[Intracardiac Thrombosis in a Child With Hereditary Thrombophilia].
A child who had undergone subclavian vein catheterization in the neonatal period was hospitalized in a grave condition at the age of 1 year 7 months with echocardiographic signs of right ventricular thrombus. Further examination revealed low level of protein C and mutations in methylenetetrahydrofolate reductase and plasminogen activator inhibitor-1 genes. Basing on this observation, the authors recommend purposeful search for genetic thrombophilia in children with history of prolonged catheterization of veins and prophylactic anticoagulation therapy in case of positive result. article describes a case of intracardiac thrombosis in a child 1 year 7 month having a reduction of protein C and mutations in the genes of methylenetetrahydrofolate reductase and plasminogen activator inhibitor 1. e suffered a subclavian vein catheterization in the neonatal period. The patient was hospitalized in serious condition. According to the results of echocardiography revealed a thrombus in the right ventricle. This case shows that the intracardiac thrombi in children are the result of exposure to many of prothrombotic factors. With this in mind, the authors recommend a survey of genetic thrombophilia children having long vein catheterization and use of anticoagulation therapy as a prophylactic measure.


Association Between Geriatric Nutritional Risk Index and Frailty in Older Hospitalized Patients.
Previous studies have explored the association between malnutrition and frailty, but no study has investigated whether the Geriatric Nutritional Risk Index (GNRI), a simple and objective nutritional risk screening tool, is associated with the frailty of older adults. The study aimed to examine the relationship between nutrition-related risk, as assessed by the GNRI, and frailty among older hospitalized patients. A cross-sectional study was conducted in the West China Hospital of Sichuan University with 740 patients aged ≥70 years between March 2016 and Jan 2017. Nutritional and frailty status was evaluated with the GNRI and FRAIL scale, respectively. The adjusted and unadjusted ordinal logistic regression analyses were used to examine the relationship between nutritional risk and frailty. The ability of GNRI in detecting frailty was assessed by receiver operating characteristic (ROC) curve analysis. The prevalence of low, moderate, and severe nutritional risk among frail patients were 30.1%, 27.6%, and 12.5%, respectively. Ordinal logistic regression analysis showed that malnutrition assessed by the GNRI had a significant association with frailty after adjustment of age, sex, polypharmacy, comorbidity, vision impairment, hearing impairment, cognitive impairment, and depression. In the ROC analysis, the area under the curve for GNRI identifying frailty was 0.698 (95% CI: 0.66-0.74; P<0.001), and the optimal cut-point value was 97.16 (sensitivity: 64.3%; specificity: 66.9%). Nutrition-related risk screened by the GNRI was independently associated with frailty. The GNRI could be used as a simple tool in detecting nutritional risk and frailty status of older patients.


Impact of adhesions in colorectal surgery.
The extent of the problem of adhesions is considerable and poses a significant burden on healthcare systems, the workload of surgeons and the lives of patients. This paper reviews the work undertaken and the associated evidence for the impact of adhesions. It considers the various options and strategies to reduce adhesions alongside the fundamental necessity for good surgical technique.


Entanglement combing.
We show that all multipartite pure states can, under local operations, be transformed into bipartite pairwise entangled states in a "lossless fashion": An arbitrary distinguished party will keep pairwise entanglement with all other parties after the asymptotic protocol--decorrelating all other parties from each other--in a way that the degree of entanglement of this party with respect to the rest will remain entirely unchanged. The set of possible entanglement distributions of bipartite pairs is also classified. Finally, we point out several applications of this protocol as a useful primitive in quantum information theory.


Diet and adult age-at-death among mobile foragers: A synthesis of bioarcheological methods.
The research explores whether the combined study of cortical bone histology, bone morphology, and dietary stable isotopes can expand insights into past human health and adaptations, particularly dietary sufficiency and life span. Midthoracic rib cortices from 54 South African Late Holocene adult skeletons (28 M, 24 F, two sex undetermined) are assessed by transmitted-light microscopy for cross-sectional area measurements, osteon area (On.Ar), osteon population density, and presence/absence of secondary osteon variants. Values for δ13 Cbone collagen , δ15 Nbone collagen , 14 C dates, Southwestern and Southern Cape geographic regions, body size measures, estimated ages-at-death from both morphological and histological methods are integrated into analyses, which include Spearman correlations, χ2 tests and Kruskal-Wallis ANOVAs. There is reduced On.Ar variability with higher δ15 N (r = -.41, p = .005); rib %cortical area and δ15 N are negatively correlated in the Southern Cape group (r = -.60, p = .03). Osteon variants are more common in older adults; histological ages at death are significantly older than those determined from gross morphology. We found bone tissue relationships with measures of diet composition, but indicators of dietary adequacy remain elusive. Relationships of tissue quality and isotopes suggest that some Southern Cape adults lived long lives. Osteon variants are associated with age-at-death; some association with diet remains possible. Gross morphological methods appear to underestimate adult ages-at-death, at least among small-bodied adults.


Child development and the scope of parental responsibility: part 1.
The scope of parental responsibility has once again come under scrutiny following the case of Neon Roberts (Walker, 2012) whose mother objected to treatment for his brain tumour. This first of two articles considering the scope of parental responsibility sets out the key provisions and discusses the right of the court to overrule a parent's decision to refuse medical treatment for their child.


Effects of oils rich in eicosapentaenoic and docosahexaenoic acids on the oxidizability and thrombogenicity of low-density lipoprotein.
Consumption of oily fish and fish oils is associated with protection against cardiovascular disease. Paradoxically, long-chain polyunsaturated fatty acids present in low-density lipoprotein (LDL) are suggested to be susceptible to oxidation. It is not clear whether eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have similar effects on the susceptibility of LDL to oxidation or whether they affect the thrombogenicity of oxidized LDL. This study examined the influence of highly purified preparations of EPA and DHA on LDL oxidizability and LDL-supported thrombin generation in healthy human volunteers. Forty-two healthy volunteers were randomly assigned to receive olive oil (placebo), an EPA-rich oil or a DHA-rich oil for 4 weeks at a dose of 9 g oil/day. EPA and DHA were incorporated into LDL phospholipids and cholesteryl esters during the supplementation period, but were progressively lost during ex vivo copper-mediated oxidation. Following supplementation, the EPA treatment significantly increased the formation of conjugated dienes during LDL oxidation compared with baseline, whereas the DHA treatment had no effect. Neither treatment significantly affected the lag time for oxidation, oxidation rate during the propagation phase or maximum diene production. Neither EPA nor DHA significantly affected the thrombotic tendency of oxidized LDL compared with the placebo, although DHA tended to decrease it. In conclusion, there are subtle differences in the effects of EPA and DHA on the oxidizability and thrombogenicity of LDL. DHA does not appear to increase the susceptibility of LDL to oxidation to the same degree as EPA and has a tendency to decrease LDL-supported thrombin generation.


Novel Coconut Vinegar Attenuates Hepatic and Vascular Oxidative Stress in Rats Fed a High-Cholesterol Diet.
Hypercholesterolemia is an independent modifiable risk factor that accelerates the development of both non-alcoholic fatty liver and atherosclerosis. Coconut water contains a variety of phytochemicals that make it appealing for producing vinegar. Coconut vinegar is rapidly gaining popularity for health benefits in Southeast Asia. The purpose of this study is to evaluate the effect of daily supplementation of coconut vinegar on hepatic and vascular oxidative stress in rats fed a high-cholesterol diet (HCD). Mature coconut water was fermented with coconut sap sugar using Saccharomyces cerevisiae and Acetobacter aceti vat Europeans, respectively. Bioactive compounds and antioxidant capacity of coconut vinegar were examined in vitro. Adult male Sprague-Dawley rats were randomly divided into four groups; the control group fed a standard diet (S), a group that received HCD (SC), a group that received HCD supplemented with coconut vinegar at a dose of 1 mL/kg/day (SCV), and a group that received HCD with atorvastatin at a dose of 30 mg/kg/day (SCA). After 8 weeks, serum metabolic profiles, fatty liver, hepatic, and vascular oxidative stress were determined. In in vitro studies, coconut vinegar was rich in phenolic compounds and organic acids. The antioxidant capacity of 30 μL of coconut vinegar was 181.55 ± 8.15 μM Trolox equivalent antioxidant capacity (TEAC). In the HCD fed rats, daily supplementation of coconut vinegar reduced weight gain, serum triglycerides, and fasting blood sugar levels without renal or liver toxicity. In the liver, coconut vinegar reduced the accumulation of both hepatic cholesterol and hepatic triglyceride, and it also reduced hepatic 4-hydroxynonenal (4-HNE) lipid peroxidation. In the aortic tissues, coconut vinegar increased nitric oxide bioavailability and reduced aortic 4-HNE lipid peroxidation. Novel coconut vinegar is the source of antioxidants, and daily supplementation of coconut vinegar was found to attenuate dyslipidemia-induced hepatic and vascular oxidative stress by protective against cellular lipid peroxidation.


A powerful toolkit for synthetic biology: Over 3.8 billion years of evolution.
The combination of evolutionary with engineering principles will enhance synthetic biology. Conversely, synthetic biology has the potential to enrich evolutionary biology by explaining why some adaptive space is empty, on Earth or elsewhere. Synthetic biology, the design and construction of artificial biological systems, substitutes bio-engineering for evolution, which is seen as an obstacle. But because evolution has produced the complexity and diversity of life, it provides a proven toolkit of genetic materials and principles available to synthetic biology. Evolution operates on the population level, with the populations composed of unique individuals that are historical entities. The source of genetic novelty includes mutation, gene regulation, sex, symbiosis, and interspecies gene transfer. At a phenotypic level, variation derives from regulatory control, replication and diversification of components, compartmentalization, sexual selection and speciation, among others. Variation is limited by physical constraints such as diffusion, and chemical constraints such as reaction rates and membrane fluidity. While some of these tools of evolution are currently in use in synthetic biology, all ought to be examined for utility. A hybrid approach of synthetic biology coupled with fine-tuning through evolution is suggested.


