Periprocedural bleeding complications of brain AVM embolization with Onyx.
The advent of Onyx has provided a new method for neurointerventional therapists to treat brain AVMs. Although some retrospective studies have reported complications for AVM embolization with Onyx, periprocedural bleeding complications with Onyx embolization have not yet been described in detail. The aim of this retrospective study was to analyze the factors of Onyx-related bleeding complications and to find a way to avoid and manage these complications.From January 2003, patients with AVMs recruited in our institution started to be treated by Onyx embolization. From January 2007 to July 2009, 143 consecutive interventions were performed in 126 patients using flow-independent microcatheters and Onyx as embolic agents. Seven patients encountered bleeding complications (5.4% per patients and 4.7% per procedures) during or after the endovascular procedures. Among them, five bleeding episodes occurred during procedures, the other two after procedures. Details of the seven patients' clinical presentations, imaging presentations, speculative reasons and management of these complications were recorded. Follow-up data, including postoperative course, clinical symptoms and duration of follow-up were documented. The five active bleedings discovered in procedures were managed in time, and the patients recovered without any new neurological symptoms compared with preoperation. However, of the two bleeding episodes that occurred after interventional procedures, one was detected half an hour later: the patient was remained comatose two months later after resection of right occipital hematoma; the other who encountered intraventricular and midbrain hemorrhage was treated conservatively and suffered Parinaud syndrome and hemianesthesia. Periprocedural bleeding of AVMs embolization is considered a severe and devastating complication. The clinical course and prognosis of bleeding mostly depends on prompt detection and management. Interventional embolization is an effective method to manage bleeding during procedures, and the detection of risk factors and imaging signs of bleeding is extremely important.


The roles of GABAergic and glycinergic inhibition on binaural processing in the dorsal nucleus of the lateral lemniscus of the mustache bat.
1. We studied the monaural and binaural response properties of 99 neurons in the dorsal nucleus of the lateral lemniscus (DNLL) of the mustache bat before and during the iontophoretic application of antagonists that blocked gamma-aminobutyric acid-A (GABAA) receptors (bicuculline) or glycine receptors (strychnine). All cells were driven by monaural stimulation of the contralateral ear, whereas monaural stimulation of the ipsilateral ear never evoked discharges. The binaural properties of 81 neurons were determined by holding the intensity constant at the contralateral ear and presenting a variety of intensities to the ipsilateral ear. This procedure generated interaural intensity disparity (IID) functions and allowed us to determine the effect of ipsilaterally evoked inhibition on a constant excitatory drive evoked by the contralateral ear. 2. One of the main findings is that the IID functions in the majority of DNLL neurons were not affected by application of either strychnine or bicuculline. Blocking glycinergic inhibition with strychnine had no effect on the IID functions in 75% of the cells studied. However, strychnine did change the IID functions in approximately 25% of the DNLL population. In those cells glycinergic inhibition appeared to be partially, or, in a few cases, entirely responsible for the ipsilaterally evoked spike suppression. In contrast, blocking GABAergic inhibition with bicuculline had no discernible effect on the ipsilaterally evoked spike suppression in any of the excitatory/inhibitory cells that we recorded. GABAergic inhibition, therefore, plays no role in the formation of IID functions of neurons in the DNLL. Furthermore, the results suggest that glycinergic inhibition also does not contribute to the suppression of spikes evoked by stimulation of the contralateral ear in the vast majority of DNLL neurons. 3. Although the majority of IID functions were not influenced when either GABAergic or glycinergic innervation was blocked, ipsilateral stimulation alone evoked both a glycinergic and GABAergic inhibition in most DNLL cells. These inhibitory events were demonstrated in 18 other cells by evoking discharges with the iontophoretic application of glutamate. Stimulating the ipsilateral ear alone under these conditions caused a suppression of the glutamate-evoked discharges. Furthermore, the spike suppression persisted for a period of time that was longer than the duration of the tone burst at the ipsilateral ear. 4. The application of bicuculline or strychnine had different effects on the glutamate-elicited spikes. Bicuculline reduced the duration of the inhibition, and it was always the latter portion of the inhibition that was abolished by bicuculline. In more than half of the cells studied strychnine also reduced the duration of the inhibition.(ABSTRACT TRUNCATED AT 400 WORDS)


Residential HVAC runtime from smart thermostats: characterization, comparison, and impacts.
In North America, the majority of homes use forced-air systems for heating and cooling. The proportion of time these systems operate, or runtime, has a significant impact on many building performance parameters. The recent adoption of smart thermostats in many North American homes presents a potential data source for runtime. Smart thermostat data collected from over 7000 homes were compared with nine other investigations and a runtime estimation method based on exterior temperature. The smart thermostat runtimes have a median of 18% across all homes, but show considerable variation between homes, even at constant exterior temperature conditions suggesting that factors besides climate (eg, system sizing, user operation) have a significant impact on runtime. Results from other investigations suggest that smart thermostat runtimes are consistent with other measurement approaches. The practical implications of runtime include the impact on central filtration performance. At low to average runtimes, the filter efficiency matters much less for effectiveness because the system does not run enough for a sufficient air volume to pass through the filter and have a substantial impact on particle concentrations. This work illustrates the importance of measuring runtime for a particular home, and the value of data obtained from smart thermostats.


Non-invasive measurement of fecal estrogens in the spotted hyena (Crocuta crocuta).
Fecal hormone analysis is a useful tool for frequent, non-invasive sampling of free-living animals. Estrogens fluctuate throughout life among reproductive states in female animals, and intensive repetitive sampling can permit accurate assessment of female reproductive condition. This type of repetitive sampling is difficult in large carnivores, including the spotted hyena (Crocuta crocuta). Patterns of estrogen secretion in captive and free-living hyenas are virtually unknown. Here we present validation of an enzyme-immunoassay to measure fecal estrogen (fE) concentrations in wild and captive spotted hyenas. Results from high-performance liquid chromatography indicate that an antibody specific for estradiol exhibits high immunoreactivity with our extracted samples. Fecal extract displacement curves paralleled our estradiol standard curve within the range of 20-80% antibody binding. Additionally, animals treated with luteinizing hormone-releasing hormone showed a measurable rise in fE concentrations. Finally, once we controlled for effects of time of day of sample collection from wild hyenas, patterns in fE concentrations resembled those in plasma estradiol, including higher levels of fE in mature than immature females, and higher levels of fE during late than early pregnancy. Together, these results suggest that fE concentrations reflect circulating estrogens in spotted hyenas.


Patient Experiences of Self-Management for Chronic Low Back Pain: A Qualitative Study.
Chronic low back pain (CLBP) is a lifelong condition causing disability and distress. One aim of treatment is to enhance self-management. To date, self-management interventions have had limited effectiveness. A greater understanding of self-management for CLBP has the potential to improve future interventional trials. The purpose of this study was to identify the experience of CLBP self-management for patients attending outpatient physical therapy and assess how the experience of CLBP self-management changes over time. This qualitative study used constructivist grounded theory. Patients with CLBP who were attending an outpatient physical therapy department were recruited using convenience sampling. Each participant attended a semistructured interview. These were audio recorded and transcribed verbatim. The data were coded and thematically analyzed by the lead researcher. Recruitment continued until data saturation. Participants reviewed preliminary themes for validation. Six subthemes emerged from 9 interviews: (1) self-doubt, (2) coping day to day, (3) independent discovery, (4) developing resilience, (5) health care: opportunity and threat, and (6) living with pain differently. Two themes took on greatest significance. Self-doubt appeared most strongly and was prevalent in all experiences. However, living with pain differently appeared in those who had developed a level of pain acceptance. These themes formed a conceptual model, "Fluctuating Uncertainty." The experience of CLBP self-management is one of fluctuating self-doubt. Self-doubt is the predominant experience and is characterized by the perception of pain as a threat and low pain self-efficacy. During times of greater clarity, individuals develop strategies that increase pain self-efficacy and reinforce the perception of pain without threat. These are features of learning to live well with pain. CLBP is a lifelong condition requiring self-management. The current study characterizes the self-management strategies used by patients attending physical therapy. The fluctuating nature of these strategies is dependent upon perception of pain and pain self-efficacy. People with CLBP who self-manage their pain fluctuate between attempting to control pain and learning to live with pain. People who understand their condition develop wider-ranging self-management strategies.


Functional MRI of the rodent somatosensory pathway using multislice echo planar imaging.
A multislice EPI sequence was used to obtain functional MR images of the entire rat brain with BOLD contrast at 11.7 T. Ten to 11 slices covering the rat brain, with an in-plane resolution of 300 microm, provided enough sensitivity to detect activation in brain regions known to be involved in the somatosensory pathway during stimulation of the forelimbs. These regions were identified by warping a digitized rat brain atlas to each set of images. Data analysis was constrained to four major areas of the somatosensory pathway: primary and secondary somatosensory cortices, thalamus, and cerebellum. Incidence maps were generated. Electrical stimulation at 3 Hz led to significant activation in the primary sensory cortex in all rats. Activation in the secondary sensory cortex and cerebellum was observed in 70% of the studies, while thalamic activation was observed in 40%. The amplitude of activation was measured for each area, and average response time courses were calculated. Finally, the frequency dependence of the response to forepaw stimulation was measured in each of the activated areas. Optimal activation occurred in all areas at 3 Hz. These results demonstrate that whole-brain fMRI can be performed on rodents at 11.7 T to probe a well-defined neural network.


Polyhomeotic stably associates with molecular chaperones Hsc4 and Droj2 in Drosophila Kc1 cells.
Polycomb group (PcG) proteins silence target loci in Drosophila. Although the mechanism of PcG-mediated silencing remains unknown, there is considerable evidence that PcG proteins act via multiple complexes. We have epitope-tagged Polyhomeotic Proximal, PHP, the major isoform of the proximal product of the polyhomeotic locus, at both termini (F-PHP-HA) and generated a stable Kc1 cell line in order to isolate F-PHP-HA-associated proteins. Using either column chromatography followed by immunoaffinity precipitation or a double immunoaffinity precipitation procedure, we observed multiple proteins that stably associate with F-PHP-HA. Sequencing the five major bands identified PHP-170 and PHP-140 isoforms, Polycomb, Heat shock cognate 4 (Hsc4), and a novel Drosophila J class chaperone we term Droj2. Mutations in both chaperone genes enhance homeotic transformations in PcG genes, suggesting that they have a role in silencing. We show by Western blotting that minor components of F-PHP-HA-associated proteins include TBP, TAF(II)42, TAF(II)85, and p55. However, unlike in PRC1, Psc, TAF(II)62, Modulo, dMI-2, or Rpd3/HDAC1 do not associate with F-PHP-HA. We discuss the role of chaperones and F-PHP-HA-associated proteins in PcG-mediated silencing and the evidence for different complexes containing Polyhomeotic in vivo.


