Clinical trials with long-term treatment of pulmonary hypertension due to lung disease.
Many drugs have been tested for the treatment of pulmonary hypertension of different origins, but even the acute effects are controversial and side-effects are frequently important. In a few studies, vasodilators have been used in the long-term treatment of chronic pulmonary hypertension related to chronic lung disease (calcium channel blockers, hydralazine, nitrates); here, also, the results are inconstant and the side-effects are sometimes major. No vasodilator specific for the pulmonary circulation is presently available.


Antihypertensive potential of the aqueous extract which combine leaf of Persea americana Mill. (Lauraceae), stems and leaf of Cymbopogon citratus (D.C) Stapf. (Poaceae), fruits of Citrus medical L. (Rutaceae) as well as honey in ethanol and sucrose experimental model.
The present study was designed to evaluate the effects of the aqueous extract obtained from the mixture of fresh leaf of Persea americana, stems and fresh leaf of Cymbopogon citratus, fruits of Citrus medica and honey on ethanol and sucrose induced hypertension in rats. Rats were divided into eight groups of 6 rats each and daily treated for 5 weeks. The control group received distilled water (1 mL/kg) while rats of groups 2, 3 and 4 received ethanol 40 degrees (3 g/kg/day), 10% sucrose as drinking water and the two substances respectively. The remaining groups received in addition to sucrose and ethanol, the aqueous extract (50, 100 and 150 mg/kg) or nifedipine (10 mg/kg) respectively. Many parameters including hemodynamic, biochemical and histopathological were assessed at the end of the study. The concomitant consumption of ethanol and sucrose significantly (p < 0.001) increased the blood pressure and the heart rate compared to distilled water treated-rats. The levels of total cholesterol, LDL-cholesterol, triglycerides, atherogenic index, glucose, proteins, AST, ALT, creatinin, potassium, sodium and albumin increased while the HDL-cholesterol decreased under ethanol and sucrose feeding. Chronic ethanol and sucrose intake significantly decreased the activities of superoxide dismutase (SOD) and catalase (CAT) as well as the contents of reduced glutathione (GSH) and nitrites whereas elevated the malondialdehyde (MDA) levels. Histological analysis revealed among other vascular congestion, inflammation, tubular clarification and thickening of the vessel wall in rats treated with alcohol and sucrose. Administration of the aqueous extract or nifedipine prevented the hemodynamic, biochemical, oxidative and histological impairments induced chronic ethanol and sucrose consumption. Current results suggest that the aqueous extract used in this study possess antihypertensive activity against ethanol and sucrose induced hypertension in rats by the improvement of biochemical and oxidative status, and by protecting liver, kidney and vascular endothelium against damages induced by chronic consumption of ethanol and sucrose.


Reversed anaphylaxis with anti-IgE on mouse and rat mast cells.
Peritoneal mast cells of four inbred strains of mice (BABL/c, 129, C3H/A, C57BL/6J) and F1 hybrids of August and Wistar rats were studied for their sensitivity to the action of anti-IgE antibody for histamine release. The mast cells of normal mice from four mouse strains tested showed different abiltiy to release histamine after challenge with several dilutions of anti-IgE; mast cells of BALB/c mice showed the lowest reaction to anti-IgE. After active sensitization of mice and rats their mast cells release histamine after challenge with specific antigen, however, the detectable changes in their sensitivity to anti-IgE were not observed. After passive sensitization of mice the mast cells of three out of four strains tested show slightly enhanced sensitivity to anti-IgE for histamine release. Thus, the sensitization of mast cells not always stimulates their sensitivity to anti-IgE in reversed anaphylaxis.


Long-term Lens Complications Following Removal of Persistent Pupillary Membrane.
We evaluated the long-term surgical outcome and lens complications in children with persistent pupillary membrane following removal using vitreous scissors. Patients diagnosed with persistent pupillary membrane who received surgical treatment from 1987 to 2012 were retrospectively reviewed. The removal was performed using vitreous scissors after instillation of miotics. The minimum follow-up period after surgery was four years. Factors of age, sex, visual acuity, refractive errors, and complications during or after surgery were evaluated. A total of 32 eyes of 26 patients were included. The mean age at the initial visit was 22.6 ± 34.7 (range, 0.9 to 141.2) months, and the mean age at surgery was 43.7 ± 36.0 (range, 1.0 to 142.5) months. There were no intraoperative complications using vitreous scissors, and all lesions were completely removed. After a mean follow-up period of 6.5 ± 3.3 (range, 4.0 to 14.8) years, the best corrected visual acuity at the final visit was 0.6 ± 0.9 logarithm of the minimum angle of resolution, and two eyes (6.3%) presented with lens opacity during follow-up. In children with persistent pupillary membrane, there were no intraoperative complications, and only two patients presented with lens change during the long-term postoperative follow-up period. Surgical removal should be considered a safe and effective treatment for patients with visually significant persistent pupillary membrane.


Multistep energy and electron transfer in a "V-configured" supramolecular BODIPY-azaBODIPY-fullerene triad: mimicry of photosynthetic antenna reaction-center events.
A new photosynthetic antenna-reaction-center model compound composed of covalently linked BF2 -chelated dipyrromethene (BODIPY), BF2 -chelated azadipyrromethene (azaBODIPY), and fullerene (C60 ), in a "V-configuration", has been newly synthesized and characterized by using a multistep synthetic procedure. Optical absorbance and steady-state fluorescence, computational, and electrochemical studies were systematically performed in nonpolar, toluene, and polar, benzonitrile, solvents to establish the molecular integrity of the triad and to construct an energy-level diagram revealing different photochemical events. The geometry obtained by B3LYP/6-31G* calculations revealed the anticipated V-configuration of the BODIPY-azaBODIPY-C60 triad. The location of the frontier orbitals in the triad tracked the site of electron transfer determined from electrochemical studies. The different photochemical events originated from (1) BODIPY* were realized from the energy-level diagram. Accordingly, (1) BODIPY* resulted in competitive ultrafast energy transfer to produce BODIPY-(1) azaBODIPY*-C60 and electron transfer to produce BODIPY(.) (+) -azaBODIPY-C60 (.) (-) as major photochemical events. The charge-separated state persisted for few nanoseconds prior populating (3) C60 *, which in turn revealed an unusual triplet-triplet energy transfer to produce (3) azaBODIPY* prior returning to the ground state. These findings delineate the importance of multimodular systems in energy harvesting, and more importantly, their utility in building multifunction performing optoelectronic devices.


Pinna synthetic mold for otoplasty techniques application.
The ear deformity Tanzer type V, also known as prominent ears, is the most common genetic defect of the pinna. The surgery designed for its correction is known as otoplasty. This esthetic surgery can be performed using different techniques, which requires great skill of its operator. The purpose of this work is the development of a new tool for otoplasty techniques training, aimed on the possibility to minimize errors during the otoplasty. Synthetic molds of the external ear from patients with Tanzer type V deformity were made, using silicone material and rayon. The main procedures of otoplasty could be performed in the molds made of silicone and rayon with a good esthetic result. The elaborated molds had identical size and shape of a human ear and could be positioned in the same shape of the patient ears. Thus, the synthetic molds were presented as promising simulation tools for the training and surgical enhancement of otoplasty, especially for doctors beginners.


Localized and extended patterns in the cubic-quintic Swift-Hohenberg equation on a disk.
Axisymmetric and nonaxisymmetric patterns in the cubic-quintic Swift-Hohenberg equation posed on a disk with Neumann boundary conditions are studied via numerical continuation and bifurcation analysis. Axisymmetric localized solutions in the form of spots and rings known from earlier studies persist and snake in the usual fashion until they begin to interact with the boundary. Depending on parameters, including the disk radius, these states may or may not connect to the branch of domain-filling target states. Secondary instabilities of localized axisymmetric states may create multiarm localized structures that grow and interact with the boundary before broadening into domain-filling states. High azimuthal wave number wall states referred to as daisy states are also found. Secondary bifurcations from these states include localized daisies, i.e., wall states localized in both radius and angle. Depending on parameters, these states may snake much as in the one-dimensional Swift-Hohenberg equation, or invade the interior of the domain, yielding states referred to as worms, or domain-filling stripes.


Evaluation of transgenic Leishmania infantum expressing mLLO-BAX-SMAC in the apoptosis of the infected macrophages in vitro and in vivo.
Leishmaniasis is an important infectious disease that develops because of escaping parasite from the host immune system or preventing host macrophages apoptosis. Recently, the development of transgenic methods and the manipulation of the parasite genome has provided many advantages. So, in this study, the effect of the transgenic Leishmania infantum expressing mLLO-BAX-SMAC proteins was examined in accelerating host cell apoptosis. The entire coding sequence of designed codon-optimized mLLO-Bax-Smac was cloned in the pLexyNeo2 vector and integrated downstream of the 18srRNA locus of L infantum genome by homologous recombination. Next, the expression of mLLO-BAX-SMAC fusion protein was evaluated by the Western blotting technique and the pathogenesis of transgenic parasite was surveyed in vitro and in vivo. The results of PCR and Western blot confirmed proper integration and expression of mLLO-Bax-Smac sequence into the 18srRNA locus of L infantum. Flow cytometry showed accelerating apoptosis of transgenic Leishmania-infected macrophages compared to wild-type parasite. Also, transgenic parasites were less virulent as a fewer parasitic burden was found in the spleen and liver of transgenic-infected mice compared to the control. The data suggested that the transgenic L infantum expressing BAX-SMAC can be used as an experimental model for developing vaccination against leishmaniasis.


Space-Confined Synthesis of Monolayer Graphdiyne in MXene Interlayer.
Graphdiyne (GDY) is an artificial carbon allotrope that is conceptually similar to graphene but composed of sp- and sp2 -hybridized carbon atoms. Monolayer GDY (ML-GDY) is predicted to be an ideal 2D semiconductor material with a wide range of applications. However, its synthesis has posed a significant challenge, leading to difficulties in experimentally validating theoretical properties. Here, it is reported that in situ acetylenic homocoupling of hexaethynylbenzene within the sub-nanometer interlayer space of MXene can effectively prevent out-of-plane growth or vertical stacking of the material, resulting in ML-GDY with in-plane periodicity. The subsequent exfoliation process successfully yields free-standing GDY monolayers with micrometer-scale lateral dimensions. The fabrication of field-effect transistor on free-standing ML-GDY makes the first measurement of its electronic properties possible. The measured electrical conductivity (5.1 × 103 S m-1 ) and carrier mobility (231.4 cm2 V-1 s-1 ) at room temperature are remarkably higher than those of the previously reported multilayer GDY materials. The space-confined synthesis using layered crystals as templates provides a new strategy for preparing 2D materials with precisely controlled layer numbers and long-range structural order.


