Estimating the cumulative number of human immunodeficiency virus diagnoses by cross-linking from four different sources.
We estimated the cumulative number of people diagnosed with human immunodeficiency virus (HIV) infection in a region of Italy by cross-linking data from four surveillance systems and applying capture-recapture methods. The study was conducted using data referring to residents of the Veneto Region (population 4.4 million). We cross-linked data from the AIDS Registry (data 1983-2000), the HIV Registry (1988-2000), the Death Registry (1992-1999), and the Hospital-Discharge Registry (1997-2000), using a code based on name, birth date, and sex. A specific software for capture-recapture models (CARE-1) was used to estimate the size of the target population with two different statistical approaches (sample coverage and log-linear models). A total of 2801 people were reported to the AIDS Registry, 6415 to the HIV Registry, 1598 to the Death Registry as HIV/AIDS-related deaths, and 3330 to the Hospital-Discharge Registry with a diagnosis of HIV infection. Overall, 8723 people were present in at least one registry: 4896 people were present in only one registry, 2387 in two registries, 1286 in three registries, and 154 in all four registries. Using the sample coverage approach, we estimated that, since the beginning of the epidemic in Veneto, an estimated 11 281 people (95% CI: 10 981, 11 621) should have been reported to at least one registry; thus the estimated coverage of the four registries was 77.3% (i.e. 8723/11 281). Results obtained applying the log-linear approach were similar, although the fitting of this model was not adequate. Cross-linking data from four different sources and applying the capture-recapture method can improve the accuracy of the estimates of the dimensions of the HIV epidemic.


Effectiveness of cardiac simulator on the acquirement of cardiac auscultatory skills of medical students.
Cardiac simulators have been developed as an alternative training model in order to improve the cardiac auscultation skills of medical students. The effectiveness of the cardiac simulator's use in cardiac auscultatory training is presently not yet well established. The authors aimed to investigate whether the use of a cardiac simulator can improve the auscultation skills of medical students. The students taking the auscultation training on the cardiac simulator were grouped as Group A and the students not taking the auscultation training on the cardiac simulator were grouped as Group B (before). The students in Group B (before) were grouped as Group B (after) after receiving the auscultation training on the cardiac simulator. The percentages of accurate diagnoses for the tested heart murmurs were compared between Group A and Group B (before), and between Group B (before) and Group B (after). The rate of making correct diagnoses of normal heart sounds was similar in all the groups (Group A, Group B (before), and Group B (after)). By contrast, the percentage of accurate diagnoses for the tested heart murmurs was notably improved among the students in Group A with respect to Group B (before) (p < 0.01). Similarly, the rate of correct diagnoses for the tested heart murmurs was markedly higher among the students in Group B (after) than in Group B (before) (p < 0.01). The use of a cardiac simulator as a training tool can improve the auscultation skills of medical students quickly and efficiently.


Structural Optimization and Anticancer Activity of Polo-like Kinase 1 (Plk1) Polo-Box Domain (PBD) Inhibitors and Their Prodrugs.
Polo-like kinase 1 (Plk1), a mitotic kinase whose activity is widely upregulated in various human cancers, is considered an attractive target for anticancer drug discovery. Aside from the kinase domain, the C-terminal noncatalytic polo-box domain (PBD), which mediates the interaction with the enzyme's binding targets or substrates, has emerged as an alternative target for developing a new class of inhibitors. Various reported small molecule PBD inhibitors exhibit poor cellular efficacy and/or selectivity. Here, we report structure-activity relationship (SAR) studies on triazoloquinazolinone-derived inhibitors, such as 43 (a 1-thioxo-2,4-dihydrothieno[2,3-e][1,2,4]triazolo[4,3-a]pyrimidin-5(1H)-one) that effectively block Plk1, but not Plk2 and Plk3 PBDs, with improved affinity and drug-like properties. The range of prodrug moieties needed for thiol group masking of the active drugs has been expanded to increase cell permeability and mechanism-based cancer cell (L363 and HeLa) death. For example, a 5-thio-1-methyl-4-nitroimidazolyl prodrug 80, derived from 43, showed an improved cellular potency (GI50 4.1 μM). As expected, 80 effectively blocked Plk1 from localizing to centrosomes and kinetochores and consequently induced potent mitotic block and apoptotic cell death. Another prodrug 78 containing 9-fluorophenyl in place of the thiophene-containing heterocycle in 80 also induced a comparable degree of anti-Plk1 PBD effect. However, orally administered 78 was rapidly converted in the bloodstream to parent drug 15, which was shown be relatively stable toward in vivo oxidation due to its 9-fluorophenyl group in comparison to unsubstituted phenyl. Further derivatization of these inhibitors, particularly to improve the systemic prodrug stability, could lead to a new class of therapeutics against Plk1-addicted cancers.


Improving Surgical Complications and Patient Safety at the Nation's Largest Military Hospital: An Analysis of National Surgical Quality Improvement Program Data.
The U.S. Military Health System cares for over 9 million patients and encompasses 63 hospitals and 413 clinics worldwide. Military medicine balances the simultaneous tasks of caring for those patients wounded in military engagements, treating large numbers of families of service men and women, and training the next generation of health care providers and ancillary staff. Similar to civilian health care delivery in the United States, military medicine has also seen increased scrutiny in the areas of cost and quality. In 2014, the U.S. military medical health care system was criticized for higher than average surgical complication rates and concerns regarding patient safety, quality of care, lack of transparency, and compartmentalized leadership. The San Antonio Military Medical Center was specifically cited as having "a perennial problem with surgical infection control…the infection rate of surgical wounds was 77% higher than expected given the mix of cases, according to a Pentagon-ordered comparison with civilian hospitals." To determine the scope of complication rates, data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) were analyzed. The goal of this article is to describe the NSQIP surgical outcome data for the U.S. Military's largest medical center from 2009 to 2014 and compare national averages in the areas of mortality, morbidity, cardiac occurrences, pneumonia, unplanned intubation, ventilator use greater than 48 hours, infections, readmissions, and return to operating room. Retrospective data analysis of NSQIP data from 2009 to 2014 at the San Antonio Military Medical Center, a level I trauma center for military members and eligible dependents along with civilian trauma patients. Observed event rates were compared with expected event rates for each year with the 2-tail Fisher's exact test to determine if rates were significantly different from each other. Cochran-Armitage Trend Test was performed to compare trends in time for the observed event rates. This study was exempt from institutional review board Approval. Complication rates remained stable or decreased over the 5 years studied. Significant improvement in morbidity and surgical site infections were observed during the observation period. All other variables except urinary tract infections were within expected range or decreased during this time. Urinary tract infection rates, although decreasing, remain above the expected value. NSQIP data at the Department of Defense's largest hospital reveals complication rates similar to civilian hospitals. The majority of areas studied revealed improving or stable complication rates. The ACS NSQIP is a nationally validated, risk-adjusted, outcomes program that is widely used by many leading hospital institutions. Similar to most quality data reporting articles, a weakness of our study may have been collection of all complications. Yet, we are confident that the majority of complications were captured as we have dedicated personnel monitoring the adverse events measured by ACS NSQIP. Future areas of study should focus on continued analysis of surgical quality improvement within the entire military system.


[Difficulties in diagnosis of lyme borreliosis].
A case of borreliosis in female aged 28 years is presented. Diagnosis was made late. The course of the disease was characterized by long-lasting high fever, enlargement of liver and spleen, pancreatitis, pneumonia of the left lung and anemia. During the antibiotic therapy (rocephin) neutropenia was observed. In every case of long-lasting fever of unknown origin, borreliosis should be taken into consideration.


Comparative Analysis of Flow Cytometry and Cytomorphology for Neuroblastoma Cell Detection in Effusion and Bone Marrow Specimens.
Background:Neuroblastoma (NB) frequently metastasizes to the bone marrow (BM), pleural and peritoneal cavities. The detection of NB cells in the BM and effusion specimens is important in clinical staging. Objective: The aim of this study was to compare the ability of flow cytometry (FCM) and cytomorphology (CM) in detecting NB cells. Materials and methods:From 21 patients with suspected NB metastasis, BM and effusion specimens were analyzed by FCM and CM. Results:A total of 16 effusion (76.2%) and 9 BM (42.9%) specimens were classified by FCM as positive for malignancy. CM revealed 12 (57.1%) and 9 (42.9%) positive effusion and BM specimens, respectively. There were three effusions detected by CM but not by FCM. There was no significant differences between FCM and CM in the detection of NB cells in effusions (p = 0.344). Conclusions:FCM can be used as an adjunct to CM for the detection of NB cells in effusion specimens.


Prevalence and Factors Associated With Youth Vaping Cessation Intention and Quit Attempts.
This study sought to examine the prevalence and factors associated with youth vaping cessation behaviors. Current (past 30-day) electronic-cigarette (e-cigarette) users from the 2020 National Youth Tobacco Survey (n = 1660, typically aged 11-18 years) were analyzed to examine the prevalence of youth intention to quit vaping, past-year quit attempts, and the frequency of quit attempts. Multivariable logistic or linear regressions were performed to assess the correlates with youth vaping cessation behaviors. In 2020, 53.4% of current e-cigarette users reported intention to quit vaping and 67.4% reported having tried to quit vaping. Intention to quit was lower among female individuals (versus male individuals, adjusted odds ratio [aOR] = 0.7, P = .0004), users of a modifiable system (versus disposable e-cigarettes, aOR = 0.4, P = .0204), and dual or poly users (versus sole e-cigarette use, aOR = 0.7, P = .0144). e-cigarette harm perception was positively associated with intention to quit (aOR = 2.2, P < .0001) and past-year quit attempts (aOR = 1.6, P = .0037). Reasons for e-cigarette use were related to cessation behaviors. Adolescents who vaped because of curiosity had higher odds of past-year quit attempts (aOR = 1.4, P = .0306), whereas users to disguise vaping had a lower likelihood of intention to quit (aOR=0.4, P < .0001) and past-year quit attempts (aOR = 0.7, P = .0126). The average number of past-year quit attempts was 5.3, and it was lower among female individuals (versus male individuals), users of e-cigarettes with prefilled pods or cartridges (versus disposable e-cigarettes), and those with nicotine cravings (versus no nicotine craving). Intention to quit vaping and past-year quit attempts are prevalent among US adolescent e-cigarette users. The study findings inform the development of multifaceted vaping cessation programs to take sex, e-cigarette devices, vaping reasons and patterns, harm perception, and nicotine dependence into account.


