Impact of multiple sclerosis risk loci in postinfectious neurological syndromes.
The genetic component of multiple sclerosis (MS) is now set to 200 autosomal common variants. However, it is unclear how genetic knowledge be clinically used in the differential diagnosis between MS and other inflammatory conditions like adult-onset postinfectious neurological syndromes (PINS). The aim of this study was to investigate whether PINS and MS have a shared genetic background using an updated polygenic risk scores. Eighty-eight PINS patients have been consecutively recruited between 1996 and 2016 at Mondino Foundation of Pavia, diagnosed according to clinical, MRI and CSF findings and followed-up for several years. Patients were typed using Illumina array, and genotypes imputed using the 1000 Genomes Project reference panel. A weighted genetic risk score (wGRS) has been calculated based on autosomal MS risk loci derived from large-scale studies, and an HLA genetic burden (HLAGB) was also calculated on loci associated to MS. PINS occurred as an episode of myelitis in 44% of patients, encephalomyelitis in 44%, and encephalitis in remaining cases, with an involvement of peripheral nervous system in 41% of patients. Mean age of onset was 50.1 years, and female:male ratio was 1.4. Patients were followed-up for a mean of 7.2 years, and at last visit 55% had a low disability grade (mRS 0-1). Disease was monophasic in 67% of patients, relapsing in 18% and chronic-progressive in 15%. The wGRS of PINS cases was comparable to 370 healthy controls, while significantly lower compared to 907 bout-onset MS (BOMS) cases (wGRS= 20.9 vs 21.2; p<0.0001). The difference was even larger for PINS with peripheral nervous system involvement (wGRS=20.6) vs BOMS. The distinction between MS and PINS is not easy to make in clinical practice. However, our study shows that the new set of MS risk alleles does not confer increased susceptibility to PINS. These data support the importance to discriminate these cases from MS with pathophysiological and therapeutic implications.


[Experience with the use of communicative movement therapy in children and adolescents].
Our experience shows that the use of communicative motion therapy for children and youths demands greater flexibility in the handling of the task and exercise conception and of the verbalization phases than when this form of treatment is used for adults. The behaviour of the therepeutist is particularly important. In contrast to his role when treating adults, he must be integrated more completely into the group and must act as an indirect leader. Although this makes the group more or less leader-centred, it loses none of its inherent dynamics if the therapeutist uses appropriate forms of communication.


Neopterin: from forgotten biomarker to leading actor in cardiovascular pathophysiology.
Inflammation plays a role at all stages of atherosclerosis. Neopterin, a pteridine mainly synthesized by activated macrophages, is a marker of inflammation, immune system activation and an active participant in cardiovascular disease. Measurement of neopterin levels may help follow the evolution of specific inflammatory conditions (e.g. viral infection, renal transplant rejection, systemic inflammatory diseases, nephritic syndrome and autoimmune diseases). Serum levels of neopterin are elevated also in patients with coronary artery disease (CAD) and peripheral artery disease (PAD). Moreover, plasma levels of this molecule might predict adverse cardiovascular events in patients with CAD, acute coronary syndromes or severe PAD. In addition, neopterin levels are related to the development of heart failure. We provide an updated overview on neopterin and, its links with CAD, left ventricular dysfunction, and PAD. We also describe its potential role in cardiac regenerative strategies with using bone marrow cells.


Leukemic infiltration of the testes in acute nonlymphocytic leukemia.
Two children with ANLL in complete remission developed testicular relapse 18 and 34 months after diagnosis. Their clinical presentation was similar to that observed in patients with ALL. Although the testicular leukemia responded to between 2,400 and 3,000 rads, bone marrow relapse occurred within 4 months and death within 6 months of the testicular relapse. This points out the need for surveillance of the testicles in males with ANLL, and raises the question of need for testicular biopsy among long-time male survivors.


The lipid-associated 3D structure of SPA, a broad-spectrum neuropeptide antagonist with anticancer properties.
[D-Arg(1), D-Trp(5,7,9), Leu(11)] substance P (SPA) belongs to a family of peptides including antagonist G and SpD that act as broad-spectrum neuropeptide antagonists at several peripheral receptors. The lipid-induced structure of these peptides may be important for the receptor interactions of these analogs. Thus we describe the tertiary structure of SPA in the presence of sodium dodecylsulfate micelles at pH 5.0, and 25 degrees C as determined from two-dimensional (1)H-NMR data recorded at 500 MHz. The resulting three-dimensional structure can be generally described as two type IV nonstandard turns around Arg(1)*, Pro(2), Lys(3), and Pro(4) and Gln(6), Trp(7)*, Phe(8), and Trp(9)* residues, respectively, inserted into the interfacial region of the micelles (the asterisks denote D-form amino acid). These turns juxtapose the N- and C-termini of SPA and may form the basis of this peptide's unique ability to inhibit peptide receptor interactions at multiple receptor types.


Prevalence and environmental impact factors of somatization tendencies in eastern Chinese adolescents: a multicenter observational study.
The aim of this study is at examining the prevalence and impact factors of adolescent somatization tendencies (ST) across three eastern Chinese provinces. A multicenter school-based cross-sectional study was conducted in these provinces from 2015 to 2016. The sample included 11,153 middle-school students aged 13-18 years, who were randomly selected using a multi-phase stratified cluster sampling technique. We also designed a multicenter school-based case-control study to evaluate the potential environmental impact of ST factors on this population. The overall positive rate of ST among the eastern Chinese adolescents was 12.1%. Somatic symptoms score (SSS) and positive ST rate were higher in females than males. Additionally, the SSS and positive ST rate for the 18-year-old group were significantly higher than in other age groups. In comparison to those in urban areas, adolescents in rural areas had significantly higher SSS and positive ST rate. Multiple conditional regression analyses revealed that family medical history, anxiety and depression scores; superstitious beliefs; left-behind adolescents; teacher-student support; family conflict; and family independence and achievement orientation were significantly linked to ST in adolescents. The models also indicated family medical history was the strongest impact factor to adolescent ST, even though ST were prevalent in the three studied eastern Chinese provinces. Gender, age, and dwelling differences were very significant in the SSS and positive ST rate in adolescents. This study concludes that adolescent ST are influenced by multiple environments.


Failure of endovascular aortoaortic tube grafts: a plea for preferential use of bifurcated grafts.
Aortoaortic tube graft repair was the first technique used for the endovascular treatment of abdominal aortic aneurysms (AAAs). However, progressive changes in the morphology of the distal aortic neck may be responsible for procedural failure. This study examines the use of aortoaortic tube prostheses and analyzes the factors that contributed to their failure and the methods used for their subsequent repair. During a 7-year period, 462 patients with abdominal aortic aneurysms underwent endovascular aortic aneurysm repair. Of these, 65 patients (14%) underwent treatment with aortoaortic tube endoprostheses. Aortoaortic tube prostheses used included Talent (n = 44) (Medtronic-Worldmedical, Sunrise, Fla), Vanguard (n = 8) (Boston Scientific, Natick, Mass), EVT/Ancure (n = 4) (Guidant, Menlo Park, Calif), and physician-fabricated (n = 9). All the tube graft procedures were performed in the operating room with fluoroscopic guidance. The average age of patients for aortoaortic tube grafts was 74.5 years, and 48 of the patients were men. Failure was defined as aneurysm expansion, any type I endoleak, or type II endoleak persistent after 6 months. No aneurysm ruptures or perioperative deaths were seen. Retrograde aneurysm perfusion from lumbar or inferior mesenteric arteries (type II endoleak) that persisted beyond 6 months was present in three patients. Proximal attachment site endoleaks were present in two patients. No distal implantation site endoleaks were present within 1 month of the initial endovascular repair; however, endoleaks at the distal attachment site developed in 12 patients subsequently and included all graft types (Talent, n = 6; Vanguard, n = 2; Ancure/EVT, n = 1; physician-fabricated, n = 3). The average time interval to failure was 12.9 months. Preoperative distal aortic neck length showed a significant correlation with the subsequent development of distal endoleak (endoleak, 16.6 +/- 6.8 versus no endoleak, 23.3 +/- 9.6; P =.03). Preoperative distal aortic neck diameter, however, did not show significance (23.8 +/- 5.2 versus 22.6 +/- 4.7; P = not significant). Endovascular aortoaortic tube grafts are vulnerable to failure even when initial exclusion of the aneurysm is successful. A significant association is seen between distal neck length and eventual failure. Because of the propensity toward eventual failure, the use of aortoaortic tube grafts in the infrarenal aorta cannot be recommended for typical fusiform aneurysms, even when an adequate distal neck appears to be present.


The RASopathies.
The RASopathies are a clinically defined group of medical genetic syndromes caused by germline mutations in genes that encode components or regulators of the Ras/mitogen-activated protein kinase (MAPK) pathway. These disorders include neurofibromatosis type 1, Noonan syndrome, Noonan syndrome with multiple lentigines, capillary malformation-arteriovenous malformation syndrome, Costello syndrome, cardio-facio-cutaneous syndrome, and Legius syndrome. Because of the common underlying Ras/MAPK pathway dysregulation, the RASopathies exhibit numerous overlapping phenotypic features. The Ras/MAPK pathway plays an essential role in regulating the cell cycle and cellular growth, differentiation, and senescence, all of which are critical to normal development. Therefore, it is not surprising that Ras/MAPK pathway dysregulation has profound deleterious effects on both embryonic and later stages of development. The Ras/MAPK pathway has been well studied in cancer and is an attractive target for small-molecule inhibition to treat various malignancies. The use of these molecules to ameliorate developmental defects in the RASopathies is under consideration.


Cholinergic atrial fibrillation: I(K,ACh) gradients determine unequal left/right atrial frequencies and rotor dynamics.
We tested the hypothesis that left atrial (LA) myocytes are more sensitive to acetylcholine (ACh) than right atrial (RA) myocytes, which results in a greater dose-dependent increase in LA than RA rotor frequency, increased LA-to-RA frequency gradient and increased incidence of wavelet formation during atrial fibrillation (AF). AF was induced in seven Langendorff-perfused sheep hearts in the presence of ACh (0.1-4.0 microM) and studied using optical mapping and bipolar recordings. Dominant frequencies (DFs) were determined in optical and electrical signals and phase movies were used to identify rotors and quantify their dynamics. DFs in both atria increased monotonically with ACh concentration until saturation, but the LA frequency predominated at all concentrations. Rotors were also seen more often in the LA, and although their life span decreased, their frequency and number of rotations increased. Patch-clamp studies demonstrated that ACh-activated potassium current (I(K,ACh)) density was greater in LA than RA sheep myocytes. Additionally, ribonuclease protection assay demonstrated that Kir3.4 and Kir3.1 mRNAs were more abundant in LA than in RA. A greater abundance of Kir3.x channels and higher I(K,ACh) density in LA than RA myocytes result in greater ACh-induced speeding-up of rotors in the LA than in the RA, which explains the ACh dose-dependent changes in overall AF frequency and wavelet formation.