Marginal analysis in practice: an alternative to needs assessment for contracting health care.
Prioritising health care services on the basis of total needs can lead to inefficient use of resources. A better option is to determine priorities by marginal analysis, which examines the effects of altering the existing balance of expenditure between health care programmes. Resources to support investment are released from disinvestments-that is, the strategy is resource neutral. Thus an increase in total health benefits is achieved independent of any gains that may result from increased spending on health. In 1989 the Welsh Health Planning Forum identified 10 health gain areas, outlining within each one where further investment was likely to produce health gains and where disinvestment might be considered. All Welsh districts then attempted, with varying degrees of success, to produce a resource neutral strategy. Mid Glamorgan further explored the possibility of using marginal analysis in producing its strategy and influencing its policy for contracting. Working groups for most health gain areas each proposed 10 programmes for investment and a further 10 for disinvestment, which were then evaluated by a core evaluation team. In the case of maternal and child health the team dropped 10 of the 20 proposals. The remainder were considered by the health authority, which dropped a further proposal. Nine of the original 20 proposals thus formally became policy for 1995.


Highly Conserved Elements and Chromosome Structure Evolution in Mitochondrial Genomes in Ciliates.
Recent phylogenetic analyses are incorporating ultraconserved elements (UCEs) and highly conserved elements (HCEs). Models of evolution of the genome structure and HCEs initially faced considerable algorithmic challenges, which gave rise to (often unnatural) constraints on these models, even for conceptually simple tasks such as the calculation of distance between two structures or the identification of UCEs. In our recent works, these constraints have been addressed with fast and efficient solutions with no constraints on the underlying models. These approaches have led us to an unexpected result: for some organelles and taxa, the genome structure and HCE set, despite themselves containing relatively little information, still adequately resolve the evolution of species. We also used the HCE identification to search for promoters and regulatory elements that characterize the functional evolution of the genome.


Full-mouth rehabilitation with monolithic CAD/CAM-fabricated hybrid and all-ceramic materials: A case report and 3-year follow up.
Esthetic full-mouth rehabilitation represents a great challenge for clinicians and dental technicians. Computer-aided design/ computer-assisted manufacture (CAD/CAM) technology and novel ceramic materials in combination with adhesive cementation provide a reliable, predictable, and economic workflow. Polychromatic feldspathic CAD/CAM ceramics that are specifically designed for anterior indications result in superior esthetics, whereas novel CAD/CAM hybrid ceramics provide sufficient fracture resistance and adsorption of the occlusal load in posterior areas. Screw-retained monolithic CAD/CAM lithium disilicate crowns (ie, hybrid abutment crowns) represent a reliable and time- and cost-efficient prosthetic implant solution. This case report details a CAD/CAM approach to the full-arch rehabilitation of a 65-year-old patient with toothand implant-supported restorations and provides an overview of the applied CAD/CAM materials and the utilized chairside intraoral scanner. The esthetics, functional occlusion, and gingival and peri-implant tissues remained stable over a follow-up period of 3 years. No signs of fractures within the restorations were observed.


Cell differentiation in Wilms' tumor (nephroblastoma): an immunohistochemical study.
Using an indirect immunoperoxidase technique, we tested frozen specimens from 12 Wilms' tumors with monoclonal antibodies (MoAbs) reacting against a large panel of molecules including laminin, fibronectin, cytokeratin, vimentin, villin, CD24, CALLA/CD10, CR1, CD26, class I and class II major histocompatibility complex (MHC) molecules, and endothelium factor VIII. These molecules were chosen because they are markers of specific segments of the mature kidney and because their loss or acquisition is indicative of different steps of human nephrogenesis. KI67 MoAb was used to evaluate the proliferating activity of the cells. The blastemal component (cell compact areas) of Wilms' tumors consisted of vimentin-positive cells with a fibronectin network. However, signs of epithelial maturation were present in compact areas where cytokeratin-positive cells producing laminin were observed. The cells exhibited a high degree of proliferating activity. The tubule formations consisted of cytokeratin-positive cells and had a defined laminin border. All the cells, whether in compact areas or in tubules, were strongly CD24-positive. Some tubular formations showed signs of proximal maturation with the presence of CALLA, CD26, and even villin. In four cases class I-MHC molecules were expressed by some tubular cells. Large cystic cavities present in five cases were edged by cytokeratin, CD24-positive cells, or by vimentin, CALLA, CR1-positive cells. Some glomeruloid bodies, present in two cases, were also composed of vimentin, CALLA, and CR1-positive cells which correspond to the mature podocyte phenotype. The interstitial tissue contained mainly laminin and fibronectin network with macrophages and few CD3 lymphocytes. The presence of large cells with muscular differentiation was noted; round vimentin and CD26-positive cells were also seen. The endothelial cells of the vessels exhibited vimentin, factor VIII, and class I and class II MHC molecules as do mature cells, but in some cases the endothelial cells lacked class II molecule expression and were CALLA-positive. These results which confirmed and extended those previously described show that cell differentiation in Wilms' tumor mimics that observed during metanephros development. Moreover, this study shows that tumoral cells in nephroblastoma share several antigens with cells from lymphoid lineage (CD24, CALLA, and CD26) as do developing and mature kidney cells. Such cell phenotype dissection provides a useful and reliable tool for testing the influence of various factors on the development of hetero-transplanted or cultured Wilms' tumors.


A new isoniazid preparation designed for moderately fast and "fast" metabolizers of the drug.
The bioavailability of a new isoniazid preparation consisting of 37% ordinary isoniazid (INH) and 63% matrix component was investigated in 11 slow, 8 moderately fast, and 9 "fast" acetylators of the drug. Initially, a 15 mg/kg dose of normal INH was administered to all the participants. In addition, the two groups of fast metabolizers received 30 and 45 mg INH-matrix/kg, respectively, with a one-week interval between the test doses. These high dosages of the INH-matrix could be given without encountering toxic reactions because of the delayed absorption of the matrix formulation. In moderately fast acetylators, with a triple dose of matrix isoniazid, it was possible to mimic the blood levels produced by 15 mg ordinary INH/kg in slow inactivators. However, in "fast" acetylators the blood concentrations achieved with the 45 mg/kg dose of INH-matrix were somewhat lower. This study also showed that a large input rate is essential to procure the required, high blood levels in fast metabolizers. The therapeutic implications of the results of this bioavailability trial are discussed.


DaTSCAN (123I-FP-CIT SPECT) imaging in early versus mid and late onset Parkinson's disease: Longitudinal data from the PPMI study.
It has been reported that early onset Parkinson's Disease (PD) patients have a less profound dopaminergic degeneration. The aim of the current study was to determine whether there are longitudinal differences in dopaminergic denervation [signal reduction in 123I-FP-CIT SPECT] in early versus mid and late onset PD. DaTSCAN (123I-FP-CIT SPECT) imaging was acquired at Parkinson's Progression Markers Initiative (PPMI) imaging centers and sent to the imaging core for calculation of striatal binding ratios. Data from the PPMI database of 58 early de novo PD patients (age ≤ 50 years) were compared to those of 362 mid and late onset PD patients (age > 50 years). Although raw striatal binding ratios were higher in early onset versus mid/late onset PD, especially on the ipsilateral side, such differences were not observed, and were in fact reversed in the contralateral putamen, after age correction. The rate of signal decline was similar between the two groups. Interestingly, based on both raw and age-adjusted data, caudate nucleus and putamen asymmetry (contralateral/ipsilateral ratio) was more pronounced in early onset PD. Striatal asymmetry also significantly correlated with age at onset as a continuous variable. Early onset PD patients exhibited similar rates of decline of dopaminergic denervation compared to mid/late onset PD. These results are not supportive of a more benign disease in this subgroup. The more pronounced asymmetry in early onset PD may however signify a qualitatively different pattern of neurodegeneration compared to mid/late onset PD.


Correlation of neuroradiological, electroencephalographic and clinical findings in cortical dysplasias in children.
Cortical dysplasias (CD) are defined as malformations of cortical development. They result from impairment of neuronal proliferation, migration and differentiation. CD are common pathological substrates in patients with early-onset childhood epilepsy and/or developmental delay as well as neurological signs. Recognition of the importance of cortical dysplasias has been shown in many studies when introducing structural MRI. The following study was performed in order to correlate the neuroimaging findings with the electroencephalographic and clinical picture of children with cortical dysplasias. 46 patients with the presence of CD features in MRI were identified. There were 18 female and 28 male patients. The age ranged from 3 months to 12 years (mean age = 6.2, median age = 3.1). The objectives of the study were explained to the parents or legal representatives of children when possible and also informed consent was obtained. Multiple EEG recordings as well as detailed clinical analysis of all patients were performed. Statistical analysis was conducted in order to correlate the type of CD with clinical outcome and electrophysiological findings. There were 31 patients with focal dysplasias, 6 with schizencephaly, 4 with heterotopias, 3 lissencephaly and 2 with band heterotopia. 80% presented epilepsy (60% of them drug-resistant). Additionally, we tried to elucidate the clinical characteristics of epilepsy. In 75% of epilepsy patients the electroencephalographic changes correlated with anatomical localization of CD. 74% of patients were mentally retarded and 30% had focal neurological deficits. There were no correlations between the type of CD and the severity of the clinical picture, especially the level of mental retardation and presence of drug-resistant epilepsy. Different age at epilepsy onset and various responsiveness to antiepileptic drugs in the majority of patients may reflect different dynamics in epileptogenicity of the underlying CD.


[Quality management of treatment of rheumatoid arthritis in a rheumatological setting].
Rheumatoid arthritis is a chronic inflammatory rheumatic disease affecting about 1% of the general population world-wide. It is characterised by severe pain and a reduction of functional capacity leading to a reduced quality of life. The initiation of an early, effective, continuous and long-term treatment is essential for preventing or delaying progression of disease as long as possible. The implementation of a comprehensive and structured quality management program including both general practitioners and specialists in rheumatology will help to support structural, procedural and outcome quality based on special indices that can be used for benchmarking. The Swiss Clinical Quality Management (SCQM) and the regional model project of the Regional Co-operative Rheumatology Centre in Hanover, Germany (Regionales Kooperatives Rheumazentrum Hannover e.V.) are two examples for total quality management (TQM) of inflammatory rheumatic diseases.


