Cost and contribution margin of transcatheter versus surgical aortic valve replacement.
To compare the cost of and payments for transcatheter aortic valve replacement (TAVR), a novel and expensive technology, and surgical aortic valve replacement (SAVR). Medicare claims provided hospital charges, payments, and outcomes between January and December 2012. Hospital costs and charges were estimated using hospital-specific cost-to-charge ratios. Costs and payments were examined in propensity score- matched TAVR and SAVR patients. Medicare spent $215,770,200 nationally on 4083 patients who underwent TAVR in 2012. Hospital costs were higher for TAVR patients (median, $50,200; interquartile range [IQR], $39,800-$64,300) than for propensity-matched SAVR patients ($45,500; IQR, $34,500-$63,300; P < .01), owing largely to higher estimated medical supply costs, including the implanted valve prosthesis. Postprocedure hospital length of stay (LOS) length was shorter for TAVR patients (median, 5 days [IQR, 4-8 days] vs 7 days [IQR, 5-9 days]; P < .01), as was total intensive care unit (ICU) LOS (median, 2 days [IQR, 0-5 days] vs 3 days [IQR, 1-6 days]; P < .01). Medicare payments were lower for TAVR hospitalizations (median, $49,500; IQR, $36,900-$64,600) than for SAVR (median, $50,400; IQR, $37,400-$65,800; P < .01). The median of the differences between payments and costs (contribution margin) was -$3380 for TAVR hospitalizations and $2390 for SAVR hospitalizations (P < .01). TAVR accounted for $215 million in Medicare payments in its first year of clinical use. Among SAVR Medicare patients at a similar risk level, TAVR was associated with higher hospital costs despite shorter ICU LOS and hospital LOS. Overall and/or medical device cost reductions are needed for TAVR to have a net neutral financial impact on hospitals.


Enterococcus gallinarum endocarditis occurring on native heart valves.
We report the first case of Enterococcus gallinarum endocarditis developing on normal native heart valves. Using phenotypic and molecular methods, a precise identification of this naturally vancomycin-resistant species allowed an optimal antibiotic therapy and the patient's recovery.


Exercise and Weight Management: The Role of Leptin-A Systematic Review and Update of Clinical Data from 2000-2022.
A well-balanced metabolism means a lower risk for metabolism-related neuropsychiatric disorders. Leptin is a secretory adipokine involved in the central control of appetite that appears to play a role in the etiology of feeding-related disorders. Additionally, the influence of exercise on feeding behaviors potentially modulates the circulation of metabolites that signal through the central nervous system. In this systematic review, we collected the recent clinical evidence on the effect of exercise on leptin concentrations in health individuals published from 2000 to 20 September 2022, according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA 2020 statement). Six hundred and thirty-eight papers were retrieved and forty-eight papers were included in the qualitative synthesis. Data supports that exercise positively influences appetite via enhancing peripheral and central leptin signaling (reuptake), especially during weight loss. Exercise modulation of leptin signaling through leptin receptors helps to stabilize increases in food intake during periods of negative energy balance, prior to a decrease in the body fat tissue content. At a high intensity, exercise appears to counteract leptin resistance.


Undiagnosed phaeochromocytoma masquerading as eclampsia.
The authors report the case of a previously well 34-year-old woman presenting with a hypertensive crises and a grand-mal seizure following elective caesarean section. Initial treatment of extreme hypertension, of a presumed eclamptic aetiology, with magnesium and labetalol was complicated by intermittent profound hypotensive episodes. This was accompanied by severe biventricular failure and fluctuating systemic vascular resistance. Abdominal ultrasound revealed a left suprarenal mass. A diagnosis of phaeochromocytoma was confirmed on abdominal CT and urinary assays. The patient was stabilised with α and β blockade, was successfully extubated and subsequently had the tumour surgically excised. The cardiac function returned to normal on echocardiography and she has made a complete recovery.


Characterizing the Role of Monocytes in T Cell Cancer Immunotherapy Using a 3D Microfluidic Model.
In the hepatitis B virus (HBV)-related hepatocellular carcinoma tumor microenvironment (TME), monocytes reportedly impede natural T cell functions via PD-L1/PD-1 signaling. However, it remains unclear if T cell receptor-redirected T cells (TCR T cells) are similarly inhibited. Hence, we developed a 3D intrahepatic TME microfluidic model to investigate the immunosuppressive potential of monocytes toward HBV-specific TCR T cells and the role of PD-L1/PD-1 signaling. Interestingly, in our 3D static microfluidic model, we observed that monocytes suppressed only retrovirally transduced (Tdx) TCR T cell cytotoxicity toward cancer cells via PD-L1/PD-1, while mRNA electroporated (EP) TCR T cell cytotoxicity was not affected by the presence of monocytes. Importantly, when co-cultured in 2D, both Tdx and EP TCR T cell cytotoxicity toward cancer cells were not suppressed by monocytes, suggesting our 3D model as a superior tool compared to standard 2D assays for predicting TCR T cell efficacy in a preclinical setting, which can thus be used to improve current immunotherapy strategies.


Intermediate-sized filaments of the prekeratin type in myoepithelial cells.
Myoepithelial cells from mammary glands, the modified sweat glands of bovine muzzle, and salivary glands have been studied by electron microscopy and by immunofluorescence microscopy in frozen sections in an attempt to further characterize the type of intermediate-sized filaments present in these cells. Electron microscopy has shown that all myoepithelial cells contain extensive meshworks of intermediate-sized (7--11-nm) filaments, many of which are anchored at typical desmosomes or hemidesmosomes. The intermediate-sized filaments are also intimately associated with masses of contractile elements, identified as bundles of typical 5--6-nm microfilaments and with characteristically spaced dense bodies. This organization resembles that described for various smooth muscle cells. In immunofluorescence microscopy, using antibodies specific for the various classes of intermediate-sized filaments, the myoepithelial cells are strongly decorated by antibodies to prekeratin. They are not specifically stained by antibodies to vimentin, which stain mesenchymal cells, nor by antibodies to chick gizzard desmin, which decorate fibrils in smooth muscle Z bands and intercalated disks in skeletal and cardiac muscle of mammals. Myoepithelial cells are also strongly stained by antibodies to actin. The observations show (a) that the epithelial character, as indicated by the presence of intermediate-sized filaments of the prekeratin type, is maintained in the differentiated contractile myoepithelial cell, and (b) that desmin and desmin-containing filaments are not generally associated with musclelike cell specialization for contraction but are specific to myogenic differentiation. The data also suggest that in myoepithelial cells prekeratin filaments are arranged--and might function--in a manner similar to the desmin filaments in smooth muscle cells.


[Influence of Spectral Pre-Processing on PLS Quantitative Model of Detecting Cu in Navel Orange by LIBS].
Cu in navel orange was detected rapidly by laser-induced breakdown spectroscopy (LIBS) combined with partial least squares (PLS) for quantitative analysis, then the effect on the detection accuracy of the model with different spectral data ptetreatment methods was explored. Spectral data for the 52 Gannan navel orange samples were pretreated by different data smoothing, mean centralized and standard normal variable transform. Then 319~338 nm wavelength section containing characteristic spectral lines of Cu was selected to build PLS models, the main evaluation indexes of models such as regression coefficient (r), root mean square error of cross validation (RMSECV) and the root mean square error of prediction (RMSEP) were compared and analyzed. Three indicators of PLS model after 13 points smoothing and processing of the mean center were found reaching 0. 992 8, 3. 43 and 3. 4 respectively, the average relative error of prediction model is only 5. 55%, and in one word, the quality of calibration and prediction of this model are the best results. The results show that selecting the appropriate data pre-processing method, the prediction accuracy of PLS quantitative model of fruits and vegetables detected by LIBS can be improved effectively, providing a new method for fast and accurate detection of fruits and vegetables by LIBS.


[Surgical approach in tumors of the nasopharynx and the retromaxillary region in childhood].
Continuous development of well established operative techniques have widened the indication for surgery of epipharyngeal and retromaxillary tumours. The authors describe an antero-lateral and infratemporal approach for complete removal of intra- and extracranial fibromas without preoperative embolisation, radiotherapy and ligation of the carotid arteries.


Chronic cocaine exposure alters carbon dioxide reactivity but does not affect cerebral blood flow autoregulation in anesthetized dogs.
Cocaine use is common in trauma victims. Consequently, understanding how cocaine alters normal physiology is important to providing appropriate medical care for these patients. This study was designed to identify how chronic cocaine exposure alters cerebrovascular physiology. Ten dogs (seven experimental, three control) were studied. Transcranial Doppler was used to measure CO2 reactivity and autoregulation of cerebral blood flow velocity (CBFvel). Measurements were made in anesthetized animals (0.6% or 1.8% isoflurane in oxygen and intravenous fentanyl) at baseline before cocaine exposure and then at weekly intervals for 4 weeks. During the 4-week study period, cocaine was administered intravenously four times per day. Cocaine did not alter autoregulation of CBFvel in response to changes in mean arterial pressure. However, cocaine markedly impaired CO2 reactivity in three of the seven animals. In this subset of animals, increasing Paco2 decreased CBFvel, which is consistent with vasoconstriction rather than vasodilation. Chronic cocaine exposure does not alter autoregulation of CBFvel but does alter CO2 reactivity in a subset of susceptible animals. If confirmed in humans, these findings have implications for traumatic brain injury patients who are chronic cocaine users. Specifically, the findings suggest that hyperventilation could exacerbate intracranial hypertension in a subset of these patients.


Advocacy training during pediatric residency.
Despite broad concerns about the welfare of children, most pediatric residents are not able to engage in child advocacy during their busy training years. Yet residency can provide an opportunity for young pediatricians to learn valuable advocacy skills by undertaking an independent project with an experienced mentor. We describe the University of Washington Pediatrics Residency Program's experience in training interested residents in child advocacy. Basic requirements are that advocacy projects must not interfere with clinical training, resident participation must be voluntary, and faculty with advocacy skills must be available to help guide the residents. Four resident projects are outlined and guidelines for instituting such programs are presented.


