Clinical study on the arthroscopic refreshing treatment of anterior cruciate ligament injury combined with stable medial meniscus ramp injury.
This study sought to investigate the clinical efficacy of arthroscopic refreshing treatment of anterior cruciate ligament (ACL) injury combined with stable medial meniscus ramp injury. Sixty-eight patients treated between January 2010 and January 2014 were included, and their clinical data were retrospectively analyzed. All patients, after being treated using ACL reconstruction, were divided into 2 groups according to meniscus injury treatment method. The observation group (31 cases) was treated by arthroscopic refreshing, which removed the tissue on both sides of the tear edge using a cutting knife, while the control group (37 cases) was treated using Fast-fix sutures. All patients were followed up for at least 24 months. Surgical duration, postoperative function recovery time, and hospital stay for patients in the observation group were significantly shorter than for those of the control group (P⟨0.05). Both groups showed significant post-operative improvement for Lysholm scores, IKDC scores, and average knee range of motion at 12 and 24 months post-operation (P⟨0.05), but no significant differences between groups were observed (P⟩0.05). Regarding the difference in movement range between the healthy and injured sides, both groups showed significant decrease post-operation (P⟨0.05). Ultimately, there was no significant difference in the recovery of ramp damage and objective symptoms between the two groups (P⟩0.05). Arthroscopic refreshing treatment of patients with anterior cruciate ligament injury combined with stable ramp lesion can achieve similar clinical curative effects as the Fast-fix suture, thereby providing a simple alternative for patient treatment worth popularizing.


Refractive prediction error in cataract surgery using an optical biometer equipped with anterior segment OCT.
To evaluate refractive error after cataract surgery using an optical biometer equipped with anterior segment optical coherence tomography (AS-OCT). Chukyo Eye Clinic, Nagoya, Japan. Retrospective observational design. In total, 150 patients with cataract (150 eyes, mean age 73.4 ± 8.2 years, men 76, women 74), who underwent measurement of parameters with the AS-OCT scanners ANTERION (AS-OCTB) and IOLMaster 700 (OCTB) before cataract surgery, were enrolled in the study. Refractive prediction error was compared between the 2 devices using the SRK/T, Haigis, and Barrett Universal II (UII) formulas for intraocular lens (IOL) power calculation. There were significant differences between AS-OCTB and OCTB in axial length, mean corneal refractive power, anterior chamber depth, lens thickness, and corneal diameter (n = 150). In the SRK/T formula, the arithmetic means of refractive prediction errors for AS-OCTB and OCTB were -0.06 ± 0.46 diopters (D) and 0.02 ± 0.42 D, respectively. In the Haigis formula, the arithmetic means of refractive prediction errors for AS-OCTB and OCTB were -0.23 ± 0.40 D and -0.08 ± 0.35 D, respectively. In the Barrett UII formula, the arithmetic means of refractive prediction errors for AS-OCTB and OCTB were -0.02 ± 0.38 D and 0.11 ± 0.36 D, respectively. AS-OCTB showed significantly larger refractive prediction error toward myopia than OCTB in all 3 formulas (P < .0001). The refractive prediction error using AS-OCTB showed a small difference from that using OCTB. While clinically comparable, the 2 methods could drive meaningful differences in IOL selection.


Novel Cysteine Desulfidase CdsB Involved in Releasing Cysteine Repression of Toxin Synthesis in Clostridium difficile.
Clostridium difficile, a major cause of nosocomial diarrhea and pseudomembranous colitis, still poses serious health-care challenges. The expression of its two main virulence factors, TcdA and TcdB, is reportedly repressed by cysteine, but molecular mechanism remains unclear. The cysteine desulfidase CdsB affects the virulence and infection progresses of some bacteria. The C. difficile strain 630 genome encodes a homolog of CdsB, and in the present study, we analyzed its role in C. difficile 630Δerm by constructing an isogenic ClosTron-based cdsB mutant. When C. difficile was cultured in TY broth supplemented with cysteine, the cdsB gene was rapidly induced during the exponential growth phase. The inactivation of cdsB not only affected the resistance of C. difficile to cysteine, but also altered the expression levels of intracellular cysteine-degrading enzymes and the production of hydrogen sulfide. This suggests that C. difficile CdsB is a major inducible cysteine-degrading enzyme. The inactivation of the cdsB gene in C. difficile also removed the cysteine-dependent repression of toxin production, but failed to remove the Na2S-dependent repression, which supports that the cysteine-dependent repression of toxin production is probably attributable to the accumulation of cysteine by-products. We also mapped a δ54 (SigL)-dependent promoter upstream from the cdsB gene, and cdsB expression was not induced in response to cysteine in the cdsR::ermB or sigL::ermB strain. Using a reporter gene fusion analysis, we identified the necessary promoter sequence for cysteine-dependent cdsB expression. Taken together, these results indicate that CdsB is a key inducible cysteine desulfidase in C. difficile which is regulated by δ54 and CdsR in response to cysteine and that cysteine-dependent regulation of toxin production is closely associated with cysteine degradation.


Facile Preparation of the ZnSe/Ag2Se Binary Heterojunction for Photocatalytic Antibacterial Efficiency.
In a novel approach that capitalized on the differential solubility product (Ksp) of ZnSe and Ag2Se, a unique ZnSe/Ag2Se binary heterostructure was efficiently synthesized in situ. ZnSe/Ag2Se exhibited excellent antimicrobial efficiency under visible light. Incorporating Ag2Se into ZnSe significantly enhanced the photoelectric performance of the catalyst, greatly accelerating the separation of the photogenerated electrons in the system. Active species removal experiments determined that ·O2- and H2O2 played crucial roles in photocatalytic antibacterial efficiency. Further investigation into the levels of cellular membrane peroxidation, bacterial morphology, and intracellular contents concentration revealed that during the photocatalytic antimicrobial process, reactive oxygen species initially oxidize phospholipids in the cell membrane, leading to damage to the external structure of the cell and leakage of the intracellular contents, ultimately resulting in bacteria inactivation. The photocatalytic antimicrobial process of ZnSe/Ag2Se fundamentally deviates from conventional methods, offering new insights into efficient disinfection and photocatalytic antimicrobial mechanisms.


Phytochemical analysis of Myrtus communis plant: Conventional versus microwave assisted-extraction procedures.
Background Myrtle (Myrtus communis L) may constitute an interesting dietary source of health protective compounds. Microwave-assisted extraction (MAE) of total phenolic compounds (TPC) from myrtle leaf, stems, pericarp, and seeds was studied and the results were compared with those of the conventional method extraction (CME) in terms of extraction time. Methods Extraction yield/efficiency and antioxidant activity were measured using radical scavenging assay (DPPH•) and reducing power. Results The results show that the MAE was higher in terms of saving energy, extraction time (62 s) and extraction efficiency of bioactive compound compared to CME (2 h). Leaf presented the optimum content of total phenols (250 mg GAE.g-1 DW) and flavonoids (13.65 mg GAE.g-1 DW). However, the anthocyanin content was most important in pericarp extract (176.50±2.17 mg Cyd-3-glu g-1 DW). The antioxidant activity was important in all parts, mainly in leaves. The results indicated that appropriate microwave treatment could be an efficient process to phenolic compounds recovery and thus, better the antioxidant activity of myrtle extract. Conclusions Principal component analysis (PCA) applied to the experimental data shows that the distribution of the myrtle phenolic compounds depended on their plant part localization as well as the extraction method.


Notch and Wnt inhibitors as potential new drugs for intestinal neoplastic disease.
Colorectal cancer is a major cause of death in the western world. Recent advances in treatment comprise variations on the classical themes of surgical resection combined with chemotherapy using cytotoxic drugs and radiation therapy. Because this therapy is only moderately successful, novel approaches to the treatment of colorectal cancer are required. Our rapidly increasing knowledge of molecular signalling pathways that are deregulated in colorectal cancer might provide a platform from which to develop new rational cancer therapies. Here, we give an update on the roles of the Wnt and Notch signalling pathways in the self renewal of the intestinal epithelium and the consequences of Wnt deregulation in colorectal cancer. We focus on the potential of recently identified small-molecule inhibitors of the Wnt pathway and gamma-secretase inhibitors of the Notch pathway as novel colon cancer therapeutics.


Masturbation as a Cause of "Sexual Neurasthenia": Anton Chekhov's Medical Report (1883).
In the 18th and 19th centuries, in Europe and the United States, masturbation was seen not only as a deviant form of sexual activity but also as a cause of nervous diseases. Masturbation was originally thought to cause insanity, but with the introduction of George Miller Beard's concept of neurasthenia, it came to be considered a form of nervous exhaustion. In the current article, we analyzed the almost forgotten medical report of a "sexual neurasthenic," written by the famous Russian writer and physician Anton Chekhov (1860-1904). This report gives us detailed information about the treatment of a patient allegedly experiencing the effects of masturbation, and thus reflects the medical discourse on masturbation in Russia in the early 1880s. It shows that although the international debate on the causes of neurasthenia had just begun, the concept of neurasthenia toward masturbation had already been put into practice at the Moscow University Clinic in 1883.


History of environmental pathology.
Environmental pathology provides the opportunity for the pathologist to enter the mainstream of medical diagnosis and treatment through the application of his special skills and knowledge to the problems of the patient as created by his exposure to the environment.


The hemodynamic response to interictal epileptic discharges localizes the seizure-onset zone.
Intracranial electroencephalography (EEG), performed presurgically in patients with drug-resistant and difficult-to-localize focal epilepsy, samples only a small fraction of brain tissue and thus requires strong hypotheses regarding the possible localization of the epileptogenic zone. EEG/fMRI (functional magnetic resonance imaging), a noninvasive tool resulting in hemodynamic responses, could contribute to the generation of these hypotheses. This study assessed how these responses, despite their interictal origin, predict the seizure-onset zone (SOZ). We retrospectively studied 37 consecutive patients who underwent stereo-EEG (SEEG) and EEG/fMRI that resulted in significant hemodynamic responses. Hemodynamic response maps were co-registered to postimplantation anatomic imaging, allowing inspection of these responses in relation to SEEG electrode's location. The area containing the most significant t-value (primary cluster) explored with an electrode was assessed for concordance with SEEG-defined SOZ. Discriminant analysis was performed to distinguish the primary clusters having a high probability of localizing the SOZ. Thirty-one patients had at least one study with primary cluster explored with an electrode, and 24 (77%) had at least one study with primary cluster concordant with the SOZ. Each patient could have multiple types of interictal discharge and therefore multiple studies. Among 59 studies from the 37 patients, 44 had a primary cluster explored with an electrode and 30 (68%) were concordant with the SOZ. Discriminant analysis showed that the SOZ is predictable with high confidence (>90%) if the primary cluster is highly significant and if the next significant cluster is much less significant or absent. The most significant hemodynamic response to interictal discharges delineates the subset of the irritative zone that generates seizures in a high proportion of patients with difficult-to-localize focal epilepsy. EEG/fMRI generates responses that are valuable targets for electrode implantation and may reduce the need for implantation in patients in whom the most significant response satisfies the condition of our discriminant analysis.