Resonance tunneling electron-vibrational spectroscopy of polyoxometalates.
The tunneling spectra of the ordered monolayer films of decamolybdodicobaltate (DMDC) compounds deposited from aqueous solutions on HOPG were measured by scanning tunnel microscopy in air. The DMDC spectra, as well as the tunneling spectra of other polyoxometalates (POMs), exhibit well-defined negative differential resistances (NDRs). The mechanism of formation of these spectral features was established from the collection of revealed NDR dependences on the external varying parameters and found to be common to all systems exhibiting Wannier-Stark localization. A model of biresonance tunneling was developed to provide an explanation for the totality of experimental data, both the literature and original, on the tunneling POM probing. A variant of the tunneling electron-vibrational POM spectroscopy was proposed allowing the determination of the three basic energy parameters-energy gaps between the occupied and unoccupied states, frequencies of the vibrational transitions accompanying biresonance electron-tunneling processes, and electron-vibrational interaction constants on the monomolecular level.


Design of two-dimensional, ultrathin MoS₂ nanoplates fabricated within one-dimensional carbon nanofibers with thermosensitive morphology: high-performance electrocatalysts for the hydrogen evolution reaction.
Two-dimensional MoS2 nanoplates within carbon nanofibers (CNFs) with monolayer thickness, nanometer-scale dimensions and abundant edges are fabricated. This strategy provides a well-defined pathway for the precise design of MoS2 nanomaterials, offering control over the evolution of MoS2 morphology from nanoparticles to nanoplates as well as from mono- to several-layer structures, over a lateral dimension range of 5 to 70 nm. CNFs play an important role in confining the growth of MoS2 nanoplates, leading to increases in the amount of exposed edge sites while hindering the stacking and aggregation of MoS2 layers, and accelerating electron transfer. The controlled growth of MoS2 nanoplates embedded in CNFs is leveraged to demonstrate structure-dependent catalytic activity in the hydrogen evolution reaction (HER). The results suggest that increases in the number of layers and the lateral dimension result in a decrease in HER activity as a general rule. Single-layer MoS2 nanoplates with abundant edges and a lateral dimension of 7.3 nm demonstrated the lowest hydrogen evolution reaction overpotential of 93 mV (J = 10 mA/cm(2)), the highest current density of 80.3 mA/cm(2) at η = 300 mV and the smallest Tafel slope of 42 mV/decade. The ability of MoS2-CNFs hybrids to act as nonprecious metal catalysts indicates their promise for use in energy-related electrocatalytic applications.


Pediatric ophthalmic mythology.
Headaches in children are virtually never the result of eye problems. If a child needs glasses, young age is almost never a contraindication to their use. Any child in whom strabismus is recognized or suspected should be referred to an ophthalmologist. The strabismus may be a presenting sign of a serious disease. Even if it is not, spontaneous cure almost never occurs. Furthermore, the younger the child, the easier and more successful will be the treatment of both the strabismus and the amblyopia that often accompanies it. Dyslexia is not the result of abnormalities of the eyes and is unaffected by eye exercises. There are no significant ocular hazards in the use of standard mydriatic (dilating) eye drops in children.


Mucosal melanoma of nasal cavity and paranasal sinus.
Mucosal melanoma of the nasal cavity and paranasal sinuses is seldom encountered in routine ENT practice. These tumors have poor prognosis owing to higher rates of locoregional recurrence and distant metastasis. Various treatment modalities have been employed over time but the ideal treatment approach still remains an open issue. This article presents some commonly accepted guidelines in treating these rare mucosal neoplasms.


The interplay of prolactin and the glucocorticoids in the regulation of beta-cell gene expression, fatty acid oxidation, and glucose-stimulated insulin secretion: implications for carbohydrate metabolism in pregnancy.
Carbohydrate metabolism in pregnancy reflects the balance between counterregulatory hormones, which induce insulin resistance, and lactogenic hormones, which stimulate beta-cell proliferation and insulin production. Here we explored the interactions of prolactin (PRL) and glucocorticoids in the regulation of beta-cell gene expression, fatty acid oxidation, and glucose-stimulated insulin secretion (GSIS). In rat insulinoma cells, rat PRL caused 30-50% (P < 0.001) reductions in Forkhead box O (FoxO)-1, peroxisome proliferator activator receptor (PPAR)-gamma coactivator-1alpha (PGC-1alpha), PPARalpha, and carnitine palmitoyltransferase 1 (CPT-1) mRNAs and increased Glut-2 mRNA and GSIS; conversely, dexamethasone (DEX) up-regulated FoxO1, PGC1alpha, PPARalpha, CPT-1, and uncoupling protein 2 (UCP-2) mRNAs in insulinoma cells and inhibited GSIS. Hydrocortisone had similar effects. The effects of DEX were attenuated by coincubation of cells with PRL. In primary rat islets, PRL reduced FoxO1, PPARalpha, and CPT-1 mRNAs, whereas DEX increased FoxO1, PGC1alpha, and UCP-2 mRNAs. The effects of PRL on gene expression were mimicked by constitutive overexpression of signal transducer and activator of transcription-5b. PRL induced signal transducer and activator of transcription-5 binding to a consensus sequence in the rat FoxO1 promoter, reduced nuclear FoxO1 protein levels, and induced its phosphorylation and cytoplasmic redistribution. DEX increased beta-cell fatty acid oxidation and reduced fatty acid esterification; these effects were attenuated by PRL. Thus, lactogens and glucocorticoids have opposing effects on a number of beta-cell genes including FoxO1, PGC1alpha, PPARalpha, CPT-1, and UCP-2 and differentially regulate beta-cell Glut-2 expression, fatty acid oxidation, and GSIS. These observations suggest new mechanisms by which lactogens may preserve beta-cell mass and function and maternal glucose tolerance despite the doubling of maternal cortisol concentrations in late gestation.


[Care and technology: approaches through the care model].
To reflect about care in the perspective of the technology makes us rethink the human being's inherent capacity in looking for innovations. Historically, the relationship between the nursing care and the technology is permeated by the search of the scientific knowledge. Thus, the Nursing structured its knowledge body according to its abstraction degree and also having as one of its components the care model. We used mainly Mehry (2002) as referential for us to associate the approach of the technology and care in the care model. Because, the application and implementation of this refers to a light-hard and light technology and it could produce light, light-hard or hard new technologies.


[Theodor Schwann and reductionism].
In this article I have examined the cell theory of T. Schwann and considered whether Schwann is to be called a reductionist. Schwann paid more attention to the development of cells rather than to the structure of them. That was because he intended to establish the unified theory of organisms which can be used to explain the regularity of the development. Schwann assumed the unteleological force of cell development, regarded physical method as the ideal method of science, and used the analogy between cell development and crystal development. But he did not identify organic forces with unorganic forces and intended to certify the unity of organic world. So it is true that Schwann introduced physical method to life science, but reduction of biological theory to physico-chemical theory has little to do with him.


[Coping of teenagers with chronic conditions: importance of social network].
This study aimed at investigating the influence of social network on adolescent coping with chronic conditions. Qualitative research whose subjects were hospitalized adolescents who had a diagnosis of chronic disease for at least one year. Data were collected through semi-structured interview and depositions were submitted to thematical analyses. This research highlights that the chronic condition in adolescence brings substantial effects on their lives. Friends, teachers and health professionals are part of the social network. To promote autonomy it is necessary to include adolescents in care planning and to have a social network that supports them in various demands in different stages of illness.


Penicillin tolerance among oral streptococci.
Penicillin tolerance was elicited in 18 of 46 strains of viridans streptococci isolated from the mouths of 19 of 20 healthy subjects and in 31 of 54 consecutive blood-culture isolates of streptococci. Enterococci and Streptococcus sanguis were the organisms most frequently tolerant but the property was also common among isolates of S. mutans, S. mitior and Lancefield Group G streptococci. Pneumococci and S. salivarius were rarely tolerant. When incubated with penicillin at 5 x MIC in batch or continuous cultures, both tolerant and sensitive strains of oral streptococci declined in number less rapidly than S. pyogenes. However, combinations of penicillin and gentamicin killed tolerant and sensitive oral streptococci.


Spatial Distribution and Factors Associated With Risky Health Behavior Among Adult Males Aged 15-59 Years in Ethiopia: Generalized Structural Equation Modeling.
Alcohol drinking and tobacco smoking are the largest preventable causes of death and important risk factors for a number of non-communicable diseases and cause premature death and many socioeconomic consequences. Therefore, the present study is aimed to assess the spatial distribution of risky health behavior and its associated factors among adult males in Ethiopia. All men (12,688) within the age range of 15-59 years were included in the final analysis. The distribution of risky health behavior across the country was observed by using ArcGIS software. In SaTScan software, the Bernoulli model was fitted by Kulldorff methods to identify the purely spatial clusters of risky health behavior. Generalized Structural Equation Model (GSEM) was used to determine factors associated with risky health behavior (regular alcohol drinking and tobacco smoking). Risky health behavior had spatial variation across the country. The primary clusters were located in Tigray, Amhara, and north-eastern Benishangul national regional states. Spatial scan statistics identified 118 primary clusters [Log-Likelihood ratio (LLR) = 524.8, p < 0.001]. Residence, frequency of listening to a radio, occupation, and frequency of watching television were significantly associated with drinking alcohol, whereas wealth index was associated with tobacco smoking. Age, region, educational status, marital status, and religion had association with both domains of risky health behavior. Risky health behavior had spatial variation across the country. Bans on advertising and promotion of alcohol and tobacco on national press media should be strengthened. Aggressive health education efforts should be directed toward this high-risk population (Tigray, Amhara, and north-eastern Benishangul regional states). Improving risky health behavior is an important approach to reducing health disparities and promoting a more cost-effective utilization of scarce resources in the public health sector.