Uncovering QTL for resistance and survival time to Philasterides dicentrarchi in turbot (Scophthalmus maximus).
Disease resistance-related traits have received increasing importance in aquaculture breeding programs worldwide. Currently, genomic information offers new possibilities in breeding to address the improvement of this kind of traits. The turbot is one of the most promising European aquaculture species, and Philasterides dicentrarchi is a scuticociliate parasite causing fatal disease in farmed turbot. An appealing approach to fight against disease is to achieve a more robust broodstock, which could prevent or diminish the devastating effects of scuticociliatosis on farmed individuals. In the present study, a genome scan for quantitative trait loci (QTL) affecting resistance and survival time to P. dicentrarchi in four turbot families was carried out. The objectives were to identify QTL using different statistical approaches [linear regression (LR) and maximum likelihood (ML)] and to locate significantly associated markers for their application in genetic breeding strategies. Several genomic regions controlling resistance and survival time to P. dicentrarchi were detected. When analyzing each family separately, significant QTL for resistance were identified by the LR method in two linkage groups (LG1 and LG9) and for survival time in LG1, while the ML methodology identified QTL for resistance in LG9 and LG23 and for survival time in LG6 and LG23. The analysis of the total data set identified an additional significant QTL for resistance and survival time in LG3 with the LR method. Significant association between disease resistance-related traits and genotypes was detected for several markers, a single one explaining up to 22% of the phenotypic variance. Obtained results will be essential to identify candidate genes for resistance and to apply them in marker-assisted selection programs to improve turbot production.


Regulation of ROMK (Kir 1.1) channel expression in kidney thick ascending limb by hypertonicity: role of TonEBP and MAPK pathways.
The present study assessed the mechanisms by which hypertonicity caused by NaCl enhances the renal outer medullary potassium channel (ROMK) mRNA abundance in rat kidney medullary thick ascending limb (MTAL) and in cultured mouse TAL cells. Using the run-off technique, we observed that the ROMK gene transcription rate in nuclei isolated from MTAL fragments was enhanced approximately 40% by a high NaCl medium. In MTAL fragments, hypertonicity (450 mosm) caused by NaCl, not by mannitol or urea, enhanced both ROMK mRNA abundance and tonicity-responsive enhancer binding protein (TonEBP) total abundance and nuclear localization. In an immortalized mouse TAL cell culture in which ROMK is apically expressed, hypertonicity caused by both NaCl and mannitol, not urea, enhanced both ROMK mRNA abundance and TonEBP total abundance and nuclear localization. Confocal microscopy confirmed an increased nuclear translocation of TonEBP in response to NaCl-induced hypertonicity. Finally, inhibition of the p38 MAPK pathway by SB203580 and of the ERK pathway by PD98059 abolished the NaCl-induced stimulation of TonEBP and ROMK. These results establish that mRNA expression of ROMK is augmented in the MTAL by NaCl-induced hypertonicity through stimulation of ROMK gene transcription, and that TonEBP and the p38 MAPK and ERK pathways are involved in this effect.


Does the circadian clock drift when pilots fly multiple transpacific flights with 1- to 2-day layovers?
On trips with multiple transmeridian flights, pilots experience successive non-24 h day/night cycles with circadian and sleep disruption. One study across a 9-day sequence of transpacific flights (no in-flight sleep, 1-day layovers between flights) reported an average period in the core body temperature rhythm of 24.6 h (circadian drift). Consequently, pilots were sometimes flying through the circadian performance nadir and had to readapt to home base time at the end of the trip. The present study examined circadian drift in trip patterns with longer flights and in-flight sleep. Thirty-nine B747-400 pilots (19 captains, 20 first officers, mean age = 55.5 years) were monitored on 9- to 13-day trips with multiple return flights between East Coast USA and Japan (in 4-pilot crews) and between Japan and Hawaii (in 3-pilot crews), with 1-day layovers between each flight. Measures included total in-flight sleep (actigraphy, log books) and top of descent (TOD) measures of sleepiness (Karolinska Sleepiness Scale), fatigue (Samn-Perelli Crew Status Check) and psychomotor vigilance task (PVT) performance. Circadian rhythms of individual pilots were not monitored. To detect circadian drift, mixed-model analysis of variance examined whether for a given flight, total in-flight sleep and TOD measures varied according to when the flight occurred in the trip sequence. In addition, sleep propensity curves for pre-trip and post-trip days were examined (Chi-square periodogram analyses). Limited data suggest that total in-flight sleep of relief crew at landing may have decreased across successive East Coast USA-Japan (flights 1, 3, 5 or 7; median arrival 03:45 Eastern Daylight Time (EDT)). However, PVT response speed at TOD was faster on East Coast USA-Japan flights later in the trip. On these flights, circadian drift would result in flights later in the trip landing closer to the evening wake maintenance zone, when sleep is difficult and PVT response speeds are fastest. On Japan-East Coast USA flights (flights 2, 4, 6 or 8; median arrival time 14:52 EDT), PVT response speeds were slower on flight 8 than on flight 2. Circadian drift would move these arrivals progressively earlier in the SCN pacemaker cycle, where PVT response speeds are slower. Across the five post-trip days, 12 pilots (Group A) immediately resumed their pre-trip sleep pattern of a single nocturnal sleep episode; 9 pilots (Group B) had a daytime nap on most days that moved progressively earlier until it merged with nocturnal sleep and 17 pilots (Group C) had nocturnal sleep and intermittent naps. Chi-square periodogram analyses of the sleep propensity curves for each group across baseline and post-trip days suggest full adaptation to EDT from post-trip day 1 (dominant period = 24 h). However, in Groups B and C, the patterns of split sleep post-trip compared to pre-trip suggest that this may be misleading. We conclude that the trends in total in-flight sleep and significant changes in PVT performance speed at TOD provide preliminary evidence for circadian drift, as do persistent patterns of split sleep post-trip. However, new measures to track circadian rhythms in individual pilots are needed to confirm these findings.


The NMDA receptor channel blocker memantine and opioid receptor antagonist naltrexone inhibit the saccharin deprivation effect in rats.
Several drugs, such as N-methyl-D-aspartate (NMDA) receptor channel blockers (memantine), naltrexone (but not naloxone) and acamprosate, have previously been reported to attenuate the expression of the alcohol deprivation effect, a phenomenon seen as an increase in post-deprivation alcohol consumption. The present study aimed to evaluate the effects of these drugs on the development and expression of the saccharin deprivation effect in adult male Wistar rats. Memantine (13 mg/kg per day) and naltrexone (5 mg/kg, twice daily), but not naloxone (24 mg/kg per day) or acamprosate (200 mg/kg, twice daily), prevented the increase in the consumption of saccharin after a 1-week deprivation from free-choice, unlimited access to saccharin (0.1%, w/v). Taken together with the results of previous studies, these results suggest that naltrexone and memantine attenuate the expression of both the alcohol and saccharin deprivation effects.


[Lipopolysaccharide affects male reproductive function through Toll-like receptors].
Reproductive tract infection is one of the factors of male infertility, but the mechanisms responsible are hitherto poorly defined. Recent studies show that one of the microbial pattern-recognition receptors, Toll-like receptor (TLR) signaling pathway, plays a critical role in inflammation-induced male infertility. Lipopolysaccharide (LPS), a major component in the cell wall of gram-negative bacteria, could induce inflammatory response through TLRs. A large number of researches suggest that TLRs express widely in the male reproductive tract and LPS-induced inflammatory reaction through TLRs may affect male fertility. This article presents an overview on how LPS-induced inflammation through TLRs affects male fertility in terms of its influence on the testis, epididymis and sperm quality.


A comparative study of pregnant women attending a tertiary obstetric unit and a district general hospital with a previous history of postnatal depression.
The aim of this study was to compare pregnant women with a previous history of postnatal depression, attending a Tertiary Obstetric Unit in Belfast and a District General Hospital in Newry. Women with a previous history of postnatal depression recorded at booking for their most current pregnancy were studied between January 2001 and May 2002. A total of 443 women (6.6%) in Belfast had a history of postnatal depression, compared with 113 women (6%) in Newry. The most common age range was 31 - 35 years in both centres. Some 69% of women in Belfast compared with 81% of women in Newry were given treatment. Fluoxetine was the commonly prescribed drug for each centre. During this subsequent pregnancy, 19 women (4.3%) in Belfast and five women (4.4%) in Newry remained on antidepressants. There was one woman in each centre who took an overdose during this pregnancy. More women in Newry were given treatment. During the subsequent pregnancy, the percentages of women from each unit requiring antidepressant therapy were similar.


Three-dimensional myocardial strain reconstruction from tagged MRI using a cylindrical B-spline model.
In this paper, we present a new method for reconstructing three-dimensional (3-D) left ventricular myocardial strain from tagged magnetic resonance (MR) image data with a 3-D B-spline deformation model. The B-spline model is based on a cylindrical coordinate system that more closely fits the morphology of the myocardium than previously proposed Cartesian B-spline models and does not require explicit regularization. Our reconstruction method first fits a spatial coordinate B-spline displacement field to the tag line data. This displacement field maps each tag line point in the deformed myocardium back to its reference position (end-diastole). The spatial coordinate displacement field is then converted to material coordinates with another B-spline fit. Finally, strain is computed by analytically differentiating the material coordinate B-spline displacement field with respect to space. We tested our method with strains reconstructed from an analytically defined mathematical left ventricular deformation model and ten human imaging studies. Our results demonstrate that a quadratic cylindrical B-spline with a fixed number of control points can accurately fit a physiologically realistic range of deformations. The average 3-D reconstruction computation time is 20 seconds per time frame on a 450 MHz Sun Ultra80 workstation.


A novel rodent model of pregnancy complications associated with genetically determined angiotensin-converting enzyme (ACE) activity.
Brown Norway (BN) and Lewis (LW) inbred rat strains harbor different angiotensin-converting enzyme ( Ace) polymorphisms that result in higher ACE activity in BN than LW rats. Thus we hypothesized that pregnant BN rats would show pregnancy complications linked to angiotensin II (AII) activity. We performed longitudinal and cross-sectional studies in pregnant LW and BN rats. We found that BN rats have significantly higher ACE activity and AII levels at prepregnancy and throughout pregnancy compared with LW rats, except at midgestation. BN placentas and maternal kidneys had significantly higher expression of AII receptor 1 (AGTR1) and lower expression of AGTR2 than the respective LW placentas and maternal kidneys. Renin-angiotensin system activation in BN rats correlated with hypertension and proteinuria at gestational days 17-21, which were resolved after delivery. In addition, BN rat pregnancies were characterized by significant fetal loss, restricted growth in surviving fetuses, decreased uteroplacental blood flows, and decreased trophoblast remodeling of uterine arteries compared with LW pregnancies. Short-term losartan treatment significantly increased uteroplacental blood flow and fetal weight and decreased maternal blood pressure (BP) and proteinuria in BN pregnancies. In contrast, losartan treatment significantly decreased uteroplacental blood flow and fetal weight but had no significant effect on maternal BP in LW pregnancies. We conclude that Ace polymorphisms play an important role in the reproductive phenotype of BN and LW rats and that BN rats are a novel model of pregnancy complications in association with genetically controlled, increased ACE activity.