Feasibility study of pelvic helical IMRT for elderly patients with endometrial cancer.
Standard treatment for early-stage endometrial cancer involves surgery (when possible) followed by brachytherapy or external-beam radiotherapy (EBRT) for high-risk tumors. EBRT is not without toxicity, meaning that it could be difficult to complete for elderly patients, who typically have decreased reserve and resistance to stressors. Patients aged 70 and over treated between April 2009 and May 2013 for endometrial cancer and received IMRT (Intensity-Modulated Radiation Therapy) were included in this observational study. IMRT could be performed as adjuvant treatment or as an exclusive treatment for patients not amenable to surgery. The primary endpoints of this study were to assess the feasibility and toxicity of pelvic IMRT in this population. Secondary endpoints were to assess disease-specific survival, overall survival, and local control. Predictors of toxicity were also explored. Forty seven consecutive patients were included in the analysis. Median age at diagnosis was 75 years (range, 70-89 years). Eleven patients were aged 80 years and older. Toxicities were found in thirty four patients (72%) during treatment. Among these, toxicity did not exceed grade 2 for 32 patients (68%). Two patients had a grade 3 toxicity (4%). Overall survival rates were 87% and 83% at 1 and 2 years, respectively. Six patients (12.8%) had a local relapse and nine others (19.1%) had distant relapse. Pelvic helical IMRT for patients aged 70 and older is feasible with full standard radiation doses, showing that age greater than 70 should not be considered as a reason not to perform optimal treatment.


[Clinical study of ganshao capsule in treating clomiphene-resistant polycystic ovarian syndrome].
To assess the efficacy and safety of Ganshao Capsule (GSC) in treating clomiphene (CC)-resistant hyperandrogenemic polycystic ovarian syndrome (PCOS), and to explore the feasibility of using CC for improving ovulation induction after withdrawal of GSC. Twenty-seven PCOS patients were given GSC for 8 weeks (2 cycles). Changes in serum reproductive hormone, body mass index (BMI), adverse reaction, as well as pelvic ultrasonographic feature were observed before treatment, at the end of 4 weeks and 8 weeks after treatment. After stopping GSC medication, CC was used to induce ovulation in patients whose serum testosterone (T) < (2.1+/-0.8) nmol/L but without ovulation. Condition of follicle growth and effect of GSC were monitored. After 4 weeks of treatment, serum reproductive hormones were significantly changed. At the end of 8 weeks, bilateral ovarian volume, number of follicles, and diameter of follicles were significantly reduced, and endometrium obviously thinned. Within 2 months after stopping medication, 6 in the 27 patients got natural ovulation, and 2 natural pregnancy. In the other 19 patients who received ovulation induction during the 37th cycles, 17 had ovulation in the 25th cycles, 7 got pregnancy, the ovulation rate being 89.5%, ovulation cycle rate 67.6%, pregnant rate 36.8%, and pregnant cycle rate 28.0%. Endometrium, ovarian morphology and BMI got significant improvement in PCOS patients with CC- resistance and hyperandrogenemia. The sensitivity to ovulation induction with CC were also improved.


Whole body pointing movements in transient microgravity: preliminary results.
The aim of the present study is a better comprehension of strategies of motor coordination during complex movements. In this field of research microgravity represent a unique experimental condition for the investigation of the role of equilibrium control in movement planning. Namely, here we focus on two important issues: the centre of mass control and the endpoint trajectory. Preliminary results of the center of mass position and the finger path curvature during pointing movements performed under normal and transient microgravity conditions are presented.


Minimally invasive high-speed imaging of sarcomere contractile dynamics in mice and humans.
Sarcomeres are the basic contractile units of striated muscle. Our knowledge about sarcomere dynamics has primarily come from in vitro studies of muscle fibres and analysis of optical diffraction patterns obtained from living muscles. Both approaches involve highly invasive procedures and neither allows examination of individual sarcomeres in live subjects. Here we report direct visualization of individual sarcomeres and their dynamical length variations using minimally invasive optical microendoscopy to observe second-harmonic frequencies of light generated in the muscle fibres of live mice and humans. Using microendoscopes as small as 350 microm in diameter, we imaged individual sarcomeres in both passive and activated muscle. Our measurements permit in vivo characterization of sarcomere length changes that occur with alterations in body posture and visualization of local variations in sarcomere length not apparent in aggregate length determinations. High-speed data acquisition enabled observation of sarcomere contractile dynamics with millisecond-scale resolution. These experiments point the way to in vivo imaging studies demonstrating how sarcomere performance varies with physical conditioning and physiological state, as well as imaging diagnostics revealing how neuromuscular diseases affect contractile dynamics.


A model for the financial assessment of professional services in community pharmacy: A systematic review.
Limited studies have assessed the financial benefit of professional pharmacy services (PPSs) to the community pharmacy as a business. These studies are crucial in developing an insight into the long-term sustainability and broader implementation of services. We reviewed the literature to identify measures and indicators used to assess the financial performance of professional services in community pharmacy. The literature search was undertaken in Pubmed and Scopus, and a gray literature search was performed in Google.com. References of the included papers were reviewed for other relevant studies. Articles were reviewed against the following exclusion criteria: 1) literature reviews, 2) studies not reporting quantitative financial data from community pharmacy, 3) studies not assessing a PPS, 4) studies lacking a methodology for the measurement and assessment of financial outcomes, and 5) cost-effectiveness analysis, cost-utility analysis, or cost-benefit analysis studies. A piloted data extraction form was used. A selection of key data collected is as follows: 1) method of data collection and calculation, 2) currency, limitations for cost and revenue and method of data collection and method of calculation, 3) standardized currency value for the results reported, 4) professional services: number assessed, type of service, name of services, nature of services, implementation stage reported, financial result, the frequency of service, costs, sources of revenue, net total cost, net total revenue, break-even point, break-even price, net profit and loss. The 21 studies included used different methodologies and indicators to financially assess PPSs. This has led to the development of a model for assessing PPSs composed of the key financial elements identified in this systematic review. From this review, we propose a model that provides a structured approach for pharmacists to manage the financial performance of services.


Covid-19 Pandemic Strategy for Treatment of Acute Uncomplicated Appendicitis with Antibiotics- Risk Categorization and Shared Decision-Making.
During the Coronavirus disease 2019 (COVID-19) pandemic, a protocol was adopted by our department on antibiotics treatment for Acute Uncomplicated Appendicitis (AUA). Our study aimed to determine the feasibility and safety of non-operative treatment (NOT), compared to upfront laparoscopic appendectomy (LA), for AUA in children during the pandemic. Our prospective comparative study was conducted from May 1, 2020 to January 31, 2021. Patient selection criteria included: age ≥5 years, abdominal pain duration ≤48 h, ultrasound (US)/Computered Tomography scan confirmation of AUA, US appendiceal diameter 6-11 mm with no features of perforation/abscess collection and no faecolith. For NOT patients, intravenous antibiotics were administered for 24-48 h followed by oral for 10-day course. Comparison was performed between patients whose parents preferred NOT to those who opted for up-front appendectomy. Primary outcomes were NOT success at index admission, early and late NOT failure rates till 27 months. Secondary outcomes were differences in complication rate, hospital length of stay (LOS) and cost between groups. 77 patients were recruited: 43 (55.8%) underwent NOT while 34 (44.2%) patients opted for LA. Success of NOT at index admission was 90.7% (39/43). Overall, NOT failure rate at 27 months' follow-up was 37.2% (16/43). Of the NOT failures, 1 appendix was normal on histology while only 1 was perforated. There were no significant differences in secondary outcomes between both groups except for LOS of late NOT failure. Cost for upfront LA was nearly thrice that of NOT. Our stringent COVID protocol together with shared decision-making with parents is a safe and feasible treatment option during a crisis situation. Treatment study, Level II.


Weight Changes In Patients With Hodgkin Lymphoma Following Treatment: Experience From A Cancer Hospital.
Some recent studies have suggested that patients with Hodgkin lymphoma who undergo remission following treatment are likely to experience significant weight gain and may become overweight or obese. The association between treatment for Hodgkin lymphoma and subsequent weight gain has not been explored in Pakistan. We undertook a review of weight changes in adult Hodgkin lymphoma patients who received treatment at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore. In this longitudinal study, we collected and analysed secondary data including adult patients who received treatment for Hodgkin lymphoma at our institute from January 2010 till December 2013. We retrospectively noted baseline demographic, clinical characteristics, details about treatment received and change in weight from baseline at start of treatment to 6, 12, and 18 months after start of treatment. A total of 470 patients registered for Hodgkin lymphoma at our centre. Data were available for 402 patients who were included in this study. Progressive increase in weight was observed in patients after treatment. The mean weight gain from the start of treatment to 6, 12, and 18 months was 3.1 kg, 7.1 kg, and 9.5 kg, respectively. Weight gain was not significantly associated with age or sex of patients. Weight gain was significantly associated with higher stages of cancer, response to treatment and B symptoms. The evaluation of Hodgkin lymphoma patients after treatment demonstrated considerable tendency for weight gain. Further work is warranted to explore this association and its impact on HL survivors.