Pharmacokinetics of oral treprostinil sustained release tablets during chronic administration to patients with pulmonary arterial hypertension.
Pulmonary arterial hypertension (PAH) is a progressive vascular disease that ultimately leads to right ventricular failure and death. Treprostinil diolamine is an oral prostacyclin analogue; sustained release tablets of oral treprostinil are currently being evaluated for efficacy and safety as a potential therapy in patients with PAH. Previous attempts at developing an oral prostanoid have been limited by rapid absorption and short plasma half-life; thus, the aim of this study was to characterize the pharmacokinetic profile of treprostinil diolamine in PAH patients after chronic dosing. The study enrolled 74 PAH patients who had been taking treprostinil diolamine for a minimum of 4 weeks (range: 0.5-16 mg). We collected plasma samples over 12 hours and estimated pharmacokinetic parameters using noncompartmental methods. Seventy patients had complete data. After chronic twice-daily oral dosing of treprostinil diolamine, mean area under the curve (AUC0-12) of treprostinil increased from 5244 to 20,4086 pg·hr-·mL- and mean maximum observed plasma concentration (Cmax) increased from 1383 to 33588 pg/mL. The apparent clearance (CL/F) was similar across all doses, indicating a linear dose-exposure relationship after twice-daily dosing. We conclude that twice-daily oral treprostinil provides sustained and proportional treprostinil concentrations over a wide range of doses during chronic administration to PAH patients.


Mononucleotide recognition by cyclic trinuclear palladium(II) complexes containing 4,7-phenanthroline N,N bridges.
Reaction of [(dach)Pd(NO3)2] entities (dach = (R,R)-1,2-diaminocyclohexane, (S,S)-1,2-diaminocyclohexane) and 4,7-phenanthroline (phen) providing, respectively, 90 and 120 degrees bond angles, leads to the formation of two novel positively charged homochiral cyclic trinuclear metallacalix[3]arene species [((R,R)-1,2-diaminocyclohexane)Pd(phen)]3(NO3)6 (2a) and [((S,S)-1,2-diaminocyclohexane)Pd(phen)]3(NO3)6 (2b). These species have been characterised by 1)H NMR and X-ray diffraction methods (2b), showing that they possess accessible cavities suited for supramolecular recognition processes. We prove, indeed, from 1H NMR studies the inclusion of mononucleotides inside the cavity of the trinuclear species [(ethylenediamino)Pd(phen)]3(6+) (1), [((R,R)-1,2-diaminocyclohexane)Pd(phen)]3(6+) (2a) and [((S,S)-1,2-diaminocyclohexane)Pd(phen)]3(6+) (2b) in aqueous solution. Association constants (K(ass)) range from 85 +/- 6 M(-1) for the interaction between [(ethylenediamine)Pd(phen)]3(6+) and adenosine monophosphate to 37 +/- 4 M(-1) for the interaction between [(1,2-diaminocyclohexane)Pd(phen)]3(6+) and thymidine monophosphate. We invoke the synergy of electrostatic, anion-pi and pi-pi interactions to explain the recognition of mononucleotides inside the cavity of the metallacalix[3]arenes.


Low Serum Interleukin-10 Is an Independent Predictive Factor for the Risk of Second Event in Clinically Isolated Syndromes.
Objective: To evaluated the prognostic ability of several serum cytokines in clinically isolated syndrome (CIS) patients regarding second events and conversion to multiple sclerosis (MS) or neuromyelitis optica spectrum disorder (NMOSD). Methods: We enrolled 69 CIS patients whose serum samples were collected during the acute phase of the first onset before immunotherapy. Fifteen other non-inflammatory neurological disorder (OND) patients were also included. The serum levels of interleukin (IL)-2, IL-4, IL-6, IL-10, IL-13, IL-17A, IL-21, IL-23, interferon-γ (IFN-γ), and transforming growth factor beta 1 (TGF-β1) were measured using the human cytokine multiplex assay or ELISA. Patients were seen every 3-6 months. Unscheduled visits occur in case of exacerbations. Clinical measures of disease progression were recorded. Results: Twenty CIS cases had second events during follow-up at a mean time of 15.3 ± 9.9 months. Serum IL-10 levels were significantly lower in CIS patients who relapsed compared to patients who did not. Low serum IL-10 levels were associated with higher risk and shorter times to second events. In clinical correlations, a significantly higher CSF white blood cells count, number of T2 lesions, and gadolinium-enhancing (Gd+) lesions in baseline MRI were found in the low serum IL-10 level group. Of the 20 relapsed cases, seven converted to MS, and eight converted to NMOSD. No significant differences were found in any cytokine levels between these patients at first onset. Conclusions: These findings support using serum IL-10 as a biomarker associated with the risk of relapse and the time to second events in patients with CIS. However, serum cytokine levels can not differentiate between the conversion from CIS to MS or NMOSD.


[Enhancement of artemisinin biosynthesis in transgenic Artemisia annua L. by overexpressed HDR and ADS genes].
Artemisnin is a novel sesquiterpene lactone with an internal peroxide bridge structure, which is extracted from traditional Chinese herb Artemisia annua L. (Qinghao). Recommended by World Health Organization, artemisinin is the first-line drug in the treatment of encephalic and chloroquine-resistant malaria. In the present study, transgenic A. annua plants were developed by overexpressing the key enzymes involved in the biosynthetic pathway of artemisinin. Based on Agrobacterium-mediated transformation methods, transgenic plants of A. annua with overexpression of both HDR and ADS were obtained through hygromycin screening. The genomic PCR analysis confirmed six transgenic lines in which both HDR and ADS were integrated into genome. The gene expression analysis given by real-time quantitative PCR showed that all the transgenic lines had higher expression levels of HDR and ADS than the non-transgenic control (except ah3 in which the expression level of ADS showed no significant difference compared with control); and the HPLC analysis of artemisinin demonstrated that transgenic A. annua plants produced artemisinin at significantly higher level than non-transgenic plants. Especially, the highest content of artemisinin was found in transgenic line ah70, in which the artemisinin content was 3.48 times compared with that in non-transgenic lines. In summary, overexpression of HDR and ADS facilitated artemisinin biosynthesis and this method could be applied to develop transgenic plants of A. annua with higher yield of artemisinin.


Snowshoe hare virus: discovery, distribution, vector and host associations, and medical significance.
Snowshoe hare virus (SSHV), within the California serogroup of the genus Orthobunyavirus, family Peribunyaviridae, was first isolated from a snowshoe hare (Lepus americanus) in Montana, United States, in 1959. The virus, closely related to LaCrosse virus (LACV) and Chatanga virus (CHATV), occurs across Canada and the northern latitudes of the United States, primarily in the northern tier of states bordering Canada. Reports of SSHV in northern Europe and Asia are probably the closely related to CHATV, or the less closely related Tahyna virus. Vertebrate associations include snowshoe hares and ground squirrels, demonstrated by field isolation of virus from wild-caught animals, seroconversion of snowshoe hares, seroconversion of sentinel rabbits, isolation of virus from sentinel rabbits, and experimental infections demonstrating viremia. Isolations of virus from field populations of mosquitoes include primarily univoltine and boreal mosquitoes of the genus Aedes, Culiseta impatiens and Culiseta inornata; and, rarely, certain multivoltine floodwater Aedes species. Experimental transmission studies in mosquitoes show infection in and transmission by boreal Aedes and Culiseta inornata. Isolation of SSHV from larval Aedes on three occasions, and experimentation in Culiseta inornata, reveal transovarial transmission of the virus in mosquitoes. Serosurveys reveal exposure to SSHV in human and domestic animals, with rates of seropositivity commonly high in some settings in Alaska and Canada, but disease in humans or horses has rarely been reported, only in Canada.


Using a refrigerant leak detector to monitor waste gases from halogenated anesthetics.
Although halogenated gas anesthetics are indispensable in laboratory animal medicine, they are hazardous when present in the working environment. A simple technique of real-time leak detection and environmental spot monitoring can provide valuable adjunct information to current techniques of time-weighted monitoring. We investigated the minimal limit of detection of halothane, isoflurane, sevoflurane, and desflurane of a leak detector for halogenated gas refrigerants which provides a qualitative response only. We connected a container to an infrared gas analyzer to create a 135-l closed-circuit system and injected liquid halothane, isoflurane, sevoflurane, and desflurane to create calculated gas concentrations of 0.7 to 3.4 parts per million (ppm). The infrared absorbance and response of the leak detector were recorded, and a total of 5 measurements were made per concentration. The actual gas concentrations were calculated by comparison with the agent-specific absorbance standard curve. The leak detector clearly and consistently responded to halothane, isoflurane, sevoflurane, and desflurane from minimal concentrations of 2.1 +/- 0.2, 1.4 +/- 0.04, 0.8 +/- 0.04, and 1.2 +/- 0.4 ppm, respectively, as determined by infrared analysis. Although the detector does not provide numerical and time-weighted results, leak testing of equipment and repeated monitoring of the environment (spot monitoring) can provide valuable real-time information. In addition, with appropriate consideration of the methodological limitations, spot monitoring can be used to predict the likelihood of compliance with time-weighted exposure recommendations. A leak detector therefore represents a simple, effective, and inexpensive instrument for monitoring the leakage of halogenated anesthetic gases from equipment and into the working environment.


Climbing the Apex of the ORR Volcano Plot via Binuclear Site Construction: Electronic and Geometric Engineering.
Great enthusiasm in single-atom catalysts (SACs) for the oxygen reduction reaction (ORR) has been aroused by the discovery of M-NX as a promising ORR catalysis center. However, the performance of SACs lags far behind that of state-of-the-art Pt due to the unsatisfactory adsorption-desorption behaviors of the reported catalytic centers. To address this issue, rational manipulation of the active site configuration toward a well-managed energy level and geometric structure is urgently desired, yet still remains a challenge. Herein, we report a novel strategy to accomplish this task through the construction of an Fe-Co dual-atom centered site. A spontaneously absorbed electron-withdrawing OH ligand was proposed to act proactively as an energy level modifier to empower easy intermediate desorption, while the triangular Fe-Co-OH coordination facilitates O-O bond scission. Benefiting from these attributes, the as-constructed FeCoN5-OH site enables an ORR onset potential and half-wave potential of up to 1.02 and 0.86 V (vs RHE), respectively, with an intrinsic activity over 20 times higher than the single-atom FeN4 site. Our finding not only opens up a novel strategy to tailor the electronic structure of an atomic site toward boosted activity but also provides new insights into the fundamental understanding of diatomic sites for ORR electrocatalysis.