Pharmacologic Strategies to Prevent Blood Loss and Transfusion in Orthotopic Liver Transplantation.
Patients undergoing orthotopic liver transplantation are at risk of both life-threatening blood loss and thrombosis due to preexisting liver dysfunction and major intra- and postoperative coagulopathy. Traditional laboratory markers of hemostasis and coagulopathy are often inadequate to describe the alterations. Whole blood global viscoelastic tests, thromboelastography, and thromboelastometry may provide more complete pictures of the hematologic derangements and allow for more targeted therapy to prevent blood loss and massive transfusion. Antifibrinolytic medications such as aprotinin, tranexamic acid, and [Latin Small Letter Open E]-aminocaproic acid have been used successfully to reduce blood loss and the need for transfusion, although most published data are from small prospective trials or larger retrospective cohorts. Recombinant factor VIIa has not been shown to improve outcomes. Although transfusion needs have been associated with adverse outcomes, no studied medications for prevention of blood loss and transfusion have been associated with improved mortality or graft survival post-liver transplant.


[Keratitis after laser in situ keratomileusis (LASIK). A different entity and treatment management].
Keratitis after laser in situ keratomileusis (LASIK) is rare and challenging as patients may present with mild symptoms and initial management differs significantly. Post-LASIK keratitis is usually due to gram-positive bacteria or opportunistic/atypical microorganisms located beneath the corneal flap. Due to relative protective interface location it is necessary to lift the corneal flap for cultures and antibiotic irrigation. The case report demonstrates that post-LASIK keratitis requires prompt referral to ophthalmology department as correct initial management is pivotal for good visual outcome.


Can we accurately measure the concentration of clinically relevant vitamin D metabolites in the circulation? The problems and their consequences.
Increased interest in vitamin D measurements in clinical studies has contributed to the development in recent years of several new immunochemical assays (manual and for automatic analyzers). New methods, including HPLC (high performance liquid chromatography), and LC-MS/MS (liquid chromatography coupled with tandem mass spectrometry) have also been introduced into routine diagnostic laboratories. Because of the variety of assays and methods used, the question arises which one is the most accurate for the measurement of vitamin D metabolites concentration. In this review, we summarise the advantages and disadvantages of these methods, describe the complexity of vitamin D metabolites pattern in the circulation, and discuss the problem of accurate measuring its concentration.


Influence of astaxanthin, emulsifier and organic phase concentration on physicochemical properties of astaxanthin nanodispersions.
The emulsification-evaporation method was used to prepare astaxanthin nanodispersions using a three-component emulsifier system composed of Tween 20, sodium caseinate and gum Arabic. Using Response-surface methodology (RSM), we studied the main and interaction effects of the major emulsion components, namely, astaxanthin concentration (0.02-0.38 wt %, x1), emulsifier concentration (0.2-3.8 wt %, x2) and organic phase (dichloromethane) concentration (2-38 wt %, x3) on nanodispersion characteristics. The physicochemical properties considered as response variables were: average particle size (Y1), PDI (Y2) and astaxanthin loss (Y3). The results indicated that the response-surface models were significantly (p < 0.05) fitted for all studied response variables. The fitted polynomial regression models for the prediction of variations in the response variables showed high coefficients of determination (R2 > 0.930) for all responses. The overall optimum region resulted in a desirable astaxanthin nanodispersions obtained with the concentrations of 0.08 wt % astaxanthin, 2.5 wt % emulsifier and 11.5 wt % organic phase. No significant differences were found between the experimental and predicted values, thus certifying the adequacy of the Response-surface models developed for describing the changes in physicochemical properties as a function of main emulsion component concentrations.


Directional gene flow and ecological separation in Yersinia enterocolitica.
Yersinia enterocolitica is a common cause of food-borne gastroenteritis worldwide. Recent work defining the phylogeny of the genus Yersinia subdivided Y. enterocolitica into six distinct phylogroups. Here, we provide detailed analyses of the evolutionary processes leading to the emergence of these phylogroups. The dominant phylogroups isolated from human infections, PG3-5, show very little diversity at the sequence level, but do present marked patterns of gain and loss of functions, including those involved in pathogenicity and metabolism, including the acquisition of phylogroup-specific O-antigen loci. We tracked gene flow across the species in the core and accessory genome, and show that the non-pathogenic PG1 strains act as a reservoir for diversity, frequently acting as donors in recombination events. Analysis of the core and accessory genome also suggested that the different Y. enterocolitica phylogroups may be ecologically separated, in contrast to the long-held belief of common shared ecological niches across the Y. enterocolitica species.


The role of asymptomatic bacteriuria in young women with recurrent urinary tract infections: to treat or not to treat?
Little is known about the role of asymptomatic bacteriuria (AB) treatment in young women affected by recurrent urinary tract infection (UTI). We aimed to evaluate the impact of AB treatment on the recurrence rate among young women affected by recurrent UTI. A total of 673 consecutive asymptomatic young women with demonstrated bacteriuria from January 2005 to December 2009 were prospectively enrolled. Patients were split into 2 groups: not treated (group A, n = 312) and treated (group B, n = 361). Microbiological and clinical evaluations were performed at 3, 6, and 12 months. Quality of life was also measured. Recurrence-free rate at the end of the entire study period was the main outcome measure. At baseline, the 2 most commonly isolated pathogens were Escherichia coli (group A, 38.4%; group B, 39.3%) and Enterococcus faecalis (group A, 32.7%; group B, 33.2%). At the first follow-up visit, there was no difference between the 2 groups (relative risk [RR], 1.05; 95% confidence interval [CI], 1.01-1.10), whereas after 6 months, 23 (7.6%) in group A and 98 (29.7%) in group B showed recurrence with a statistically significant difference (RR, 1.31; 95% CI, 1.21-1.42; P < .0001). At the last follow-up, 41 (13.1%) in group A and 169 (46.8%) in group B showed recurrence (RR, 3.17; 95% CI, 2.55-3.90; P < .0001). One patient in group A and 2 patients in group B were found to have pyelonephritis. This study shows that AB should not be treated in young women affected by UTI, suggesting it may play a protective role in preventing symptomatic recurrence.


Epidemiological investigation of community-acquired Staphylococcus aureus infection.
The current study aimed to reveal the pathogenic and spreading mechanisms of community-acquired Staphylococcus aureus (CA-SA) by analyzing its prevalence, drug resistance, virulence, and pathogenic factors. Historical information regarding CA skin and soft tissue infections were collected and disease characteristics were analyzed. Isolated CA-SA strains were subjected to antibiotic sensitivity tests using the agar dilution method, Staphylococcus cassette chromosome mec (SCCmec) tests, multilocus sequence typing (MLST), and staphylococcal protein A (SPA) and toxin gene screening. A total of 55 skin and soft tissue infections were investigated, and 12 strains of SA bacteria were isolated, which were all CA methicillin-susceptible SA (CA-MSSA). The antibiotic sensitivity tests showed that CA-MSSA was susceptible to all antibacterials with the exception of high resistance to erythromycin, clindamycin, tetracycline, gentamicin, and levofloxacin (ranging from 8.3 to 50%). The toxin detection results showed that the Panton-Valentine leukocidin (PVL) positive rate in CA-MSSA was 33.3%, the enterotoxin positive rate was 25%, and the toxic shock syndrome toxin-1 (TSSL) positive rate was 8.3%. No Staphylococcus enterotoxin H or Staphylococcus exfoliati was detected. MLST and SPA typing showed that the clones of CA-MSSA included ST5-t002 (2 strains), ST22-t309 (2 strains), ST398-t034, ST15-t5864, ST7-t091, ST25-t078, ST30-t318, ST121-t1425, ST800-t1425, and ST630-t377. No methicillin-resistant SA (MRSA) strains were detected in this study. CA-MSSA strains have high drug susceptibility and diverse genetic backgrounds. The coexistence of multiple toxins may provide a survival advantage in community dissemination for CA-MSSA.


Predictors of functional independence and stress level of stroke survivors at discharge from inpatient rehabilitation.
Stroke is the primary cause of long-term disability among older adults. This study identifies predictors of functional independence and perceived stress for stroke survivors discharged home from inpatient rehabilitation with a spousal caregiver. Stroke survivors (N = 97) were interviewed immediately after discharge to obtain scores on the National Institutes of Health Stroke Scale, Functional Independence Measure (FIM), Stroke Impact Scale, Geriatric Depression Scale-15, Perceived Stress Scale, and Perceived Health Status. Demographic and stroke-related data were abstracted from their inpatient rehabilitation charts. Descriptive and regression analyses determined the relationships among variables and the models that best predicted functional independence and perceived stress. Stroke survivors perceived a 50% recovery in their function upon discharge from inpatient rehabilitation. National Institutes of Health Stroke Scale, age, socioeconomic status, and number of complications predicted 63% of the variance of the total FIM score (F6,88 = 24.64; P < .0001). Total FIM, depression, and Stroke Impact Scale Emotion subscale predicted 45% of the Perceived Stress Scale score (F6,88 = 12.04; P < .0001). Variables that predict the stroke survivors' recovery are complex as the severity of the stroke combines with demographic and economic variables and depression to predict functional independence and perceived stress. These factors need to be considered when preparing a discharge plan for stroke survivors who are discharged home from rehabilitation.


Tumor necrosis factor-alpha regulation of 1,25-dihydroxyvitamin D production by human keratinocytes.
The keratinocyte has receptors for, responds to, and produces both tumor necrosis factor-alpha (TNF) and 1,25-dihydroxyvitamin D [1,25-(OH)2D]. Both TNF and 1,25-(OH)2D facilitate the differentiation of keratinocytes. To explore the possibility that TNF stimulates keratinocyte differentiation at least in part by regulating 1,25-(OH)2D production we examined the effect of TNF on both 1,25-(OH)2D production and differentiation (transglutaminase activity, cornified envelope formation) at different stages of differentiation. 1,25-(OH)2D production, transglutaminase activity, and cornified envelope formation are sequentially increased during differentiation such that 1,25-(OH)2D production occurs first, followed by transglutaminase activity and, finally, cornified envelope formation. In preconfluent cells, TNF stimulated 1,25-(OH)2D production. Interferon-gamma also stimulated 1,25-(OH)2D production at low concentrations, but this was not additive to that by TNF. The stimulatory effect of TNF was maximal after 1-2 days of incubation and decreased with prolonged incubation. TNF had little effect on cornified envelope formation and transglutaminase activity in the preconfluent cells. Once keratinocytes achieved confluence, TNF stimulated transglutaminase activity and cornified envelope formation, but inhibited 1,25-(OH)2D production. Our results suggest that TNF regulates 1,25-(OH)2D production as part of its ability to accelerate keratinocyte differentiation; whether TNF stimulates or inhibits 1,25-(OH)2D production depends on whether TNF is added before or after the cell has reached its maximal capacity to make 1,25-(OH)2D.