Pharmaceuticals and the strategic national stockpile program.
This article discusses current stockpile practices after exploring a history of the use of biologic agents as weapons, the preventive measures that the federal government has used in the past, and the establishment of a Strategic National Stockpile Program in 2003. The article also describes the additional medical supplies from the managed inventory and the federal medical stations. The issues (financial burden, personnel, and materiel selection) for local asset development are also discussed. Critical is the cost to local communities of the development and maintenance of a therapeutic agent stockpile and the need for personnel to staff clinics and medical stations. Finally, the important role of the dental profession for dispensing medication and providing mass immunization in the event of a disaster is described.


Telehealth Literacy as a Social Determinant of Health: A Novel Screening Tool to Support Vulnerable Patient Equity.
Telehealth has evolved as a solution to COVID-19 isolation precautions and remote care with well-established health, socioeconomic, and practical benefits. However, there are many gaps in the current literature regarding telehealth use among older, low health literate, and resource-limited populations. There are ethical considerations that warrant understanding this digital divide. The objective of this review is to propose the Telehealth Literacy Screening Tool (TLST) for use in older adults and support the future inclusion of telehealth literacy as an important social determinant of health (SDOH). Initially a four-week outreach was performed that targeted older adults and low-health literate patients at the MedVantage Clinic (MVC) within Ochsner Health (OH) to identify common barriers to patient engagement with the OH Epic MyChart telehealth platform. Themes from those barriers directed a meta-synthetic review of the methods and ethical considerations of current, validated technological and telehealth literacy screening tools. Those findings were reported based on the standards of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Based on the barriers identified during our MVC patient outreach, PRISMA-reported review of telehealth literacy screening research, and evaluation of the MyChart platform and the technological resources required for its use; we developed a multidimensional questionnaire for telehealth literacy screening of older adults. The TLST is designed to identify patients in need of additional interventions for successful connection to telehealth services. This is an important step towards addressing the ethical obligation to decrease disparities in telehealth literacy for vulnerable populations and identifying telehealth literacy as a SDOH.


Size-Scalable Content-Based Histopathological Image Retrieval From Database That Consists of WSIs.
Content-based image retrieval (CBIR) has been widely researched for histopathological images. It is challenging to retrieve contently similar regions from histopathological whole slide images (WSIs) for regions of interest (ROIs) in different size. In this paper, we propose a novel CBIR framework for database that consists of WSIs and size-scalable query ROIs. Each WSI in the database is encoded into a matrix of binary codes. When retrieving, a group of region proposals that have similar size with the query ROI are firstly located in the database through an efficient table-lookup approach. Then, these regions are ranked by a designed multi-binary-code-based similarity measurement. Finally, the top relevant regions and their locations in the WSIs as well as the corresponding diagnostic information are returned to assist pathologists. The effectiveness of the proposed framework is evaluated on a fine-annotated WSI database of epithelial breast tumors. The experimental results have proved that the proposed framework is effective for retrieval from database that consists of WSIs. Specifically, for query ROIs of 4096 4096 pixels, the retrieval precision of the top 20 return has reached 96% and the retrieval time is less than 1.5 s.


Increased enzymatic hydrolysis of sugarcane bagasse by a novel glucose- and xylose-stimulated β-glucosidase from Anoxybacillus flavithermus subsp. yunnanensis E13T.
β-Glucosidase is claimed as a key enzyme in cellulose hydrolysis. The cellulosic fibers are usually entrapped with hemicelluloses containing xylose. So there is ongoing interest in searching for glucose- and xylose-stimulated β-glucosidases to increase the efficiency of hydrolysis of cellulosic biomass. A thermostable β-glucosidase gene (Bglp) was cloned from Anoxybacillus flavithermus subsp. yunnanensis E13T and characterized. Optimal enzyme activity was observed at 60 °C and pH 7.0. Bglp was relatively stable at 60 °C with a 10-h half-life. The kinetic parameters V max and K m for p-nitrophenyl-β-D-glucopyranoside (pNPG) were 771 ± 39 μmol/min/mg and 0.29 ± 0.01 mM, respectively. The activity of Bglp is dramatically stimulated by glucose or xylose at concentrations up to 1.4 M. After Bglp was added to Celluclast® 1.5 L, the conversion of sugarcane bagasse was 48.4 ± 0.8%, which was much higher than of Celluclast® 1.5 L alone. Furthermore, Bglp showed obvious advantages in the hydrolysis when initial concentrations of glucose and xylose are high. The supplementation of BglP significantly enhanced the glucose yield from sugarcane bagasse, especially in the presence of high concentrations of glucose or xylose. Bglp should be a promising candidate for industrial applications.


Simulations of string vibrations with boundary conditions of third kind using the functional transformation method.
The functional transformation method (FTM) is an established mathematical method for accurate simulation of multidimensional physical systems from various fields of science, including optics, heat and mass transfer, electrical engineering, and acoustics. It is a frequency-domain method based on the decomposition into eigenvectors and eigenfrequencies of the underlying physical problem. In this article, the FTM is applied to real-time simulations of vibrating strings which are ideally fixed at one end while the fixing at the other end is modeled by a frequency-dependent input impedance. Thus, boundary conditions of third kind are applied to the model at the end fixed with the input impedance. It is shown that accurate and stable simulations are achieved with nearly the same computational cost as with strings ideally fixed at both ends.


Real-time 3D reconstruction of guidewires and stents using two update X-ray projections in a rotating imaging setup.
Vascular diseases are often treated minimally invasively. The interventional material (stents, guidewires, etc.) used during such percutaneous interventions are visualized by some form of image guidance. Today, this image guidance is usually provided by 2D X-ray fluoroscopy, that is, a live 2D image. 3D X-ray fluoroscopy, that is, a live 3D image, could accelerate existing and enable new interventions. However, existing algorithms for the 3D reconstruction of interventional material require either too many X-ray projections and therefore dose, or are only capable of reconstructing single, curvilinear structures. Using only two new X-ray projections per 3D reconstruction, we aim to reconstruct more complex arrangements of interventional material than was previously possible. This is achieved by improving a previously presented deep learning-based reconstruction pipeline, which assumes that the X-ray images are acquired by a continuously rotating biplane system, in two ways: (a) separation of the reconstruction of different object types, (b) motion compensation using spatial transformer networks. Our pipeline achieves submillimeter accuracy on measured data of a stent and two guidewires inside an anthropomorphic phantom with respiratory motion. In an ablation study, we find that the aforementioned algorithmic changes improve our two figures of merit by 75 % (1.76 mm → 0.44 mm) and 59 % (1.15 mm → 0.47 mm) respectively. A comparison of our measured dose area product (DAP) rate to DAP rates of 2D fluoroscopy indicates a roughly similar dose burden. This dose efficiency combined with the ability to reconstruct complex arrangements of interventional material makes the presented algorithm a promising candidate to enable 3D fluoroscopy.


Mechanosensitive cation channels in human leukaemia cells: calcium permeation and blocking effect.
Cell-attached and inside-out patch-clamp methods were employed to identify and characterize mechanosensitive (MS) ionic channels in the plasma membrane of human myeloid leukaemia K562 cells. A reversible activation of gadolinium-blockable mechanogated currents in response to negative pressure application was found in 58 % of stable patches (n = 317). I-V relationships measured with a sodium-containing pipette solution showed slight inward rectification. Data analysis revealed the presence of two different populations of channels that were distinguishable by their conductance properties (17.2 +/- 0.3 pS and 24.5 +/- 0.5 pS), but were indistinguishable with regard to their selective and pharmacological properties. Ion-substitution experiments indicated that MS channels in leukaemia cells were permeable to cations but not to anions and do not discriminate between Na(+) and K(+). The channels were fully impermeable to large organic cations such as Tris(+) and N-methyl-D-glucamine ions (NMDG(+)). Ca(2+) permeation and blockade of MS channels were examined using pipettes containing different concentrations of Ca(2+). In the presence of 2 mM CaCl(2), when other cations were impermeant, both outward and inward single-channel currents were observed; the I-V relationship showed a unitary conductance of 7.7 +/- 1.0 pS. The relative permeability value, P(Ca)/P(K), was equal to 0.75, as estimated at physiological Ca(2+) concentrations. Partial or full inhibition of inward Ca(2+) currents through MS channels was observed at higher concentrations of external Ca(2+) (10 or 20 mM). No MS channels were activated when using a pipette containing 90 mM CaCl(2). Monovalent mechanogated currents were not significantly affected by extracellular Ca(2+) at concentrations within the physiological range (0-2 mM), and at some higher Ca(2+) concentrations.


Time-course expression of metallothioneins and tissue metals in chronic relapsing form of experimental autoimmune encephalomyelitis.
To elucidate the role of metallothioneins (MTs) in the pathomechanisms of autoimmune CNS disorders we estimated the expression of MTs I+II and the tissue concentrations of Zn²+ and Cu²+ in the brain, spinal cord (SC) and in the liver during the periods of attacks and remissions in chronic relapsing experimental autoimmune encephalomyelitis (CR-EAE). Disease was induced in the genetically susceptible Dark Agouti (DA) rats by subcutaneous injection of bovine brain homogenate in CFA. Control rats were treated with CFA. The data, obtained by clinical assessment, immunohistochemistry and inductivity coupled plasma spectrometry, have shown that during the first attack (on the 12th day) MTs I+II were markedly upregulated in subarachnoid regions and perivascular space on astrocytes, microglia and on spinal neurons. Simultaneously, the concentrations of zinc in the SC and zinc and copper in the liver have found to be increased. During the second attack (on the 22nd day) a new overexpression of MTs was found in the cerebellum, in sulcus hippocampi, in spinal neurons and particularly in hepatocytes around the central vein. Concomitantly, in the brain and SC the concentration of copper increased. The data point to a neuroprotective role of MTs and to an important regulatory role of essential metals and hepatic MTs in the pathogenesis of CR-EAE.