Fluid shear regulates the kinetics and receptor specificity of Staphylococcus aureus binding to activated platelets.
The interaction between surface components on the invading pathogen and host cells such as platelets plays a key role in the regulation of endovascular infections. However, the mechanisms mediating Staphylococcus aureus binding to platelets under shear remain largely unknown. This study was designed to investigate the kinetics and molecular requirements of platelet-S. aureus interactions in bulk suspensions subjected to a uniform shear field. Hydrodynamic shear-induced collisions augment platelet-S. aureus binding, which is further potentiated by platelet activation with stromal derived factor-1beta. Peak adhesion efficiency occurs at low shear (100 s(-1)) and decreases with increasing shear. The molecular interaction of platelet alpha(IIb)beta(3) with bacterial clumping factor A through fibrinogen bridging is necessary for stable bacterial binding to activated platelets under shear. Although this pathway is sufficient at low shear (</=400 s(-1)), the involvement of platelet gpIb and staphylococcal protein A through von Willebrand factor bridging is essential for optimal recruitment of S. aureus cells by platelets in the high shear regime. IgG plays an inhibitory role in the adhesion process, presumably by interfering with the binding of von Willebrand factor to staphylococcal protein A. This study demonstrates that platelet activation and a fluid-mechanical environment representative of the vasculature affect platelet-S. aureus cell-adhesive interactions pertinent to the process of S. aureus-induced bloodstream infections.


Cloaked electromagnetic, acoustic, and quantum amplifiers via transformation optics.
The advent of transformation optics and metamaterials has made possible devices producing extreme effects on wave propagation. Here we describe a class of invisible reservoirs and amplifiers for waves, which we refer to as Schrödinger hats. The unifying mathematical principle on which these are based admits such devices for any time harmonic waves modeled by either the Helmholtz or Schrödinger equation, e.g., polarized waves in electromagnetism, acoustical waves and matter waves in quantum mechanics. Schrödinger hats occupy one part of a parameter-space continuum of wave-manipulating structures which also contains standard transformation optics based cloaks, resonant cloaks and cloaked sensors. Possible applications include near-field quantum microscopy.


Parallelism experiments to evaluate matrix effects, selectivity and sensitivity in ligand-binding assay method development: pros and cons.
Parallelism is an essential experiment characterizing relative accuracy for a ligand-binding assay (LBA). By assessing the effects of dilution on the quantitation of endogenous analyte(s) in matrix, selectivity, matrix effects, minimum required dilution, endogenous levels of healthy and diseased populations and the LLOQ are assessed in a single experiment. This review compares and discusses all available approaches that can be used to assess key assay parameters for pharmacokinetic and biomarker LBAs, as well as the advantages and disadvantages of each approach. This review also summarizes a systematic approach that can apply to guide endogenous LBA method development and optimization with a suggested way to interpret parallelism data.


Feasibility of home administration of nebulised interferon ß-1a (SNG001) for COVID-19: a remote study.
Effective therapeutics given early to high-risk ambulatory patients with coronavirus disease 2019 (COVID-19) could improve outcomes and reduce overall healthcare burden. However, conducting site visits in non-hospitalised patients, who should remain isolated, is problematic. To evaluate the feasibility of a purely remote (virtual) study in non-hospitalised patients with COVID-19; and the efficacy and safety of nebulised recombinant interferon-β1a (SNG001) in this setting. Randomised, double-blind, parallel-group study, which was conducted remotely. Eligible patients aged ≥65 years (or ≥50 years with risk factors) with COVID-19 and not requiring hospital admission were recruited remotely. They were randomised to SNG001 or placebo once-daily via nebuliser for 14 days. The main outcomes were assessments of feasibility and safety, which were all conducted remotely. Of 114 patients treated, 111 (97.4%) completed 28 days of follow-up. Overall compliance to study medication was high, with ≥13 doses taken by 89.7% and 92.9% of treated patients in the placebo and SNG001 groups, respectively. Over the course of the study, only two patients were hospitalised, both in the placebo group; otherwise there were no notable differences between treatments for the efficacy parameters. No patients withdrew owing to an adverse event, and a similar proportion of patients experienced on-treatment adverse events in the two treatment groups (64.3% and 67.2% with SNG001 and placebo, respectively); most were mild or moderate and not treatment-related. This study demonstrated that it is feasible to conduct a purely virtual study in community-based patients with COVID-19, when the study included detailed daily assessments and with medication administered via nebuliser.


Pharmacology of palliative medicine.
To describe the concepts of both pharmacokinetics and pharmacodynamics and how it applies to palliative medicine. Research and review articles and textbooks. Most patients who have an illness that requires palliation are elderly, have co-morbid conditions, and are on many medications. Both age and disease can alter the way drugs are handled by the body (pharmacokinetics) and how they affect the body (pharmacodynamics). The oncology nurse, armed with the correct knowledge about medications, can have an important inmpact on improving the patient's care, safety, and quality of life.


Urinary interleukins in patients receiving intravesical Bacillus Calmette-Guerin therapy for superficial bladder cancer.
Intravesical administration of Bacillus Calmette-Guerin (BCG) causes a localized cell-mediated immune response. The intensity of this inflammatory response may be gauged by measuring the levels of both interleukin-2 (IL-2) and an inhibitor of interleukin-2 (IL-2-IN) activity in the urine during the hours after a BCG instillation. The levels of urinary IL-2 and IL-2-IN in the sixth week of BCG therapy predicted the subsequent clinical course in a group of 25 patients (P less than 0.01). Measurement of urinary IL-2 and IL-2-IN activity may be used to identify accurately those patients likely to develop a tumor recurrence, thereby sparing them the risk associated with inadequately treated bladder cancer. Since IL-2 and IL-2-IN are competitive with respect to biologic activity, and since relatively high urinary levels of either IL-2 or IL-2-IN activity correlated with a favorable clinical course, the authors conclude that the presence of bioactive IL-2 in urine is not required for the prevention of recurrent superficial bladder cancer.


Comparison of local ablation with Albendazole or laparoscopic hepatectomy combined with Albendazole in the treatment of early hepatic alveolar echinococcosis.
Echinococcosis (E) is a zoonotic parasitic disease caused by the larval morphology of echinococcosis tapeworms. Among the recognized species, two are of medical importance-E. granulosus and E. multilocularis-causing cystic echinococcosis (CE) and alveolar echinococcosis (AE) in humans, respectively. Diagnosis of AE is based on clinical manifestation and epidemiological data, imaging techniques, histopathology and/or nucleic acid detection, and serology. At present, WHO guidelines suggest that benzimidazoles (BMZ) are mandatory in all AE patients, temporarily after complete resection of the lesions and for life in all other AE cases. Interventional procedures should be preferred to palliative surgery whenever possible, and radical surgery is the first choice in all cases suitable for total resection of the lesion. However, some research centers have proposed that local ablation (LA) including radiofrequency ablation (RFA) and microwave ablation (MWA) is no less effective than radical surgery or better than simple medication in the early stage hepatic AE (WHO-IWGE PNM classification of AE: P1N0M0). This study attempted to compare the real efficacy of the above treatment methods, so as to find the best treatment for this kind of patient. The data of patients with hepatic AE who underwent laparoscopic hepatectomy (LH), RFA, and MWA in Qinghai Provincial People's Hospital from January 2015 to January 2021 were collected. At the same time, the cases treated with Albendazole (ABZ) were collected together with the institution for disease control and prevention. According to the treatment methods, the above cases were divided into LH group, RFA group, MWA group, and medication group. The basic data and postoperative recovery indices of the four groups were compared, respectively. A total of 199 patients with hepatic AE were enrolled in this study, including 90 males and 109 females. The youngest was 5 years old and the oldest was 66 years old, with an average of 33.41±14.64 years old. 20.6% of the patients had hepatitis B (41/ 199). A total of 45 patients underwent ultrasound-guided RFA, 47 patients underwent ultrasound-guided MWA, 51 patients were treated with ABZ, and 56 patients underwent LH. There were no significant differences in baseline characteristics among the four groups (p > 0.05). The RFA group and MWA group were more advantageous than the LH group regarding operation time and incidence of postoperative complications (p < 0.05). But recurrence rate of the lesion in the LH group was significantly lower than the RFA group, MWA group, and medication group. However, there was no significant difference in recurrence-free survival time among the four groups (p >0.05). LH has a significant effect in the treatment of early-stage hepatic AE, especially in terms of recurrence which is significantly better than LA and medication alone. Follow-up and adherence to ABZ therapy are essential if conservative treatment is to achieve better outcomes.


Chronic mesenteric ischemia. Clinical presentation and diagnosis.
Owing to a heightened awareness of the disease as well as improved diagnostic tests, chronic mesenteric ischemia is now recognized as a more common cause of abdominal pain. The classic symptoms of postprandial abdominal pain with weight loss are evident in the majority of proven cases; most patients also have other evidence of advanced atherosclerotic vascular disease. Several new diagnostic techniques are being developed and tested, most notably color duplex imaging, although angiography still remains the diagnostic gold standard. It is hoped that better noninvasive testing may eventually eliminate the need for angiography, as well as lead to a more expedient diagnosis of chronic mesenteric ischemia.


Is laparoscopic cholecystectomy a mature operative technique?
More than 10 years after its introduction, laparoscopic cholecystectomy has become the method of choice for the treatment of cholecystolithiasis. However intraoperative difficulties with dramatic postoperative consequences have been reported. The aim of this study was to identify what role the two-dimensional view, the surgeon's experience, the instruments, technical tools and their (time) influence exercised on the operation course in daily laparoscopic operations. The operative times for 30 laparoscopic cholecystectomies were investigated by ergonomic sequence analysis and analyzed statistically with the use of the Wilcoxon test. Comparing experienced and less experienced surgeons, a significant difference in the duration of the operation was observed (56 +/- 24 min compared to 75 +/- 13 min p = 0,025), especially in the laparoscopic intra-abdominal phase of the operation. The prolonged duration of the operation (15-20%) was mainly due to problems with the technical tools (40%) and the use of instruments (23.5%). Visualization had a minor influence (14.4%) on the duration of the operation, and the negative effect of the two-dimensional view (0.5%) was negligible. The last two factors did not cause any complications. The recognized difficulties still cause a loss of time and in some cases complications, which can only partly be compensated by the surgeon's experience. This leads to reluctance in the application of laparoscopic cholecystectomy in more complicated stages of the disease. Two-dimensional view satisfies the surgeon's demands for a safe procedure.