Antiviral activity and hepatoprotection by heme oxygenase-1 in hepatitis B virus infection.
Induction of heme oxygenase-1 (HO-1) has been shown to be beneficial in immune-mediated liver damage. We now investigate the effects of HO-1 induction in models of human hepatitis B virus (HBV) infection. Adenoviral transfer of an HBV 1.3 genome into wild-type mice was used as a model for acute hepatitis B. HBV transgenic animals were used as a model for chronic HBV infection. HBV replication was assessed by HBV viremia, antigenemia, and Southern blotting, liver damage was assessed by serum alanine aminotransferase activities and histopathology of liver sections. To investigate HO-1 effects on HBV replication at a molecular level, stably HBV-transfected hepatoma cells were used. HBV gene expression, protein stability, transcription, and replication were determined. HO-1 was induced by either cobalt-protoporphyrin-IX or over expressed by adenoviral gene transfer. In the acute hepatitis B model, liver injury was reduced significantly after HO-1 induction. In addition, HO-1 showed a pronounced antiviral effect, which was confirmed in stably HBV-transfected hepatoma cells and in persistently HBV replicating transgenic mice. We showed that HO-1 induction repressed HBV replication directly in hepatocytes at a posttranscriptional step by reducing stability of HBV core protein and thus blocking refill of nuclear HBV covalently closed circular (ccc)DNA. Small interfering RNA directed against HO-1 proved that this effect depended on the expression level of HO-1. Besides its hepatoprotective effect, HO-1 showed a pronounced antiviral activity in HBV infection. Therefore, induction of HO-1 might be a novel therapeutic option for inflammatory flares of hepatitis B.


Nonlinear model for an optical read-only-memory disk readout channel based on an edge-spread function.
A point-spread function (PSF) is commonly used as a model of an optical disk readout channel. However, the model given by the PSF does not contain the quadratic distortion generated by the photo-detection process. We introduce a model for calculating an approximation of the quadratic component of a signal. We show that this model can be further simplified when a read-only-memory (ROM) disk is assumed. We introduce an edge-spread function by which a simple nonlinear model of an optical ROM disk readout channel is created.


Effects of metal primers on bonding of adhesive resin cement to noble alloys for porcelain fusing.
This study evaluated the effects of metal primers on the bonding of adhesive resin to four pure metals (Au, Pd, Ag, Cu) and two noble alloys for porcelain fusing (high-gold and high-palladium content alloys). Bonding surface was polished with 600-grit silicon carbide paper and primed with one of the three metal primers (V-Primer, Metaltite, and M.L. Primer). Bonded specimens were fabricated by applying adhesive resin (Super-Bond C&B) on the primed surface. Shear bond strength (SBS) was determined both before and after thermocycling (4-60 degrees C for 2,000 cycles). The highest SBS values to each pure metal after thermocycling were 33.5 MPa for Au by M.L. Primer, 35.0 MPa for Ag by V-Primer, and 34.4 MPa for Cu by Metaltite. SBS to high-gold content alloy after thermocycling was 33.3 MPa by M.L. Primer. None of the primers was effective for pure Pd and high-palladium content alloy after thermocycling.


A typology of migration in Canada based on migrants' characteristics.
"Data from the 1981 Census of Canada are used to develop a typology of migrants on the basis of their personal characteristics. Migrants are defined as those individuals who have changed their residence since the 1976 Census, crossing at least a municipal boundary. Socio-economic and demographic characteristics are perceived to differentiate stayers from movers, and to distinguish each migrant type [that is to say] intraprovincial, interprovincial and international. Discriminant analysis is applied to classify people into migrant types based on their personal characteristics and the typology developed."


[Views of professionals and patients on the introduction of computer science into the consultation].
To compare the views of professionals and patients on the computerisation of consultations. Cross-sectional. Rural health district in the province of Barcelona, with a population of about 15,000. Consecutive sampling of people seen in the health district and the group of health professionals working in it. Two anonymous self-filled questionnaires with closed questions aimed at health professionals and a sample of patients (accuracy, 0.05; confidence, 95%; prevalence, 50%). The mean age of the 407 patients was 48.4 (SD, 17.2), with 63.6% women. 21 questionnaires were filled in by the professionals (91%), 12 by doctors, and 9 by nurses. Their mean age was 43.9 (SD, 7.5), and 71.4% were women. For common questions, 54.3% of patients were keen on seeing the screen, while professionals calculated this figure at 11%. 5.6% of patients thought computerisation had changed the relationship, whereas 31.6% of professionals did. 12.6% of patients thought it had made the visit longer, whereas 38.1% of the professionals thought it had. 10.6% of patients and 47.4% of professionals thought it had led to loss of confidentiality. The introduction of computers into consultations was accepted well. Professionals were more worried than patients about possible loss of confidentiality, and thought that there had been bigger changes in the doctor-patient relationship and that visits had become longer.


Automatic generation of anatomy-based MLC fields in aperture-based IMRT.
We have developed an algorithm to automatically generate anatomy-based MLC fields. For each beam, a first field is adjusted to the projection of the target in a beam's eye view, allowing subsequent fields to be derived from this conformal field by removing the overlapping surface of each organ at risk, respectively. The projections are based on a surface sampling of the anatomical structures. On top of the MLC mechanical constraints, verification constraints are imposed on the MLC segments, in order to get reliable dosimetry using a commercial dose calculation engine. Thus, in each direction, the aperture's cross-section must be greater than a specified threshold, in our case 2 cm. Furthermore, junctions are not tolerated in order to avoid underdosage, for instance from the tongue-and-groove effect. The use of such MLC fields simplifies the verification process. The performance of the algorithm is illustrated for head and neck, thorax and prostate cases. Only a fraction of a second of CPU time is required to perform the segmentation for each beam.


Long-term subdural strip electrocorticographic monitoring of ictal déjà vu.
We report a series of 8 patients with ictal déjà vu. Subdural strip electrocorticographic (ECoG) monitoring localized the ictal epileptogenic focus as follows: right (n = 6) and left (n = 2) mesiotemporal lobe. In all 8 patients, the left hemisphere was dominant for language function based on intracarotid amytal testing. In 6 right-handed patients, ictal déjà vu was associated with a right temporal lobe focus. However, in the 2 left-handed patients, the ictal focus was left temporal lobe. Although ictal déjà vu localizes the epileptic focus to temporal lobe, this experimental phenomenon appears to lateralize to the hemisphere nondominant for handedness.


Mapping medical specialization in Paris in the nineteenth and twentieth centuries.
This paper seeks to provide a systemic perspective on the development of medical specialization in France. Making use of information in medical directories of the period, it offers a quantitative analysis of developing specialization in Paris and the major provincial cities from 1880 to 1935. The first section examines the size and scope of the different specialties in 1884, 1905, 1920, and 1935. The second section analyses evolving patterns of linkage among specialties through the cases of multiple identification which occurred. The final part looks at the relative élitist character of specialties as measured by official hospital and faculty posts and membership in the Academy of Medicine. The conclusion suggests how these quantitative results might orient future research on specialization.


mTOR Activation by PI3K/Akt and ERK Signaling in Short ELF-EMF Exposed Human Keratinocytes.
Several reports suggest that ELF-EMF exposures interact with biological processes including promotion of cell proliferation. However, the molecular mechanisms by which ELF-EMF controls cell growth are not completely understood. The present study aimed to investigate the effect of ELF-EMF on keratinocytes proliferation and molecular mechanisms involved. Effect of ELF-EMF (50 Hz, 1 mT) on HaCaT cell cycle and cells growth and viability was monitored by FACS analysis and BrdU assay. Gene expression profile by microarray and qRT-PCR validation was performed in HaCaT cells exposed or not to ELF-EMF. mTOR, Akt and MAPKs expressions were evaluated by Western blot analysis. In HaCaT cells, short ELF-EMF exposure modulates distinct patterns of gene expression involved in cell proliferation and in the cell cycle. mTOR activation resulted the main molecular target of ELF-EMF on HaCaT cells. Our data showed the increase of the canonical pathway of mTOR regulation (PI3K/Akt) and activation of ERK signaling pathways. Our results indicate that ELF-EMF selectively modulated the expression of multiple genes related to pivotal biological processes and functions that play a key role in physio-pathological mechanisms such as wound healing.


Stool Based Testing for Colorectal Cancer: an Overview of Available Evidence.
The goal of this review is to summarize stool-based testing for colorectal cancer (CRC). The key questions answered in this review were the advantages and limitations of each available stool-based test for CRC and to examine their comparative efficacy. Guaiac-based fecal occult blood testing (gFOBT) is no longer a relevant test for CRC screening. fecal immunochemical testing (FIT) tests, especially quantitative assays, are clearly a reliable stool-based test. Multitarget DNA (mtsDNA) stool testing may represent a viable option as well, although cost and test characteristics are yet fully defined. FIT and mtsDNA represent the options for stool-based CRC screening. In larger screening centers, quantitative FIT assays represent an attractive option for stool-based testing. Qualitative FIT has applicability in smaller centers. Although a large validation trial showed promising results for mtsDNA, further head-to-head trials with FIT will help define the ultimate role of mtsDNA. Ultimately, however, the best test for CRC screening is the one performed stool-based CRC screening as an initial or alternative option can increase participation in CRC screening.


Intravascular and interstitial fluid dynamics in rats treated with minoxidil.
Edema is a major complication of vasodilatory therapy. However, the pathophysiologic mechanisms leading to the formation of vasodilator-mediated edema are insufficiently understood. The present study therefore examined the effect of the chronic administration of the potent arteriolar vasodilator, minoxidil (Mx), on extracellular fluid dynamics in rats. Extracellular volume (ECV), plasma volume (PV), interstitial fluid volume (IV), arterial pressure (AP), and interstitial fluid pressure (IP) were measured in rats treated for 10 days with Mx (1.5 mg/kg/day) and in control animals. In addition to a decreased AP, Mx-treated animals had diminished water and sodium excretion. ECV, PV, and IV and plasma renin concentration (PRC) were also increased in the Mx-treated rats. IP, which was subatmospheric in control rats (-2.6 +/- 0.04 mm Hg), was near zero in Mx-treated animals (-0.2 +/- 0.02 mm Hg, p less than 0.05). Saline ECV expansion (20 min, Ringer infusion, 3% body weight) or rat albumin injection (300 mg/2 ml) induced similar changes in the volume of the extracellular fluid compartments in both groups. However, changes in IP were blunted in Mx-treated rats. These results, therefore, show that Mx-treated rats have changes in interstitial fluid dynamics prior to any macroscopic evidence of edema accumulation. These alterations in the extracellular compartment dynamics may be a consequence of the sustained arteriolar vasodilation induced by Mx.


Esophago-gastric dissociation complicating devascularization procedure for portal hypertension.
Devascularization surgery for portal hypertension, indicated in selected patients, is considered safe. A 15-year-old boy with cirrhosis underwent elective modified Sugiura's devascularization procedure for secondary prophylaxis of variceal bleeding. He developed esophago-gastric dissociation, which was successfully managed with emergency feeding jejunostomy and restoration of gut continuity three months later.