Cardiac troponin I in calves with congenital heart disease.
The association between plasma cardiac troponin I (cTnI) and the magnitude of cardiac enlargement in calves with congenital heart disease (CHD) are not well defined. To investigate the relationship between plasma cTnI concentrations and cardiac size in healthy calves and calves with CHD. A total of 19 healthy calves (control) and 12 Holstein calves with CHD (patent ductus arteriosus, ventricular septal defect, tetralogy of Fallot or double outlet right ventricle). Case control study. All animals underwent a comprehensive transthoracic echocardiographic study to document cardiac health or presence of CHD. The vertebral heart score (VHS) was determined in each animal using right lateral survey radiographic images. Blood samples were collected via jugular venipuncture and plasma cTnI concentration and creatine kinase (CK) activity were determined by a 3rd generation immunoassay and an automatic biochemical analyzer, respectively. Groups were compared using Mann-Whitney U-test and receiver-operating characteristics (ROC) curve analysis. Calves with CHD had significantly larger VHS values and higher plasma cTnI concentrations (P < .001) compared to control. Creatine kinase activity was not different between the control and CHD groups of calves. Diagnostic cutoffs of VHS and plasma cTnI for discrimination of groups were 8.9 vertebrae and 0.035 ng/mL, respectively. The cTnI concentration in plasma was significantly correlated with VHS (r (2) =0.512, P < .001). Our results suggest that determination of plasma cTnI concentrations in calves with clinical signs compatible with CHD might prove useful as a guide to quantify cardiac remodeling associated with increased cardiac size.


Platelet-Rich Plasma for Bone Fracture Treatment: A Systematic Review of Current Evidence in Preclinical and Clinical Studies.
Background: Recently, there is an increasing interest in the therapeutic potential of platelet-rich plasma (PRP) for bone fracture treatment. Nevertheless, the effect of PRP for bone fracture treatment remains controversial and is still a matter of discussion. Therefore, we performed a systematic review to evaluate the efficacy and safety of PRP injection for treatment of bone fracture. Methods: The main bibliographic databases, including Medline, PubMed, Embase, Web of Science, and the Cochrane library, were comprehensively searched for studies focusing on the application of platelet-rich plasma (PRP) on bone fracture treatment. All relevant articles were screened for eligibility and subdivided into the preclinical and clinical studies. Data were extracted and presented systematically. Results: Finally, twenty-six in vitro preclinical studies (basic studies), nine in vivo preclinical studies (animal studies), and nine clinical studies, met the selection criteria, and were included in the present systematic review. Preclinical studies showed an overall positive effect of PRP on osteoblast-like cells in vitro and bone healing in animal models. The most used treatment for bone fracture in animal and clinical studies is fixation surgery combined with PRP injection. The clinical studies reported PRP shortened bony healing duration, and had no positive effect on improving the healing rate of closed fractures. However, the results of functional outcomes are controversial. Additionally, compared with control group, PRP would not increase the rate of postoperative wound infection. Conclusion: The present systematic review confirmed the continuing interests of PRP as an additional treatment for bone fracture. Preclinical studies highlighted the potential value of PRP as promising therapy for bone fracture. However, the preclinical evidence did not translate into a similar result in the clinical studies. In addition, types of fractures and procedures of PRP preparation are heterogeneous in enrolled studies, which might result in controversial results. Meanwhile, characteristics of PRP, such as platelet concentration, the numbers of leukocytes, still need to be determined and further research is required.


Chairside transformation of a removable partial denture to a transitional complete denture to alleviate an impaired stroke patient: A case report.
The purpose of this clinical report is to present a technique for transformation of an existing removable partial denture (RPD) into a transitional complete denture (CD) for an impaired stroke patient. A 67-year-old male who underwent an ischemic stroke 12 months ago presented in the Postgraduate Clinic of the National and Kapodistrian University of Athens, requiring treatment of his remaining teeth and repair of his existing RPD which lacked retention and stability. The treatment plan included placement of amalgam plugs on the remaining teeth which were decoronated due to poor prognosis and modification of the existing RPD to a transitional CD. The procedure included one alginate impression and chairside alteration of the prosthesis with simple means. The new prosthesis managed to improve patient's masticatory ability and reduce the risk for aspiration pneumonia. In the present case report a technique for modifying an existing RPD into a transitional CD for an impaired, stroke patient is described. Reduced treatment time, costs and patient's inconvenience while embracing the benefits provided by the utilization of an existing prosthesis regarding adaptation of the neuromuscular system are among the advantages of the described technique.


Proteomic and physiological responses of Arabidopsis thaliana exposed to salinity stress and N-acyl-homoserine lactone.
To evaluate the alleviating action of exogenous N-acyl-homoserine lactones (AHLs) on NaCl toxicity, morphological, physiological and proteomic changes were investigated in Arabidopsis thaliana seedlings. Salinity stress decreased growth parameters, increased malondialdehyde (MDA) contents and antioxidant enzymes such as superoxide dismutase (SOD), guaiacol peroxidase (POD) and catalase activities. Application of lower concentration of AHL had a relieving effect on Arabidopsis seedlings under salinity stress which dramatically decreased MDA content, and increased growth parameters as well as SOD and POD activities. Total proteins were extracted from the control, NaCl-, AHL- and NaCl + AHL-treated seedlings and were separated using two-dimensional gel electrophoresis. A total of 127 protein spots showed different expression compared with the control. Mass spectrometry analysis allowed the identification of 97 proteins involved in multiple pathways, i.e. defense/stress/detoxification, photosynthesis, protein metabolism, signal transduction, transcription, cell wall biogenesis, metabolisms of carbon, lipid, energy, sulfur, nucleotide and sugar. These results suggest that defense/stress response, metabolism and energy, signal transduction and regulation, protein metabolism and transcription-related proteins may be particularly subjected to regulation in salt stressed Arabidopsis seedlings, when treated with AHL and that this regulation lead to improved salt tolerance and plant growth. Overall, this study provides insight to the effect of AHL on salinity stress for the first time, and also sheds light on overview of the molecular mechanism of AHL-regulated plant growth promotion and salt resistance.


Determinants and constraints to household-level animal source food consumption in rural communities of Ethiopia.
Animal source foods (ASF) contain quality nutrients important for growth, development, immunity and behavioural outcomes. Plant-based foods also provide the nutrients, but with lower bioavailability than ASF. Evidence on household-level ASF consumption frequency, constraints and determinants are limited for Ethiopia. Therefore, the present study aimed to assess the consumption frequency of ASF and to identify determinants and constraints among rural households in Ethiopia. A cross-sectional study was conducted in 422 households. The consumption frequency of ASF was assessed using a food frequency screener over 30 days. Twelve statements with Likert scale responses were used to identify constraints to ASF consumption. Ordinal logistic regression was used to identify determinants of ASF consumption. About a quarter (26 %) of the households consumed milk one to two times per week. One out of five households consumed eggs one to two times per week (20 %) or one to two times per month (19 %). Poultry and meat were never consumed by 92 and 60 % of the households, respectively. Unavailability, unaffordability, consumption tradition and income generation priority were constraints identified. Food insecurity, livestock ownership, income, family size and women's education were associated (P < 0⋅05) with selected ASF consumption. Rural households in Ethiopia did not consume ASF on regular basis. Poor socio-demographic and economic conditions as determined by food insecurity, property ownership, income, educational achievement, family size and ASF unavailability and unaffordability contributed to the lower consumption frequency of ASF by households in rural Ethiopia. Nutrition policies and programmes should focus on nutrition-sensitive agricultural extension, livelihood improvement and women empowerment interventions integrated with nutrition education to improve ASF consumption in rural settings.


Is moderate-intensity interval training more tolerable than high-intensity interval training in adults with obesity?
Interval training (IT) has been shown to be a time-effective alternative to traditional training programmes in the management of obesity. Nevertheless, studies comparing the effects of different IT intensities on inflammation, muscle and liver damage, and perceptual responses in people with obesity are relatively scarce. This study aimed to compare the acute effects of two different IT protocols matched by the mean load and duration on biochemical and perceptual responses in sedentary adults with obesity. Twenty-two volunteers (age = 33.40 ± 10.01 years, BMI = 38.29 ± 7.09 kg/m²) were randomized to perform two conditions: moderate-intensity IT (MIIT) 5 × 3 min (70% of peak power output (PPO))/2 min (45%PPO) and high-intensity IT (HIIT) 8 × 1 min (90%PPO)/2 min (45%PPO). Blood samples were drawn before and after exercise for biochemical and haematological measurements. Rating of perceived exertion (RPE) was assessed during and after exercise. Perceptual pain was evaluated before, throughout and after exercise. C-reactive protein, white blood cells and neutrophils increased only after HIIT (p < 0.001, for all). Aspartate aminotransferase, alanine aminotransferase, creatine kinase and lactate dehydrogenase increased in both HIIT and MIIT (p < 0.001, for all), without any difference between sessions. HIIT induced a greater increase of blood lactate compared to MIIT (p < 0.05). Pain and RPE scores were higher during HIIT vs. MIIT (p < 0.001 and p < 0.01, respectively). MIIT induced fewer immune system perturbations and less muscle pain and was perceived as more tolerable compared to HIIT session. Therefore, MIIT could be used as a first step to promote body adaptations before starting a HIIT programme in sedentary people with obesity.


In vitro removal of beta-2-microglobulin from uremic blood with an immunoadsorption wall.
Dialysis-related amyloidosis (DRA), caused by the accumulation of beta-2-microglobulin (β-2M), remains a major concern in long-term renal replacement therapies. For years, we have developed an immunoadsorption wall (iWall) for the removal of β-2M. In this study, we employed a new approach taking advantage of the melting of a buffer ice rod to improve the conditions associated with the manufacturing of an iWall and tested its performance with uremic serum and blood. The preliminary results reveal that the present iWalls thus prepared not only possess the superior properties of affinity and specificity but also show structural stability and acceptable hemocompatibility. We believe that this breakthrough might provide a promising path to successful treatment of DRA as well as establish a useful platform for studying removal of certain pathological toxins accumulated in the blood.


Self-obtained vaginal swabs for PCR chlamydia testing: a practical alternative.
This study shows that given a choice, New Zealand women at high risk for sexually transmitted infections (STI) opt to provide a self-taken vaginal swab over a clinician-taken sample for STI testing. Self-obtained vaginal swabs have previously been shown to have equal sensitivity and specificity to endocervical swabs and greater sensitivity than urine for the detection of Chlamydia trachomatis by polymerase chain reaction (PCR). We suggest that self-obtained vaginal swabs should be a readily available option offered to women for chlamydia testing by PCR in New Zealand.