Comparison of planned menus and centre characteristics with foods and beverages served in New York City child-care centres.
The present study evaluated the extent to which child-care centre menus prepared in advance correspond with food and beverage items served to children. The authors identified centre and staff characteristics that were associated with matches between menus and what was served. Menus were collected from ninety-five centres in New York City (NYC). Direct observation of foods and beverages served to children were conducted during 524 meal and snack times at these centres between April and June 2010, as part of a larger study designed to determine compliance of child-care centres with city health department regulations for nutrition. Child-care centres were located in low-income neighbourhoods in NYC. Overall, 87 % of the foods and beverages listed on the menus or allowed as substitutions were served. Menu items matched with foods and beverages served for all major food groups by >60 %. Sweets and water had lower match percentages (40 and 32 %, respectively), but water was served 68 % of the time when it was not listed on the menu. The staff person making the food and purchasing decisions predicted the match between the planned or substituted items on the menus and the foods and beverages served. In the present study, child-care centre menus included most foods and beverages served to children. Menus planned in advance have potential to be used to inform parents about which child-care centre to send their child or what foods and beverages their enrolled children will be offered throughout the day.


NIR-Emissive Chromium(0), Molybdenum(0), and Tungsten(0) Complexes in the Solid State at Room Temperature.
The development of NIR emitters based on earth-abundant elements is an important goal in contemporary science. We present here Cr(0), Mo(0), and W(0) carbonyl complexes with a pyridyl-mesoionic carbene (MIC) based ligand. A detailed photophysical investigation shows that all the complexes exhibit dual emissions in the VIS and in the NIR region. The emissive excited states are assigned to two distinct triplet states by time-resolved emission and step-scan FTIR spectroscopy at variable temperature, supported by density functional theory. In particular, the NIR emissive triplet state exhibits unprecedented lifetimes of up to 600±10 ns and quantum yields reaching 1.7 ⋅ 10-4 at room temperature. These are the first examples of Cr(0), Mo(0) and W(0) complexes that emit in the NIR II region.


[Mammoplasty combined with irradiation: conservative treatment of breast cancer localized in the lower quadrant].
Conservative radio-surgical treatment of breast neoplasms is often responsible for poor cosmetic results when the tumor is located in the lower quadrants. Since 1986, ten patients with such a tumor were treated at the Curie Institute by a combination of a superior pedicle mammaplasty and radiotherapy. The mammaplasty was bilateral in nine cases. Four patients were operated upon before radiotherapy, while the six others had preoperative radiotherapy. The average weight of the lumpectomy was 193 g, and its margins were always tumor-free. There were no locoregional recurrences (average follow-up time: 16 months). Symmetrization enabled us to obtain contralateral histological data. The cosmetic results were very good when surgery was performed before radiotherapy. When radiotherapy was performed first, the result was often slightly asymmetric, with a smaller irradiated breast. The only complication was partial areolar necrosis in one patient who had been heavily irradiated (85 grays). The combination of a mammaplasty and radiotherapy makes it possible to perform a large lumpectomy of the lower quadrants with good cosmetic results. The interest of this protocol in the extension of the indications for conservative treatments of breast neoplasms is discussed.


Investigation of mixing viscoplastic fluid with a modified anchor impeller inside a cylindrical stirred vessel using Casson-Papanastasiou model.
In process engineering as chemical and biotechnological industry, agitated vessels are commonly used for various applications; mechanical agitation and mixing are performed to enhance heat transfer and improve specific Physico-chemical characteristics inside a heated tank. The research subject of this work is a numerical investigation of the thermo-hydrodynamic behavior of viscoplastic fluid (Casson-Papanastasiou model) in a stirred tank, with introducing a new anchor impeller design by conducting some modifications to the standard anchor impeller shape. Four geometry cases have been presented for achieving the mixing process inside the stirred vessel, CAI; classical anchor impeller, AI1; anchor impeller with added horizontal arm blade, AI2 and AI3 anchor impeller with two and three added arm blades, respectively. The investigation is focused on the effect of inertia and plasticity on the thermo-hydrodynamic behavior (flow pattern, power consumption, and heat transfer) by varying the Reynolds number (Re = 1, 10, 100, 200), Bingham number (Bn = 1, 10, 50), in addition to the effect of geometry design in the overall stirred system parameters. The findings revealed an excellent enhancement of flow pattern and heat transfer in the stirred system relatively to the increase of inertia values. Also, an energy reduction has been remarked and the effect of anchor impeller shape. AI3 geometry design significantly improves the flow pattern and enhances heat transfer by an increased rate of 10.46% over the other cases.


Cholangiocyte Epithelial to Mesenchymal Transition (EMT) is a potential molecular mechanism driving ischemic cholangiopathy in liver transplantation.
Donation after circulatory death (DCD) has expanded the donor pool for liver transplantation. However, ischemic cholangiopathy (IC) after DCD liver transplantation causes inferior outcomes. The molecular mechanisms of IC are currently unknown but may depend on ischemia-induced genetic reprograming of the biliary epithelium to mesenchymal-like cells. The main objective of this study was to determine if cholangiocytes undergo epithelial to mesenchymal transition (EMT) after exposure to DCD conditions and if this causally contributes to the phenotype of IC. Human cholangiocyte cultures were exposed to periods of warm and cold ischemia to mimic DCD liver donation. EMT was tested by assays of cell migration, cell morphology, and differential gene expression. Transplantation of syngeneic rat livers recovered under DCD conditions were evaluated for EMT changes by immunohistochemistry. Human cholangiocytes exposed to DCD conditions displayed migratory behavior and gene expression patterns consistent with EMT. E-cadherin and CK-7 expressions fell while N-cadherin, vimentin, TGFβ, and SNAIL rose, starting 24 hours and peaking 1-3 weeks after exposure. Cholangiocyte morphology changed from cuboidal (epithelial) before to spindle shaped (mesenchymal) a week after ischemia. These changes were blocked by pretreating cells with the Transforming Growth Factor beta (TGFβ) receptor antagonist Galunisertib (1 μM). Finally, rats with liver isografts cold stored for 20 hours in UW solution and exposed to warm ischemia (30 minutes) at recovery had elevated plasma bilirubin 1 week after transplantation and the liver tissue showed immunohistochemical evidence of early cholangiocyte EMT. Our findings show EMT occurs after exposure of human cholangiocytes to DCD conditions, which may be initiated by upstream signaling from autocrine derived TGFβ to cause mesenchymal specific morphological and migratory changes.


Evidence for the involvement of opioidergic systems in medprotine-induced analgesia in the mouse.
Intramuscular administration of medprotine, a protein fraction of human placenta (30-300 kDa), produced dose-dependent and long lasting analgesia as evaluated by various analgesic tests in mice. Activity was found in a dose range of 0.05-0.6 mg/kg in the phenylbenzoquinone and acetic acid writhing tests and 1.5-5 mg/kg in the hot-plate test. In this latter model, medprotine enhanced morphine-induced analgesia. Pretreatment with naloxone antagonized the effect of medprotine in all assays. The antinociceptive response of medprotine was not modified after a ten day pretreatment and no overt withdrawal symptom could be observed after either interruption of chronic treatment or administration of a precipitating dose of naloxone. It is concluded that the analgesic activity of medprotine may be mediated through either the opiate receptors or activation of endogenous opioidergic systems.


Diagnostic Value of Serum Chitinase-3-Like Protein 1 for Liver Fibrosis: A Meta-analysis.
Serum chitinase-3-like protein 1 (CHI3L1) is a promising marker for diagnosing liver fibrosis. This meta-analysis was carried out to assess the diagnostic performance of serum CHI3L1 for the estimation of liver fibrosis. Systematic searches were performed on PubMed, Embase, Web of Science, Scopus, the Cochrane Library, Google Scholar, Sinomed, the China National Knowledge Infrastructure (CNKI), the Chinese Medical Journal Database, and the Wanfang databases for available studies. The primary studies were screened strictly according to inclusion and exclusion criteria, and sensitivity, specificity, and other measures of accuracy of serum CHI3L1 for evaluating liver fibrosis were pooled with 95% confidence intervals. I 2 was calculated to assess heterogeneity, and sources of heterogeneity were explored by subgroup analysis. Deeks' test was used to assess for publication bias, and likelihood ratio was used to determine posttest probability. Our research integrated 11 articles, accounting for 1897 patients older than 18 years old. The pooled sensitivity and specificity for significant fibrosis, advanced fibrosis, and cirrhosis were 0.79 and 0.82 with an area under the receiver operating characteristic curve (AUC) of 0.85, 0.81 and 0.83 with an AUC of 0.91, and 0.72 and 0.74 with an AUC of 0.85, respectively. Random-effects models were used to assess for significant heterogeneity, and subgroup analysis showed that age and aetiology of included patients were likely sources of heterogeneity. No potential publication bias was found for serum CHI3L1 in the diagnosis of significant fibrosis, advanced fibrosis, or cirrhosis, and posttest probability was moderate. Measurement of serum CHI3L1 is a feasible diagnostic tool for liver fibrosis.


Effect of different substituents on the fluorescence properties of precursors of synthetic GFP analogues and a polarity-sensitive lipid droplet probe with AIE properties for imaging cells and zebrafish.
The green fluorescent protein (GFP) is a purely natural specialty protein that has been widely used to design synthetic fluorescent probes. In the present work we designed and synthesized a series of fluorescent compounds akin to GFP precursors by a one-step method, and investigated the luminescence properties of the fluorescent compounds by varying the substituents. We presented the first systematic summary of the photophysical data including extinction coefficients and fluorescence quantum yields for this class of fluorescent dyes. We also carried out density functional theory (DFT) calculations for these dyes to investigate the effect of electronic effects due to different substituents. These studied optical properties may provide a reference for later probe design. More interestingly, we have developed a polarity-sensitive lipid droplet probe T-LD with AIE properties on this basis. The probe exhibited not only favorable pH stability and kinetic stability in terms of optical properties, but also solvent discolouration and polarity-sensitive properties, and was able to label intracellular lipid droplets. We successfully applied the probe for intracellular lipid droplet level monitoring and zebrafish imaging.