Phosphorothioate antisense oligonucleotides induce the formation of nuclear bodies.
Antisense oligonucleotides are powerful tools for the in vivo regulation of gene expression. We have characterized the intracellular distribution of fluorescently tagged phosphorothioate oligodeoxynucleotides (PS-ONs) at high resolution under conditions in which PS-ONs have the potential to display antisense activity. Under these conditions PS-ONs predominantly localized to the cell nucleus where they accumulated in 20-30 bright spherical foci designated phosphorothioate bodies (PS bodies), which were set against a diffuse nucleoplasmic population excluding nucleoli. PS bodies are nuclear structures that formed in cells after PS-ON delivery by transfection agents or microinjection but were observed irrespectively of antisense activity or sequence. Ultrastructurally, PS bodies corresponded to electron-dense structures of 150-300 nm diameter and resembled nuclear bodies that were found with lower frequency in cells lacking PS-ONs. The environment of a living cell was required for the de novo formation of PS bodies, which occurred within minutes after the introduction of PS-ONs. PS bodies were stable entities that underwent noticeable reorganization only during mitosis. Upon exit from mitosis, PS bodies were assembled de novo from diffuse PS-ON pools in the daughter nuclei. In situ fractionation demonstrated an association of PS-ONs with the nuclear matrix. Taken together, our data provide evidence for the formation of a nuclear body in cells after introduction of phosphorothioate oligodeoxynucleotides.


Heritability of quantitative autism spectrum traits in adults: A family-based study.
Autism spectrum disorder (ASD) comprises a multi-dimensional set of quantitative behavioral traits expressed along a continuum in autistic and neurotypical individuals. ASD diagnosis-a dichotomous trait-is known to be highly heritable and has been used as the phenotype for most ASD genetic studies. But less is known about the heritability of autism spectrum quantitative traits, especially in adults, an important prerequisite for gene discovery. We sought to measure the heritability of many autism-relevant quantitative traits in adults high in autism spectrum traits and their extended family members. Among adults high in autism spectrum traits (n = 158) and their extended family members (n = 245), we calculated univariate and bivariate heritability estimates for 19 autism spectrum traits across several behavioral domains. We found nearly all tested autism spectrum quantitative traits to be significantly heritable (h2 = 0.24-0.79), including overall ASD traits, restricted repetitive behaviors, broader autism phenotype traits, social anxiety, and executive functioning. The degree of shared heritability varied based on method and specificity of the assessment measure. We found high shared heritability for the self-report measures and for most of the informant-report measures, with little shared heritability among performance-based cognition tasks. These findings suggest that many autism spectrum quantitative traits would be good, feasible candidates for future genetics studies, allowing for an increase in the power of autism gene discovery. Our findings suggest that the degree of shared heritability between traits depends on the assessment method (self-report vs. informant-report vs. performance-based tasks), as well as trait-specificity. LAY SUMMARY: We found that the scores from questionnaires and tasks measuring different types of behaviors and abilities related to autism spectrum disorder (ASD) were heritable (strongly influenced by gene variants passed down through a family) among autistic adults and their family members. These findings mean that these scores can be used in future studies interested in identifying specific genes and gene variants that are associated with different behaviors and abilities related with ASD.


The role of micro-anchor devices in medial canthopexy.
Telecanthus, the lateral displacement of the medial canthus, can be a congenital deformity or can occur after facial trauma or tumor resection. Treatment of telecanthus remains a challenge for plastic surgeons. For proper correction, it is necessary to shift the medial canthus medially, fixing its tendon to the bone. The ideal technique would allow easy, safe, and stable fixation of the tendon, permit a unilateral approach with minimal incisions, and be cost-effective. The purpose of this study was to evaluate the feasibility and results (immediate and long-term) of medial telecanthus repair using ipsilateral titanium microanchor fixation. Nine patients, 7 with unilateral telecanthus and 2 with bilateral telecanthus, underwent ipsilateral canthopexy involving a microanchor device. Anthropometric measurements of the orbital regions were taken before, immediately after, and at 1 year after surgery. Data for the affected sides were compared with those for the unaffected sides, and the evolution of those values was assessed throughout the 1-year follow-up period. For all patients, the final values were lower than those initially obtained. At 1 year after surgery, the intercanthal distance was reduced to age-adjusted normal values in all cases. On the operated side, stable improvement was observed in terms of the distance from the medial canthus to the midline, although some degree of recurrence was noted in most of the patients. The use of a microanchor system for medial canthopexy can be considered an easily performed and effective option for treating canthal dystopia, especially when an ipsilateral approach is preferred.


[Effects of Rehmannia glutinosa oligosaccharides on proliferation of HepG2 and insulin resistance].
To investigate the effects of Rehmannia glutinosa oligosaccharides (ROS) on the proliferation of HepG2 and insulin resistance. The HepG2 cells were divided into control group, rosiglitazone (3.4 mg x L(-1)) treated group and ROS (0.1-30 mg x L(-1)) treated group. The proliferation of HepG2 was detected by MTT method. Insulin resistant HepG2 cells model was induced by high concentration of insulin, then the effects of ROS on glucose consumption in insulin resistant HepG2 cells were investigated. In the middle glucose culture medium, the absorbance at 570 nm of HepG2 was increased by high concentration of ROS, and decreased by low concentration of ROS by using MTT method, a concentration-dependent manner. ROS increased glucose consumption in HepG2 cells, and showed a better effect at the dose of 10 mg x L(-1). ROS promoted the glucose consumption in insulin resistance of HepG2 cells, improved the sensitivity of insulin resistance of HepG2 cells to insulin. High concentration of ROS can promote the proliferation of HepG2, and however low concentration of ROS inhibits the proliferation of HepG2. ROS can significantly improve insulin resistance of HepG2 cells induced by high insulin.


Aided and unaided narrow band noise thresholds in listeners with sensorineural hearing impairment.
This study explored the relationship between narrow band noise thresholds obtained under aided and unaided conditions with normal listeners and with subjects demonstrating sensorineural hearing impairment. Pure-tone and narrow band noise thresholds obtained under earphone conditions were found to approximate each other within 3 dB. Mean noise thresholds obtained in sound field required less sound pressure than thresholds obtained under earphone conditions. In comparing the predicted aided noise thresholds with the observed thresholds, a 4-dB mean difference was found. The close relationship between hearing aid acoustic gain and changes in aided narrow band noise thresholds suggests the use of narrow band noise audiometry in hearing-aid selection when traditional measures cannot be used.


Laparoscopic Approach to the Adrenal Masses: Single-Center Experience of Five Years.
Currently, laparoscopic adrenalectomy is the gold standard technique for suitable patients with adrenal masses. In this study, we aimed to assess the postoperative results of patients who underwent laparoscopic adrenalectomy. Between January 2014 and October 2019, 76 cases were operated and retrospectively evaluated. Laparoscopic transabdominal adrenalectomy was applied to the patients. Demographic profiles, preoperative indications, intraoperative and postoperative complications, mortality and length of hospital stay were evaluated. Seventy-six patients (30 male, 46 female) with a mean age of 47.2±11.7 (range 22-71) years underwent laparoscopic adrenalectomy. Thirty-nine of the patients had right; 33 of the patients had left adrenal masses. Three patients had bilateral adrenal cortical hyperplasia. One patient was operated for paraganglioma. Conversion to open adrenalectomy was observed in four patients (5.26%). Nine patients (11.8%) experienced intraoperative and postoperative complications. Intraoperative and postoperative complications were bleeding from spleen (2 cases) and upper pole of kidney (1 case), renal artery injury (1 case), bleeding from liver parenchyma (2 cases), ischemia of spleen and pancreas (1 case), small intestinal injury (1 case) and incisional hernia (1 case). The complication rate is acceptable and comparable with other studies in the literature. Laparoscopic adrenalectomy can be safely applied in suitable patients with acceptable complications and low conversion rates.


Needle Parking Interrupted Suturing Technique for Microvascular Anastomosis: A Technical Note.
Interrupted and continuous suturing are 2 common techniques for microvascular anastomosis in cerebrovascular surgery. One of the technical complexities of interrupted suturing includes the risk of losing the needle in between interrupted sutures during knot tying, which may result in unnecessary movements and wasted time. To report a new needle parking technique for microvascular anastomosis that addresses a needle control problem during interrupted suturing. The needle parking technique involves puncturing both vessel walls at the site of the next provisional suture and leaving the needle parked in place while the knots at the first suture are being made. The thread is then cut, the needle is pulled through, and the process is repeated. Illustrative cases in which the needle parking technique was used are presented. We also compared time of anastomosis completion between the conventional interrupted, needle parking interrupted, and continuous suturing techniques during an in vitro study on standardized artificial vessels. This technique is being used successfully by the senior author for various cerebrovascular bypass surgeries. The in vitro study demonstrated that the needle parking technique can be significantly faster than the conventional interrupted suturing technique and may be as fast as continuous suturing. Needle parking technique is a modification of conventional interrupted suturing and solves the problem of losing the needle during knot tying. This technique is simple, prevents unnecessary movements, and may result in a faster anastomosis time.


The association between father involvement in caregiving and early childhood overweight or obesity.
Despite the increasing trend of paternal engagement in caregiving, fathers remain underrepresented in studies on parenting and childhood obesity. This study examined the association between father involvement in caregiving and child's weight status within a longitudinal dataset from Japan. The data were obtained from a population-based cohort study in Japan (N = 29 584). The association between father's involvement in child caregiving (age 18 months) on the weight status of the same children at age 3.5 years was examined by logistic regression and linear regression analysis. Furthermore, we checked the interaction between maternal employment & father involvement by creating four mutually exclusive groups of families. Children whose fathers were highly involved in caregiving were less likely to be overweight (OR = 0.90, 95% CI, 0.85-0.96). Employed mothers with high paternal involvement in caregiving were 30% less likely to have children with overweight or obesity compared to those with low paternal involvement (95% CI, 0.55-0.90). Father involvement in caregiving is associated with the development of overweight or obesity in early childhood, and may also modify the association between maternal employment and child's weight status. Social policies to support shared child-rearing such as expanding paid parental leave could help families to raise children with healthy weight.


Inter-chain double-site synergistic photocatalytic hydrogen evolution in robust cuprous coordination polymers.
Here, we evaluate photocatalytic H2 generation of three stable Cu-based coordination polymers (CPs), where each two-coordinated Cu(i) is stabilized in interchain -[Cu-imidazole(R)-Cu]- units. Importantly, a record-high H2 evolution rate of 57.64 mmol g-1 h-1 is identified for Cu-MIM. Theoretical calculations reveal that the excellent catalytic performances are due to the delicate synergies of the inter-chain double-site Cu atoms.


