 or more mitoses per 10 high-power [x400] microscopic fields); marked nuclear atypia, especially with atypical mitoticfigures; predominant tumor synthesis of gastrin, vasoactive intestinal polypeptide, somatostatin, glucagon, calcitonin, or adrenocorticotropic hormone; complete nonfunctionality of the tumor at an immunohistochemical level; or invasion of blood vessels, nerves, or adjacent organs by the neoplasm. Differential diagnosis of PETs includes lesions such as solid-pseudopapillary neoplasms, acinar carcinomas, metastatic neuroendocrine tumors, and plasmacytomas.


Microanalysis and distribution of cardiac troponin I phospho species in heart areas.
Sequential phosphorylation and dephosphorylation of cTnI by the cAMP dependent protein kinase and by protein phosphatase 2A, respectively, produce the non-, mono- and bisphosphorylated species (Jaquet et al., 1995, Eur. J. Biochem. 231, 486-490). The aim of this study was to determine these forms even in small tissue samples, e.g. in biopsy probes of approximately 30 mg which would allow to define the phosphorylation state of cTnI in heart areas. In order to do so a micro isolation procedure for cTnI had to be established. cTnI is extracted from small bovine, rabbit and human heart tissue samples (30-100 mg) under special conditions avoiding dephosphorylation and is isolated by affinity chromatography on cTnC Sepharose. All three species, the bis-, mono- and dephospho cTnI, are precipitated quantitatively by acetone, then they are separated by non-equilibrium isoelectric focusing and quantified by scanning densitometry. The method presented here allows to quantify the three cTnI species reproducibly. No other phosphorylated species are detected. Truncated cTnI forms of each phospho species are found in human biopsy samples due to removal of a approximately 36 amino acid peptide from the C-terminus. In bovine, human and rabbit heart the pattern of the three cTnI phospho species is characteristic for left and right atrium, left and right ventricle and septum.


Survival outcomes of patients treated with hypofractionated stereotactic body radiation therapy for parotid gland tumors: a retrospective analysis.
to review a single-institution experience with the management of parotid malignancies treated by fractionated stereotactic body radiosurgery (SBRT). Between 2003 and 2011, 13 patients diagnosed with parotid malignancies were treated with adjuvant or definitive SBRT to a median dose of 33 Gy (range 25-40 Gy). There were 11 male and two female patients with a median age of 80. Ten patients declined conventional radiation treatment and three patients had received prior unrelated radiation therapy to neighboring structures with unavailable radiation records. Six patients were treated with definitive intent while seven patients were treated adjuvantly for adverse surgical or pathologic features. Five patients had clinical or pathologic evidence of lymph node disease. at a median follow-up of 14 months only one patient failed locally, and four failed distantly. The actuarial 2-year overall survival, progression-free survival, and local-regional control rates were 46, 84, and 47%, respectively. Statistical analysis revealed surgery as a positive predictor of overall survival while presence of gross disease was a negatively correlated factor (p < 0.05).


Oculoectodermal syndrome: twentieth described case with new manifestations.
Oculoectodermal syndrome is a rare disease characterized by the association of aplasia cutis congenita, epibulbar dermoids, and other abnormalities. This report describes the twentieth case of the disease. We report a 4-year-old female child who presented with the classical features of the syndrome: aplasia cutis congenita and epibulbar dermoids. Our case expands the clinical spectrum of the disease to include: diffuse hyperpigmentation (some following the Blaschko´s lines); hypopigmented skin areas on the trunk; arachnoid cyst on the right fronto-parietal border; rounded left side of the hippocampus; and dermoid cyst underlying the bulb-medullary transition. Our patient also reported infantile hemangioma on the right wrist and verrucous hemangioma on the left leg, the latter not previously described in the literature.


Ethics and Oncofertility: A Call for Religious Sensitivity.
For patients of reproductive age, treating cancer may come at the price of infertility. Literature regarding fertility preservation recommendations in this population has increased significantly, but this literature too often overlooks or insufficiently considers the relevance of religious preferences. Similarly, practice guidelines do not address the role of religion in the oncofertility discussion. The acceptance of oncofertility practices varies significantly among Christianity, Judaism, and Islam. A patient's faith-based spirituality or secular morality may enhance his or her interpretation of the meaning of illness and should be incorporated into the informed-consent process. In this article, we describe the role of religious sensitivity in oncofertility care and argue for its importance in such care. We briefly summarize the views and moral reasoning about oncofertility in a few religions commonly encountered in many patient populations today. We recommend that clinicians discuss fertility options early in the decision process and, when relevant, incorporate the patient's moral and religious preferences into the treatment plan. We encourage providers to be prepared to offer resources to patients who desire moral and spiritual guidance about fertility preservation options. Hospital chaplains should be able to provide such resources.


Relationships between infant temperament, demographic variables, and family dynamics of childrearing families.
Relationships between infant temperament, demographic variables, and family dynamics of child-rearing families were investigated in this study. The revised Infant Temperament Questionnaire (RITQ), the Family Dynamics Questionnaire (FDQ) and the Family Dynamics Measure (FDM) were sent to 118 families who had participated in the first stage of the study as child-bearing families. About 8 months after childbirth 96 mothers and 95 fathers completed the questionnaires. The characteristics of infant temperament and demographic variables related to the variance of dimensions of family dynamics. Characteristics of the temperamentally easy baby related to more positive family dynamics perceived by child-rearing parents. Fathers rearing their first child reported that their families functioned better than fathers with their second infant. In child health clinics families rearing their second child should also be supported, especially families with arrhythmic and negative mood infants.


Imaging of Pelvic Floor Reconstruction.
Stress urinary incontinence and pelvic organ prolapse are 2 common pelvic floor disorders that are important causes of pelvic pain and disability. Mesh and sling placement are some of the surgical treatment options available for treatment of these conditions. In addition to clinical assessment, imaging plays an important role in managing postoperative patients with complications such as recurrent organ prolapse and chronic pain. Role of high-resolution pelvic magnetic resonance imaging with additional advanced imaging techniques, such as magnetic resonance neurography that are invaluable in managing such patients, are discussed in this article.


Didactic and narrative persuasion: An experiment to promote colorectal cancer screening.
We tested whether a didactic and a narrative video (i.e. educational content and personal stories versus irrelevant information) could boost colorectal cancer (CRC) screening intention directly and through cognitive predictors of CRC screening behavior. We also tested whether exposure to a story changed participants' affective forecasting, reducing the perception of negative emotions associated with CRC screening (disgust, embarrassment, and fear). The study was conducted online with a between-participants design and recruiting a convenience sample (N = 375). We found that, compared with watching the control video, being exposed to the narrative video about CRC screening was indirectly associated with greater screening intention via vicarious experience and positive attitudes, whereas watching the didactic video was positively associated with CRC screening intention only among participants who had received an invitation letter but did not get screened, and among those yet to receive an invitation to screen. In the latter group, screening intention was boosted through positive attitudes. Our findings do not confirm that stories change affective forecasting, but narration likely fosters messages acceptance through vicarious experience. We also found support for the effectiveness of physicians' recommendations in promoting CRC screening, an intervention that might be effectively administered through a generalized, cost-effective video.