Modeling and prediction of subject accrual and event times in clinical trials: a systematic review.
Modeling and prediction of subject accrual and event times in clinical trials has been a topic of considerable interest for important practical reasons. It has implications not only at the initial planning stage of a trial but also on its ongoing monitoring. To provide a systematic view of the recent research in the field of modeling and prediction of subject accrual and event times in clinical trials. Two classes of methods for modeling and prediction of subject accrual are reviewed, namely, one that uses the Brownian motion and the other uses the Poisson process. Extensions of the accrual models in multicenter clinical trials are also discussed. Trials with survival endpoints require proper joint modeling of subject accrual and event/lost-to-follow-up (LTFU) times, the latter of which can be modeled either parametrically (e.g., exponential and Weibull) or nonparametrically. Flexible stochastic models are better suited when modeling real trials that does not follow constant underlying enrollment rate. The accrual model generally improves as center-specific information is accounted for in multicenter trials. The choice between parametric and nonparametric event models can depend on confidence on the underlying event rates. All methods reviewed in event modeling assume noninformative censoring, which cannot be tested. We recommend using proper stochastic accrual models, in combination with flexible event time models when applicable, for modeling and prediction of subject enrollment and event times in clinical trials.


Acute exposure of water soluble fractions of marine diesel on Arctic Calanus glacialis and boreal Calanus finmarchicus: effects on survival and biomarker response.
The use of marine diesels in Arctic areas is expected to increase due to increased shipping transport, oil and gas activities, and the ban of heavy bunker oils in many areas. This project aimed at gathering information regarding the sensitivity of an Arctic copepod to marine diesel. The approach undertaken was to study the effects on survival (LC50s) and gene expression of a known detoxification gene (glutathione S-transferase [GST]) in Calanus glacialis following exposure to water soluble fractions (WSFs) of marine diesel (at 2 °C). We compared the observed LC-values of C. glacialis to the identical experimental data of the boreal Calanus finmarchicus (at 10 °C), and to the predicted LC50-values using regression models. The C. glacialis appeared more tolerant to the acute effects of marine diesel WSF compared to the "average pelagic crustacean" as predicted by regression models, and compared to C. finmarchicus. Although these results may be explained by a slower equilibration of petrogenic chemicals from the WSF at lower temperatures, C. glacialis also displayed higher GST expression following exposure than C. finmarchicus. In addition, the lipid content of the test organisms appears to be an important factor for the determination of acute toxicity, as copepods with high lipid content survived longer than copepods with low lipid content.


Regulatory effects of zinc on cadmium-induced cytotoxicity in chronic inflammation.
Zinc (Zn) has major effects on immune system activation while Cadmium (Cd) has anti-inflammatory and anti-proliferative effects in several chronic inflammatory contexts. The aim of this work was to investigate by which mechanisms Zn could compete with Cd and eventually counteract its deleterious effects. Rheumatoid arthritis (RA) synoviocytes exposed to cytokines were used as a model of chronic inflammation; osteoarthritis (OA) synoviocytes were used as control. Cell/medium fractionation constants were analyzed for different metals by inductively-coupled-plasma mass-spectrometry by comparison to the 70Zn spike. Interleukin-17 (IL-17) and tumor necrosis factor-alpha (TNF-α) were used to mimic inflammation. Gene expression of ZIP-8 importer, metallothioneins-1 (MT-1s) and the ratio between metalloprotease-3 and the tissue inhibitor of metalloproteinases (MMP-3)/TIMP-1) were evaluated after pre-exposure to cytokines and Cd, with or without the addition of exogenous Zn (0.9 ppm). Cell viability was measured by neutral red assay and IL-6 production by ELISA. Synoviocytes selectively absorbed and retained Cd in comparison to Zn. Metal import increased with IL-17/TNF-α exposure, through the enhanced ZIP-8 expression. Zn did not modify ZIP-8 expression, while Cd reduced it (p<0.05). Zn induced a reduction of Cd-induced MT-1s expression, in particular of MT-1X (3-fold), and subsequently the final intra-cellular content of Cd. By reducing Cd accumulation in cells, Zn reversed Cd anti-proliferative and anti-inflammatory effects but preserved the low MMP-3/TIMP-1 ratio induced by Cd, which was enhanced by inflammatory conditions. Zinc counteracts the deleterious effect of Cd by reducing its import and accumulation in the cell, without the reactivation of destructive pathways such as MMPs.


The multi-level approach: a road map for couples therapy.
This paper presents a multi-level framework and road map to guide the therapeutic process. Starting with the couple's reactive pattern, the multi-level approach first orients the therapist on how to create a "holding environment." It then suggests how the therapist, in collaboration with the couple, can proceed to explore interactional, sociocultural/ organizational, intrapsychic, and intergenerational processes that might be fueling the couple's dynamics. Central to this approach is the construct of the vulnerability cycle, a nexus of integration that helps the therapist stay anchored while moving through the many layers of therapeutic work. The overall goal is to help the partners move from reactivity to responsibility for their own feelings and behavior; from impasse to a greater ability to reflect, express feelings, listen, negotiate, and make choices about how to be in the relationship. This paper describes a range of concepts and interventions from basic to complex; it is intended as an organizational tool for practice and clinical training.


The new proximal femoral nail antirotation (PFNA) in daily practice: results of a multicentre clinical study.
The treatment of unstable trochanteric femoral fractures is still challenging. The ideal implant should be easy to handle, allow for immediate full weight-bearing postoperatively and should have sufficient purchase in the femoral head/neck-fragment to limit cut-outs due to varus-deviation and rotation. The proximal femoral nail antirotation (PFNA), designed by AO, is an intramedullary device with a helical blade rather than a screw for better purchase in the femoral head and was tested in a clinical study. Consecutive patients with unstable trochanteric fractures (AO-classification 31.A.2 and A.3 only) were included and followed for 1 year. Primary objectives were assessment of operative and postoperative complications, whereas secondary objectives included surgical details, general complications and final outcome measurements. In 11 European clinics, 315 patients were included and treated with a PFNA. Almost all fractures healed within 6 months. Fifty-six percent of the patients regained the pre-trauma mobility and 18% died within the follow-up period. Forty-six implant-related complications--leading to 28 unplanned re-operations--were recorded, with four acetabular penetrations (three of which were after a new fall on that hip) and seven ipsilateral femoral shaft fractures as the most serious ones. As the joint-penetrations did not resemble the cut-out seen with other implants it is concluded that the PFNA--due to its helical blade--possibly limits the effects of early rotation of the head/neck-fragment in unstable trochanteric fractures and therefore seems currently to be the optimal implant for the treatment of these fractures especially in osteoporotic bone.


Trends in the Prevalence of Myopia and Myopic Maculopathy in a Japanese Population: The Hisayama Study.
To examine trends in the prevalence of myopia and myopic maculopathy in a general Japanese population. Residents of a Japanese community aged 40 years and older participated in surveys conducted in 2005, 2012, and 2017. Each participant underwent comprehensive eye examinations that included measurements of refractive error, axial lengths, and color fundus photography. Myopic maculopathy was defined according to the criteria of the Meta-analysis of Pathologic Myopia Study Group classification system. Trends in the prevalence of myopia and myopic maculopathy were tested by using a logistic regression analysis fitted by generalized estimating equations to account for individuals submitting to repeated examination. The age-adjusted frequencies of myopia increased significantly from 2005 to 2017 (myopia, 37.7%-45.8%; high myopia 5.8%-9.5%; all P for trend <0.001). The age-adjusted frequency of an axial length level of 26.5 mm or more increased significantly from 2005 to 2017 (3.6%-6.0%; P for trend <0.001). The age-adjusted prevalence of myopic maculopathy also increased significantly with time (1.6% in 2005, 3.0% in 2012 and 3.6% in 2017; P for trend <0.001). Upward trends were observed in the prevalence of diffuse chorioretinal atrophy and patchy chorioretinal atrophy (all P for trend <0.05). Our findings suggest that the prevalence of myopia and myopic maculopathy, especially diffuse chorioretinal atrophy and patchy chorioretinal atrophy, increased significantly over the past 12 years in a general Japanese population.


Force Transfer through the Scaphotrapeziotrapezoid (STT) Joint.
Background The scaphotrapeziotrapezoidal (STT) joint transfers forces to the proximal carpal row from the thumb and fingers. Clinically, STT joint osteoarthritis is frequently observed on plain radiographs though its role in the mechanics of the wrist joint remains unclear. Questions/Purposes Our purpose was to use a model of normal wrist types, to predict STT motion upon load. Patients and Methods Five normal computed tomography scans of a wrist type 1 and five wrist type 2 were used to model the wrist. A 200-N force was split and applied to the trapezoid and capitate to replicate forces during a knuckle pushup. The bony movement was predicted by the model as bony movement using finite element analysis. Results We found differences in force transfer through the STT joint between the two wrist types when loading the index and middle fingers. Type 1 wrists moved quantitatively more anterior-posterior, type 2 wrists moved more medially-laterally and more proximally-distally. The trapezium in type 1 wrists moved more in the coronal plane than in type 2 wrists. The trapezoid moved more from distal to proximal in a type 2 wrist, p = 0.03. Conclusion/Clinical Relevance This study found differences in motion upon loading through the STT joint between type 1 and 2 wrists. Type 2 wrists moved more radially toward the proximal scaphoid and scapholunate ligament. This study may provide a mechanical basis for degenerative configurations. By linking observed patterns of degeneration to their mechanical causes we can aid in prevention of arthritis.


Bone morphogenetic protein down-regulation of neuronal pituitary adenylate cyclase-activating polypeptide and reciprocal effects on vasoactive intestinal peptide expression.
Among bone morphogenetic proteins (BMPs), the decapentaplegic (Dpp; BMP2, BMP4) and glass bottom boat (Gbb/60A; BMP5, BMP6, BMP7) subgroups have well-described functions guiding autonomic and sensory neuronal development, fiber formation and neurophenotypic identities. Evaluation of rat superior cervical ganglia (SCG) post-ganglionic sympathetic neuron developmental regulators identified that selected BMPs of the transforming growth factor beta superfamily have reciprocal effects on neuronal pituitary adenylate cyclase-activating polypeptide (PACAP) and vasoactive intestinal peptide (VIP) expression. Dpp and Gbb/60A BMPs rapidly down-regulated PACAP expression, while up-regulating other sympathetic neuropeptides, including PACAP-related VIP. The suppressive effects of BMP on PACAP mRNA and peptide expression were potent, efficacious and phosphorylated mothers against decapentaplegic homolog (Smad) signaling-dependent. Axotomy of SCG dramatically increases PACAP expression, and the possibility that abrogation of inhibitory retrograde target tissue BMP signaling may contribute to this up-regulation of sympathetic neuron PACAP was investigated. Replacement of BMP6 to SCG explant preparations significantly blunted the injury-induced elevated PACAP expression, with a concomitant decrease in sympathetic PACAP-immunoreactive neuron numbers. These studies suggested that BMPs modulate neuropeptide identity and diversity by stimulating or restricting the expression of specific peptidergic systems. Furthermore, the liberation of SCG neurons from target-derived BMP inhibition following axotomy may be one participating mechanism associated with injury-induced neuropeptidergic plasticity.


