The gastrocnemius myocutaneous flap in lower-extremity injuries.
Coverage of full-thickness lower extremity wounds has been the bane of surgeons who care for patients with skin and soft-tissue losses. A prolonged period of convalescence may be avoided by immediate coverage with a gastrocnemius myocutaneous flap. Case reports demonstrating the successful use of medial and lateral gastrocnemius myocutaneous flaps are presented. Advantages are that large amounts of tissue can be moved in one step, shortening hospitalization, and most are reliable because of their excellent blood supply. Care must be taken to preserve deep fascia and to dissect the fascia from the Achilles tendon. Fluorescein examination is recommended.


Bacteriocin of a group B streptococcus: partial purification and characterization.
The production of bacteriocin-like inhibition by two of 135 strains of group B streptococci was demonstrated during the growth of these organisms on solid nutrient media. Although a variety of gram-positive organisms was susceptible, none of a wide range of different gram-negative strains was inhibited. The active substance produced by one of these strains was extracted from cultures grown on solid media (Todd-Hewitt agar) and was shown to be bactericidal in action. This bacteriocin (streptocin B(1)) was partially purified by ammonium sulfate precipitation followed by gel filtration and ion-exchange chromatography. Production of the bacteriocin was repressed by addition of certain fermentable carbohydrates to the basic medium and enhanced by the addition of yeast extract. The bacteriocin was shown to exist in two distinct and interconvertible physical forms: a basic unit of molecular weight 10,000 and an aggregate having a molecular weight of over 200,000. The bacteriocin was inactivated by proteolytic enzymes and, although labile in alkali, it was stable to boiling in mild acids.


Myocardial biosynthesis of prostacyclin and the influence of cardiac loading and drugs.
Cardiac tissue from different parts of hearts from guinea pigs and rabbits have the capacity to rapidly synthesize prostacyclin (PGI2). Auricles show a higher PGI2-formation than ventricles. Addition of the endoperoxide PGH2 markedly enhanced the myocardial PGI2-biosynthesis. Furthermore many cardiotonic drugs induced a significant rise, but eicosanoids or cyclooxygenase inhibitors a marked reduction of the cardiac PGI2-formation. Acute pressure overload by graduated aortic stenosis, ischemia by coronary ligation or pacing with high frequency reduced the cardiac contractility. After aortic stenosis the myocardial PGI2-biosynthesis is lowered, but increased after coronary ligation or pacing. Under these conditions indomethacin, PGE1, iloprost, verapamil and trapidil markedly reduced the PGI2-biosynthesis and exert a protective effect in regard to cardiac damage. The results indicate that pathophysiological changes significantly influence the PGI2-biosynthesis of the heart. The drug induced inhibition of the myocardial PGI2-formation parallels a cardioprotective effect of these substances.


Clonal cytopenia of undetermined significance and atypical Behçet's: the importance of zinc.
Atypical Behçet's is recognised in myelodysplastic syndrome (MDS) cases and is associated with trisomy 8. Clonal cytopenia of undetermined significance (CCUS) is recognised as a precursor to MDS. Our case describes the presentation of atypical Behçet's, in association with CCUS, post a Streptococcal infection. A mutation of a zinc finger RNA spliceosome, ZRSR2, is also described. Our patient initially presented with macrocytic anaemia, together with neutropenia and lymphocytopenia on routine monitoring. Later gastrointestinal symptoms together with oral and anal ulcerations developed. He was treated with oral zinc therapy and had resolution of recurrent oral ulcerations and significant reduction in severity of anal ulcerations. The functional impact of ZRSR2 mutation on spliceosome assembly is yet to be defined, but has been previously reported in CCUS with a clinical phenotype of macrocytic anaemia.


[Relevance of reactive fillets in detecting urinary infections in African paediatric environment].
It is quite obvious that African paediatricians are facing numerous challenges. However, their daily fight against frequent pathologies such as malaria, diarrhoeal diseases and respiratory infections should not prevent them from taking into consideration the existence of other pathologies, particularly urinary infections. The clinical picture of urinary infections which is often polymorphic would require a systematic test among infants. Reactive fillets may therefore be relevant in detecting such urinary infections. This survey shows that the best intrinsic values of the fillets used (multistix 8 SG) are reached with leucocytes (sensibility: 95%) and with the combination of leucocytes and nitrites (specificity: 77.1%). The best predictable validities were obtained with the combination of leucocytes and nitrites (positive predictable value: 68.1%) as well as with the combination of leucocytes or nitrites (negative predictable value: 86%). In the daily practice, reactive fillets may turn out to be helpful to the clinician. The negativity of both tests speaks for the isolation and exclusion of urinary infections. On the other hand, the positivity of both tests highlights a strong urinary infection which is subject to a careful and rigorous use of fillets.


Two-dimensional confinement of 3d{1} electrons in LaTiO_{3}/LaAlO{3} multilayers.
We report spectroscopic ellipsometry measurements of the anisotropy of the interband transitions parallel and perpendicular to the planes of (LaTiO3)n(LaAlO3)5 multilayers with n=1-3. These provide direct information about the electronic structure of the two-dimensional (2D) 3d{1} state of the Ti ions. In combination with local density approximation, including a Hubbard U calculation, we suggest that 2D confinement in the TiO2 slabs lifts the degeneracy of the t{2g} states leaving only the planar d{xy} orbitals occupied. We outline that these multilayers can serve as a model system for the study of the t{2g} 2D Hubbard model.


Etiology of cranial diabetes insipidus in 164 adults.
The etiology of cranial diabetes insipidus (CDI) in adult patients has been studied in 164 cases hospitalized in the "G. I. Parhon" Institute of Endocrinology, over the last 10 years. Of those, 109 cases (66,9%) had the idiopathic form whereas 55 had secondary CDI. In the latter group, the most frequently encountered etiologies were traumatic (surgical and accidental head trauma) and tumoral (the primary hypothalamo-pituitary tumors and the metastatic ones had the same incidence). Sex distribution shows males and females to be equally affected. Fifteen cases (9,2%) showed associated allergic syndromes due to the wide use of posterior pituitary powder in Romania. The association of pregnancy with CDI was observed in 13 patients, and a normal evolution of gestation and delivery in 9 patients under therapy with desmopressin (DDAVP). The authors suggest that, at present, there is an increasing incidence both of posttraumatic CDI in adults and of well borne pregnancies.


Prevention of thiopental and thiopental/halothane cardiac sensitization to epinephrine in the sheep.
The effects of epinephrine (5 microgram/kg of body weight) on ten unanesthetized sheep were experimentally tested: all sheep displayed serious arrhythmias. Sheep anesthetized with thiopental and thiopental/halothane combination displayed cardiac arrhythmias of the order of 10% and 20% respectively. Challenge injections of epinephrine (5 microgram/kg of body weight) to ten sheep anesthetized with thiopental, and to the same number of animals after 45 minutes of anesthesia with thiopental/halothane, produced serious arrhythmias. However, following preanesthetic treatment with acepromazine maleate (0.5 mg/kg) to 15 sheep, serious arrhythmias were prevented in all of them when they were given arrhythmic doses of epinephrine.


Neutrophil-to-lymphocyte ratio is increased in patients with rheumatic mitral valve stenosis?
The role of systemic and chronic inflammatory processes in the pathophysiology of rheumatic heart valve disease is well known. The neutrophil-to-lymphocyte ratio (NLR) was shown to be an indicator of systemic inflammation. In this study, we aimed to investigate relationship between NLR as a marker of systemic inflammation and rheumatic mitral valve stenosis (RMVS). This is a retrospective study. Among patients who underwent transthoracic echocardiography between January 2008-March 2013, 314 patients with RMVS were included retrospectively in the study. The control group included 57 healthy persons who underwent transthoracic echocardiography during the study period. Basal characteristics and NLR were compared between the two groups. Independent predictors of RMVS were determined by logistic regression analysis. Basal characteristics were similar among the groups (age, 50.2 ± 14.2 vs. 49.2 ± 13.0, p=0.60). The NLR was significantly higher in patients with RMVS [2.9 (0.6-13.0) vs. 2.1 (0.7-5.8), p<0.001]. Besides, C-reactive protein (CRP) was also higher in the RMVS group [5.99 (0.3-23.7) vs. 2.98 (0.6-6.3), p=0.001]. In the regression analysis, NLR (OR: 2.24, p=0.04), CRP (OR: 1.34, p=0.03), and left atrial diameter (OR: 1.21, p=0.001) were independent predictors of RMVS. In the correlation analysis, there was a significant positive correlation between NLR and CRP (r=0.43, p<0.001). We found that NLR was significantly increased in RMVS. Furthermore, NLR was an independent predictor of the presence of RMVS in our study population. According to these findings, NLR can be used as a predictor of RMVS. Since it is an easily available and cheap method, it can easily be used in daily clinical practice. Increased NLR can also be a sign of ongoing chronic inflammation in patients with RMVS.


Surgical simulation: a current review.
Simulation tools offer the opportunity for the acquisition of surgical skill in the preclinical setting. Potential educational, safety, cost, and outcome benefits have brought increasing attention to this area in recent years. Utility in ongoing assessment and documentation of surgical skill, and in documenting proficiency and competency by standardized metrics, is another potential application of this technology. Significant work is yet to be done in validating simulation tools in the teaching of endoscopic, laparoscopic, and other surgical skills. Early data suggest face and construct validity, and the potential for clinical benefit, from simulation-based preclinical skills development. The purpose of this review is to highlight the status of simulation in surgical education, including available simulator options, and to briefly discuss the future impact of these modalities on surgical training.


Detection of silent coronary artery disease by computed tomographic scan: coronary artery calcium versus noninvasive coronary angiography.
Multislice computerized tomographic scan can identify coronary artery disease (CAD) with quantification of coronary artery calcium (CAC) and computed tomographic coronary angiography (CTA). The utility of CAC in comparison with CTA in asymptomatic patients has not been assessed. Patients with risk factors for CAD, who were referred for screening, were studied using CAC and CTA, using a Phillips Mx8000 IDT 16 multislice computed tomographic scanner. Three hundred and forty-seven patients with a mean age of 55 years, 89.9% male, were included. CAC showed calcium deposits in 171 patients (49.3%) whereas CTA found lesions in 157 patients (45%). CAC correctly identified 309 patients with respect to CTA (presence of any disease) implying a test accuracy of 89%, sensitivity of 85%, specificity of 86%, and negative predictive value of 93%. Obstructive lesions were shown by 7.7% of the patients (stenosis >50%), 22% of the patients with CAC greater than 400, and 2.8% of the patients with CAC of 0. To undergo a CTA scan after CAC permits to re-classify 11% of the patients on the basis of CTA. CAC, in detecting silent CAD, seems to be a good alternative to CTA, in these asymptomatic patients, but CAC is inappropriate to predict the presence or absence of a coronary artery obstruction.