In vitro susceptibility of lamivudine-resistant hepatitis B virus to adefovir and tenofovir.
Emergence of lamivudine-resistant hepatitis B virus (HBV) is a major concern in human immunodeficiency virus (HIV) and HBV coinfected patients. Following selection of resistant mutants, hepatitis flare or rapid progression to cirrhosis may occur. Treatment of patients with new nucleotide analogues such as adefovir dipivoxil (ADV) or tenofovir disoproxil fumarate (TDF) has shown good efficacy in controlling wild-type or lamivudine-resistant HBV replication. The purpose of this study was to assess the in vitro efficacy of new nucleotide analogues on HBV strains isolated from lamivudine-treated patients. After purification of HBV DNA from patient sera, the whole HBV genome was PCR-amplified and cloned. Drug sensitivity was measured after transfection of the isolated full genomes into HepG2 cells and measurement of HBeAg, HBsAg and viral replication in the culture media under increasing drug concentrations. A wild-type strain isolated from an untreated patient served as control. In a clinical study of ADV (Gilead 460i study), seven of the 35 patients carried HBV strains with the triple lamivudine resistance-associated amino-acid changes rtV173L/L180M/M204V at baseline. Although all patients responded to ADV in this clinical study, the serum HBV reduction was lower in the seven patients with the triple mutation (median -3.3 log copies/ml) compared to the patients who had only the rtL180M/M204V mutations (median -4.1 log copies/ml) at week 48 (P=0.04, Mann-Whitney test). In our in vitro system, lamivudine IC50 on lamivudine-resistant HBV carrying amino-acid substitutions rtL180M and rtM204V within the polymerase encoding region increased by more than 16,000-fold (from 6 nM to over 100 microM) when compared to wild-type HBV. For ADV and TDF, comparison of wild-type and lamivudine-resistant HBV IC50 (rtL180M-M204V) showed, respectively, 2.85-fold (from 0.07 to 0.2 microM) and 3.3-fold (from 0.06 to 0.2 microM) increases, indicating a mild decrease of both drug activities, in vitro. At the ADV concentration of 0.1 microM, presence of the V173L mutation reduced the inhibition of HBsAg production from 50 to 30% (P<0.01) and the viral replication from 45 to 32% (P<0.01, Mann-Whitney). Conversely, tenofovir had similar potency on both HBV mutation profiles with 60% inhibition of HBsAg production and 45% inhibition of viral replication at 0.1 microM. Our study supports the high efficacy of ADV and TDF seen in patients after lamivudine breakthrough. The excellent activity of TDF on lamivudine-resistant virus independently of the resistance mutation profile offers an interesting treatment alternative to HIV-HBV coinfected patients.


Factors associated with metabolic syndrome among Korean office workers.
To assess the prevalence of metabolic syndrome (MetS) and identify risk factors associated with MetS among Korean office workers, this cross-sectional study was conducted with 776 office workers. The prevalence of MetS was 13.5%; elevated waist circumference (27.5%), elevated fasting glucose (23.1%), elevated triglycerides (22.2%), low high-density lipoprotein cholesterol (HDL-C) (13.4%), and elevated BP (9.4%). Having any medical health problems (OR = 3.98, 95% CI: 2.01-7.85), more knowledge of MetS (OR = 1.26, 95% CI: 1.02-1.56), higher BMI (OR = 1.42, 95% CI: 1.30-1.57), current smoking (OR = 3.78, 95% CI: 1.04-13.73), and physical inactivity (OR = 3.22, 95% CI: 1.21-8.58) were significantly associated with increased likelihood of MetS. Addressing the influence of these factors on MetS could lead to the development of workplace-based intervention strategies to encourage lifestyle changes and prevent the risk of MetS among Korean office workers.


Heart rate variability in adults with chronic musculoskeletal pain: A systematic review.
The aim of this review was to compare the heart rate variability (HRV) responses at rest of adults with chronic musculoskeletal pain against healthy controls. The PubMed, Scopus, Web of Science (Science and Social Science Citation Index), and CINAHL databases were searched, with no date restrictions. Two independent reviewers selected observational studies that characterized the HRV responses at rest in adults with chronic musculoskeletal pain compared with those of healthy controls. Methodological quality was assessed using the Downs and Black checklist. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. HRV in adults with chronic musculoskeletal pain was evaluated systematically. Of the 4893 studies screened, 20 of poor-to-moderate quality met the inclusion criteria. Most studies used electrocardiography and at least one time and/or frequency domain index. Studies were found that investigated HRV in adults with temporomandibular disorders, neck pain, whiplash, low back pain, and fibromyalgia. The heterogeneity of the studies in relation to painful conditions, parameters or position for HRV analysis precluded a meta-analysis. In general, these studies seem to show increased sympathetic and decreased parasympathetic modulation in adults with musculoskeletal pain when compared to controls. Adults with musculoskeletal pain exhibited a decline in HRV compared to controls. However, definitive conclusions cannot be drawn since the evidence is heterogeneous and of moderate quality. Further high-quality research with standardized measurements is needed.


Genetics and infection dynamics of Paratrichosoma sp in farmed saltwater crocodiles (Crocodylus porosus).
Paratrichosoma-associated helminthiasis has been identified in saltwater crocodiles under intensive farming conditions. The development of sustainable integrated management practices is dependent on a detailed understanding of Paratrichosoma population genetics and infection dynamics. This study investigated the genetic relationships of Paratrichosoma sp in a population of commercially farmed saltwater crocodiles, Crocodylus porosus, in northern Australia. 18S ribosomal RNA gene sequence data were obtained from Paratrichosoma sp eggs present in the epidermis of infected animals. A high level of genetic diversity was distributed within the Paratrichosoma sp population (241 variable positions in the 1094 bp alignment), indicating an accelerated rate of nucleotide base-pair substitutions in this genus of nematodes. Several possible environmental correlates of the incidence and intensity of helminthiasis, including season, rainfall, and mean monthly temperature, were investigated by visual inspection of crocodile skins. Stepwise logistic regression revealed a significant negative linear relationship (P = 0.011, R (2) = 32.69 %) between mean monthly rainfall and the incidence of monthly Paratrichosoma-associated helminthiasis. Variation in the severity of Paratrichosoma-associated helminthiasis could not be explained by any of the independent environmental variables included within an ordinal regression analysis. The large genetic diversity in these nematodes indicates a high probability of anthelmintic resistant alleles occurring in the population. We discuss how the spread of these alleles may be mitigated by adopting targeted treatment protocols.


Sickness behavior in feverish children is independent of the severity of fever. An observational, multicenter study.
Behavioral changes in a febrile child are usually considered to stem from the fever. We studied sickness behavior (SB) in terms of its clinical components and its relation to fever. This observational, multicenter study included children aged 6 months to 3 years who were either febrile (fever ≥12 hours, ≥ 39°C and ≥38°C at inclusion) or non-febrile and well. The child had to have been awake for the 2 hours preceding the consultation and cared for by the parent who brought him/her to the doctor. SB was evaluated according to 6 parameters over this 2-hour period: time spent playing, distance covered, time spent seeking comfort, time spent whining or crying, time spent in a state of irritation or of anger, most distorted facial expression. Two parameters were assessed for the 24-hour period preceding the consultation: time spent sleeping and appetite. The parent reported the degree of change in these parameters compared with the usual situation, using rating scales. 200 febrile children (most with nonspecific upper respiratory infections) and 200 non-febrile children were included. The mean values of the 8 parameters differed significantly (p<0.001) between the 2 groups and were independent of the height of fever at inclusion in the febrile children. In the study conditions, paracetamol failed to improve SB when the child was still feverish. The 8 parameters suggested that SB and fever are two independent manifestations that are activated simultaneously during an infection. This independence is in harmony with recommendations to treat the discomfort of SB and not the fever.


The development of chalcones as promising anticancer agents.
Chalcones are polyketide natural products that display various biological activities, including anticancer properties. Compelling data from laboratory studies indicate that chalcones have important effects on cancer cell growth and proliferation. Many mechanisms of action have been identified, including the inhibition of tubulin assembly, inhibition of angiogenesis, induction of apoptosis, anti-estrogenic activity and reversal of multidrug resistance - or a combination of these mechanisms. Based on these results, chalcones appear to be promising anticancer agents.