The management of breast cysts by aspiration.
A review is given of 75 patients presenting with breast cysts treated by aspiration. The patients have been followed for an average of four years and in no case has a carcinoma been detected. The technique is considered to be safe provided the guidelines laid down by the writers are followed.


Differences in mental health engagement and follow-up among Black and White patients after traumatic injury.
Severe injury necessitating hospitalization is experienced by nearly three million US adults annually. Posttraumatic stress disorder and depression are prevalent clinical outcomes. The mechanisms by which programs equitably promote mental health recovery among trauma-exposed patients are understudied. We evaluated clinical outcomes and engagement among a cohort of Black and White patients enrolled in the Trauma Resilience and Recovery Program (TRRP), a stepped-care model to accelerate mental health recovery after traumatic injury. Trauma Resilience and Recovery Program is a four-step model that includes (1) bedside psychoeducation about mental health recovery following traumatic injury, (2) a text-messaging symptom tracking system, (3) a 30-day postinjury mental health screen, and (4) referrals to mental health services. Data describe 1,550 patients enrolled in TRRP within a Level I trauma center ( Mage = 40.86; SD, 17.32), 611 of whom identified as Black (74.5% male) and 939 of whom identified as White (67.7% male). Enrollment in TRRP was nearly universal (97.9%) regardless of race or injury mechanism. Enrollment and usage of the text-message system were statistically similar between Black (35.7%) and White patients (39.5%). Trauma Resilience and Recovery Program reengaged Black and White patients at a similar rate at the 30-day postinjury follow-up. However, Black patients were more likely to report peritraumatic distress at the bedside and clinical elevations in posttraumatic stress disorder and depression on the 30-day screen. Referrals were more likely to be accepted by Black patients relative to White patients with clinically elevated symptoms. Enrollment and engagement were comparable among Black and White patients served by TRRP. Data provide preliminary evidence to suggest that TRRP is feasible and acceptable and engages patients in mental health follow-up equitably. However, research that includes careful measurement of social determinants of health and long-term follow-up examining initiation, completion, and benefit from treatment is needed. Therapeutic/Care Management; Level III.


Aneurysmal rupture following resection of abdominal malignancy.
Four cases of ruptured abdominal aortic aneurysms as a postoperative complication are reported. This represents a 24 per cent mortality for elective operation in patients with known abdominal aortic aneurysm. Three cases followed resection of abdominal malignancy. The possibility exists that subtle trauma during operative manipulation may have heightened the risk of rupture. The risk to life from large abdominal aortic aneurysms (more than 6 cm) exceeds the risk of most malignancies. Abdominal aortic aneurysm should be resected first when co-incidental to a malignancy, unless the malignancy is complicated by hemorrhage, obstruction or perforation.


[Complement-independent bulla formation in pemphigus vulgaris by IgG4].
In cryostat sections from lesional skin of a patient with pemphigus, a typical pattern of IgG deposits was detected at the epidermal intercellular space. However, there were no deposits of complement (C) components. By the highly sensitive APAAP technique using monoclonal antibodies, it was demonstrated that the IgG deposits consisted exclusively of IgG4. IgG subclass analysis of serum autoantibodies against epidermal intercellular substance antigen revealed an identical subclass restriction to IgG4. The IgG4 portion of the serum IgG fraction was significantly increased. Since IgG4 is known to be a an almost ineffective activator of complement, the lack of deposits of C components is not surprising. Our ex vivo observations suggest that complement is not essential for the induction of pemphigus acantholysis.


Role of RNA-binding protein 5 in the diagnosis and chemotherapeutic response of lung cancer.
Lung cancer remains one of the leading causes of cancer-associated mortality in the world. Lung carcinogenesis is frequently associated with deletions or the loss of heterozygosity at the critical chromosomal region 3p21.3, where RNA-binding protein 5 (RBM5) is localized. RBM5 regulates cell growth, cell cycle progression and apoptosis in cell homeostasis. In the lungs, altered RBM5 protein expression leads to alterations in cell growth and apoptosis, with subsequent lung pathogenesis and varied responses to treatment in patients with lung cancer. Detection of RBM5 expression may be a tumor marker for diagnosis, prediction and treatment response in lung cancer, and may be developed as a potential therapeutic target for drug resistant lung cancer. This review discusses the most recent progress on the role of RBM5 in lung cancer.


Developmental programming of long non-coding RNAs during postnatal liver maturation in mice.
The liver is a vital organ with critical functions in metabolism, protein synthesis, and immune defense. Most of the liver functions are not mature at birth and many changes happen during postnatal liver development. However, it is unclear what changes occur in liver after birth, at what developmental stages they occur, and how the developmental processes are regulated. Long non-coding RNAs (lncRNAs) are involved in organ development and cell differentiation. Here, we analyzed the transcriptome of lncRNAs in mouse liver from perinatal (day -2) to adult (day 60) by RNA-Sequencing, with an attempt to understand the role of lncRNAs in liver maturation. We found around 15,000 genes expressed, including about 2,000 lncRNAs. Most lncRNAs were expressed at a lower level than coding RNAs. Both coding RNAs and lncRNAs displayed three major ontogenic patterns: enriched at neonatal, adolescent, or adult stages. Neighboring coding and non-coding RNAs showed the trend to exhibit highly correlated ontogenic expression patterns. Gene ontology (GO) analysis revealed that some lncRNAs enriched at neonatal ages have their neighbor protein coding genes also enriched at neonatal ages and associated with cell proliferation, immune activation related processes, tissue organization pathways, and hematopoiesis; other lncRNAs enriched at adolescent ages have their neighbor protein coding genes associated with different metabolic processes. These data reveal significant functional transition during postnatal liver development and imply the potential importance of lncRNAs in liver maturation.


The use of uncertainty forecasts in complex decision tasks and various weather conditions.
Recent research on weather-related decision-making suggests that the inclusion of numeric uncertainty estimates in weather forecasts improves decision quality over single value forecasts or specific advice. However, it is unclear if the benefit of uncertainty estimates extends to more complex decision tasks, presumably requiring greater cognitive effort, or to tasks in which the decision is clear-cut, perhaps making the additional uncertainty information unnecessary. In the present research, participants completed a task in which they used single value weather forecasts, either alone, with freeze probabilities, advice, or both, to decide whether to apply salt to roads in winter to prevent icing or to withhold salt and risk a penalty. Participants completed either a simple binary choice version of the task or a complex version with 3 response options and accompanying rules for application. Some participants were shown forecasts near the freezing point, such that the need for salt was ambiguous, whereas other participants were shown forecasts well below the freezing point. Results suggest that participants with uncertainty estimates did better overall, and neither the task complexity nor the coldness of the forecasts reduced that advantage. However, unexpectedly colder forecasts lead to poorer decisions and an advantage for specific advice.


Establishing a combined stimulation protocol hFSH followed by rFSH might represent a breakthrough in the IVF practice.
Controlled ovarian stimulation directly influences assisted reproductive technology (ART) outcomes. Indeed, several studies have shown that the total IU of gonadotropins used for ovarian stimulation inversely correlates with pregnancy rate. Nowadays, two main gonadotropins are used in ART protocols, human-derived and recombinant follicle-stimulating hormone (FSH). The difference between these two hormones is dramatic. Indeed, the human-derived FSH is an acidic isoform of the hormone while the recombinant is a less acid one. In particular, during a physiological menstrual cycle the acid isoform is produced during the follicular phase (probably it is more effective in recruiting follicles) while less acidic isoform is produced during the mid follicular phase (preovulatory). In the present study, we aim to evaluate the efficacy of a protocol that mimics the physiological shift form an acidic to a less acid FSH isoform during oocyte maturation. A total of 308 infertile couples undergoing their first Intracytoplasmic Sperm Injection (ICSI) treatment were enrolled. All patients underwent a standard down-regulation protocol with GnRH analogue hormone. Patients were randomized in two groups: group 1, patients that received 225 IU of human-derived FSH (hFSH Fostimon, IBSA, Lodi, Italy) for 6 days from the second day of the cycle and then 225 IU of recombinant FSH (rFSH Gonal-F; Serono, Rome, Italy) from the 7th day of stimulation until hCG administration, and group 2, control group, patients that received 225 IU recombinant FSH alone from the second day of the cycle until hCG administration. The combined protocol (hFSH + rFSH) resulted in significantly less IU of FSH necessary for ovarian stimulation together with the stimulation days. Furthermore, oocyte and embryo quality was higher in the group of patients treated with the combined protocol. Noteworthy, a significantly higher implantation rate and pregnancy rate were observed in favour of group 1 compared to group 2. We demonstrated that establishing a stimulation protocol able to mimic the physiological differences in FSH isoforms, hFSH combined with rFSH positively impact on ART outcome.


Change in Children's Physical Activity: Predictors in the Transition From Elementary to Middle School.
Interventions to promote physical activity in children should be informed by knowledge of the factors that influence physical activity behavior during critical developmental transitions. The purpose of this study is to identify, from a comprehensive, multidomain set of factors, those that are associated with change in objectively measured physical activity in children as they transition from elementary to middle school. The study used a prospective cohort design, with children observed in fifth, sixth, and seventh grades. Growth curve analyses were used to examine associations between exposure variables measured at baseline and children's physical activity across three observations. A total of 828 children, aged 10.6 (SD=0.5) years at baseline provided physical activity data in fifth grade and at one or both follow-ups. Exposure variables assessed child characteristics, parent characteristics, home characteristics, social factors, school environment, and community characteristics. Physical activity was measured via accelerometry. Data were collected in two school districts in South Carolina in 2010-2013 and analyzed in 2017. Variables measured within the child, parent/home, and community domains were positively associated with children's physical activity as they transitioned from fifth to seventh grade. These included parent encouragement of physical activity, parental support for physical activity, child sports participation, parent's report of the child's physical activity level, the child's time spent outdoors, social spaces for physical activity in the community, and the number of physical activity facilities that were proximal to the child's home. Interventions designed to increase children's physical activity should include strategies that target multiple domains of influence.


The role of gallium-67 scanning in febrile patients.
The source of sepsis in febrile patients can be a difficult diagnostic problem. Gallium-67 has been utilized as a diagnostic tool in the evaluation of these patients. A retrospective review was done of 47 patients who presented with pyrexia of unknown origin (27 patients), postoperative fever (11 patients), septicaemia (4 patients) and miscellaneous sepsis (5 patients). Whole body imaging with Gallium-67 gave an overall sensitivity and specificity of 86 and 77%, respectively, which compares favourably with previous studies. The sensitivity and specificity was similar in all patient subgroups. Gallium-67 allowed for more effective and directed use of organ-specific imaging modalities, such as computed tomography, ultrasound and guided intervention, in localizing and defining the source of sepsis. Where more than one possible source of fever was present. Gallium-67 scanning correctly identified the activity of the different foci. Gallium-67 scanning should be used early in the evaluation of patients presenting with fever of uncertain origin.