Recent research advances on corrosion mechanism and protection, and novel coating materials of magnesium alloys: a review.
Magnesium alloys have achieved a good balance between biocompatibility and mechanical properties, and have great potential for clinical application, and their performance as implant materials has been continuously improved in recent years. However, a high degradation rate of Mg alloys in a physiological environment remains a major limitation before clinical application. In this review, according to the human body's intake of elements, the current mainstream implanted magnesium alloy system is classified and discussed, and the corrosion mechanism of magnesium alloy in vivo and in vitro is described, including general corrosion, localized corrosion, pitting corrosion, and degradation of body fluid environment impact etc. The introduction of methods to improve the mechanical properties and biocorrosion resistance of magnesium alloys is divided into two parts: the alloying part mainly discusses the strengthening mechanisms of alloying elements, including grain refinement strengthening, solid solution strengthening, dislocation strengthening and precipitation strengthening etc.; the surface modification part introduces the ideas and applications of novel materials with excellent properties such as graphene and biomimetic materials in the development of functional coatings. Finally, the existing problems are summarized, and the future development direction is prospected.


Explaining the differences in income-related health inequalities across European countries.
This paper provides new evidence on the sources of differences in the degree of income-related inequalities in self-assessed health in 13 European Union member states. It goes beyond earlier work by measuring health using an interval regression approach to compute concentration indices and by decomposing inequality into its determining factors. New and more comparable data were used, taken from the 1996 wave of the European Community Household Panel. Significant inequalities in health (utility) favouring the higher income groups emerge in all countries, but are particularly high in Portugal and - to a lesser extent - in the UK and in Denmark. By contrast, relatively low health inequality is observed in the Netherlands and Germany, and also in Italy, Belgium, Spain Austria and Ireland. There is a positive correlation with income inequality per se but the relationship is weaker than in previous research. Health inequality is not merely a reflection of income inequality. A decomposition analysis shows that the (partial) income elasticities of the explanatory variables are generally more important than their unequal distribution by income in explaining the cross-country differences in income-related health inequality. Especially the relative health and income position of non-working Europeans like the retired and disabled explains a great deal of 'excess inequality'. We also find a substantial contribution of regional health disparities to socio-economic inequalities, primarily in the Southern European countries.


Shoulder proprioception in baseball pitchers.
We examined proprioceptive differences between the dominant and nondominant shoulders of 21 collegiate baseball pitchers without a history of shoulder instability or surgery. A proprioceptive testing device was used to measure kinesthesia and joint position sense. Joint position sense was significantly (P =.05) more accurate in the nondominant shoulder than in the dominant shoulder when starting at 75% of maximal external rotation and moving into internal rotation. There were no significant differences for proprioception in the other measured positions or with kinesthesia testing. Six pitchers with recent shoulder pain had a significant (P =.04) kinesthetic deficit in the symptomatic dominant shoulder compared with the asymptomatic shoulder, as measured in neutral rotation moving into internal rotation. The net effect of training, exercise-induced laxity, and increased external rotation in baseball pitchers does not affect proprioception, although shoulder pain, possibly due to rotator cuff inflammation or tendinitis, is associated with reduced kinesthetic sensation.


[Comparison between the diagnosis of attention deficit hyperactivity disorder with the DSM-5 and neuropsychological evaluation of the executive functions].
The attention deficit-hyperactivity disorder (ADHD) has a prevalence among 3-7% in scholar population and it is associated with learning disabilities and executive dysfunctions. To study the relationship between the ADHD diagnostic through DSM-5 criteria and the neuropshychology evaluation of executive functions. The sample of this study consisted in 50 subjects, 12 females and 38 males, with an age between 8 and 10 years old. To evaluate the inhibitory control, we used the Stroop Test and the Continuous Performance Test (CPT), to evaluate intelligence and working memory we use the Wechsler Intelligence Scale WISC-IV, to evaluate attention we used the CPT and Selective Attention Test. There weren't significant differences between both subtypes of ADHD regarding working memory, on the other hand the female group had better abilities in cognitive flexibility task than males and subjects diagnosed with combined ADHD had more difficulties in inhibitory control. We can confirm that the definition of ADHD in DSM-5 isn't enough as them are imprecise. Therefore, the disease definition it's performed by a specific evaluation of attention and inhibitory control mechanisms and its necessary a neuropshychological evaluation of these brain functions.


Low‑dose halofuginone inhibits the synthesis of type I collagen without influencing type II collagen in the extracellular matrix of chondrocytes.
Full‑thickness and large area defects of articular cartilage are unable to completely repair themselves and require surgical intervention, including microfracture, autologous or allogeneic osteochondral grafts, and autologous chondrocyte implantation. A large proportion of regenerative cartilage exists as fibrocartilage, which is unable to withstand impacts in the same way as native hyaline cartilage, owing to excess synthesis of type I collagen in the matrix. The present study demonstrated that low‑dose halofuginone (HF), a plant alkaloid isolated from Dichroa febrifuga, may inhibit the synthesis of type I collagen without influencing type II collagen in the extracellular matrix of chondrocytes. In addition, HF was revealed to inhibit the phosphorylation of mothers against decapentaplegic homolog (Smad)2/3 and promoted Smad7 expression, as well as decrease the synthesis of type I collagen synthesis. Results from the present study indicated that HF treatment suppressed the synthesis of type I collagen by inhibiting the transforming growth factor‑β signaling pathway in chondrocytes. These results may provide an alternative solution to the problems associated with fibrocartilage, and convert fibrocartilage into hyaline cartilage at the mid‑early stages of cartilage regeneration. HF may additionally be used to improve monolayer expansion or 3D cultures of seed cells for the tissue engineering of cartilage.


Altered regulation of contraction-induced Akt/mTOR/p70S6k pathway signaling in skeletal muscle of the obese Zucker rat.
Increased muscle loading results in the phosphorylation of the 70 kDa ribosomal S6 kinase (p70S6k), and this event is strongly correlated with the degree of muscle adaptation following resistance exercise. Whether insulin resistance or the comorbidities associated with this disorder may affect the ability of skeletal muscle to activate p70S6k signaling following an exercise stimulus remains unclear. Here, we compare the contraction-induced activation of p70S6k signaling in the plantaris muscles of lean and insulin resistant obese Zucker rats following a single bout of increased contractile loading. Compared to lean animals, the basal phosphorylation of p70S6k (Thr389; 37.2% and Thr421/Ser424; 101.4%), Akt (Thr308; 25.1%), and mTOR (Ser2448; 63.0%) was higher in obese animals. Contraction increased the phosphorylation of p70S6k (Thr389), Akt (Ser473), and mTOR (Ser2448) in both models however the magnitude and kinetics of activation differed between models. These results suggest that contraction-induced activation of p70S6k signaling is altered in the muscle of the insulin resistant obese Zucker rat.


Cystoscopic stent removal using a guidewire loop.
Stent removal is a simple procedure performed with a rigid cystoscope and a stent removal forceps. In the rare event when the stent removal forceps does not work or breaks down, a guidewire loop can be used to remove the stent.


Combined rehabilitation program for postural instability in progressive supranuclear palsy.
Progressive supranuclear palsy (PSP) is an atypical parkinsonism clinically characterized by prominent axial extrapyramidal motor symptoms with frequent falls. The clinical response to L-dopa is poor and there is strong need for alternative treatment strategies. We tested the efficacy of a rehabilitative program combining a dynamic antigravity postural system (SPAD) and a vibration sound system (ViSS) on postural instability of 10 patients affected by PSP. The patients underwent SPAD and VISS treatments with a 3 sessions/week schedule for 2 months. Patients were clinically examined at baseline, every week during the 2-months treatment, and at 1 month after the end of treatment for the following parameters: baropodometry static, baropodometry dynamic and stabilometry. PSP rating scale and PD36 quality of life scale were also administered. The combined rehabilitative program produced improvement of all the parameters explored (p = 0.01-0.05) at the end of treatment as compared to baseline. Baropodometric dynamics improvement lasted until the end of follow-up. Our results suggest that a specific rehabilitation program could improve postural instability in PSP patients. A more continuous treatment protocol would allow stabilizations of results.


Feto-placental vascular dysfunction as a prenatal determinant of adult cardiovascular disease.
Low birthweight is associated with increased rates of coronary heart disease, stroke, hypertension and non-insulin-dependent diabetes during adult life. This is thought to be the consequence of a 'programming', whereby a stimulus or insult at a critical, sensitive period of early life has permanent effects on structure, physiology and metabolism. Programming of the fetus may, hence, result from adaptations to a condition where placental nutrient supply fails to match fetal demand. Recently, compensatory feto-placental up-regulation of the nitric oxide system during fetal growth restriction (FGR) was shown. Particularly, restricted hypoxic fetuses present an elevation of nitrites and a reduction of asymmetric dimethylarginine. S-nitrosohemoglobin is consumed under hypoxic conditions. These events are followed by nitric oxide pathway down-regulation postnatally, increasing susceptibility to cardiovascular disorders later in life. The relative hyperoxia would favor any such occurrence through depletion of tetrahydrobiopterin secondary to oxygen radical formation. This concept may lead to new therapeutic strategies, based on tetrahydrobiopterin supplementation, free-radical scavenging, L-arginine administration and/or inhaled NO therapy in FGR hypoxic newborns, to improve their postnatal adaptation and to reduce the risk of metabolic pathologies in adult age.


Identifying target reference points for harvesting assessment-limited wildlife populations: a case study.
Identifying appropriate strategies for sustainable harvest is a challenge for many terrestrial vertebrate species because of uncertain system dynamics, limited data to inform population models, and potentially conflicting objectives that seek to harvest and maintain populations at desirable levels. The absence of monitoring and assessment infrastructure needed to regularly estimate abundance accentuates this challenge for many species, and limits application of rigorous state-dependent frameworks for decision making that are commonly advocated in natural resource management. Reference points, which define management targets or triggers for changing management, are often used to guide decision-making, but suffer from ambiguity when developed without explicit consideration of uncertainty or trade-offs among competing objectives. We describe an approach for developing unambiguous target reference points for assessment-limited species using structured decision making, and demonstrate the approach to develop target harvest rates for management of fall Wild Turkey (Meleagris gallopavo) harvests in the face of uncertain population and harvest dynamics. We use simulation and decision analyses to identify harvest rates that are optimal for accomplishing explicit management objectives in the face of uncertainty, and harvest rates with robust performance over broad regions of the demographic and harvest model parameter space. We demonstrate that population and harvest parameters commonly uncertain to wildlife managers interact to determine appropriate target harvest rates for Wild Turkeys, and that formally acknowledging a range of plausible values for structurally uncertain parameters results in more conservative target reference points than suggested by previously published studies. The structured decision making framework described here provides a natural conceptual and quantitative framework for extending our approach to develop unambiguous harvest targets for other assessment-limited wildlife populations while formally acknowledging structural uncertainty in system dynamics.