Low ABA concentration promotes root growth and hydrotropism through relief of ABA INSENSITIVE 1-mediated inhibition of plasma membrane H+-ATPase 2.
The hab1-1abi1-2abi2-2pp2ca-1 quadruple mutant (Qabi2-2) seedlings lacking key negative regulators of ABA signaling, namely, clade A protein phosphatases type 2C (PP2Cs), show more apoplastic H+ efflux in roots and display an enhanced root growth under normal medium or water stress medium compared to the wild type. The presence of low ABA concentration (0.1 micromolar), inhibiting PP2C activity via monomeric ABA receptors, enhances root apoplastic H+ efflux and growth of the wild type, resembling the Qabi2-2 phenotype in normal medium. Qabi2-2 seedlings also demonstrate increased hydrotropism compared to the wild type in obliquely-oriented hydrotropic experimental system, and asymmetric H+ efflux in root elongation zone is crucial for root hydrotropism. Moreover, we reveal that Arabidopsis ABA-insensitive 1, a key PP2C in ABA signaling, interacts directly with the C terminus of Arabidopsis plasma membrane H+-dependent adenosine triphosphatase 2 (AHA2) and dephosphorylates its penultimate threonine residue (Thr947), whose dephosphorylation negatively regulates AHA2.


Differential accessibility of the carbohydrate moieties of Cls-Clr-Clr-Cls, the catalytic subunit of human Cl.
The catalytic subunit of human Cl, Cls-Clr-Clr-Cls, is a Ca2+-dependent tetrameric association of two serine proteases, Clr and Cls, which are glycoproteins containing asparagine-linked carbohydrates. With a view to investigate the accessibility and the possible functional role of these carbohydrates, the isolated proteases and their Ca2+-dependent complexes were submitted to deglycosylation by peptide:N-glycosidase F, an endoglycosidase that specifically hydrolyzes all classes of N-linked glycans. Treatment of isolated Clr and Cls led to the removal of the carbohydrate moieties attached to their N-terminal alpha region, whereas those located in the C-terminal gamma-B catalytic domains were resistant to hydrolysis. Formation of the Ca2+-dependent Cls-Cls dimer and Cls-Clr-Clr-Cls tetramer induced specific protection of the single carbohydrate attached to the alpha region of Cls and of one of the two carbohydrates located in the corresponding region of Clr. Sequence studies indicated that the carbohydrates protected upon homologous (Cls-Cls) or heterologous (Clr-Cls) interactions are attached to asparagine residues 159 of Cls and 204 of Clr, at the C-terminal end of the EGF-like domain of both proteases. These data bring further evidence that Ca2+-dependent interactions between Clr and Cls are mediated by their N-terminal alpha regions and strongly suggest that, inside these regions, the EGF-like domains play an essential role in these interactions.


Novel Therapy for Primary Canaliculitis: A Pilot Study of Intracanalicular Ophthalmic Corticosteroid/Antibiotic Combination Ointment Infiltration.
In patients with primary canaliculitis, conservative medical therapy is associated with a high recurrence rate. Surgical treatments carry a great resolution rate but sometimes can result in the lacrimal pump dysfunction and canalicular scarring. The aim of this study is to introduce a minimally invasive approach, intracanalicular ophthalmic corticosteroid/antibiotic combination ointment infiltration (IOI, intracanalicular ointment infiltration), and to report our preliminary results for treating primary canaliculitis. In this retrospective, interventional case series, 68 consecutive patients with newly developed primary canaliculitis at a major tertiary eye center between January 2012 and January 2015. Thirty-six patients received conservative medical treatment alone (group 1; 36 eyes). Twenty-two patients and 10 medically uncontrolled patients from group 1 underwent IOI therapy (group 2; 32 eyes). Ten patients and 26 recurrent patients from group 1 and group 2 underwent surgery (group 3; 36 eyes). Patients were followed-up for at least 8 weeks. Clinical characteristics and outcomes were analyzed and compared. In this study, patients' age, sex, onset location, and durations of disease among 3 groups showed no significant difference. The resolution rate in group 2 was 72.7% (16/22) for new patients and 68.8% (22/32) for gross patients, respectively, both of which are higher than that of group 1 (22.2%, 10/36) but lower than that of group 3 (100%, 36/36). Of group 3, 2 patients received 2 surgical interventions and resolved finally. Microbiological workup was available in 51 patients. The most common isolates were staphylococcus species (27.9%) and streptococcus species (20%). Canalicular laceration developed in 1 patient during the IOI procedure and 1 patient undergoing surgery. Only 2 had postoperative lacrimal pump dysfunction and 1 had canalicular scarring in group 3. The IOI may be an effective and minimally invasive technique for treating primary canaliculitis and obviate the need for further intensive surgery.


Continuous chemical operations and modifications on magnetic γ-Fe2O3 nanoparticles confined in nanoliter droplets for the assembly of fluorescent and magnetic SiO2@γ-Fe2O3.
We present a microfluidic platform that allows undergoing different chemical operations in a nanoliter droplet starting from the colloidal suspension of magnetic iron oxide (γ-Fe2O3) nanoparticles "NPs" (ferrofluid). These operations include: mixing, flocculation, magnetic decantation, colloidal redispersion, washing, surface functionalization, heating and colloidal assembly. To prove the platform capabilities, we produced fluorescent and magnetic nanoassemblies composed of fluorescent silica and magnetic NPs.


Investigating the ability to read others' intentions using humanoid robots.
The ability to interact with other people hinges crucially on the possibility to anticipate how their actions would unfold. Recent evidence suggests that a similar skill may be grounded on the fact that we perform an action differently if different intentions lead it. Human observers can detect these differences and use them to predict the purpose leading the action. Although intention reading from movement observation is receiving a growing interest in research, the currently applied experimental paradigms have important limitations. Here, we describe a new approach to study intention understanding that takes advantage of robots, and especially of humanoid robots. We posit that this choice may overcome the drawbacks of previous methods, by guaranteeing the ideal trade-off between controllability and naturalness of the interactive scenario. Robots indeed can establish an interaction in a controlled manner, while sharing the same action space and exhibiting contingent behaviors. To conclude, we discuss the advantages of this research strategy and the aspects to be taken in consideration when attempting to define which human (and robot) motion features allow for intention reading during social interactive tasks.


Pharmacologic modulation of reduced glutathione circadian rhythms with buthionine sulfoximine: relationship with cisplatin toxicity in mice.
The relationship between the rhythm in reduced glutathione (GSH) and that in cisplatin (CDDP) toxicity was investigated in a total of 560 male B6D2F1 mice, using buthionine sulfoximine (BSO). GSH was measured by high-performance liquid chromatography (HPLC) in four tissues, at each of six sampling times, 4 hr apart. A significant 24-hr rhythm was statistically validated in liver, jejunum, and colon, but not in bone marrow. Relative to liver, glutathione content was 56% in colon, 38% in bone marrow, 25% in jejunum, and negligible in kidney, where cysteine, a final product of GSH catabolism, displayed a 12-hr rhythmic variation. This rhythm may reflect that in the activity of GSH-degrading enzymes. BSO (450 mg/kg ip, 4 hr before sampling) reduced liver GSH threefold and kidney cysteine content was halved, but this pretreatment had no significant effect upon GSH content in the other organs. Furthermore, the period of the physiologic liver GSH rhythm changed from 24 hr to a composite (24 + 12 hr) period. This change in the period may result from an unmasking of the 12-hr rhythm in GSH-degrading enzyme activity by GSH synthesis blockade. Maximal values occurred in the mid-rest span and in the mid-active span after BSO administration. In the other tissues, the 24-hr period remained unchanged. BSO injection largely enhanced CDDP toxicity (as assessed by survival, leukopenia, and histologic lesions in kidney and bone marrow) and kidney mean platinum concentration. Furthermore, BSO pretreatment modified the period of CDDP toxicity rhythm: survival followed a significant 12-hr-rhythm, instead of a 24-hr rhythm. The cycling of GSH concentration results from a balance between synthesis and catabolism and likely constitutes one of the main components of the circadian rhythm in CDDP toxicity in mice.