A description of the Purnell Model for Cultural Competence.
To meet the needs of a multicultural society, health care in the new millennium stresses teamwork in providing culturally sensitive and competent care to improve client outcomes. Publications addressing the future predict an increasingly diverse workforce. Accordingly, care providers can benefit from a conceptual model of cultural competence that can be used by all health disciplines in all practice settings. The Purnell Model for Cultural Competence, developed in 1995, is applicable to all health care providers. This article (a) describes the development of the model; (b) provides a description of the model; (c) lists the major assumptions on which the model is based; (d) describes the model's use in practice, education, administration, and research across disciplines; and (e) includes a brief evaluation of the model. Important cultural domains missing from other transcultural and cross-cultural models, which are found in the Purnell Model, are biocultural ecology and workforce issues.


Assessment of ß-lactams and Carbapenems Antimicrobials Resistance in Klebsiella Oxytoca Isolated from Patients with Urinary Tract Infections in Najaf, Iraq.
Antimicrobial resistance is becoming an arising global issue. Until recent years, more than 50% of commercially available antibiotics were ß-lactam. Pathogenic bacteria which are resistant to antibiotics include all ß-lactams except for cephamycin and carbapenems. This study aimed to evaluate some ß-lactams and carbapenems antimicrobials resistance in Klebsiella oxytoca. In total, 177 urinary tract infection samples were collected for the purposes of the study. Isolates were identified using morphological features and routine biochemical testing. All isolates were tested for susceptibility to 11 antibiotics using the usual disc diffusion method. The result showed that 155 (87.57%) and 20 (11.29%) out of 177 collected urine samples were gram-negative bacterial isolates and gram-positive bacterial isolates, respectively. The findings also showed that there were two samples (1.12 %) with no growth. The results proved no susceptibility to Ampicillin, Cloxacillin, Ceftazidime, Penicillin, Piperacillin with a resistance rate of 100%.


Effects of an abdominal muscle exercise program in people with intellectual disabilities residing in a residential care facility.
[Purpose] The purpose of this study was to provide basic information as reference and guidelines for the implementation of abdominal muscle exercise programs for people with intellectual disabilities residing in residential care facilities. [Subjects and Methods] The study period was 12 weeks, from July 1, 2015, to September 30, 2015. The study participants comprised of 10 people with intellectual disabilities who were residing in a residential care facility. An occupational therapist measured each subject's weight and physical fitness (muscle strength and flexibility). Collected data were encoded by using items and analyzed using SPSS ver.18.0. [Results] Weight decreased significantly, and physical fitness (muscle strength and flexibility) increased significantly. [Conclusion] To actively improve abdominal muscle strength and health management in people with intellectual disabilities residing in residential care facilities, consistent implementation of abdominal muscle exercise programs and improvements are indispensable, as these could lead to the development of systematic programs for rehabilitation physical activities.


Drosophila pacemaker neurons require g protein signaling and GABAergic inputs to generate twenty-four hour behavioral rhythms.
Intercellular signaling is important for accurate circadian rhythms. In Drosophila, the small ventral lateral neurons (s-LN(v)s) are the dominant pacemaker neurons and set the pace of most other clock neurons in constant darkness. Here we show that two distinct G protein signaling pathways are required in LN(v)s for 24 hr rhythms. Reducing signaling in LN(v)s via the G alpha subunit Gs, which signals via cAMP, or via the G alpha subunit Go, which we show signals via Phospholipase 21c, lengthens the period of behavioral rhythms. In contrast, constitutive Gs or Go signaling makes most flies arrhythmic. Using dissociated LN(v)s in culture, we found that Go and the metabotropic GABA(B)-R3 receptor are required for the inhibitory effects of GABA on LN(v)s and that reduced GABA(B)-R3 expression in vivo lengthens period. Although no clock neurons produce GABA, hyperexciting GABAergic neurons disrupts behavioral rhythms and s-LN(v) molecular clocks. Therefore, s-LN(v)s require GABAergic inputs for 24 hr rhythms.


High performance thin film transistor with ZnO channel layer deposited by DC magnetron sputtering.
Research in large area electronics, especially for low-temperature plastic substrates, focuses commonly on limitations of the semiconductor in thin film transistors (TFTs), in particular its low mobility. ZnO is an emerging example of a semiconductor material for TFTs that can have high mobility, while a-Si and organic semiconductors have low mobility (<1 cm2/Vs). ZnO-based TFTs have achieved high mobility, along with low-voltage operation low off-state current, and low gate leakage current. In general, ZnO thin films for the channel layer of TFTs are deposited with RF magnetron sputtering methods. On the other hand, we studied ZnO thin films deposited with DC magnetron sputtering for the channel layer of TFTs. After analyzing the basic physical and chemical properties of ZnO thin films, we fabricated a TFT-unit cell using ZnO thin films for the channel layer. The field effect mobility (micro(sat)) of 1.8 cm2/Vs and threshold voltage (Vth) of -0.7 V were obtained.


Cutaneous drug delivery of capsaicin after in vitro administration of the 8% capsaicin dermal patch system.
Epicutaneous application of capsaicin causes a long-lasting analgesic effect by binding to the membrane transient receptor potential vanilloid 1 (TRPV1) on mechanoheat-sensitive C and Aδ fibres, changing axonal integrity and inhibiting neurogenic inflammatory processes. To date, no information is available regarding the cutaneous drug delivery of capsaicin following patch application. Using a Franz diffusion cell, the cutaneous concentration-time profiles 30, 60 and 90 min after application of a patch containing 8% capsaicin (640 µg/cm(2)) on ex vivo thin (mamma) and thick (plantar) human skin were investigated at 32 °C, and additionally at 42 °C for thin skin and 10 °C for thick skin. An HPLC-MS method was used for the analytic detection of capsaicin. The results show that already after a 30-min application of the 8% capsaicin patch, an equilibrium reservoir can be found in the stratum corneum in both thick and thin skin. Under physiological temperature conditions, a sufficient bioavailability of capsaicin in the cutaneous target compartments can be found. Raising the temperature to 42 °C has no relevant impact on the concentration-time profile, while reducing the temperature to 10°C leads to a significantly lower bioavailability. After 30 min of application, a sufficient cutaneous bioavailability of capsaicin is reached in thick as well as thin skin. Whether shorter application times may suffice to achieve therapeutic effectiveness requires further investigation.


Improved signs, symptoms, and quality of life associated with dry eye syndrome: hydroxypropyl cellulose ophthalmic insert patient registry.
To evaluate the acceptability, ease of use, and efficacy of hydroxypropyl cellulose ophthalmic inserts in reducing signs and symptoms of moderate-to-severe dry eye syndrome (DES), and improving quality of life (QoL) and activities of daily living (ADL). The multicenter, prospective, open-label, 4-week registry comprised 520 patients with bilateral DES and a history of artificial tear use, or a desire to use artificial tears within the previous week. Visit 1 encompassed a clinical evaluation and symptom and QoL questionnaires, including the Ocular Surface Disease Index. Patients were trained to use inserts, which were used once daily, thereafter, as monotherapy or with existing therapy. At visit 2, clinical evaluation and questionnaires evaluated changes in signs, symptoms, ADL, and QoL. Adverse events were monitored throughout the registry. There were 418 (80.4%) completers. Statistically significant improvements in discomfort, burning, dryness, grittiness, stinging, and light sensitivity, as well as clinical signs of keratitis, conjunctival staining, and tear volume were seen (P<0.05). Mean Ocular Surface Disease Index total scores improved by 21.3% (P<0.05). Blurred vision, affecting 8.7% of patients, was the most commonly reported adverse event leading to discontinuation. Hydroxypropyl cellulose ophthalmic inserts significantly improved signs and symptoms of moderate-to-severe DES, as well as ADL and QoL. Benefits were additive to those seen with patients' existing care.


Deletions spanning the neurofibromatosis type 1 gene: implications for genotype-phenotype correlations in neurofibromatosis type 1?
Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder characterized by abnormalities of tissues predominantly derived from the neural crest. Symptoms are highly variable and severity cannot be predicted, even within families. DNA of 84 unrelated patients with NF1, unselected for clinical features or severity, were screened with intragenic polymorphic repeat markers and by Southern analysis with cDNA probes. Deletions of the entire gene were detected in five patients from four unrelated families. Their phenotype resembled that of five previously reported patients with deletions, including intellectual impairment and dysmorphic features, but without an excessive number of dermal neurofibromas. This report supports the hypothesis that large deletions spanning the entire NF1 gene may lead to a specific phenotype.


A new determinant, defined by PLT, coded for in the HLA region and apparently independent of the HLA-D and DR loci.
A PLT cell was raised between a responder cell which carried the HLA-D and DR specificities Dw3, 8; DRw3, 8 and a stimulator cell which was most likely homozygous for HLA-Dw3, DRw3. The PLT cell appeared to recognize a determinant (PL3A) which was (1) different from the officially recognized HLA-D and DR determinants, (2) was associated with HLA-A1, B8, Dw3 and DRw3, and (3) segregated in three informative families with HLA. Another responder-stimulator combination could be selected to raise PLT cells which recognized the same determinant.


Child fatality associated with pathological features of histiocytic necrotizing lymphadenitis (Kikuchi-Fujimoto disease).
We report a case of histiocytic necrotizing lymphadenitis without granulocytic infiltration (Kikuchi-Fujimoto disease), diagnosed at necropsy in a 19-month-old child dying unexpectedly after a febrile illness. This is the youngest case with this disease that has been thus far reported. It is one of only two reported cases in which the patient died during the acute phase of the illness. Histological findings not unlike those seen in the lymph nodes were present at extranodal sites; this is the first case in which this feature has been described. In keeping with many other reported cases, it was not possible to identify an underlying etiology that might explain the morphologic changes.


Implications of metabolic dysfunction associated fatty liver disease in COVID-19.
Metabolic associated fatty liver disorder (MAFLD) characterizes the contributing etiologies (i.e., type 2 diabetes mellitus, metabolic syndrome, overweight) of individuals with fatty liver disease that affects 1/3rd of the world population. In 2020, the coronavirus disease 2019 (COVID-19) crisis was unprecedented, and people with different comorbidities became more susceptible to the infection caused by severe acute respiratory syndrome coronavirus 2. MAFLD patients are frequently obese with added metabolic menace like diabetes, hypertension, and dyslipidemia leading to greater jeopardy of COVID-19. MAFLD patients are 4 to 6-fold more prone towards infections. COVID-19 induces liver injury with elevated levels of aspartate aminotransferase and alanine aminotransferase and insignificantly elevated bilirubin. Hence, MAFLD in COVID-19 patients worsens the condition significantly. The evidence highlighting the interaction between MAFLD and altered liver functioning in COVID-19 suggested that COVID-19 patients with pre-existing MAFLD are at greater risk of morbidity or intensive care unit admission. Direct hepatic injury, enhanced levels of inflammatory cytokines, declined hepatic mitochondrial activity, and compromised immunity are considered as some underlying mechanisms. The main focus of this review is to discuss the implications of metabolic dysfunction associated with fatty liver disease in COVID-19 patients. The review systematically analyzes the effect of striking two worldwide pandemics (MAFLD and COVID-19) together in the present era.