Keeping an eye on eye care: monitoring progress towards effective coverage.
The eye care sector is well positioned to contribute to the advancement of universal health coverage within countries. Given the large unmet need for care associated with cataract and refractive error, coupled with the fact that highly cost-effective interventions exist, we propose that effective cataract surgery coverage (eCSC) and effective refractive error coverage (eREC) serve as ideal indicators to track progress in the uptake and quality of eye care services at the global level, and to monitor progress towards universal health coverage in general. Global targets for 2030 for these two indicators were endorsed by WHO Member States at the 74th World Health Assembly in May, 2021. To develop consensus on the data requirements and methods of calculating eCSC and eREC, WHO convened a series of expert consultations to make recommendations for standardising the definitions and measurement approaches for eCSC and eREC and to identify areas in which future work is required.


QT spatial dispersion and sudden cardiac death in hypertrophic cardiomyopathy: Time for reappraisal.
The 12-lead surface electrocardiographic (ECG) analysis is able to provide independent predictors of prognosis in several cardiovascular settings, including hypertrophic cardiomyopathy (HCM). The present single-center study investigated the possible ability of several ECG-derived variables in stratifying sudden cardiac death (SCD) risk and, possibly, in improving the accuracy of the 2014 European Society of Cardiology guidelines. A total of 221 consecutive HCM outpatients were recruited and prospectively followed. All of them underwent a full clinical and instrumental examination, including a 12-lead surface ECG to calculate the dispersion for the following intervals: QRS, Q-Tend (QT), Q-Tpeak (QTp), Tpeak-Tend (TpTe), J-Tpeak (JTp), and J-Tend (JT). The study composite end-point was SCD, aborted SCD, and appropriate implantable cardioverter defibrillator (ICD) interventions. During a median follow-up of 4.4 years (25th-75th interquartile range: 2.4-9.4 years), 23 patients reached the end-point at 5-years (3 SCD, 3 aborted SCD, 17 appropriate ICD interventions). At multivariate analysis, the spatial QT dispersion corrected according to Bazett's formula (QTcd) remains independently associated to the study endpoint over the HCM Risk-SCD score (C-index 0.737). A QTcd cut-off value of 93ms showed the best accuracy in predicting the SCD endpoint within the entire HCM study cohort (sensitivity 56%, specificity 75%, positive predictive value 22%, negative predictive value 97%). Our data suggest that the QTcd might be helpful in SCD risk stratification, particularly in those HCM categories classified at low-intermediate SCD risk according to the contemporary guidelines.


Dorsal Spanning Plate for Perilunate Dislocations.
Purpose The purpose of this study was to compare radiographic outcomes in patients treated with the traditional method of open reduction, internal fixation (ORIF) and casting as compared with those treated with ORIF and dorsal spanning plate (DSP) fixation. We hypothesized that the application of a DSP to augment the repair of perilunate dislocations would maintain carpal stability while also allowing early loadbearing through the carpus. Materials and Methods This is a retrospective radiographic review of patients with a perilunate dislocation, who were treated with ORIF and casting or ORIF with a dorsal spanning plate between 2012-2018. Scapholunate (SL) and lunotriquetral (LT) intervals were measured immediately after the index surgery and after scheduled hardware removal. A total of 28 patients met inclusion criteria, including 13 cases with traditional treatment and 15 cases with dorsal spanning plate fixation. Results Comparison of the change in SL interval and LT interval between the 13 patients in the traditional treatment group and the 15 patients in the DSP group did not yield any clinically relevant variation after statistical analysis. Both groups demonstrated minimal change in the radiographic markers of carpal stability from postoperative radiographs obtained immediately after the index repair and after the removal of hardware. Conclusion DSP fixation placed at the index surgery with early loadbearing for the treatment of perilunate dislocation is not inferior to the current mainstay of treatment consisting of cast immobilization without loadbearing and does not confer any increased carpal instability in comparison to ORIF and casting.


Biodegradable polymer nanofiber mesh to maintain functions of endothelial cells.
Maintaining functions of endothelial cells in vitro is a prerequisite for effective endothelialization of biomaterials as an approach to prevent intimal hyperplasia of small-diameter vascular grafts. The aim of this study was to design suitable nanofiber meshes (NFMs) that further maintain the phenotype and functions of human coronary artery endothelial cells (HCAECs). Collagen-coated random and aligned poly(L-lactic acid)-co-poly(epsilon-caprolactone) (P(LLA-CL)) NFMs were fabricated using electrospinning. Mechanical testing showed that tensile modulus and strength were greater for the aligned P(LLA-CL) NFM than for the random NFM. Spatial distribution of the collagen in the NFMs was visualized by labeling with fluorescent dye. HCAECs grew along the direction of nanofiber alignment and showed elongated morphology that simulated endothelial cells in vivo under blood flow. Both random and aligned P(LLA-CL) NFMs preserved phenotype (expression of platelet endothelial cell adhesion molecule-1, fibronectin, and collagen type IV in protein level) and functions (complementary DNA microarray analysis of 112 genes relevant to endothelial cell functions) of HCAECs. The P(LLA-CL) NFMs are potential materials for tissue-engineered vascular grafts that may enable effective endothelialization.


Biological activities of 2-styrylchromones.
2-Styrylchromones (2-SC) are chromone derivatives characterized by the attachment of a styryl group to the 2-position of the chromone structure. The 2-styrylchromone structure has been demonstrated to bear important biological activities such as antiallergic, antitumor, affinity and selectivity for A(3) adenosine receptors, antiviral, antioxidant and anti-inflammatory. The aim of the present paper was to review the available information on this field.


[Treatment of post-dural-puncture headache with intravenous cortisone].
Postdural puncture headache (PDPH) is the most frequent complication of procedures involving dural penetration for spinal anesthesia or following unintentional dural puncture during attempted epidural anesthesia or analgesia. PDPH causes serious problems for women who have just given birth, as they are unable to give adequate care to their infants. The causes of PDPH are poorly understood and treatments are therefore various and symptomatic; most are empirical and not all are effective. When conservative measures fail, an alternative that may be proposed is the blood patch, an invasive technique which is not without risk and which many patients reject. We report three cases of incapacitating PDPH in women after vaginal or caesarian delivery in which symptoms resolved with intravenous hydrocortisone treatment. Hydrocortisone treatment for PDPH has never been reported in the literature, but given our results, we consider that clinical trials are warranted to establish the efficacy of this treatment and to determine if there is a chance that it might offer an alternative to the blood patch.


Recurrent hyperthyroidism after thyroidectomy.
For 53 patients with toxic recurrent goiter (TRG), the interval between thyroidectomy and recurrent hyperthyroidism range from six months to 50 years (average, 12.4 +/- 11.9 years). Recurrent hyperthyroidism may occur in older patients for whom cardiac decompensation may be the initial manifestation. Reports on surgically treated hyperthyroid patients may underestimate the incidence of TRG unless follow-up is extended for many years.


Analysis of occupational injuries in the sea fishing industry according to the type of fishery and the fishing activity.
Sea fishing is one of the most dangerous occupations. Numerous studies have already sought to evaluate the risk level of this occupation through the analysis of the frequency and seriousness of occupational injuries. The purpose of the present study is to analyse these accidents in terms of two main characteristics of the vessels involved: the fishery type (high seas, offshore, coastal, or inshore fishery) and the fishing activity (use of passive or active gears). Injury rates were calculated for the Brittany region and for the year 2012. A second analysis was carried out on 8,286 reported injuries that occurred in France from 2002 to 2012, while vessels were in the process of fishing. This first analysis shows that the incidence rate is very high (103 per 1,000 full-time equivalent fishermen) and that it depends more on the fishery type than on the fishing activity; the highest rates concern the offshore and the coastal fleets. Results of the second analysis show that the nature of accidents depends more on the fishing activity than on the type of fishery. These findings lead to a discussion of the causes of the highest incidence rate values and the causes of the observed variations. The discussion also involves the methodological difficulties related to the incidence rate calculations.


Commentary on small-volume biopsy of follicular lymphoma: Practical issues in the molecular era.
Follicular lymphoma (FL) is a common subtype of non-Hodgkin lymphoma derived from germinal center B-cells. Small-volume biopsies (SVBs), including fine-needle aspiration, needle core biopsy, and cell blocks, are often used for the assessment of patients with FL. Recently, Fitzpatrick et al. found that additional biopsies were frequently needed to supplement SVB for the initial diagnosis of FL. However, regardless of the type of SVB used, additional biopsies were usually not necessary for assessments for transformed or recurrent FL. Their multi-institutional study reflects the fact that SVB may be sufficient for clinical decision-making in these medical settings, although surgical excision is the gold standard for a definitive diagnosis of FL. With ancillary tests and advances in molecular testing, SVB has become increasingly popular and helpful, although there are practical limitations.


Long term iNOS expression in thoracic lymph nodes of silicotic rats.
Beside the lung, thoracic lymph nodes are most affected during silicosis. The mechanisms leading to enlargement of the lymph nodes and partial activation of lymph node cells are still unclear. The present study demonstrates an increase in iNOS mRNA expression in the lung draining lymph nodes of rats at 1, 2, and 8 months following silica exposure. Histopathological analysis revealed that iNOS protein was exclusively expressed by macrophages located within the granulomatous areas of the enlarged lymph nodes. In contrast, no differences in mRNA expression and number of iNOS-positive cells were found in the lungs of silica-exposed and non-exposed rats. In vitro experiments showed that silica particles alone did not induce NO release in primary alveolar macrophages (AMs) or the alveolar macrophage cell line NR8383. However, the addition of interferon (IFN)-gamma led to a significant nitric oxide production by primary AMs. NR8383 cells responded only when a combination of IFN-gamma and silica particles was applied. These results indicate that the macrophage activator IFN-gamma, which has already been shown to be expressed at elevated levels by lymphocytes of the silicotic lymph nodes, may be responsible for the long-lasting iNOS expression in thoracic lymph nodes. Our observations support the hypothesis that the mutual activation of lymphocytes and macrophages is a central process in the development of chronic silicosis.