Tumor-grade hyperprolactinemia induced by multiple medications in the setting of renal failure.
To describe a patient with galactorrhea and severe hyperprolactinemia in whom workup revealed a nontumoral mechanism. We present the medical history of a woman with long-standing diabetes in whom bilateral galactorrhea and hyperprolactinemia developed. In addition, the details of her clinical course and management are reviewed. A 33-year-old woman with diabetes, end-stage renal disease, and gastroparesis was admitted to the hospital because of intractable nausea and vomiting. Several months before admission, she had been noted to have galactorrhea and irregular menses. Routine medications included captopril, verapamil, furosemide, prochlorperazine, metoclopramide, cisapride, and Ortho-Novum. Laboratory evaluation showed normal thyroid function, increased serum prolactin levels (up to 1,197 ng/mL), and normal findings on magnetic resonance imaging of the pituitary. Electrophoresis of the patient's serum on a protein A Sepharose column showed no evidence of macro-prolactinemia. Orally administered medications were discontinued, and the patient was given total parenteral nutrition. These measures resulted in a decrease of 300 ng/mL in serum prolactin levels in 4 days. The prolactin levels eventually normalized after withdrawal of verapamil, prochlorperazine, and metoclopramide. A modest increase in serum prolactin level often can be produced by a variety of medications, but gross hyperprolactinemia of 200 ng/mL or higher usually raises suspicion of an underlying prolactin-secreting tumor. This case report demonstrates that conventional limits for nontumoral hyperprolactinemia can be exceeded by concurrent exposure to multiple lactotropic medications in the setting of renal failure.


Mitigation of nitrous oxide (N2 O) emission from swine wastewater treatment in an aerobic bioreactor packed with carbon fibers.
Mitigation of nitrous oxide (N2 O) emission from swine wastewater treatment was demonstrated in an aerobic bioreactor packed with carbon fibers (CF reactor). The CF reactor had a demonstrated advantage in mitigating N2 O emission and avoiding NOx (NO3 + NO2 ) accumulation. The N2 O emission factor was 0.0003 g N2 O-N/gTN-load in the CF bioreactor compared to 0.03 gN2 O-N/gTN-load in an activated sludge reactor (AS reactor). N2 O and CH4 emissions from the CF reactor were 42 g-CO2 eq/m(3) /day, while those from the AS reactor were 725 g-CO2 eq/m(3) /day. The dissolved inorganic nitrogen (DIN) in the CF reactor removed an average of 156 mg/L of the NH4 -N, and accumulated an average of 14 mg/L of the NO3 -N. In contrast, the DIN in the AS reactor removed an average 144 mg/L of the NH4 -N and accumulated an average 183 mg/L of the NO3 -N. NO2 -N was almost undetectable in both reactors.


Vesicoureteral reflux: From prophylaxis to surgery.
Vesicoureteral reflux (VUR) is one of the most common pathologies encountered in pediatric urology. Better understanding of the evolution of VUR and new endoscopic surgical techniques in the last decades have led to major changes in the management of this pathology. However, the treatment algorithm remains complex and is composed of a wide variety of options, from active surveillance to surgical treatment. Herein, we propose to review treatment options for VUR in order to help clinicians make the right treatment decision for the right patient.


Combined 3D-tomography and 3D-power Doppler for vascular imaging of the liver.
This study aimed to investigate the role of three-dimensional color tomographic ultrasound (3D-CTU) and three-dimensional color power Doppler (3D-CPD) imaging in diagnostics of liver lesions. Based on 3D-anatomical sectional structures of the liver, we used 3D-CTU and 3D-CPD techniques to reconstitute 3D-images of lobes, segments, and intra-segmental blood vessels, and lesions of the liver. With the use of this technique, we were able to generate 3D vascular patterns of liver lobes, segments and tumor lesions, and their spatial relationship. The observed vascular patterns of intra- and peri-tumor (including surrounding lobes and segments) and the spatial relation can be used for accurate positioning of liver lesions.


The MET axis as a therapeutic target.
The MET receptor tyrosine kinase and its ligand hepatocyte growth factor (HGF) have been implicated in transformation of a variety of malignancies. Chronic or dysregulated activation of the MET/HGF pathway may lead to increased cell growth, invasion, angiogenesis, and metastasis, reduced apoptosis, altered cytoskeletal functions and other biological changes. It has been suggested that ligand activated MET stimulation can be sufficient for a transforming phenotype. In addition, amplification and activation mutations (germline and/or somatic) within the tyrosine kinase domain, juxtamembrane domain, or semaphorin domain have been identified for MET. MET gain-of-function mutations lead to either deregulated or prolonged tyrosine kinase activity, which are instrumental to its transforming activity. A number of therapeutic strategies targeting ligand-dependent activation or the kinase domain have been employed to inhibit MET. The different structural requirements for activation of signaling events and biological functions regulated by MET will be summarized. Therapeutic targets and current pre-clinical and clinical approaches will be described. Targeting the HGF/MET pathway, alone or in combination with standard therapies, is likely to improve present therapies in MET-dependent malignancies.


Photo and Collision Induced Isomerization of a Cyclic Retinal Derivative: An Ion Mobility Study.
A cationic degradation product, formed in solution from retinal Schiff base (RSB), is examined in the gas phase using ion mobility spectrometry, photoisomerization action spectroscopy, and collision induced dissociation (CID). The degradation product is found to be N-n-butyl-2-(β-ionylidene)-4-methylpyridinium (BIP) produced through 6π electrocyclization of RSB followed by protonation and loss of dihydrogen. Ion mobility measurements show that BIP exists as trans and cis isomers that can be interconverted through buffer gas collisions and by exposure to light, with a maximum response at λ = 420 nm.Graphical Abstract.


Total synthesis of (-)-blepharocalyxin D.
[reaction: see text] The Prins cyclization strategy was successfully applied in the total synthesis of (-)-blepharocalyxin D, a cytotoxic dimeric diarylheptanoid isolated from Alpinia blepharocalyx.


National Policies and Older People's Healthcare in Sub-Saharan Africa: A Scoping Review.
Sub-Saharan Africa (SSA) is undergoing a rapid demographic change, with more people reaching old age. There is, however, little information available about healthcare policies with regards to this age group in this region of the world. This scoping review aims to map the healthcare policies in sub-Saharan Africa (SSA) after the 2002 United Nations Madrid International Plan of Action on Ageing (MIPAA) with an eye towards to identifying strategies for promoting older people's access to health care, integration of older people's diseases into primary health care and the level of training and research in geriatrics and gerontology in SSA. This review adopted Arskey and O'Malley's five-step methodology for scoping review and used the guide by Levac et al to operationalize the steps. Potentially relevant literature in English published between January 2003 and December 2017 was identified through PubMed, Google Scholar, EBSCOhost, and manual search. Articles that related to ageing in SSA in line with the aims of the review were included. The identified articles were independently assessed by the authors and the decision on the articles to be included was reached by a consensus. A total of 363 articles were identified through the databases and manual search of which only 4.7% (17/363) of the articles were included in the review. The findings showed that many SSA countries have formulated policies on healthy ageing and a few have policies to promote access to health care for the older people. The integration of non-communicable diseases (NCDs) management into primary health care (PHC) is encouraging but mental health appears to have been completely neglected. Training and research in gerontology and geriatrics are hardly supported by governments in SSA. Significant progress has been made by the SSA countries in policy formulation with regards to older persons but not much has been achieved with the implementation of the policies.


HIV disease surveillance. Collaboration between medicine and public health.
Public Health Surveillance is critical to the management of programs designed to control the epidemic of HIV-AIDS. Surveillance defines changing trends, helps to formulate preventive initiatives and evaluate their effectiveness, and to allocate resources. Collaboration between clinical medicine and public health is essential to achieve reliable surveillance.


Sociodemographic and psychological determinants of influenza vaccine intention among recipients of autologous and allogeneic haematopoietic stem cell transplant: a cross-sectional survey of UK transplant recipients using a modified health belief model.
Studies exploring vaccination rates among haematopoietic stem cell transplant (HSCT) recipients have focused on physician factors that limit uptake. Understanding the patient factors that determine vaccination intention is crucial to delivering a successful vaccination programme. Using a modified health belief model (mHBM), we conducted a cross-sectional survey with the objective of exploring the sociodemographic and psychological factors that determined autologous and allogeneic HSCT recipients' intention to receive the seasonal inactivated influenza vaccine (SIIV) during the 2015-2016 influenza season. The setting of our study was three tertiary level, UK National Health Service (NHS) autologous and allogeneic HSCT centres. Eligible patients were aged 16 years or over and recipients of autologous or allogeneic HSCT for any disease indication, with no absolute contraindication to receiving the SIIV during the next influenza season, and having not received the SIIV since transplant. 93 participants from 3 UK NHS HSCT centres completed an anonymous study-specific questionnaire. 78.5% were recipients of allogeneic and 21.5% autologous HSCT. 23.7% of participants expressed low intent to receive the SIIV. Patients aged over 65 (OR 0.02, 95% CI 0.01 to 0.57, p=0.02) and those who had not received the SIIV prior to HSCT (OR 0.04, 95% CI 0.02 to 0.56, p=0.02) were less likely to have high intent. A multivariate logistic regression model incorporating constructs of the mHBM was statistically significant (p<0.001) and explained 74.7% of variation in SIIV intention. More patients felt that a recommendation from their HSCT team than their general practitioner would prompt them to receive the SIIV, and this was most pronounced in those who had low intent. The mHBM may provide a useful structure for addressing low vaccine intent among HSCT recipients and further interventional studies are warranted. We would encourage HSCT and general practitioners to discuss SIIV intention as a routine part of care.


Direct gene transfer into mouse muscle in vivo.
RNA and DNA expression vectors containing genes for chloramphenicol acetyltransferase, luciferase, and beta-galactosidase were separately injected into mouse skeletal muscle in vivo. Protein expression was readily detected in all cases, and no special delivery system was required for these effects. The extent of expression from both the RNA and DNA constructs was comparable to that obtained from fibroblasts transfected in vitro under optimal conditions. In situ cytochemical staining for beta-galactosidase activity was localized to muscle cells following injection of the beta-galactosidase DNA vector. After injection of the DNA luciferase expression vector, luciferase activity was present in the muscle for at least 2 months.