[Signet ring cancer of the stomach: clinico-morphological features, postsurgical results and prognosis].
Clinico-morphological features of signet ring cancer of the stomach were evaluated in 372 out of 2,308 gastric cancer patients undergoing gastroectomy or stomach resection. Signet ring tumor pathology occurs mostly in young females and younger patients generally. It features high incidence of early cancers, low frequency of metastatic spreading to lymph nodes (T1-T2), high frequency of immediate involvement of perigastric fatty tissues, peritoneum and ovaries and infrequent spreading to the liver. Post-surgical survival rates among patients with T1-T2 were relatively high, yet declining in cases of extension through the serous membrane of the stomach. D2-lymphdissection failure to improve the end-results of surgical treatment of signet ring cancer might be accounted for by the predominance of peritoneal metastases of this morphological pattern. Histochemical assay of mucines might be contribute additional data on prognosis.


Elegant pH-Responsive Nanovehicle for Drug Delivery Based on Triazine Dendrimer Modified Magnetic Nanoparticles.
Owing to properties of magnetic nanoparticles and elegant three-dimensional macromolecule architectural features, dendrimeric structures have been investigated as nanoscale drug delivery systems. In this work, a novel magnetic nanocarrier, generation two (G2) triazine dendrimer modified Fe3O4@SiO2 magnetic nanoparticles (MNP-G2), was designed, fabricated, and characterized by Fourier transform infrared (FT-IR), thermal gravimetric analysis (TGA), vibrating sample magnetometer (VSM), field emission scanning electron microscopy (FE-SEM), transmission electron microscopy (TEM), and dynamic light scattering (DLS). The prepared MNP-G2 nanosystem offers a new formulation that combines the unique properties of MNPs and triazine dendrimer as a biocompatible material for biomedical applications. To demonstrate the potential of MNP-G2, the nanoparticles were loaded with methotrexate (MTX), a proven chemotherapy drug. The MTX-loaded MNP-G2 (MNP-G2/MTX) exhibited a high drug-loading capacity of MTX and the excellent ability for controlled drug release. The cytotoxicity of MNP-G2/MTX using an 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide based assay and MCF-7, HeLa, and Caov-4 cell lines revealed that MNP-G2/MTX was more active against the tumor cells than the free drug in a mildly acidic environment. The results of hemolysis, hemagglutination, and coagulation assays confirmed the good blood safety of MNP-G2/MTX. Moreover, the cell uptake and intracellular distribution of MNP-G2/MTX were studied by flow cytometry analysis and confocal laser scanning microscopy (CLSM). This research suggests that MNP-G2/MTX with good biocompatibility and degradability can be selected as an ideal and effective drug carrier in targeted biomedicine studies especially anticancer applications.


Ownership of the affected leg is further reduced following deceptive behaviors in body integrity dysphoria.
Although predicted by the notion of embodied morality, it remains unknown whether a reduced sense of body ownership (SoO) is associated with increased or decreased dishonesty. To clarify this issue, we tested patients with body integrity dysphoria (BID), a clinical condition characterized by chronic reductions of SoO toward one leg that patients persistently desire to have amputated. Participants with BID played a card game in which they could voluntarily tell the truth or cheat an opponent, and thus either steal or give them money. To assess whether SoO toward the effector limb influences (im)moral decisions, responses were communicated with the affected or the unaffected leg. We found that a higher number of self-gain lies was followed by further reductions of SoO toward the affected leg. Our result supports the idea that reductions of SoO may follow immoral behaviors to distance from unwanted characteristics of the self, like one's own dishonesty.


Peripheral and Cerebral Resistance Arteries in the Spontaneously Hypertensive Heart Failure Rat: Effects of Stilbenoid Polyphenols.
Hypertension is associated with aberrant structure and mechanical properties of resistance arteries. We determined the effects of resveratrol, a non-flavonoid polyphenol found in foods such as red grapes, and structurally-similar analogues (pterostilbene and gnetol) on systolic blood pressure (SBP) and resistance arteries from the spontaneously hypertensive heart failure (SHHF) rat. SBP was elevated in 17-week-old SHHF vs. Sprague-Dawley rats (normotensive control; 194 ± 3 vs. 142 ± 6 mmHg, p < 0.01) and was unaffected by resveratrol, pterostilbene, or gnetol (2.5 mg/kg/d). Geometry and mechanical properties of pressurized mesenteric resistance arteries and middle cerebral arteries were calculated from media and lumen dimensions measured at incremental intraluminal pressures. SHHF arteries exhibited remodeling which consisted of augmented media-to-lumen ratios, and this was attenuated by stilbenoid treatment. Compliance was significantly reduced in SHHF middle cerebral arteries but not mesenteric arteries vis-à-vis increased wall component stiffness; stilbenoid treatment failed to normalize compliance and wall component stiffness. Our data suggest that neither AMPK nor ERK mediate stilbenoid effects. In conclusion, we observed arterial bed-specific abnormalities, where mesenteric resistance arteries exhibited remodeling and cerebral arteries exhibited remodeling and stiffening. Resveratrol, pterostilbene, and gnetol exhibited similar abilities to attenuate vascular alterations.


Total thoracoscopic posterior basal segmentectomy for primary lung cancer.
This report introduces a hilar side approach for posterior basal segmentectomies by the process of specific vision thoracoscopic surgery, which has been used extensively for peripheral small lung cancer by the author. Although it requires a deeper understanding of hilar anatomy and fine control, it is safer and less invasive to the thoracic wall and results in less postoperative pain than the thoracotomy counterpart and as a hilar side approach allows for less deformation. The necessary order of processes involves specific vision, inflation-deflation and blunt dissection from the hilum.


Stressors and coping mechanisms among pregnant women with psychiatric disorders during the COVID-19 pandemic.
Women with psychiatric disorders are vulnerable to relapse in pregnancy, and the COVID-19 pandemic has presented an additional stressor. Data came from a supplemental study offered to women enrolled in the Massachusetts General Hospital Center for Women's Mental Health National Pregnancy Registry for Psychiatric Medications. Registry participants were also invited to complete an email questionnaire relating to their experiences of pregnancy during the pandemic. Prepartum experiences of 230 respondents were analyzed. The most common diagnoses in this group were depression (30%), anxiety disorders (29%), and bipolar affective disorder (17%). Common stressors included changes in employment, greater childcare and/or schooling responsibilities, more conflict in the household, and increased isolation. Participants reported negative impacts and/or coping mechanisms associated with the pandemic, such as sleep problems, reduced physical activity, changes in eating, and greater amounts of screen time. Positive impacts and/or coping mechanisms were also reported, including more quality time with family, more time in nature, and being more appreciative of aspects of life previously taken for granted. Our findings suggest that the COVID-19 pandemic has had an overall negative psychosocial impact on many pregnant women with preexisting psychiatric disorders. We also observed positive coping mechanisms, which could be drawn on as sources of resilience.


Endoscopic therapeutics for patients with cholangitis caused by the juxtapapillary duodenal diverticulum.
The role of endoscopic intervention for cholangitis caused by the juxtapapillary duodenal diverticulum without choledocholithiasis, i.e., the Lemmel's syndrome remains controversial. The aims of the study were to characterize these patients and evaluate endoscopic therapy for Lemmel's syndrome. This study retrospectively reviewed 1923 endoscopic retrograde cholangiopancreatograms of patients with cholangitis during a three-year period, and 337 of these patients with juxtapapillary duodenal diverticula were included. Two groups (i.e., one with and one without Lemmel's syndrome) were compared. Lemmel's syndrome was diagnosed in 39 patients (39/337, 11.6%). Both groups had similar cannulation success rates (94.9% vs. 87.9%, p = 0.28) and complication rates (2.6% vs. 8%, p = 0.33). Patients with Lemmel's syndrome were significantly older (mean 74.5 years vs. 66.6 years, p < 0.001) and had significantly larger diverticula (mean 3.9cm vs. 1.9cm, p < 0.001). Of these 39 patients, 15 received endoscopic sphincterotomy (38.5%), 3 received stenting (7.7%), 6 had impacted bezoars (15.4%), 2 underwent surgery due to failed cannulation (5.1%), 19 (48.7%) received conservative treatment after diagnostic cholangiography, and 1 had significant bleeding (2.6%). Patients with Lemmel's syndrome are older and have larger juxtapapillary duodenal diverticula. Endoscopic cannulation is not hampered by this anatomical difference and is not associated with higher complication rate.


Intrathecal Morphine-Related Perioperative Hypothermia in Women Undergoing Cesarean Delivery: A Retrospective Case-Control Study.
Rates of inadvertent perioperative hypothermia among women undergoing spinal anesthesia for cesarean delivery are reported to be high. Intrathecal morphine has been noted to have a potentially potent effect on thermoregulation. This retrospective case-control study sought to investigate the incidence of perioperative hypothermia in women undergoing cesarean delivery with and without intrathecal morphine and to describe any clinical factors associated with the condition, the identification of which would provide direction for nursing priorities in the care of the condition. A retrospective case-controlled study design was used. The charts of 358 women who had undergone emergency or elective cesarean delivery under spinal anesthesia were reviewed: 179 having received intrathecal morphine and 179 having received spinal anesthesia without intrathecal morphine (control group). SPSS (IBM, Armonk, New York), version 22, was used for data analysis, including logistic regression to predict the outcome of hypothermia across the study population. There was no significant difference (P = .62; 95% confidence interval, -0.09 to 0.15) in mean postoperative temperature for the morphine group (mean postanesthesia care unit arrival temperature, 35.91°C; standard deviation, 0.59) and the no morphine group (mean postanesthesia care unit arrival temperature, 35.88°C; standard deviation, 0.52). However, within groups, the temperature decline preoperatively to postoperatively was statistically (and clinically) significant. The results refute the suggestion that intrathecal morphine contributes to greater core temperature decline in this population; however, it does confirm that perioperative hypothermia is a prevalent concern for women undergoing cesarean delivery and that pre-emptive measures should be routinely considered by health care providers.