Close association of a DNA replication origin and an ARS element on chromosome III of the yeast, Saccharomyces cerevisiae.
Two dimensional gel electrophoretic techniques were used to locate all functional DNA replication origins in a 22.5 kb stretch of yeast chromosome III. Only one origin was detected, and that origin is located within several hundred bp of an ARS element.


Implications for human leukocyte antigen antibodies after lung transplantation: a 10-year experience in 441 patients.
Long-term survival after lung transplant is limited by the development of chronic and progressive airflow obstruction, a condition known as bronchiolitis obliterans syndrome (BOS). While prior studies strongly implicate cellular rejection as a strong risk factor for BOS, less is known about the clinical significance of human leukocyte antigen (HLA) antibodies and donor HLA-specific antibodies in long-term outcomes. A single-center cohort of 441 lung transplant recipients, spanning a 10-year period, was prospectively screened for HLA antibodies after transplant using flow cytometry-based methods. The prevalence of and predictors for HLA antibodies were determined. The impact of HLA antibodies on survival after transplant and the development of BOS were determined using Cox models. Of the 441 recipients, 139 (32%) had detectable antibodies to HLA. Of these 139, 54 (39%) developed antibodies specific to donor HLA. The detection of posttransplant HLA antibodies was associated with BOS (HR, 1.54; P=.04) and death (HR, 1.53; P=.02) in multivariable models. The detection of donor-specific HLA antibodies was associated with death (HR, 2.42; P<.0001). The detection of posttransplant HLA antibodies was associated with pretransplant HLA-antibody detection, platelet transfusions, and the development of BOS and cytomegalovirus pneumonitis. Approximately one-third of lung transplant recipients have detectable HLA antibodies, which are associated with a worse prognosis regarding graft function and patient survival.


Binding of uridine 5'-diphosphate in the "basic patch" of the zinc deacetylase LpxC and implications for substrate binding.
LpxC is a zinc metalloenzyme that catalyzes the first committed step in the biosynthesis of lipid A, a vital component of the outer membrane of Gram-negative bacteria. Accordingly, the inhibition of LpxC is an attractive strategy for the treatment of Gram-negative bacterial infections. Here, we report the 2.7 A resolution X-ray crystal structure of LpxC from Aquifex aeolicus complexed with uridine 5'-diphosphate (UDP), and the 3.1 A resolution structure of LpxC complexed with pyrophosphate. The X-ray crystal structure of the LpxC-UDP complex provides the first view of interactions likely to be exploited by the substrate UDP group in the "basic patch" of the active site. The diphosphate group of UDP makes hydrogen bond interactions with strictly conserved residue K239 as well as solvent molecules. The ribose moiety of UDP interacts with partially conserved residue E197. The UDP uracil group hydrogen bonds with both the backbone NH group and the backbone carbonyl group of E160, and with the backbone NH group of K162 through an intervening water molecule. Finally, the alpha-phosphate and uracil groups of UDP interact with R143 and R262 through intervening water molecules. The structure of LpxC complexed with pyrophosphate reveals generally similar intermolecular interactions in the basic patch. Unexpectedly, diphosphate binding in both complexes is accompanied by coordination to an additional zinc ion, resulting in the identification of a new metal-binding site termed the E-site. The structures of the LpxC-UDP and LpxC-pyrophosphate complexes provide new insights with regard to substrate recognition in the basic patch and metal ion coordination in the active site of LpxC.


Inverse scattering from phaseless measurements of the total field on open lines.
A new solution approach to inverse scattering from aspect-limited phaseless measurements of the total field is introduced and discussed. In analogy with the case of measurements on closed curves [J. Opt. Soc. Am. A21, 622 (2004)], the procedure splits the problem into two different steps. In the first step, amplitude and phase of the scattered field are estimated from only amplitude information of the total field. By properly extending the concept of reduced radiated field to the case of scattered fields (as a function of both illumination and measurement variables) and taking advantage of the properties of the square amplitude distribution of the total field, criteria are given for an optimal choice of the measurement setup and a successful retrieval. Then the complex permittivity profile is reconstructed in the second step, starting from the scattered fields estimated in the previous step. Numerical examples are provided to assess the effectiveness of the whole chain in the presence of noise-corrupted data and the relevance of the representation introduced for the scattered fields.


Why urban voluntary hospitals close.
In this paper, we argue for the importance of understanding hospital closings and relocations. Broad descriptive data on closings, relocations, and other reconfigurations of beds in 52 large and mid-size U.S. cities are presented. The period covered is 1937 to 1980. Two contrasting outlooks on hospital closings and relocations are offered. As hypothesized, smaller and less specialized nonteaching hospitals and those located in minority neighborhoods or serving above-average proportions of minority or Medicaid-funded patients were more likely to close. A potentially more effective but more costly and less accessible system of urban health care appears to result.


Cytotoxicity of Endoperoxides from the Caribbean Sponge Plakortis halichondrioides towards Sensitive and Multidrug-Resistant Leukemia Cells: Acids vs. Esters Activity Evaluation.
The 6-epimer of the plakortide H acid (1), along with the endoperoxides plakortide E (2), plakortin (3), and dihydroplakortin (4) have been isolated from a sample of the Caribbean sponge Plakortis halichondrioides. To perform a comparative study on the cytotoxicity towards the drug-sensitive leukemia CCRF-CEM cell line and its multi-drug resistant subline CEM/ADR5000, the acid of plakortin, namely plakortic acid (5), as well as the esters plakortide E methyl ester (6) and 6-epi-plakortide H (7) were synthesized by hydrolysis and Steglich esterification, respectively. The data obtained showed that the acids (1, 2, 5) exhibited potent cytotoxicity towards both cell lines, whereas the esters showed no activity (6, 7) or weaker activity (3, 4) compared to their corresponding acids. Plakortic acid (5) was the most promising derivative with half maximal inhibitory concentration (IC50) values of ca. 0.20 µM for both cell lines.


EOS1, whose deletion confers sensitivity to oxidative stress, is involved in N-glycosylation in Saccharomyces cerevisiae.
The deletion strain of Saccharomyces cerevisiae YNL080c (designed as EOS1) was identified as a strain sensitive to high-sucrose stress in our previous report [A. Ando, F. Tanaka, Y. Murata, H. Takagi, J. Shima, Identification and classification of genes required for tolerance to high sucrose stress revealed by genome-wide screening of Saccharomyces cerevisiae, FEMS Yeast Res. 6 (2006) 249-267]. Delta eos1 showed higher sensitivity to oxidative stress than to high-sucrose stress. Immunofluorescence microscopic and cellular fractionation analyses suggested that Eos1 localizes in the endoplasmic reticulum membrane. We found that the deletion of EOS1 enhances tunicamycin tolerance and that in Delta eos1 the transcription level of KAR2, which is the ER stress-inducible gene, was much lower than that in the wild-type strain (BY4741) when exposed to tunicamycin. The inhibition of the N-glycosylation of carboxypeptidase Y and invertase activity caused by the addition of tunicamycin was depressed in Delta eos1, suggesting that EOS1 may be involved in N-glycosylation of the cellular proteins.


Mortality causes and trends associated with giant cell arteritis: analysis of the French national death certificate database (1980-2011).
Comprehensive analyses of cause-specific death patterns in GCA are sparse. We studied the patterns and time trends in GCA-related mortality using a large death certificate database. We obtained multiple-cause-of-death data from the French national death certificate database for 1980-2011. GCA-associated deaths were defined as decedents ⩾55 years old with GCA listed as an underlying or non-underlying cause of death. Time trends of death rates were analysed and the mean age at death with GCA and in the general population ⩾55 years old were calculated. Standardized mortality odds ratios (SMORs) were calculated for 17 selected causes of death (based on 2000-11 data). The analyses pertained to approximately 15 000 death certificates listing GCA (including approximately 6300 for 2000-11). Annual standardized death rates for GCA increased to a peak in 1997 and then decreased (Spearman's correlation test, both P < 0.0001). Mean age at death was higher for GCA than for general population decedents (Student's t-test, P < 0.0001). GCA deaths were frequently or strongly associated with aortic aneurysm and dissection (1.85% of death certificates, SMOR: 3.09, 95% CI: 2.48, 3.82), hypertensive disease (20.78%, SMOR: 2.22, 95% CI: 1.97, 2.50), diabetes mellitus (11.27%, SMOR: 1.96, 95% CI: 1.72, 2.23), certain infectious and parasitic diseases (12.12%, SMOR: 1.76, 95% CI: 1.55, 2.00) and ischaemic heart disease (16.54%, SMOR: 1.45, 95% CI: 1.35, 1.64). GCA is associated with increased risk of dying from large-vessel disease, other cardiovascular diseases and potentially treatment-related co-morbidities. These findings help provide better insights into the outcomes of GCA.


[External fixation as an aid in plastic surgery].
Today, reconstructive surgery knows many different skin flaps for treating soft tissue defects. The advantages of Hoffmann's external anchorage are demonstrated by immobilizing skin flaps during their process of healing.


The outcome of triplet pregnancies at Hartford Hospital--1989-1996.
The advent of artificial induction of ovulation has increased the incidence of triplet pregnancies. Although the outcome of triplet pregnancies has improved through advanced technology, several studies have suggested that triplets conceived by artificial induction of ovulation have worse prenatal and perinatal outcomes than those conceived naturally. Our study examined the outcome of 14 sets of triplets conceived at Hartford Hospital between 1989 and 1996. Five of 14 sets of triplets were conceived by artificial methods and nine of 14 were conceived naturally. The mean gestational age was 31.8 weeks for artificially conceived infants vs 29.7 weeks for naturally conceived infants. Average weight at birth was 1.625 kg in the artificially conceived study group and 1.377 kg in the naturally conceived group. Time spent in the neonatal intensive care unit was 4.67 weeks for the artificially conceived study group and 3.57 weeks for the naturally conceived group. It is concluded that there was no difference in outcome in the triplets conceived by artificial induction of ovulation vs natural conception. Maternal age and sex of triplets were important factors determining perinatal outcomes of triplets.