Microscopic calculation of the energetics of charged states in amorphous polyethylene.
Polarization energies are calculated for a single excess charge on a polyethylene chain in amorphous polyethylene using (i) local segment and nonlocal distributed molecular polarizabilities, (ii) material structures simulated by both general-purpose and specialist Monte Carlo software, and (iii) uniform and Gaussian distributions of charge with different extents of charge delocalization. Local and distributed response lead to results that are essentially the same except that they correspond to different mean polarizabilities. With increasing delocalization of the charge along the chain, the polarization energies shift to higher values and the width of their distribution decreases, the differences being more pronounced for the uniform distribution. The polarization energies for charges delocalized over 10-20 methylene units form a distribution some 14 eV wide centered around 1 eV, narrowing significantly for more homogeneous polymer melts. The calculations are relevant to trapping of charge in polyethylene. They also yield the microscopic variation in the potential along the polymer chain caused by the polarization energy difference, and so may provide useful inputs to theories of electronic conduction in polymer materials.


Sulfur, trace nitrogen and iron codoped hierarchically porous carbon foams as synergistic catalysts for oxygen reduction reaction.
Sulfur, trace nitrogen and iron codoped, hierarchically porous carbon foams (HPCFs) were fabricated by directly pyrolyzing sulfur-enriched conductive polymer, poly(3,4-ethylenedioxythiphene)-polystyrenesulfonic acid (PEDOT-PSS) aerogels under argon atmosphere. This simple pyrolysis treatment results in the molecular rearrangement of heteroatom sulfur, adjacent carbons and trace nitrogen/iron from oxidants to form active catalytic sites of HPCFs. At the same time, the high porosity of HPCFs provides the large surface area for the uniform distribution of active sites, and allows rapid oxygen transport and diffusion. As a result, these HPCFs exhibit the enhanced catalytic performances for oxygen reduction reaction (ORR) via a direct four-electron reduction pathway in alkaline electrolyte. Besides, they also display a higher stability and better methanol/CO tolerance than the commercial Pt/C catalyst, which makes them promising low cost, non-precious-metal ORR catalysts for practical application in fuel cells and metal-air batteries.


Frequency of Lewis group substances in patients with cancer of stomach.
Authors examined the frequency of Lewis group substances in red blood cells (RBC) and saliva of 293 patients with cancer of stomach, and of 760 healthy volunteers. Lewis (a-b-) substances on RBC surfaces were significantly more frequent in patients with cancer of stomach compared to normal controls. Most patients with cancer of stomach who had Lewis (a-b-) type red blood cells had Lewis-a and Lewis-b substances in their saliva. The deficiency of Lea substance and the loss or weakening of Leb antigen on RBCs may be a prognostic and diagnostic indicator in patients with cancer of stomach.


Childhood IQ and social factors on smoking behaviour, lung function and smoking-related outcomes in adulthood: linking the Scottish Mental Survey 1932 and the Midspan studies.
To investigate the associations of childhood IQ and adult social factors, and smoking behaviour, lung function (forced expiratory volume in one second; FEV(1)), and smoking-related outcomes in adulthood. Retrospective cohort study. Participants were from the Midspan prospective studies conducted on Scottish adults in the 1970s. The sample consisted of 938 Midspan participants born in 1921 who were successfully matched with their cognitive ability test results on the Scottish Mental Survey 1932. Structural equation modelling showed that age 11 IQ was not directly associated with smoking consumption, but that IQ and adult social class had indirect effects on smoking consumption via deprivation category. The influence of IQ on FEV(1) was partly indirect via social class. Gender influenced smoking consumption and also IQ and social class. There was a 21% higher risk of having a smoking-related hospital admission, cancer, or death during 25 years of follow-up for each standard deviation disadvantage in IQ. Adjustment for adult social class, deprivation category, and smoking reduced the association to 10%. Childhood IQ was associated with social factors which influenced lung function in adulthood, but was not associated directly with smoking consumption. In future studies, it is important to consider other pathways which may account for variance in the link between childhood IQ and health in later life.


The active microbial diversity drives ecosystem multifunctionality and is physiologically related to carbon availability in Mediterranean semi-arid soils.
Biogeochemical processes and ecosystemic functions are mostly driven by soil microbial communities. However, most methods focus on evaluating the total microbial community and fail to discriminate its active fraction which is linked to soil functionality. Precisely, the activity of the microbial community is strongly limited by the availability of organic carbon (C) in soils under arid and semi-arid climate. Here, we provide a complementary genomic and metaproteomic approach to investigate the relationships between the diversity of the total community, the active diversity and ecosystem functionality across a dissolved organic carbon (DOC) gradient in southeast Spain. DOC correlated with the ecosystem multifunctionality index composed by soil respiration, enzyme activities (urease, alkaline phosphatase and β-glucosidase) and microbial biomass (phospholipid fatty acids, PLFA). This study highlights that the active diversity (determined by metaprotoemics) but not the diversity of the whole microbial community (evaluated by amplicon gene sequencing) is related to the availability of organic C and it is also connected to the ecosystem multifunctionality index. We reveal that DOC shapes the activities of bacterial and fungal populations in Mediterranean semi-arid soils and determines the compartmentalization of functional niches. For instance, Rhizobales thrived at high-DOC sites probably fuelled by metabolism of one-C compounds. Moreover, the analysis of proteins involved in the transport and metabolism of carbohydrates revealed that Ascomycota and Basidiomycota occupied different nutritional niches. The functional mechanisms for niche specialization were not constant across the DOC gradient.


Cadmium(II) iodide and thiocyanate complexes adopted by polycyclic 1,4-bis(pyridazin-4-yl)benzene: interplay of coordination and π-π stacking interactions.
New complexes containing the 1,4-bis(pyridazin-4-yl)benzene ligand, namely diaquatetrakis[1,4-bis(pyridazin-4-yl)benzene-κN(2)]cadmium(II) hexaiodidodicadmate(II), [Cd(C14H10N4)4(H2O)2][Cd2I6], (I), and poly[[μ-1,4-bis(pyridazin-4-yl)benzene-κ(2)N(2):N(2')]bis(μ-thiocyanato-κ(2)N:S)cadmium(II)], [Cd(NCS)2(C14H10N4)]n, (II), demonstrate the adaptability of the coordination geometries towards the demands of slipped π-π stacking interactions between the extended organic ligands. In (I), the discrete cationic [Cd-N = 2.408 (3) and 2.413 (3) Å] and anionic [Cd-I = 2.709 (2)-3.1201 (14) Å] entities are situated across centres of inversion. The cations associate via complementary O-H...N(2') hydrogen bonding [O...N = 2.748 (4) and 2.765 (4) Å] and extensive triple π-π stacking interactions between pairs of pyridazine and phenylene rings [centroid-centroid distances (CCD) = 3.782 (4)-4.286 (3) Å] to yield two-dimensional square nets. The [Cd2I6](2-) anions reside in channels generated by packing of successive nets. In (II), the Cd(II) cation lies on a centre of inversion and the ligand is situated across a centre of inversion. A two-dimensional coordination array is formed by crosslinking of linear [Cd(μ-NCS)2]n chains [Cd-N = 2.3004 (14) Å and Cd-S = 2.7804 (5) Å] with N(2):N(2')-bidentate organic bridges [Cd-N = 2.3893 (12) Å], which generate π-π stacks by double-slipped interactions between phenylene and pyridazine rings [CCD = 3.721 (2) Å].


Missed diagnosis of a wooden intra-orbital foreign body.
Intraorbital foreign bodies often present a confusing clinical picture. Wooden foreign bodies are notorious for remaining quiescent for a long time, before presenting with a variety of complications. The wound of entry may often be small and self-sealing. Wooden foreign bodies also show a propensity to break during attempted removal. Intraorbital wood is often not detected by standard diagnostic tests like the computed tomography scan, adding to the diagnostic dilemma. The presence of an intraorbital mass with a discharging sinus should evoke suspicion of a retained organic foreign body, regardless of the time interval between the trauma and current presentation. It is imperative to maintain a high index of suspicion in such cases to avoid misdiagnosis. We report an unusual case of a missed wooden intraorbital foreign body, which spontaneously extruded after five years.


Evaluation of the tablets' surface flow velocities in pan coaters.
The tablet pan coating process involves various types of transverse tablet bed motions, ranging from rolling to cascading. To preserve satisfactory results in terms of coating quality after scale-up, understanding the dynamics of pan coating process should be achieved. The aim of this study was to establish a methodology of estimating translational surface velocities of the tablets in a pan coater and to assess their dependence on the drum's filling degree, the pan speed, the presence of baffles and the selected tablet properties in a dry bed system and during coating while varying the drum's filling degree and the pan speed. Experiments were conducted on the laboratory scale and on the pilot scale in side-vented pan coaters. Surface movement of biconvex two-layer tablets was assessed before, during and after the process of active coating. In order to determine the tablets' surface flow velocities, a high-speed video of the tablet surface flow was recorded via a borescope inserted into the coating drum and analysed via a cross-correlation algorithm. The obtained tablet velocity data were arranged in a linear fashion as a function of the coating drum's radius and frequency. Velocity data obtained during coating were close to those of dry tablets after coating. The filling degree had little influence on the tablet velocity profile in a coating drum with baffles but clearly affected it in a coating drum without baffles. In most but not all cases, tablets with a lower static angle of repose had tablet velocity profiles with lower slopes than tablets with higher inter-tablet friction. This particular tablet velocity response can be explained by case specific values of tablet bed's dynamic angle of repose.


Psychological Construction in the OCC Model of Emotion.
This article presents six ideas about the construction of emotion: (a) Emotions are more readily distinguished by the situations they signify than by patterns of bodily responses; (b) emotions emerge from, rather than cause, emotional thoughts, feelings, and expressions; (c) the impact of emotions is constrained by the nature of the situations they represent; (d) in the OCC account (the model proposed by Ortony, Clore, and Collins in 1988), appraisals are psychological aspects of situations that distinguish one emotion from another, rather than triggers that elicit emotions; (e) analyses of the affective lexicon indicate that emotion words refer to internal mental states focused on affect; (f) the modularity of emotion, long sought in biology and behavior, exists as mental schemas for interpreting human experience in story, song, drama, and conversation.