Anonymous online cognitive behavioral therapy for sleep disorders in shift workers-a study protocol for a randomized controlled trial.
Many shift workers suffer from sleep issues, which negatively affect quality of life and performance. Scientifically evaluated, structured programs for prevention and treatment are scarce. We developed an anonymous online cognitive behavioral therapy for insomnia (CBT-I) program. After successful completion of a feasibility study, we now start this prospective, randomized, controlled superiority trial to compare outcomes of two parallel groups, namely an intervention group and a waiting-list control-group. Additionally, we will compare these outcomes to those of a face-to-face CBT-I outpatient sample. Collaborating companies will offer our anonymous online intervention to their shift-working employees. Company physicians and counseling services will screen those interested for inclusion and exclusion criteria. Participants will receive access to our online service, where they will complete psychometric assessment and receive random assignment to either the intervention group or the waiting-list control group. Participants and providers will be aware of the group assignment. We aim to allocate at least N = 60 participants to the trial. The intervention consists of psychoeducation, sleep restriction, stimulus control, relaxation techniques, and individual feedback delivered via four e-mail contacts. During the intervention, as well as during the waiting period, participants will fill out weekly sleep diaries. Immediately after completion of the program, the post-intervention assessment takes place. Participants in the control group will be able to participate in the program after all study assessments. To recruit an additional sample, collaborating outpatient sleep clinics will provide six sessions of standard face-to-face CBT-I to an ad hoc sample of shift working patients. We expect both the online and the face-to-face CBT-I interventions to have beneficial effects compared to the control group on the following primary outcomes: self-reported symptoms of depression and insomnia, sleep quality, and daytime sleepiness. The online intervention allows shift workers to follow a CBT-I program independently of their working schedule and location. Forthcoming results might contribute to further improvement of prevention and therapy of sleep issues in shift workers. German Clinical Trials Register DRKS DRKS00017777 . Registered on 14 January 2020-retrospectively registered.


The occurrence of abruptio placentae in Canada: 1990 to 1997.
Abruptio placentae is a serious obstetric condition associated with an increased incidence of perinatal mortality and morbidity. Despite this, there is little information on the occurrence of abruptio placentae in Canada. The Discharge Abstract Database from the Canadian Institute for Health Information was used to identify a cohort of women who had singleton live or stillbirth deliveries in Canada between 1990 and 1997 (n = 2,162,815). Rates of abruptio placentae and abruptio placentae ending in stillbirth were examined by calendar year, province, maternal age and urban/rural status. There is a trend towards an increasing rate of abruptio placentae by year, from 10.9 (95 % confidence interval [CI] 10.5-11.3) cases/1000 deliveries in 1990 to a high of 12.1 (95% CI 11.6-12.5) cases/1000 deliveries in 1996, while the rate ending in stillbirth remained relatively constant. The abruptio placentae rate was highest in mothers over 40 years of age and the case-fatality rate highest in those under 20. These results provide a baseline reference for rates of abruptio placentae in Canada.


Germline pathogenic variants in metaplastic breast cancer patients and the emerging role of the BRCA1 gene.
Metaplastic breast cancer (MpBC) is a rare, aggressive breast cancer (BC) histotype. Scarce information is available about MpBC genetic predisposition. Previous studies, mainly consisting of case reports, retrospective reviews and others on target therapies, pointed to a possible involvement of the BRCA1 gene in increasing MpBC risk, without ever confirming it. In this study, we retrospectively reviewed all BC patients counseled at our Institute for genetic testing of at least BRCA1 or BRCA2 (BRCA) genes and we found that 23 (23/5226 = 0.4%) were affected by MpBC. About 65% (15/23) of MpBC patients harbored a germline pathogenic variant (PV): 13 in BRCA1 (86.7%), including two patients who received genetic testing for known familial PV, one in TP53 (6.7%), and one in MLH1 (6.7%). We observed a statistically different frequency of MpBC in patients who carried a PV in the BRCA genes (13/1114 = 1.2%) vs. all other BC patients (10/4112 = 0.2%) (p = 0.0002). BRCA carriers proved to have an increased risk of developing MpBC compared to all other BC patients who were tested for BRCA genes (OR = 4.47; 95% CI: 1.95-10.23). Notably, MpBCs were diagnosed in 2.1% (13/610) of BRCA1 carriers. No MpBCs were observed in BRCA2 carriers (0/498 = 0%), revealing a statistically significant difference between the prevalence of MpBCs in BRCA1 and BRCA2 carriers (p = 0.0015). Our results confirmed that BRCA1 is involved in MpBC predisposition. Further studies on unselected patients are needed to elucidate the authentic role of BRCA1 and to explore the possible implication of other genes in MpBC predisposition.


Clinical and laboratory studies on human sclera allografts.
In the first section of this two-part report human peripheral blood leukocytes were tested for reactivity to extracts of sclera. Absence of scleral antigenicity is suggested by the results which showed that the leukocytes reacted similarly in sclera stimulated cultures and in the controls. The second part of the report discusses the clinical aspects of sclera allografts and provides guidelines for their clinical use. A case is presented where a sclera graft was in position for approximately a year. The tooth was removed with the attached graft and a histologic study made.


[Pleural effusion in rheumatoid arthritis (R.A.). Biochemical study of the pleural fluid (author's transl)].
The diagnosis of pleural effusion in R.A. is largely done by exclusion. Histopathological data, obtained by pleural punch-biopsy, are unreliable. It is generally a serofibrinous pleural effusion. Biochemical study of the pleural fluid shows a high protein level (> 40 g/l), high latex factor (larger than or equal to 1/2560) and, predominantly, low sugar rate in pleural fluid (< 0,35 g/l) and low complement level (whole hemolytic complement C3 and C4).


Analyzing Liposomal Drug Delivery Systems in Three-Dimensional Cell Culture Models Using MALDI Imaging Mass Spectrometry.
Cancer chemotherapeutics often fail to reach all diseased cells. To help solve this problem, researchers are investigating novel drug delivery systems. Liposomes are an attractive option due to their low toxicity, high biocompatibility, and potential to carry a large amount of a drug to the tumor site, all while avoiding being eliminated from the body. This study evaluates the penetration of doxorubicin-encased liposomes into three-dimensional cell cultures, or spheroids. Liposomes composed of lipids containing head groups of phosphatidylcholine (PC), phosphatidylethanolamine (PE), and cholesterol were created by extrusion. Doxorubicin is encapsulated within the hydrophilic core of the liposome. The drug is actively released in the spheroid as the lipids bind to cellular lipid bilayers. Spheroids were dosed with liposomal doxorubicin, free doxorubicin, or media control to assess drug distribution over the course of 72 h. Drug penetration was visualized by Matrix-Assisted Laser Desorption/Ionization-Imaging Mass Spectrometry (MALDI-IMS) with confirmation by steady state fluorescence microscopy, creating a comprehensive picture of drug distribution. This technique is able to identify both free and liposomal doxorubicin throughout the spheroid after just 12 hours of treatment. Additionally, MALDI-IMS is able to detect three metabolites of doxorubicin, indicating that cells actively metabolize the drug during treatment. Steady state fluorescence microscopy cannot distinguish the drug from its metabolites as they have the same emission spectra. This report summarizes the first study to use MALDI-IMS to analyze drug penetration of a liposomal drug carrier as well as its metabolites.


[Why does a mastoidectomy cavity become suppurative? Our experience and revision of the literature].
The main goal for performing surgery for chronic otitis media is to eliminate the disease and improve hearing whenever possible. Persistent drainage of a mastoid cavity means failure of surgery and of achieving the goal. In this study, we present our department's attitude for suppurative mastoid cavities as well as the reasons that do not allow adequate control of them.


Localization of post-disaster psychosocial care in China.
Disaster is not independent of society and culture and always happens in specific cultural and social contexts. Cultural and social characteristics influence the responses of people affected by disaster, as well as the process of disaster relief. As one of the countries in the world that suffer most from natural disasters, various ethnic groups in China vary greatly in psychology and behavior characteristics after major disasters due to different geographical environments and economic and political conditions. To launch an effective post-disaster psychosocial care, 1) it is necessary to consider how to satisfy material, health, and other fundamental biological needs of affected people; 2) it is necessary to relieve disaster victims of their mental pain (spiritual in Chinese) and help them restore their psychological health; 3) it is necessary to revitalize the seriously unbalanced communities affected by disasters so that these communities would burst with vitality again. In addition, it is necessary to take specific ethnic and regional culture into account when helping people in these areas gradually achieve social adaptation and cultural identification. All these require us to intensify our efforts in the following four aspects: 1) to strengthen legislation and institutional construction in this field; 2) to help citizens master the most fundamental psychological principles and methods of coping with disasters to enable timely self-aid and mutual-aid; 3) to build a national database of the post-disaster psychosocial care teams; 4) to continue the research on disaster psychology, so as to provide a scientific basis as well as techniques and methods for implementing disaster relief efforts in a scientific way.


[Psychosomatic and somatopsychic aspects of progressive chronic polyarthritis (author's transl)].
By means of psychiatric depth-psychological investigations in more than 100 patients with PCP the somatopsychic aspect of the disease is described, which manifests itself in two thirds of the patients as an inhibited to agitated humble-depressive psychosyndrome. On the basis of family anamneses and analytical inquiries the somatopsychic aspects of the disease is described in more the half of the patients as consistent continuation of a specific way of life, so that psychosomatic and somatopsychic aspects of the disease are mentioned as one strategy persuing the same fictitious goal. Both aspects appear as functions of a seemingly threatened psychic-physical motivity.


The ovine fetal endocrine reflex responses to haemorrhage are not mediated by cardiac nerves.
This study was designed to test the hypothesis that cardiac receptors tonically inhibit the secretion of renin, arginine vasopressin (AVP) and adrenocorticotropic hormone (ACTH) in late-gestation fetal sheep. Eight chronically catheterised fetal sheep between 122 and 134 days gestation were subjected to injection or infusion of saline or 4 % procaine into the pericardial space. Fetal blood pressure and heart rate were monitored and fetal blood samples were drawn to measure the response to these injections. Injection of procaine into the pericardial space effectively blocked cardiac nerves, as evidenced by a reduction in the variability of fetal heart rate and by the blockade of reflex reductions in fetal heart rate after intravenous injection of phenylephrine (an alpha-adrenergic agonist which raises blood pressure). Injection of saline had no discernable effects on any of the measured variables. A single injection of procaine, followed by a slow infusion, produced a transient blockade of cardiac nerves. Multiple injections of procaine produced a sustained blockade of cardiac nerves and a sustained rise in fetal plasma renin activity and ACTH. In none of the experiments did procaine significantly alter fetal plasma AVP concentrations. In 11 fetuses between 121 and 134 days gestation, we combined the cardiac nerve blockade with slow haemorrhage to test the cardiac nerves as mediators of the endocrine response to haemorrhage in utero. Cardiac nerve blockade exaggerated the fetal blood gas response to haemorrhage somewhat but did not significantly alter the magnitude of the ACTH, AVP, or plasma renin activity response to haemorrhage. We conclude that cardiac nerves in the late-gestation fetal sheep have minor influences on plasma renin activity and ACTH in normovolaemic fetuses, but that changes in cardiac nerve activity do not mediate the endocrine responsiveness to haemorrhage.