Highly sensitive and rapid gene mapping using miniaturized blot hybridization: application to prenatal diagnosis.
We have developed a protocol for the preparation and analysis of amniocyte DNA which permits more sensitive and more rapid antenatal detection of sickle-cell anemia (SCA) than previously has been possible. After rapid extraction of DNA from amniotic cells, only 50 ng of MstII-digested DNA need be analyzed by mini-gel electrophoresis and hybridization detection to determine reliably the fetal genotype. Under these conditions, the entire gene-mapping procedure can be performed within 5 days. When larger amounts of DNA (greater than 500 ng) are analyzed, the minimal diagnosis time is reduced to 2 days. The resolution of restriction fragments on mini-gels is comparable to that obtained with larger gels. The 1.15-kb betaA and 1.35-kb betaS MstII fragments are well separated. The technique is useful whenever rapid and sensitive analysis of genomic DNA is desired.


Covered stent implantation through a single 8-french guide catheter for the management of a distal coronary perforation.
Distal coronary perforation can cause early or late tamponade and is usually treated with fat or coil embolization. An alternative treatment strategy is occlusion of the ostium of the perforated vessel via implantation of a covered stent in the main vessel, which is typically achieved using the ping-pong guide catheter technique. In this technique, a balloon is inflated over one guide catheter to stop pericardial bleeding and a covered stent is delivered through a second guide catheter due to inability to fit both a balloon and a covered stent through a single guide catheter. With development of lower profile rapid exchange covered stents, a single guide catheter can be used to both occlude the target vessel and deliver the covered stent. We describe a case of distal vessel perforation in which a balloon was inflated to stop pericardial bleeding, followed by delivery of a covered stent (Graftmaster, Abbott Vascular) through a single 8-Fr guide catheter. This "block and deliver" technique represents a novel paradigm for treating coronary perforations through a single guide catheter, obviating the need for the ping-pong guide catheter technique. © 2017 Wiley Periodicals, Inc.


Physicochemical, cooking, and textural characteristics of grains of different rice (Oryza sativa L.) cultivars of temperate region of India and their interrelationships.
The aim of the study was to explore the physiochemical, cooking, and textural characteristics of 12 traditional rice cultivars grown in Kashmir (India) and develop their interrelationship. The results revealed a significant variation (p ≤ .05) among the different characteristics analyzed on the basis of characteristics evaluated for each cultivar. The novel attributes depicted by these cultivars as reflected includes their higher kernel elongation during cooking, lowest solids in gruel loss and lower adhesiveness together with desirable hardness which can fetches their increasing demand commercially besides having lacerative palatability. Pearson correlation and principal component analysis was carried out to elucidate the relationship among physicochemical, cooking, and textural characteristics as analyzed in the experimental study. The physicochemical characteristics such as gelatinization temperature, gel consistency, amylose, and amylopectin showed a significant correlation (positively or negatively) with the cooking and textural characteristics (water uptake ratio, kernel elongation during cooking, elongation ratio, solids in gruel loss, volume expansion ratio, optimum cooking time, hardness, and adhesiveness) with resulting in the selection of desired varieties having improved eating characteristics. The desirable characteristics depicted by these cultivars exploit the agriculturists/institutions to preserve these races and enhance the farmers to cultivate all these cherished rice cultivars. There is increasing demand for rice varieties with excellent quality characteristics throughout the world. It has been observed that the traditional rice cultivars are of immense health benefits which lead to their increasing surge among consumers. Cooking and eating quality (mouth feel characteristics) of rice has a major role in determining its economic value and consumer acceptability. The cultivars explored in this study include traditional pigmented rice cultivars of temperate region of India. The aim was to promote the revival of old cultivars, and also to indicate their beneficial characteristics over hybrid varieties by studying their physiochemical, cooking, and textural characteristics and develop their interrelationship. With this research, the desirable properties of traditional rice cultivars could be exploited that had better characteristics than the hybrid varieties. This in turn led the various agencies to motivate the farmers to encourage their cultivation, provide an essential platform to scientists to inherit their valuable characteristics.


The acute effects of nasal positive pressure ventilation in patients with advanced cystic fibrosis.
To evaluate the acute effects of noninvasive positive pressure ventilation (NPPV) in patients with stable chronic respiratory failure secondary to cystic fibrosis. Eight patients (29+/-5 years of age) with severe airflow limitation (mean FEV1, 24+/-3% predicted) and chronic respiratory failure (PaO2=67+/-15 mm Hg and PaCO2=50+/-4 mm Hg) were evaluated. Tidal volume, respiratory rate, minute ventilation, oxygen saturation, and transcutaneous CO2 (TcCO2) measurements were made over a 20-min period before and after the application of NPPV (inspiratory pressure of 10 to 12 cm H2O and expiratory pressure of 4 to 6 cm H2O). NPPV increased saturation from 88+/-2% to 90+/-1% (p<0.05) and decreased TcCO2 from 51+/-3 mm Hg to 50+/-2 mm Hg (p<0.05). Tidal volume increased from 219+/-20 mL to 256+/-37 mL (p=not significant [NS]) and respiratory rate decreased from 24+/-2 to 18+/-1 (p<0.01). Minute ventilation decreased from 5.3+/-0.8 L/min to 4.6+/-0.6 L/min (p=0.08). There was no change in duty cycle (32+/-5% to 34+/-5%, p=NS). In two patients, esophageal pressure measurements were also recorded. There was a decrease in pressure from -21+/-1 cm H2O to -11+/-2 cm H2O and -14+/-1 cm H2O to -7+/-1 cm H2O. In patients with stable, severe cystic fibrosis, NPPV (1) acutely improves gas exchange, (2) decreases minute ventilation, suggesting either a reduction in CO2 production or an increase in alveolar ventilation, and (3) reduces work of breathing.


Formation of DNA adducts by the carcinogen N-hydroxy-2-naphthylamine.
The probable ultimate urinary bladder carcinogen, N-hydroxy-2-naphthylamine (N-OH-2-NA), reacted with nucleic acids and proteins under mildly acidic conditions (pH 5) to form covalently bound derivatives. The extent of reaction was in the order: Polyguanylic acid greater than DNA approximately protein greater than rRNA greater than tRNA greater than polyadenylic acid approximately polyuridylic acid greater than polycytidylic acid. At pH 7, appreciable reaction occurred only with protein. Enzymatic hydrolyses of the DNA, which contained 1.5 naphthyl residues/1,000 nucleotides, yielded 3 nucleoside-arylamine adducts. From chemical, UV, nuclear magnetic resonance, and mass spectrometric analyses, the adducts were identified as 1-(deoxyguanosin-N2-yl)-2-NA, 1-(deoxyadenosin-N6-yl)-2-NA, and a purine ring-opened derivative of N-(deoxyguanosin-8-yl)-2-NA, tentatively identified as 1-[5-(2-6-diamino-4-oxopyrimidinyl-N6-deoxyriboside)]-2-(2-naphthyl)urea. Preliminary experiments with a dog given [3H]2-NA suggested the presence of these adducts in vivo. The properties of adducts derived from N-OH-1-NA and N-OH-2-NA and their possible roles in the initiation of carcinogenesis are discussed.


Polyneuropathy due to cobalamin deficiency in the rat.
In the present study, we investigated the peripheral nervous system (PNS) (both in terms of its ultrastructure and in terms of its function) of rats made cobalamin (Cbl)-deficient either through total gastrectomy or through prolonged feeding on a Cbl-deficient diet. In both these types of Cbl-deficient neuropathies we found: (a) ultrastructurally, intramyelin and endoneural edema, with no or minimal axonal damage in the PNS, in dorsal root ganglia, and the ventral and dorsal rootlets of the spinal cord; (b) electrophysiologically, a significant reduction in the nerve conduction velocity, consistent with that reported in (a); (c) morphometrically, a significant reduction in the density of myelinated fibers both in the sciatic nerve and in the peroneal nerve. All these pathological changes were reversed by chronic postoperative administration of Cbl into totally gastrectomized (TGX)-rats, hinting at the specificity of the damage itself in relation to the permanent Cbl-deficient status of the TGX-rats. No signs of segmental demyelination or remyelination were found. We also observed a turning of type I fibers into type II fibers in the soleus muscle of all our Cbl-deficient rats, however the Cbl deficiency had been induced. This muscular change was still present in TGX- and Cbl-treated rats, and it cannot be related to a malnutrition status, since it has been observed also in rats fed a Cbl-deficient diet. All these results demonstrate that Cbl deficiency strongly affects rat PNS within different parameters.


Access to Routinely Collected Clinical Data for Research: A Process Implemented at an Academic Medical Center.
Electronic health records are valuable for clinical and translational research. Institutions must protect patient privacy and comply with applicable regulations while allowing appropriate access to clinical data for research. The processes that investigators must follow to access clinical data can be substantially different at different institutions. In this paper, we describe the process developed at our institution that has been active for 5 years and was used to satisfy over 200 requests for access to identified clinical data, usually within 1 day for internal requests and 3 days for visiting researchers.


Effect of mesenchymal stromal cell transplantation on long-term survival in amyotrophic lateral sclerosis.
Thanks to their immunomodulatory, tissue-protective and regenerative properties, mesenchymal stromal cells (MSCs) are a promising approach for amyotrophic lateral sclerosis (ALS); however, trials are limited and few follow-up studies have been published. This post-hoc analysis aims to describe the potential long-term effects of MSCs in ALS, analyzing data from two phase 1 clinical trials in ALS patients conducted by our group in 2002 and 2006. We conducted two consecutive phase 1 prospective, open, pilot clinical trials, enrolling a total of 19 ALS patients. We followed patients for the duration of the disease. For each patient, we used the European Network to Cure ALS (ENCALS) survival prediction model to retrospectively calculate the expected survival at diagnosis. We then compared the predicted disease duration with the observed survival, analyzing patients at a single-patient level. Using the ENCALS model, we predicted short survival in one patient, intermediate survival in three patients, long survival in three patients and very long survival in 12 patients. The difference between predicted and observed survival for the whole group was significant and demonstrated a mean predicted survival of 70.79 months (standard deviation [SD], 27.53) and a mean observed survival of 118.8 months (SD, 89.26) (P = 0.016). Based on the monthly ALS Functional Rating Scale-Revised progression rate (median, 0.64/month), we considered 10 of 19 patients slow progressors and nine of 19 patients fast progressors. Of the slow progressors, eight of 10 (80%) had significantly increased disease duration compared with predicted, and only two (20%) had decreased estimated disease duration. By contrast, five of nine (55%) fast progressors had increased disease duration, whereas four (45%) had decreased disease duration. To date, four patients are still alive. The current study represents the first very long-term analysis of survival as an effect of MSC focal transplantation in the central nervous system of ALS patients, demonstrating that MSC transplantation could potentially slow down ALS progression and improve survival. Due to the interindividual variability in clinical course, at the current state of our knowledge, we cannot generalize the results, but these data provide new insights for planning the next generation of efficacy MSC clinical trials in ALS.


