Remodeling of left ventricular geometry and function induced by lacidipine and nifedipine SR in mild-to-moderate hypertension.
The effects of nifedipine SR and lacidipine on blood pressure, left ventricular (LV) hypertrophy, and diastolic function were evaluated in 15 male patients (mean age of 45 +/- 8 years) with mild-to-moderate hypertension. Clinical evaluation and complete echocardiography were performed at baseline (after 15 days of washout). Seven patients received nifedipine SR (20-40 mg twice daily) and eight lacidipine (4-6 mg once daily). Clinical evaluation and complete echocardiography studies were repeated after 1 and 6 months of active treatment. In addition, full echocardiographic evaluations were carried out in 10 normotensive subjects (for comparison). Results were similar with either drug. After 1 month of therapy, systolic and diastolic blood pressures were significantly decreased (p less than 0.05); after 6 months of therapy, further changes were observed, confirming their significance. Analysis of our data suggests that (a) mild essential hypertension induces early modifications of LV geometry with consequent LV diastolic function characterized by a prolonged and incomplete diastolic filling; thus, LV wall thickness may be increased with a simultaneous reduction in LV end-diastolic short-axis diameter and volume; and (b) antihypertensive treatment with calcium antagonists such as nifedipine SR and lacidipine leads to early normalization of LV geometry and diastolic function without a significant change in total LV mass.


Intrapartum amniotic fluid index for predicting fetal acidemia. Results of receiver operating characteristic curve analysis.
The objective of this study was to determine if the discriminatory intrapartum amniotic fluid index can reliably predict respiratory or metabolic acidosis in the newborn. Among 256 parturients at 37 weeks' gestation or more, the intrapartum amniotic fluid index was obtained in early labor, and umbilical arterial blood gas analysis was performed within 30 minutes of delivery. The mean (+/- SD) amniotic fluid indices in labor among newborns with no acidosis versus those with respiratory or metabolic acidosis were compared. A receiver operating characteristic curve was used to determine the best discriminatory intrapartum amniotic fluid index for respiratory and metabolic acidosis. Statistical analysis revealed that the mean intrapartum amniotic fluid index among 12 newborns with respiratory acidosis and 26 with metabolic acidosis was significantly lower than the mean index in 218 newborns without fetal acidemia. Despite the differences in the mean intrapartum amniotic fluid index in the three groups analyzed, the receiver operating characteristic curve indicated that an intrapartum amniotic fluid index alone is a poor test for predicting acidosis (respiratory or metabolic) in the neonate. The mean intrapartum amniotic fluid index in labor among newborns with respiratory or metabolic acidosis was significantly lower than that among nonacidotic newborns. The receiver operating characteristic curve indicated that the intrapartum amniotic fluid index cannot reliably distinguish nonacidotic infants from those with respiratory or metabolic acidosis.


Binding of a third metal ion by the human phosphatases PP2Cα and Wip1 is required for phosphatase activity.
The PPM phosphatases require millimolar concentrations of Mg²⁺ or Mn²⁺ to activate phosphatase activity in vitro. The human phosphatases PP2Cα (PPM1A) and Wip1 (PPM1D) differ in their physiological function, substrate specificity, and apparent metal affinity. A crystallographic structure of PP2Cα shows only two metal ions in the active site. However, recent structural studies of several bacterial PP2C phosphatases have indicated three metal ions in the active site. Two residues that coordinate the third metal ion are highly conserved, suggesting that human PP2C phosphatases may also bind a third ion. Here, isothermal titration calorimetry analysis of Mg²⁺ binding to PP2Cα distinguished binding of two ions to high affinity sites from the binding of a third ion with a millimolar affinity, similar to the apparent metal affinity required for catalytic activity. Mutational analysis indicated that Asp239 and either Asp146 or Asp243 was required for low-affinity binding of Mg²⁺, but that both Asp146 and Asp239 were required for catalysis. Phosphatase activity assays in the presence of MgCl₂, MnCl₂, or mixtures of the two, demonstrate high phosphatase activity toward a phosphopeptide substrate when Mg²⁺ was bound to the low-affinity site, whether Mg²⁺ or Mn²⁺ ions were bound to the high affinity sites. Mutation of the corresponding putative third metal ion-coordinating residues of Wip1 affected catalytic activity similarly both in vitro and in human cells. These results suggest that phosphatase activity toward phosphopeptide substrates by PP2Cα and Wip1 requires the binding of a Mg²⁺ ion to the low-affinity site.