Solvent effect on ion-pair extraction of 2-(2-pyridylazo)-1-naphthol-4-sulfonate anion with solvated hydroxonium ion using alcohols and 1-octanol/octane mixed solvents.
Extraction of 2-(2-pyridylazo)-1-naphthol-4-sulfonate anion with solvated hydroxonium ion was carried out using 14 kinds of alcohols and 1-octanol/octane mixed solvents as a solvent at 25 degrees C. Alcohols are 1-pentanol, 1-hexanol, 1-heptanol, 2-heptanol, 3-heptanol, 4-heptanol, 1-octanol, 2-octanol, 3-octanol, 1-nonanol, 2-nonanol, 3-nonanol, 5-nonanol and 1-decanol. Among them, 1-octanol was found to be extremely high in extractability for 2-(2-pyridylazo)-1-naphthol-4-sulfonate anion with hydroxonium cation. The extraction equilibrium for the systems using 1-octanol/octane mixed solvents was analyzed in detail in order to examine the extraction mechanism for these extraction systems. 2-(2-Pyridylazo)-1-naphthol-4-sulfonate anion was found to be extracted with the hydroxonium ion solvated by three 1-octanol molecules as an ion-pair. The extraction and partition constants of the ion-pair of 2-(2-pyridylazo)-1-naphthol-4-sulfonate anion with solvated hydroxonium ion were estimated in the 1-octanol/octane mixed solvent systems.


[Coping: meanings, interference in the health-disease process and relevance to nursing].
This article is a bibliographic review about Coping in a cognitive-interactionist model. The goal is to analyse this psychological referencial within the health-illness process and stress its importance and the possible ways to be worked by nurses, understanding that it can be an important model which direct them in the development of their essistencial works.


Biology and life-cycle of the microsporidium Kneallhazia solenopsae Knell Allan Hazard 1977 gen. n., comb. n., from the fire ant Solenopsis invicta.
Thelohania solenopsae is a unique microsporidium with a life-cycle finely tuned to parasitizing fire ant colonies. Unlike other microsporidia of social hymenopterans, T. solenopsae infects all castes and stages of the host. Four distinctive spore types are produced: diplokaryotic spores, which develop only in brood (Type 1 DK spores); octets of octospores within sporophorous vesicles, the most prominent spore type in adults but never occurring in brood; Nosema-like diplokaryotic spores (Type 2 DK spores) developing in adults; and megaspores, which occur occasionally in larvae 4, pupae, and adults of all castes but predominantly infect gonads of alates and germinate in inseminated ovaries of queens. Type 2 DK spores function in autoinfection of adipocytes. Proliferation of diplokaryotic meronts in some cells is followed by karyogamy of diplokarya counterparts and meiosis, thereby switching the diplokaryotic sequence to octospore or megaspore development. Megaspores transmit the pathogen transovarially. From the egg to larvae 4, infection is inapparent and can be detected only by PCR. Type 1 DK spore and megaspore sequences are abruptly triggered in larvae 4, the key stage in intra-colony food distribution via trophallaxis, and presumably the central player in horizontal transmission of spores. Molecular, morphological, ultrastructural and life-cycle data indicate that T. solenopsae must be assigned to a new genus. We propose a new combination, Kneallhazia solenopsae.


Characterization of the hepatic disposition of lanoteplase, a rationally designed variant of tissue plasminogen activator in rodents.
Lanoteplase is a recombinant mutant of tissue-type plasminogen activator (t-PA) that was developed with an aim to overcome the drawback of rapid systemic elimination of t-PA. In this study, we examined the disposition profile of lanoteplase in vivo and the kinetics of receptor-mediated endocytosis (RME) of this recombinant t-PA in vitro to kinetically characterize the mechanism(s) underlying its tissue distribution and elimination. Integration plot analysis of the initial-phase tissue distribution in rats revealed a much lower uptake clearance (CL(uptake)) of lanoteplase in the liver than that of t-PA. Rate constants for cell surface binding, internalization, and degradation of lanoteplase were also lower than those for t-PA in primary cultured rat hepatocytes. These results suggest that the improved stability of lanoteplase in vivo could be accounted for by the delay in the RME of this recombinant protein. The CL(uptake) in the liver decreased with coadministration of lactoferrin, a ligand for the low-density lipoprotein receptor-related protein (LRP) and the asialoglycoprotein (ASGP) receptors in normal mice, and in lrpap1((-/-)) mice, which have a hereditary deficiency of LRP; In contrast, CL(uptake) was not affected by mannose, whereas that of t-PA decreased with both ligands and in the lrpap1((-/-)) mice. Thus, the hepatic disposition of lanoteplase seems to be mediated by common specific receptors for t-PA, including LRP and the ASGP receptors, whereas the mannose receptor seems to be only minimally involved in the disposition of lanoteplase.


[Factors affecting eating attitude of female undergraduates in regard to BMI].
The purpose of this study was to examine the factors affecting eating attitude of female undergraduates according to BMI. A descriptive survey design with a convenience sampling was used and data collection was done using a self-report questionnaire answered by 406 female undergraduates from four universities located in Seoul, Kangwon, Gyeongsangbuk and Chungcheongnam Provinces. ANOVA, Pearson correlation coefficients, and hierarchial multiple regression were used the SPSS WIN 17.0 Program to analyze the data. With respect to BMI, the students were found to be in 3 groups, whose differences in eating attitude were significant. Eating attitude had significant positive correlation with height (r=.118, p=.017), weight (r=.267, p<.000), BMI (r=.239, p<.001), and depression (r=.375, p<.001), and negative correlation with subjective well-being (r=-.153, p=.002) and body esteem (r=-.287, p<.001). In the hierarchial multiple regression analysis, college major, height, weight and religion, were controlled. Depression and body esteem regarding weight significantly predicted 40.7% of eating attitude for the underweight group and normal weight group, body esteem: weight and depression were significant predictors for 27.5% of eating attitude for the normal weight group. Body esteem: weight explained 32.6% of eating attitude for the overweight group. Findings of this study allow a comprehensive understanding of eating attitudes and related factors among female undergraduates in Korea. Further study with a larger random sample from various universities is necessary.


The effects of di-n-butyl phthalate on the germ cells of laboratory mice.
Phthalate are found in the environmental samples due to their wide use in the industry as plasticizers. Di-n-butylphthalate (DBP) is mainly used in nitrocellulose and polyvinyl acetate products as well as in personal-care products. This study was performed to investigate the influence of exposure to DBP on the quantity and quality (motility, morphology) and DNA damage (induction of micronuclei and DNA strand breaks) of male mice gametes. The estimation of DBP residues was also done. Eight weeks exposure to DBP (500 mg/kg bw and 2000 mg/kg bw) did not significantly affect testes and epididymes weights as well as sperm count. DBP clearly diminished sperm motility, enhanced frequency of abnormal sperm heads and not significantly increased DNA strand breaks in germ cells as well as frequency of micronuclei in spermatids. There were no bioacumulation of DBP in mice. Results suggest that DBP may affect the male mice germ cells.


Recurrence of oxalate deposition in a renal transplant during ciclosporin A therapy.
A 14.5-year-old boy with end-stage renal failure due to familial primary hyperoxaluria underwent cadaver donor renal transplantation. The graft function was stable for a period of 22 months, while he was on conventional immunosuppressive therapy (prednisolone and azathioprine) and additional oral pyridoxine, phosphorus, and magnesium supplementation. When ciclosporin A was introduced instead of azathioprine, the blood levels of oxalate rose, and oxalate deposition in the renal tubuli became evident. These observations suggest that ciclosporin A interferes with oxalate metabolism and, therefore, should be given with utmost caution in patients with primary hyperoxaluria.


Photodissociation of benzene under collision-free conditions: an ab initio/Rice-Ramsperger-Kassel-Marcus study.
The ab initio/Rice-Ramsperger-Kassel-Marcus (RRKM) approach has been applied to investigate the photodissociation mechanism of benzene at various wavelengths upon absorption of one or two UV photons followed by internal conversion into the ground electronic state. Reaction pathways leading to various decomposition products have been mapped out at the G2M level and then the RRKM and microcanonical variational transition state theories have been applied to compute rate constants for individual reaction steps. Relative product yields (branching ratios) for C(6)H(5)+H, C(6)H(4)+H(2), C(4)H(4)+C(2)H(2), C(4)H(2)+C(2)H(4), C(3)H(3)+C(3)H(3), C(5)H(3)+CH(3), and C(4)H(3)+C(2)H(3) have been calculated subsequently using both numerical integration of kinetic master equations and the steady-state approach. The results show that upon absorption of a 248 nm photon dissociation is too slow to be observable in molecular beam experiments. In photodissociation at 193 nm, the dominant dissociation channel is H atom elimination (99.6%) and the minor reaction channel is H(2) elimination, with the branching ratio of only 0.4%. The calculated lifetime of benzene at 193 nm is about 11 micros, in excellent agreement with the experimental value of 10 micros. At 157 nm, the H loss remains the dominant channel but its branching ratio decreases to 97.5%, while that for H(2) elimination increases to 2.1%. The other channels leading to C(3)H(3)+C(3)H(3), C(5)H(3)+CH(3), C(4)H(4)+C(2)H(2), and C(4)H(3)+C(2)H(3) play insignificant role but might be observed. For photodissociation upon absorption of two UV photons occurring through the neutral "hot" benzene mechanism excluding dissociative ionization, we predict that the C(6)H(5)+H channel should be less dominant, while the contribution of C(6)H(4)+H(2) and the C(3)H(3)+C(3)H(3), CH(3)+C(5)H(3), and C(4)H(3)+C(2)H(3) radical channels should significantly increase.


Use of procalcitonin in patients on chronic hemodialysis: procalcitonin is not related with increased serum calcitonin.
Objectives. To investigate whether procalcitonin (PCT) could be useful for detecting bacterial infections in patients on hemodialysis (HD) and with increased calcitonin (CT). Methods. This prospective study included 42 males and 34 females on HD. The infection group consisted of 15 patients with proven bacterial infections; the other 61 patients were designated as the noninfection group. Serum C-reactive protein (CRP), interleukin (IL)-6, white blood cell (WBC) count, immature and total neutrophil (I/T) ratio, and CT were measured at the beginning of HD, and serum PCT levels at the beginning of HD and after HD. Results. The mean CT level in the both groups was apparently higher than that of nonchronic kidney disease. Significantly higher values between the infection and noninfection groups were seen for CRP, IL-6, WBC, I/T ratio, PCT, and CT. The PCT value of the area under the receiver operating characteristic curve was 0.921, which was significantly higher than the values for CRP (0.853; P < 0.01), IL-6 (0.739; P < 0.01), WBC (0.692; P < 0.01), and I/T ratio (0.584; P < 0.01). Conclusions. PCT was useful marker of bacterial infection in patients on HD and with increased CT. PCT levels should be determined before HD.