Effect of spray volume on the deposition, viability and infectivity of entomopathogenic nematodes in a foliar spray on vegetables.
Spray volume can influence the amount of free water on the leaf surface and subsequently the ability of entomopathogenic nematodes (EPNs) to move. In this study, an investigation was made of the effect of spray volume (548, 730 and 1095 L ha(-1) ) on the deposition, viability and infectivity of EPNs against Galleria mellonella on savoy cabbage, cauliflower and leek. Increasing spray volume decreased nematode deposition on 7.1 cm2 leek leaf discs at a 15° angle with the spray nozzle. Although the number of living nematodes observed on leek after 240 min of exposure was not significantly different between the low-volume application (548 L ha(-1) ) and the high-volume application (1095 L ha(-1) ), a greater infectivity was obtained in the latter application. The higher number of droplets deposited on the leek discs in the high-volume application may have stimulated nematode movement. No significant effect of spray volume was observed on the relative deposition of Steinernema carpocapsae on the bottom side of cauliflower and savoy cabbage leaf discs. In spite of the low S. carpocapsae deposition on the bottom side of the savoy cabbage discs, high infectivity was obtained against G. mellonella. Using the lowest spray volume on savoy cabbage, infectivity decreased with increasing exposure time, while infectivity was not affected by exposure time when a spray volume of 730 L ha(-1) or more was used. Spray volume is an important application parameter, as it affects nematode infectivity. Future research should investigate the effect of spray volume in the field and its influence on the effect of adjuvants.


[The predictive value of a risk assessment tool for falls in elderly hospitalized patients].
Falls represent a significant problem in acute care settings, and are responsible of severe complications, especially in older adults. Although the literature has suggested a large number of instruments for the assessment of fall risk, their validity is questionable. A prospective cohort study was designed to test the performance of FRASS (Fall Risk Assessment Scoring System) in identifying at risk patients. All patients aged > 65 years admitted to seven Medical Units of Bergamo Hospital (Italy) between November 1, 2007 and January 31, 2008 were screened with the FRASS. Falls occurred in 16/564 (2.8%) patients. FRASS sensitivity and specificity were low (50% and 59%, respectively). Since this instrument classifies too many patients who do not fall as at risk, and some patients who fall at no risk, its implementation in our hospital cannot be recommended.


Photosensitive polymeric materials for two-photon 3D WORM optical data storage systems.
We report the photochemistry and development of a fluorescence readout-based, nonlinear absorption, three-dimensional optical data storage system. In this system, writing was achieved by acid generation upon two-photon absorption (2PA) of a photoacid generator (PAG; at 710 or 730 nm). Readout was then performed by interrogating two-photon-absorbing dyes, after protonation, at 860 nm. Linear and nonlinear photophysical characterization of 2PA PAGs and acid-sensitive fluorescent dyes demonstrates good spectral resolution between the PAG and protonated 2PA dye and relatively high two-photon absorptivity. Solution spectroscopic studies confirm photoacid generation and dye protonation. Two-photon recording and readout of voxels were demonstrated in five and eight consecutive, crosstalk-free layers within a polymer matrix, generating a data storage capacity of up to 1.8 x 10(13) bits/cm(3).


Evidence for post-translational processing of auriculin B to atriopeptin III immediately prior to secretion by hypothalamic neurons in culture.
In rats, the precursor of atrial natriuretic peptide (ANP) is produced and processed into its smaller congeners in the heart and the brain. We have demonstrated that a congener of ANP, auriculin B (ANP4-28), was present in long term monolayer cultures of neonatal rat hypothalamic neurons. In addition, forskolin and 3-isobutyl-1-methyl-xanthine (IBMX) augmented the cellular content of auriculin B in a dose dependent manner. Thus, cyclic AMP may act as an intracellular signal for modulating the functional development of hypothalamic immunoreactive (ir) ANP producing neurons. Furthermore, our data suggest that the form of ANP released from these cultures, following either forskolin treatment alone or forskolin treatment followed by acute high potassium depolarisation, was atriopeptin III (ANP5-28). Thus atriopeptin III, rather than auriculin B, may represent the endogenous ligand for ANP receptors in the central nervous system.


Three-dimensional joint reaction forces and moments at the low back during over-ground walking in persons with unilateral lower-extremity amputation.
Abnormal mechanics of locomotion following lower-extremity amputation are associated with increases in trunk motion, which in turn may alter loads at the low back due to changes in inertial and gravitational demands on the spine and surrounding trunk musculature. Over-ground gait data were retrospectively compiled from two groups walking at similar self-selected speeds (~1.35m/s): 40 males with unilateral lower-extremity amputation (20 transtibial, 20 transfemoral) and 20 able-bodied male controls. Three-dimensional joint reaction forces and moments at the low back (L5/S1 spinal level) were calculated using top-down and bottom-up approaches. Peak values and the timings of these were determined and compared between and within (bilaterally) groups, and secondarily between approaches. Peak laterally-directed joint reaction forces and lateral bend moments increased with increasing level of amputation, and were respectively 83% and 41% larger in prosthetic vs. intact stance among persons with transfemoral amputation. Peak anteriorly-directed reaction forces and extension moments were 31% and 55% larger, respectively, among persons with transtibial amputation compared to controls. Peak vertical reaction forces and axial twist moments were similar between and within groups. Peak joint reaction forces and moments were larger (3-14%), and the respective timing of these sooner (11-62ms), from the bottom-up vs. top-down approach. Increased and asymmetric peak reaction forces and moments at the low back among persons with unilateral lower-extremity amputation, particularly in the frontal plane, suggest potential mechanistic pathways through which repeated exposure to altered trunk motion and spinal loading may contribute to low-back injury risk among persons with lower-extremity amputation.


Distinct molecular alterations in complex endometrial hyperplasia (CEH) with and without immature squamous metaplasia (squamous morules).
Several molecular alterations, most commonly PTEN mutations but also K-ras mutations, microsatellite instability, and beta-catenin mutations have been detected in endometrioid endometrial carcinoma (EEC). Specifically, mutations in the beta-catenin gene are seen in 15% to 20% of EECs, whereas immunohistochemical expression of beta-catenin ranges from 13% to 44%, nuclear staining being concentrated in areas of immature squamous metaplasia (squamous morules). Complex endometrial hyperplasia with atypia (CEH-A) is a well-known precursor of EEC, which can also show immature squamous metaplasia. In this study, we compared the immunohistochemical and molecular profiles of 13 CEH-A with and 11 CEH-A without squamous morules (SM) for mutations of beta-catenin, PTEN, K-ras, and microsatellite instability (MSI). In all cases of CEH-A with SM, beta-catenin immunostaining showed strong and diffuse nuclear expression in areas of SM and weak to moderate nuclear expression in the glandular component. Six different beta-catenin mutations were found in 7 of 13 cases (54%) (G34E, G34V, S33C, D32Y, S33F, D32A); however, no mutations of the PTEN or K-ras genes were identified. beta-Catenin immunostaining showed focal nuclear staining in only 2 cases of CEH-A without SM. Only 1 case had a beta-catenin mutation (S45A), which was associated with a K-ras mutation (G12D). Another 3 cases had both PTEN and K-ras mutations (C296Stop Ex 8 and G12V, 244del C Ex 7 and G12D, 251ins TGAT Ex 7 and G13D), and one had a PTEN mutation (G230E Ex 7) only. Of all 24 cases, only 1 case of CEH-A without SM showed MSI. In conclusion, marked differences in the molecular profiles regarding beta-catenin, PTEN, and K-ras mutations were observed between CEH-A with and without SM. beta-catenin mutations might represent a signaling pathway leading to a distinctive morphology in hyperplastic/neoplastic endometrium with SM. Other molecular events such as K-ras or PTEN mutations are likely to occur in CEH-A independently from beta-catenin. Furthermore, morphologic differences between CEH-A with SM and CEH-A without SM seem to correlate, at least to some extent, with the clinical course of the disease. In our series, cases of CEH-A with SM and beta-catenin alterations appeared to have a less aggressive behavior when compared with CEH-A without SM and with K-ras and PTEN mutations.


9-Chloro-2,3-dihydro-5H-1,4-dioxepino(6,5-b)benzofuran, a novel antilipidemic agent structurally related to clofibrate.
The synthesis and antilipidemic activity of 9-chloro-2,3-dihydro-5H-1,4-dioxepino[6,5-b]benzofuran (3), a novel enol lactone which is considerably more resistant to serum esterase hydrolysis than clofibrate (1), are discussed. Whereas both 3 and 1 reduced hypercholesterolemic and hypertriglyceridemic serum levels in the Triton WR-1339 induced hyperlipidemic Sprague-Dawley rat to normal, the hydrolysis product of 3, namely 5-chloro-3(2'-hydroxyethoxy)-2-benzofurancarboxylic acid (4), was found to be inactive. Further, 3 is comparable to the hydrolysis product of 1 when both were assessed for their ability to block norepinephrine (NE) induced lipolysis in vitro. 4 is inactive at comparable concentrations (5 times 10(-4)-10(-3) M). The antilipidemic action of 3 and 1 may, in part, be due to their ability to block NE-induced lipolysis.


High prevalence of Enterocytozoon bieneusi zoonotic genotype D in captive golden snub-nosed monkey (Rhinopithecus roxellanae) in zoos in China.
Enterocytozoon bieneusi is the dominant specie of microsporidia which can infect both anthroponotic and zoonotic species. The golden snub-nosed monkey is an endangered primate which can also infect by E. bieneusi. To date, few genetic data on E. bieneusi from golden snub-nosed monkeys has been published. Therefore, to clarify the prevalence and genotypes of E. bieneusi in captive golden snub-nosed monkeys is necessary to assess the potential for zoonotic transmission. We examined 160 golden snub-nosed monkeys from six zoos in four cities in China, using PCR and comparative sequence analysis of the ribosomal internal transcribed spacer (ITS). The overall prevalence of E. bieneusi was 46.2% (74/160); while the prevalence was 26.7%, 69.1%, 69.4% and 33.3% in Shanghai Zoo, Shanghai Wild Animal Park, Tongling Zoo, and Taiyuan Zoo respectively (P = 0.006). A total of seven E. bieneusi genotypes were found that included four known (D, J, CHG1, and CHG14) and three new (CM19-CM 21) genotypes. The most common genotype was D (54/74, 73.0%), followed by J (14/74, 18.9%); other genotypes were restricted to one or two samples. Phylogenetic analysis revealed that genotype D belonged to the previously-characterized Group 1, with zoonotic potential; whereas genotypes J, CHG1, CHG14 and CM19-CM 21 clustered in the previously-characterized Group 2, the so-called cattle host specificity group. The findings of high prevalence of zoonotic E. bieneusi genotypes D and J in golden snub-nosed monkeys suggest that golden snub-nosed monkeys may be the reservoir hosts for human microsporidiosis, and vice versa.