Dynamical activities of primary somatosensory cortices studied by magnetoencephalography.
A blind identification method of transfer functions in feedback systems is introduced for examination of dynamical activities of cortices by magnetoencephalography study. Somatosensory activities are examined in 5 Hz periodical median nerve stimulus. In the present paper, we will try two careful preprocessing procedures for the identification method to obtain impulse responses between primary somatosensory cortices. Time series data of the somatosensory evoked field are obtained by using a blind source separation of the T/k type (fractional) decorrelation method. Time series data of current dipoles of primary somatosensory cortices are transformed from the time series data of the somatosensory evoked field by the inverse problem. Fluctuations of current dipoles of them are obtained after elimination of deterministic periodical evoked waveforms. An identification method based on feedback system theory is used for estimation of transfer functions in a feedback model from obtained fluctuations of currents dipoles of primary somatosensory cortices. Dynamical activities between them are presented by Bode diagrams of transfer functions and their impulse responses: the time delay of about 30 ms via corpus callosum is found in the impulse response of identified transfer function.


Prehospital therapeutic hypothermia after cardiac arrest: a systematic review and meta-analysis of randomized controlled trials.
Therapeutic hypothermia has been recommended for the treatment of cardiac arrest patients who remain comatose after the return of spontaneous circulation. However, the optimal time to initiate therapeutic hypothermia remains unclear. The objective of the present study is to assess the effectiveness and safety of prehospital therapeutic hypothermia after cardiac arrest. Databases such as MEDLINE, Embase, and Cochrane Library were searched from their establishment date to May of 2012 to retrieve randomized control trials on prehospital therapeutic hypothermia after cardiac arrest. Thereafter, the studies retrieved were screened based on predefined inclusion and exclusion criteria. Data were extracted and the quality of the included studies was evaluated. A meta-analysis was performed by using the Cochrane Collaboration Review Manager 5.1.6 software. Five studies involving 633 cases were included, among which 314 cases were assigned to the treatment group and the other 319 cases to the control group. The meta-analysis indicated that prehospital therapeutic hypothermia after cardiac arrest produced significant differences in temperature on hospital admission compared with in-hospital therapeutic hypothermia or normothermia (patient data; mean difference=-0.95; 95% confidence interval -1.15 to -0.75; I(2)=0%). However, no significant differences were observed in the survival to the hospital discharge, favorable neurological outcome at hospital discharge, and rearrest. The risk of bias was low; however, the quality of the evidence was very low. This review demonstrates that prehospital therapeutic hypothermia after cardiac arrest can decrease temperature on hospital admission. On the other hand, regarding the survival to hospital discharge, favorable neurological outcome at hospital discharge, and rearrest, our meta-analysis and review produces non-significant results. Using the Grading of Recommendations, Assessment, Development and Evaluation methodology, we conclude that the quality of evidence is very low.


Nonparametric identification and maximum likelihood estimation for hidden Markov models.
Nonparametric identification and maximum likelihood estimation for finite-state hidden Markov models are investigated. We obtain identification of the parameters as well as the order of the Markov chain if the transition probability matrices have full-rank and are ergodic, and if the state-dependent distributions are all distinct, but not necessarily linearly independent. Based on this identification result, we develop a nonparametric maximum likelihood estimation theory. First, we show that the asymptotic contrast, the Kullback-Leibler divergence of the hidden Markov model, also identifies the true parameter vector nonparametrically. Second, for classes of state-dependent densities which are arbitrary mixtures of a parametric family, we establish the consistency of the nonparametric maximum likelihood estimator. Here, identification of the mixing distributions need not be assumed. Numerical properties of the estimates and of nonparametric goodness of fit tests are investigated in a simulation study.


Utility of Ascitic Fluid Adenosine Deaminase Levels in the Diagnosis of Tuberculous Peritonitis in General Medical Practice.
Tuberculous peritonitis is difficult to diagnose due to its varying clinical features, in addition to the low yield on bacterial culture or polymerase chain reaction using ascitic fluid samples. This study aimed to investigate the sensitivity and specificity of elevated adenosine deaminase (ADA) levels as a diagnostic marker for tuberculous peritonitis. A retrospective cohort of 181 adult patients who underwent ascitic fluid ADA level examination at Jichi Medical University Hospital between January 2006 and December 2015 were included. We collected data regarding ascitic fluid analyses including ADA levels, bacteriology and cytology, final diagnosis (cause of ascites), basis of the diagnosis, duration to diagnosis, and disease outcome. Among 181 patients, elevated ascitic ADA levels (≥40 IU/L) were observed in 15 patients (median, 87.2 IU/L; range, 44.0-176.1 IU/L); 8 patients had tuberculous peritonitis, 4 had lymphoma-related ascites, and 2,had peritoneal carcinomatosis with bacterial coinfection, and 1 had chlamydial pelvic inflammatory disease. Among 166 patients without ascitic ADA level elevation (median, 7.3 IU/L; range, <2.0-39.1 IU/L), none had tuberculosis, 4 had lymphoma-related ascites, 28 had cancer/mesothelioma-related ascites, and 134 had ascites due to other causes. In our cohort, elevated ascitic fluid ADA levels (≥40 IU/L) showed 100% sensitivity, 96.0% specificity, 53.3% positive predictive value (PPV), and 100% negative predictive value for the diagnosis of peritoneal tuberculosis. Ascitic fluid ADA levels ≥40 IU/L showed excellent sensitivity, despite a low PPV, for the diagnosis of tuberculous peritonitis. Lymphoma-related ascites is an important mimic of tuberculous peritonitis that can result in high ascitic fluid ADA levels with similar clinical manifestations.


Refinement of the crystal structure of fresnoite, Ba2TiSi2O8, from Löhley (Eifel district, Germany); Gladstone-Dale compatibility, electronic polarizability and vibrational spectroscopy of minerals and inorganic compounds with pentacoordinated TiIV and a titanyl bond.
Most known compounds with five-coordinated Ti4+ are natural and synthetic titanosilicates. The crystal structure of natural fresnoite, Ba2TiSi2O8 [tetragonal, space group P4bm, a = 8.510 (1) Å, c = 5.197 (1) Å, V = 376.4 (1) Å3, Z = 2], has been refined to R = 0.011 on the basis of 807 unique single-crystal reflections with I > 2σ(I). Titanium has fivefold coordination with one short (`titanyl') bond of 1.692 (5) Å. Bonds in the TiO5 polyhedron are discussed in comparison to analogous coordination polyhedra in other minerals and compounds. A review of all known compounds with Ti4+O5 polyhedra shows that most of them are titanosilicates in which titanium forms a short Ti-O bond (∼1.61 to ∼1.77 Å). Poor Gladstone-Dale compatibility between chemical composition, optical characteristics and density of these compounds is explained by the anomalous contribution of [5]Ti4+ to the optical properties as shown by calculations based on the relationship between electronic polarizabilities and refractive indices. An improved Gladstone-Dale coefficient of 0.29 is suggested for TiO2 with [5]Ti4+. A negative correlation between `titanyl' bond lengths and wavenumbers of the bands of Ti-O stretching vibrations (in the range of 890-830 cm-1) in infrared and Raman spectra is observed.


Age-related risk profile and chemotherapy dose response in acute myeloid leukemia: a study by the German Acute Myeloid Leukemia Cooperative Group.
The purpose of the study was to assess the contribution of age and disease variables to the outcome of untreated patients with acute myeloid leukemia (AML) receiving varying intensive induction chemotherapy. Patients 16 to 85 years of age with primary AML, known karyotype, and uniform postremission chemotherapy enrolled onto two consecutive trials were eligible and were randomly assigned to induction either with a standard-dose (cytarabine, daunorubicin, and 6-thioguanine) and a high-dose (cytarabine and mitoxantrone) combination, or with two courses of the high-dose combination. Subgroups were defined by karyotype, nucleophosmin and FLT3 mutation, WBC count, serum lactate dehydrogenase, and residual blasts. In 1,284 patients, the overall survival at 4 years in those younger and older than 60 years was 37% versus 16% (P < .001) and the ongoing remission duration was 46% versus 22% (P < .001). Similar age-related differences in outcome were found for all defined subgroups. No difference in outcome according to randomly assigned treatment regimen was observed in any age group or prognostic subset. Regarding prognostic subgroups, molecular factors were also considered. Under harmonized conditions, older and younger patients with AML show modest differences in their risk profiles and equally no dose response to intensified chemotherapy. Their observed fundamental difference in outcome across all subgroups remains unexplained. Further molecular investigation may elucidate the age effect in AML and identify new targets.


Brief report: requirement of TACE/ADAM17 for hair follicle bulge niche establishment.
Hair follicles (HFs) are equipped with stem cell niches that allow regeneration. Tumor necrosis factor-α converting enzyme (TACE), also known as A disintegrin and metalloproteinase 17, is a proteolytic enzyme that regulates a variety of cell surface molecules including TNF-α, via ectodomain shedding. We found TACE expression on mouse HFs and conditionally depleted it in cells that expressed sex-determining region Y-related high-mobility-group box 9 (SOX9) transcription factor, an HF stem cell transcription factor (Tace(flox/flox) -Sox9-Cre, hereafter, "Tace/Sox9"). Tace/Sox9 mice were born with brittle hair with prolonged anagen phase. They underwent diffuse, progressive, and ultimately whole-body hair loss by 20 weeks old. Tace/Sox9 HFs lacked CD34(+) bulge cells as demonstrated via immunofluorescence microscopy and flow cytometry. Real-time PCR revealed downregulation of transcription factors Sox9, Lhx2, and Gata3 and upregulation of Lef1. In vitro colony-forming capacity was abolished in Tace/Sox9 keratinocytes, and HFs exhibited increased proliferation in situ, collectively demonstrating that Tace/Sox9 mice failed to establish the bulge niche and to maintain "stemness" of HF stem cells. Epidermal growth factor receptor (EGFR) signaling was impaired in Tace/Sox9 keratinocytes, and mice depleted of Egfr in SOX9-expressing tissues exhibited hair phenotype nearly identical to Tace/Sox9 mice, demonstrating EGFR signaling as a pathway downstream of TACE in HF homeostasis. This study provides mechanistic implication for human TACE-deficiency and for hair abnormality caused by EGFR inhibitors.