Slow dynamics and aging of a confined granular flow.
We present experimental results on slow flow properties of a granular assembly confined in a vertical column and driven upwards at a constant velocity V. The wall roughness is much lower than the typical grain size. For monodisperse assemblies this study evidences at low velocities (1<V<100 microm/s) a stiffening behavior, i.e., the stress necessary to obtain a steady-state velocity increases roughly logarithmically with velocity. On the other hand, at very low driving velocity (V<1 microm/s), we evidence a discontinuous and hysteretic transition to a stick-slip regime characterized by a strong divergence of the maximal blockage force when the velocity goes to zero. We show that all this phenomenology is strongly influenced by surrounding humidity. We also present an attempt to establish a link between the granular rheology and the solid friction forces between the wall and the grains. We base our discussions on a simple theoretical model and independent grain/wall tribology measurements. We also use finite element numerical simulations to compare experimental results with isotropic elasticity. A second system made of polydisperse assemblies of glass beads is investigated. We emphasize the onset of a new dynamical behavior, i.e., the large distribution of blockage forces evidenced in the stick-slip regime.


Sinusitis in allergic patients.
Allergy is one of the aetiologic factors in the pathogenesis of sinusitis. To determine its influence on the occurrence of sinusitis the authors studied CT-scans of the sinuses in 59 allergic children and 62 allergic adults. Sinusitis was found in 36 children (61%) and 36 adults (58%). These results were compared with two previous studies consisting of mainly non-allergic children (n = 196) and mainly non-allergic adults (n = 350). Except for allergy, identical inclusion and evaluation criteria were used. In the previous studies, sinusitis was found in 125 children (64%) and 201 adults (57.5%). According to these results it seems that the prevalence and the extent of sinus mucosa involvement is not determined by aetiology (allergic or non-allergic). Age seems to be of major importance regarding the extent of sinus disease.


In vitro release of luteinizing hormone releasing hormone (LH-RH) from the hypothalamus in pregnant rats.
Using the superfusion system, the basal LH-RH release from the hypothalamus was investigated during pregnancy in rats. Pregnant rats were sacrificed on day 10, 15, 18 and 21 of pregnancy by decapitation. The hypothalamus was taken out as a block, and superfused with Krebs-Ringer bicarbonate buffer in conditions of 37 degrees C, 95% O2 + 5% CO2. The changes in LH-RH concentrations in the superfused medium were measured using a radioimmunoassay for LH-RH. Serum LH levels were significantly decreased from day 10 to 15, but increased rapidly from day 18 to 21. On the other hand, the release of LH-RH from the hypothalamus remained stable until day 18, followed by a significant increase on day 21. These results suggested that the decrease in LH secretion from day 10 to 15 would not be due to the changes in LH-RH release, while the increase in serum LH levels on day 21 might depend on the increase in the release of LH-RH.


Sugar-phosphole oxide conjugates as "turn-on" luminescent sensors for lectins.
A mixture of sugar-phosphole oxide conjugates and lectins in a buffer solution displays an intense blue emission, thereby acting as a "turn-on" fluorescent sensor for lectins as they form aggregates.


On describing idiosyncratic phonologic systems.
A phone distribution procedure for analyzing idiosyncratic phonologic systems in children is applied to a phonologically impaired child's distribution of alveolar and velar stops. Results show that these stops occur in complementary distribution: Alveolar stops occur before high vowels and velar stops occur before nonhigh vowels. It is further demonstrated that phonologic process analysis fails to reveal this unusual distribution of alveolar and velar stops. Thus, it is argued that phonologic process analysis must necessarily be supplemented by other procedures capable of detecting and describing unusual distribution patterns in order to achieve an accurate clinical diagnosis and to select the most appropriate target for a successful clinical treatment program.


Association between Lysholm score and muscular torque deficit after anterior cruciate ligament reconstruction.
The asymmetry of muscular strength after anterior cruciate ligament reconstruction (ACLR) is associated with increase in the development of new lesions. This asymmetry is precisely assessed by isokinetic dynamometry which is a high-cost technique, limited to major centers and hospitals. Thus, the aim of this study was to test the accuracy of one of the most frequently used functional questionnaires, the Lysholm score, to diagnose the knee torque deficit. In total, 115 patients were evaluated after ACLR. Knee symptoms were evaluated using the Lysholm questionnaire and knee extensor and flexor peak torque during maximal isokinetic concentric contractions at 60° s-1 (5 repetitions) and 180° s-1 (15 repetitions). Patients with <20% peak torque deficit were considered symmetric (normal). An increase in the Lysholm score was associated with a deficit reduction in the peak torque of knee extensors at 60° s-1 (r = -0.294) and 180° s-1 (r = -0.297) (p < 0.05 for both). Cutoff Lysholm scores of >90 points for 60° s-1 allowed the correct diagnosis of symmetry in 71% and of >89 points for 180º·s-1 allowed the correct diagnosis of symmetry in 73%, for knee extensors. Patients with a Lysholm score of >89 points presented an isokinetic deficit 36% lower than patients with a Lysholm score of ≤89 points (p < 0.05). A Lysholm score of >89 points has predictive value for deficits in the peak torque of knee extension (<20%). However, replacement of the isokinetic evaluation by this instrument must be performed with caution because of its accuracy.


Pumping by flapping in a viscoelastic fluid.
In a world without inertia, Purcell's scallop theorem states that in a Newtonian fluid a time-reversible motion cannot produce any net force or net flow. Here we consider the extent to which the nonlinear rheological behavior of viscoelastic fluids can be exploited to break the constraints of the scallop theorem in the context of fluid pumping. By building on previous work focusing on force generation, we consider a simple, biologically inspired geometrical example of a flapper in a polymeric (Oldroyd-B) fluid, and calculate asymptotically the time-average net fluid flow produced by the reciprocal flapping motion. The net flow occurs at fourth order in the flapping amplitude, and suggests the possibility of transporting polymeric fluids using reciprocal motion in simple geometries even in the absence of inertia. The induced flow field and pumping performance are characterized and optimized analytically. Our results may be useful in the design of micropumps handling complex fluids.


Survey of the management of acute traumatic first-time anterior shoulder dislocation among trauma clinicians in the UK.
The aim of this work was to survey how acute traumatic first-time anterior shoulder dislocation (AFSD) is managed among trauma clinicians in UK using a postal questionnaire. A total of 150 questionnaires were sent out to active consultant members of the British Trauma Society in the UK. Questions were laid out in two 'workgroups'. In Workgroup One, an assortment of questions was included regarding choices and methods of analgesia, methods of monitoring used, methods of reduction, and position of immobilisation. In Workgroup Two, three different case scenarios were analysed to look into the 'post-reduction' management. The response rate was 60%. Of respondents, 22% have a local protocol for managing AFSD. Almost all respondents recommended pre- and post-reduction X-rays as standard practice. Most respondents favoured systemic analgesia and sedation with airways' monitoring, as opposed to intra-articular anaesthesia (68 versus 9). Eighty-four respondents advocated immobilisation in internal rotation compared to six in external rotation. Only 19% (16 of 84) of respondents would perform an immediate arthroscopic stabilisation in young, fit patients presenting with this type of injury. This survey revealed variations among trauma clinicians in managing AFSD on the 'front-line'. There is a need to address the issue of intra-articular analgesia, immobilisation technique and management of AFSD in the young patient with regards to immediate surgical intervention. We suggest that these issues be revised and clarified, ideally in a randomised, controlled, clinical trial prior to the introduction of a protocol for managing this problem.