Interactions between calcium intake and polymorphisms in genes essential for calcium reabsorption and risk of colorectal neoplasia in a two-phase study.
The SLC8A1 (solute carrier family 8, member 1) gene, encoding Na+ /Ca2+ exchanger, is essential in regulating calcium reabsorption and homeostasis. Calcium homeostasis plays a key role in cell proliferation and apoptosis. We hypothesized that polymorphisms in five calcium-regulating genes (SLC8A1, ATP2B1, CALB1, CALB2, and CABP1) interact with calcium intake in relation to the risk of colorectal neoplasia. A two-phase (discovery and replication) study was conducted within the Tennessee Colorectal Polyp Study, including a total of 1275 cases and 2811 controls. In Phase I, we identified six out of 135 SNPs that significantly interacted with calcium intake in relation to adenoma risk. In Phase II, the calcium intake by rs4952490 (SLC8A1) interaction was replicated (Pinteraction = 0.048). We found an inverse association between calcium intake (1000-2000 mg/day) and colorectal adenomas, particularly for multiple/advanced adenomas, among the G-allele carriers but not among homozygous carriers of the common variant (A) in rs4952490. In the joint analysis of SLC8A1, KCNJ1, and SLC12A1 SNPs, carriers of variant alleles in at least two genes and with calcium intake above the DRI (1000 mg/day) were approximately 30-57% less likely to have adenomas than those whose calcium intake was below the DRI. The association was stronger for multiple/advanced adenomas. No association was found among those who did not carry any variant alleles in these genes when calcium intake was below 2500 mg/day. These findings, if confirmed, may provide a new avenue for the personalized prevention of colorectal adenoma and cancer.


Modeling fusion/fission-dependent intracellular transport of fluid phase markers.
A fundamental feature of eukaryotic cells is the presence of distinct membrane-bound compartments having unique protein and lipid composition. These compartments are interconnected by active trafficking mechanisms that must direct macromolecules to defined locations, and at the same time maintain the protein and lipid composition of each organelle. It is well accepted that Rab proteins play a central role in intracellular transport regulating the recognition, fusion and fission of organelles. However, how the transport is achieved is not completely understood. We propose a model whereby a soluble component in the luminal compartment is transported along different Rab-containing organelles that interact according to the following simple principles: (i) only organelles with the same or compatible Rab membrane domains can fuse; (ii) after fusion, an asymmetric fission occurs producing a tubule and a round-shaped vesicle; and (iii) Rab membrane domains distribute asymmetrically between the two resulting organelles. When this model was tested in a simulation, efficient unidirectional transport was observed, while the compartment identity was preserved. All three principles were absolutely necessary for transport. The model is compatible with Rab association/dissociation dynamics and with Rab conversion. In simulations mimicking a simplified endocytic pathway, soluble and membrane-associated markers were efficiently transported preserving the identity of the interacting compartments.


The use of fibrin glue to stop venous bleeding in the epidural space, vertebral venous plexus, and anterior cavernous sinus: technical note.
Various techniques have been used to stop venous bleeding from the epidural space, vertebral venous plexus, and cavernous sinus. Here, we describe our experience with the use of fibrin glue to stop venous bleeding in these areas. During the last 8 years, the senior author (LNS) has used injection of Tisseel fibrin glue (Baxter Healthcare Corp., Deerfield, IL) into the epidural space (n = 200 patients), anterior cavernous sinus (n = 46 patients), vertebral venous plexus (n = 20 patients), and superior petrosal sinus (n = 20 patients) to assist in hemostasis. The technical nuances are illustrated in three videos. Injection of fibrin glue in the epidural space, anterior cavernous sinus, and vertebral venous plexus yielded good results in assisting with hemostasis. Two patients experienced complications caused by occlusion of veins draining the brainstem after fibrin glue was injected into the superior petrosal sinus. Fibrin glue injection is an excellent option for hemostasis in the epidural space, anterior cavernous sinus, and vertebral venous plexus. However, based on our experience, fibrin glue injection into the superior petrosal sinus is not recommended.


Perceived effectiveness of fear appeals in AIDS education: relationship to ethnicity, gender, age, and group membership.
A study was conducted with 261 community residents, college students, and intravenous drug users to investigate perceived effectiveness of fear appeals in AIDS education posters. Experimental posters with high-fear pictures portraying severe consequences of AIDS and low-fear posters that were neutral regarding disease severity were evaluated in terms of their perceived effectiveness in motivating people to use condoms. Posters also contained written messages communicating high and low levels of personal vulnerability and response efficacy. High-severity/fear posters were rated as significantly more effective than low-severity/fear posters (p less than .0001), but response efficacy and personal vulnerability were significant only in interaction with other variables (p less than .01). Age, gender, ethnicity, and group membership did not, in general, influence rated effectiveness. However, group membership and age were significant as interactions with severity/fear level and response efficacy, respectively (p less than .01). Subjects showed no differential preference for posters portraying individuals whose ethnicity was the same as their own. Findings confirmed previous research supporting the effectiveness of fear appeals and suggest that fear-oriented appeals may be effective in promoting changes in community norms and motivating individuals to adopt AIDS risk-reduction strategies.


Health economic evaluations: how to find them.
The aim of this study was to demonstrate the best way of identifying all relevant published health economic evaluation studies, which have increased in number rapidly in the past few decades. Nevertheless, health technology assessment projects are often faced with a scarcity of relevant studies. Six bibliographic databases were searched using various individually adapted strategies. The particular example involves the cost-effectiveness of diagnosing gastroesophageal reflux disease. Inclusion and exclusion criteria were formulated. After irrelevant studies and duplicates had been excluded, sixty-eight abstracts were reviewed. We chose forty-one of them as relevant for full-text review, which identified fourteen papers as having met the inclusion criteria. Most of the relevant studies were identified by searching the National Health Service Economic Evaluation Database (NHS EED) and PubMed databases. A search in NHS EED, by means of the Cochrane Library or the Center for Reviews and Dissimination, along with a supplementary search in PubMed, is generally an appropriate, cost-effective strategy. However, because "cost-effectiveness" is not consistently indexed with Medical Subject Heading terms in PubMed, all economic search terms need to be used to fully identify the relevant references.


Carbon price volatility: The case of China.
Based on carbon spot prices selected from seven carbon pilots, we assess the financial performances related to carbon volatility in China on the overall perspective. According to the results, the Chinese carbon market fluctuated severely at the beginning of carbon trading, but has stabilised in general, despite several dramatic changes related to 'yearly compliance events'. Long-term memory exists in the volatility series. Moreover, asymmetry exists in the Chinese carbon market, and volatility reacts more severely to good news than to bad news. Finally, we discuss our empirical results, and make certain suggestions regarding firms' awareness, international cooperation and individual investors not only for policy makers in China but also for other developing countries who are contemplating either commencing carbon trading or improving the current market.


Mutation of isoleucine 705 of the oxidosqualene-lanosterol cyclase from Saccharomyces cerevisiae affects lanosterol's C/D-ring cyclization and 17α/β-exocyclic side chain stereochemistry.
Site-saturated substitution in Saccharomyces cerevisiae oxidosqualene-lanosterol cyclase at Ile705 position produced three chair-boat-chair (C-B-C) truncated tricyclic compounds, two 17α-exocyclic protosteryl intermediates, two protosteryl C-17 truncated rearranged intermediates and the normal biosynthetic product, lanosterol. These results indicated the importance of the Ile705 residue in affecting lanosterol's C/D ring stabilization including 6-6-5 tricyclic and protosteryl C-17 cations and 17α/β-exocyclic side chain stereochemistry.


In vivo Portal Imaging Dosimetry Identifies Delivery Errors in Rectal Cancer Radiotherapy on the Belly Board Device.
We recently developed a novel, open-source in vivo dosimetry that uses the electronic portal imaging device to detect dose delivery discrepancies. We applied our method on patients with rectal cancer treated on a belly board device. In vivo dosimetry was performed on 10 patients with rectal cancer treated prone on the belly board with a 4-field box arrangement. Portal images were acquired approximately once per week from each treatment beam. Our dosimetry method used these images along with the planning CT to reconstruct patient planar dose at isocenter depth. Our algorithm proved sensitive to dose discrepancies and detected discordances in 7 patients. The majority of these were due to soft tissue differences between planning and treatment, present despite matching to bony anatomy. As a result of this work, quality assurance procedures have been implemented for our immobilization devices. In vivo dosimetry is a powerful quality assurance tool that can detect delivery discrepancies, including changes in patient setup and position. The added information on actual dose delivery may be used to evaluate equipment and process quality and to guide for adaptive radiotherapy.


Evaluation of endoscopic salpingectomy for sterilization of female Formosan macaques (Macaca cyclopis).
We evaluated the safety and postsurgical outcomes of endoscopic salpingectomy for sterilization of female Formosan macaques (Macaca cyclopis) as a method of population control. Nineteen adult female Formosan macaques were included in our study. The fallopian tubes of each anesthetized macaque were cauterized and excised endoscopically using a 2.7-mm rigid endoscope system. We recorded the complications encountered, and objectively scored the amount of hemorrhage throughout the procedure. Postoperative ovarian function was evaluated by monitoring the serum levels of sex hormones in ten of the macaques for two ovarian cycles following the salpingectomy. Two to 13 months later, eight of the 19 macaques underwent laparoscopy for the objective evaluation of inflammation at the surgical sites on the fallopian tubes. No major anesthetic- or surgical-associated complications were observed in any of the macaques. The hormonal evaluation showed cyclic ovarian function after salpingectomy in all of the ten macaques examined, and the parameters were comparable to those of other macaque species. The long-term postoperative level of inflammation at the surgical site was minimal to low, and was lower than that reported for other tubal occlusion techniques used in macaques. The use of a 2.7-mm rigid endoscope for salpingectomy in macaques is safe and efficient, with fewer postoperative complications than comparable sterilization techniques.