[Clinicopathological features and prognostic factors of breast cancer patients with inguinal lymph node metastases: a report of 17 cases].
To analyze the clinicopathological features and prognostic factors of breast cancer patients with inguinal lymph node metastases. Seventeen breast cancer patients with inguinal lymph node metastases were treated from January 1999 to December 2010 in our cancer center. All of the patients had a history of breast cancer without other primary cancer. Their clinicopathological characteristics and prognostic factors were surveyed. The frequency of breast cancer cases with inguinal lymph node metastaseis consisted of 0.11% of the total number of breast cancer patients in the same period. Two patients (11.8%) had inguinal lymph node metastasis only, and multi-site metastases were observed in the remaining 15 (88.2%) patients. The number of ER- and/or PR-positive and negative were 10 (58.8%) and 7 (41.2%) cases, respectively, and among the 13 cases who underwent HER-2 test, the number of HER-2-positive was 4 (30.8%). For the 16 patients who underwent surgery, 9 patients were detected with metastatic axillary lymph nodes equal or greater than 4. All of the 17 patients were treated with chemotherapy.The median follow-up time was 156 months. The 5-year overall survival rate was 49.9%. Univariate analysis revealed that metastatic axillary lymph nodes ≥ 4, ER- and(or) PR-negative, adjuvant chemotherapy ≤ 6 cycles, disease stage as III/IV at diagnosis and the period from diagnosis of breast cancer to the occurrence of inguinal lymph node metastasis ≤ 36 months were predictors of shorter PFS (P < 0.05). Metastatic axillary lymph nodes ≥ 4, ER- and(or) PR-negative, adjuvant chemotherapy ≤ 6 cycles, primary recurrence as multiple distant metastases, the period from diagnosis of breast cancer to the occurrence of inguinal lymph nodes metastasis ≤ 36 months and pleural effusion were predictors of shorter OS (P < 0.05). Multivariate analysis revealed that the period from diagnosis of breast cancer to the occurrence of inguinal lymph node metastasis was an independent prognostic factor concerning PFS (P < 0.05). The prognostic factors of breast cancer patients with inguinal lymph node metastases include the number of metastatic axillary lymph nodes, ER and(or) PR status, the cycles of adjuvant chemotherapy, type of primary recurrence, the period from diagnosis of breast cancer to the occurrence of inguinal lymph node metastasis and pleural effusion. Regular and complete physical examination after surgery as well as prompt intensive treatment for high-risk patients may have positive significance in the treatment of such type of patients. However, a type of more reasonable and individualized treatment is warranted in future studies.


Chronic kidney disease monitoring in Australian general practice.
Kidney Health Australia recommends regular monitoring of patients with chronic kidney disease (CKD) to reduce progression and prevent complications such as cardiovascular disease. The objective of this study was to examine how practice aligns with the recommendations in Kidney Health Australia's CKD guidelines. Australian general practice data from the NPS MedicineWise MedicineInsight program (1 January 2013 - 1 June 2016) for 19,712 adults with laboratory evidence of stage 3 CKD were analysed. Complete monitoring in these individuals was defined as having at least one recorded assessment of blood pressure, urine albumin-to-creatinine ratio, estimated glomerular filtration rate and serum lipids over an 18-month period. Complete monitoring was performed for 25% of the cohort; 54.9% among patients with concomitant diabetes and 14.1% among patients without diabetes. Patients with diabetes, hypertension and a documented diagnosis of CKD were more likely to have complete monitoring. There is room for improvement in monitoring of patients with stage 3 CKD, particularly for albuminuria, which was monitored in fewer than 50% of these patients.


Clinically insignificant (natural) autoantibodies against acetyl cholinesterase in the sera of patients with a variety of neurologic, muscular and autoimmune diseases.
Acetyl cholinesterase (AChE) antibodies were shown to be associated with myasthenia-like neuromuscular disease. However, it is not clear whether they cause the disease, or their presence is secondary to the disease or an unrelated epiphenomenon. Therefore, AChE antibodies were studied in the sera of 135 patients with neurologic, muscular and autoimmune diseases, using enzyme linked immunosorbent assay (ELISA), immunoblotting and enzyme inhibition assay. In 12 sera the AChE binding by ELISA was greater than 2 standard deviations (SDs) above the mean value of the 20 healthy controls. However, this increased binding was not disease-specific, had no clinical correlates and could not be demonstrated using Western blotting and AChE enzyme inhibition assay, suggesting that these antibodies are naturally occurring, pathogenically unimportant autoantibodies. The finding also supports a possible pathogenic role for the previously reported, high titer, high affinity, inhibitory AChE antibodies in the neuromuscular disease.


[COMMON TREATMENT FOR ACUTE TONSILLITIS IN THE COMMUNITY].
Streptococcal tonsillitis among adults is a common diagnosis. There is wide agreement regarding the recommended treatment, which is Phenoxymethyl Penicillin (Penicillin V) 1000 mg daily (usually 500 mg BID for 10 days). Description of the variability of routine antibiotic treatment prescribed by family physicians in the community for the treatment of acute tonsillitis (which represents a common diagnosis in primary care), and observation of the prescribed antibiotics adherence to the guidelines. Nine primary care physicians in urban clinics of Clalit Health Services, were included in the study. Information regarding 320 adult patients, 18 years of age or older, treated by them, was collected. Patients allergic to penicillin were not included. Comparison between the different medications was performed with relevant statistical tests. Data regarding 95 men (30% of patients) and 224 women (70% of patients) was collected; the age range was 24 - 86 years old (average 38 years). Streptococcus group A was sensitive to all antibiotics prescribed; 70% (n=224) were prescribed with Penicillin V and the rest were given prescriptions for other antibiotics. From those who were given Penicillin V, 54% (n=121) were prescribed the recommended dosage (500 mg BID); 34% (n=77) were prescribed double dosage (1000 mg BID), whereas the rest of the patients received prescriptions for other dosages. Difference in treatment regimens was observed among the participating physicians regarding the choice and the dosage of the antibiotics they prescribed. In the medical files, there were no explanations regarding the different antibiotics or dosages. Streptococcus A tonsillitis is a common diagnosis with wide consensus regarding the recommended antibiotic treatment. In spite of this consensus, there is significant prescribing variability among different physicians. This is emphasized by the fact that all the physicians who were included in the study work in urban clinics with similar characteristics. In view of the variation among primary care physicians regarding antibiotic prescription for a very common diagnosis, we see a need to investigate other treatment protocols for other common diagnoses. This is in order to ensure proper care and avoiding health complications while saving funds.


[Association of FOXP3 gene polymorphism in Chinese women with endometriosis].
To assess the association between single nucleotide polymorphisms (SNPs) of forkhead box P3 gene (FOXP3) and endometriosis in Chinese Han women from central China. MassARRAY IPLEX and matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS) technique was used to determine the genotypes of FOXP3 gene in 314 patients with endometriosis and 358 healthy controls. Genotypes of C/T polymorphism for the rs2280883 locus, A/C for the rs3761548 locus, and C/T for the rs3761549 locus were determined. No significant difference was detected in distribution of genotypes CC, CT and TT (P=0.770, OR=0.960; P=0.923, OR=1.013) and frequencies of C and T alleles (P=0.772, OR=0.960; P=0.925, OR=1.013) for rs2280883 and rs3761549 between the two groups. And no significant difference was detected in distribution of genotypes AA, AC and CC (P=0.762, OR=0.958) and frequencies of A and C alleles (P=0.715, OR=0.950) for rs3761548 was detected between the two groups. Based on r-AFS classification, the patients were divided into two groups (respectively with I-II stage and III-IV stage endometriosis). Again, no significant difference was detected in distribution of genotypes CC, CT and TT (P=0.454, OR=1.198, P=0.526, OR=0.909; P=0.220, OR=0.750, P=0.548, OR=1.094) and frequencies of C and T alleles (P=0.473, OR=1.215, P=0.532, OR=0.912; P=0.204, OR=0.737, P=0.558, OR=1.089) for rs22080883 and rs3761549 loci between the two patient groups. No association was found between distribution of genotypes AA, AC and CC (P=0.431, OR=1.211; P=0.508, OR=0.905) and frequencies of A and C alleles (P=0.417, OR=1.226; P=0.516, OR=0.908) for rs3761548 locus between the two patient groups. Our study has failed to found any association between FOXP3 gene polymorphisms rs2280883, rs3761548 and rs3761549 with endometriosis in Chinese Han patients.


The dynamics of physical and mental health in the older population.
Mental and physical aspects are both integral to health but little is known about the dynamic relationship between them. We consider the dynamic relationship between mental and physical health using a sample of 11,203 individuals in six waves (2002-2013) of the English Longitudinal Study of Ageing (ELSA). We estimate conditional linear and non-linear random-effects regression models to identify the effects of past physical health, measured by Activities of Daily Living (ADL), and past mental health, measured by the Centre for Epidemiological Studies Depression (CES-D) scale, on both present physical and mental health. We find that both mental and physical health are moderately state-dependent. Better past mental health increases present physical health significantly. Better past physical health has a larger effect on present mental health. Past mental health has stronger effects on present physical health than physical activity or education. It explains 2.0% of the unobserved heterogeneity in physical health. Past physical health has stronger effects on present mental health than health investments, income or education. It explains 0.4% of the unobserved heterogeneity in mental health. These cross-effects suggest that health policies aimed at specific aspects of health should consider potential spill-over effects.


Application of plasma immersion ion implantation for surface modification of nickel-titanium rotary instruments.
By means of X-ray photoelectron spectroscopy (XPS) and differential scanning calorimetry (DSC), this study set out to investigate the application of plasma immersion ion implantation (PIII) for the surface modification of ProTaper NiTi rotary instruments. This study was undertaken because the PIII method was perceived to have the potential of developing into a standard surface modification technique that improves clinical quality and outcome. Specimens received nitrogen ion or nitrogen plus argon ion implantation. XPS analyses with and without argon ion etching were obtained for all specimens. In addition, DSC analysis was performed to investigate the phase transformation behavior of the bulk material. Results indicated that the surfaces of NiTi instruments were successfully modified by nitrogen PIII, whereby a light golden TiN layer was yielded. Moreover, the PIII technique did not alter the superelastic character of NiTi instruments because it was carried out at near-room temperature. We thus concluded that nitrogen PIII is a promising surface modification technique to improve the surface characteristics of NiTi rotary instruments.