Cavitands as Reaction Vessels and Blocking Groups for Selective Reactions in Water.
The majority of reactions currently performed in the chemical industry take place in organic solvents, compounds that are generally derived from petrochemicals. To promote chemical processes in water, we examined the use of synthetic, deep water-soluble cavitands in the Staudinger reduction of long-chain aliphatic diazides (C8 , C10 , and C12 ). The diazide substrates are taken up by the cavitand in D2 O in folded, dynamic conformations. The reduction of one azide group to an amine gives a complex in which the substrate is fixed in an unsymmetrical conformation, with the amine terminal exposed and the azide terminal deep and inaccessible within the cavitand. Accordingly, the reduction of the second azide group is inhibited, even with excess phosphine, and good yields of the monofunctionalized products are obtained. In contrast, the reduction of the free diazides in bulk solution yields diamine products.


An Analysis of the Comparative Efficacy Between a Third-Generation and a Second-Generation Supraglottic Airway Device in Patients Undergoing Laparoscopic Cholecystectomy.
Background and objective Supraglottic airway devices are extensively used nowadays to secure the airway and minimize postoperative airway-related complications. This study aimed to evaluate whether the Baska® mask (BM) provides higher seal pressure and a better first-time insertion compared to the laryngeal mask airway (LMA) ProSeal™ (LMA-P) in adult laparoscopic cholecystectomy. Methodology This prospective, randomized, single-blinded interventional study was performed after obtaining ethical approval from the Institutional Ethics Committee at the Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. Sixty adult patients of both genders scheduled for laparoscopic cholecystectomy under general anesthesia were divided into two groups, with 30 patients in each group. Our study observed the number of insertion attempts, time of insertion, oropharyngeal seal pressure (OSP), number of patients requiring manipulation for proper placement of supraglottic airway devices, and ease of insertion. Results There were no significant differences in terms of insertion attempts, ease of insertion, and laryngopharyngeal morbidity between the groups. The mean OSP at five minutes was 31.55 ±2.23 cm H2O, and that at 30 minutes was 35.86 ±3.70 cm H20 in the BM group, while in the LMA-P group, it was 24.17 ±3.74 cm H20 and 25.97 ±3.79 cm H20 respectively (p<0.001). In our study, the trend of OSP continued to increase in the BM group more than in the LMA-P group during surgery. Conclusion The BM provided better OSP than the LMA-P, which was observed throughout the surgery.


Copper-Catalyzed Trifluoromethylation of Alkenes with Redox-Neutral Remote Amidation of Aldehydes.
A room-temperature and one-pot synthesis of ε-CF3-substituted amides via the copper-catalyzed trifluoromethylation of alkenes with redox-neutral remote amidation of aldehydes is described. This reaction is featured by an unprecedented 1,5-H atom abstraction from aldehydic C-H bonds by α-CF3-alkyl radicals resulting from the radical trifluoromethylation of alkenes, thus enabling a new possibility of the trifluoromethylation-initiated remote sp(2) C-H functionalization.


Curved ratchets improve bacteria rectification in microfluidic devices.
We study how bacteria rectification in microfluidics devices can be optimized by performing experiments with eight ratchets of different shape and size. Results show that curved ratchets perform best and that their radius of curvature influences how well they perform, as it affects the time bacteria spend on the ratchet surface. We find that the optimal bacterial ratchet is a 60μm radius semicircle witch 15μm concavities. We also show that the angle at which bacteria leave the ratchets can play an important role in their efficiency. Lastly, we reproduce our experimental conditions in a simple numerical simulation to confirm our findings.


Acupuncture in the treatment of HTLV-I-associated myelopathy / tropical spastic Paraparesis.
We investigate the possible effects of acupuncture on the improvement of neurological problems in HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP)disease. Twenty patients with HAM/TSP were studied in this pre and post-test clinical trial. Urinary incontinence, global motor disability, spasticity, and pain severity were evaluated before, one month, and three-month after the intervention. Analyses demonstrated a significant reduction of urinary symptoms one month after acupuncture (P = 0.023). A significant improvement was observed in patients' pain and the spasticity at the upper extremity joints, one and three-month after the intervention (P < 0.05). This study suggests that body acupuncture can be used as a complementary treatment to improve HAM/TSP neurological symptoms.


Identification and association study with lung cancer for novel insertion polymorphisms of human endogenous retrovirus.
Sequences of human endogenous retroviruses (HERVs) are members of the long terminal repeat (LTR) retrotransposon family. Although the expression of HERV has long been a topic of investigation, HERV-insertion polymorphisms are not well known, and a genetic association between HERV-insertion polymorphisms and cancer has never been reported. To identify novel HERV loci in the genome from cancer tissues, we carried out the inverse PCR method targeting a conserved LTR region of HML-2, which is the most recently acquired HERV group. Novel two insertions, HML-2_sLTR(1p13.2) and HML-2_sLTR(19q12), were identified as insertionally polymorphic solo LTRs. Furthermore, a significant prevalence of HML-2_sLTR(1p13.2) homozygosity was detected in female never-smoking patients aged 60 years and over who had lung adenocarcinoma [versus the other genotyping; odds ratio (OR): 1.97; 95% confidence interval (CI): 1.01-3.81]. In another cohort consisting of female never-smoking patients with lung adenocarcinoma, a prevalence of HML-2_sLTR(1p13.2) homozygosity tended to be high in patients aged 60 years and over (versus the other genotyping; OR: 2.03; 95% CI: 0.96-4.29), whereas a low prevalence of HML-2_sLTR(1p13.2) homozygosity was detected in patients <60 years old (versus the other genotyping; OR: 0.31; 95% CI: 0.11-0.94). Our results suggest that HML-2_sLTR(1p13.2) is involved with the susceptibility to lung adenocarcinoma in female never-smokers in an age-dependent manner and that other HERV polymorphisms related to human diseases might remain to be identified in the human genome.


Inhibition of Na+/H+ Exchanger With EMD 87580 does not Confer Greater Cardioprotection Beyond Preconditioning on Ischemia-Reperfusion Injury in Normal Dogs.
Postischemic accumulation of intracellular Na+ promotes calcium overload and contributes to cellular necrosis. Cardioprotection afforded by pharmacologic blockade of the sodium-hydrogen exchanger subtype 1 (NHE1) is thought to be more remarkable than that obtained by ischemic conditioning (IC). The window of protection provided by IC pretreatment is maintained even when performed up to 48 hours before ischemia. In addition, the perception exists that combined NHE1 inhibition plus IC produces greater than additive protection against ischemic injury. The current study compared the efficacy of NHE1 blockade by N-[2-methyl-4,5-bis(methylsulfonyl)-benzoyl]-guanidine (EMD 87580 5 mg/kg) combined with first- or second-window IC on ischemic tolerance in dogs subject to 90-minute acute ischemia and 180-minute reperfusion. Infarct size (tetrazolium staining), vascular responses, and myocardial perfusion (microspheres) were assessed. EMD 87580 given before ischemia or before reperfusion did not reduce infarct size (compared to vehicle-treated group). Significant protection against tissue necrosis was obtained by both first- and second-window IC, but additive cardioprotection (ie, greater than that afforded by IC) was not observed by treatment with EMD 87580. Vascular reactivity in the infarct-related artery was not preserved after ischemia-reperfusion in any of the experimental groups. Likewise, either the pharmacologic or the nonpharmacologic interventions did not modify myocardial perfusion. These data demonstrate that EMD 87580 did not protect against ischemia-reperfusion injury regardless of the time of drug administration. Combined EMD 87580 and IC did not antagonize protection that was achieved by either first- or second-window IC alone; no additive protection beyond preconditioning was obtained. Further study is necessary to assess the value of NHE1 blockers as protective agents against myocardial injury.


Nanodiamond promotes surfactant-mediated triglyceride removal from a hydrophobic surface at or below room temperature.
We demonstrate that ca. 5 nm nanodiamond particles dramatically improve triglyceride lipid removal from a hydrophobic surface at room temperature using either anionic or nonionic surfactants. We prepare nanodiamond-surfactant colloids, measure their stability by dynamic light scattering and use quartz crystal microbalance-dissipation, a technique sensitive to surface mass, in order to compare their ability to remove surface-bound model triglyceride lipid with ionic and nonionic aqueous surfactants at 15-25 °C. Oxidized, reduced, ω-alkylcarboxylic acid, and ω-alkylamidoamine surface-modified adducts are prepared, and then characterized by techniques including (13)C cross-polarization (CP) magic-angle spinning (MAS) NMR. Clear improvement in removal of triglyceride was observed in the presence of nanodiamond, even at 15 °C, both with nanodiamond-surfactant colloids, and by prior nanoparticle deposition on interfacial lipid, showing that nanodiamonds are playing a crucial role in the enhancement of the detergency process, providing unique leads in the development of new approaches to low-temperature cleaning.


Identification of lactylation related model to predict prognostic, tumor infiltrating immunocytes and response of immunotherapy in gastric cancer.
The epigenetic regulatory chemical lactate is a product of glycolysis. It can regulate gene expression through histone lactylation, thereby promoting tumor proliferation, metastasis, and immunosuppression. In this study, a lactylation-related model for gastric cancer (GC) was constructed, and its relationships to prognosis, immune cell infiltration, and immunotherapy were investigated. By contrasting normal tissues and tumor tissues, four lactylation-related pathways that were substantially expressed in GC tissues were found in the GSEA database. Six lactylation-related genes were screened for bioinformatic analysis. The GC data sets from the TCGA and GEO databases were downloaded and integrated to perform cluster analysis, and the lactylation related model was constructed by secondary clustering. The fingding demonstrated that the lactylation score has a strong correlation with the overall survival rate from GC and the progression of GC. Mechanistic experiments showed that abundant immune cell infiltration (macrophages showed the highest degree of infiltration) and increased genetic instability are traits of high lactylation scores. Immune checkpoint inhibitors (ICIs) demonstrated a reduced response rate in GC with high lactylation scores. At the same time, tumors with high lactylation scores had high Tumor Immune Dysfunction and Exclusion scores, which means that they had a higher risk of immune evasion and dysfunction. These findings indicate that the lactylation score can be used to predict the malignant progression and immune evasion of GC. This model also can guide the treatment response to ICIs of GC. The constructed model of the lactate gene is also expected to become a potential therapeutic target for GC and diagnostic marker.