Super-Resolution-Chip: an in-vitro platform that enables super-resolution microscopy of co-cultures and 3D systems.
The development of organs-on-a-chip platforms has revolutionized in-vitro cellular culture by allowing cells to be grown in an environment that better mimics human physiology. However, there is still a challenge in integrating those platforms with advanced imaging technology. This is extremely important when we want to study molecular changes and subcellular processes on the level of a single molecule using super-resolution microscopy (SRM), which has a resolution beyond the diffraction limit of light. Currently, existing platforms that include SRM have certain limitations, either as they only support 2D monocultures, without flow or as they demand a lot of production and handling. In this study, we developed a Super-Res-Chip platform, consisting of a 3D-printed chip and a porous membrane, that could be used to co-culture cells in close proximity either in 2D or in 3D while allowing SRM on both sides of the membrane. To demonstrate the functionality of the device, we co-cultured in endothelial and epithelial cells and used direct stochastic optical reconstruction microscopy (dSTORM) to investigate how glioblastoma cells affect the expression of the gap-junction protein Connexin43 in endothelial cells grown in 2D and in 3D. Cluster analysis of Connexin43 distribution revealed no difference in the number of clusters, their size, or radii, but did identify differences in their density. Furthermore, the spatial resolution was high also when the cells were imaged through the membrane (20-30 nm for x-y) and 10-20 nm when imaged directly both for 2D and 3D conditions. Overall, this chip allows to characterize of complex cellular processes on a molecular scale in an easy manner and improved the capacity for imaging in a single molecule resolution complex cellular organization.


Syntheses of Bipyricorroles and Their Meso-Meso Coupled Dimers.
The metal-templated condensation strategy has been developed for the synthesis of meso-free bipyricorrole complexes. The reactive meso-CH in the monomer complex is further treated with various oxidative coupling reagents such as AgPF6, AgOTf, and FeCl3. Unlike Ag(I) salts, the FeCl3 resulted in a meso-meso-linked corrole homologue dimer. The synthetic methodologies successfully introduce the PdII monomer as well as PdII-PdII dimeric complexes in the corrole chemistry.


Sensitivity and specificity of Czechoslovak ELISA HBsAg Sevac tests: comparison with other third-generation tests and counter-immunoelectrophoresis.
Two variants of sandwich-type ELISA (Enzyme Linked Immunosorbent Assay) kits for HBsAg detection (Sevatest ELISA HBsAg Macro I and Sevatest ELISA HBsAg Micro I) in human sera and plasmas were developed. As the solid phase, the ELISA Macro kit and ELISA Micro kit make use of polystyrene microtubes, and polystyrene microtitration plates, respectively, of Czechoslovak production (Koh-i-noor, Dalecín). Capture anti HBs antibody for adsorption to solid phase and rabbit anti HBs antibody for labelling with horse-radish peroxidase were prepared for both tests. The sensitivity of both ELISA kits for HBsAg, equal to approx. 2 ng/ml, was determined by titrating six selected HBsAg-positive sera and the WHO Agk 76 panel of HBsAg-positive sera and the results were compared with those obtained by ELISA, RIA (Radioimmunoassay) and RPHA (Reverse passive hemagglutination) kits of different producers and by counter-immunoelectrophoresis (CIEP). The sensitivity of the new ELISA kits was comparable to that of other producers' ELISA kits, higher than that of RPHA kits and only a little lower than that of RIA kits. A set of sera of patients hospitalised with different diagnoses was tested for HBsAg. The detection rate by ELISA Macro kit 2.8 and 1.5 times higher than by CIEP and RPHA (Raphadex B), respectively, and 1.1 time lower than by RIA (Austria II).


Structural breaks in mean temperature over agroclimatic zones in India.
Amongst Asian countries India is one of the most vulnerable countries to climate change. During the past century, surface temperature in India has shown a significant increasing trend. In this paper, we have investigated behavior of mean monthly temperature during the period 1901-2001 over four agroclimatic zones of India and also tried to detect structural change in the temperature series. A structural break in the series has been observed at the national as well regional levels between 1970 and 1980. An analysis of trends before and after the structural break shows a significant increase in July temperature in the arid zone since 1972.


Study of binding affinity and selectivity of perylene and coronene derivatives towards duplex and quadruplex DNA by ESI-MS.
In this paper, we report an extensive electrospray ionization mass spectrometry (ESI-MS) study of the noncovalent interactions between different intermolecular and intramolecular G-quadruplex structures and several perylene and coronene ligands. The selectivity of these compounds toward quadruplex structures with respect to duplex DNA, a fundamental topic for the biological evaluation and the pharmacological application of these ligands as potential chemotherapeutic agents, has also been investigated. After exploring this topic according to the classical approach based on the very simple duplex model of an autocomplementary dodecamer, we extended our analysis reporting for the first time a competition ESI-MS experiment in the presence of genomic DNA fragments. Whereas those ligands showing a high level of selectivity between quadruplex and duplex oligonucleotides, in terms of binding constants and percentage of bound DNA, confirmed their selectivity in the competition experiment, the contrary was not always true: some ligands showing poor selectivity with the autocomplementary dodecamer resulted selective in the presence of genomic DNA fragments. This result suggests that physiologically nonrelevant interactions are possible with a short duplex oligonucleotide. This means that the dodecamer can fail in representing a biologically significant structural model, or, better, that it can be used to quickly screen potentially selective molecules, but bearing in mind the high probability of false negative results.


Learning Psychodynamic Psychotherapy in Southeast Asia.
The subjective nature of psychodynamic psychotherapy (PP) makes training and supervision more abstract compared to other forms of psychotherapy. The issues encountered in the learning and supervision process of PP of Malaysian psychiatry trainees are discussed in this article. Issues of preparation before starting PP, case selection, assessment of patients, dynamic formulations, supervision, anxieties in the therapy, countertransference, termination of therapy, the treatment alliance, transfer of care, the therapeutic setting, and bioethical considerations are explored. Everyone's experience of learning PP is unique and there is no algorithmic approach to its practice. With creative thinking, effort, and "good enough" supervision, a trainee can improve PP skills, even in underserved areas of the world.


Synthesis and biological properties of triazole-linked locked nucleic acid.
We have synthesized and studied the biological and biophysical properties of triazole-linked ribo and xylo locked nucleic acid (LNA). The combination of LNA with the Isobe triazole linkage gave high binding affinity when incorporated at the 3' or 5' termini of oligonucleotides, but low binding affinity at internal positions. Antisense oligonucleotides (ASOs) and siRNAs containing triazole dimers were highly active and nuclease resistant. Surprisingly, the xyloLNA-modified siRNA was the most active of the series.


Does synchronous nasal surgery increase the risk of post-operative haemorrhage in adult patients undergoing tonsillectomy?
Otolaryngologists occasionally perform simultaneous procedures on their patients, the indication being co-existent pathology. This is not a universally accepted practice as some feel that the post-operative morbidity is increased in such patients. Tonsillectomy is a common otolaryngological procedure and the main life-threatening complication, haemorrhage is easily identifiable. This study compares the incidence of post-operative haemorrhage requiring admission in patients undergoing tonsillectomy alone with that in patients undergoing tonsillectomy and nasal surgery. A retrospective study was undertaken of all adult patients undergoing tonsillectomy alone or tonsillectomy and synchronous nasal surgery in Aberdeen Royal Infirmary. Seventy-one patients (34 male) with a mean age of 23 years underwent tonsillectomy and synchronous nasal surgery over a nine-year period 1991-1999. The commonest nasal procedure was reduction of the inferior turbinates (in 48 cases). Three hundred and ninety-eight patients (131 male) with a mean age of 23 years underwent tonsillectomy alone over a nine-month period, July 1998 to April 1999. The incidence of post-tonsillectomy haemorrhage in the synchronous nasal surgery group was 12.7 per cent (9 out of 71) compared with four per cent (16 out of 398) in the tonsillectomy alone group (p <0.01, Chi-squared test). There was no difference in hospital stay between the two groups (mean two days). Synchronous nasal surgery increases the incidence of post-tonsillectomy haemorrhage.


Unexpected Presentation of Perianal Granular Cell Tumor in a Young Woman.
Granular cell tumors originate from Schwann cells of the soft tissues and are rarely observed in the perianal region. Often, correct diagnosis can be challenging owing to nonspecific clinical symptoms and imaging characteristics, as well as its ability to mimic other malignant lesions histologically. We describe the case of a previously healthy 36-year-old woman who presents with a slow growing, painless lump in her perianal region who underwent surgical excision and was found to have a granular cell tumor on microscopic evaluation. This case highlights the importance for radiologists, pathologists, surgeons, and other health care providers to be aware of this rare neoplasm and consider it in the differential diagnosis when encountering perianal masses.


Progress and perspective on algal plastics - A critical review.
There is a growing interest in developing bio-based biodegradable plastics to reduce the dependence on depleting fossil fuels and provide a sustainable alternative. Bio-based plastics can usually be produced from lipids, proteins or carbohydrates, which are major components of microalgae. Despite its potential for algal plastics, little information is available on strain selection, culture optimization and bioplastics fabrication mechanism. In this review, we summarized the recent developments in understanding the utilization of seaweed polysaccharides, such as alginate and carrageenan for bio-based plastics. In addition, a conceptual biorefinery framework for algal plastics through promising components (e.g., lipids, carbohydrates and proteins) from microalgae is comprehensively presented. Moreover, the reasons for variations in bioplastics performance and underlying mechanism of various algal biocomposites have been critically discussed. We believe this review can provide valuable information to accelerate the development of innovative green technologies for improving the commercial viability of algal plastics.


Ultrastructure of interactions between activated murine natural killer cells and melanoma cells in an extracellular matrix (Matrigel) environment.
Mixed suspensions of B16-F10 melanoma cells and murine interleukin 2 (IL2)-activated (adherent) natural killer (A-NK) cells cultured for 5 days were enclosed in gelled droplets of reconstituted basement membrane extracellular matrix (Matrigel). After incubation under cell culture conditions +/- IL2, samples were fixed for electron microscopy after 10 min and 2, 6, and 24 h. At the first time point cells were rounded and randomly distributed in the gel, at 2 h A-NK cells migrated vividly and formed contacts with target cells. At 6 h there were extensive effector:target conjugates and melanoma cell debris in the gel. Directed exocytosis of A-NK cell-specific granules could not be verified. At 24 h very few intact B16 cells remained in IL2-substituted specimens and there were large amounts of lytic melanoma cell remnants; in the absence of IL2 substantial numbers of surviving melanoma cells formed aggregates. At this time some A-NK cells had ingested melanoma cell components which probably fused with specific two-compartment granules to form large phagolysosomes. A-NK cells enlarged into a giant cell type with huge cytoplasmic accumulations of amorphous material described as mucoid masses by others.