Glioma FMISO PET/MR Imaging Concurrent with Antiangiogenic Therapy: Molecular Imaging as a Clinical Tool in the Burgeoning Era of Personalized Medicine.
The purpose of this article is to provide a focused overview of the current use of positron emission tomography (PET) molecular imaging in the burgeoning era of personalized medicine in the treatment of patients with glioma. Specifically, we demonstrate the utility of PET imaging as a tool for personalized diagnosis and therapy by highlighting a case series of four patients with recurrent high grade glioma who underwent 18F-fluoromisonidazole (FMISO) PET/MR (magnetic resonance) imaging through the course of antiangiogenic therapy. Three distinct features were observed from this small cohort of patients. First, the presence of pseudoprogression was retrospectively associated with the absence of hypoxia. Second, a subgroup of patients with recurrent high grade glioma undergoing bevacizumab therapy demonstrated disease progression characterized by an enlarging nonenhancing mass with newly developed reduced diffusion, lack of hypoxia, and preserved cerebral blood volume. Finally, a reduction in hypoxic volume was observed concurrent with therapy in all patients with recurrent tumor, and markedly so in two patients that developed a nonenhancing reduced diffusion mass. This case series demonstrates how medical imaging has the potential to influence personalized medicine in several key aspects, especially involving molecular PET imaging for personalized diagnosis, patient specific disease prognosis, and therapeutic monitoring.


Corneal transplantation.
Corneal transplantation has become increasingly successful as a result of improved methods of tissue procurement and preservation, refined surgical techniques, better medical care, heightened public awareness and an expanded network of eye banks. Vision improves within a day of surgery and continues to improve for six months to one year. Careful screening of donors and donor corneal tissue is essential. Causes of transplantation failure include rejection, glaucoma and recurrent infections.


Pain prevalence in patients with chronic kidney disease.
The prevalence of pain in patients with chronic kidney diseases (CKD) is not known. In the current study, we aim to determine the prevalence of pain in CKD patients and its associations with various medical and psychosocial factors. Consecutive CKD patients who were presented to the renal clinic at Olive View-UCLA Medical Center, a Los Angeles County tertiary referral center, over a 3-month period were interviewed on their medical and psychosocial histories and a history of pain including duration, severity and source. Chi2-testing for independence and binary logistic regression performed for the presence of pain and CKD stages as well as other medical and psychosocial factors were determined. A separate survey for pain was also done for 100 consecutive non-CKD patients who were presented to our ambulatory medicine clinic for routine care. 54.6% of 130 patients with known CKD interviewed were women. Any type of pain of at least a 2 week duration was reported in 72.9%. The most common source of pain was musculoskeletal. The presence of pain of less than a 2 week duration was associated with worse CKD stages (3 - 5 versus 1 - 2) and non-exercisers. Higher body mass index was associated with having pain lasting longer than a 2 week duration. Among patients who had pain, 33.8% used acetaminophen, 15.4% nonsteroidal anti-inflammatory drugs and 7.8% combination analgesics. In contrast to CKD patients, only 9% of non-CKD patients reported to have any type or duration of pain. Pain was much more prevalent among our CKD compared with non-CKD patients.


Adipokines, myokines and cardiovascular disease.
It is recognized that obesity contributes to cardiovascular and metabolic disorders through alterations in the levels of adipocyte-derived cytokines (adipokines). Adiponectin is an adipokine that is downregulated in obese individuals. It has beneficial actions on the cardiovascular system by directly acting on the heart and blood vessels, and acute administration of adiponectin can minimize the tissue damage resulting from myocardial infarction. More recent research has been aimed at identifying novel adiponectin-like factors involved in metabolic and cardiovascular regulation. Activation of Akt, a protein kinase involved in cell signaling, has been implicated in the control of skeletal muscle hypertrophy. An experimental mouse model demonstrates that substantial increases in muscle fiber hypertrophy, weight and strength occur upon induction of Akt signaling in skeletal muscle. In a mouse model of obesity, the increase in muscle mass caused by myogenic Akt induction results in diminished fat deposition and improvements in whole body metabolism. Based on these findings a protocol to identify novel muscle-secreted proteins (myokines) that confer the phenotypic changes brought on by myogenic Akt induction has been devised. One of these newly discovered factors, referred to as follistatin-like 1, is able to promote revascularization in ischemic limbs and protect the heart from ischemic stress.


Are children's dental panoramic tomographs and lateral cephalometric radiographs sufficiently optimized?
Children are especially vulnerable to harmful effects of ionizing radiation. Cutting down the dimensions of the X-ray beam is the most effective way to reduce the patient dose. We evaluated the appropriateness of field-size in the most frequent radiographs, dental panoramic tomographs (DPTs) and lateral cephalometric radiographs (LCRs) among 7- to 12-year-olds. The image field-size of 241 DPTs and 118 LCRs was analysed. The image field was considered appropriate when it did not include anatomic structures beyond the area of clinical interest. The image field was compared with factors such as the age of the patient, the radiographic equipment used and the programme selected. Moreover, we assessed the use of thyroid shield in LCR. The field-size was too large in 70% of the DPTs horizontally and in 96% vertically. None of the DPTs were segmented. Every LCR showed appropriate limitation anteriorly, but the image field was too large in 54% posteriorly, in 86% superiorly, and in 76% inferiorly. A thyroid shield had been used in only 71% of cases. Most DPTs and LCRs had been performed sub-optimally. An abundancy of DPTs had been taken using an adult programme, and the field-size had not been sufficiently adjusted in LCRs, possibly for technical reasons. To facilitate adherence to radiological best practice the equipment used for DPTs and LCRs should facilitate the adjustment of field-size in both the vertical and horizontal planes. In addition, those involved in taking radiographs should maintain their skills through regular update courses.


Regulation of Charge Carrier Dynamics in ZnO Microarchitecture-Based UV/Visible Photodetector via Photonic-Strain Induced Effects.
A feasible, morphological influence on photoresponse behavior of ZnO microarchitectures such as microwire (MW), coral-like microstrip (CMS), fibril-like clustered microwire (F-MW) grown by one-step carrier gas/metal catalyst "free" vapor transport technique is reported. Among them, ZnO F-MW exhibits higher photocurrent (IPh ) response, i.e., IPh/ZnO F-MW > IPh/ZnO CMS > IPh/ZnO MW . The unique structural alignment of ZnO F-MW has enhanced the IPh from 14.2 to 186, 221, 290 µA upon various light intensities such as 0 to 6, 11, 17 mW cm-2 at λ405 nm . Herein, the nature of the as-fabricated ZnO photodetector (PD) is also demonstrated modulated by tuning the inner crystals piezoelectric potential through the piezo-phototronic effect. The IPh response of PD decreases monotonically by introducing compressive strain along the length of the device, which is due to the synergistic effect between the induced piezoelectric polarization and photogenerated charge carriers across the metal-semiconductor interface. The current behavior observed at the two interfaces acting as the source (S) and drain (D) is carefully investigated by analyzing the Schottky barrier heights (ΦSB ). This work can pave the way for the development of geometrically modified strain induced performances of PD to promote next generation self-powered optoelectronic integrated devices and switches.


The medical futility debate: patient choice, physician obligation, and end-of-life care.
Physicians' use of the "medical futility" concept to override the treatment demands of patients or their family/surrogates is difficult to justify in principle. At the same time, patient demands for obviously futile treatments can conflict with physicians' professional obligation to do no harm to their patients. There is no clear general principle available to resolve this conflict between patient self-determination and physician autonomy; extended negotiation between patient or family/surrogates and physicians provides the only prospect for satisfactory resolution. Though such negotiation will not invariably succeed in reaching agreement, the legal system should ensure that each side has some practical measure of independent authority and power to exert against the other in order to maximize the likelihood that the negotiating process will be seriously engaged.


Antidepressant-like effect of tramadol in the unpredictable chronic mild stress procedure: possible involvement of the noradrenergic system.
Tramadol, which inhibits the reuptake of noradrenaline and serotonin, is effective in animal models of depression. Its antidepressant-like effects may be mediated mainly by the noradrenergic system. This study investigated the role of the noradrenergic system in the antidepressant-like effects of tramadol and desipramine in the unpredictable chronic mild stress model. We assessed the involvement of beta-adrenoreceptors, particularly beta2-receptors in the activity of these drugs. In addition, we measured the level of noradrenaline and its metabolite 3-methoxy-4-hydroxy-phenylglycol (MHPG) in the locus coeruleus, hypothalamus, hippocampus and cerebellum in stressed mice. Unpredictable chronic mild stress induced a degradation of coat state and decreased grooming behaviour in the splash test, which was reversed by the chronic administration of tramadol (20 mg/kg) and desipramine (10 mg/kg). The nonselective beta-adrenoreceptor antagonist propranolol (5 mg/kg, intraperitoneally) and the selective beta2-receptor antagonist ICI 118,551 (2 mg/kg, intraperitoneally) reversed the antidepressant-like effects of tramadol and desipramine. Moreover, chronic tramadol and desipramine treatment increased the level of noradrenaline (NA) and MHPG in the locus coeruleus but not in the cerebellum, whereas only MHPG level was increased in the hypothalamus. Tramadol, however, increased the levels of MHPG and NA in the hippocampus, whereas desipramine only increased NA level. These data support the view that the noradrenergic system plays an important role in the antidepressant-like action of tramadol.


[A case of giant thyroid tumor with tracheal stenosis].
A 61-year-old female underwent resection of a giant thyroid tumor, and tracheal stenosis ensued. She had cough, dyspnea, and palpitation in the supine position. The giant thyroid tumor was of the size of 11 x 12 cm and the diameter of trachea was 8 x 6 mm at 3.5 cm below the vocal cord, at which point the trachea was the narrowest on cervical computed tomography. The peak expiratory flow rate from the flow-volume curve was 2.94 l x sec(-1) (% predicted value 55.2%) in the upright position. We were concerned about difficult airway management. Oro-tracheal intubation with an armored tube (ID 7.5 mm) was performed after intravenous midazolam 2 mg and fentanyl 50 microg, 4% lidocaine spray 2 ml with oxygen 6 l x min(-1) inhalation keeping spontaneous breathing and consciousness. Anesthesia was induced and maintained with intravenous propofol, fentany, vecuronium and nitrous oxide in oxygen to keep the bispectral index between 40 and 60. The extracted thyroid tumor was 620 g in weight. A careful preoperative evaluation of the airway using ultrasonography, CT, MRI, laryngoscopy, bronchoscopy and respiratory function test, especially peak expiratory flow rate of the flow-volume curve is important in such a case of a giant thyroid tumor. Intubation under conscious sedation with midazolam and fentanyl is useful for a patient with a giant thyroid tumor and tracheal stenosis.