Dynamic changes in hippocampal diffusion and kurtosis metrics following experimental mTBI correlate with glial reactivity.
Diffusion magnetic resonance imaging biomarkers can provide quantifiable information of the brain tissue after a mild traumatic brain injury (mTBI). However, the commonly applied diffusion tensor imaging (DTI) model is not very specific to changes in the underlying cellular structures. To overcome these limitations, other diffusion models have recently emerged to provide a more complete view on the damage profile following TBI. In this study, we investigated longitudinal changes in advanced diffusion metrics following experimental mTBI, utilising three different diffusion models in a rat model of mTBI, including DTI, diffusion kurtosis imaging and a white matter model. Moreover, we investigated the association between the diffusion metrics with histological markers, including glial fibrillary acidic protein (GFAP), neurofilaments and synaptophysin in order to investigate specificity. Our results revealed significant decreases in mean diffusivity in the hippocampus and radial diffusivity and radial extra axonal diffusivity (RadEAD) in the cingulum one week post injury. Furthermore, correlation analysis showed that increased values of fractional anisotropy one day post injury in the hippocampus was highly correlated with GFAP reactivity three months post injury. Additionally, we observed a positive correlation between GFAP on one hand and the kurtosis parameters in the hippocampus on the other hand three months post injury. This result indicated that prolonged glial activation three months post injury is related to higher kurtosis values at later time points. In conclusion, our findings point out to the possible role of kurtosis metrics as well as metrics from the white matter model as prognostic biomarker to monitor prolonged glial reactivity and inflammatory responses after a mTBI not only at early timepoints but also several months after injury.


Transcutaneous pressure-adjustable valves and magnetic resonance imaging: an ex vivo examination of the Codman-Medos programmable valve and the Sophy adjustable pressure valve.
We investigated the compatibility of magnetically adjustable cerebrospinal fluid valves with clinical magnetic resonance imaging. Torque acting on the valves, subjective sensations of valve-carrying volunteers, extension of artifacts on acquired images, changes in valve pressure setting, and accurate valve function after repeated exposure to the magnetic field were tested. Two externally adjustable differential pressure valves, i.e., the Codman-Medos programmable valve (Medos S.A., Le Locle, Switzerland) (n = 5) and the Sophy programmable pressure valve (Sophysa, Orsay, France) (Model SP3, n = 4; Model SU8, n = 3; and Model SM8, n = 2) were exposed to the magnetic fields of 1.5-T clinical scanners. Ferromagnetic properties were investigated according to an established protocol. Subjective sensations during positioning and scanning and image artifacts were investigated using standard clinical imaging protocols. Changes in opening pressure setting during repeated magnetic field exposure were examined using valves affixed to a dummy. Deflection forces measured 117 dynes in the Medos valve, and 2439 (Model SP3), 2172 (Model SU8) and 1914 (Model SM8) dynes in the Sophy valves. Torque during positioning and during imaging was reported for the Sophy valves. Distortion of the magnetic field with artifacts on acquired images ranged 6 x 6 x 12 cm around the Sophy valve and 4 x 4 x 4 cm around the Medos valves. Artifact extension increased with longer TE times on T2-weighted images and when using gradient-echo sequences. The pressure setting of the Medos valves did not change in 31 of 88 tests. Below 170 mm H2O, the maximal disadjustment was 60 mm H2O in each direction. Minor changes of the pressure setting were observed at 50 and 30 mm H2O. In 11 of 15 tests at 200 mm H2O, the setting after magnetic field exposure was below 30 mm H2O. One Medos valve could no longer be programmed after being exposed four times to the static magnetic field. Sophy valves remained at or changed to "high" in 68 of 81 tests and to "low" in 9. All Sophy valves exhibited paramagnetic behavior after the tests. All remained programmable. Observed changes always occurred within the safety area of the magnet. Subjective disturbances resulting from paramagnetic valve behavior are absent in Medos valves and are minor in Sophy valves. Image artifacts require careful planning of valve position. Artifacts observed in magnetic resonance imaging are less disturbing than those observed in computed tomography. Medos valves are more stable regarding disadjustment than are Sophy valves. Radiological control of valve setting after exposure to the magnetic field is mandatory in both. The 0.5-mT safety line encircling the area that patients with pacemakers should not enter is a useful safety borderline for patients with pressure-adjustable valves. Failure of the programming mechanism of one Medos valve after several exposures to the magnetic field requires clarification.


Perspective on precision medicine in paediatric heart failure.
In 2015, President Obama launched the Precision Medicine Initiative (PMI), which introduced new funding to a method of research with the potential to study rare and complex diseases. Paediatric heart failure, a heterogeneous syndrome affecting approximately 1 in 100000 children, is one such condition in which precision medicine techniques may be applied with great benefit. Current heart failure therapies target downstream effects of heart failure rather than the underlying cause of heart failure. As such, they are often ineffective in paediatric heart failure, which is typically of primary (e.g. genetic) rather than secondary (e.g. acquired) aetiology. It is, therefore, important to develop therapies that can target the causes of heart failure in children with greater specificity thereby decreasing morbidity, mortality and burden of illness on both patients and their families. The benefits of co-ordinated research in genomics, proteomics, metabolomics, transcriptomics and phenomics along with dietary, lifestyle and social factors have led to novel therapeutic and prognostic applications in other fields such as oncology. Applying such co-ordinated research efforts to heart failure constitutes an important step in advancing care and improving the lives of those affected.


Understanding Infants' In-Home Injuries: Context and Correlates.
Infancy is a time of elevated risk of injury. Past research has focused mostly on the type of injuries, leaving many gaps in knowledge about contextual information that could aid in injury prevention planning. In this longitudinal study, a participant-event recording method was used in which mothers tracked their infants' home injuries through three motor development stages (sitting up independently, crawling, and walking). A contextual analysis elucidated where injuries occurred, their type and severity, the infant's and parent's behaviors at the time, if the infant had done the risk behavior before and been injured, the level of supervision, and the nature of any safety precautions parents implemented following these injuries. Injuries occurred as often in play as in nonplay areas and were due to physically-active nonplay activities more so than play activities; mothers were often doing chores. Bumps and bruises were the most common types of injuries. As infants became more mobile, supervision scores declined and injury severity scores increased. Infants had done the risk behavior leading to injury previously about 60% of the time, with higher scores associated with parents implementing fewer preventive actions in response to injury. When mothers did implement a safety precaution, greater injury severity was associated with more modifications to the environment and increased supervision; teaching about safety was infrequent. Implications of these results for injury prevention messaging are discussed.


DYNAMICS OF STUDENTS' PHYSICAL WELL-BEING INDICATORS DURING QUARANTINE RESTRICTIONS.
The aim: To study the dynamics of students' physical well-being and physical fitness during the quarantine restrictions caused by the COVID-19 pandemic. Materials and methods: The research involved 263 students (148 men and 115 women) aged 18-20. Depending on the volume of physical activity performed by students during quarantine restrictions, they were divided into three groups (with sufficient, high, and low volume). The physical well-being of students was determined by the method proposed by Ye. A. Pyrohova. The level of physical fitness was determined by the results of students' performance of the exercises. Results: The most pronounced negative changes in physical well-being indicators were found in group C students (both men and women), whose volume of motor activity during quarantine restrictions was low. Among the physical qualities, the level of endurance of students was the most negatively affected. Conclusions: It was found that physical exercises have a positive effect on students' physical well-being during quarantine restrictions. The rational use of physical education makes it possible to mobilize the reserve motor capabilities of the students' body, offset the negative impact of low motor activity and sedentary lifestyle during quarantine restrictions, and help maintain the physical well-being and level of physical fitness at the proper level.


[Comparative genomics analysis of nitrate and nitrite respiration in gamma proteobacteria].
Nitrate and nitrite are preferred respiration oxidants during anaerobic conditions. In Escherichia coli such nitrate- and nitrite respiration is controlled by homologous transcriptional factors NarL and NarP. Although this system was intensively studied during the last two decades, the exact mechanisms of regulation and the structure of the NarL binding signals remained elusive. By the use of comparative genomics approach it was determined that most of the gammaproteobacteria contained only NarP protein. Regulog analysis revealed that whole structure of NarP regulons varied in different genomes and only regulation of nitrate and nitrite reduction system seemed to be highly conservative. Correlation between changes in the respiration system and the presence of the single regulatory system was shown. Conservative NarP binding sites upstream of fnr gene and genes for aerobic metabolism point to alteration in NarP role in respiration control during evolution. Thirty five new regulog members were determined and autoregulation of narQP operon in Vibrionaceae genomes was predicted.


[Expression of a pectin lyase A gene from Aspergillus niger in Pichia pastoris GS115].
In this study, the mature peptide sequence of a pectin lyase gene A was amplified from Aspergillus niger strain EIM-6 by using RT-PCR reverse transcription technique. The cloned gene was then inserted into a Pichia pastoris expression vector pPIC9k to produce the recombinant expression plasmid pPIC9K-pelA. By using electric shocks, we successfully transformed the recombinant pPIC9K-pelA into Pichia pastoris GS115. The activity of the engineered strain reached to 2.3 U/mL after induction with the final concentration of 1.5% methanol. SDS-PAGE analysis revealed that the pPIC9K-pelA transformant had an additional protein band of approximately 38 kD, which was not present in the control. There were no significant differences between the recombinant and native pectin lyase with regard to their hydrolysis activities.


The autonomy of adult women should be paramount, not the exam.
The respect shown by clinic personnel for the adult status of their patients, and the right of people with mental retardation to good routine gynecologic care are not at issue. What is at issue is the right of a mentally retarded woman to refuse the intrusion of a pelvic examination. To accept an accommodated decisional capacity to say yes or indicate assent but to deny the reverse might be in the patients' medical best interest, but it is neither consistent nor respectful of their autonomy.


Improved Kaplan-Meier Estimator in Survival Analysis Based on Partially Rank-Ordered Set Samples.
This study presents a novel methodology to investigate the nonparametric estimation of a survival probability under random censoring time using the ranked observations from a Partially Rank-Ordered Set (PROS) sampling design and employs it in a hematological disorder study. The PROS sampling design has numerous applications in medicine, social sciences and ecology where the exact measurement of the sampling units is costly; however, sampling units can be ordered by using judgment ranking or available concomitant information. The general estimation methods are not directly applicable to the case where samples are from rank-based sampling designs, because the sampling units do not meet the identically distributed assumption. We derive asymptotic distribution of a Kaplan-Meier (KM) estimator under PROS sampling design. Finally, we compare the performance of the suggested estimators via several simulation studies and apply the proposed methods to a real data set. The results show that the proposed estimator under rank-based sampling designs outperforms its counterpart in a simple random sample (SRS).