A direct energy balance method for approximating envelope decay of oscillating MEMS structures.
The real pole component (envelope decay coefficient) of an oscillating microelectromechanical systems (MEMS) structure is calculated directly in the energy domain without using an equation of motion. Similar to the simplified Rayleigh frequency calculation in which maximum potential and kinetic energy are equated, our method equates the initial minus dissipated energy to present energy.


Efficient 3D Molecular Design with an E(3) Invariant Transformer VAE.
This work introduces a three-dimensional (3D) invariant graph-to-string transformer variational autoencoders (VAE) (Vagrant) for generating molecules with accurate density functional theory (DFT)-level properties. Vagrant learns to model the joint probability distribution of a 3D molecular structure and its properties by encoding molecular structures into a 3D-aware latent space. Directed navigation through this latent space implicitly optimizes the 3D structure of a molecule, and the latent embedding can be used to condition a generative transformer to predict the candidate structure as a one-dimensional (1D) sequence. Additionally, we introduce two novel sampling methods that exploit the latent characteristics of a VAE to improve performance. We show that our method outperforms comparable 3D autoregressive and diffusion methods for predicting quantum chemical property values of novel molecules in terms of both sample quality and computational efficiency.


Impact of poplar-based phytomanagement on soil properties and microbial communities in a metal-contaminated site.
Despite a long history of use in phytomanagement strategies, the impacts of poplar trees on the structure and function of microbial communities that live in the soil remain largely unknown. The current study combined fungal and bacterial community analyses from different management regimes using Illumina-based sequencing with soil analysis. The poplar phytomanagement regimes led to a significant increase in soil fertility and a decreased bioavailability of Zn and Cd, in concert with changes in the microbial communities. The most notable changes in the relative abundance of taxa and operational taxonomic units unsurprisingly indicated that root and soil constitute distinct ecological microbial habitats, as exemplified by the dominance of Laccaria in root samples. The poplar cultivar was also an important driver, explaining 12% and 6% of the variance in the fungal and bacterial data sets, respectively. The overall dominance of saprophytic fungi, e.g. Penicillium canescens, might be related to the decomposition activities needed at the experimental site. Our data further highlighted that the mycorrhizal colonization of poplar cultivars varies greatly between the species and genotypes, which is exemplified by the dominance of Scleroderma under Vesten samples. Further interactions between fungal and bacterial functional groups stressed the potential of high-throughput sequencing technologies in uncovering the microbial ecology of disturbed environments.


Is it possible to evaluate the efficacy of amino acid solutions after major surgical procedures or accidental injuries? Evaluation in a randomized and prospective study.
Two unbalanced amino acid solutions (essential amino acids, branched-chain amino acids) were compared to a complete and balanced amino acid solution with regard to efficacy of nitrogen balance. Patients were randomized to receive the amino acid solutions over 3 days for each regimen. The patients were examined postoperatively or directly after accidental trauma. Nonprotein calories were given as 40 kcal/kg/day consisting of 50% fat and 50% glucose. Nitrogen was given at the amount of 0.15 g N/kg/day. Unbalanced amino acid solutions gave a 2-fold more negative nitrogen balance than a balanced and complete amino acid solution. However, this difference disappeared and nitrogen balance approached equilibrium irrespective of the amino acid composition of the infused solutions when nitrogen in blood products was accounted for. All patients received a considerable amount of blood products in a comparable but unpredictable way. Blood products corresponded to around 40% of the daily nitrogen intake. Our study demonstrates that it is not possible to test the efficacy of amino acids for nitrogen retention in patients who are in the need of blood-product transfusions. It is likely that amino acids in blood proteins serve as a significant amino acid source that is utilized for resynthesis of body proteins especially in flow-phase patients with high protein breakdown. This fact has not been sufficiently accounted for in the previous literature.


Fundamental radar properties: hidden variables in space-time.
A derivation of the properties of pulsed radiative imaging systems is presented with examples drawn from conventional, synthetic aperture, and interferometric radar. A geometric construction of the space and time components of a radar observation yields a simple underlying structural equivalence among many of the properties of radar, including resolution, range ambiguity, azimuth aliasing, signal strength, speckle, layover, Doppler shifts, obliquity and slant range resolution, finite antenna size, atmospheric delays, and beam- and pulse-limited configurations. The same simple structure is shown to account for many interferometric properties of radar: height resolution, image decorrelation, surface velocity detection, and surface deformation measurement. What emerges is a simple, unified description of the complex phenomena of radar observations. The formulation comes from fundamental physical concepts in relativistic field theory, of which the essential elements are presented. In the terminology of physics, radar properties are projections of hidden variables--curved worldlines from a broken symmetry in Minkowski space-time--onto a time-serial receiver.


What goes up must come down: homeostatic synaptic plasticity strategies in neurological disease.
Brain activity levels are tightly regulated to minimize imbalances in activity state. Deviations from the normal range of activity are deleterious and often associated with neurological disorders. To maintain optimal levels of activity, regulatory mechanisms termed homeostatic synaptic plasticity establish desired 'set points' for neural activity, monitor the network for deviations from the set point and initiate compensatory responses to return activity to the appropriate level that permits physiological function [1,2]. We speculate that impaired homeostatic control may contribute to the etiology of various neurological disorders including epilepsy and Alzheimer's disease, two disorders that exhibit hyperexcitability as a key feature during pathogenesis. Here, we will focus on recent progress in developing homeostatic regulation of neural activity as a therapeutic tool.


Failure of ETV in patients with the highest ETV success scores.
OBJECTIVE Endoscopic third ventriculostomy (ETV) is a surgical alternative to placing a CSF shunt in certain patients with hydrocephalus. The ETV Success Score (ETVSS) is a reliable, simple method to estimate the success of the procedure by 6 months of postoperative follow-up. The highest score is 90, estimating a 90% chance of the ETV effectively treating hydrocephalus without requiring a shunt. Treatment with ETV fails in certain patients, despite their being the theoretically best candidates for the procedure. In this study the authors attempted to identify factors that further predicted success in patients with the highest ETVSSs. METHODS A retrospective review was performed of all patients treated with ETV at 3 institutions. Demographic, radiological, and clinical data were recorded. All patients by definition were older than 1 year, had obstructive hydrocephalus, and did not have a prior shunt. Failure of ETV was defined as the need for a shunt by 1 year. The ETV was considered a success if the patient did not require another surgery (either shunt placement or a repeat endoscopic procedure) by 1 year. A statistical analysis was performed to identify factors associated with success or failure. RESULTS Fifty-nine patients met the entry criteria for the study. Eleven patients (18.6%) required further surgery by 1 year. All of these patients received a shunt. The presenting symptom of lethargy statistically correlated with success (p = 0.0126, odds ratio [OR] = 0.072). The preoperative radiological finding of transependymal flow (p = 0.0375, OR 0.158) correlated with success. A postoperative larger maximum width of the third ventricle correlated with failure (p = 0.0265). CONCLUSIONS The preoperative findings of lethargy and transependymal flow statistically correlated with success. This suggests that the best candidates for ETV are those with a relatively acute elevation of intracranial pressure. Cases without these findings may represent the failures in this highly selected group.


Instrumentation for contrast echocardiography.
A number of new imaging methods have been developed specifically for use with ultrasound contrast agents. These methods rely on the peculiar behavior of microbubbles in an ultrasound field. At low incident acoustic pressures (reflected by the mechanical index, MI) microbubbles emit harmonics. These can be detected using harmonic or pulse inversion imaging. At higher MI, bubbles are disrupted, emitting a strong, nonlinear echo. Harmonic power Doppler methods are able to detect this echo, offering the most sensitive method for the detection of microbubble at the perfusion level. Although the first images of myocardial perfusion were made using this disruption method, it requires intermittent imaging with interframe intervals of up to 6 heart beats. Pulse inversion Doppler imaging is a newer method that is able to detect the nonlinear component of bubble echoes at a very low MI, thereby making possible real-time myocardial perfusion imaging. An understanding of the behavior of bubbles during an imaging examination is an essential prerequisite to its success in clinical practice.


Tyrosine phosphorylation of Munc18c regulates platelet-derived growth factor-stimulated glucose transporter 4 translocation in 3T3L1 adipocytes.
Platelet-derived growth factor (PDGF) stimulation of skeletal muscle, cultured myotubes, and 3T3L1 adipocytes results in glucose transporter 4 (Glut4) translocation, albeit to a reduced level compared with insulin. To address the mechanism of PDGF action, we have determined that the Syntaxin 4 negative regulatory protein, Munc18c, undergoes PDGF-stimulated phosphorylation on tyrosine residue 521. The tyrosine phosphorylation of Munc18c on Y521 occurred concomitant with the dissociation of the Munc18c protein from Syntaxin 4 in a time frame consistent with Glut4 translocation. Moreover, expression of the wild-type Munc18c protein did not inhibit PDGF-induced Glut4 translocation, whereas expression of Y521A-Munc18c mutant was inhibitory and failed to dissociate from Syntaxin 4. In contrast, expression of either wild-type Munc18c or the Y521A-Munc18c mutant both resulted in a marked inhibition of insulin-stimulated Glut4 translocation. Together, these data demonstrate that one mechanism accounting for the PDGF induction of Glut4 translocation is the suppression of the Munc18c negative regulation of Syntaxin 4 function.


p21{Waf1/CIP1} is a poor diagnostic and prognostic marker for OSCC although its expression increases in patients with N1 regional metastasis.
Downregulation of p21{Waf1/CIP1} (a cyclin-dependent kinase inhibitor) has been reported for mouth cancer. The goal of this article is to quantitatively report expression of p21{Waf1/CIP1} and evaluate its relationship with the clinical and prognostic factors. this is a retrospective study of 68 patients diagnosed with OSCC. We constructed a tissue microarray to develop an immunohistochemical assessment of p21{Waf1/CIP1} expression. A multivariate analysis using a forward-selection stepwise regression model (Cox, 1972) for predicting survival was performed. The quantitative expression of p21{Waf1/CIP1} showed a statistically significant relationship with the risk of lymph node metastasis, showing a higher expression in patients with homolateral single nodes of less than 3 cm (N1) (X{2}=6.58; p< 0.05). We found no statistically significant relationship with any other clinical or pathological parameters. The Cox univariate regression analysis verifies that the effect of the value of p21{Waf1/CIP1} on survival was not statistically significant (p=0.6). The best predictive multivariate Cox analysis included the covariates: recurrence, p21{Waf1/CIP1}, gender, stage, and dysplasia in the adjacent margin. All these variables showed a statistically significant relationship with survival, except p21{Waf1/CIP1}. quantitative determination of p21{Waf1/CIP1} standardizes and facilitates its analysis. Although its expression increases in patients with N1 regional metastasis, the loss of p21{WAF1/CIP1} does not seem to have any relationship with the clinical and pathological variables of the tumors.