Clinical and radiological outcomes of a cervical cage with integrated fixation.
Cervical cages with integrated fixation have been increasingly used in anterior cervical discectomy and fusion (ACDF) to avoid complications associated with anterior cervical plates. The purpose of this paper is to provide 2-year follow-up results of a prospective study after implantation of a cervical cage with an integrated fixation system.This was a prospective multicenter outcome study of 90 patients who underwent ACDF with a cage with integrated fixation. Fusion was evaluated from computed tomography images (CT-images) by an independent laboratory at 2-year follow-up (FU). Clinical and radiological findings were recorded preoperatively and at FU visits and complications were reported.At 24 months, the fusion rate was 93.4%. All average clinical outcomes were significantly improved at 2 years FU compared to baseline: neck disability index (NDI) 18.9% vs 44.4%, visual analog scale (VAS) for arm pain 18.2 mm vs 61.9 mm, VAS for neck pain 23.9 mm vs 55.6 mm. Short form-36 (SF-36) scores were significantly improved. One case of dysphagia, which resolved within 12 months, and 1 reoperation for symptomatic pseudarthrosis were reported. Subsidence with no clinical consequence or reoperation was reported for 5/125 of the implanted cages (4%). There was also 1 case of per-operative vertebral body fracture that did not require additional surgery. Superior and inferior adjacent discs showed no significant change of motion at 2-year FU compared to baseline. Disc height index (DHI) and lordosis were enhanced and these improvements were maintained at 1 year.The ACDF using cages with an integrated fixation system demonstrated reliable clinical and radiological outcomes and a high interbody fusion rate. This rate is comparable to the rate reported in recent series using other implants with integrated fixation, but the present device had a lower complication rate.


The brassinosteroid chemical toolbox.
Chemical biology approaches have been instrumental in understanding the mode of action of brassinosteroids, a group of plant steroid hormones essential for plant development and growth. The small molecules used for such approaches include inhibitors of biosynthetic enzymes and signaling components. Additionally, recent structural data on the brassinosteroid receptor complex together with its ligand brassinolide, the most active brassinosteroid, and knowledge on its different analogs have given us a better view on the recognition of the hormone and signaling initiation. Moreover, a fluorescently labeled brassinosteroid enabled the visualization of the receptor-ligand pair in the cell. Given the insights obtained, small molecules will continue to provide new opportunities for probing brassinosteroid biosynthesis and for unraveling the dynamic and highly interconnected signaling.


[Research on the newfound inscriptive measuring vessels and the measurement system of medicines of the Han dynasty].
The standard of weights and measures of medicines in the Han Dynasty has always been an important topic in the study of the ancient Chinese medical history. However, the difference of titles and systems of measurement units recorded in different literature are quite diverse and short of material evidences for a long time, leading to a long debate on the research of ancient measuring system of medicines. The titles in the newly announcing inscriptions of a series of the measuring system of dosages of Eastern Han Dynasty, carried on the 4 containers are ge, yue, cuo and dao gui, confirming the measuring system of the Han Dynasty for the first time. Through actual measurement, the numerical values of ge, yue, cuo, dao gui are 20ml, 10ml, 2ml, and 0.5 ml respectively, and the calculating equation are: 1 ge = 2 yue, 1 yue = 5 cuo, 1 cuo = 4 dao gui. These values were basically the same as the official measuring containers of the Han Dynasty, demonstrating that the official weights and measures system for medicines was adopted by the Eastern Han Dynasty. The appearance of the new measuring tool, fang cun bi (square-inch-spoon), reveals its actual morphology which is frequently mentioned in the Han-Tang's classical recipes yet unable to witness this actual object. This measuring system is significant to the studies of ancient weights and measures of medicines.


Pulmonary venous flows reflect changes in left atrial hemodynamics during mitral balloon valvotomy.
Patients with mitral stenosis have usually blunted pulmonary venous (PV) flow, because of decreased mitral valve area and diastolic dysfunction. The authors compared changes in Doppler PV velocities by using transesophageal echocardiography (TEE) against hemodynamics parameters before and after mitral balloon valvotomy to observe relevance of PV velocities and endsystolic left atrial (LA) pressure-volume relationship. In 25 patients (aged 35 +/- 17 years) with mitral stenosis in sinus rhythm, changes in LA pressure and volumes were compared with PV velocities before and after valvotomy. Mitral valve area, mitral gradients, and deceleration time were obtained. Mitral valve area and mitral gradients changed from 1 +/- 0.2 cm2 and 14.6 +/- 5.4 mmHg to 1.9 +/- 0.3 cm2 and 6.3 +/- 1.7 mmHg, respectively (p<0.001). AR peak reverse flow velocity and AR duration decreased from 29 +/- 13 cm/s and 110 =/- 30 msec to 19 +/- 6 cm/s and 80 +/- 29 msec respectively (p<0.001). Transmitral Doppler E wave deceleration time decreased from 327 +/- 85 to 209 +/- 61 s and cardiac output increased from 4.2 +/- 1.0 to 5.2 +/- 1.1 L/minute (p<0.001). The changes in LA pressure were correlated with changes in S/D (r=0.57, p<0.05). The changes in endsystolic LA pressure-volume relationship were also correlated with changes in S/D (r=0.52, p<0.05). Endsystolic LA pressure-volume relationship decreased after mitral balloon valvotomy, as a result of a large decrease in pressure. PV systolic/diastolic (S/D) waves ratio reflects endsystolic LA pressure-volume relationship and may be used as another indicator of successful valvotomy.


In vivo evaluation of the anti-infection potential of gentamicin-loaded nanotubes on titania implants.
Titanium-based implants have been widely used in orthopedic surgery; however, failures still occur. Our in vitro study has demonstrated that gentamicin-loaded, 80 nm-diameter nanotubes possessed both antibacterial and osteogenic activities. Thus, the aim of this study was to further investigate the in vivo anti-infection effect of the titanium implants with gentamicin-loaded nanotubes. Thirty-six male Sprague Dawley rats were used to establish an implant-associated infection model. A volume of 50 μL Staphylococcus aureus suspension (1×10(5) CFU/mL) was injected into the medullary cavity of the left femur, and then the titanium rods without modification (Ti), titanium nanotubes without drug loading (NT), and gentamicin-loaded titanium nanotubes (NT-G) were inserted with phosphate-buffered saline-inoculated Ti rods as a blank control. X-ray images were obtained 1 day, 21 days, and 42 days after surgery; micro-computed tomography, microbiological, and histopathological analyses were used to evaluate the infections at the time of sacrifice. Radiographic signs of bone infection, including osteolysis, periosteal reaction, osteosclerosis, and damaged articular surfaces, were demonstrated in the infected Ti group and were slightly alleviated in the NT group but not observed in the NT-G group. Meanwhile, the radiographic and gross bone pathological scores of the NT-G group were significantly lower than those of the infected Ti group (P<0.01). Explant cultures revealed significantly less bacterial growth in the NT-G group than in the Ti and NT groups (P<0.01), and the NT group showed decreased live bacterial growth compared with the Ti group (P<0.01). Confocal laser scanning microscopy, scanning electron microscopy, and histopathological observations further confirmed decreased bacterial burden in the NT-G group compared with the Ti and NT groups. We concluded that the NT-G coatings can significantly prevent the development of implant-associated infections in a rat model; therefore, they may provide an effective drug-loading strategy to combat implant-associated infections in clinic.


Identification and linkage analyses of a gene, Rcs-1, suppressing spontaneous SJL/J lymphoma expression.
Populations of SJL/J (SJL), A.SW/SnJ (A.SW), F1, and backcross mice were followed over 2 years for the spontaneous development of reticulum cell sarcoma (RCS). A.SW, F1, and SJL mice demonstrated cumulative RCS incidences of 0, 9, and greater than 95%, respectively. The incidence of RCS in SJL X (SJL X A.SW), SJL X (A.SW X SJL), and (SJL X A.SW) X SJL backcross mice was 58%, a rate consistent (P less than .001) with a single dominant A.SW gene, termed "Rcs-1," suppressing disease. Rcs-1 is not an H-2 gene nor is it on the X- or Y-chromosome. Rcs-1 abrogates tumor initiation relatively early rather than later by affecting tumor growth; its effect is not transmitted by (SJL X A.SW)F1 females to their offspring by non-Medelian maternal factors. No linkage was detected between Rcs-1 and the marker genes Igh-1 (chromosome 12), Pgm-1 (chromosome 5), Hbb (chromosome 7), Idh-1 (chromosome 1), or Gr-1 (chromosome 8). Thus Rcs-1 is different from three genes linked to these markers and known to influence murine leukemia virus, Fv-4 (chromosome 12), Cv (chromosome 5), and Fgv-1 (chromosome 7).


Influence of the specific antagonist of PAF-acether, BN 52021, and of Ginkgo extract on the rejection of murine tail skin allografts and the PAF-acether mortality in mice in particular consideration of the role of TXB2.
An oral application of 2 x 10 mg/kg daily of the PAF antagonist, BN 52021, significantly prolonged the distal allograft survival in the murine tail skin model of cell-mediated allograft rejection. BN 52021 diminished the TXB2 content in the skin at and near to the transplantation site by two thirds whereas PAF-acether significantly enhanced the TXB2 content in murine tail skin. Similar to the tail skin BN 52021 also reduced by more than 70% the TXB2 release from human granulocytes stimulated by calcium ionophore A 23187. The PAF-acether mortality (LD75) in NMRI mice was decreased to 20% by BN 52021 with a lower dose than by BN 52020. Comparing Ginkgo total extract in doses which significantly diminished the 75% mortality by PAF-acether in mice with BN 52021 and BN 52020 in doses that produced the same inhibitory effect, a potentiated effect of Ginkgo extract resulted with respect to the share of BN 52021 and BN 52020 in Ginkgo extract.


Pervasive interactions between ungulate browsers and disturbance regimes promote temperate forest herbaceous diversity.
Disruptions to historic disturbance and herbivory regimes have altered plant assemblages in forests worldwide. An emerging consensus suggests that these disruptions often result in impoverished forest biotas. This is particularly true for eastern U.S. deciduous forests where large gaps and understory fires were once relatively common and browsers were far less abundant. Although much research has focused on how disturbance and browsers affect tree diversity, far less attention has been devoted to forest understories where the vast majority (>75%) of the vascular species reside. Here we test the hypothesis that the reintroduction of disturbances resembling historic disturbance regimes and moderate levels of ungulate browsing enhance plant diversity. We explore whether once-common disturbances and their interaction with the top-down influence of browsers can create conditions favorable for the maintenance of a rich herbaceous layer in a region recognized as a temperate biodiversity hotspot in West Virginia, U.S.A. We tested this hypothesis via a factorial experiment whereby we manipulated canopy gaps (presence/absence) of a size typically found in old-growth stands, low-intensity understory fire (burned/unburned), and deer browsing (fenced/unfenced). We tracked the abundance and diversity of more than 140 herb species for six years. Interactions among our treatments were pervasive. The combination of canopy gaps and understory fire increased herbaceous layer richness, cover, and diversity well beyond either disturbance alone. Furthermore, we documented evidence that deer at moderate levels of abundance promote herbaceous richness and abundance by preferentially browsing fast-growing pioneer species that thrive following co-occurring disturbances (i.e., fire and gaps). This finding sharply contrasts with the negative impact browsers have when their populations reach levels well beyond those that occurred for centuries. Although speculative, our results suggest that interactions among fire, canopy gaps, and browsing provided a variable set of habitats and conditions across the landscape that was potentially capable of maintaining much of the plant diversity found in temperate forests.