Discussing the COSTS of asthma: controlling outcomes, symptoms, and treatment strategies.
Asthma is a very common chronic disease characterized by clinically recurrent episodes of wheezing, dyspnea, chest tightness, and coughing. Both genetic and environmental factors appear to play major roles in the etiology of asthma. The economic and social costs of asthma are varied and far reaching. Patients suffer a significant decline in quality of life, and managed care organizations have become increasingly aware of its impact on health care expenditures. This article explores current treatment therapies for asthma, the challenges of managing asthma effectively, and strategies for improving outcomes in patients with asthma.


Immunologic, virologic, and pharmacologic characterization of the female upper genital tract in HIV-infected women.
: A comparative analysis of cellular and soluble markers of immune activation in HIV-infected women on combination antiretroviral therapy showed that the upper genital tract (UGT) compared to the lower female genital tract was characterized by higher frequencies of potential HIV target cells and increased inflammatory molecules. Despite the activated UGT milieu, HIV RNA could not be detected in paired samples of plasma, cervicovaginal or endometrial lavage. As antiretroviral concentrations were ≥3-fold higher in the endometrium than in the lower genital tract, high antiretroviral penetration and/or metabolism may limit viral replication in the UGT.


Relationship Between Transfusion of Blood Products and the Incidence of Thrombotic Complications in Neonates and Infants Undergoing Cardiac Surgery.
The authors hypothesized that transfusion of blood products in neonates and infants undergoing high-risk cardiac surgery in the absence of intraoperative coagulation monitoring increases the risk of thrombotic complications. Prospective observational study. Neonates and infants undergoing cardiac surgery at a tertiary pediatric center. Neonates weighing >2.5 kg and infants ≤12 months of age undergoing elective cardiac surgery with cardiopulmonary bypass were included in this prospective observational study. None. Demographic data, surgical characteristics, transfusion data, and coagulation parameters (thromboelastography and thromboelastometry) were collected. Logistic regression analysis was performed to identify potential determinants of postoperative thrombotic complications. Among the 138 neonates and infants included in the study, 12 (9%) developed a postoperative thrombotic complication. Unadjusted logistic regression analysis confirmed that the number and volume of blood products transfused were associated significantly with the increased incidence of thrombotic complication (odds ratio: 2.78, 95% confidence interval: 1.30-5.94, p = 0.008). This association persisted after adjustment for patient's age, the need for deep hypothermic cardiac arrest, and bypass time (odds ratio: 2.23, 95% confidence interval: 1.02-4.87, p = 0.044). The number of blood products transfused was associated with a significant increase in parameters of clot amplitudes measured at cardiac intensive care unit admission, while no difference was reported when measured after the administration of protamine. This prospective observational study reports a significant association between transfusion of blood products in neonates and young infants undergoing cardiac surgery and an increased incidence of thrombotic complications in the absence of intraoperative coagulation monitoring.


Thermomechanics of the shape memory effect in polymers for biomedical applications.
We examine the shape memory effect in polymer networks intended for biomedical, and specifically cardiovascular, applications. The polymers were synthesized by photopolymerization from a tert-butyl acrylate monomer with a diethyleneglycol diacrylate crosslinker. Three-point flexural tests were used to systematically investigate the thermomechanics of shape storage (predeformation) and shape recovery. The glass transition temperature, T(g), of the polymers was determined to be approximately 65 degrees C. The polymers show 100% strain recovery, at low and high predeformation temperatures, up to maximum strains of approximately 80%. The polymers show a sigmoidal free strain recovery response as a function of increasing temperature at a constant heating rate. Free strain recovery was determined to depend on the temperature during predeformation; lower predeformation temperatures (T < T(g)) decreased the temperature required for free strain recovery. Constrained stress recovery shows a complex evolution as a function of temperature and also depends on the temperature during predeformation. Stress recovery after low-temperature predeformation (T < T(g)) shows a peak in the generated recovery stress, whereas stress recovery after high-temperature predeformation (T > T(g)) is sigmoidal. The isothermal free strain recovery rate was found to increase with increasing temperature or decreasing predeformation temperature. The thermomechanical results are discussed in light of potential biomedical applications, and a prototype device is presented.


Strengthening the growth of Rubrivivax gelatinosus in sewage purification through ferric ion regulated photophosphorylation and respiration.
Rubrivivax gelatinosus has the potential of biomass resource recycling combined with sewage purification. However, low biomass production and yield restricts the potential for sewage purification. Thus, this research investigated the improvement of biomass production and yield and organics reduction by Fe(3+) in R. gelatinosus wastewater treatment. Results showed that 10-30 mg/L Fe(3+) improved biomass yield in wastewater to a level found in culture medium. With optimal dosage (20 mg/L), biomass production reached 4,300 mg/L, which was 1.67 times that of the control group. Biomass yield was improved by 43.3%. Chemical oxygen demand (COD) removal reached above 91%. Hydraulic retention time was shortened by 25%. Mechanism analysis indicated that Fe(3+) enhanced the succinate and NADH dehydrogenase activities and, bacteriochlorophyll content in three energy metabolism pathways. These effects then enhanced adenosine triphosphate (ATP) production, which led to more biomass accumulation and COD removal. With 20 mg/L Fe(2+) dosage, succinate and NADH dehydrogenase, coproporphyrinogen III oxidase activities, bacteriochlorophyll content and ATP production were improved, respectively, by 48.4, 50.8, 50, 67 and 56% compared to those of the control group.


[Deep lobe of parotid gland tumors].
Surgery of the parotid gland tumors can be difficult because of the presence of the facial nerve branches in the parotid tissue. The aim of the surgical treatment is complete removal of the tumor without damaging the facial nerve. There are several surgical techniques to expose the main trunk and the branches of the facial nerve. On the other hand during the surgery the nerve function is continuously observed by using facial nerve monitor. In the years of 2002-2004 208 patients with the parotid gland tumors were treated. There were 177 benign and 31 malignant tumors. 159 tumors were located in the superficial lobe of the parotid gland, 35 in the superficial and the deep lobe, and 14 only in the deep lobe. All patients were treated surgically. In cases concerning the operations of the tumors located in the deep lobe, the facial nerve branches had to be exposed with help of the microscopic operating techniques. All tumors were removed totally. A paralysis of the facial nerve was observed in two cases of the pleomorhic adenoma with a diameter over 6 cm, and in 9 cases of malignant tumors of the superficial and the deep lobe, where the main trunk or the branches of the facial nerve were integrated with the tumor mass. Surgical treatment of the parotid gland tumors presented in our study demonstrates good results. The risk of facial nerve paresis is higher in malignant tumors and big pleomorphic adenomas.


On the Presence of Fixed Ammonium in Rocks.
From one-fourth to one-half of the nitrogen in some granite rocks, and up to two-thirds of that in some paleozoic shales, occurred as ammonium ions held within the lattice structure of silicate minerals. The results provide greater insight into the origin of the earth's atmosphere.


Transactivation by the adenovirus E1A gene.
The 289aa product of the adenovirus E1A gene mediates the transcriptional activation of the set of early viral genes as well as several cellular genes. The E1A protein is not a DNA binding protein but, rather, acts indirectly to achieve the activation. The process of viral gene activation involves the use of cellular transcription factors, and in at least one case, in vivo assays have demonstrated a stimulation of stable promoter complex formation as a function of the E1A gene product. Analysis of transcription factors in nuclear extracts has identified a cellular factor, termed E2F, with specificity for the viral E2 promoter. The concentration of this factor increases as a result of the action of E1A. This increase in DNA binding activity does not require protein synthesis, thus indicating an E1A-mediated modification of a pre-existing factor. The E2F factor has been purified to homogeneity and is a polypeptide of 54,000 molecular weight. Analysis of an additional viral promoter, the E4 promoter, has identified a protein that interacts with sequences critical for transcription. This factor, termed E4F, is also increased as a function of the E1A product. The E4F factor has also been purified to homogeneity and has a molecular weight of 50,000. Therefore, the coordinate control of transcription by the E1A gene product involves the activation of multiple promoter specific factors.


Effect of fat replacers on kefir quality.
The purpose of the study was to determine the effects of fat replacers on the quality of non-fat kefir. Skim milk fortified with Dairy Lo (DL) and inulin (INU) was fermented with kefir grains to manufacture kefir. The results of compositional, microbiological, rheological and sensorial analyses were compared with whole kefir (WK) and non-fat kefir (NFK) controls. Results for dry matter, pH and lactic acid ranged between 82.4 and 109.1 g kg(-1), 4.26 and 4.40, and 7.0 and 9.2 g L(-1), respectively. Acetaldehyde and ethanol contents of samples were between 2.89 and 7.28 mg L(-1), and 151.46 and 323.89 mg L(-1), respectively. In all samples, Lactobacillus spp., Streptococcus spp. and yeast counts were between 9.1 and 9.9, 9.3 and 9.9, and 5.2 and 5.6 log cfu mL(-1), respectively. Kefir samples had non-Newtonian behaviour and pseudoplastic fluid with thixotropy. At the first day, DL had the highest apparent viscosity (3.119 Pa s) while NFK had the lowest value (1.830 Pa s). In the sensory evaluation, odour and taste scores of samples were not different. Dairy Lo and inulin could be used without any adverse effect for the production of non-fat kefir.


Seizures associated with oxamniquine therapy.
Three patients who were treated for schistosomiasis mansoni with oxamniquine suffered generalized seizures. We suggest that this side effect may be more common than previously reported. Specific ethnic groups may be particularly at risk.