Hepatitis B virus of genotype B with or without recombination with genotype C over the precore region plus the core gene.
The entire nucleotide sequences of 70 hepatitis B virus (HBV) isolates of genotype B (HBV/B), including 38 newly determined and 32 retrieved from the international DNA database (DDBJ/EMBL/GenBank), were compared phylogenetically. Two subgroups of HBV/B were identified based on sequence divergence in the precore region plus the core gene, one with the recombination with genotype C and the other without it. The analysis over the entire genome of HBV/B by the SimPlot program located the recombination with genotype C in the precore region plus the core gene spanning nucleotide positions from 1740 to 1838 to 2443 to 2485. Within this genomic area, HBV/B strains with the recombination had higher nucleotide and amino acid homology to genotype C than those without the recombination (96.9 versus 91.1% in nucleotides and 97.0 versus 92.9% in amino acids). There were 29 HBV/B strains without the recombination, and they were all recovered from carriers in Japan. The remaining 41 HBV/B isolates having the recombination with genotype C were from carriers in China (12 strains), Hong Kong (3 strains), Indonesia (4 strains), Japan (3 strains), Taiwan (4 strains), Thailand (3 strains), and Vietnam (12 strains). Due to the frequency of the distribution of HBV/B without the recombination (29 of 32 isolates, or 91%) and the fact that it was exclusive to Japan, it was provisionally classified into the Bj (j standing for Japan) subgroup, and HBV/B with the recombination was classified into the Ba (a for Asia) subgroup. Virological differences between HBV/Bj and HBV/Ba may be reflected in the severity of clinical disease in the patients infected with HBV of genotype B, which seems to be under strong geographic influences in Asia.


How do people with intellectual disabilities construct their social identity? A review.
A 2005 review by Beart, Hardy and Buchan, asking how people with intellectual disabilities view their social identities, has been widely cited, indicating this important topic needs an updated review. This review covers research on how people with intellectual disabilities view their ascribed label; to what extent they ascribe it to themselves; and whether they recognize it as devalued in society. Rapid review methodology using PsycINFO, citation- and hand-searching identified relevant studies. The 16 studies identified indicate that the majority are aware of their ascribed label, or acknowledge they are "different". Others reject it, focusing on alternative attributes or roles. Most recognize others view the label negatively and express feelings of shame, anger and powerlessness. The review advances our understanding of social identity formation in people with intellectual disabilities, with implications for future research and practice to support construction of positive social identities and stigma resistance.


Circulating dendritic cells are severely decreased in idiopathic pulmonary fibrosis with a potential value for prognosis prediction.
Dendritic cells (DCs) accumulate in the lung of patients affected by idiopathic pulmonary fibrosis (IPF). We measured the frequencies of circulating conventional CD1c + and CD141+ cells (namely, cDC2 and cDC1) and of plasmacytoid CD303+ DCs in a cohort of 60 therapy naive IPF patients by flow cytometry. Peripheral levels of reactive oxygen species (ROS) and of pro-inflammatory and Th1/Th2 polarizing cytokines were also analyzed. All blood DC subtypes were significantly reduced in IPF patients in comparison to age- and sex-matched controls, while ROS and interleukin (IL-6) levels were augmented. IL-6 expression increased along with disease severity, according to the gender-age-physiology index, and correlated with the frequency of cDC2. IL-6 and cDC2 were not influenced by anti-fibrotic therapies but were associated with a reduced survival, the latter being an independent predictive biomarker of worse prognosis. Deciphering the role of DCs in IPF might provide information on disease pathogenesis and clinical behavior.


[The value of the social service unit in ambulatory gerontopsychiatric management].
Care of aged mentally diseased patients is one of the subjects whose reform had been underlined as particularly urgent in the 1975 report on the state of psychiatry in the Federal Republic of Germany. Whereas in psychiatric hospitals there is now evidence of a growing trend to reduced hospital stay and to readmission after a period of release, no change seems to be in sight in respect of caring for the aged on an outpatient basis. The financial losses suffered by public health care organisations for aged mental outpatients have resulted in housing an increasing number of mentally ill persons of old age in homes for the aged, instead of caring for them as psychiatric outpatients. Since more and more aged persons will be represented among the population in future, it is more than ever before imperative to arrive at suggestions for a feasible solution. The article reviews the present situations (including acceptance of existing institutions by the aged) and explains the importance of public social care units in outpatient care of elderly people. The assessment was made by means of an official questionnaire operation in the Land of Baden-Württemberg. Efforts are suggested in respect of revised basis rules of organisation and staff to improve public outpatient gerontopsychiatric care.


Neoadjuvant chemotherapy in stage IB2 squamous cell carcinoma of the cervix.
To determine the effects of neoadjuvant chemotherapy (NAC) in the management of cervical carcinoma Stage IB2 (tumor diameter > 4 cm), we reviewed 52 surgically treated patients diagnosed between January 1987 and December 1993. There were 20 patients treated with preoperative neoadjuvant chemotherapy and 32 treated by primary radical hysterectomy. Mean tumor diameter was significantly larger in the neoadjuvant, compared with the primary surgery group (6.5 +/- 1.8 vs 5.4 +/- 0.7, P = 0.003). In the NAC group, 5 of 20 patients were treated with three courses of cisplatin, methotrexate, and bleomycin every 21 days, whereas 15 of 20 patients received three courses of cisplatin, vincristine, and bleomycin every 10 days. Postoperative adjuvant therapy consisting of either radiation or chemotherapy was employed in 13/20 patients (65%) in the NAC group and 20/32 patients (63%) in the primary surgical group. At a median follow-up of 52.5 months, 4/20 patients (20%) in the NAC group recurred vs 11/32 (34%) in the primary surgery group. The overall response rate to NAC was 90%, with 2/20 complete clinical responders and 16/20 partial responders. High-risk pathologic factors were less commonly observed in the NAC group when compared with the primary surgical group with the incidence of nodal metastases, positive vascular space involvement, undiagnosed parametrial disease, and > or = 75% depth of invasion observed in 10.0% vs 37.5%, 20.0% vs 46.9%, 0.0% vs 15.6%, and 30.0% vs 68.8%, respectively. No differences were noted in operative time or blood loss. Cox proportional-hazards analysis indicated that the most significant prognostic factor was depth of invasion. Although the patients who received neoadjuvant chemotherapy had significantly larger tumors at baseline, their 5-year survival rate was slightly higher than that of the primary surgery group (80.0% vs 68.7%, P = 0.162). Patients receiving neoadjuvant chemotherapy, despite having significantly larger pretreatment tumors, had fewer high-risk pathologic factors, postoperatively. Although this was a small, nonrandomized study, the relative improvement in pathologic response and long-term outcome associated with neoadjuvant chemotherapy was encouraging. This highlights the need for a prospective randomized clinical trial to establish whether neoadjuvant chemotherapy can significantly improve the long-term outcome of women with Stage IB2 squamous cell carcinoma of the cervix.


Wintertime vertical variations in particulate matter (PM) and precursor concentrations in the San Joaquin Valley during the California Regional Coarse PM/Fine PM Air Quality Study.
Air quality monitoring was conducted at a rural site with a tower in the middle of California's San Joaquin Valley (SJV) and at elevated sites in the foothills and mountains surrounding the SJV for the California Regional PM10/ PM2.5 Air Quality Study. Measurements at the surface and n a tower at 90 m were collected in Angiola, CA, from December 2000 through February 2001 and included hourly black carbon (BC), particle counts from optical particle counters, nitric oxide, ozone, temperature, relative humidity, wind speed, and direction. Boundary site measurements were made primarily using 24-hr integrated particulate matter (PM) samples. These measurements were used to understand the vertical variations of PM and PM precursors, the effect of stratification in the winter on concentrations and chemistry aloft and at the surface, and the impact of aloft-versus-surface transport on PM concentrations. Vertical variations of concentrations differed among individual species. The stratification may be important to atmospheric chemistry processes, particularly nighttime nitrate formation aloft, because NO2 appeared to be oxidized by ozone in the stratified aloft layer. Additionally, increases in accumulation-mode particle concentrations in the aloft layer during a fine PM (PM2.5) episode corresponded with increases in aloft nitrate, demonstrating the likelihood of an aloft nighttime nitrate formation mechanism. Evidence of local transport at the surface and regional transport aloft was found; transport processes also varied among the species. The distribution of BC appeared to be regional, and BC was often uniformly mixed vertically. Overall, the combination of time-resolved tower and surface measurements provided important insight into PM stratification, formation, and transport.