Behavioral Training of High-Functioning Autistic Children by Music Education of Occupational Therapy.
Autistic children, also known as "children from the stars", have been discovered for more than half a century, but there is still no unified conclusion on the diagnosis, causes, manifestations, and education of autism. The current theory and practice suggest that there is a need to improve the treatment and education of these children. According to existing theories and practices, most autistic children show a special interest in music, and music is very effective in the treatment of autistic children, and through musical activities, children with autism can improve their language, social and emotional, cognitive, and sensorimotor development. In this paper, we record and observe the music classes of children with autism. We select two classes with a total of seven children with autism as the observation subjects in the music classes, record the changes in various aspects and behavioral performance of these seven children with autism in the music activities, and analyze and summarize them. The main purpose of this study is to analyze and summarize how the three major music teaching methods are implemented in the music classroom for autistic children and how they can help autistic children with different characteristics. In the end, we summarize the main problems of music teaching for autistic children found in practice and try to make some suggestions, hoping to provide reference for scholars who study music education for autistic children. The music teaching activities were effective in improving the children's joint attention, movement imitation, rhythm imitation, and cooperation ability, and all three children improved to varying degrees, fulfilling the goals of the teaching activities. The behavioral analysis of the three children during the teaching activities showed that the three children improved their ability to sit comfortably, awareness, musical ability, and rule awareness and reduced inappropriate behaviors and bad emotions, which proved that music education could improve the social and cognitive skills of the children.


Lactoferrin inhibits the inflammatory and angiogenic activation of bovine aortic endothelial cells.
Lactoferrin (Lf) is known to have anti-cancer and anti-inflammatory activities; however, its therapeutic mechanism has not been defined. In this study, to explain the therapeutic mechanism of Lf, we examined the effect of Lf on endothelial cell activation, leukocyte integration, and angiogenesis in vitro. Endothelia-leukocyte adhesion assays were used to assess primary cultures of bovine aortic endothelial cells (BAECs) activation following LPS treatment. The mRNA expression of ICAM-1 and proinflammatory cytokines was measured using RT-PCR. Each step of angiogenesis was evaluated in vitro, including endothelial cell proliferation, migration, and tube formation. Proliferation was examined using WST-1 and BrdU incorporation assays, while wound migration assays were used to evaluate cell migration; capillary-like tube formation assays on Matrigel were used to assess tube formation. Lf reduced the adhesion of human monocyte-like THP-1 cells to BAECs by 45%. Lf also reduced mRNA expression of ICAM-1 and proinflammatory cytokines in BAECs. Lf significantly inhibited BAEC proliferation, migration, and tube formation. Lf exerted a potent effect on BAEC activation, suggesting that it might function via an endothelia-based mechanism in the treatment of various diseases, including rheumatoid arthritis and cancer.


Follicular Lymphoma Diagnosed With Medical Thoracoscopy.
Non-Hodgkin lymphomas may present with a recurrent pleural effusion, usually with involvement of other thoracic or extrathoracic sites. Lymphomas typically presenting with pleural disease include primary effusion lymphoma and pyothorax-associated lymphoma. We describe an unusual case of recurrent pleural effusion secondary to follicular lymphoma with no other known extrathoracic involvement at the time of diagnosis.


A genome-wide association study meta-analysis of clinical fracture in 10,012 African American women.
Osteoporosis is a major public health problem associated with excess disability and mortality. It is estimated that 50-70% of the variation in osteoporotic fracture risk is attributable to genetic factors. The purpose of this hypothesis-generating study was to identify possible genetic determinants of fracture among African American (AA) women in a GWAS meta-analysis. Data on clinical fractures (all fractures except fingers, toes, face, skull or sternum) were analyzed among AA female participants in the Women's Health Initiative (WHI) (N = 8155), Cardiovascular Health Study (CHS) (N = 504), BioVU (N = 704), Health ABC (N = 651), and the Johnston County Osteoarthritis Project (JoCoOA) (N = 291). Affymetrix (WHI) and Illumina (Health ABC, JoCoOA, BioVU, CHS) GWAS panels were used for genotyping, and a 1:1 ratio of YRI:CEU HapMap haplotypes was used as an imputation reference panel. We used Cox proportional hazard models or logistic regression to evaluate the association of ~ 2.5 million SNPs with fracture risk, adjusting for ancestry, age, and geographic region where applicable. We conducted a fixed-effects, inverse variance-weighted meta-analysis. Genome-wide significance was set at P < 5 × 10- 8. One SNP, rs12775980 in an intron of SVIL on chromosome 10p11.2, reached genome-wide significance (P = 4.0 × 10- 8). Although this SNP has a low minor allele frequency (0.03), there was no evidence for heterogeneity of effects across the studies (I2 = 0). This locus was not reported in any previous osteoporosis-related GWA studies. We also interrogated previously reported GWA-significant loci associated with fracture or bone mineral density in our data. One locus (SMOC1) generalized, but overall there was not substantial evidence of generalization. Possible reasons for the lack of generalization are discussed. This GWAS meta-analysis of fractures in African American women identified a potentially novel locus in the supervillin gene, which encodes a platelet-associated factor and was previously associated with platelet thrombus formation in African Americans. If validated in other populations of African descent, these findings suggest potential new mechanisms involved in fracture that may be particularly important among African Americans.


Isolation and identification of adherent epimural bacteria during succession in young lambs.
Successive changes in aerobic and anaerobic bacterial counts and changes in the generic composition of the epimural community in lambs from 1 to 10 weeks were determined. Bacterial culture counts revealed a predominantly anaerobic community, with the mean anaerobic count being 1.4 X 10(7) CFU/cm2 of tissue surface. The aerobic count was highest at 1 week of age and declined significantly thereafter to a mean of 1.8 X 10(4) CFU/cm2, thus representing only 0.13% of the mean anaerobic count after week 1. Of the 345 strains isolated anaerobically at 1, 2, 4, 6, 8, and 10 weeks of age, 47, 32, 12, 32, 2, and 5% were capable of growth in a partially reduced medium, indicating a reduction in the number of facultative anaerobes with time. The majority of isolated strains were identified as belonging to genera commonly isolated from rumen contents. In some instances, however, strains did not correspond to previously described species, and some genera were present in proportions different from those expected in rumen fluid. At three of the sampling times, one genus was dominant, constituting 45 to 55% of the isolates. These dominant isolates were Streptococcus bovis, Bacteroides sp., and an anaerobic Streptococcus sp. for weeks 1, 2, and 10, respectively. During the transition period (weeks 4 to 8), two or more groups were codominant.


Multiorgan Development of Oxidative and Nitrosative Stress in LPS-Induced Endotoxemia in C57Bl/6 Mice: DHE-Based In Vivo Approach.
Detection of free radicals in tissues is challenging. Most approaches rely on incubating excised sections or homogenates with reagents, typically at supraphysiologic oxygen tensions, to finally detect surrogate, nonspecific end products. In the present work, we explored the potential of using intravenously (i.v.) injected dihydroethidine (DHE) to detect superoxide radical (O2 ∙-) abundance in vivo by quantification of the superoxide-specific DHE oxidation product, 2-hydroxyethidium (2-OH-E+), as well as ethidium (E+) and DHE in multiple tissues in a murine model of endotoxemia induced by lipopolysaccharide (LPS). LPS was injected intraperitoneally (i.p.), while DHE was delivered via the tail vein one hour before sacrifice. Tissues (kidney, lung, liver, and brain) were harvested and subjected to HPLC/fluorescent analysis of DHE and its monomeric oxidation products. In parallel, electron spin resonance (EPR) spin trapping was used to measure nitric oxide (∙NO) production in the aorta, lung, and liver isolated from the same mice. Endotoxemic inflammation was validated by analysis of plasma biomarkers. The concentration of 2-OH-E+ varied in the liver, lung, and kidney; however, the ratios of 2-OH-E+/E+ and 2-OH-E+/DHE were increased in the liver and kidney but not in the lung or the brain. An LPS-induced robust level of ∙NO burst was observed in the liver, whereas the lung demonstrated a moderate yet progressive increase in the rate of ∙NO production. Interestingly, endothelial dysfunction was observed in the aorta, as evidenced by decreased ∙NO production 6 hours post-LPS injection that coincided with the inflammatory burden of endotoxemia (e.g. elevated serum amyloid A and prostaglandin E2). Combined, these data demonstrate that systemic delivery of DHE affords the capacity to specifically detect O2 ∙- production in vivo. Furthermore, the ratio of 2-OH-E+/E+ oxidation products in tissues provides a tool for comparative insight into the oxidative environments in various organs. Based on our findings, we demonstrate that the endotoxemic liver is susceptible to both O2 ∙--mediated and nonspecific oxidant stress as well as nitrosative stress. Oxidant stress in the lung was detected to a lesser extent, thus underscoring a differential response of liver and lung to endotoxemic injury induced by intraperitoneal LPS injection.


Interactions between the chemotherapeutic agent eribulin mesylate (E7389) and P-glycoprotein in CF-1 abcb1a-deficient mice and Caco-2 cells.
Eribulin is a new anticancer agent currently in Phase III clinical trials for the treatment of metastatic breast cancer. In the current studies, we have investigated the effects of P-glycoprotein (P-gp) on the in vivo disposition of eribulin using CF-1 abcb1a-deficient mice, and the influence of eribulin on P-gp-mediated efflux of digoxin in Caco-2 cells. Eribulin was administered intravenously and orally in both CF-1 wild-type and CF-1 abcb1a-deficient mice. P-gp-mediated efflux of digoxin in Caco-2 cell monolayers was measured in the presence of eribulin. The plasma exposure to eribulin was higher in CF-1 abcb1a-deficient mice than that in CF-1 wild-type mice after intravenous (IV) and oral (PO) administrations. The oral bioavailability of eribulin was 62.3% in CF-1 abcb1a-deficient mice compared with 7.6% in wild-type mice. The brain penetration of eribulin in CF-1 abcb1a-deficient mice was 30-fold greater than that in wild-type mice. Eribulin decreased the efflux ratio of digoxin in a concentration-dependent manner, with the result of IC(50) greater than 10 µM. The [I]/IC(50) of eribulin was estimated to be <0.05. P-gp is likely to limit the oral absorption and brain penetration of eribulin in CF-1 wild-type mice. Eribulin inhibited the efflux of digoxin with IC(50) greater than 10 µM in Caco-2 cells. These results suggest that eribulin, given intravenously at the clinically relevant concentrations, may not alter P-gp-mediated disposition of concurrently administered drugs.