Fully automated synthesis of DNA-binding Py-Im polyamides using a triphosgene coupling strategy.
The fully automated solid-phase synthetic strategy of hairpin pyrrole-imidazole polyamides is described. A key advance is the development of methodology for the application of triphosgene as a coupling agent in the automated synthesis of hairpin polyamides without racemization. This automated methodology is compatible with all the typical building blocks, enabling the facile synthesis of polyamide libraries in good yield (9-15%) and crude purity.


Surgical revascularization for chronic intestinal ischemia.
The aim of this study was to assess outcome after surgical revascularization for chronic intestinal ischemia (CII). From 1980 until 2003, 34 patients underwent revascularization for CII. Records were reviewed for operative technique, perioperative mortality and long-term outcomes. CII was diagnosed on the basis of clinical, arteriographic and angio-magnetic resonance imaging (MRI) criteria. Revascularization patency was monitored by arteriography, color duplex ultrasound scanning (CDS), computed tomography (CT)-scanning or angio-MRI. The celiac artery (CA) was severely diseased in 26 cases and the superior mesenteric artery (SMA) in 30 cases. Four patients presented single-vessel, 15 patients two-vessel, and 15 three-vessel involvement. Revascularization was performed by either simple (N=15) or double (N=19) bypass grafting. In 2 patients bypass grafting was combined with reimplantation. One patient underwent reimplantation alone. Median follow-up was 45 months. The 30-day mortality rate was 3%; there were 22 late death (64%). Primary revascularization patency was 94% at 1 month and 79.4% at 4 years. Clinical success rates were 85% and 70% respectively at 1 month and at 4 years. To choose the most suitable intervention, the Authors distinguished isolated CII treatable by single SMA revascularization from the digestive arteritis affecting the supramesocolic level of the abdomen, which requires double CA and SMA revascularization.


Screw Fixation Versus Hemiarthroplasty for Nondisplaced Femoral Neck Fractures in Elderly Patients: A Multicenter Randomized Controlled Trial.
Elderly patients with a displaced femoral neck fracture treated with hip arthroplasty may have better function than those treated with internal fixation. We hypothesized that hemiarthroplasty would be superior to screw fixation with regard to hip function, mobility, pain, quality of life, and the risk of a reoperation in elderly patients with a nondisplaced femoral neck fracture. In a multicenter randomized controlled trial (RCT), Norwegian patients ≥70 years of age with a nondisplaced (valgus impacted or truly nondisplaced) femoral neck fracture were allocated to screw fixation or hemiarthroplasty. Assessors blinded to the type of treatment evaluated hip function with the Harris hip score (HHS) as the primary outcome as well as on the basis of mobility assessed with the timed "Up & Go" (TUG) test, pain as assessed on a numerical rating scale, and quality of life as assessed with the EuroQol-5 Dimension-3 Level (EQ-5D) at 3, 12, and 24 months postsurgery. Results, including reoperations, were assessed with intention-to-treat analysis. Between February 6, 2012, and February 6, 2015, 111 patients were allocated to screw fixation and 108, to hemiarthroplasty. At the time of follow-up, there was no significant difference in hip function between the screw fixation and hemiarthroplasty groups, with a 24-month HHS (and standard deviation) of 74 ± 19 and 76 ± 17, respectively, and an adjusted mean difference of -2 (95% confidence interval [CI] = -6 to 3; p = 0.499). Patients allocated to hemiarthroplasty were more mobile than those allocated to screw fixation (24-month TUG = 16.6 ± 9.5 versus 20.4 ± 12.8 seconds; adjusted mean difference = 6.2 seconds [95% CI = 1.9 to 10.5 seconds]; p = 0.004). Furthermore, screw fixation was a risk factor for a major reoperation, which was performed in 20% (22) of 110 patients who underwent screw fixation versus 5% (5) of 108 who underwent hemiarthroplasty (relative risk reduction [RRR] = 3.3 [95% CI = 0.7 to 10.0]; number needed to harm [NNH] = 6.5; p = 0.002). The 24-month mortality rate was 36% (40 of 111) for patients allocated to internal fixation and 26% (28 of 108) for those allocated to hemiarthroplasty (RRR = 0.4 [95% CI = -0.1 to 1.1]; p = 0.11). Two patients were lost to follow-up. In this multicenter RCT, hemiarthroplasty was not found to be superior to screw fixation in reestablishing hip function as measured by the HHS (the primary outcome). However, hemiarthroplasty led to improved mobility and fewer major reoperations. The findings suggest that certain elderly patients with a nondisplaced femoral neck fracture may benefit from being treated with a latest-generation hemiarthroplasty rather than screw fixation. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.


Evidence that the 90-kilodalton heat shock protein is associated with tubulin-containing complexes in L cell cytosol and in intact PtK cells.
It has been established that the 90-kilodalton murine heat shock protein, hsp90, is associated with the untransformed, non-DNA-binding form of the glucocorticoid receptor in L cell cytosol. In this work, we show that incubation of L cell cytosol with Affi-Gel-coupled monoclonal antibodies directed against either alpha-tubulin alone or both alpha- and beta-tubulin results in the immune-specific adsorption of hsp90 identified by Western blotting with the AC88 monoclonal antibody. Similarly, the AC88 antibody, which is specific for hsp90, causes the immune-specific isolation of both alpha- and beta-tubulin from hypotonic cytosol. The distribution of hsp90 in cultured Potorous tridactylis kidney cells was examined by indirect immunofluorescence using the AC88 monoclonal as primary antibody. In interphase cells, AC88-dependent fluorescence was distributed like antitubulin antibody-dependent fluorescence in a fibrillar array located in the cytoplasm and around the periphery of the nucleus. In cells undergoing mitosis, AC88 fluorescence was located in the mitotic spindle. These observations suggest that a significant portion of hsp90 is associated with a tubulin-containing complex both in a hypotonic cytosol preparation from mouse fibroblasts and in intact marsupial kidney epithelial cells. The distribution of AC88 fluorescence in interphase Potorous tridactylis kidney cells is similar to the distribution of glucocorticoid receptor demonstrated by Wikstrom, A. C., Bakke, O., Okret, S., Bronnegard, M., and Gustafsson, J. A in rat hepatoma and human uterine cells.


Diabetes is associated with increased perioperative mortality but equivalent long-term outcome after hepatic resection for colorectal cancer.
Diabetes is associated with alterations in liver metabolism and immune response that may influence postoperative recovery and long-term survival after hepatectomy for cancer. Patients with type I or type II diabetes mellitus submitted to a potentially curative hepatic resection for metastatic colorectal cancer were identified from the prospective database, and compared with patients with hepatic colorectal metastases submitted to resection during the same time interval, but without diabetes mellitus. Data on operative morbidity and mortality and long-term survival were analyzed. Between December 1990 and July 1999, a total of 727 patients underwent hepatic resection, 61 of whom (8.1%) had type I and type II diabetes mellitus. Operative mortality in the diabetic patients was significantly greater than in nondiabetic patients (8% vs. 2%, P < 0.02). Among patients with diabetes mellitus, four of the five perioperative deaths were due to liver failure after major hepatic resection (lobectomy or greater). All four of these patients had significant parenchymal abnormality (three with steatosis). Long-term survival was identical to that in nondiabetic control subjects. We conclude that the presence of diabetes is associated with a higher incidence of perioperative mortality. In patients with diabetes mellitus and parenchymal steatosis, major hepatic resection should be undertaken with caution.


Salt Promotes Protonation of Amine Groups at Air/Water Interface.
Interfacial water reorientation caused by charged Langmuir monolayers consisting of primary fatty amine (ODA) and cationic lipid having quaternary amine headgroup (DPTAP) were investigated by interface-selective vibrational sum-frequency generation spectroscopy. For DPTAP monolayer, initially large sum-frequency intensity from interfacial water OH band decreased steadily by increasing monovalent salt (NaCl, NaI) concentration due to counterion adsorption. On the other hand, ODA/water exhibited significantly smaller sum-frequency intensity than DPTAP/water, implying only small portion of protonated amine group (-NH3+) initially existed. By increasing the ionic strength, however, SF intensity of water OH band was enhanced markedly up to ∼1 mM, and then decreased in both NaCl and NaI solutions. By measuring the phase of the sum-frequency spectra, it was found that water dipoles under the ODA headgroup point downward, indicating that the surfaces were always positively charged. This demonstrated that increasing ionic strength facilitates protonation of primary amine headgroups. A simple model based on Poisson-Boltzmann (PB) theory explained this protonation behavior of primary amines.


Stochastic load-redistribution model for cascading failure propagation.
A class of probabilistic models for cascading failure propagation in interconnected systems is proposed. The models are able to represent important physical characteristics of realistic load-redistribution mechanisms, e.g., that the load increments after a failure depend on the load of the failing element and that they may be distributed nonuniformly among the remaining elements. In the limit of large system sizes, the models are solved analytically in terms of generalized branching processes, and the failure propagation properties of a prototype example are analyzed in detail.


Alzheimer's Disease in Down Syndrome.
A key challenge to adults with Down syndrome (DS) as they age is an increased risk for cognitive decline, dementia, and Alzheimer disease (AD). In DS persons ranging from 40-49 years of age, 5.7-55% may be clinically demented and between 50-59 years, dementia prevalence ranges from 4-55% (reviewed in [1]). Despite the wide ranges reported for dementia prevalence, a consistent feature of aging in DS is the progressive accumulation of AD brain pathologies. By the age of 40 years, virtually all have sufficient senile plaques and neurofibrillary tangles for a neuropathological diagnosis of AD [2]. Thus, there is dissociation between the age of onset of AD neuropathology (40 years) and increasing signs of clinical dementia. We discuss the hypothesis that frontal impairments are a critical factor affecting cognitive function and are associated with white matter (WM) and AD neuropathology. While these may be an early sign of conversion to dementia, we also review several other clinical comorbidities that may also contribute to dementia onset.