Tissue targeting of angiotensin peptides.
Angiotensin II (Ang II) is an octapeptide generated by the sequential proteolytic action of renin and angiotensin converting enzyme on the glycoprotein angiotensinogen. While numerous mammalian tissues have been shown to express some or all of the components of the renin-angiotensin system (RAS), the function of most of these tissue RAS remains a matter of conjecture. To test for tissue-specific functions of Ang II and as an alternative to co-expressing all the components of RAS, we have engineered a fusion protein that leads to direct Ang II release within specific tissues. The angiotensin peptide is cleaved from the fusion protein within the secretory pathway by the ubiquitous endoprotease furin and is released from the cell by constitutive secretion. Direct injection of an expression vector encoding such a fusion protein into rat cardiac ventricles results in a highly localized expression of atrial natriuretic peptide mRNA (an angiotensin responsive marker of cardiac hypertrophy), demonstrating the utility of this approach for local targeting of mature peptides to tissues in animal models.


Optimization solutions depend on the choice of coordinate system.
The assumption that optimization results depend on coordinate system selected to describe a biomechanical model is tested by comparing two solutions obtained with generalized and natural coordinate systems. A 5-degrees of freedom planar musculoskeletal model actuated by 9 Hill-type musculotendon units was created to simulate lifting a leg up. Each individual muscle force was discretized into a set of independent design variables, and an inverse dynamic parameter optimization method was used in the computations. The optimal time characteristics of the predicted muscle forces for both solutions are presented. Some remarks concerning the efficiency of natural coordinates for solving optimal control problems are also included.


High-dose cholecalciferol to correct vitamin D deficiency in haemodialysis patients.
Vitamin D has emerged as an important survival factor in patients with chronic kidney disease. Non-activated vitamin D may also have beneficial effects on bone, cardiovascular and immune functions. Cholecalciferol is the prevalent non-activated vitamin D in Europe, but there is no valid prospective data available about its use in haemodialysis patients. Thus, we initiated a prospective study to evaluate dosing, safety and tolerability of cholecalciferol supplementation in haemodialysis patients. The prospective study included 64 haemodialysis patients. During replenishment phase patients received 20 000 IU cholecalciferol/week for 9 months. In the open maintenance phase (15 months), patients were randomized to a treated group (20 000 IU cholecalciferol/month) and an untreated group, which did not receive cholecalciferol. Calcidiol [25(OH)D] deficiency (<37.5 nmol/l; <15 microg/l) was detected in 61/64 patients (95%). During the replenishment phase, calcidiol increased significantly from 16.65 +/- 9.6 to 79.48 +/- 27.15 nmol/l (6.66 +/- 3.84 microug/l to 31.79 +/- 10.86 microg/l) (P < 0.001). Recommended levels (>75 nmol/l; >30 microg/l; K/DOQI) were achieved in 57% of patients. Calcium increased from 2.28 +/- 0.17 to 2.37 +/- 0.19 mmol/l (9.1 +/- 0.69 mg/dl to 9.49 +/- 0.75 mg/dl) (P<0.01). Phosphorus, calcium-phosphorus product and parathyroid hormone showed no significant changes. Fifty-nine patients progressed to the maintenance phase. Analysis per protocol showed a significant drop of calcidiol in the treated [83.98 +/- 31.73 versus 78.5 +/- 38.75 nmol/l (33.59 +/- 12.69 versus 31.4 +/- 15.5 microg/l) (P < 0.001)] and untreated groups [86.35 +/- 40.75 versus 53.4 +/- 26.2 nmol/l (34.54 +/- 16.3 versus 21.36 +/- 10.48 microg/l) (P < 0.001)]. The comparison of the treated and the untreated groups showed no significant differences at the beginning of the maintenance phase: 83.98 +/- 31.73 versus 86.35 +/- 40.75 nmol/l (33.59 +/- 12.69 versus 34.54 +/- 16.3 microg/l). At the end they differed significantly: 78.5 +/- 38.75 versus 53.4 +/- 26.2 nmol/l (31.4 +/- 15.5 versus 21.36 +/- 10.48 microg/l) (P < 0.001). Vitamin D deficiency is present in a majority of haemodialysis patients. Supplementation with cholecalciferol is safe, well tolerated and reasonable to replenish vitamin D stores in haemodialysis patients. However, only 57% of patients achieved recommended calcidiol levels, thus favouring additional dose-finding studies.


Discriminating natural image statistics from neuronal population codes.
The power law provides an efficient description of amplitude spectra of natural scenes. Psychophysical studies have shown that the forms of the amplitude spectra are clearly related to human visual performance, indicating that the statistical parameters in natural scenes are represented in the nervous system. However, the underlying neuronal computation that accounts for the perception of the natural image statistics has not been thoroughly studied. We propose a theoretical framework for neuronal encoding and decoding of the image statistics, hypothesizing the elicited population activities of spatial-frequency selective neurons observed in the early visual cortex. The model predicts that frequency-tuned neurons have asymmetric tuning curves as functions of the amplitude spectra falloffs. To investigate the ability of this neural population to encode the statistical parameters of the input images, we analyze the Fisher information of the stochastic population code, relating it to the psychophysically measured human ability to discriminate natural image statistics. The nature of discrimination thresholds suggested by the computational model is consistent with experimental data from previous studies. Of particular interest, a reported qualitative disparity between performance in fovea and parafovea can be explained based on the distributional difference over preferred frequencies of neurons in the current model. The threshold shows a peak at a small falloff parameter when the neuronal preferred spatial frequencies are narrowly distributed, whereas the threshold peak vanishes for a neural population with a more broadly distributed frequency preference. These results demonstrate that the distributional property of neuronal stimulus preference can play a crucial role in linking microscopic neurophysiological phenomena and macroscopic human behaviors.


Buspirone in the Management of Agitation and Aggression Associated With Dementia.
Buspirone, a nonbenzodiazepine anxiolytic, has been shown to decrease aggression in animal models and reduce agitation in a small number of patients with organic brain syndromes. An open pilot study was conducted to assess the usefulness of buspirone in managing agitation and aggression in elderly dementia patients. Sixteen patients, ages 65-89, with various types of dementia associated with severe agitation and aggression were treated with buspirone. Outcome was measured by the Clinical Global Impression Scale. Significant improvement was noted in six patients. Buspirone holds promise as a modestly effective and relatively safe alternative to neuroleptics in the management of agitation and behavioral disturbances associated with dementia. More systematic trials are indicated.


VHL-deficient vasculogenesis in hemangioblastoma.
Hemangioblasts are capable of differentiation into vascular structures and blood. Patients with von Hippel-Lindau (VHL) disease develop hemangioblastomas which are composed of VHL-deficient tumor cells with protracted hemangioblastic differentiation potential. In a subset of these tumors, hemangioblastic differentiation is characterized by different stages of red blood cell formation. It has remained controversial, however, whether VHL-deficient hemangioblastic cells are similarly capable of differentiating into vascular cells and functioning vascular structures in vivo. By histologic, immunohistologic and microdissection-based genetic analysis of 60 VHL disease-associated hemangioblastomas, we re-examined the controversial question whether VHL-deficient neoplastic hemangioblastic cells are capable of vascular differentiation (vasculogenesis). In most tumors (n=47), there was no evidence of either vasculogenesis or hematopoiesis; tumor cells were either scattered between reactive angiogenetic vascular structures or arranged in solid clusters. A subset of tumors (n=13), however, revealed vaculogenetic structures that were composed of cuboidal or flat cells and frequently contained red blood cell precursors or mature red blood cells. Microdissection-based deletion analysis of epithelial cells confirmed them to be VHL-deficient tumor cells. Immunohistochemistry for CD31 was consistently negative in these structures, and no evidence could be obtained for connectivity with reactive vasculature. We demonstrate that hemangioblastic differentiation capacity of VHL-deficient hemangioblastic cells includes not only erythropoiesis, but also differentiation into primitive vasculogenetic structures. Tumor cells, however, do not appear to have the potential of terminal differentiation into mature and functional vascular structures.


Aneurysmal bone cyst in a 21-year-old woman presenting with chronic low back pain in a chiropractic office: a case report.
To emphasize the importance of early detection, recognition, appropriate investigation, accurate diagnosis, proper referral, and treatment of an aneurysmal bone cyst (ABC) presenting as chronic low back pain (LBP) in a chiropractic office. A 21-year-old female student presented to the chiropractic office with a 2-year history of severe and progressive LBP. The patient described the LBP as an aching type of pain that was more pronounced during activity and exercises. She also reported weight loss and increased fatigue. A detailed clinical, physical, and imaging evaluation was performed. A well-defined, expansile, and lytic bone lesion with the appearance of a possible ABC was detected; it involved the left inferior half and posterolateral aspect of the vertebral body of L3. Treatment consisted of an L3 hemivertebrectomy resection en bloc and a vertebral fusion from L2 to L4 with tricortical iliac crest graft. After surgery and recovery, LBP was relieved and the bone lesion did not recur. Although uncommon, ABC is an important lesion that can affect the spine. Healthcare providers must be aware that the cause of LBP may extend beyond musculoskeletal dysfunction. It is important to identify an ABC and refer the patient for appropriate evaluation and care.


Pathological evaluation of the effects of intentional disocclusion and overloading occlusion in odontogenesis disorders in N-methylnitrosourea-treated hamsters.
This study compares the effects of disocclusion and overloading occlusion on dental lesions. Ten-day-old Syrian hamsters were divided into 4 groups: group I, untreated animals; group II, animals whose hemilateral incisors were disoccluded; group III, N-methylnitrosourea (MNU)-treated animals; and group IV, MNU-treated animals whose hemilateral incisors were disoccluded. The ipsilateral maxillary and mandibular incisors were repetitively cut with diamond discs. The hamster is easier to anesthetize. Animals received a 0.2% solution of MNU (10 mg/kg body weight) intragastrically twice a week for 16 wk. All the cut mandibular incisors and the MNU-treated uncut mandibular incisors showed lack of iron deposition on the enamel surface. The eruption rate was significantly higher in the cut disoccluded incisors of groups II and IV (p < 0.05) and significantly lower in the uncut overloaded incisors of groups II and IV (p < 0.05). In the cut mandibular incisors of group IV, the degree of the disturbance of odontogenesis and the atypical proliferation of odontogenic epithelium were more prominent (p < 0.02), and the dental lesions occurred earlier. Histologically, the disturbed Hertwig's epithelial sheath and the Hertwig's epithelial sheath-like transformed U-shaped part and enamel organ seemed to lead to disturbances of amelogenesis and detinogenesis as well as to atypical proliferation of odontogenic epithelium nests. Thus, this method of disocclusion of the incisors of rodents may represent a useful model for the investigation of the effects of various agents on tooth formation over a short experimental period.