Life events and subsequent illness.
The objective was to examine for relationships between stress, as measured by life events, and hospitalization or death during the following 6 to 12 months, using a case-control design. As part of the Community Mental Epidemiology Program, life events data for the preceding year were gathered on a random sample of the population at two sites, and health data for the interval between interviews were collected at follow-up. A case is defined as anyone becoming ill and being hospitalized or dying during the interval between interviews. Each case was individually matched by several variables to a control who had neither been sick nor hospitalized. There were no significant demographic differences between cases and control in either site or between sites. When life events were examined by various scoring methods, there were no differences between cases and controls. This finding is important since most longitudinal studies that have shown a positive relationship between life events and subsequent illness have had methodologic limitations or have been based on healthy, young, male populations who generally did not become seriously ill during the study period. The results of this study plus the lack of generalizability of previous findings and their somewhat conflicting results raise serious questions about the etiologic relationship of life events to subsequent illness.


Impact of neck length on the safety of percutaneous and surgical tracheotomy: a prospective, randomized study.
To investigate a correlation between neck length and the incidence of complications after both percutaneous and surgical tracheotomy (ST) and to compare the relative safety of the two procedures at our institution. Prospective, randomized study of patients undergoing tracheotomy at a tertiary care center. Forty-three patients evaluated for tracheotomy at our institution between the years 2003 and 2004 were enrolled in the study and were randomly assigned to receive either an ST or a percutaneous dilatational tracheotomy (PDT). All patients underwent standardized measurement of the cricosternal distance (CSD) in the neutral and extended positions before the procedure. Demographic and procedural variables were recorded, and the occurrence of postoperative complications was followed for 1 week. PDT was performed in 29 patients and ST in 14 patients. The mean CSD of 2.7 cm increased to 3.7 cm after extension with a shoulder roll. PDT required less time (mean 8 vs. 23 minutes) and resulted in less blood loss compared with ST. A trend toward a higher incidence of complications with PDT (40%) compared with ST (7%) and in the first half of our series (learning curve) was noted. This, however, did not reach statistical significance. There was no correlation between the incidence of complications and neck length as determined by the CSD in either group of patients. We failed to demonstrate a correlation between CSD and tracheotomy related complications. Patients with short necks may be at no higher risk during either a PDT or ST. Experience, awareness of complications, and a dedicated team approach are necessary for the safe performance of PDT.


Copper-catalyzed electrophilic amination of sodium sulfinates at room temperature.
By using O-benzoyl hydroxylamines as amine sources, the first convenient copper-catalyzed electrophilic amination of sodium sulfinates has been realized. Even with 2 mol% catalyst loading, the protocol provided an efficient and straightforward synthesis of a broad range of functional sulfonamides under ambient reaction conditions without an additional base and ligand. Based on the control experiments, a plausible mechanism was proposed.


[Does left-handedness affect the pattern of cerebral blood flow during cognitive activity?].
In most people the left hemisphere of the brain is dominant for language functions. Because of an increased incidence of atypical language lateralisation in the right hemisphere of left-handed neurological patients, more systematic studies on handedness and cerebral asymmetry of language have been undertaken. The present study is aimed at clarification of the relationship between handedness and language dominance in healthy subjects. Lateralisation was measured directly using functional transcranial Doppler sonography in left-handed subjects. Twenty-six individuals participated in the study. Three kinds of tasks were used, differing in the material involved and in appropriate strategies to be employed by the subjects. Two important parameters of the MCA blood flow were analysed: mean relative increase in the blood flow velocity (MDV) and specific patterns of cognitive task performance (i.e. performance profiles). Our results indicate that the incidence of the right hemisphere dominance for language depends on the degree of handedness, since only in the group of consistent left-handers language was right lateralised. In other left-handers both cerebral hemispheres were functionally equivalent. The measurement of MCA blood flow velocity changes using transcranial Doppler ultrasonography seems to be a simple and non-invasive method of assessing the functioning of the two hemispheres of human brain.


A facile synthesis of poly(3-octylthiophene)-titanium dioxide nanocomposite particles in supercritical CO2.
Poly(3-octylthiophene) (P3OT)-titanium dioxide (TiO2) nanocomposite powder where TiO2 was embedded with homogeneous dispersion was synthesized by in-situ chemical oxidative polymerization of 3-octylthiophene in the presence of TiO2 nanoparticles in supercritical carbon dioxide (scCO2), using ferric chloride as the oxidant. The synthesized materials could be obtained as dry powder upon venting of CO2 after the polymerization. The composites were subsequently characterized by FT-IR spectroscopy, transmission electron microscopy (TEM), X-ray diffraction studies (XRD), thermogravimetric analysis (TGA) and photoluminescence (PL). The incorporation of TiO2 in the composite was endorsed by FT-IR studies. TGA revealed enhanced thermal stability of P3OT/TiO2 nanocomposite compared to 3-octylthiophene. TEM analysis showed that well dispersed TiO2 nanoparticles in the polymer matrix. Photoluminescence quenching increased with increasing TiO2 concentration in the composite.


Two ear problems you may not need to refer. Otitis externa and bullous myringitis.
Primary care physicians are being forced to broaden the scope of their practice because of the financial restraints placed on them by managed care. Common otologic conditions such as otitis externa and bullous myringitis, which are often referred to otolaryngologists, can be promptly diagnosed and treated by primary care physicians. Referral to a subspecialist is indicated when symptoms persist despite treatment and when the cause of ear pain remains unexplained after thorough evaluation.


Strategies to prevent BK virus infection in kidney transplant recipients.
Despite improvements in posttransplant care, BK virus (BKV) remains one of the most challenging posttransplant infections in kidney transplant recipients with high rates of allograft failure. In the absence of well tolerated and efficacious viral specific therapeutics, treatment is primarily focused on reduction of immunosuppression, which poses a risk of rejection and fails to lead to viral clearance in a number of patients. Recent work has turned toward preventive therapies analogous to those used for other infections like cytomegalovirus. These efforts have focused on the use of quinolone antibiotic prophylaxis to prevent BKV infection and pretransplant vaccination to boost humoral and cellular immunity. Despite promising in-vitro and observational data, quinolone antibiotic prophylaxis has not been effective in preventing BKV infection in prospective studies. However, prophylaxis with newer less toxic viral specific agents such as brincidofovir - the lipid oral formulation of cidofovir - may yet prove effective. Strategies focused on eliciting a humoral immune response to recombinant virus-like particles or using adoptive transfer of BKV-specific T cells have also shown significant potential to prevent BKV infection in organ transplant recipients.


Alcohol use disorder in the intensive care unit a highly morbid condition, but chemical dependency discussion improves outcomes.
Alcohol use disorders (AUD) are common in patients admitted to intensive care units (ICU) and increase the risk for worse outcomes. In this study, we describe factors associated with patient mortality after ICU admission and the effect of chemical dependency (CD) counseling on outcomes in the year following ICU admission. We retrospectively reviewed patient demographics, hospital data, and documentation of CD counseling by medical providers for all ICU patients with AUD admitted to our institution between January 2017 and March 2019. Primary outcomes were in-hospital and 1-year mortality. Of the 527 patients with AUD requiring ICU care, median age was 56 years (range, 18-86). Both in-hospital (12%) and 1-year mortality rates (27%) were high. Rural patients, comorbidities, older age, need for mechanical ventilation, and complications were associated with increased risk of in-hospital and 1-year mortality. CD counseling was documented for 73% of patients, and 50% of these patients accepted alcohol treatment or resources prior to discharge. CD evaluation and acceptance was associated with a significantly decreased rate of readmission for liver or alcohol-related issues (36% vs. 58%; odds ratio [OR], 0.41; 95% confidence interval [CI], 0.27-0.61) and 1-year mortality (7% vs. 19.5%; OR, 0.32; 95% CI, 0.16-0.64). CD evaluation alone, regardless of patient acceptance, was associated with a significantly decreased 1-year post-discharge mortality rate (12% vs. 23%; OR, 0.44; 95% CI, 0.25-0.77). ICU patients with AUD had high in-hospital and 1-year mortality. CD evaluation, regardless of patient acceptance, was associated with a significant decrease in 1-year mortality.


[Effect of some trace elements on Heterakis gallinarum invasion].
It was found that sodium chloride at the rate of 0.5 per cent in the mixtures lowers by 25 times the survival of the Heterakis helminths in birds, prevents the manifestation of verminous typhlitis, alters the ratio between the female and the male worms in favour of the latter, contributes to the increase in body weight and rises the level of the total protein in the blood serum, and changes the protein spectrum raising the level of globulins. Positive results at a lower size were established in feeding cobaltinitrite and soduim selenite to birds. Last ranked the effects produced with the offer of zinc sulfate. The admixture of sodium chloride at the rate of 0.5 per cent of birds is suggested both from the standpoint of Heterakis control and prophylaxis and from the point of view of pathogenesis.


[Coronary syndromes in the elderly].
Acute coronary syndromes (ACS) are frequent in the elderly and carry a poor prognosis. Severe coronary artery disease, frequent comorbidity, late diagnosis, and treatments themselves are responsible for high morbidity and mortality rates. Reluctance to treat elderly patients with new mechanical or chemical revascularization techniques is due to the higher risk profile. ACS may or may not be accompanied by ST elevation: STEMI corresponds to acute myocardial infarction before myocardial necrosis, while non STEMI corresponds to unstable angina and subendocardial necrosis. Despite the high incidence of STEMI in the elderly, older patients have been excluded from large randomized trials. Chemical and mechanical reperfusion are the two recommended treatments for patients hospitalized before the 6th hour. Intravenous thrombolysis is the most common strategy: it offers a 26% reduction in mortality compared to conventional treatment, but carries a higher risk of brain hemorrhage than in younger patients. In high-throughput centers with experienced cardiologists, primary angioplasty seems to be the optimal strategy, with fewer deaths and recurrent ischemia. Two approaches are possible for NST-ACS: conservative or interventional. The latter includes medical treatment, early coronarography and revascularization by angioplasty or surgery. This strategy, combined with aspirin, clopidogrel, and glycoprotein II B/IIIa receptor inhibitors, offers a larger absolute reduction in the 30-day major adverse clinical event rate than conservative management. Dedicated randomized trials are needed to provide a more thorough picture of ACS management in the elderly.


Sacred space at the moment of birth.
This paper focuses on the experience of sacred space at the moment of birth. Through the stories of those present, a powerful and vulnerable space is revealed, where something magical and deeply tender emerges, creating feelings of connection and transformative new possibilities. Sacred space is a revered and honoured space that holds a shared sense of the miraculous. This paper argues that something ineffable occurs at the moment of birth, opening up sacred space which requires our protection in whatever circumstances it happens. How we are and what we do in birth's sacred space is highlighted, to challenge and initiate further thinking. Data in this paper are drawn from a larger hermeneutic phenomenological study that examines the experiences of joy at birth, for which ethical approval was given by AUTEC, New Zealand.