Evaluating conformational changes in protein structures binding RNA.
Many protein-RNA recognition events are known to exhibit conformational changes from qualitative observations of individual complexes. However, a quantitative estimation of conformational changes is required if protein-RNA docking and template-based methods for RNA binding site prediction are to be developed. This study presents the first quantitative evaluation of conformational changes that occur when proteins bind RNA. The analysis of twelve RNA-binding proteins in the bound and unbound states using error-scaled difference distance matrices is presented. The binding site residues are mapped to each structure, and the conformational changes that affect these residues are evaluated. Of the twelve proteins four exhibit greater movements in nonbinding site residues, and a further four show the greatest movements in binding site residues. The remaining four proteins display no significant conformational change. When interface residues are found to be in conformationally variable regions of the protein they are typically seen to move less than 2 A between the bound and unbound conformations. The current data indicate that conformational changes in the binding site residues of RNA binding proteins may not be as significant as previously suggested, but a larger data set is required before wider conclusions may be drawn. The implications of the observed conformational changes for protein function prediction are discussed.


Cognitive-motor exergaming for reducing fall risk in people with chronic stroke: A randomized controlled trial.
Dual-task (simultaneous motor and cognitive task) (DT) training via virtual-reality exergaming is known to benefit balance control post-stroke. However, the efficacy of such training on DT balance control (volitional and reactive) and cognitive (executive function and attention) domains associated with fall risk remains unclear. We evaluated the efficacy of cognitive-motor exergame training (CMT) (Wii-fit games in conjunction with cognitive tasks) for improving balance control (volitional and reactive) and cognition (executive function and attention) among people with chronic stroke (PwCS). Hemiparetic, ambulatory PwCS were randomly assigned to either CMT (n = 12) or conventional training (CT) (n = 12) and underwent six weeks of high-intensity, tapered balance training. The CMT group performed Wii-fit games in conjunction with cognitive tasks, while CT group underwent customized, progressive balance training. Performance under DT conditions on Limits of Stability (volitional) and Slip-Perturbation (reactive) tests, and letter-number sequencing (cognition) determined the efficacy of CMT. Post-intervention, under DT reactive conditions, CMT group improved both motor and cognition, while the CT group improved motor alone. Under DT volitional conditions, motor performance improved only in CMT group. Cognitive-motor exergaming appears to be effective for improving balance control and cognition and could be implemented in clinical stroke rehabilitation settings.


Visible-Light-Induced Radical Carbo-Cyclization/gem-Diborylation through Triplet Energy Transfer between a Gold Catalyst and Aryl Iodides.
Geminal diboronates have attracted significant attention because of their unique structures and reactivity. However, benzofuran-, indole-, and benzothiophene-based benzylic gem-diboronates, building blocks for biologically relevant compounds, are unknown. A promising protocol using visible light and aryl iodides for constructing valuable building blocks, including benzofuran-, indole-, and benzothiophene-based benzylic gem-diboronates, via radical carbo-cyclization/gem-diborylation of alkynes with a high functional group tolerance is presented. The utility of these gem-diboronates has been demonstrated by a 10 g scale conversion, by versatile transformations, by including the synthesis of approved drug scaffolds and two approved drugs, and even by polymer synthesis. The mechanistic investigation indicates that the merging of the dinuclear gold catalyst (photoexcitation by 315-400 nm UVA light) with Na2CO3 is directly responsible for photosensitization of aryl iodides (photoexcitation by 254 nm UV light) with blue LED light (410-490 nm, λmax = 465 nm) through an energy transfer (EnT) process, followed by homolytic cleavage of the C-I bond in the aryl iodide substrates.


Development of a new haemostatic dissecting forceps utilizing controlled heat as an energy source.
We tested a prototype of a new thermal surgical system in animal experiments. This device utilizes controlled heat as an energy source and seals and divides small- to medium-size vessels. The forceps we used in the current study are shaped like dissecting forceps used in conventional open surgery, and their grippers can open bilaterally. Heating elements are built into a gripper. The temperature adjustment is controlled by monitoring the electric resistance. Since the new device utilizes no ultrasonic energy, unfavorable phenomena such as cavitations or mist production are not observed. In a preliminary experiment, 12 segments of animal arteries were sealed and cut by the prototype forceps. Five artery stumps did not burst at the maximum pressure of the manometer system (1471 mmHg). The other seven stumps showed burst pressure ranging from 525 mmHg to 1051 mmHg. It is feasible to utilize controlled heat as a new alternative energy source for haemostatic surgical dissection. The new thermal dissector we are in the process of developing showed safe and quick sealing and cutting of the vessels in the experimental settings.


Genital Mycoplasma infection among Mexican women with systemic lupus erythematosus.
To assess the prevalence of genital Mycoplasma spp. among women with systemic lupus erythematosus (SLE) and to identify factors associated with such infection. A cross-sectional study was conducted among patients with SLE and healthy women who attended a hospital in Puebla, Mexico, between July 29, 2014, and January 4, 2015. All participants were aged 18 years or older and sexually active. A structured interview assessed sociodemographic, obstetric, gynecologic, and clinical characteristics. Disease activity was evaluated using the Mexican SLE Disease Activity Index. Polymerase chain reaction was used to detect the presence of Mycoplasma spp. in genital samples. Ureaplasma urealyticum was the only genital mycoplasma detected; it was present in 32 (24.6%) of 130 patients with SLE and 12 (12.8%) of 94 healthy women. Patients with SLE had increased odds of infection (odds ratio 2.120, 95% confidence interval 1.046-4.296). Among patients with SLE, multiparity was more common in those with U. urealyticum infection (P=0.043). One-quarter of women with SLE had genital infection with U. urealyticum. An association was found between infection and multiparity among women with SLE.


multiplierz v2.0: A Python-based ecosystem for shared access and analysis of native mass spectrometry data.
The continued evolution of modern mass spectrometry instrumentation and associated methods represents a critical component in efforts to decipher the molecular mechanisms which underlie normal physiology and understand how dysregulation of biological pathways contributes to human disease. The increasing scale of these experiments combined with the technological diversity of mass spectrometers presents several challenges for community-wide data access, analysis, and distribution. Here we detail a redesigned version of multiplierz, our Python software library which leverages our common application programming interface (mzAPI) for analysis and distribution of proteomic data. New features include support for a wider range of native mass spectrometry file types, interfaces to additional database search engines, compatibility with new reporting formats, and high-level tools to perform post-search proteomic analyses. A GUI desktop environment, mzDesktop, provides access to multiplierz functionality through a user friendly interface. multiplierz is available for download from: https://github.com/BlaisProteomics/multiplierz; and mzDesktop is available for download from: https://sourceforge.net/projects/multiplierz/.


Hindsight bias as a function of anchor distance and anchor plausibility.
This study explored the influence of anchor distance on hindsight bias and how the subjective plausibility of different anchors moderates this relation. In addition to the standard memory design used in hindsight bias research, participants were asked to indicate the range of values for possible answers to difficult almanac questions. Varying anchor distance on the basis of each participant's individual range of possible answers showed (1) that anchor plausibility decreased with increasing anchor distance following a non-linear monotone function, (2) that size of hindsight bias initially increased with increasing anchor distance but, from a certain distance, started to decrease, and (3) that hindsight bias was found to be always higher for plausible than for implausible anchors.


Prediction and management of cardiovascular outcomes in systemic lupus erythematosus.
Atherosclerosis is the major cause of cardiovascular disease (CVD), which represents the major cause of death. During recent years, it has become clear that atherosclerosis is a chronic inflammatory condition where immunity could play an important role. Usually, it is when atherosclerotic plaques rupture that CVD follows, but some cases of CVD can occur without apparent atherosclerosis. In systemic lupus erythematosus, the risk of CVD is very high and the prevalence of atherosclerotic plaques, including vulnerable ones, is increased. A combination of traditional and non-traditional risk factors is implicated for the prediction of CVD in systemic lupus erythematosus. Traditional risk factors include hypertension, dyslipidemia, smoking and diabetes, though the exact importance of each of these in systemic lupus erythematosus is not clear. Anti-phospholipid antibodies, systemic inflammation and low levels of natural antibodies such as those against phosphorylcholine (anti-PC) are examples of non-traditional risk factors. Control of disease activity and disease manifestations and of established risk factors is important.


The genetic epidemiology of personality disorders.
Genetic epidemiologic studies indicate that all ten personality disorders (PDs) classified on the DSM-IV axis II are modestly to moderately heritable. Shared environmental and nonadditive genetic factors are of minor or no importance. No sex differences have been identified, Multivariate studies suggest that the extensive comorbidity between the PDs can be explained by three common genetic and environmental risk factors. The genetic factors do not reflect the DSM-IV cluster structure, but rather: i) broad vulnerability to PD pathology or negative emotionality; ii) high impulsivity/low agreeableness; and iii) introversion. Common genetic and environmental liability factors contribute to comorbidity between pairs or clusters of axis I and axis II disorders. Molecular genetic studies of PDs, mostly candidate gene association studies, indicate that genes linked to neurotransmitter pathways, especially in the serotonergic and dopaminergic systems, are involved. Future studies, using newer methods like genome-wide association, might take advantage of the use of endophenotypes.