Nesfatin-1 stimulates the hypothalamus-pituitary-interrenal axis hormones in goldfish.
Stress in vertebrates is mediated by the hypothalamus-pituitary-adrenal (in mammals)/interrenal (in fish) (HPA/I) axis, which produces the corticotropin-releasing factor (CRF), adrenocorticotropic hormone (ACTH), and corticosteroids, respectively. Nesfatin-1, a novel anorexigenic peptide encoded in the precursor nucleobindin-2 (NUCB2), is increasingly acknowledged as a peptide that influences the stress axis in mammals. The primary aim of this study was to characterize the putative effects of nesfatin-1 on the fish HPI axis, using goldfish (Carassius auratus) as an animal model. Our results demonstrated that nucb2/nesfatin-1 transcript abundance was detected in the HPI tissues of goldfish, with most abundant expression in the pituitary. NUCB2/nesfatin-1-like immunoreactivity was found in the goldfish hypothalamus, pituitary, and interrenal cells of the head kidney. GPCR12, a putative receptor for nesfatin-1, was also detected in the pituitary and interrenal cells. NUCB2/nesfatin-1-like immunoreactivity was observed in ACTH-expressing pituitary corticotrophs. Acute netting and restraint stress upregulated nucb2/nesfatin-1 mRNA levels in the forebrain, hypothalamus, and pituitary, as well as crf and crf-r1 expression in the forebrain and hypothalamus. Intraperitoneal and intracerebroventricular administration of nesfatin-1 increased cortisol release and hypothalamic crf mRNA levels, respectively. Finally, we found that nesfatin-1 significantly stimulated ACTH secretion from dispersed pituitary cells in vitro. Collectively, our data provide the first evidence showing that nesfatin-1 is a stress responsive peptide, which modulates the stress axis hormones in fish.


Local and distant neuronal degeneration following intrastriatal injection of kainic acid.
After intrastriatal injection, the neurotoxin, kainic acid, was cleared from the rat forebrain in a biphasic manner with 70% eliminated within 2 hours; by 24 hours after infusion, less than 1% of the kainic acid remained in the forebrain. The kainic acid diffused into adjacent brain structures, achieving mu molar concentrations in several regions ipsilateral to the injected striatum. At various times after intrastriatal injection of 9.3 nmoles of kainic acid, the brain was serially sectioned; the sections were stained for Nissl substance with cresyl violet or for degenerating neurons with the ammoniacal silver method. Neuronal degeneration spread unevenly into contiguous structures from the central sphere in the injected striatum and affected the ipsilateral pyriform cortex and amygdala, the deep layers of the overlying cerebral cortex, and the medial aspects of the bed nucleus of the stria terminalis and of the nucleus accumbens. In half of the rats, the pyriform cortex contralateral to the side of injection also underwent degeneration. A subpopulation of pyramidal cells in layer IV of the lateral neocortex and the CA3-CA4 pyramidal cells in the ipsilateral hippocampus were selectively affected, whereas adjacent neurons remained intact. The distribution of agyrophilic fibers and terminals in subcortical structures was consistent with the degeneration of neurons of origin in the affected striatal and extrastriatal regions. Brain sections stained by the gold sublimate technique from rats perfused 20 days after injection revealed an intense astrocytic response in all areas affected by acute neuronal degeneration. Extrastriatal damage could be markedly reduced by injection of lower doses of kainic acid (2.3 nmoles) with brief anesthesia; under these conditions, however, the subpopulation of large striatal neurons were relatively resistant, as compared to the Golgi II neurons. These studies demonstrate significant and variable neuronal degeneration beyond the primary site of the lesion after intracerebral injection of kainic acid; several factors affect the pattern of degeneration, including the amount of kainic acid injected, its biological activity, its diffusion, duration of anesthesia, and variable sensitivity of neurons. Consequently, care must be exercised in the use of this neurotoxin to determine the extent and selectivity of neuronal damage, particularly with reference to neuronal vulnerability beyond the central sphere of intrinsic neuronal degeneration.


Factors affecting determination of the optimal ketamine dose for pediatric sedation.
Children are sedated before undergoing diagnostic imaging tests in emergency medicine or pediatric sedation anesthesia units. The aim of this study was to identify variables potentially affecting the dose of ketamine required for induction of sedation in pediatric patients undergoing diagnostic imaging. This retrospective study included children aged 0 to 18 years who underwent sedation with ketamine for computed tomography or magnetic resonance imaging in the pediatric sedation anesthesia unit of a tertiary medical center between January 2011 and August 2016. The children's hemodynamic status and depth of sedation were monitored during the examination. We recorded data on demographics, categories of imaging tests, ketamine doses administered, adverse events, respiratory interventions, and duration of sedation. Data for patients who experienced adverse events were excluded. Sixty-six patients were included in the final analysis. Univariate linear regression analysis revealed that patient age, height, and body surface area (BSA) affected the sedative dose of ketamine administered. These three variables showed multicollinearity in multivariate linear regression analysis and were analyzed in three separate models. The model with the highest adjusted R-squared value suggested the following equation for determination of the dose of ketamine required to induce sedation: ketamine dose (mg)=-1.62+0.7×age (months)+36.36×BSA (m2). Variables such as age and BSA should be considered when estimating the dose of ketamine required for induction of sedation in pediatric patients.


Genetic profiling identifies two classes of soft-tissue leiomyosarcomas with distinct clinical characteristics.
Data about the prognostic factors of soft-tissue leiomyosarcomas and their correlation with molecular profile are limited. From 1990 to 2010, 586 adult patients with a primary soft-tissue leiomyosarcoma were included in the French Sarcoma Group (GSF) database after surgery of the primary tumor. Multivariate analyses were conducted by Cox regression model in a backward stepwise procedure. Genetic profiling was conducted for 73 cases. Median age was 59 years (range, 21-98 years). The median follow-up of patients alive was 46 months. The 5-year metastasis-free survival (MFS) rate was 51% (95% location and grade > I were independent adverse prognostic factors for MFS). The 5-year overall survival (OS) rate was 63% [95% confidence interval (CI), 59-67]. On multivariate analysis, age ≥ 60 years old, tumor size > 5 cm, deep location, and grade > I were independent adverse prognostic factors for OS. Molecular profiling identified specific clusters with activation of different biologic pathways: retroperitoneal leiomyosarcomas are characterized by overexpression of genes involved in muscle differentiation and nonretroperitoneal leiomyosarcomas characterized by overexpression of genes mainly involved in extracellular matrix, wounding, and adhesion pathways. The CINSARC signature but not comparative genomic hybridization (CGH) profiling was predictive of outcome. Soft-tissue leiomyosarcomas represent a heterogeneous group of tumors with at least two categories, retroperitoneal and extremities leiomyosarcomas, having specific clinical outcome and molecular features. Future clinical trials should consider this heterogeneity for a better stratification of patients.


Enhanced Mutation Rate, Relaxed Selection, and the "Domino Effect" are associated with Gene Loss in Blattabacterium, A Cockroach Endosymbiont.
Intracellular endosymbionts have reduced genomes that progressively lose genes at a timescale of tens of million years. We previously reported that gene loss rate is linked to mutation rate in Blattabacterium, however, the mechanisms causing gene loss are not yet fully understood. Here, we carried out comparative genomic analyses on the complete genome sequences of a representative set of 67 Blattabacterium strains, with sizes ranging between 511 and 645 kb. We found that 200 of the 566 analyzed protein-coding genes were lost in at least one lineage of Blattabacterium, with the most extreme case being one gene that was lost independently in 24 lineages. We found evidence for three mechanisms influencing gene loss in Blattabacterium. First, gene loss rates were found to increase exponentially with the accumulation of substitutions. Second, genes involved in vitamin and amino acid metabolism experienced relaxed selection in Cryptocercus and Mastotermes, possibly triggered by their vertically inherited gut symbionts. Third, we found evidence of epistatic interactions among genes leading to a "domino effect" of gene loss within pathways. Our results highlight the complexity of the process of genome erosion in an endosymbiont.