Ventricular tachycardia and fibrillation in normal hearts.
Although ventricular tachyarrhythmias usually occur in the setting of definable heart disease, up to 15% of ventricular tachycardias and 10% of ventricular fibrillation occur in patients without heart disease. Of the various clinical entities comprising these idiopathic ventricular tachyarrhythmias, a few well-defined clinical syndromes have been described, such as idiopathic right ventricular outflow tract tachycardia, idiopathic left posterior fascicular ventricular tachycardia, and the right bundle branch block and ST segment elevation syndrome of idiopathic ventricular fibrillation. Many advances have been made in the past few years in our understanding and treatment of idiopathic ventricular tachyarrhythmias, and these advances are the subject of this review.


Aberrant Expression of High Mobility Group Box Protein 1 in the Idiopathic Inflammatory Myopathies.
High Mobility Group Box Protein 1 (HMGB1) is a DNA-binding protein that exerts inflammatory or pro-repair effects upon translocation from the nucleus. We postulate aberrant HMGB1 expression in immune-mediated necrotising myopathy (IMNM). Herein, we compare HMGB1 expression (serological and sarcoplasmic) in patients with IMNM with that of other myositis subtypes using immunohistochemistry and ELISA. IMNM (n = 62) and inclusion body myositis (IBM, n = 14) patients had increased sarcoplasmic HMGB1 compared with other myositis patients (n = 46). Sarcoplasmic HMGB1 expression correlated with muscle weakness and histological myonecrosis, inflammation, regeneration and autophagy. Serum HMGB1 levels were elevated in patients with IMNM, dermatomyositis and polymositis, and those myositis patients with extramuscular inflammatory features. Aberrant HMGB1 expression occurs in myositis patients and correlates with weakness. A unique expression profile of elevated sarcoplasmic and serum HMGB1 was detected in IMNM.


[The effect of multimodality induction therapy for locally advanced non-small cell lung cancer].
In this study we analyzed induction therapy for locally advanced non-small cell lung cancer. Eligible patients had mediastinoscopic proven N2 disease and T4 with mediastinal involvement. From January 1997 to May 2005, 56 patients entered the study. They received 2 cycle chemotherapy (platinums based 2 or 3 drugs), in 32 patients with concurrent radiotherapy followed by surgery. Response rates were 57.1%. Fifty-one patients underwent surgery. A radical resection was possible in 39 patients. Complication occurred in 14 patients (27.5%). Overall 5-year survival was 27.5%. In N2 disease, there was no statistically significant difference in survival between the induction group and the historical group. In T4 disease, overall 5-year survival was 30.2% for the induction group and 5.2% for historical group. There was significant difference in survival between the groups (p < 0.05).


THE PONTIA DAPLIDICE-ED USA HYBRID ZONE IN NORTHWESTERN ITALY.
The pierid butterflies Pontia daplidice and P. edusa, parapatrically distributed in southern Europe, have very similar morphologies and life histories, but show fixed differences at four allozyme markers. We sampled these allozymes in a 28-population transect north of Genoa in Italy, through the hybrid zone where these taxa meet. We used the numerical techniques developed for hybrid zone analysis to study the patterns of genetic differentiation and their underlying evolutionary causes. The hybrid zone is characterized by a very short and steep central region, flanked by broad tails of introgression extended up to 100 km in either direction. From mean two-locus disequilibium of D = 0.148 (maximum-likelihood two-unit support limits 0.139-0.153), and after accounting for minor differences in the center locations of the single-locus clines, which act to bias the dispersal estimate, we estimated a dispersal rate of σ = 4.4 (3.7-5.5) km/gen1/2 . The effective selection needed to maintain the steep central portion is strong, 0.47 < s∗ < 0.64, when combined over potential intrinsic (genetic background) and extrinsic (ecological) sources of selection. The clines in allozyme loci showed variation that was significantly different between the most divergent shapes, and the differences are attributable to different degrees of introgression on the edusa side of the zone. The average selection acting on individual allozyme loci was high at s∗∗∗e  1.5%, but because of the narrowness of the central region of the cline, we suspect that this estimate is somewhat biased by selection on loci closely linked to the allozyme markers. A common question for taxa that show fixed allozyme differences in parapatry is whether or not they are genetically isolated. A fairly general measure of genetic isolation across hybrid zones is the time, T, that it takes a neutral allele to cross the hybrid zone and recombine into the opposite genetic background, given by T = (β/σ)2 , where β is the barrier strength of the hybrid zone. Genetic isolation in the Pontia zone is weak, with T  25 generations for most allozyme markers. By this measure, populations of daplidice and edusa on opposite sides of the hybrid zone share more identical-by-descent alleles than do populations of phenotypically pure daplidice in, say, France and Morocco. Accordingly, we think it best for systematists to consider edusa as a well-marked subspecies of P. daplidice.


Bistable behaviour in a neocortical neurone model.
Intracellular recordings have shown that neocortical pyramidal neurones have an intrinsic capacity for regenerative firing. The cellular mechanism of this firing was investigated by computer simulations of a model neurone endowed with standard action potential and persistent sodium (gNaP) conductances. The firing mode of the neurone was determined as a function of leakage and NaP maximal conductances (gl and gNaP). The neurone had two stable states of activity (bistable) over wide range of gl and gNaP, one at the resting potential and the other in a regenerative firing mode, that could be triggered by a transient input. This model points to a cellular mechanism that may contribute to the generation and maintenance of long-lasting sustained neuronal discharges in the cerebral cortex.


Standardized shrinking LORETA-FOCUSS (SSLOFO): a new algorithm for spatio-temporal EEG source reconstruction.
This paper presents a new algorithm called Standardized Shrinking LORETA-FOCUSS (SSLOFO) for solving the electroencephalogram (EEG) inverse problem. Multiple techniques are combined in a single procedure to robustly reconstruct the underlying source distribution with high spatial resolution. This algorithm uses a recursive process which takes the smooth estimate of sLORETA as initialization and then employs the re-weighted minimum norm introduced by FOCUSS. An important technique called standardization is involved in the recursive process to enhance the localization ability. The algorithm is further improved by automatically adjusting the source space according to the estimate of the previous step, and by the inclusion of temporal information. Simulation studies are carried out on both spherical and realistic head models. The algorithm achieves very good localization ability on noise-free data. It is capable of recovering complex source configurations with arbitrary shapes and can produce high quality images of extended source distributions. We also characterized the performance with noisy data in a realistic head model. An important feature of this algorithm is that the temporal waveforms are clearly reconstructed, even for closely spaced sources. This provides a convenient way to estimate neural dynamics directly from the cortical sources.


Effects of acute administration of cyclazocine on the metabolism of biogenic amines in different regions of rat brain.
The effects of cyclazocine on the metabolism of dopamine (DA), noradrenaline (NA) and 5-hydroxytryptamine (5-HT) in regions of rat brain were studied by measuring changes in the levels of the monoamines and their major metabolites. Doses ranging from 4-32 mg/kg were tested. Rats were sacrificed 1 or 2 h after administration of the drug, according to the experiment. Administration of cyclazocine significantly decreased DA concentration and increased the levels of DOPAC and HVA in striatum. Cyclazocine decreased the levels of NA, and markedly increased the levels of MHPG-SP4 and 5-HIAA in cortex, hypothalamus, midbrain and pons-medulla, while little change in 5-HT concentration, except a decrease after the highest dose, was observed. These changes in the metabolism of the monoamines differed in their amplitude and temporal nature. The possible roles of dopaminergic, noradrenergic and serotoninergic neurons in different brain regions are discussed in relation to modifications of locomotor activity and the induction of bizarre behavior resulting from cyclazocine administration in rats. These investigations may add to the understanding of the mechanism of psychotomimetic effects produced in man by this drug.


A Rare Case of Double-Headed Psoas Minor Muscle with Review of its Known Variants.
Variations of the muscles of humans are important to remember for those who interpret imaging and for those who operate near these anomalies. Herein, we describe a rare two-headed psoas minor muscle found incidentally during dissection of the posterior abdominal wall. This case is presented with a detailed review of all known variations of the minor psoas and is analyzed through a literature review.


[Analysis of the amount of plasma cholesterol and triglycerides in patients with coronary heart disease].
Fluorescence technique was used to study the time course of changes in the amount of blood cholesterol and triglycerides (C+TG) in 43 patients with Q- and non-Q-wave myocardial infarction (MI) on days 1, 2, 3, and 10 of the disease, in 82 patients with chronic coronary heart disease (CHD), and in 43 apparently healthy donors. Within the first 3 days of the disease, the level of C+TG in the patients with acute MI (AMI) was significantly lower than that in the patients with chronic CHD and in the donors. By day 10 of their hospital stay, the level of lipids in patients with AMI increased and reached the levels observed in the control group.


Associations of PLA2G7 gene polymorphisms with plasma lipoprotein-associated phospholipase A2 activity and coronary heart disease in a Chinese Han population: the Beijing atherosclerosis study.
The human PLA2G7 gene encodes lipoprotein-associated phospholipase A(2) (Lp-PLA(2)), an emerging risk factor for cardiovascular diseases. In the present study, seven single nucleotide polymorphisms (SNPs) in the PLA2G7 gene were genotyped in 827 patients with coronary heart disease (CHD), of which 512 were patients with myocardial infarction (MI), and 947 age- and gender-matched controls in a Chinese Han population. Plasma Lp-PLA(2) activity was measured in 416 randomly selected controls and 689 randomly selected CHD patients, including 423 MI patients. Lp-PLA(2) activity in CHD and MI cases was significantly higher (233.42+/-57.66 and 234.27+/-59.51 nmol ml(-1) min(-1), respectively) than in controls (211.47+/-58.61 nmol ml(-1) min(-1)). After adjusting for traditional risk factors by logistic regression, the odds ratios for CHD and MI per 1 standard deviation increment of Lp-PLA(2) activity were 1.27 (95% CI, 1.07-1.50) and 1.27 (95% CI, 1.05-1.54), respectively. Both single SNP analysis and haplotype analysis showed that the V279F and I198T polymorphisms were significantly associated with the reduced Lp-PLA(2) activity, but neither was associated with increased CHD risk. Both univariate and multivariate analyses, adjusting effects of conventional factors, indicated that the rs13210554 T allele increased the risk of MI in this Chinese Han population. In summary, an independent association of increased plasma Lp-PLA(2) activity with CHD and MI existed in this Chinese Han Population. Although V279F and I198T mutations significantly decreased the activity of Lp-PLA(2), only the promoter rs13210554 polymorphism was associated with MI. Lp-PLA(2) activity appears to influence the CHD and MI risk in Chinese Han population.