Regulated expression and RNA processing of transcripts from the Srp20 splicing factor gene during the cell cycle.
Eukaryotic splicing factors belonging to the SR family are essential splicing factors consisting of an N-terminal RNA-binding region and a C-terminal RS domain. They are believed to be involved in alternative splicing of numerous transcripts because their expression levels can influence splice site selection. We have characterized the structure and transcriptional regulation of the gene for the smallest member of the SR family, SRp20 (previously called X16). The mouse gene encoding SRp20, termed Srp20, consists of one alternative exon and six constitutive exons and was mapped to a 2-centimorgan interval on chromosome 17. When cells are transfected with SRp20 genomic DNA, both standard and alternatively spliced transcripts and corresponding proteins are produced. Interestingly, in starved (G0) cells, the amount of SRp20 mRNA containing the alternative exon is large, whereas the amount of the standard SRp20 mRNA without the alternative exon is small. When starved cells are stimulated with serum, the alternative form is lost and the standard form is induced. These results suggest that splicing could be regulated during the cell cycle and that this could be, at least in part, due to regulated expression of SR proteins. Consistent with this, experiments with synchronized cells showed an induction of SRp20 transcripts in late G1 or early S. We have also characterized the promoter of SRp20. It lies within a GC-rich CpG island and contains two consensus binding sites for E2F, a transcription factor thought to be involved in regulating the cell cycle. These motifs may be functional since reporter constructs with the SRp20 promoter can be stimulated by cotransfection with E2F expression plasmids.


[Palliative surgery and computer-assisted-tomography of lymphangiokeratoma circumscriptum naeviforme (author's transl)].
More than 50 percent of classified lymphangioma circumscriptum naeviforme are combined with subcutaneous lymphangioma. Therefore an exact examination before surgical operation is necessary. The computer-assisted-tomography is a new way to clarify the exact dimension of such a lymphangioma. Classification, clinical manifestations and problems in treatment of lymphangiomas are discussed.


Flexible Carbon-Fiber/Semimetal Bi Nanosheet Arrays as Separable and Recyclable Plasmonic Photocatalysts and Photoelectrocatalysts.
In this work, we prepared flexible carbon-fiber/semimetal Bi nanosheet arrays from solvothermal-synthesized carbon-fiber/Bi2O2CO3 nanosheet arrays via a reductive calcination process. The flexible carbon-fiber/semimetal Bi nanosheet arrays can function as photocatalysts and photoelectrocatalysts for 2,4-dinitorphenol oxidation. Compared with carbon-fiber/Bi2O2CO3 nanosheet arrays, the newly designed flexible carbon-fiber/semimetal Bi nanosheet arrays show enhanced ultraviolet-visible (UV-vis) light absorption efficiency and photocurrent, photocatalytic, and photoelectrocatalytic activities. Photocatalytic analyses indicate that the surface plasmon resonance (SPR) of semimetal Bi occurs under solar-simulated light irradiation during the photocatalytic process. The carbon-fiber traps the hot electrons exerted from the SPR of semimetal Bi and creates holes in the semimetal Bi nanosheets, which boosts the photocatalytic activity of the carbon fiber through plasmonic sensitization. Both photocatalytic experiments and density functional theory (DFT) calculations indicate that the electrons transferred to the carbon fiber and the holes created in semimetal Bi contribute to the formation of •O2- and •OH, respectively. The synergistic effect between electrocatalysis and photocatalysis under the solar-simulated light results in almost complete degradation of 2,4-dinitorphenol during the photoelectrocatalytic process. This work realizes a non-noble-metal plasmonic catalyst and provides a new avenue for the commercialization of photocatalysis and photoelectrocatalysis using the separable and recyclable carbon-fiber/semimetal Bi nanosheet arrays in the environment-related field.


Impaired insula functional connectivity associated with persistent pain perception in patients with complex regional pain syndrome.
Given that the insula plays a contributory role in the perception of chronic pain, we examined the resting-state functional connectivity between the insular cortex and other brain regions to investigate neural underpinnings of persisting perception of background pain in patients with complex regional pain syndrome (CRPS). A total of 25 patients with CRPS and 25 matched healthy controls underwent functional magnetic resonance imaging at rest. With the anterior and posterior insular cortices as seed regions, we compared the strength of the resting-state functional connectivity between the two groups. Functional connectivity between the anterior and posterior insular cortices and the postcentral and inferior frontal gyri, cingulate cortices was reduced in patients with CRPS compared with controls. Additionally, greater reductions in functional connectivity between the anterior insula and right postcentral gyrus were associated with more severe sensory pain in patients with CRPS (short-form McGill Pain Questionnaire sensory subscores, r = -.517, P = .023). The present results imply a possible role of the insula in aberrant processing of pain information in patients with CRPS. The findings suggest that a functional derangement of the connection between one of the somatosensory cortical functions of perception and one of the insular functions of awareness can play a significant role in the persistent experience of regional pain that is not confined to a specific nerve territory.


[Studies on the thinning of the upper acrylic resin complete denture with the reinforced palate. (Part 2) Influence of the different palate forms on the thin plate dentures (author's transl)].
In this paper, succeeding the study of the part 1 on the thinning of the upper acrylic resin complete denture with the reinforced palate, it was investigated to keep the same stiffness and strength as the normal resin dentures, and to make the patient comfortable. Besides, many different palate forms exist in the patient's mouth in clinical cases, and so, influence of these forms on the thin plate dentures comes into question. Therefore, 3 types of the palate forms (the standard shape, the extremely large torus and the generally shallow shape) were established, and then the flexural stiffness and strength, and the deformation of the denture bases were scrutinized in this paper. The results obtained in this investigation are as follows: 1) The maxillary torus with sheer bulk had little influence on the flexural stiffness and strength. But, about the generally shallow-shaped denture bases, the mechanical properties dropped a little as compared the normal resin denture bases. The reinforced thin denture bases of which thickness was 60% of the normal one, showed the excellent mechanical properties in spite of the difference of the palate forms. 2) In the upper complete denture base, in spite of the palate forms, anteriority and posteriority of the one were deformed against the load direction around the frontal section through the bilateral canines, and the bilateral ridges of the one were deformed to the load direction around the midline of the denture base. The deformation was extremely decreased by not only the palate but also the whole of the denture base as the reinforced one.


Carbon Nanoparticle Hybrid Aerogels: 3D Double-Interconnected Network Porous Microstructure, Thermoelectric, and Solvent-Removal Functions.
We report reduced graphene oxide (rGO)/single-walled carbon nanotube (SWCNT) hybrid aerogels with enhanced thermoelectric (TE) performance and removal of organic solvents by designing 3D double-interconnected network porous microstructures. A convenient, cost-effective, and scalable preparation procedure is proposed compared with conventional high-temperature pyrolysis and supercritical drying techniques. The obtained hybrid aerogels are systematically characterized by apparent density, scanning electron microscopy, X-ray photoemission spectroscopy, Raman spectroscopy, and porosity. An enhanced TE performance of ZT ≈ ∼8.03 × 10-3 has been achieved due to the 3D double-interconnected network porous microstructure, the energy-filtering effect, and the phonon scattering at the abundant interfaces and joints. In addition, upon a large axial compression deformation, a high degree of retention of the Seebeck coefficient and a simultaneously significant enhancement of the electrical conductivity are observed. Finally, the hybrid aerogels display high capability for the removal of diverse organic solvents and good recyclability. These findings open a new avenue for exploiting aerogels with multifunctions and widening the applications of TE materials by judicious microstructure design.


Differences in symptoms during and post PTCA versus rotational ablation.
Percutaneous transluminal coronary rotational ablation (PTCRA) has emerged as an effective therapy for the treatment of coronary artery disease. However, nursing management of these patients may differ from standard practices designed to care for coronary balloon angioplasty (PTCA) patients. To examine factors that could impact nursing care we compared 233 patients undergoing PTRCA with 301 patients undergoing PTCA. Overall, clinical success did not differ between the groups. Patients undergoing PTCRA were more likely to experience hypotension and prolonged angina in the cardiac catherization laboratory than patients undergoing PTCA. PTCRA patients were also more likely to require i.v. heparin and i.v. nitroglycerin post procedure than PTCA patients. In addition, PTCRA patients were on i.v. nitroglycerin for longer periods of time post procedure than PTCA patients. There were no differences between the groups in the occurrence of peripheral bleeding, hematoma, or length of hospital stay. In summary, PTRCA patients have more hypotension and angina during rotational ablation procedures, and are more likely to require heparin and nitroglycerin post procedure. These differences require nursing strategies which incorporate closer monitoring of patients and patients' symptoms, along with educating patients about the need for longer i.v. drug therapy.


Pancreatic hyperplasia after gastric bypass surgery in a GK rat model of non-obese type 2 diabetes.
Gastric bypass surgery produces clear antidiabetic effects in a substantial proportion of morbidly obese patients. In view of the recent trend away from 'bariatric' surgery and toward 'metabolic' surgery, it is important to elucidate the enhancing effect of bypass surgery on pancreatic β-cell mass, which is related to diabetes remission in non-obese patients. We investigated the effects of gastric bypass surgery on glycemic control and other pancreatic changes in a spontaneous non-obese type 2 diabetes Goto-Kakizaki rat model. Significant improvements in postprandial hyperglycemia and plasma c-peptide level were observed when glucose was administered orally post-surgery. Other important events observed after surgery were enhanced first phase insulin secretion in a in site pancreatic perfusion experiment, pancreatic hyperplasia, improved islet structure (revealed by immunohistochemical analysis), striking increase in β-cell mass, slight increase in ratio of β-cell area to total pancreas area, and increased number of small islets closely related to exocrine ducts. No notable changes were observed in ratio of β-cell to non-β endocrine cell area, β-cell apoptosis, or β-cell proliferation. These findings demonstrate that gastric bypass surgery in this rat model increases endocrine cells and pancreatic hyperplasia, and reflect the important role of the gastrointestinal system in regulation of metabolism.