Screening of α-amino acid ester acyl transferase variant with improved activity by combining rational and random mutagenesis.
Random and rational mutagenesis of an α-amino acid ester acyl transferase from Sphingobacterium siyangensis AJ2458 (SAET) was conducted to examine the production of aspartame, an α-l-aspartyl-l-phenylalanine methyl ester. We previously reported aspartame production via combination of enzymatic and chemical methods. However, the productivity of the aspartame intermediate by SAET was approximately one-fifth that of l-alanyl-l-glutamine (Ala-Gln), whose production method has already been established. Here, to improve the enzymatic activity of SAET, we performed random mutagenesis in the gene encoding SAET and obtained 10 mutations that elevated the enzymatic activity (1.2- to 1.7-fold increase) relative to that of wild-type SAET. To further improve the activity, we performed mutagenesis to optimize the combination of the obtained mutations and finally selected one SAET variant with 10 amino acid substitutions (M35-4 SAET). An Escherichia coli strain overexpressing M35-4 SAET displayed a 5.7-fold higher activity than that of the wild-type SAET, which was almost equal to that of Ala-Gln by an E. coli strain overexpressing wild-type SAET. The Vmax value of M35-4 SAET was 2.0-fold greater, and its thermostability was higher than those of wild-type SAET. These results suggest that the obtained SAET variants contribute to improvement in aspartame production.


Evaluation of percutaneous gastrostomy as a technique for permanent gastropexy.
This study was designed to evaluate right-sided percutaneous endoscopic gastrostomy (PEG) as a method for creation of a permanent gastropexy. Percutaneous endoscopic gastrostomy adhesions were evaluated by gross examination and by mechanical testing and the results were compared with those obtained by conventional incisional gastropexy. Fourteen mixed-breed dogs. Incisional gastropexies were performed on the dogs of group one (N = 7) and PEG tubes were placed in the dogs of group 2 (N = 7). All skin sutures (group 1) and PEG tubes (group 2) were removed on day 14. The animals were maintained for an additional 44 days before euthanasia and immediate necropsy. Gastropexy adhesions were evaluated and collected for biomechanical evaluation using a materials testing machine. The duration of the procedure for group 2 was less (32.86 min +/- 7.65) than for group 1 (56.29 min +/- 8.28). The number of complications was not significantly different between group 1 and group 2 (P = .103). Gastroperitoneal adhesions were present in 7 of 7 dogs in group 1 and 4 of 7 dogs in group 2. The adhesion lengths and widths were significantly lager in dogs in group 1 compared with those in group 2. The adhesions present in group 1 dogs sustained significantly greater tensile loads to failure (61.98 +/- 14.65 N), compared with the adhesions present in group 2 dogs (22.31 +/- 26.87 N). Right-sided PEG inconsistently formed a weak gastropexy and the procedure was associated with a trend toward greater morbidity than incisional gastropexy. Right-sided PEG is not recommended as a means of prophylactic gastropexy.


Use of the Adult Attachment Projective Picture System in the formulation of a case of an adolescent refugee with PTSD.
Forced displacements and their psychosocial consequences in adolescent refugees and their families have received increasing attention in recent years. Although supportive family relations play a key role in buffering the impact of traumatization in adolescents, parental ability to provide such is often subject to extreme pressure. Under conditions of forced dislocation and fear, maladaptive interpersonal strategies in the parent-child relationships may develop, contributing to the onset of psychopathology. We explore new aspects of attachment-related issues for the understanding and treatment of adolescent refugees who have experienced multiple traumas in their childhood. We used a multimethod assessment battery including the Adult Attachment Projective Picture System (AAP), the Structured Clinical Interview, the Youth Self Report and the Wechsler Intelligence Scale in an adolescent boy with post-traumatic stress disorder (PTSD). Our subject was an adolescent refugee from the Middle East who demonstrated an unresolved attachment when confronted with loss and fear. His responses on the AAP evoked aspects of insecure-unresolved attachment, including his belief that it is not safe to trust in attachment figures, his limited access to traumatic attachment experiences, his impaired ability to take concrete actions when dealing with threatening attachment situations and the unintentional role-reversal shed new light on our understanding of his traumatic experiences, family functioning and psychopathological symptoms. Our results demonstrate the utility of the AAP in an adolescent refugee with PTSD by expanding our knowledge of a diverse range of experiences across the interpersonal, cognitive, cultural and developmental contexts that formed the basis for an individualized treatment plan.


Serum antimüllerian hormone in response to dietary management and/or physical exercise in overweight/obese women with polycystic ovary syndrome: secondary analysis of a randomized controlled trial.
To investigate whether randomized diet and/or physical exercise influence serum levels of antimüllerian hormone (AMH) in obese women with polycystic ovary syndrome (PCOS). Randomized, 4-month trial with three interventions. Women's health clinical research unit at a university hospital. Fifty-seven overweight/obese women with PCOS. Diet, physical exercise, or both, using programs individually adapted and supervised by a dietician and/or a physiotherapist. Serum AMH levels before and after the interventions and correlations to reproductive function, body composition, and endocrine and metabolic variables. After intervention, serum levels of AMH were significantly decreased only in the diet group, and the levels were significantly lower than in the exercise group. The strongest predictor of decreased AMH was a decrease in free T, whereas weight loss had no significant influence. Normalized levels of AMH were associated with improvements in menstrual cyclicity and hyperandrogenism but not in metabolic variables. This randomized study supports that diet reduces serum AMH in association with decreased androgen levels in obese women with PCOS. Increased serum AMH may be used as a marker of ovulatory dysfunction and hyperandrogenism but not as a marker of insulin resistance. ISRCTN48342048.


Hyperbaric oxygen therapy exerts anti-osteoporotic effects in obese and lean D-galactose-induced aged rats.
Obesity accelerates the aging processes, resulting in an aggravation of aging-induced osteoporosis. We investigated the anti-osteoporotic effect of hyperbaric oxygen therapy (HBOT) in obese- and lean-aged rats through measurement of cellular senescence, hypoxia, inflammation, antioxidants, and bone microarchitecture. Obese and lean male Wistar rats were injected with 150 mg/kg/day of D-galactose for 8 weeks to induce aging. Then, all rats were randomly given either sham or HBOT for 14 days. Metabolic parameters were determined. Expression by bone mRNA for cellular senescence, hypoxia, inflammation, antioxidative capacity, and bone remodeling were examined. Micro-computed tomography and atomic absorption spectroscopy were performed to evaluate bone microarchitecture and bone mineral profiles, respectively. We found that HBOT restored the alterations in the mRNA expression level of p16, p21, HIF-1α, TNF-α, IL-6, RANKL, RANK, NFATc1, DC-STAMP, Osx, ALP, and Col1a1 in the bone in obese-and lean- aging rats. In obese-aging rats, HBOT increased the level of expression of Sirt1 and CuZnSOD mRNA and diminished the expression level of HIF-2α and ctsk mRNA to the same levels as the control group. However, HBOT failed to alter catalase and OCN mRNA expression in obese-aged rats. HBOT partially improved the bone microarchitecture in obese-aged rats, but completely restored it in lean-aged rats. Interestingly, HBOT protected against obesity-induced demineralization in obese-aged rats. In summary, HBOT exerts an anti-osteoporotic effect in lean-aged rats and prevents some, but not all the negative effects of obese-aged conditions on bone health. Therefore, HBOT is considered as a potential therapy for aging-induced osteoporosis, regardless of obese status.


Report of the Skin Research Working Groups from the GRAPPA 2021 Annual Meeting.
The International Dermatology Outcome Measures (IDEOM) initiative presented an update on their progress related to instruments for psoriasis (PsO) and psoriatic arthritis (PsA) patient-centered outcome measures at the 2021 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). The Treatment Satisfaction working group presented the development of a 7-item treatment satisfaction questionnaire specific for dermatological conditions. The group is beginning by assessing the validity and reliability of the instrument in PsO patient populations, with the ultimate goal of validating it for use in multiple dermatological diseases. The Musculoskeletal Symptoms working group discussed how implementation of a screening measurement tool in patients with PsO can help identify unknown diagnoses of PsA or prevent worsening of symptoms.


Current trends in the management of trapeziometacarpal arthritis.
The purpose of this update is to report on a variety of topics related to trapeziometacarpal arthritis that have been recently investigated. The keyword trapeziometacarpal arthritis was utilized to query the PubMed database of the U.S. National Library of Medicine. From the resulting list, papers published from the beginning of April 2014 through the beginning of April 2017 were reviewed. The forty-five studies identified are reviewed here and referenced.


Functional consequences of ligand-dependent conformational changes in trypsin-solubilized and in membrane particle constrained-acetylcholinesterase.
The effect of a class of ligands on the catalytic activity of acetylcholinesterase (acetylcholine hydrolase, EC 126.96.36.199) from Torpedo californica electroplax tissue has been studied via the transient reaction of a fluorophoric acetylcholine analog, 7-(N,N-dimethyl)carbamoxy-N-methylquinolinium iodide (M7C). These "peripheral" ligands inhibit the formation of a metastable carbamyl-enzyme intermediate from M7C. They induce slow isomerization to a new conformational state that shows little or no reaction with M7C. At saturating ligand concentration, the unimolecular isomerization rate constant is 0.03 +/- 0.01 sec-1, a slow rate compared to the rate of carbamylation of the active conformation. Peripheral ligands alter the distribution between reactive and unreactive conformations, thus inducing biphasic rates and amplitudes of carbamylation. The amplitudes, but not the two specific rates, are affected by the concentration of ligand. Zn2+ and d-tubocurarine are two ligands that induce the same slow isomerization rate. On the basis of this identity of function by ligands of disparate structure, we postulate the existence of only a single active conformation and a single inactive conformation (stabilized by interaction with both ligands). In the absence of ligands, the active conformation predominates. Peripheral ligands bind specifically to the inactive conformation. Alkaline earth cations such as Ca2+ and Mg2+ interact strongly and preferentially with the active conformation and drive the conformational equilibrium toward the active state. Ligand-induced inactivation is observed both with highly purified trypsin-solubilized enzyme and with enzyme bound to unfractionated membrane fragments.