[Prevalence and control of gastrintestinal parasitosis in calves from dairy farms in the municipality of Alegre, Espírito Santo].
The objectives of the present study were to evaluate the prevalence of gastrintestinal helminthosis of calves and to identify control aspects related to these infections in dairy farms of the municipality of Alegre, Espírito Santo. A total of 222 calves varying of one to 18 months of age were examined and proportionally divided between 12 dairy farms. After techniques in the laboratory of parasitic diseases of the veterinary hospital of Centro de Ciências Agrárias of the Universidade Federal do Espírito Santo, the prevalence of eggs of Strongyloidea, Trichuris sp., Moniezia sp, Strongyloides papillosus and coccidial oocysts were, in properties and calves: 100 and 66; 100 and 57.8; 50 and 8.2; 25 and 1.8, and 33.3 and 7.8%, respectivelly. Of the 66 for eggs of the Strongyloidea, 64 were attributed to Haemonchus spp. and 53.75% to Cooperia spp. Despite the existence of parasite control programs in the farms, were identify some wrong practices, as lack of weighting animals for the calculation of the dose rate of the drugs and lack of use of the compost of excrements. Thus, the drugs uses of incorrect form may be able to cause future damages with development of parasites resistance to these products.


Prognostic Role of the FGFR4-388Arg Variant in Lung Squamous-Cell Carcinoma Patients With Lymph Node Involvement.
The identification of prognostic biomarkers for lung squamous-cell carcinoma (SCC) pathology is crucial because of its poor prognosis. A variant of the FGFR4 (fibroblast growth factor receptor 4) gene, FGFR4-388Arg, has been associated with prognosis and is linked to oncogenesis in vitro in several types of cancer. We analyzed the association of this variant with prognosis and downstream signaling alteration in lung SCC patients. The presence of the FGFR4-388Arg variant was determined in 114 formalin-fixed, paraffin-embedded lung SCC tissue samples by DNA genotyping and was correlated with clinicopathologic data. The activation of the protein kinase B (AKT) and mitogen-activated protein kinase (MAPK) pathways was determined by immunohistochemistry, and its association with the presence of FGFR4-388Arg was analyzed. We found that tumor differentiation status and adjuvant chemotherapy administration could be independent prognostic factors for overall survival (OS) in lymph node-affected patients, as expected. The progression-free survival and OS of patients with lymph node involvement (n = 41) and the FGFR4-388Arg genotype were significantly lower than those of patients lacking this variant (P = .035 and P = .042, respectively). Importantly, multivariate analysis supported the independent prognostic role of the FGFR4-388Arg genotype in OS (P = .025). Regarding downstream signaling, the FGFR4-388Arg genotype was not correlated with altered AKT signaling but was associated with increased MAPK activation in the SCC tumor samples (P = .017). The FGFR4-388Arg variant may represent a promising prognostic biomarker in SCC patients with lymph node involvement. For these patients, FGFR4 may be a potential therapeutic target.


Determinants of sleep quality among pregnant women in China: a cross-sectional survey.
Sleep disturbances are common during pregnancy, yet few studies are currently available regarding the determinants of sleep quality among pregnant women in China. This study aimed to: (a) calculate the prevalence of sleep disorder during pregnancy, (b) examine the difference in sleep quality among three trimesters, and (c) identify determinants of sleep quality in pregnant women. This study was designed as a cross-sectional survey. Five hundred pregnant women were recruited at the outpatient department of obstetrics and gynecology of two teaching hospitals in central China. Five selfreport questionnaires were used for gathering data, including information of sample characteristics, sleep quality (Pittsburgh Sleep Quality Index (PSQI)), prenatal depression (the Edinburgh Postnatal Depression Scale (EPDS)), perceived stress (Perceived Stress Scale (PSS)), and perceived social support (Multidimensional Scale of Perceived Social Support (MSPSS)). A total of 454 pregnant women participated in the study between September 2016 and April 2017. Eighty-seven percent pregnant women experienced sleep disorder (PSQI score >5). Poorer global sleep quality, subjective sleep quality, lower sleep efficiency and sleep disturbances were most prevalent during third trimester. The significant contributors to sleep quality for pregnant women were prenatal depression, maternal age, and gestational age. Sleep disorder is very common in pregnant women from China. Depressive symptoms, increased maternal age, and gestational age are determinants of sleep quality. These determinants can assist healthcare professionals in preventative intervention.


A comparative study on the effect of lidocaine and furosemide on urinary output and graft function after renal transplantation.
Renal transplantation is an ideal treatment for patients with chronic renal failure. It was demonstrated that despite the adhesion to surgical and anesthetic principles, urinary output is not satisfactory after transplantation. It seems that microvascular spasm of renal vasculature is responsible for this phenomenon. We designed a study to investigate whether lidocaine injection into renal artery can relieve vasospasm and subsequently improve output and graft function better than furosemide. In a randomized clinical trial, from July 2002 to November 2003, 100 consecutive patients who were referred to our center for kidney transplantation were recruited in this study. After obtaining written informed consent, they were divided blindly into two groups. In group 1, lidocaine was injected into renal artery, before arterial anastomosis, and group 2 received furosemide as the conventional intervention. Urine volume within 1, 4, and 24 postoperative hours and serum creatinine levels in the first three weeks were recorded and compared between the two groups. Urine volumes at 1, 4, and 24 hours after transplantation were higher significantly in lidocaine group (P <0.001). Serum creatinine levels were lower significantly in the first postoperative day and also 21 days after transplantation in group 1 (P <0.001). Comparing to furosemide, it seems that lidocaine can cause a more effective vasodilation in renal arteries of kidney allograft, resulting in a better diuresis. This may have a role in the betterment of graft function.


Happiness Management: A Culture to Explore From Brand Orientation as a Sign of Responsible and Sustainable Production.
The overarching call to action represented by the sustainable development goals (SDGs) calls for new sustainable production and management models. Likewise, in periods of crisis, such as the current COVID-19 pandemic, companies are forced to develop competitive and sustainable development strategies to increase their brand value and achieve a good market position. Therefore, this work's main objective is to design a structural equation modelling (SEM) to analyse the main critical dimensions of brand orientation to influence happiness in responsible and sustainable entities. For this purpose, a descriptive cross-sectional study was carried out based on primary data from a survey of a representative sample of 216 managers of small- and medium-sized enterprises in Andalusia (Spain) in the construction, industry and services sectors. The model results reveal significant dimensions of brand orientation and positively direct influence on happiness management. One of the significant managerial implications of this work is that the model allows for more responsible and sustainable management of entities by considering brand orientation about happiness.


Perceived Biases and Prejudices Experienced by International Medical Graduates in the US Post-Graduate Medical Education System.
Purpose - The purpose of this project was to collect qualitative data on the types of bias and prejudices experienced by international medical graduates (IMGs) in the US graduate medical education system. Methods - We conducted thirty-six qualitative interviews from a single internal medicine residency program in a large mid-western city over a four-year time period. The study population consisted of 33 IMGs and 3 USMGs. Results - The data aggregated into four major themes; the externship requirements of residency programs for IMGs, difficult interview experiences, US medical students are critical of residency programs with IMGs, and greater difficulties for IMGs finding employment after residency. Conclusion - The IMGs from one Internal Medicine residency program in the US post-graduate medical system self-reported considerable bias and prejudice.


Nonlinearity and asymmetry in the human vestibulo-ocular reflex.
The horizontal vestibulo-ocular reflex was studied in normal and unilaterally vestibulopathic human subjects; the latter before and after surgical vestibular ablation. Subjects were oscillated at 0.025-4 Hz, 50 o/s peak head velocity, and for 0.025 and 0.25 Hz, at 50-300 o/s peak head velocity. Gain (peak eye/head velocities), phase (delay in degrees between peak eye and head velocities), and asymmetry (including d.c. bias; the average eye velocity over the cycle) were assessed for each rotation. In patients preoperatively, gain was subnormal while phase lead was greater than normal only at lowest frequencies. As head velocity increased at 0.025 and 0.25 Hz, gain dropped in patients, but not in normals. Furthermore, d.c. bias at 0.25 Hz tended to shift abnormally toward the lesioned side in most patients. After surgery, gain dropped and phase lead rose for all stimuli, but showed varied recovery over 4 months. d.c. bias also rose after surgery, and showed an enhancement with increasing head velocity at 0.25 Hz. d.c. bias remained unchanged even after 4 months for 300 o/s rotations, but disappeared at low head velocity. d.c. bias (and other asymmetry measures) represents a lateralizing sign which can be improved by utilizing high head velocities at moderate frequencies.


Synthesis of cyclopentadienyl capped polyethylene and subsequent block copolymer formation via hetero Diels-Alder (HDA) chemistry.
In the current contribution it is demonstrated - for the first time - that poly(ethylene) (M(n) = 1,400 as well as 2,800 g · mol(-1) , PDI = 1.2) can be readily equipped with highly reactive cyclopentadienyl (Cp) end groups. The Cp terminal poly(ethylene) can subsequently be reacted in an efficient hetero Diels-Alder (HDA) reaction with macromolecules (poly(isobornyl acrylate) (M(n) = 4,600 g · mol(-1) , PDI = 1.10) and poly(styrene) (M(n) = 6,300 g · mol(-1) , PDI = 1.13) featuring strongly electron withdrawing thiocarbonyl thio end groups, prepared via reversible addition fragmentation chain transfer (RAFT) polymerization employing benzylpyridin-2-yldithioformate (BPDF) as transfer agent. The resulting block copolymers have been analyzed via high-temperature size exclusion chromatography (SEC) as well as nuclear magnetic resonance (NMR) spectroscopy. The current system allows for the removal of the excess of the non-poly(ethylene) containing segment via filtration of the poly(ethylene)-containing block copolymer. However, the reaction temperatures need to be judiciously selected. Characterization of the generated block copolymers at elevated temperatures can lead - depending on the block copolymer type - to the occurrence of retro Diels-Alder processes. The present study thus demonstrates that RAFT-HDA ligation can be effectively employed for the generation of block copolymers containing poly(ethylene) segments.