Improving Neurodevelopmental Outcomes in NICU Patients.
Premature infants experience stressors such as external stimulation with sounds, light, touch, and open positioning in NICU that negatively affect outcomes. The purpose of this study was to measure the effectiveness of a developmental positioning intervention on length of stay, weight gain, and tone/flexion compared with neonates without structured positioning. Study design was quasi-experimental with nonequivalent groups. A retrospective chart review of 50 neonates with the inclusion criteria of 34 weeks of gestation or less and no anomalies provided a preintervention sample. After the education in-service on positioning, a convenience sample of 27 infants was enrolled. Infant Position Assessment Tool was used as a visual guide for positioning and scoring by the researcher for intervention fidelity. Hammersmith scoring was completed by the occupational therapist prior to discharge. The postintervention group was younger and sicker than the control group (P < .05). The postintervention sample (M = 7.05 where 7 = 29 to <30 weeks of gestation) was younger than the preintervention sample (M = 7.22). The postintervention sample was smaller (M = 1302.15 g) than the preintervention sample (M = 1385.94 g). Results showed that the postintervention group had clinically significant weight gain and mean Hammersmith score (3.28) was higher showing positioning positively affected tone and flexion scores. With greater structure and consistent attention to developmental positioning, outcomes are positively affected. Further research with larger sample sizes will identify stronger associations and relationships between positioning and outcome measures.


Light-induced changes in protein nitration in photoreceptor rod outer segments.
Light has been shown to modulate protein nitration in rat retinas. To better understand the role of protein nitration in photoreceptor cell death induced by intense light, we examined retinal protein nitration and identified target proteins in rod outer segments (ROS). Cyclic light-reared rats, treated or not with the antioxidant, dimethylthiourea (DMTU), were exposed to intense green light for 8 h. A subset of these rats was kept in the dark for 24 h after 8 h of light exposure. Western analysis of ROS proteins with an anti-nitrotyrosine antibody was performed to examine changes in protein nitration. 2D-immunoblots with anti-nitrotyrosine antibody followed by liquid chromatography tandem mass spectrometry was used to identify nitrated proteins in ROS. The expression levels of three nitric oxide synthase (NOS) isoforms, inducible, neuronal-, and endothelial-NOS were semi-quantified by immunoblot analysis. Western analysis revealed that the level of ROS protein nitration increased during the dark recovery period after 8 h of light treatment in both DMTU treated and untreated rats. However, DMTU effectively reduced protein nitration in ROS during light exposure and during the subsequent dark recovery period. Using 2D-immunoblotting followed by liquid chromatography tandem mass spectrometry analysis, we identified ten ROS proteins as nitration targets. Most of these proteins were glycolytic enzymes. The level of inducible-NOS in the retina was increased by light exposure. The effect of DMTU in reducing ROS protein nitration during and after light suggests the involvement of protein nitration during light-induced photoreceptor cell death. Nitration of glycolytic enzymes specifically may alter their activities. Increased levels of iNOS during and after intense light exposure suggest that this isoform is responsible for intense light induced protein nitration in ROS during the dark recovery period. The limited nitration seen in ROS during light exposure may reflect a quenching effect by endogenous antioxidants on the generation of reactive oxygen and nitrogen species.


[A locked knee without previous trauma].
A 22-year-old female presented at our hospital with a spontaneous extension deficit of the left knee. Examination revealed a luxation of the semitendinosus tendon under an osteochondroma on the posteromedial side of the proximal tibia. The tendon was repositioned by flexion and endorotation of the knee. Subsequently, the osteochondroma was surgically resected to prevent recurrence of the complaints.


Deep Capillary Macular Perfusion Indices Obtained with OCT Angiography Correlate with Degree of Nonproliferative Diabetic Retinopathy.
To evaluate the integrity of macular and temporomacular vasculature in nonproliferative diabetic retinopathy (NPDR) with noninvasive optical coherence tomography angiography (OCTA) and correlate perfusion indices with degree of NPDR. In this prospective observational cross-sectional study, 102 eyes with newly diagnosed NPDR (mild NPDR, 36; moderate NPDR, 21; severe NPDR, 13; NPDR with diabetic macular edema [DME], 32) underwent OCTA. Sixty eyes of normal subjects served as control. Degree of NPDR (based on Early Treatment Diabetic Retinopathy Study criteria) was confirmed with fluorescein angiography. Automated OCTA/split-spectrum amplitude decorrelation angiography software generated perfusion indices (vessel density and flow index) from images of the retina. The perfusion index of superficial and deep retinal plexuses was obtained in both perifoveal (central 1-3 mm) and parafoveal (3-6 mm) areas. Deep plexus parafoveal vessel density was 25.23% (±6.1) in mild NPDR, 20.16% (±6.16) in moderate NPDR, 11.16% (±4.16) in severe NPDR, and 17.91% (±4.42) in NPDR + DME compared to normal subjects (36.93% [±8.1]; (p<0.01). Spearman correlation coefficient (rs) between vessel density and level of NPDR severity in the parafoveal region showed inverse correlation for both superficial (rs -0.87; p = 0.083) and deep (rs -0.96; p = 0.017) plexus. Similarly, when vessel density of the perifoveal region was compared with level of NPDR severity, inverse correlation was noted in both superficial (rs -0.85; p = 0.08) and deep (rs -0.98; p = 0.011) plexus. Optical coherence tomography angiography clearly delineated the retinal microcirculation and allowed quantification of vascular perfusion of each layer. As diabetic retinopathy progressed, a decrease in perfusion index is more pronounced in the deep retinal plexus and precedes changes in superficial plexus.


The Development of a Readiness Scale for Changing Farmers' Behaviors of Using Pesticides.
Inappropriate pesticide-using behaviors impose significant negative impacts on health and environment. Developmentalprograms to change such behaviors offarmers should target those who are ready to change in order to achieve efficiency. The objective was to develop a readiness scale in changing behavior ofusing pesticides offarmers. The scale of this study is expected to be used in recruiting targetfarmers in developmental programs. A cross-sectional study was divided into two phases. The first phase, qualitative method, performed on 17farmers participated to seek factors related to the farmers' safe use of pesticides. The second phase, quantitative method to develop the readiness scale, an exploratoryfactor analysis (EFA) was analyzed on 230farmers and was randomly selected to measure the scale's construct validity, internal consistency (reliability), one-dimensionality and the appropriate cut-off point, respectively. Farmers' pesticide use, safety behaviors involved several factors, and are applied to create a set ofquestions on the readiness scale; there were 33 main items (with 40 sub-items), which could be grouped into 8 factors associated with farmers using pesticide safety, the scale, the best way to predict farmers who are ready to change. Finally, they were reduced to 23 main questions with 30 sub-questions in the scale. The development of a readiness scale application of changing behaviors as a guide, to assess content validity using index of item-objective congruence measurement (IOC), the exploratory factor analysis was used to determine an item and to test reliability on the scale. The scale can be a useful tool for recruiting farmers into intervention program in changing pesticide use, safety behaviors.


Genetic linkage analysis of a variant of juvenile onset neuronal ceroid lipofuscinosis with granular osmiophilic deposits.
A number of variant forms of the neuronal ceroid lipofuscinoses (NCL) have been described and remain unmapped. The genes for infantile (CLN1), juvenile (CLN3) and Finnish-variant late-infantile (CLN5) have previously been mapped to chromosome regions 1p32, 16p12 and 13q21.1-32 respectively. The locus for a variant form of juvenile onset NCL characterised by cytosomal granular osmiophilic deposits (GROD) has been excluded from the CLN3 region of chromosome 16. This study describes the outcome of genetic linkage analysis in four families with this variant at the loci for the CLN1 and CLN5 genes. Using highly informative microsatellite markers tightly linked to the CLN5 locus we have excluded the JNCL variant with GROD from this region. Marker typing across the CLN1 region suggests that JNCL with GROD may be an allelic variant of infantile NCL.


Comparison of the light charged particles on scatter radiation dose in thyroid hadron therapy.
Hadron therapy is a novel technique of cancer radiation therapy which employs charged particles beams, (1)H and light ions in particular. Due to their physical and radiobiological properties, they allow one to obtain a more conformal treatment, sparing better the healthy tissues located in proximity of the tumor and allowing a higher control of the disease. Objective : As it is well known, these light particles can interact with nuclei in the tissue, and produce the different secondary particles such as neutron and photon. These particles can damage specially the critical organs behind of thyroid gland. In this research, we simulated neck geometry by MCNPX code and calculated the light particles dose at distance of 2.14 cm in thyroid gland, for different particles beam: (1)H, (2)H, (3)He, and (4)He. Thyroid treatment is important because the spine and vertebrae is situated right behind to the thyroid gland on the posterior side. The results show that (2)H has the most total flux for photon and neutron, 1.944E-3 and 1.7666E-2, respectively. Whereas (1)H and (3)He have best conditions, 8.88609E-4 and 1.35431E-3 for photon, 4.90506E-4 and 4.34057E-3 for neutron, respectively. The same calculation has obtained for energy depositions for these particles. In this research, we investigated that which of these light particles can deliver the maximum dose to the normal tissues and the minimum dose to the tumor. By comparing these results for the mentioned light particles, we find out (1)H and (3)He is the best therapy choices for thyroid glands whereas (2)H is the worst.


Trophic transfer of 134Cs in the Manila clam Ruditapes philippinarum.
Bioaccumulation of radiocaesium in many marine organisms occurs through complex trophic transfer mechanisms. The present study addresses the trophic transfer of 134Cs in the widely distributed marine bivalve, the Manila clam Ruditapes philippinarum, by experimentally determining the assimilation efficiency (AE) and the specific role of food quality or diet on the AE in this marine invertebrate. Pulse-chase feeding experiments were carried out on this clam using the phytoplankton species Tetraselmis chuii, Phaeodactylum tricornutum and Isochrysis galbana. Depuration kinetics of 134Cs over 21 days were analysed using a two-component exponential model. Observed assimilation efficiencies were consistently less than 10% but slightly varied among individuals fed on the three different phytoplankton species diets (T. chuii: AE = 8.4 ± 0.6%; P. tricornutum: AE = 9.8 ± 0.5%; I. galbana: AE = 5.3 ± 0.6%), although no statistical differences were observed. Comparing results from these experiments with existing data from the literature on the same species exposed to caesium through seawater, it appears that trophic transfer processes are the main accumulation pathway, contributing up to 96% of the global 134Cs bioaccumulation in this bivalve species.