Contralateral seventh cervical nerve transfer for central spastic arm paralysis: a systematic review and meta-analysis.
The specific benefits of a contralateral cervical 7 nerve transplant in people with spastic paralysis of the upper extremity caused by cerebral nerve injury are unclear. To evaluate the efficacy and safety of contralateral C7 nerve transfer for central spastic paralysis of the upper extremity, we conducted a comprehensive literature search and meta-analysis. PRISMA guidelines were used to search the databases for papers comparing the efficacy of contralateral cervical 7 nerve transfer vs. rehabilitation treatment from January 2010 to August 2022. The finishing indications were expressed using SMD ± mean. A meta-analysis was used to assess the recovery of motor function in the paralyzed upper extremity. The meta-analysis included three publications. One of the publications offers information about RCTs and non-RCTs. A total of 384 paralyzed patients were included, including 192 who underwent CC7 transfer and 192 who received rehabilitation. Results from all patients were combined and revealed that patients who had CC7 transfer may have regained greater motor function in the Fugl-Meyer score (SMD 3.52, 95% CI = 3.19-3.84, p < 0.00001) and had superior improvement in range of motion compared to the rehabilitation group (SMD 2.88, 95% CI = 2.47-3.29, p < 0.00001). In addition, the spasticity in the paralyzed upper extremity significantly improved in patients with CC7 transfer (SMD -1.42, 95% CI = -1.60 to -1.25, p < 0.00001). Our findings suggested that a contralateral C7 nerve transfer, which has no additional adverse effects on the healthy upper limb, is a preferable method to restore motor function.


Polymorphism of interleukin-18 promoter influences the onset of kidney graft function after transplantation.
It has been well recognized that the promoter polymorphisms of interleukin-18 (IL-18) influence the level of cytokine expression. In our previously published data, we showed constitutive IL-18 expression in the epithelium of renal distal tubules in patients after kidney transplantation and significantly elevated IL-18 expression during acute rejection. In this study, we evaluated the clinical significance of two functional promoter polymorphisms of the IL-18 gene at positions -607 A/C (rs1946518) and -137 C/G (rs187238) in patients after kidney transplantation and looked for associations with the onset of graft function and the incidence of rejection episodes. Promoter polymorphisms in 124 patients and 103 unrelated controls were evaluated by sequence-specific primer polymerase chain reaction and the allele, genotype and haplotype frequencies were statistically correlated. We found a statistically different distribution of the allele frequency of -607 A/C polymorphism between patients with immediate or delayed onset of kidney graft function. Data showed that the C allele, which contributes to higher IL-18 expression, is more frequent in patients with delayed onset of function (P = 0.03, odds ratio = 1.93; 95% confidence interval = 1.15-3.25). A/C single nucleotide polymorphisms of the IL-18 promoter at position -607 may influence the onset of early kidney allograft function.


Clonal types and antimicrobial resistance profiles of methicillin-resistant Staphylococcus aureus isolates from hospitals in south Brazil.
In the present study were evaluated the DNA macrorestriction profile and SCCmec types for nine multi-resistant MRSA selected. Also antimicrobial susceptibility testing by disk diffusion method was evaluated for 68 MRSA isolates against 12 antimicrobial agents. The isolates were recovered from blood culture collected from hospitalized patients in three hospitals of Porto Alegre, Brazil. PFGE and PCR for mecA and SCCmec I, II, III, IV types genes were done on selected nine isolates with susceptibility only to vancomycin, teicoplanin and linezolid. Two clone profiles, with five subtypes, were demonstrated among multi-resistant MRSA analyzed. Eight isolates showed harbor SCCmec type III and one isolate was not typeable. The knowledge of SCCmec type, clone and antimicrobial profiles among S. aureus is essential mainly to prevention and control of dissemination of the antimicrobial resistance.


[Pharmacological adjuvants for surgical treatment of proliferative vitreoretinopathy].
Proliferative vitreoretinopathy (PVR) is the major cause of retinal detachment surgery failure. Many adjuvants were studied in vitro and on animals, some were studied on humans. Daunomycin seems to reduce PVR recidivism. 5-FU and steroids are nontoxic but their efficacy is not clear. Heparin reduced postoperative inflammation and seems to reduce PVR recidivism when associated with 5-FU. Associating heparin and steroids seems to reduce PVR in some groups of patients (aphakic, anterior PVR). Colchicine and retinoic acid per os are ineffective, silicone oil is effective as an internal tamponade but not as an adjuvant of PVR. Currently, no molecule has proven efficacy as an adjunctive treatment of PVR.


A study of inotropic mechanisms in the papillary muscle preparation.
The length-tension diagram, the force-velocity relation, the characteristics of the series elasticity, and the duration of the active state have been studied on the papillary muscle preparation of the cat heart, and on other examples of cardiac muscle. Positive inotropic changes such as the staircase phenomenon and post-extrasystolic potentiation occur without lengthening, but frequently with shortening, of the duration of the active state. They are accompanied by an increased velocity of contraction, and may be caused either by an intensification of the active state or by an alteration of the force-velocity characteristics of the contractile component. The changes in the force-velocity relation point to an adaptation of the velocity-efficiency relation in dependence on the frequency of contraction.


[Aspirin treatment for patients with Kawasaki disease].
Aspirin was first used for patients with Kawasaki disease(KD) at 1970s. Favorable outcomes of KD patients treated with aspirin were reported in 1970-80s and now it is one of the standard therapeutic agents for KD. Its anti-inflammation effects suppress vascular wall inflammation of KD at acute phase. In addition, its antiplatelet effects heal endothelial dysfunction and prevent clot formation in coronary arteries at sub-acute and convalescent phase. Long-term dosage for patients with coronary artery aneurysms(CAA) is also important, however, there are few evidences of risk-benefit assessment for its long-term use especially for middle-aged and senior adults with KD and CAA.


Do effects of sodium-glucose cotransporter-2 inhibitors in patients with diabetes give insight into potential use in non-diabetic kidney disease?
Our aim was to review the rationale for the role of sodium-glucose cotransporter-2 inhibitors (SGLT-2i) as renoprotective therapy in patients with and without diabetes. SGLT-2i are antihyperglycemic agents, approved for treating type 2 diabetes to reduce glycosylated hemoglobin, type A1c. Primary glucoregulatory effects occur through selective inhibition of SGLT-2 at the renal proximal tubule promoting glucosuria leading to blood glucose lowering. From a hemodynamic perspective, SGLT-2 inhibition is also associated with decreased glomerular hyperfiltration, an effect that is mediated through natriuresis and tubuloglomerular feedback. With renal injury and progressive nephron loss, diabetic kidney disease, and nondiabetic chronic kidney diseases share overlapping phenotypes exhibiting single nephron hyperfiltration, along with increased proteinuria. Importantly, the impact of SGLT-2 inhibition on renal and systemic hemodynamic function, including effects on lowering blood pressure, hyperfiltration, and plasma volume, are independent of blood glucose lowering and instead are because of natriuresis. Accordingly, large clinical trials with SGLT-2i investigating the potential use of SGLT-2i in patients without diabetes are now underway. Based on prominent nonglycemic effects, the clinical use of SGLT-2i as renoprotective therapy may extend to nondiabetic chronic kidney diseases subtypes, which could help to address a large, unmet clinical need.


Autonomic Nervous System and Stress to Predict Secondary Ischemic Events after Transient Ischemic Attack or Minor Stroke: Possible Implications of Heart Rate Variability.
Transient ischemic attack (TIA) and minor stroke have high risks of recurrence and deterioration into severe ischemic strokes. Risk stratification of TIA and minor stroke is essential for early effective treatment. Traditional tools have only moderate predictive value, likely due to their inclusion of the limited number of stroke risk factors. Our review follows Hans Selye's fundamental work on stress theory and the progressive shift of the autonomic nervous system (ANS) from adaptation to disease when stress becomes chronic. We will first show that traditional risk factors and acute triggers of ischemic stroke are chronic and acute stress factors or "stressors," respectively. Our first review shows solid evidence of the relationship between chronic stress and stroke occurrence. The stress response is tightly regulated by the ANS whose function can be assessed with heart rate variability (HRV). Our second review demonstrates that stress-related risk factors of ischemic stroke are correlated with ANS dysfunction and impaired HRV. Our conclusions support the idea that HRV parameters may represent the combined effects of all body stressors that are risk factors for ischemic stroke and, thus, may be of important predictive value for the risk of subsequent ischemic events after TIA or minor stroke.


Aberrant intranucleolar maturation of ribosomal precursors in the absence of protein synthesis.
To help elucidate the role of protein in the maturation of ribosomal RNA in cultured L cells, we have studied the effects of cycloheximide upon the maturation process and upon the intranucleolar ribonucleoprotein particles containing the "preribosomal RNA's." Five parameters of these particles were analyzed: (a) extractability, (b) sedimentation characteristics in sucrose gradients, (c) RNA composition, (d) buoyant density in CsCl gradients, and (e) effects of increased ionic strength on the buoyant density. When protein synthesis is inhibited, the rate of conversion of the precursor 45S ribosomal RNA is rapidly diminished, falling to less than 30% of the control rate within 1 hr. Nevertheless, in terms of the first three parameters there is no difference between control and cycloheximide nucleolar particles. However, the cycloheximide particles have a lower and more heterogeneous buoyant density and a more variable response to increased ionic strength. The results imply that the protein composition of the cycloheximide particles is different from that of particles from control cells, and that the entire protein complement is not necessary for the first cleavages in the maturation process, although it is necessary for the normal rate of processing and for the eventual appearance of both 18S and 28S rRNA in mature ribosomes.


Fall Armyworm (Lepidoptera: Noctuidae) Development, Survivorship, and Damage on Cotton Plants Expressing Insecticidal Plant-Incorporated Protectants.
Cotton, Gossypium hirsutum (L.), plants expressing insecticidal crystal (Cry) proteins of Bacillus thuringiensis (Bt) Berliner are planted on significant acreage across the southern region of the United States. Fall armyworm, Spodoptera frugiperda (J. E. Smith), can be a significant cotton pest in some years, but this species has not been a primary target of Bt cotton technologies. The objective of this study was to quantify fall armyworm larval survivorship and fruiting form injury on transgenic cotton lines expressing Cry1Ac (Bollgard), Cry1Ac+Cry2Ab (Bollgard II), and Cry1Ac+Cry1F (WideStrike) Bt proteins. Larval survivorship and fruiting form damage of fall armyworm on Bollgard, Bollgard II, WideStrike, and non-Bt (control) cotton lines were evaluated in no-choice field studies. Fall armyworm (third instars) were placed on flower buds (squares), white flowers, and bolls, enclosed within a nylon mesh exclusion cage, and evaluated at selected intervals after infestation. Exposure of fall armyworm larvae to Bollgard cotton lines generally resulted in no significant effects on survivorship compared with larvae exposed to the non-Bt cotton line. Survivorship and plant injury by fall armyworm on Bollgard II cotton lines was variable compared with that on non-Bt cotton lines, and significant differences between treatments were inconsistent. Fall armyworm had significantly lower survivorship and caused less plant injury on WideStrike cotton lines than on non-Bt cotton lines across all plant structures. Development and survivorship of fall armyworm larvae on these cotton lines also were evaluated in no-choice laboratory assays by offering the previously described fruiting forms to third instars. Bollgard II and WideStrike cotton lines significantly reduced fall armyworm development and survivorship compared with those larvae offered non-Bt tissue. These results suggest that differences exist among selected Bt cotton technologies in their performance against fall armyworm.