[Surgical cure of stress urinary incontinence with vaginal tissue sling: technique, results, indications].
Describe a new surgical technique of sling procedure using a vaginal sling and report complications and mid-term functional results. According to these results, it's necessary to discuss the best indications. Retrospective study of the first 75 patients operated for urinary stress incontinence. The average age of patients was 56 (30-90). Preoperative complications have been rare with only one bladder injury (1.3%). Postoperative complications have been more frequent and the most of them was caused by 76% of urine retention lasting a mean of 14 days and 44% of urinary infections. 20% of the patients have presented secondary dysuria and/or urinary urgency. 4 patients (5.3%) have presented a vaginal mucocele between 9 and 32 months after the operation. At mean follow-up of 25.1 months, the success rate was 70.6%, with 61.3% of patients who have been cured and 9.3% which was improved. In case of severe sphincter insufficiency, the success rate was 80%. Success rate was 30% when the vaginal sling was the only procedure and 66.1% when it was associated to another vaginal procedure (p = 0.006) as vaginal hysterectomy or sacro-spinous suspension. This original surgical technique for cure of urinary stress incontinence is inexpensive and easy to learn. It can be associated to other operations by vaginal way. The realization of this procedure under regional anaesthesia should enable to warn urine retention which is the mean postoperative complication. The success rate of this series is cheerful because it takes into account any patients no selected and operated on the learning phase of the technique. The best results of this technique are urinary stress incontinence associated with vaginal surgery for genital prolapse. The final assessment of this surgical technique will be require longer follow-up and comparative studies with other procedures on an elevated number of patients.


Pigeons at the edge of the empire: Bioarchaeological evidences for extensive management of pigeons in a Byzantine desert settlement in the southern Levant.
Metric data of 6th century CE pigeons from the Negev Desert, Israel, are employed to test competing hypotheses on flock management strategies: that directed selection for size or shape took place under intensive management; or, alternatively, that stabilizing selection was a stronger determinant of size and shape under extensive management conditions. The results of the analysis support the second hypothesis by demonstrating that the Byzantine Negev pigeons were like wild pigeon (Columba livia) in shape, albeit small-sized. The inferred extensive management system is then discussed in the context of pigeon domestication and human micro-ecologies in marginal regions.


Effects of lung hyperinflation on mean arterial pressure and postsuctioning hypoxemia.
Our purpose was to determine the effect of five different lung hyperinflation volumes (tidal volume, 12 cc/kg, 14 cc/kg, 16 cc/kg, and 18 cc/kg lean body weight) on mean arterial pressure and postsuctioning hypoxemia (arterial blood gases). Subjects received three consecutive lung hyperinflations at one of the five randomly ordered volumes in 15 seconds via a ventilator "sigh" control at a fraction of inspired oxygen of 1.0. The three lung hyperinflations were followed by 10 seconds of continuous suction (flow rate 16 L/min). The procedure was repeated three times. The sample consisted of eight men and women 4 hours after coronary artery bypass graft surgery. Data indicated a statistically significant (by analysis of variance, p = 0.000) mean increase of 15 mm Hg in mean arterial pressure over the three lung hyperinflation sequences that was not volume dependent. There was a significant increase (p = 0.0001) in arterial oxygen pressure at 0 seconds after suctioning that increased with each increasing lung hyperinflation volume.


Comparative Mitogenomic Analysis of Species Representing Six Subfamilies in the Family Tenebrionidae.
To better understand the architecture and evolution of the mitochondrial genome (mitogenome), mitogenomes of ten specimens representing six subfamilies in Tenebrionidae were selected, and comparative analysis of these mitogenomes was carried out in this study. Ten mitogenomes in this family share a similar gene composition, gene order, nucleotide composition, and codon usage. In addition, our results show that nucleotide bias was strongly influenced by the preference of codon usage for A/T rich codons which significantly correlated with the G + C content of protein coding genes (PCGs). Evolutionary rate analyses reveal that all PCGs have been subjected to a purifying selection, whereas 13 PCGs displayed different evolution rates, among which ATPase subunit 8 (ATP8) showed the highest evolutionary rate. We inferred the secondary structure for all RNA genes of Tenebrio molitor (Te2) and used this as the basis for comparison with the same genes from other Tenebrionidae mitogenomes. Some conserved helices (stems) and loops of RNA structures were found in different domains of ribosomal RNAs (rRNAs) and the cloverleaf structure of transfer RNAs (tRNAs). With regard to the AT-rich region, we analyzed tandem repeat sequences located in this region and identified some essential elements including T stretches, the consensus motif at the flanking regions of T stretch, and the secondary structure formed by the motif at the 3' end of T stretch in major strand, which are highly conserved in these species. Furthermore, phylogenetic analyses using mitogenomic data strongly support the relationships among six subfamilies: ((Tenebrionidae incertae sedis + (Diaperinae + Tenebrioninae)) + (Pimeliinae + Lagriinae)), which is consistent with phylogenetic results based on morphological traits.


Atypical pathogens associated with cardiac implantable electronic device infections.
Cardiovascular implantable electronic device (CIED) infections are associated with significant morbidity and mortality making the identification of the causative organism critical. The vast majority of CIED infections are caused by Staphylococcal species. CIED infections associated with atypical pathogens are rare and have not been systematically investigated. The objective of this study is to characterize the clinical course, management and outcome in patients with CIED infection secondary to atypical pathogens. Medical records of all patients who underwent CIED system extraction at the University of Chicago Medical Center between January 2010 and November 2020 were retrospectively reviewed to identify patients with CIED infection. Demographic, clinical, infection-related and outcome data were collected. CIED infections were divided into typical and atypical groups based on the pathogens isolated. Among 356 CIED extraction procedures, 130 (37%) were performed for CIED infection. Atypical pathogens were found in 5.4% (n = 7) and included Pantoea species (n = 2), Kocuria species (n = 1), Cutibacterium acnes (n = 1), Corynebacterium tuberculostearicum (n = 1), Corynebacterium striatum (n = 1), Stenotrophomonas maltophilia (n = 1), and Pseudozyma ahidis (n = 1). All patients with atypical CIED infections were successfully treated with total system removal and tailored antibiotic therapy. There were no infection-related deaths. CIED infections with atypical pathogens were rare and associated with good outcome if diagnosed early and treated with total system removal and tailored antimicrobial therapy. Atypical pathogens cultured from blood, tissue or hardware in patients with CIED infection should be considered pathogens and not contaminants.


Differences in growth of Salmonella enterica and Escherichia coli O157:H7 on alfalfa sprouts.
Sprout producers have recently been faced with several Salmonella enterica and Escherichia coli O157:H7 outbreaks. Many of the outbreaks have been traced to sprout seeds contaminated with low levels of human pathogens. Alfalfa seeds were inoculated with S. enterica and E. coli O157:H7 strains isolated from alfalfa seeds or other environmental sources and sprouted to examine growth of these human pathogens in association with sprouting seeds. S. enterica strains grew an average of 3.7 log(10) on sprouting seeds over 2 days, while E. coli O157:H7 strains grew significantly less, an average of 2.3 log(10). The initial S. enterica or E. coli O157:H7 inoculum dose and seed-sprouting temperature significantly affected the levels of both S. enterica and E. coli O157:H7 on the sprouts and in the irrigation water, while the frequency of irrigation water replacement affected only the levels of E. coli O157:H7. Colonization of sprouting alfalfa seeds by S. enterica serovar Newport and E. coli O157:H7 strains transformed with a plasmid encoding the green fluorescent protein was examined with fluorescence microscopy. Salmonella serovar Newport colonized both seed coats and sprout roots as aggregates, while E. coli O157:H7 colonized only sprout roots.


Inefficiency of isoprenaline to induce drinking in the goat.
Isoprenaline, which acts as a potent dipsogen in water-satiated rats and dogs, did not elicit water intake when infused intravenously at 0.1 or 0.3 mu/kg min-1 in non-hydrated goats. Even the low dose of the drug caused a marked reduction of parotid salivary flow. The possibility is discussed that reduced salivary secretion might be the particular effect which makes isoprenaline dipsogenic in prandially drinking species. The intravenous infusion of isoprenaline at the high dose level caused an inhibition of the water diuresis of hydrated goats, concomitant with reduced renal Na+ excretion and a marked, sustained fall in the arterial blood pressure. Significant amounts of ADH were recovered from the urine secreted during the antidiuresis. This ADH-release was apparently not due to central beta-adrenergic stimulation since no inhibition of the water diuresis was observed during intraventricular infusions of isoprenaline. Rather, the ADH-release appears to have been secondary to the isoprenaline-induced fall in arterial blood pressure.


Glucocorticoids negatively regulate the transcription of KC, the mouse homolog of MGSA/GRO.
The KC gene is a member of the small inducible gene family of regulated chemokines. It encodes a growth factor and chemoattractant that appears to mediate inflammatory and immune responses in vitro and in vivo. We now show that the transcriptional induction of KC by serum is inhibited by glucocorticoids. The effect of glucocorticoids is dose-dependent, requires one hour of exposure, is reversed by the protein synthesis inhibitors puromycin and cycloheximide and acts at the transcriptional level. The results support the hypothesis that the major anti-inflammatory action of glucocorticoids may be to inhibit the induction of immediate-early genes that encode cytokines involved in intercellular communication.


Changes in Physical Activity Barriers among American Indian Elders: A Pilot Study.
The objective of the present study was to assess whether selfreported physical activity barriers could be reduced among American Indian elders who participated in a 6-week randomized physical activity trial that compared the use of a pedometer only to that of pedometers with step-count goal setting. Elders (N = 32) were compared on the Barriers to Being Physically Active Quiz after participating in a pilot physical activity trial. Elders were classified into high- and low-barrier groups at baseline and compared on self-reported physical activity, health-related quality of life, pedometer step counts, and 6-minute walk performance. At the conclusion of the 6-week trial, only the lack of willpower subscale significantly decreased. The low-barrier group reported significantly higher physical activity engagement and improved mental health quality of life than the high-barrier group. The groups did not differ on daily step counts or 6-minute walk performance. Additional research is needed with a larger sample to understand relevant activity barriers in this population and assess whether they can be modified through participation in structured physical activity and exercise programs.


Health-related quality of life assessment in euthymic and depressed patients with bipolar disorder. Psychometric performance of four self-report measures.
The purpose of this study was to evaluate the psychometric properties of selected health-related quality of life (HRQL) self-report measures in 62 euthymic and depressed patients diagnosed with bipolar disorder. Patients completed the Quality of Life in Depression Scale (QLDS), Mental Health Index-17 (MHI-17), Cognitive Function Scale, and Medical Outcomes Study Short Form-36 (SF-36) at baseline and 8 weeks following treatment. Hamilton and Young Rating Scales were used to assess clinical status and validate the HRQL measures. The MHI-17, Cognitive Function Scale, QLDS, and SF-36 social function, vitality, role limitations-emotional, and mental health scales have good reliability and validity, and are responsive to changes in clinical status in patients with bipolar disorder. Although the small sample size limits generalizablity, euthymic and depressed outpatients with bipolar disorder appear to contribute reliable self reports on selected aspects of their quality of life.