Abandoning Prophylactic Abdominal Drainage after Hepatic Surgery: 10 Years of No-Drain Policy in an Enhanced Recovery after Surgery Environment.
Routine prophylactic abdominal drainage after hepatic surgery is still being debated, as it may be unnecessary, possibly harmful, and uncomfortable for patients. This study evaluated the safety of a no-drain policy after liver resection within an Enhanced Recovery after Surgery (ERAS) programme. All hepatectomies performed without prophylactic drainage during 2005-2014 were included. Primary end points were resection-surface-related (RSR) morbidity, defined as the presence of postoperative biloma, hemorrhage or abscess, and reinterventions. Secondary end points were length of stay, total postoperative morbidity, the composite end point of liver surgery-specific complications, readmissions, and 90-day mortality. Uni- and multivariate analyses were performed to identify independent risk factors for RSR morbidity. A systematic search was performed to compare the results of this study to literature. A total of 538 resections were included in the study. The RSR complication and reintervention rate was 15 and 12%, respectively. Major liver resection (≥3 segments) was an independent risk factor for the development of RSR morbidity (OR 3.01, 95% CI 1.61-5.62; p = 0.001) and need for RSR reintervention (OR 3.02, 95% CI 1.59-5.73; p = 0.001). RSR morbidity, mortality, and reintervention rates after liver surgery without prophylactic drainage in patients, treated within an ERAS programme, were comparable to previously published data. A no-drain policy after partial hepatectomy seems safe and feasible.


Role of nitric oxide and prostanoids in attenuation of rapid baroreceptor resetting.
Because the regulation of vascular function involves complex mutual interactions between nitric oxide (NO) synthase (NOS) and cyclooxygenase (COX) products, we examined the contribution of NO and prostanoids derived from the COX pathway in modulating aortic baroreceptor resetting during an acute (30 min) increase in arterial pressure in anesthetized rats. Increase in pressure was induced either by administration of the nonselective NOS inhibitor N(G)-nitro-L-arginine methyl ester (L-NAME) or aortic coarctation (COA) with or without treatment with the COX inhibitor indomethacin (INDO) or the selective neuronal NOS inhibitor 1-(2-trifluoromethylphenyl)imidazole (TRIM). The activity of the aortic depressor nerve and arterial pressure were simultaneously recorded, and the degree of resetting was determined by the shift of the pressure-nerve activity curve using the ratio [delta systolic pressure at 50% of maximum baroreceptor activity/delta systolic pressure] x 100. The magnitude of pressure rise was similar in the different groups (59 +/- 6, 53 +/- 5, 53 +/- 5, 45 +/- 5, 49 +/- 3, and 41 +/- 3 mmHg for COA, L-NAME, INDO+COA, INDO+L-NAME, TRIM+COA, and TRIM+INDO+COA, respectively, P = 0.27). The degree of resetting that occurred with L-NAME or COA combined with treatment with TRIM was attenuated compared with COA alone (7 +/- 4, 5 +/- 2, and 31 +/- 6%, respectively, P = 0.04). INDO failed to influence baroreceptor resetting to higher pressure but prevented L-NAME- and TRIM-induced effects (20 +/- 7, 21 +/- 8, and 32 +/- 6% for INDO+COA, INDO+L-NAME, and INDO+TRIM+COA, respectively; P = 0.38). Baroreceptor gain was affected only by l-NAME. These findings indicate that NO, probably from neuronal origin, may exert stimulatory influence on the degree of rapid baroreceptor resetting to hypertension that involves COX-derived prostanoids.


The reliability of computed tomography (CT) values and dimensional measurements of the oropharyngeal region using cone beam CT: comparison with multidetector CT.
To evaluate the reliability of cone beam CT (CBCT) values and dimensional measurements of oropharyngeal air spaces as compared with those of multidetector row CT (MDCT). A soft tissue equivalent phantom with different sized holes was used. The phantom was scanned using CBCT and MDCT. In addition, a volunteer was examined using both methods for clinical comparison. The CT data were retrieved to a personal computer and treated using image processing software for three-dimensional rendering and dimensional measurements. The CT values of air, water and soft tissues were measured experimentally and the CT values of air, fat and muscle were measured in a clinical case. The diameter of each hole drilled in the phantom was measured on CBCT and MDCT images using the software tool and digimatic callipers. The CBCT values were quite different from the Hounsfield units obtained with a typical MDCT system. The standard deviations were almost ten times larger with CBCT. In vivo assessment showed that the CBCT values for fat had a wide range that partially overlapped the values for muscle. The measurement of distances greater than 4 mm was consistent for all methods. The difference for holes was less than 0.2 mm. The phantom study showed that CBCT provides limited quantitative CT values for each pixel on sliced images for differentiating air, water and soft tissues. However, the measurement of air spaces with CBCT was quite accurate.


Biomass-Derived Carbonaceous Materials with Graphene/Graphene-Like Structures: Definition, Classification, and Environmental Applications.
Biomass-derived carbonaceous materials with graphene/graphene-like structures (BGS) have attracted tremendous attention in the field of environmental remediation. The introduction of graphene/graphene-like structures into raw biochars can effectively improve their properties, such as electrical conductivity, surface functional groups, and catalytic activity. In 2021, the International Organization for Standardization defined graphene as a "single layer of carbon atoms with each atom bound to three neighbours in a honeycomb structure". Considering this definition, several studies have incorrectly referred to BGS (e.g., biomass-derived few-layer graphene or porous graphene-like nanosheets) as "graphene". The definitions and classifications of BGS and their applications in environmental remediation have not been assessed critically thus far. Comprehensive analysis and sufficient and robust evidence are highly desired to accurately determine the specific structures of BGS. In this perspective, we provide a systematic framework to define and classify the BGS. The state-of-the-art methods currently used to determine the structural properties of BGS are scrutinized. We then discuss the design and fabrication of BGS and how their distinctive features could improve the applicability of biomass-derived carbonaceous materials, particularly in environmental remediation. The environmental applications of these BGS are highlighted, and future research opportunities and needs are identified. The fundamental insights in this perspective provide critical guidance for the further development of BGS for a wide range of environmental applications.


Pancreatic Pseudocyst Pleural Fistula in Gallstone Pancreatitis.
Extra-abdominal complications of pancreatitis such as pancreaticopleural fistulae are rare. A pancreaticopleural fistula occurs when inflammation of the pancreas and pancreatic ductal disruption lead to leakage of secretions through a fistulous tract into the thorax. The underlying aetiology in the majority of cases is alcohol-induced chronic pancreatitis. The diagnosis is often delayed given that the majority of patients present with pulmonary symptoms and frequently have large, persistent pleural effusions. The diagnosis is confirmed through imaging and the detection of significantly elevated amylase levels in the pleural exudate. Treatment options include somatostatin analogues, thoracocentesis, endoscopic retrograde cholangiopancreatography (ERCP) with pancreatic duct stenting, and surgery. The authors present a case of pancreatic pseudocyst pleural fistula in a woman with gallstone pancreatitis presenting with recurrent pneumonias and bilateral pleural effusions.


Assessment of awareness level on tobacco and smoking habits as risk factors for cancer among lung and laryngeal cancer patients in Kolkata--a case control study.
The burden of tobacco related cancers is increasing alarmingly throughout the world; therefore tobacco control merits the highest priority in the fight against cancer worldwide. The present report concerns a case control study of males with cancers of lung and larynx, to assess tobacco use, level of exposure and the awareness of risk of tobacco as a main cause of cancer. A total of 217 new patients with cancer of lung and larynx registered at Chittaranjan National Cancer Institute were recruited for the study, along with 200 healthy male (age, religion and residential status matched ) visiting controls. Information on socio-demographic parameters, details of the disease, tobacco use, and awareness about effects of tobacco were obtained through a standardized questionnaire. Smokers were at a higher risk of disease than nonsmokers, with a direct correlation between duration and number of smoking, monthly income, family size and education level. Adjusted ORs observed for smokers for duration more than 40 years of smoking and smoking more than 40 beedi/cigarettes per day were 4.3 and 3.9, respectively. Awareness level towards tobacco chewing, active and passive smoking revealed poor response among the subjects. Thus improved health education for antismoking and awareness generation of tobacco hazards should be strongly recommended as a preventive measure.


Patients with normal-range CA19-9 levels represent a distinct subgroup of pancreatic cancer patients.
Pancreatic cancer remains a lethal disease that responds poorly to multiple types of treatment. Therefore, the identification of distinct subgroups that exhibit unique therapeutic responses is an urgent requirement. In the present multicenter study (1,912 cases), the differences between the therapeutic responses and clinical characteristics of two subgroups of pancreatic cancer, carbohydrate antigen 19-9 (CA19-9)-normal (baseline serum level, ≤37 U/ml) and CA19-9-elevated (baseline serum level, >37 U/ml), were analyzed. CA19-9-normal expression was identified to be an independent prognostic factor for patients with stage I-II [hazard ratio (HR)=0.77; P=0.037] and stage III-IV (HR=0.68; P<0.001) pancreatic cancer. The 5-year survival rate of the stage III-IV CA19-9-normal subgroup was increased compared with the stage I-II CA19-9-elevated subgroup (15.4 vs. 13.8%). In the stage I-II CA19-9-normal and CA19-9-elevated subgroups, gemcitabine-based chemotherapy was a significant positive prognostic factor for survival (CA19-9-normal, HR=0.54, P=0.013; CA19-9-elevated, HR=0.55, P<0.001). However, among stage III-IV patients, the CA19-9-normal subgroup exhibited a poor response to gemcitabine-based chemotherapy (HR=0.77; P=0.165), while the CA19-9-elevated subgroup exhibited a favorable response, resulting in a lower rate of mortality (HR=0.70; P<0.001) compared with no chemotherapy. It was concluded that CA19-9-normal pancreatic cancer is a less aggressive subgroup; however, advanced CA19-9-normal pancreatic cancer exhibits a poorer response to gemcitabine-based chemotherapy.