Genetic variants in the human leukocyte antigen region and survival of Chinese patients with non-small cell lung carcinoma.
Human leukocyte antigen (HLA) is highly polymorphic, driving antigen presentation, complement cascade and leukocyte maturation against cancer cells. Therefore, we extracted genotyping data in the HLA region from an ongoing Chinese genome-wide association study of non-small cell lung cancer (NSCLC). Using deep sequencing data of 10 689 healthy Han Chinese, we imputed for untyped genetic variants in the HLA region, followed by a two-stage survival analysis of 1531 NSCLC patients. In the discovery stage of 758 patients, we identified 301 out of 15 138 single-nucleotide polymorphisms to be independently associated with overall survival [P < 0.05 and Bayesian false-discovery probability < 0.8]. In further validation of another 773 patients, we confirmed chromosome 6p21, rs241424 (located at intron 3 of TAP2) and rs6457642 as two independent survival predictors. In the combined analysis of 1531 NSCLC patients, rs241424 G>A and rs6457642 C>T were associated with a hazards ratio of 1.26 [95% confidence interval (CI) = 1.14-1.40 and P = 4.04 × 10-6] and 0.76 (95% CI = 0.66-0.87 and P = 1.16 × 10-4), respectively. The analysis of publically available ChIP-sequencing and Hi-C data found that the rs241424 locus was involved in potential cis-regulatory element by a long-range interaction with the HLA-DQA1 promoter. Additional expression quantitative trait loci analysis showed that the rs241424 G>A change decreased HLA-DQA1 mRNA expression. Furthermore, expression levels of HLA-DQA1 were lower in lung cancer tissues than in adjacent normal tissues, and the lower expression was associated with a worse prognosis for patients with lung adenocarcinoma. Collectively, HLA genetic variants may modulate OS of NSCLC patients, possibly via a mechanism of long-range promoter interaction regulating HLA-DQA1 expression.


Alpha-lipoic Acid Protects Against Chronic Alcohol Consumption-induced Cardiac Damage by the Aldehyde Dehydrogenase 2-associated PINK/Parkin Pathway.
Chronic alcohol intake contributes to high mortality rates due to ethanol-induced cardiac hypertrophy and contractile dysfunction, which are accompanied by increased oxidative stress and disrupted mitophagy. Alpha-lipoic acid (α-LA), a well-known antioxidant, has been shown to protect against cardiac hypertrophy and inflammation. However, little is known about its role and mechanism in the treatment of alcoholic cardiomyopathy. Here, we evaluated the role of α-LA in alcohol-induced cardiac damage by feeding mice a 4.8% (v/v) alcohol diet with or without α-LA for 6 w. Our results suggested that chronic alcohol consumption increased mortality, blood alcohol concentrations, and serum aldehyde levels, but a-LA attenuated the elevations in mortality and aldehydes. Chronic alcohol intake also induced cardiac dysfunction, including enlarged left ventricles, reduced left ventricular ejection fraction, enhanced cardiomyocyte size, and increased serum levels of brain natriuretic peptide, lactate dehydrogenase, and creatine kinase myocardial isoenzyme. Moreover, alcohol intake led to the accumulation of collagen fiber and mitochondrial dysfunction, the effects of which were alleviated by α-LA. In addition, α-LA intake also prevented the increase in reactive oxygen species production and the decrease in mitochondrial number that were observed after alcohol consumption. Chronic alcohol exposure activated PINK1/Parkin-mediated mitophagy. These effects were diminished by α-LA intake by the activation of aldehyde dehydrogenase 2. Our data indicated that α-LA helps protect cardiac cells against the effects of chronic alcohol intake, likely by inhibiting PINK1/Parkin-related mitophagy through the activation of aldehyde dehydrogenase 2.


Effect of smoking and refrigeration on lipid oxidation of Clupea harengus: A fish commonly consumed in Cameroon.
Changes in lipids of herring (Clupea harengus) muscle during different smoking methods and 9 days of refrigeration at 4°C were investigated. The proximate analysis of raw herring revealed that the total lipid, the total protein content and the crude ash were 10.20%, 69.43%, and 19.42%, respectively. The results also indicated that during all processing free fatty acids (FFAs) and peroxide value (PV) increased, whereas iodine value (IV) and total triglycerides decreased. The change were more significantly (p < .05) during unbleached + hot smoking and refrigeration at more than 6 days. All these modification decrease the nutritional value of herring. Bleaching combined to smoking and refrigeration at <6 days had more desire effect on lipid oxidation of herring compared to other treatments. The fish obtained in these conditions are more suitable for feeding heath nutrition.


Long term oxygen therapy adherence and COPD: what we don't know.
Persons utilizing long term oxygen therapy (LTOT) at home suffer from chronic obstructive pulmonary disease (COPD). Adherence to LTOT ranges from 45% to 70% and utilization of 15 hours per day is widely accepted as efficacious. Although studies have reviewed the level of patient adherence with LTOT, few have introduced or evaluated interventions. The paucity of information regarding patients following oxygen prescription is an enormous void that must be tackled to augment clinical effectiveness and cost containment for the long term. A research agenda for LTOT adherence is postulated to help connect treatment adherence variables and concepts with clinical outcomes and quality of life.


Developing theoretical and environmental policy for underage drinking.
To estimate concern/support for policy for underage drinkers and formulate policy-specific communication strategies. An environmentally based approach to policy formulation used concepts from the transtheoretical, decision-balance, and social-norms models. Interviews were conducted with community stakeholders, and surveys were collected on community residents as part of the evaluation effort. The triangulated evaluation revealed specific policies for underage drinking and techniques for facilitating policy implementation. The results demonstrate techniques for using multiple models and evaluation techniques for formulating public policy in the promotion of community health.


Venous superdrained gastric tube pull-up procedure for hypopharyngeal and cervical esophageal reconstruction reduces postoperative anastomotic leakage and stricture.
Gastric pull-up is a common procedure to reconstruct the continuity of the upper digestive tract after esophageal resection. However, this technique sometimes causes postoperative anastomotic leakage or stricture, resulting from insufficient blood flow at the distal end. To overcome this problem, additional microvascular venous anastomoses were performed. The purpose of this study was to compare the outcomes of post-surgical anastomotic leakage and stricture in patients with and without additional microvascular venous superdrainage after cervical esophageal and hypopharyngeal resection and gastric tube reconstruction. A total of 29 consecutive patients with esophageal or hypopharyngeal cancer who underwent total esophagectomy and hypopharyngectomy with gastric tube reconstruction in the National Organization Nagasaki Medical Center between April 2014 and May 2016 were analyzed in this study. Of these patients, 20 underwent additional venous anastomoses (superdrainage group), and 9 did not undergo additional procedures (standard group). We compared the frequency of post-surgical stricture and leakage in the two groups retrospectively. Three of nine patients (33.3%) developed postoperative leakage in the standard group, and 1 of 20 (5.0%) did so in the superdrainage group. Six of nine patients (66.7%) showed postoperative anastomotic stricture in the standard group, but none did so in the superdrainage group. Patients who did not undergo additional venous superdrainage were significantly more likely to develop postsurgical leakage (P < 0.05, Chi-square test) and anastomotic stricture (P < 0.001, Chi-square test). Our study revealed that only additional venous anastomoses could reduce the incidence of postoperative anastomotic leakage and stricture. This procedure is of merit to perform after total esophagectomy and hypopharyngectomy with gastric tube reconstruction.


Thermal diffusivity measurement of focused-ion-beam fabricated sample using photothermal reflectance technique.
Focused-Ion-Beam (FIB) can lift-off micrometer-sized samples from bulk materials for structural characterization and property measurement. The ability to determine thermophysical properties of such samples offers unique insight into the local microstructure-property relationship. A photothermal reflectance technique is developed to measure the thermal diffusivity of FIB-fabricated, micrometer-sized samples in this study. An analytic model is established to guide the experimental design and data analysis for the limited sample size and thickness. The thermal diffusivity of the sample can be extracted from a series of spatial-scan measurements at several modulated heating frequencies. To demonstrate the viability of the technique, a FIB-fabricated SiC plate with the size of 42 μm × 31 μm × 8 μm was used to represent high conductivity materials, which pose more challenges for the technique. The result compares favorably with literature values of SiC. The measurement uncertainty is quantified and possible experimental error sources are discussed. This technique is specially promising for thermal property measurements on nuclear fuels and materials.


c-Ha-ras down regulates the alpha-fetoprotein gene but not the albumin gene in human hepatoma cells.
We studied the effects of transfection of the normal c-Ha-ras gene, rasGly-12, and its oncogenic mutant, rasVal-12, on expression of the alpha-fetoprotein (AFP) and albumin genes in a human hepatoma cell line, HuH-7. The mutant and, to a lesser extent, the normal ras gene caused reduction of the AFP mRNA but not the albumin mRNA level in transfected HuH-7 cells. Cotransfection experiments with a rasVal-12 expression plasmid and a chloramphenicol acetyltransferase reporter gene fused to AFP regulatory sequences showed that rasVal-12 suppressed the activity of enhancer and promoter regions containing A + T-rich sequences (AT motif). In contrast, rasVal-12 did not affect the promoter activity of the albumin and human hepatitis B virus pre-S1 genes even though these promoters contain homologous A + T-rich elements. ras transfection appeared to induce phosphorylation of nuclear proteins that interact with the AFP AT motif, since gel mobility analysis revealed the formation of slow-moving complexes which was reversed by phosphatase treatment. However, similar changes in complex formation were observed with the albumin and hepatitis B surface antigen pre-S1 promoters. Therefore, this effect alone cannot explain the specific down regulation of the AFP promoter and enhancer activity. ras-mediated suppression of the AFP gene may reflect the process of developmental gene regulation in which AFP gene transcription is controlled by a G-protein-linked signal transduction cascade triggered by external growth stimuli.