The flexibility-complementarity dichotomy in receptor-ligand interactions.
Synthetic supramolecular complexes provide an opportunity for quantitative systematic exploration of the relationship between chemical structure and molecular recognition phenomena. A family of closely related zinc porphyrin-pyridine complexes was used to examine the interplay of conformational flexibility and geometric complementarity in determining the selectivity of molecular recognition events. The association constants of 48 zinc porphyrin-pyridine complexes were measured in two different solvents, toluene and 1,1,2,2-tetrachloroethane (TCE). These association constants were used to construct 32 chemical double mutant cycles to dissect the free energy contributions of intramolecular H-bonds between the phenol side arms of the porphyrins and the ester or amide side arms of the pyridine ligands. Effective molarities (EM) for the intramolecular interactions were determined by comparison with the corresponding intermolecular H-bonding interactions. The values of EM do not depend on the solvent and are practically identical for amide and ester H-bond acceptors located at the same site on the ligand framework. However, there are variations of an order of magnitude in EM depending on the flexibility of the linker used to connect the H-bond acceptors to the pyridine ligands. Rigid aromatic linkers give values of EM that are an order of magnitude higher than the values of EM for the corresponding ester linkers, which have one additional torsional degree of freedom. However, the most flexible ether linkers give values of EM that are also higher than the values of EM for the corresponding ester linkers, which have one less torsional degree of freedom. Although the penalty for conformational restriction on binding is higher for the more flexible ether linkers, this flexibility allows optimization of the geometric complementarity of the ligand for the receptor, so there is a trade off between preorganization and fit.


Green laser induced foveal cyst sustained in a recreational laser light show.
We report the case of a 9-year-old boy complained of visual loss in his right eye after watching green laser light show being hit by a ray of a laser at shopping center before five days ago. The laser had a maximum power rating of 30 mW (US Food and Drug Administration class IIIB). Best-corrected visual acuity in his right eye was 0.2 with Snellen at 5 days after the injury. Dilated fundoscopic examination demonstrated a macular hole appearance in the right eye. Spectral domain optical coherence tomography (OCT, Spectralis, Heidelberg Engineering, Heidelberg, Germany) demonstrates a steep fovea contour, a thickening of the macular edges, intraretinal cysts, disruption of the photoreceptor inner segment/outer segment layer and macular pseudohole formation. Central foveal thickness (515 µm) was increased. Two months after the injury, the patient's visual acuity improved to 0.9 in the right eye without any ocular treatment. Spectral domain OCT revealed the closure of the macular hole with the resolution of the cystic spaces. At 6-months follow-up, visual function had fully recovered and macular assessment was normal.


Electron beam annealing of Fe+ implanted Si nanostructures.
Silicon nanostructures (nanowhiskers) have been formed at surface densities approximately 10(9) cm-2 by electron beam annealing (EBA) prior to the implantation of 7 keV Fe+ ions to fluences from 1 x 10(13) - 4 x 10(15) Fe+ cm(-2). A second EBA step is then applied to relieve implantation-induced stresses. RBS analysis shows that the implanted Fe remains close to the surface. AFM characterisations of the implanted nanowhiskers before and after the final EBA step are summarised in graphs of height versus surface density. In a striking result it is shown that the nanowhiskers not only survive processing but also grow significantly. For example, at the highest fluence of 4 x 10(15) Fe+ cm(-2), the average height more than doubles: the increases are from 5.0 nm to 6.5 nm under implantation and from 6.5 nm to 11.8 nm under EBA. In addition there is a significant increase in surface density from an initial value of 1.6 x 10(9) cm(-2) to 4.3 x 10(9) cm(-2). These results highlight the feasibility of doping Si surface nanostructures with magnetic ions to fabricate Si devices for spin-dependent enhanced field emission.


Prevention of post-transfusion graft-versus-host disease.
Post-transfusion graft-versus-host disease (PT-GVHD) is a rare complication of blood transfusion. However, it occurs not only in immunosuppressed patients but also in immunocompetent patients, and is a phenomenon with a heavy mortality rate of more than 90 percent. At present, the use of blood irradiated is considered the most effective method of preventing of PT-GVHD. However, there are some unsettled problems such as the appropriate dose of irradiation, the influence of irradiation on the function of blood components, the elevation of potassium levels and the selection of patients suitable for irradiated blood transfusion.


Significance of muscular disturbances in the localization of fractures of the proximal femur.
Of 1322 patients with fractures of the proximal femur, 86 had muscular disturbances. Of these, 65 were suffering from paresis due to cerebrovascular stroke and 21 had Parkinson's disease. In the paretic patients, except for one case, the fracture occurred on the affected (paretic) side, and it was intertrochanteric in the majority of cases. In the patients with Parkinson's disease, cervical (intracapsular) fractures predominated. Muscle weakness or disturbance is a factor in the causation and location of hip fractures.


A Comparative Study Examining the Management of Bowen's Disease in the United Kingdom and Australia.
Background and Aim. The optimum management of Bowen's Disease (BD) is undefined. A review of current practice is required to allow the development of best practice guidelines. Methods. All BD cases, diagnosed in one UK centre and one Australian centre over a year (1 July 2012-30 June 2013), were analysed retrospectively. Patients with BD were identified from histopathology reports and their medical records were analysed to collect demographic data, site of lesion, and treatment used. Results. The treatment of 155 lesions from the UK centre and 151 lesions from the Australian centre was analysed. At both centres BD was most frequently observed on the face: UK had 70 (45%) lesions and Australia had 83 (55%) lesions (P = 0.08). The greatest number of lesions was managed by the plastic surgery department in the UK centre, 72 (46%), and the dermatology department in the Australian centre, 121 (80%). The most common therapy was surgical excision at both centres. Conclusions. In both UK and Australia, BD arises on sun-exposed sites and was most commonly treated with surgical excision despite a lack of robust evidence-based guidelines.


Acute myocardial infarction complicated by cardiogenic shock. In-hospital and mid-term results of invasive treatment in the National Institute of Cardiology, Warsaw-Anin.
Mortality in acute myocardial infarction (MI) complicated by cardiogenic shock approaches 90%, regardless of the type of pharmacological treatment. To assess in-hospital and mid-term results of invasive treatment of patients with acute MI with ST segment elevation (STEMI) complicated by cardiogenic shock. From a prospective registry of all patients admitted to our institution for urgent coronary angiography due to acute coronary syndrome between February 2001 and June 2002, patients with STEMI, symptom duration up to 12 hours and cardiogenic shock diagnosed on admission were identified. The in-hospital and mid-term outcome of 37 patients (mean age 65 years, range 54-77, 68% of males) treated with primary percutaneous coronary intervention (PCI) was analysed. Of the 41 patients with STEMI and cardiogenic shock, total occlusion or critical stenosis of a coronary artery were found in 38 patients. One patient with the occlusion of three main coronary arteries underwent urgent surgical revascularisation and remains alive after an 18-month follow-up. In the remaining 37 patients primary PCI of an infarct-related artery was performed (stent implantation in 70%, abciximab administration in 54%) which restored normal blood flow (TIMI grade 3 flow) in 54% of subjects. In patients with TIMI grade 3 flow the in-hospital mortality was 25%. Of the whole PCI-treated group, 18 (48.6%) patients died during stay in our institution, an additional two - after transfer to another hospital, and one - during a 19-month follow-up period. The remaining 16 patients remain alive (median follow-up of 8 months). Invasive treatment of patients with STEMI complicated by cardiogenic shock significantly reduces mortality in this high-risk population. The mid-term results in patients discharged from hospital are good. Invasive treatment of acute MI should be accessible for all patients with extensive acute MI.


Intestinal microflora in breastfed colicky and non-colicky infants.
Infantile colics are a common problem in the first months of life. During this period, a process of intestinal colonization rapidly occurs. A difference in the gut microflora could play an important role in the pathogenesis of colics, changing the metabolism of carbohydrates and fatty acids. Actually, in the literature, only few data have been collected about this topic. In this study, we evaluated intestinal microflora in breastfed colicky and non-colicky infants. Seventy-one breastfed infants, aged 3.2 +/- 0.6 wk, free from episodes of gastroenteritis and without previous assumption of antibiotic and probiotic drugs, were enrolled in the study. They were divided into two groups: colicky (42 cases) and non-colicky (29 cases), according to Wessel's criteria. Stool samples were collected, diluted and cultured on several selective media to detect lactobacilli, clostridia, gram-negative anaerobes and Enterobacteriaceae. Statistical analysis was performed using Student's t-test, chi2 test and a non-parametric test (Mann-Whitney U-test). Differences in gut microflora were found among colicky and non-colicky infants: colicky infants were less frequently colonized by Lactobacillus spp., and more frequently by anaerobic gram-negative bacteria. Our study indicates that colicky infants have different patterns of gut microflora. Further studies are required to understand whether gut microflora is the primary cause of colics or its consequence.


New shift models for doctors in a large German University Neurosurgery Department: how they comply with the European Working Time Directive 3 years after implementation.
Due to the European Working Time Directive (EWTD) and a new collective agreement for doctors working at University hospitals in 2006 new shift models had to be designed in the Department of Neurosurgery of the University Hospital Tübingen, Germany. The aim of the study was to show the fit of the models regarding the average weekly working time limits (aWTL), the daily maximum of 10-h working time (10-h dWT), and the staff expenditures 3 years after implementation. The new shift model was implemented in 2008, and hence planning and documentation were done electronically. Adherence to the work schedules was measured, and aWTL adherence rates were compared. The relative number of 10-h dWT violations in 2009 and 2010 was analysed. Staff costs relative to performance before and after implementation were calculated and tested using analysis of variance (ANOVA). Four other departments without alteration of shift models served as a control group in cost trend analysis. In 2010 all doctors in the Department of Neurosurgery were able to stay within the limit of 54 h/week; one doctor without opt-out exceeded the 48 h/week limit (50.1 h/week). The median per capita rate of 10-h dWT violations in 2009 was 20.3 % of all eligible working days and further declined to 10.7 % in 2010 (p < 0.001). Staff costs per case-weight point did not change significantly (2007: 339.88€, 2009: 307.99€, 2010: 322.54€; p = 0.22) in neurosurgery or in the control group (2007: 633.72€, 2009: 637.06€, 2010: 690.30€; p = 0.67). After implementation of the new shift model, current monitoring and properly matching modifications led to long-term stability in complying with the EWTD regulations without increasing costs for staff expenditures.