Reduced-portion entrées in a worksite and restaurant setting: impact on food consumption and waste.
Large portion sizes in restaurants have been identified as a public health risk. The purpose of the present study was to determine whether customers in two different food-service operator segments (non-commercial worksite cafeteria and commercial upscale restaurant) would select reduced-portion menu items and the impact of selecting reduced-portion menu items on energy and nutrient intakes and plate waste. Consumption and plate waste data were collected for 5 weeks before and 7 weeks after introduction of five reduced-size entrées in a worksite lunch cafeteria and for 3 weeks before and 4 weeks after introduction of five reduced-size dinner entrées in a restaurant setting. Full-size entrées were available throughout the entire study periods. A worksite cafeteria and a commercial upscale restaurant in a large US Midwestern metropolitan area. Adult worksite employees and restaurant patrons. Reduced-size entrées accounted for 5·3-12·8 % and 18·8-31·3 % of total entrées selected in the worksite and restaurant settings, respectively. Food waste, energy intake and intakes of total fat, saturated fat, cholesterol, Na, fibre, Ca, K and Fe were significantly lower when both full- and reduced-size entrées were served in the worksite setting and in the restaurant setting compared with when only full-size entrées were served. A relatively small proportion of reduced-size entrées were selected but still resulted in reductions in overall energy and nutrient intakes. These outcomes could serve as the foundation for future studies to determine strategies to enhance acceptance of reduced-portion menu items in restaurant settings.


Genome-Wide Identification and Characterization of Tyrosine Kinases in the Silkworm, Bombyx mori.
The tyrosine kinases (TKs) are important parts of metazoan signaling pathways and play significant roles in cell growth, development, apoptosis and disease. Genome-wide characterization of TKs has been conducted in many metazoans, however, systematic information about this family in Lepidoptera is still lacking. We retrieved 33 TK-encoding genes in silkworm and classified them into 25 subfamilies by sequence analysis, without members in AXL, FRK, PDGFR, STYK1 and TIE subfamilies. Although domain sequences in each subfamily are conserved, TKs in vertebrates tend to be remarkably conserved and stable. Our results of phylogenetic analysis supported the previous conclusion for the second major expansion of TK family. Gene-Ontology (GO) analysis revealed that a higher proportion of BmTKs played roles in binding, catalysis, signal transduction, metabolism, biological regulation and response to stimulus, compared to all silkworm genes annotated in GO. Moreover, the expression profile analysis of BmTKs among multiple tissues and developmental stages demonstrated that many genes exhibited stage-specific and/or sex-related expression during embryogenesis, molting and metamorphosis, and that 8 BmTKs presented tissue-specific high expression. Our study provides systematic description of silkworm tyrosine kinases, and may also provide further insights into metazoan TKs and assist future studies addressing their functions.


Governmental efforts for cardiovascular disease prevention efforts in the Russian Federation.
Cardiovascular disease (CVD) is the leading cause of death and disability in Russia as is case with the most other countries of the world, although Russia has unique features and demographic trends. In the late 90's and early 2000's Russia has sustained a profound demographical crisis with a period of overmortality but since 2003 the mortality rates are declining. By 2013, the birth rates exceeded mortality. The reversal of the demographic crisis took place on the background of a number of comprehensive governmental efforts with focus on non-communicable diseases prevention. The National Priority Project "Health" implied enhancement of primary care along with improving availability of state-of-art care for CVD patients. The most notable activities in the field of preventive medicine were the launch of Health Centers for universal free-of-charge screening for risk factors and for preventive counseling and the Dispanserization program (a large scale health screening aiming on detection of both people with chronic conditions and of high-risk persons).


Hybrid polymer-silicon proton conducting membranes via a pore-filling surface-initiated polymerization approach.
An alternative approach for the creation of proton conducting platforms is presented. The methodology is based on the so-called "pore-filling concept", which relies on the filling of porous matrices with polyelectrolytes to obtain proton conducting platforms with high dimensional stability. Polymer-silicon composite membranes, with well-defined polyelectrolyte microdomains oriented normal to the plane of the membrane, were prepared using photoelectrochemically etched silicon as a microstructured scaffold. Ordered two-dimensional macroporous silicon structures were rendered proton conducting by filling the micropores via a surface-initiated atom transfer radical polymerization process. The morphological aspects, chemical stability, and performance of the hybrid assemblies were characterized by a set of techniques including scanning electron microscopy, Fourier transform infrared spectroscopy, X-ray photoelectron spectroscopy, nuclear magnetic resonance and impedance spectroscopy, among others. The fabricated silicon-poly(sodium 2-acrylamide-2-methylpropane sulfonate) hybrid membranes displayed proton conductivities in the range of 1x10(-2) S/cm. This work illustrates the potential of hybrid polymer-silicon composite membranes synthesized by pore-filling surface-initiated polymerization to create proton conducting platforms in a simple and straightforward manner. Versatility and relative ease of preparation are two key aspects that make this approach an attractive alternative for the molecular design and preparation of proton conducting systems.


Adult-type granulosa cell tumor of the testicle: case report.
Granulosa cell tumor (GCT) is a sex-cord neoplasm of the gonads classified into either juvenile (jGrCT) or adult type (aGrCT). It is commonly arising in ovaries but is much rarer in men, with only around 50 male cases previously reported in the literature. We report on a 54-year-old male patient with a right testicular GCT measuring 10.0×8.0×6.0 cm. The tumor was treated successfully with radical orchiectomy followed by computed tomography to assess lymph node involvement, and no further treatment was done. Pathological reports showed diffuse positivity for immunohistochemical stains, inhibin, vimentin, calretinin, and CD99. The clinical and histopathological features, treatment, and prognosis of aGrCT arising in the testicle of an adult male are also reviewed in this manuscript.


Differential effects of systemic ethanol administration on protein kinase cepsilon, gamma, and beta isoform expression, membrane translocation, and target phosphorylation: reversal by chronic ethanol exposure.
Systemic ethanol administration alters protein kinase C (PKC) activity in brain, but the effects of ethanol on the expression and translocation of specific isoforms are unknown. Rats were administered ethanol (2 g/kg i.p.) or saline and PKC levels were measured in the cytosolic and membrane fractions by Western blot analysis. PKCepsilon expression was increased in the cytosol and decreased in the membrane (P2) fraction of cerebral cortex at 10 min. At 60 min, expression of PKCepsilon in the P2 fraction was increased by 42.2 +/- 12%, but cytosolic levels were unchanged. In contrast, PKCgamma in the P2 fraction was decreased 32.7 +/- 7% at 60 min but not at 10 min post-ethanol administration. PKCgamma levels in the cytosol were reduced at 10 min post-ethanol administration and unchanged at 60 min. PKCbeta expression was increased 36 +/- 10 and 144 +/- 52% in the P2 fraction both at 10 and 60 min post-ethanol administration, whereas cytosolic levels were unchanged. Serine phosphorylation of GABA(A) receptor beta-chain was reduced, and phosphorylation of N-methyl-d-aspartate receptor NR1 subunit was increased 60 min following ethanol administration. There was no effect of acute ethanol administration on PKC isoform levels in the hippocampus. Ethanol challenge did not alter PKC isoform expression in the P2 fraction of cerebral cortex following chronic ethanol administration. These findings suggest that acute ethanol administration alters PKC synthesis and translocation in an isoform and brain region specific manner that leads to alterations in serine phosphorylation of receptors. Furthermore, chronic ethanol administration prevents ethanol-induced alterations in PKC expression in the P2 fraction, where PKC interacts with ethanol-responsive ion channels.


Interactive properties of human glioblastoma cells with brain neurons in culture and neuronal modulation of glial laminin organization.
The harmonious development of the central nervous system depends on the interactions of the neuronal and glial cells. Extracellular matrix elements play important roles in these interactions, especially laminin produced by astrocytes, which has been shown to be a good substrate for neuron growth and axonal guidance. Glioblastomas are the most common subtypes of primary brain tumors and may be astrocytes in origin. As normal laminin-producing glial cells are the preferential substrate for neurons, and glial tumors have been shown to produce laminin, we questioned whether glioblastoma retained the same normal glial-neuron interactive properties with respect to neuronal growth and differentiation. Then, rat neurons were co-cultured onto rat normal astrocytes or onto three human glioblastoma cell lines obtained from neurosurgery. The co-culture confirmed that human glioblastoma cells as well as astrocytes maintained the ability to support neuritogenesis, but non-neural normal or tumoral cells failed to do so. However, glioblastoma cells did not distinguish embryonic from post-natal neurons in relation to neurite pattern in the co-cultures, as normal astrocytes did. Further, the laminin organization on both normal and tumoral glial cells was altered from a filamentous arrangement to a mixed punctuate/filamentous pattern when in co-culture with neurons. Together, these results suggest that glioblastoma cells could identify neuronal cells as partners, to support their growth and induce complex neurites, but they lost the normal glia property to distinguish neuronal age. In addition, our results show for the first time that neurons modulate the organization of astrocytes and glioblastoma laminin on the extracellular matrix.


The next generation of research: views of a sibling-psychiatrist-researcher.
A sibling of a person with severe mental illness who is also a psychiatrist and a researcher responds to the next generation of research proposed in the articles in this special section. Four issues are emphasized: benefit vs. burden; association, causation, and statistical modeling; strengths and limitations of study samples; and interventions.


Demographics, reproduction, growth, and abundance of Jollyville Plateau salamanders (Eurycea tonkawae).
Insights into the ecology and natural history of the neotenic salamander, Eurycea tonkawae, are provided from eight years of capture-recapture data from 10,041 captures of 7,315 individuals at 16 sites. Eurycea tonkawae exhibits seasonal reproduction, with peak gravidity occurring in the fall and winter. Size frequency data indicated recruitment occurred in the spring and summer. Open-population capture-recapture models revealed a similar seasonal pattern at two of three sites, while recruitment was dependent on flow at the third site. Females can reach sexual maturity within one year, and oviposition likely takes place below ground. The asymptotic body length of 1,290 individuals was estimated as 31.73 mm (at ca. two years of age), although there was substantial heterogeneity among growth trajectories. Longevity was approximately eight years, and the median age for a recaptured adult was 2.3 years. Abundance estimated from closed-population and robust-design capture-recapture models varied widely within and among sites (range 41-834), although, surprisingly, dramatic changes in abundance were not observed following prolonged dry periods. Seasonal migration patterns of second-year and older adults may help explain lower ratios of large individuals and higher temporary emigration during the latter half of the year, but further study is required. Low numbers of captures and recaptures precluded the use of open-population models to estimate demographic parameters at several sites; therefore, closed-population (or robust-design) methods are generally recommended. Based on observations of their life history and population demographics, E. tonkawae seems well adapted to conditions where spring flow is variable and surface habitat periodically goes dry.