Re-interventions after endovascular aortic repair for infrarenal abdominal aneurysms: a retrospective cohort study.
Early morbidity and mortality are generally lower after endovascular aortic repair (EVAR), than after open repair but re-interventions and late complications are more common. The aim of the present study was to make a detailed description of re-interventions after EVAR-including incidence, indications, procedures, and outcome-with special reference to non-access-related re-interventions. This is a retrospective single-center cohort study of re-interventions after standard EVAR with special reference to non-access-related re-interventions. Consecutive patients (n = 405) treated with standard EVAR for non-ruptured (n = 337) or ruptured (n = 68) infrarenal aneurysms between 2005 and 2013 were analysed. Median follow-up was 29 months (range 0-108). Eighty-nine patients (22 %) underwent 113 re-interventions during follow-up. Twenty-seven patients (7 %) had 28 access related re-intervention, 65 patients (16 %) had 85 non-access related reinterventions. Non-access related re-interventions were more common in ruptured aneurysms than in unruptured aneurysms (22 vs. 15 %, p = 0.002). The most frequent indications were endoleak type I (n = 19), type II (n = 21), or type III (n = 5); stent graft migration (n = 9); and thrombosis (n = 14). The most frequent procedures were embolization of endoleak type II (n = 21), additional iliac stent graft (n = 19), proximal extension (n = 12), thrombolysis (n = 8), iliac limb bare-metal stenting (n = 6), and stent graft relining (n = 7). Endovascular technique was used in 83 % of re-interventions. Thirty-day mortality after non-access-related re-interventions was 15 % when initiated from symptoms (rupture or infection) and 0 % when initiated from follow-up findings (p = 0.014). Cumulative survival five years after EVAR was 72 % in patients with a re-intervention and 59 % in patients without (p = 0.21). Non-access-related re-intervention rates are still considerable after EVAR and more frequent after ruptured aneurysms. Endoleak embolization is the most frequent procedure, followed by additional iliac stent grafts. Outcomes after re-interventions are generally good, except when initiated by rupture or infection.


Focal renal masses: magnetic resonance imaging.
Thirty patients with focal renal masses were evaluated on a .12-Tesla resistive magnetic resonance unit using partial saturation and spin echo pulse sequences. A short repetition time (TR = 143 ms) was employed for partial saturation images and a spin echo was present in each case (TE = 10 ms). Additional pulse sequences through regions of interest were also obtained. Fifteen patients had cystic lesions, nine patients had renal cell carcinoma, two had metastatic lesions, one had an angiomyolipoma, and three had focal bacterial infection. Cystic lesions were well circumscribed and demonstrated a range of signal intensities. Small intra-parenchymal cysts were difficult to identify. Renal cell carcinomas demonstrated areas of increased signal using a partial saturation sequence (TR = 143-415 ms, TE = 10 ms). Magnetic resonance imaging accurately detected perinephric extension and vascular invasion in all patients. Metastatic disease to the kidney was uniformly low in signal, in contrast to primary renal cell carcinoma; an angiomyolipoma demonstrated very high signal intensity. Two masses resulting from acute focal bacterial nephritis were uniformly low in signal. One additional case of a more indolent pyelonephritis demonstrated high signal in regions of replacement lipomatosis and low signal in sites of active infection. Magnetic resonance imaging appears to be an accurate way of detecting, identifying, and staging focal renal masses.


Acute hypoxic pulmonary hypertension associated with right heart failure.
COPD is a cause of chronic pulmonary hypertension, with increased pressure during exacerbations. But acute right ventricular failure is very rare in this condition. We reported two cases in which exacerbation and hypoxaemia have induced an acute severe pulmonary hypertension complicated by right ventricular failure and cardiogenic shock. The supportive treatment and the correction of hypoxaemia have rapidly solved the clinical situation.


Mechanism of removal of aflatoxin B1 by a resistant bacterium.
A bacterium resistant to aflatoxin B1 isolated from the soil was shown to remove a maximum 26% of toxin at 3 microg ml(-1). A comparison of spectrophotometric and radioisotope methods showed that a maximum of 48 hr was sufficient to remove the toxin. Radioisotope analysis showed that the radioactivity decreased in the chloroform phase while it increased in the aqueous phase during the time course of the experiment. An analysis of the supernatant of culture medium showed that the bacterium had converted aflatoxin B1 to water soluble compounds with lambda(max) of 338 and 374.


[Surgical management of patients with pathological deformities of carotid arteries].
Surgical management of pathological deformities of the internal carotid arteries, a cause of chronic brain ischemia, is discussed. This pathology is very common and is found in 25% of all individuals who underwent preventive medical examination according to the ultrasonography data. Most deformities do not pose any threat to patients, while some of them may cause ischemic stroke and chronic brain ischemia. The study included 165 patients with the known follow-up history who had been operated on at the N.N. Burdenko Neurosurgical Institute since 2001. A total of 196 reconstructive interventions of carotid arteries were analyzed. The indications for surgical management of pathological deformities based on clinical symptoms and identification of the signs of vascular wall dysplasia are thoroughly discussed. The local and cerebral hemodynamics during pre- and postoperative period are analyzed. The results of pathomorphological examination of the resected fragments of the deformed arteries are presented; they show that the changes are identical to those in patients with fibromuscular dysplasia. The follow-up history of the patients was recorded; it showed a sustained regression of transitory ischemic strokes and cerebral symptoms in most cases (69%). For proper indications for surgical management, reconstructive surgical interventions are a reliable and effective method for treating chronic brain ischemia and preventing recurrent ischemic strokes in patients with deformities of carotid arteries.


Social communication difficulties and autism spectrum disorder in young children with optic nerve hypoplasia and/or septo-optic dysplasia.
the aim of this study was to study systematically social, communication, and repetitive/restrictive (SCRR) behavioural difficulties and clinical autism spectrum disorder (ASD) in children with optic nerve hypoplasia (ONH) and/or septo-optic dysplasia (SOD), and to investigate the relationship between visual impairment, SCRR difficulties, ASD, and cognition. a case-note study of clinic records from a specialist developmental vision service was completed. Standardized assessments of vision and development and clinician judgements about SCRR difficulties and clinical ASD were made by a multidisciplinary team. a total of 45 females and 38 males (mean age 3y 5mo; range 10mo-6y 10mo) with ONH or SOD and profound visual impairment (PVI) or severe visual impairment (SVI) were assessed. A total of 58% of children had at least one SCRR difficulty, and 31% had a clinical diagnosis of ASD. The prevalence of ASD was slightly higher in children with SOD than in children with ONH (36% vs 26%) also slightly more frequent in children with PVI than in children with SVI (36% vs 27%). The prevalence of SCRR difficulties was statistically higher in children with PVI than in children with SVI (p=0.003). Clinical ASD was most likely to be diagnosed between 2 years 4 months and 4 years 6 months. Development was significantly delayed in children with ASD compared with children without social communication difficulties (p=0.001). children with SVI or PVI are at risk of SCRR difficulties and clinical ASD. Children with ONH and/or SOD and visual impairment have a similar risk of developing clinical ASD as other visual impairment groups. However, ASD prevalence data from this study are a minimum estimate, as some young children may have developed ASD behaviours in later childhood. Developmental surveillance for children with ONH and/or SOD should continue until at least the age of 4 years 6 months.


[Negative D-dimers and peripheral pulmonary embolism].
The measurement of D-dimers is a recent addition to the diagnostic strategy of pulmonary embolism and has been shown to be a valuable tool with excellent sensitivity. However, there have been rare reports of patients with pulmonary embolism but negative D-dimer tests. The object of this study was to study patients with pulmonary embolism but negative D-dimers and to compare them with a population of patients with pulmonary embolism and raised D-dimers. One hundred and fifty consecutive patients admitted for pulmonary embolism were included in this study. All underwent measurement of D-dimers (normal <500 ng/ml) by an ELISA technique. The data of clinical examination and complementary investigations were analysed with respect to the D-dimers result. The sensitivity of raised D-dimers for pulmonary embolism was 96% (6 patients had results <500 ng/ml). The finding of chest pain was statistically greater in the group with negative D-dimers (p=0.01). In these cases, the emboli were all distal (p=0.0003), the average Miller index was significantly lower than in patients with high D-dimers (p=0.04) and the diagnostic value of ultrasound investigations (echocardiography, ultrasonography of lower limb veins) was less (p<0.0001). The authors conclude that measurement of D-dimers by the ELISA method may be non-diagnostic in distal pulmonary embolism and one explanation could be the less extensive thromboembolic process. In cases with negative D-dimers, a strong clinical suspicion of pulmonary embolism should lead to the request for further investigations.


Blastomeres from somatic cell nuclear transfer embryos are not allocated randomly in chimeric blastocysts.
A marker has been developed to allow detection of blastomeres that originate from embryos produced by nuclear transfer (NT) of genetically engineered fetal fibroblasts. A plasmid (phEFnGFP) was constructed with a G418 resistance cassette for selection in fibroblasts and a nuclear localized green fluorescent protein (nGFP) expression cassette that expresses in every cell of day-6, -7, and -8 bovine embryos. This construct was utilized to follow the blastomere distribution in aggregation chimeras produced from fertilized embryos (in vitro produced, IVP) or parthenotes and NT embryos. Fluorescent and nonfluorescent NT embryos were aggregated early on day 4 and evaluated on day 8. Nuclei of blastomeres that carried the transgene were fluorescent under both UV epifluorescence (Hoechst 33342) and blue epifluorescence (nGFP). There was no bias in the distribution of green fluorescent blastomeres in the inner cell mass (ICM) or trophectoderm in NT<>NT chimeras. However, there was a strong bias for NT blastomeres to populate the ICM when aggregated with IVP embryos or parthenotes. There was also a strong bias against NT blastomeres in the trophectoderm when aggregated to IVP embryos. However, the bias against NT blastomeres in the trophectoderm was significantly less (p < 0.05) when aggregated with parthenotes as compared to aggregation with IVP embryos. In NT<>NT aggregates, no chimeric embryos were produced that had an ICM composed of blastomeres from a single origin. However, in NT<>Parthenote aggregates, 67% of the blastocysts had an ICM composed exclusively of NT origin. The remaining blastocysts ranged from 0% to 83% of the ICM that expressed nGFP. Similarly, in NT<>IVP aggregates 50% of the blastocysts had an ICM composed exclusively of NT origin. The remaining blastocysts ranged from 19% to 71% of the ICM being of NT origin. We conclude that production of divaricated chimeras from NT origin is feasible. Other applications of this technology are discussed.


Breast feeding and anaesthesia.
Anaesthetists require a good knowledge of the excretion of drugs in breast milk and the potential hazards to suckling infants of drug ingestion via breast milk. A brief account of the physiology of lactation is given. The mechanisms of drug passage into breast milk are discussed followed by a review of the excretion in breast milk of drugs used in anaesthetic practice. Suggestions for the management of anaesthesia in breast feeding mothers are offered.