Adaptive Temporal Matched Filtering for Noise Suppression in Fiber Optic Distributed Acoustic Sensing.
Distributed vibration sensing based on phase-sensitive optical time domain reflectometry ( ϕ -OTDR) is being widely used in several applications. However, one of the main challenges in coherent detection-based ϕ -OTDR systems is the fading noise, which impacts the detection performance. In addition, typical signal averaging and differentiating techniques are not suitable for detecting high frequency events. This paper presents a new approach for reducing the effect of fading noise in fiber optic distributed acoustic vibration sensing systems without any impact on the frequency response of the detection system. The method is based on temporal adaptive processing of ϕ -OTDR signals. The fundamental theory underlying the algorithm, which is based on signal-to-noise ratio (SNR) maximization, is presented, and the efficacy of our algorithm is demonstrated with laboratory experiments and field tests. With the proposed digital processing technique, the results show that more than 10 dB of SNR values can be achieved without any reduction in the system bandwidth and without using additional optical amplifier stages in the hardware. We believe that our proposed adaptive processing approach can be effectively used to develop fiber optic-based distributed acoustic vibration sensing systems.


[Associations between cardiovascular diseases and psychosocial factors and options for intervention].
Coronary artery disease is a highly prevalent heart disease and the leading cause of morbidity and mortality in developed countries. During the last decades, numerous studies have focused on the comprehension of the relationship between coronary heart disease and different psychosocial factors. Coronary artery bypass graft surgery is a common treatment for coronary artery disease and is usually associated with improved clinical outcomes. Symptoms of anxiety and unipolar depression are common psychological disorders in patients awaiting coronary artery bypass graft surgery. Several prospective cohort studies have been carried out on the factors affecting the short- and long-term outcome of coronary artery bypass graft surgery. Scientific literature reports that not only clinical features, e.g., cardial state, comorbidity or intraoperative factors influence the outcome of cardiac surgery. In a comprehension of psychosocial factors over traditional risk factors (hypertension, LDL cholesterol level, diabetes mellitus, smoking, obesity and physical inactivity) on morbidity and mortality rates, the previously mentioned ones proved to be determinant. Gathering patients' psychological status before undergoing heart surgery and providing psychological interventions if they are indicated would be beneficial. A better understanding of whether and when psychological interventions affect specific outcomes may help design even more powerful interventions and make better predictions of which patients will benefit from which psychological intervention. Psychological assessment and intervention thus merit integration into routine surgical care. Orv Hetil. 2023; 164(11): 411-419.


Trends in operative experience of pediatric surgical residents in the United States and Canada.
Expansion of the number of training programs in pediatric surgery occurred from 2003 through 2010. We sought to determine the effect of program expansion on case volume and distribution of operative experience. Public domain data on pediatric surgery resident summary statistics available from the Accreditation Council for Graduate Medical Education (ACGME) from July 2003 through June 2010 were analyzed. Total case volume as primary surgeon or teaching assistant, mean case volume per resident, standard deviation, mode, minimum, and maximum number of cases per resident were evaluated. Mean total cases per resident, minimally invasive laparoscopic and thoracoscopic cases, and requisite cases as defined by the ACGME categories of: tumor, important pediatric surgical, and neonatal cases were analyzed by a Cuzick Wilcoxon-type nonparametric trend statistic using a significance level of 0.05. Skew was assessed by Pearson coefficient with levels of -0.5 to 0.5 defining a parametric distribution. The number of pediatric surgical training residents increased by 42% during the years reported, from 24 to 34. No statistically significant difference was found in the mean number of total cases or requisite cases per resident. The mean volume of minimally invasive procedures increased significantly. Case volume per resident was non-parametrically distributed with increasing positive skew over time. The increase in number of pediatric surgical resident training positions has not adversely affected overall operative experience or exposure to highly specialized requisite cases, on average. The increasing positive skew of total and index cases, however, suggests that variability between programs in case exposure is increasing over time.


Carotid sinus nerve electrical stimulation in conscious rats attenuates systemic inflammation via chemoreceptor activation.
Recent studies demonstrated a critical functional connection between the autonomic (sympathetic and parasympathetic) nervous and the immune systems. The carotid sinus nerve (CSN) conveys electrical signals from the chemoreceptors of the carotid bifurcation to the central nervous system where the stimuli are processed to activate sympathetic and parasympathetic efferent signals. Here, we reported that chemoreflex activation via electrical CSN stimulation, in conscious rats, controls the innate immune response to lipopolysaccharide attenuating the plasma levels of inflammatory cytokines such as tumor necrosis factor (TNF), interleukin 1β (IL-1β) and interleukin 6 (IL-6). By contrast, the chemoreflex stimulation increases the plasma levels of anti-inflammatory cytokine interleukin 10 (IL-10). This chemoreflex anti-inflammatory network was abrogated by carotid chemoreceptor denervation and by pharmacological blockade of either sympathetic - propranolol - or parasympathetic - methylatropine - signals. The chemoreflex stimulation as well as the surgical and pharmacological procedures were confirmed by real-time recording of hemodynamic parameters [pulsatile arterial pressure (PAP) and heart rate (HR)]. These results reveal, in conscious animals, a novel mechanism of neuromodulation mediated by the carotid chemoreceptors and involving both the sympathetic and parasympathetic systems.


Model and observations of Schottky-noise suppression in a cold heavy-ion beam.
Some years ago it was found at GSI in Darmstadt that the momentum spread of electron-cooled beams of highly charged ions dropped abruptly to very low values when the particle number decreased to 10 000 or less. This has been interpreted as an ordering of the ions, such that they line up after one another in the ring. We report observations of similar transitions at CRYRING, including an accompanying drop in Schottky-noise power. We also introduce a model of the ordered beam from which the Schottky-noise power can be calculated numerically. The good agreement between the model calculation and the experimental data is seen as evidence for a spatial ordering of the ions.


A new method of colorimetric assay of beta-lactamase suitable for estimation of beta-lactamase inhibition in crude microbial culture filtrates.
A simple procedure is described for the rapid assay of beta-lactamases suitable for use in the quantitation of beta-lactamase inhibition in crude culture filtrates of soil microbes. The proposed method is based on measuring the blue reaction product (lambda max 750 nm) formed during reduction of phosphomolybdic acid with reducing products generated from beta-lactam hydrolysis and is not influenced significantly by the metabolites of microbial culture filtrates which often interfere with conventional beta-lactamase assay techniques.


Salvinia auriculata in post-treatment of dairy industry wastewater.
The present study aimed to evaluate the aquatic macrophyte Savinia auriculata in post-treatment of wastewater from a dairy industry. The experiment was carried out in a greenhouse between February and March 2015. A batch system was used, each reactor was composed of polyethylene and had capacity of 250 liters of post-treated effluent. Every seven days, pH, turbidity, temperature, dissolved oxygen, chemical oxygen demand and series of solids (total, fixed and volatile) were determined in the wastewater. Besides that, the concentration of macro and micronutrients (P, N, K, Ca, Mg, Cu, Zn, Mn, and Fe) were determined in the wastewater and in plant tissue before and after the experiment. The results showed efficiency in the decrease of N, P, turbidity, pH, solids (ST, SF) and inefficiency in the reduction of volatile solids in the wastewater. The concentration of COD, Ca, Mn, Mg, and Fe increased at the end of the experiment. Due to the absorption of some nutrients such as N and P it is possible to conclude that Salvinia auriculata is a good option for the post-treatment of the wastewater from dairy industry. However, plant senescence promotes the elevation of some elements in the effluent because in this process, nutrients that were previously retained in the plant tissue are inserted into the wastewater again. Because of this it is necessary to remove plants of the reactor in the beginning of the process of senescence.


[PIBF - Progesterone-Induced Blocking Factor].
Pregnancy is a unique immunological situation in which 2 allogeneic organisms live in intimate symbiosis without developing rejection reactions. At different locations, interfaces exist between mother and foetus with direct contact between both individuals: 1) maternal blood surrounds foetal villi, which are covered with syncitiotrophoblast cells; 2) cytotrophoblast cells invade the decidua, in which they touch tissue lymphocytes; 3) trophoblast cells, which substitute endothelium of maternal arterioles filled with maternal blood; and 4) trophoblast particles, which are expressed from syncytiotrophoblast and circulate within the maternal blood until they settle in the lung capillaries, where they become degraded by alveolar macrophages. Several factors are known which support the specific immunotolerance of the mother to her foetus and are focussed by current research in reproductive immunology. One of these factors is progesterone-induced blocking factor (PIBF). Originally, it was discovered as a 34 kDa protein, which is released from lymphocytes of healthy pregnant women under the influence of progesterone. PIBF has immunomodulatory functions in vivo and in vitro, which are important for the establishment of immunotolerance between mother and foetus and, thereby, for the regular course of pregnancy. Finally, during the last years, several tumours have been identified to produce PIBF, which supports their immune escape and which may have the potential to become a novel tumour biomarker and which may lead to the development of new therapeutic strategies.


MLAA-based attenuation correction of flexible hardware components in hybrid PET/MR imaging.
Accurate PET quantification demands attenuation correction (AC) for both patient and hardware attenuation of the 511 keV annihilation photons. In hybrid PET/MR imaging, AC for stationary hardware components such as patient table and MR head coil is straightforward, employing CT-derived attenuation templates. AC for flexible hardware components such as MR-safe headphones and MR radiofrequency (RF) surface coils is more challenging. Registration-based approaches, aligning CT-based attenuation templates with the current patient position, have been proposed but are not used in clinical routine. Ignoring headphone or RF coil attenuation has been shown to result in regional activity underestimation values of up to 18%. We propose to employ the maximum-likelihood reconstruction of attenuation and activity (MLAA) algorithm to estimate the attenuation of flexible hardware components. Starting with an initial attenuation map not including flexible hardware components, the attenuation update of MLAA is applied outside the body outline only, allowing to estimate hardware attenuation without modifying the patient attenuation map. Appropriate prior expectations on the attenuation coefficients are incorporated into MLAA. The proposed method is investigated for non-TOF PET phantom and 18F-FDG patient data acquired with a clinical PET/MR device, using headphones or RF surface coils as flexible hardware components. Although MLAA cannot recover the exact physical shape of the hardware attenuation maps, the overall attenuation of the hardware components is accurately estimated. Therefore, the proposed algorithm significantly improves PET quantification. Using the phantom data, local activity underestimation when neglecting hardware attenuation was reduced from up to 25% to less than 3% under- or overestimation as compared to reference scans without hardware present or to CT-derived AC. For the patient data, we found an average activity underestimation of 7.9% evaluated in the full brain and of 6.1% for the abdominal region comparing the uncorrected case with MLAA. MLAA is able to provide accurate estimations of the attenuation of flexible hardware components and can therefore be used to significantly improve PET quantification. The proposed approach can be readily incorporated into clinical workflow.