Oleylphosphocholine (OlPC) arrests Cryptosporidium parvum growth in vitro and prevents lethal infection in interferon gamma receptor knock-out mice.
Cryptosporidium parvum is a species of protozoa that causes cryptosporidiosis, an intestinal disease affecting many mammals including humans. Typically, in healthy individuals, cryptosporidiosis is a self-limiting disease. However, C. parvum can cause a severe and persistent infection that can be life-threatening for immunocompromised individuals, such as AIDS patients. As there are no available treatments for these patients that can cure the disease, there is an urgent need to identify treatment options. We tested the anti-parasitic activity of the alkylphosphocholine oleylphosphocholine (OlPC), an analog of miltefosine, against C. parvum in in vitro and in vivo studies. In vitro experiments using C. parvum infected human ileocecal adenocarcinoma cells (HCT-8 cells) showed that OlPC has an EC50 of 18.84 nM. Moreover, no cell toxicity has been seen at concentrations ≤50 μM. C57BL/6 interferon gamma receptor knock-out mice, were infected by gavage with 4000 C. parvum oocysts on Day 0. Oral treatments, with OlPC, miltefosine, paromomycin or PBS, began on Day 3 post-infection for 10 days. Treatment with OlPC, at 40 mg/kg/day resulted in 100% survival, complete clearance of parasite in stools and a 99.9% parasite burden reduction in the intestines at Day 30. Doses of 30 and 20 mg/kg/day also demonstrated an increased survival rate and a dose-dependent parasite burden reduction. Mice treated with 10 mg/kg/day of miltefosine resulted in 50% survival at Day 30. In contrast, control mice, treated with PBS or 100 mg/kg/day of paromomycin, died or had to be euthanized between Days 6 and 13 due to severe illness. Results of parasite burden were obtained by qPCR and cross-validated by both flow cytometry of stool oocysts and histological sections of the ileum. Together, our results strongly support that OlPC represents a potential candidate for the treatment of C. parvum infections in immunocompromised patients.


Design of Mobile Health Tools to Promote Goal Achievement in Self-Management Tasks.
Goal-setting within rehabilitation is a common practice ultimately geared toward helping patients make functional progress. The purposes of this study were to (1) qualitatively analyze data from a wellness program for patients with spina bifida (SB) and spinal cord injury (SCI) in order to generate software requirements for a goal-setting module to support their complex goal-setting routines, (2) design a prototype of a goal-setting module within an existing mobile health (mHealth) system, and (3) identify what educational content might be necessary to integrate into the system. A total of 750 goals were analyzed from patients with SB and SCI enrolled in a wellness program. These goals were qualitatively analyzed in order to operationalize a set of software requirements for an mHealth goal-setting module and identify important educational content. Those of male sex (P=.02) and with SCI diagnosis (P<.001) were more likely to achieve goals than females or those with SB. Temporality (P<.001) and type (P<.001) of goal were associated with likelihood that the goal would be achieved. Nearly all (210/213; 98.6%) of the fact-finding goals were achieved. There was no significant difference in achievement based on goal theme. Checklists, data tracking, and fact-finding tools were identified as three functionalities that could support goal-setting and achievement in an mHealth system. Based on the qualitative analysis, a list of software requirements for a goal-setting module was generated, and a prototype was developed. Targets for educational content were also generated. Innovative mHealth tools can be developed to support commonly set goals by individuals with disabilities.


Pregnancy Complications and Outcomes Among Women With Congenital Heart Disease in Beijing, China.
To conduct a comparative analysis of the complications and outcomes in pregnant women with and without congenital heart disease (CHD) in Beijing, China. We compared pregnancy-related complications and outcomes experienced by women with and without CHD throughout 19,424 deliveries in Beijing Anzhen Hospital between 2010 and 2019, including cardiovascular and obstetric factors, fetal events, delivery methods, and other complications over a mean 5-years post-delivery follow-up period. There were 1,040 women with CHD (5.35% of all deliveries). Compared to women without CHD, these women had longer hospital stays (7.83 ± 4.65 vs. 4.93 ± 3.26 days) and a higher death rate (1.92 vs. 0.02%). They also had a greater risk of comorbidities, including pre-term delivery (odds ratio: 13.65 vs. 6.71), heart failure (odds ratio: 4.90 vs. 0.40), and arrhythmia (odds ratio 12.69 vs. 4.69). Pulmonary hypertension, New York Heart Association functional class III~IV, and no congenital heart disease surgery prior to pregnancy were associated with adverse events such as cesarean section, pre-term delivery, and heart failure. The fetuses of mothers with CHD were more likely to be born pre-term (odds ratio: 13.65 vs. 6.71) and have low birth weight (odds ratio: 8.56 vs. 4.36). Eleven infants (1.82%) born to mothers with CHD and four infants (0.64%) born to mothers without CHD were diagnosed with CHD. Women with CHD generally increase maternal and infant risk during pregnancy and the perinatal period. Pulmonary hypertension, decrease in cardiac function, and no previous CHD surgery increase the risk in women with CHD. Greater attention should be paid to pregnant women with CHD and their fetuses, newborns.


Three-dimensional reconstruction from serial section images by computer graphics.
A method is described which allows a three-dimensional object to be reconstructed from micrographs of serial sections using computer graphic techniques. The reconstructed object, which can be rotated three-dimensionally, is displayed on a color CRT and the surface of the object is shaded in order that it can be observed to provide an illusion of a three-dimensional structure. Using biological samples, some useful representation methods are demonstrated, which are a transparent display, smoothing of a reconstructed surface, cuts through a reconstructed model and a three-dimensional distribution representation of particles, and so forth. Furthermore, an example measuring the volume and surface area of reconstructed objects is shown.


Why Non-contact Tonometry Tests Cannot Evaluate the Effects of Corneal Collagen Cross-linking.
To assess the feasibility of characterizing and following up the mechanical behavior of the corneal tissue after corneal cross-linking (CXL) by using a combined mechanical (in vivo indentation and in vitro uniaxial tensile tests) and morphological (immunohisto-chemistry) experimental protocol. CXL (3 mW/cm2; 370 nm) for 20 minutes (total dose 3.6 J/cm2) was performed on 12 New Zealand rabbits. The mechanical behavior of the cornea was characterized in small and large strain regimens using an in vivo indentation test with a laboratory device and an in vitro uniaxial tensile test, respectively. These tests and corneal immunohistochemistry were performed before (PreCXL) and on the 7th (PostCXL-7d) and 56th days (PostCXL-56d) after CXL. The intraocular pressure and corneal thickness were measured before each test. For the indentation tests, significant differences were found between PreCXL and PostCXL-7d and between PostCXL-7d and PostCXL-56d, but not between PreCXL and PostCXL-56d. On average, for the small strain regimen, PostCXL-7d corneas showed the most compliant behavior, with progressive recovery of the corneal stiffness over time. For the large strain regimen, significant differences in the maximum tangent modulus between PreCXL and PostCXL-7d and between PreCXL and PostCXL-56d were observed for the uniaxial tensile tests, with no significant differences between PostCXL-7d and PostCXL-56d. Immunohistochemistry showed a lack of cells in the anterior stroma at PostCXL-7d, but at PostCXL-56d the cell density and morphology were comparable to PreCXL. Indentation tests cannot characterize the changes in the corneal collagen scaffold caused by the CXL, but the uniaxial test can. However, indentation tests can assess the recovery of keratocyte density after CXL. [J Refract Surg. 2017;33(3):184-192.].


There is no structural relationship between nasal septal deviation, concha bullosa, and paranasal sinus fungus balls.
This study aims to determine the relationship between nasal septal deviation, concha bullosa, and chronic rhinosinusitis by using a definitive pathological and simplified model. Fifty-two consecutive sinus computed tomography scans were performed on patients who received endoscopic sinus surgery and whose final diagnosis was paranasal sinus fungus balls. The incidences of nasal septal deviation and concha bullosa for patients diagnosed with paranasal sinus fungus balls among the study group were 42.3% and 25%, respectively. About 63.6% sinuses with fungus balls were located on the ipsilateral side of the nasal septal deviation, and 46.2% were located on the ipsilateral side of the concha bullosa. When examined by Pearson's chi-square test and the chi-squared goodness-of-fit test, no significant statistical difference for the presence of paranasal sinus fungus balls between ipsilateral and contralateral sides of nasal septal deviation and concha bullosa was noted (P = 0.292 and P = 0.593, resp.). In conclusion, we could not demonstrate any statistically significant correlation between the location of infected paranasal sinus, the direction of nasal septal deviation, and the location of concha bullosa, in location-limited rhinosinusitis lesions such as paranasal sinus fungal balls. We conclude that the anatomical variants discussed herein do not predispose patients to rhinosinusitis.


[Polymorphism of the Full-Length mRNA Sequences of MNS blood group-related genes GYPA, GYPB and GYPE].
The characteristics of the full-length mRNA sequences of MNS blood group-related genes GYPA, GYPB and GYPE were analyzed to understand the polymorphism of MNS blood group genes. Anticoagulated blood within 24 h from 500 unpaid blood donors (8 ml each) were randomly selected, and MN, Ss and Mia blood types were identified by serological methods. 5 samples with different combinations of MNS and Mia blood types were randomly selected from 500 samples, and peripheral blood mononuclear cells (PBMC) were isolated by density gradient centrifugation, then total mRNA was extracted. cDNA was prepared by using the reverse transcription kit. The target fragments were amplified by nested PCR, and the full-length mRNA sequences of GYPA, GYPB and GYPE were sequenced after gel cutting and recycling, and the base sequences were analyzed by Oligo 6.0 software. The MN, Ss and Mia phenotypes were detected by serological methods, and there were differences in agglutination intensity of red blood cells (RBC) and anti-Mia serum between different individuals. The full-length mRNA sequences of GYPA, GYPB and GYPE genes in 5 samples of different phenotype combinations were detected. The exon-6 was completely deleted from the GYPA mRNA in 1 sample, and the full-length of GYPA mRNA in the other 4 samples were complete. The exon-2 was completely deleted from the GYPB mRNA in 2 samples, with Mia blood type negative. 2 samples showed complete full-length of GYPB mRNA, with Mia blood type positive. There was base substitution in exon-5 of GYPB mRNA in 1 sample. The full-length of GYPE mRNA was intact in 5 samples. MNS blood group related-genes have obvious polymorphism, and the detection of full-length mRNA sequence lays a foundation for the analysis of GYPA, GYPB and GYPE gene structure and in-depth study of MNS blood group antigen expression.