Emergence of variant avian infectious bronchitis virus in India.
Infectious bronchitis virus (IBV) is the etiological agent of an acute and highly contagious disease. Infectious bronchitis (IB) affects chicken of all ages and poses major economic loses to the poultry industry worldwide. The continuous evolution of the spike protein (S1) of IBV is responsible for the prevalence of many serotypes/genotypes around the world. Multiple lineages of IBV strains have been detected in chicken flocks in India since 2003. To detect IBV genotypes prevalent in India. Organ samples from 20 IBV-positive flocks with variable clinical signs were used for the amplification of the S1 gene of IBV by reverse transcriptase-polymerase chain reaction (RT-PCR). Positive PCR amplicons were sequenced. Sequence analysis showed that 14 field isolates belonged to the GI-1 genetic lineage (Mass 41 serotype), two field isolates belonged to the GI-13 (UK 4/91 variant IBV strain), one field isolate grouped with GIII, GV, and GVI genetic lineage and three belonged to a variant genotype unique to India (GI-24). Phylogenetic analysis also showed a similar type of grouping within the field isolates. Among the fourteen GI-1 isolates, 12 were isolated between 2003 and 2006 and only two were isolated between 2009 and 2011. The two field isolates belonging to GI-13 were isolated in 2007, another one belonging to GIII, GV, and GVI was isolated in 2010 and three field isolates were not close to any reference IBV sequences isolated in 2006 (IND-TN-168-06), 2010 (IND-TN-280-10) and 2011 (IND-TN-290-11). A unique variant of IBV is emerging in India (GI-24). Our findings will have important implications for future vaccine intervention.


Increased enterocyte production in gnotobiotic rats mono-associated with Lactobacillus rhamnosus GG.
There is increasing scientific and commercial interest in using beneficial microorganisms (i.e., probiotics) to enhance intestinal health. Of the numerous microbial strains examined, Lactobacillus rhamnosus GG has been most extensively studied. Daily intake of L. rhamnosus GG shortens the course of rotavirus infection by mechanisms that have not been fully elucidated. Comparative studies with germfree and conventional rats have shown that the microbial status of an animal influences the intestinal cell kinetics and morphology. The present study was undertaken to study whether establishment of L. rhamnosus GG as a mono-associate in germfree rats influences intestinal cell kinetics and morphology. L. rhamnosus GG was easily established in germfree rats. After 3 days of mono-association, the rate of mitoses in the upper part of the small intestine (jejunum 1) increased as much as 14 and 22% compared to the rates in germfree and conventional counterparts, respectively. The most striking alteration in morphology was an increase in the number of cells in the villi. We hypothesis that the compartmentalized effects of L. rhamnosus GG may represent a reparative event for the mucosa.


Comparative study of the chemical composition and biological activities of Magnolia grandiflora and Magnolia virginiana flower essential oils.
The biological activities and the determined major volatile components in the Magnolia grandiflora and M. virginiana flowers extracts were compared. Volatile components were detected in the essential oil by dynamic headspace sampling (HS). 2-Phenylethanol (40% and 61%) was found as the main constituent in the essential oil and HS samples of M. virginiana, respectively. In the M. grandiflora oil sample, (E,E)-farnesol (18%) and 2-phenylethanol (10%) were found as main constituents, whereas germacrene D (17%) and β-bisabolene (17%) were the main components of the HS sample. The essential oil in M. virginiana displayed a moderate antioxidant activity relative to vitamin E, whereas both essential oils were active against human lung carcinoma and breast carcinoma cell lines, even at concentrations higher than 200 µg mL(-1).


Statin resistant dyslipidemia in a patient treated with amiodarone.
The authors describe a patient treated with amiodarone presented with high low-density lipoprotein cholesterol (LDL-C) levels who did not respond to treatment with a statin. Both amiodarone and amiodarone induced hypothyroidism influence the synthesis of LDL-receptor which may explain the lack of effect of statin. This was confirmed by normalisation of LDL-C upon discontinuation of amiodarone and treatment with thyroxine.


Coexistence of Strong Second Harmonic Generation Response and Wide Band Gap in AZn4 Ga5 S12 (A=K, Rb, Cs) with 3D Diamond-like Frameworks.
Mid-infrared (MIR, 2-20 μm) second-order nonlinear optical (NLO) materials with outstanding performances are of great importance in laser science and technology. However, the enormous challenge to design and synthesize an excellent MIR NLO material lies in achieving simultaneously a strong second harmonic generation (SHG) response [dij >0.6 × AgGaS2 (AGS)] and wide band gap (Eg >3.5 eV). Herein three new MIR NLO materials, AZn4 Ga5 S12 (A=K, Rb, Cs) are reported, which crystallize in the KCd4 Ga5 S12 -type structure and adopt a 3D diamond-like framework (DLF) consisting of MS4 (M=Zn/Ga) tetrahedra; achieving the desired balance with strong powder SHG response (1.2-1.4 × AGS) and wide band gap (Eg ≈3.65 eV). Moreover, they also show large laser induced damage thresholds (LIDTs, 36 × AGS), a wide range of optical transparency (0.4-25 μm) and ultrahigh thermal stability (up to 1400 K). Upon analyzing the structure-property relationship of AXII4 XIII5 Q12 family, these 3D DLF structures can be used as a highly versatile and tunable platform for designing excellent MIR NLO materials.


Free transplantation of sub-axillary lateral thoraco-dorsal flap in burn surgery.
Free transplantation of subaxillary lateral thoracodorsal flap is recommended. The thoraco-dorsal artery and its accompanying veins may nourish and drain a large musculo-cutaneous flap. The calibres of both the artery and the veins are big enough to be anastomosed to the recipient vessels using the naked eye. The donor area can be closed by first intention suture without interfering with the functional recovery of the donor area. Both the functional and cosmetic results after free transplantations of this flap are good. In acute electrical or other deep burns, this flap can be used to prevent infection, to protect the deep vital structures, and to lessen the amputation rate. A better condition is created for functional recovery and facilitating reconstructive surgery. The muscular branch of the thoraco-dorsal artery was always present in our 50 patients whereas only 20 cases (40 per cent) had an independent cutaneous branch which nourishes the flap. We stress the point of preserving and using the muscular branch as the main blood vessel to be anastomosed for this free flap.


Advances and challenges in laparoscopic surgery in the management of hepatocellular carcinoma.
Hepatocellular carcinoma is the fifth most common malignancy and the third most common cause of cancer-related mortality worldwide. From the wide variety of treatment options, surgical resection and liver transplantation are the only therapeutic ones. However, due to shortage of liver grafts, surgical resection is the most common therapeutic modality implemented. Owing to rapid technological development, minimally invasive approaches have been incorporated in liver surgery. Liver laparoscopic resection has been evaluated in comparison to the open technique and has been shown to be superior because of the reported decrease in surgical incision length and trauma, blood loss, operating theatre time, postsurgical pain and complications, R0 resection, length of stay, time to recovery and oral intake. It has been reported that laparoscopic excision is a safe and feasible approach with near zero mortality and oncologic outcomes similar to open resection. Nevertheless, current indications include solid tumors in the periphery < 5 cm, especially in segments II through VI, while according to the consensus laparoscopic major hepatectomy should only be performed by surgeons with high expertise in laparoscopic and hepatobiliary surgery in tertiary centers. It is necessary for a surgeon to surpass the 60-cases learning curve observed in order to accomplish the desirable outcomes and preserve patient safety. In this review, our aim is to thoroughly describe the general principles and current status of laparoscopic liver resection for hepatocellular carcinoma, as well as future prospects.