Effects of interval training and a taper on cycling performance and isokinetic leg strength.
The purpose of this study was to determine whether changes in isokinetic leg strength parallel changes in cycling performance during a six-week high-intensity aerobic interval training program and a subsequent two-week taper. Eleven male collegiate cyclists participated in one competitive cycling graded exercise test, four consecutive days of aerobic intervals (30 min @82.2 +/- 0.74% HRmax, 1:1 work:relief), and four continuous rides (1-2 hr @65-80% HRmax) weekly. Pedalling cadence during training was generally 70-80 rpm suggesting a knee joint velocity of approximately 210 degrees.sec-1. Cycling performance and peak isokinetic torque (TQpk) for knee flexors (HAM) and knee extensors (QUAD) @30, 120, 210, and 300 degrees.sec-1 were assessed before, every two weeks during, and each week for two weeks following six weeks of interval training. Performance increased significantly during training (15%) and increased further during the taper (8%). QUAD TQpk @30 and 120 degrees.sec-1 increased significantly during training and the taper. In contrast, QUAD TQpk @210 and 300 degrees.sec-1 and HAM TQpk for all velocities were not significantly elevated following training. Interestingly, QUAD TQpk @300 but not 210 degrees.sec-1 significantly increased during the taper. Data from this study demonstrates that high-intensity aerobic interval cycling can promote gains in QUAD strength which occur primarily at contraction velocities slower than those utilized during cycling training. Additionally, a two-week taper can produce significant improvements in cycling performance (8%) and QUAD strength (8-9%) at 30 and 120 degrees.sec-1, however, the time-courses for these improvements do not parallel one another.


Hybrid endovascular and open surgical repair of a Crawford type III thoracoabdominal aneurysm in a high-risk patient.
Open thoracoabdominal aortic aneurysm repair carries a risk of significant morbidity and mortality. Thoracic endovascular aortic repair is an alternative, less invasive approach with lower morbidity and mortality but is not an option for thoracoabdominal aortic aneurysm because of visceral artery involvement. The authors describe the treatment of a 61-year-old high-risk male with an enlarging Crawford type III thoracoabdominal aneurysm using simultaneous aortic visceral debranching and thoracoabdominal endovascular aortic repair. A hybrid approach may be a safe alternative treatment option in high-risk surgical patients with thoracoabdominal aortic aneurysm.


The validity of ESIN method of osteosynthesis compared to other active surgical methods of treatment of diaphyseal fractures of long bones in children and adolescents.
We investigated the relationship of efficiency in the application of the ESIN method of intramedullary osteosynthesis and other active surgical methods in the treatment of diaphyseal fractures of long bones in children and adolescents. The study comprised 100 subjects treated by elastic stable intramedullary osteosynthesis (ESIN - group A) and 50 subjects in whom other active surgical methods were applied (group B). The following criteria of efficiency of treatment were applied: 1. length of perioperative hospitalization, 2. time elapsed since the operation until the beginning of loading of the traumatized extremity, 3. time elapsed since the operation until the full loading of the extremity, i.e. until the recovery of the fracture, 4. incidence of complications, 5. number of post-operative outpatient clinical visits until the recovery of the fracture and 6. overall number of X-ray images of the fractured bone since the accident until the coalescence of the fracture. The results obtained in both groups were compared. 1. The length of perioperative hospitalization is shorter in patients in whom ESIN method was applied. The difference between arithmetic means was 4.45 days and is statistically significant (p < 0.001). 2. The time between the operation until the beginning of loading of the extremity is shorter in patients subjected to ESIN method of osteosynthesis, the difference of mean values being 23.49 days and is statistically significant (p < 0.001). 3. The time between the operation until the full loading of the extremity is shorter in patients subjected to ESIN method of osteosynthesis, the difference being 16.6 days and is statistically significant (p < 0.001). 4. The number of complications in patients treated by the ESIN method of osteosynthesis is not statistically different from that in group B (chi2 = 0.25, p = 0.62). 5. In postoperative period there were fewer outpatient controls in patients to whom ESIN method of osteosynthesis was applied, and the difference is statistically significant (Z = 7.69, p < 0.001). 6. Likewise, the overall number of X-ray controls was lesser (Z = 8.06, p < 0.001). The results of examining the above parameters point to a greater efficiency of treating diaphyseal fractures of long bones in children and adolescents by the ESIN method of osteosynthesis, compared to other active surgical methods.


Monopolar coagulation versus conventional endoscopic treatment for high-risk peptic ulcer bleeding: a prospective, randomized study.
Severe upper GI hemorrhage from an actively bleeding peptic ulcer is sometimes difficult to treat by conventional endoscopic means, such as multipolar electrocoagulation, heat probe coagulation, and injection therapy. It was hypothesized that monopolar coagulation with a "hot biopsy" forceps may be more effective in such cases. A prospective, randomized trial was performed to assess the safety and short-term efficacy of monopolar coagulation versus conventional treatment (combination heat probe coagulation and injection therapy) in the treatment of patients with various types of actively bleeding or high-risk ulcers. Primary hemostasis was achieved in 54 of 56 actively bleeding patients in the monopolar coagulation group. In contrast, primary hemostasis was achieved in 33 of 43 patients in the control group (p = 0.003), with 8 of the remaining 10 being treated successfully by crossover monopolar coagulation. During 30-day follow-up, bleeding recurred in 6 patients in the conventional therapy group versus none in the monopolar coagulation group (p = 0.012). Post-endoscopy blood transfusion requirements were lower in the monopolar coagulation group. Mortality and surgery rates were zero in both groups. There was no procedure-related complication. This study demonstrated improved primary hemostasis and a reduced short-term rate of recurrent bleeding for patients with actively bleeding and high-risk non-bleeding peptic ulcers treated by monopolar coagulation. The complication rate associated with monopolar coagulation was low.


[Therapeutic effects of chemotherapeutic regimen with pirarubicin for adult high-risk acute leukemia].
To evaluate the therapeutic effects of chemotherapeutic regimen with pirarubicin in the management of adult high-risk acute leukemia. Twenty-nine high-risk acute leukemia patients were selected as the treatment group and another 29 patients with similar pretreatment conditions as the control group. In the treatment group, 18 patients had acute non-lymphocytic leukemia (ANLL), and 8 had acute lymphocytic leukemia (ALL) and 3 had mixed leukemia, all received treatment regimens with pirarubicin+cytarabine, vincristine+pirarubicin+prednisone, Vincristine+pirarubicin+L-asparaginase (L)+prednisone or pirarubicin+cytarabine+vincristine+prednisone. Routine therapeutic regimens were adopted in the management of the control. In ANLL patients, the overall remission rate was significantly higher in the treatment group than in the control group (77.78% vs 44.44%, P=0.031). Patients in the treatment group had greater marrow suppression and higher incidence of infections than the control group (P=0.012). Regimens with pirarubicin is more effective than the routine regimens in the management of patients with high-risk ANLL and produce greater but tolerable marrow suppression.


Transdermal systems for overactive bladder: principles and practice.
The transdermal system for delivery of medication to treat overactive bladder may provide an improved efficacy-to-tolerability ratio by regulating serum drug levels; avoiding gastrointestinal and hepatic metabolism, which is important when the metabolite has a lesser therapeutic index than the parent drug; and achieving clinical efficacy with a lower total drug burden. Additional advantages may include increased compliance and obviation of the need for oral drug administration, which is especially beneficial for the patient who is taking multiple oral medications or is caregiver-dependent. An efficient patch system must preserve the physical integrity of the drug layer, provide adequate adhesion, store and release the drug and permeation-enhancing agent in a predictable manner, promote consistent absorption through the skin regardless of location or skin or subcutaneous tissue differences, demonstrate dose proportionality, maintain skin integrity during product use and removal, and be cosmetically acceptable. A novel transdermal delivery system that incorporates an occlusive layer covering an acrylic adhesive containing the active agent oxybutynin and a skin permeation enhancer has been demonstrated in clinical trials to achieve these goals.


Seismic Investigations of Seychelles and Saya de Malha Banks, Northwest Indian Ocean.
Seismic refraction lines on Seychelles Bank confirm the presence of granite rock under a considerable portion of the bank. Saya de Malha Bank, also on the Mascarene Ridge, appears to be composed of volcanic rocks capped by coral. It is suggested that the two areas are structurally independent.


The ten commitments: a value base for mental health recovery.
The concept of recovery is an important part of contemporary mental health services. During the past 5 years, Tidal Model projects, focused on developing the recovery attitude within nursing practice, have been established in several different countries. The Tidal model emphasizes 10 philosophical assumptions the "Ten Commitments," that are central to recovery-focused practice.


The Effect of Ischemic Preconditioning on Repeated Sprint Cycling Performance.
Ischemic preconditioning enhances exercise performance. We tested the hypothesis that ischemic preconditioning would improve intermittent exercise in the form of a repeated sprint test during cycling ergometry. In a single-blind, crossover study, 14 recreationally active men (mean ± SD age, 22.9 ± 3.7 yr; height, 1.80 ± 0.07 m; and mass, 77.3 ± 9.2 kg) performed twelve 6-s sprints after four 5-min periods of bilateral limb occlusion at 220 mm Hg (ischemic preconditioning) or 20 mm Hg (placebo). Ischemic preconditioning resulted in a 2.4% ± 2.2%, 2.6% ± 2.7%, and 3.7% ± 2.4% substantial increase in peak power for sprints 1, 2, and 3, respectively, relative to placebo, with no further changes between trials observed for any other sprint. Similar findings were observed in the first three sprints for mean power output after ischemic preconditioning (2.8% ± 2.5%, 2.6% ± 2.5%, and 3.4% ± 2.1%, for sprints 1, 2, and 3, respectively), relative to placebo. Fatigue index was not substantially different between trials. At rest, tissue saturation index was not different between the trials. During the ischemic preconditioning/placebo stimulus, there was a -19.7% ± 3.6% decrease in tissue saturation index in the ischemic preconditioning trial, relative to placebo. During exercise, there was a 5.4% ± 4.8% greater maintenance of tissue saturation index in the ischemic preconditioning trial, relative to placebo. There were no substantial differences between trials for blood lactate, electromyography (EMG) median frequency, oxygen uptake, or rating of perceived exertion (RPE) at any time points. Ischemic preconditioning improved peak and mean power output during the early stages of repeated sprint cycling and may be beneficial for sprint sports.