ELF magnetic field exposure system with feedback-controlled disturbance rejection.
Extremely low-frequency (ELF) magnetic field exposure systems are usually subject to field disturbances induced by external sources. Here, a method for designing a feedback control system for cancelling the effect of external ELF magnetic field disturbances on the magnetic field over the exposure area is presented. This method was used in the design of a feedback-controlled exposure system for an inverted microscope stage. The effectiveness of the proposed feedback control system for disturbance rejection was verified experimentally and by means of computer simulation.


Gantry and isocenter displacements of a linear accelerator caused by an add-on micromultileaf collimator.
The delivery of high quality stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) treatments to the patient requires knowledge of the position of the isocenter to submillimeter accuracy. To meet the requirements the deviation between the radiation and mechanical isocenters must be less than 1 mm. The use of add-on micromultileaf collimators (μMLCs) in SRS and SRT is an additional challenge to the anticipated high-level geometric and dosimetric accuracy of the treatment. The aim of this work was to quantify the gantry excursions during rotation with and without an add-on μMLC attached to the gantry head. In addition, the shift in the position of the isocenter and its correlation to the kV beam center of the cone-beam CT system was included in the study. The quantification of the gantry rotational performance was done using a pointer supported by an in-house made rigid holder attached to the gantry head of the accelerator. The pointer positions were measured using a digital theodolite. To quantify the effect of an μMLC of 50 kg, the measurements were repeated with the μMLC attached to the gantry head. The displacement of the isocenter due to an add-on μMLC of 50 kg was also investigated. In case of the pointer measurement the μMLC was simulated by weights attached to the gantry head. A method of least squares was applied to determine the position and displacement of the mechanical isocenter. Additionally, the displacement of the radiation isocenter was measured using a ball-bearing phantom and the electronic portal image device system. These measurements were based on 8 MV photon beams irradiated onto the ball from the four cardinal angles and two opposed collimator angles. The measurements and analysis of the data were carried out automatically using software delivered by the manufacturer. The displacement of the mechanical isocenter caused by a 50 kg heavy μMLC was found to be (-0.01 ± 0.05, -0.10 ± 0.03, -0.26 ± 0.05) mm in lateral, longitudinal, and vertical direction, respectively. Similarly, the displacement of the radiation isocenter was found to be (0.00 ± 0.03, -0.08 ± 0.06, -0.32 ± 0.02) mm. Good agreement was found between the displacement of the two isocenters. A displacement of the kV cone-beam CT beam center due to the attached weight of 50 kg could not be detected. General characteristics of the gantry arm excursions and displacements caused by an add-on μMLC have been reported. A 50 kg heavy add-on μMLC results in a isocenter displacement downward of 0.26-0.32 mm. The authors recommend that the beam center of the kV cone-beam CT image system should be matched to the isocenter related to the weight of the μMLC. Consequently, the imperfections in isocenter localizations are transferred to the conventional radiotherapy where the clinical consequences of uncertainties in the submillimeter regime are negligible.


What is the future of problem-based learning in medical education?
Student-centered problem-based learning (PBL) has been implemented as an alternative curriculum by several medical schools in the United States and elsewhere. Recently, attempts to integrate PBL with lecture-based curricula have created "hybrid" curricula with varying amounts of the philosophical underpinnings of student-centered PBL. Greater clinical and research demands on faculty time threaten to diminish the use of PBL in existing curricula, whereas opportunities for expansion of PBL in medical education are being created by community-based and interdisciplinary education programs.


Controlled synthesis and magnetic properties of 2D and 3D iron azide networks infinity2[Fe(N3)2(4,4'-bpy)] and infinity3[Fe(N3)2(4,4'-bpy)].
Controlled synthesis of transition metal complexes with mixed ligands has led to two new compounds with the same empirical formula [Fe(N3)2(4,4'-bpy)] (4,4'-bpy=4,4'- bipyridine). The compound 2D-[Fe(N3)2(4,4'-bpy)] (I) contains end-on (EO) bridging azido ligands. It crystallizes in the orthorhombic crystal system, space group Cmmm (No. 65): a=11.444(2) A, b=15.181(3) A, c=3.458(1) A, V=600.8(2) A(3), and Z=2. The compound 3D-[Fe(N3)2(4,4'-bpy)] (II) contains end-to-end (EE) azido bridges. It belongs to the tetragonal crystal system, space group P4(1)2(1)2 (No. 92): a=8.132(1) A, b=8.132(1) A, c=16.708(3) A, V=1104.9(5) A(3), and Z=4. Crystals of I and II have been grown by the diffusion method. Phase-pure samples of both compounds have been obtained by means of an optimal solution synthesis. Spontaneous long-range magnetic ordering was found in both I and II, with I being a metamagnet, and II being a ferromagnet. For I, in the low-field region, multiple transitions at TN1=20 K and TN2=5 K were observed, and these indicated the existence of Fe moment reorientation. Heat capacity measurements on II confirmed ferromagnetic transition at TC=20 K.


Heparin-induced immune thrombocytopenia.
We studied five patients in whom severe thrombocytopenia developed during intermittent intravenous heparin treatment of arterial and venous thrombosis. Platelet aggregation was demonstrated when heparin (0.5 U per milliliter) was incubated with the patients' citrated platelet-rich plasma or with normal platelet-rich plasma in the presence of the patients' serum. Antiplatelet antibody was not detected in the patient globulin fractions prepared from serum collected within one week after heparin withdrawal by use of the platelet factor 3 availability technic. When the studies were repeated with modifications to detect heparin-dependent antiplatelet antibodies, positive results were obtained in four of five patients. The data suggest that a casual relation, mediated by an immune mechanism, existed between heparin therapy and thrombocytopenia, and that this syndrome may occur more often than has previously.


Description of cysticercoid of Coronacanthus vassilevi Genov, 1980 (Cestoda:Hymenolepididae).
Genus Coronacanthus Spassky, 1954 contains three species--C. integra (Hamann, 1891), C. omissa (Baer et Joyeux 1943) and C. vassilevi Genov, 1980--but larval stages of only first two species were described before. During 1991-1993 cysticercoids of all three species were found from gammarid crustaceans in Eastern Carpathians. The article contains an illustrated description of the cysticercoid of C. vassilevi. It differs considerably from the formerly known Coronacanthus larvae by the egg-shaped (not lens-shaped) form of the cyst, absence of marginal thickening of the cyst wall, by the shape and length of cercomer and besides, by the invagination of the anterior part of the scolex. Microvilli on the cyst surface were not detected with light microscope. Cercomer of C. vassilevi is narrow and very long as for mammalian hymenolepidid (4.7 to 8 times longer than cyst). The number (37-38), length (8-9 microns) and shape of rostellar hooks well correspond to those of adult worms (Genov, 1980).


The tear fluid mucin 5AC change of primary angle-closure glaucoma patients after short-term medications and phacotrabeculectomy.
This paper proposed to evaluate the tear fluid mucin 5AC (MUC5AC) change in Chinese primary angle-closure glaucoma and cataract patients after short-term medications and phacotrabeculectomy. Twenty-five eyes of 25 consecutive Chinese patients with coexisting visually significant cataract and angle-closure glaucoma and 40 eyes of 40 volunteers enrolled in this study were investigated. Tear fluid from normal subjects and patients (1 day pre-operatively, 1 month, 3 months, and 6 months post-operatively, respectively) were collected. The MUC5AC protein levels in the tear fluid were determined by Enzyme-Linked ImmunoSorbent Assay (ELISA). The MUC5AC change after phacotrabeculectomy was evaluated. The MUC5AC quantity of the patients after short-term medications was 16.95±12.86 ng/ml, compared with 32.39±18.44 ng/ml MUC5AC quantity of the controls. There was a significant difference between the two groups (p<0.05). The MUC5AC of the patients decreased significantly to 6.91±7.11 ng/ml at 1 month after surgery (p<0.05). At 3 months after surgery, the MUC5AC recovered to 15.53±12.63 ng/ml, and had no significant difference with the pre-operative level (p=0.26). At 6 months after surgery, the MUC5AC was 18.94±14.64 ng/ml and had no significant difference with before-surgery levels (p=0.14). Both phacotrabeculectomy and short-term anti-glaucoma medications can decrease the MUC5AC in the tear fluid of primary angle-closure glaucoma patients. At 3 months after phacotrabeculectomy, the MUC5AC could recover to the pre-operative level. More attention should be paid to the tear film stability and ocular surface physiology in these patients.


Adverse Effects of the Apolipoprotein E ε4 Allele on Episodic Memory, Task Switching and Gray Matter Volume in Healthy Young Adults.
Many studies have shown that healthy elderly subjects and patients with Alzheimer's disease (AD) who carry the apolipoprotein E (ApoE) ε4 allele have worse cognitive function and more severe brain atrophy than non-carriers. However, it remains unclear whether this ApoE polymorphism leads to changes of cognition and brain morphology in healthy young adults. In this study, we used an established model to measure verbal episodic memory and core executive function (EF) components (response inhibition, working memory and task switching) in 32 ApoE ε4 carriers and 40 non-carriers between 20 years and 40 years of age. To do this, we carried out an adapted auditory verbal learning test and three computerized EF tasks. High-resolution head magnetic resonance scans were performed in all participants and voxel-based morphometry (VBM) was used for image processing and analysis. Multivariate analysis of variance (ANOVA) performed on memory measures showed that the overall verbal episodic memory of ApoE ε4 carriers was significantly worse than non-carriers (Wilk's λ = 4.884, P = 0.004). No significant differences were detected in overall EF between the two groups. Post hoc analyses revealed group differences in terms of immediate recall, recognition and task switching, which favored non-carriers. VBM analysis showed gray matter (GM) bilateral reductions in the medial and dorsolateral frontal, parietal and left temporal cortices in the carrier group relative to the non-carrier group, which were most significant in the bilateral anterior and middle cingulate gyri. However, these changes in GM volume were not directly associated with changes in cognitive function. Our data show that the ApoE ε4 allele is associated with poorer performance in verbal episodic memory and task switching, and a reduction in GM volume in healthy young adults, suggesting that the effects of ApoE ε4 upon cognition and brain morphology exist long before the possible occurrence of AD.