Limits and possibilities experienced by nurses in the treatment of women with chronic venous ulcers.
Objective To understand the experiences and expectations of nurses in the treatment of women with chronic venous ulcers. Method Phenomenological research was based on Alfred Schütz, whose statements were obtained in January, 2012, through semi-structured interviews with seven nurses. Results The nurse reveals the difficulties presented by the woman in performing self-care, the perceived limitations in the treatment anchored in motivation, and the values and beliefs of women. It showed professional frustration because venous leg ulcer recurrence, lack of inputs, interdisciplinary work and training of nursing staff. There was an expected adherence to the treatment of women, and it emphasized the need for ongoing care, supported self-care and standard practices in treatment. Conclusion That treatment of chronic venous leg ulcers constitutes a challenge that requires collective investment, involving women, professionals, managers and health institutions.


Quantum graphs and microwave networks as narrow-band filters for quantum and microwave devices.
We investigate properties of the transmission amplitude of quantum graphs and microwave networks composed of regular polygons such as triangles and squares. We show that for the graphs composed of regular polygons, with the edges of the length l, the transmission amplitude displays a band of transmission suppression with some narrow peaks of full transmission. The peaks are distributed symmetrically with respect to the symmetry axis kl=π, where k is the wave vector. For microwave networks the transmission peak amplitudes are reduced and their symmetry is broken due to the influence of internal absorption. We demonstrate that for the graphs composed of the same polygons but separated by the edges of length l^{'}<l, the transmission spectrum is generally not symmetric according to the axis kl^{'}=π. We also show that graphs composed of regular polygons of different size with the edges being irrational numbers are not fully chaotic and their level spacing distribution and the spectral rigidity are well described by the Berry-Robnik distributions. Moreover, the transmission spectrum of such a graph displays peaks which are very close to one. Furthermore, the microwave networks are investigated in the time-domain using short Gaussian pulses. In this case the delay-time distributions, though very sensitive to the internal structure of the networks, show the sequences of transmitted peaks with the amplitudes much smaller than the input one. The analyzed properties of the graphs and networks suggest that they can be effectively used to manipulate quantum and wave transport.


Impact of visualization on simulation training for vascular anastomosis.
There is mounting evidence supporting the benefit of surgical simulation on the learning of skills independently and in a patient-safe environment. The objective of this study was to examine the effect of visualization of surgical steps via instructional media on performance of an end-to-side microvascular anastomosis. Thirty-two first- and second-year surgical trainees from the University of Ottawa received an expert-guided, didactic lecture on vascular anastomosis and performed an end-to-side anastomosis on a procedural model to assess baseline skills. Assessments were performed by 2 blinded, expert observers using validated measurements of skill. Subjects were then proctored to perform anastomoses using the model. Subjects were then randomized to watch an instructional video on performance of vascular anastomosis using visualization as the education strategy. One week later, subjects were again assessed for technical skill on the model. The primary outcome was the score achieved on the Objective Structured Assessment of Technical Skill (OSATS) scale. Secondary outcomes included an anastomosis-specific End-Product Rating Score and time to completion. Compared with residents who received expert-guided simulator training alone, those who used the supplementary multimedia scored significantly greater on OSATS (17.4 ± 2.9 vs 14.2 ± 3.2, P = .0013) and on End-Product Rating Score (11.24 ± 3.0 vs 7.4 ± 4.1, P = .011). However, performance time did not differ between groups (15.7 vs 14.3 minutes, P = .79). Residents with supplemental instructional media performed an end-to-side anastomosis more proficiently as assessed by OSATS and with a greater quality end-product. This suggests that both didactic simulation training as well as use of visualization multimedia improves learning and performance of vascular anastomosis and should be incorporated into surgical curricula.


Technological advancements in stroke rehabilitation.
Early, coordinated, and multidisciplinary rehabilitation plays a major part in motor recovery after stroke. The conventional stroke rehabilitation primarily includes physical therapy, occupational therapy, and speech therapy. However, with these conventional methods, many stroke survivors still have a residual functional disability which impairs their ability to perform activities of daily living. This could be attributed to the insufficient therapy dose, low engagement and motivation of the patient, and lack of objective feedback to achieve significant improvements in function. Various technology-based stroke rehabilitation interventions have been developed in the last few decades which have shown promising results in improving stroke patients' functional mobility and independence. The use of technology promotes repetitive, task-specific training, active engagement of patients, integrating constructive and concurrent feedback, and accurately measuring functional improvement. This review summarizes the important technological advances in stroke rehabilitation, including exergames, telerehabilitation, robotic-assisted systems, virtual and augmented reality, wearable sensors, and smartphone applications.


[Resumption of professional work after cerebral aneurysm surgery].
The influence of various factors upon the resumption of professional work was examined in the group of 87 patients, who had undergone an operation of single cerebral aneurysms. Professional activity was resumed by 59.9% members of the examined group. The age and the level of education or professional training were found to be the most influential factor. The location of aneurysms and sex of patients was found to have no influence. The fact that greater percent of those living in the country resumed their professional activities than those living in towns or cities can be explained by greater difficulty in to suffering was a quite frequent factor which can be overcome due to proper information given to the patients, thereby the greater number of patients can resume their professional career.


Proliferation in the developing intestine is regulated by the endosomal protein Endotubin.
During postnatal intestinal development, the intestinal epithelium is highly proliferative, and this proliferation is regulated by signaling in the intervillous and crypt regions. This signaling is primarily mediated by Wnt, and requires membrane trafficking. However, the mechanisms by which membrane trafficking regulates signaling during this developmental phase are largely unknown. Endotubin (EDTB, MAMDC4) is an endosomal protein that is highly expressed in the apical endocytic complex (AEC) of villus enterocytes during fetal and postnatal development, and knockout of EDTB results in defective formation of the AEC and giant lysosome. Further, knockout of EDTB in cell lines results in decreased proliferation. However, the role of EDTB in proliferation during the development of the intestine is unknown. Using Villin-CreERT2 in EDTBfl/fl mice, we deleted EDTB in the intestine in the early postnatal period, or in enteroids in vitro after isolation of intervillous cells. Loss of EDTB results in decreased proliferation in the developing intestinal epithelium and decreased ability to form enteroids. EDTB is present in cells that contain the stem cell markers LGR5 and OLFM4, indicating that it is expressed in the proliferative compartment. Further, using immunoblot analysis and TCF/LEF-GFP mice as a reporter of Wnt activity, we find that knockout of EDTB results in decreased Wnt signaling. Our results show that EDTB is essential for normal proliferation during the early stages of intestinal development and suggest that this effect is through modulation of Wnt signaling.


[Pulmonary thromboembolism associated with antiphospholipid syndrome in scleroderma].
A 51-year-old woman was referred to our hospital with dyspnea. Chest roentgenogram on admission showed dilation of the pulmonary arteries and hyperlucency in the lung fields. An ultrasonic cardiographic examination showed that the right atrium and ventricle were dilated. Pulmonary thromboembolism due to left popliteal vein thrombosis was diagnosed by perfusion scintigram of the lung, which showed multiple wedge-shaped defects, and by digital subtraction angiogram, which showed a filing defect in the left popliteal vein. Antiphospholipid syndrome was diagnosed after IgG anticardiolipin antibody was defected. Scleroderma was subsequently diagnosed because the patient exhibited Raynaud's phenomenon and proximal scleroderma. Although closely associated with lupus erythematosus and other lupus variants, antiphospholipid syndrome has not been recognized as a common complication of scleroderma. This is the first report of a patient with pulmonary thromboembolism associated with antiphospholipid syndrome and scleroderma.