Parathyroidectomy improves bone geometry and microarchitecture in female patients with primary hyperparathyroidism: a one-year prospective controlled study using high-resolution peripheral quantitative computed tomography.
Following parathyroidectomy (PTX), bone mineral density (BMD) increases in patients with primary hyperparathyroidism (PHPT), yet information is scarce concerning changes in bone structure and strength following normalization of parathyroid hormone levels postsurgery. In this 1-year prospective controlled study, high-resolution peripheral quantitative computed tomography (HR-pQCT) was used to evaluate changes in bone geometry, volumetric BMD (vBMD), microarchitecture, and estimated strength in female patients with PHPT before and 1 year after PTX, compared to healthy controls. Twenty-seven women successfully treated with PTX (median age 62 years; range, 44-75 years) and 31 controls (median age 63 years; range, 40-76 years) recruited by random sampling from the general population were studied using HR-pQCT of the distal radius and tibia as well as with dual-energy X-ray absorptiometry (DXA) of the forearm, spine, and hip. The two groups were comparable with respect to age, height, weight, and menopausal status. In both radius and tibia, cortical (Ct.) vBMD and Ct. thickness increased or were maintained in patients and decreased in controls (p < 0.01). Radius cancellous bone architecture was improved in patients through increased trabecular number and decreased trabecular spacing compared with changes in controls (p < 0.05). No significant cancellous bone changes were observed in tibia. Estimated bone failure load by finite element modeling increased in patients in radius but declined in controls (p < 0.001). Similar, albeit borderline significant changes in estimated failure load were found in tibia (p = 0.06). This study showed that females with PHPT had improvements in cortical bone geometry and increases in cortical and trabecular vBMD in both radius and tibia along with improvements in cancellous bone architecture and estimated strength in radius 1 year after PTX, reversing or attenuating age-related changes observed in controls.


Phytochemical investigation on Atriplex halimus L. from Sardinia.
In this study, we reported the phytochemical composition of the aerial parts of Atriplex halimus L. collected from Sardinia. This species is a halophytic shrub, typical of the Mediterranean Basin. Four new glycosylated flavonoids were isolated and their structures were elucidated on the basis of 1D, 2D NMR and MS spectra as 3',5'-dimethoxymyricetin-3-O-β-D-xylopyranosyl-7-O-fucopyranosyl-(1 → 3)-β-D-glucopyranoside (1), 3'-methoxyquercetin-7-O-β-D-fucopyranosyl-(1 → 3)-β-d-glucopyranosyl-3-O-β-xylopyranosyl-(1 → 4)-β-xylopyranoside (2), 3'-methoxyquercetin-7-O-α-l-rhamnopyranosyl-3-O-α-arabinofuranosyl-(1 → 6)-β-D-glucopyranoside (3) and 3',5'-dimethoxymyricetin-7-O-fucopyranosyl-(1 → 3)-β-D-glucopyranoside (4). LC-MS(n) analysis on the extract revealed the presence of other myricetin, quercetin, isorhamnetin glycosides, simple phenolic acids and esters.


Separation of Saturated Fatty Acids and Fatty Acid Methyl Esters with Epoxy Nanofiltration Membranes.
Epoxy nanofiltration membranes were fabricated by the step polymerization of a primary diamine and a diepoxide or triepoxide conomomer. Membrane selectivity and flux were tuned by changing the identity of the diepoxides and by increasing the concentration of triepoxides in the polymerization. The membranes were used to separate even chain length saturated fatty acids (FAs) and saturated fatty acid methyl esters (FAMEs) that possessed molecular weights between 80 - 300 g mol-1. Our membranes show excellent selectivities of up to 100:1 for the separation of the C4-C18 FAMEs. The flux of the FAMEs through the membranes showed an exponential dependence based on the number of carbons. Fabrication of thin epoxy membranes with thicknesses of 150 nm allowed for an increase in flux of FAMEs through the membrane and demonstrated that these separations can be used under industrially relevant conditions.


Network Diffusion-Based Prioritization of Autism Risk Genes Identifies Significantly Connected Gene Modules.
Autism spectrum disorder (ASD) is marked by a strong genetic heterogeneity, which is underlined by the low overlap between ASD risk gene lists proposed in different studies. In this context, molecular networks can be used to analyze the results of several genome-wide studies in order to underline those network regions harboring genetic variations associated with ASD, the so-called "disease modules." In this work, we used a recent network diffusion-based approach to jointly analyze multiple ASD risk gene lists. We defined genome-scale prioritizations of human genes in relation to ASD genes from multiple studies, found significantly connected gene modules associated with ASD and predicted genes functionally related to ASD risk genes. Most of them play a role in synapsis and neuronal development and function; many are related to syndromes that can be in comorbidity with ASD and the remaining are involved in epigenetics, cell cycle, cell adhesion and cancer.


[Laryngeal anomalies in newborn infants. Apropos of 687 cases].
Congenital laryngeal anomalies are a frequent cause of obstructive dyspnea in neonates and young infants, and raise diagnostic and emergency treatment problems. Clinical symptomatology includes stridor of variable severity, obstructive dyspnea and deglutition disorders, but a less typical picture may be seen of apnea, cyanotic episodes, bradycardia and even cardiac arrests. A retrospective study of 687 case-reports of infants treated between 1974 and 1983 was conducted. Lesions included essential congenital laryngeal stridor (laryngomalacia) in 378 cases (50%), of which 15% were severe with respiratory distress and/or deglutition disorders; laryngeal palsy in 161 cases (23%), bilateral in 56 and unilateral in 105 cases; laryngeal incoordination in 23 cases; laryngeal stenosis: 79 cases (11%) including 58 subglottic and 18 dysphragmatic stenoses and 3 atresias; subglottic hematoma: 49 cases; ary-epiglottic or glosso-epiglottic cyst: 15 cases; laryngeal diastema: 11 cases; and bifid epiglottis: 1 case. Clinical, radiologic and endoscopic findings, and the principal therapies used, are discussed for each anomaly.


Dysfunction of rat liver mitochondria by selenite: induction of mitochondrial permeability transition through thiol-oxidation.
Selenium is an essential trace element in mammals and is thought to play a chemopreventive role in human cancer, possibly by inducing tumor cell apoptosis. Mitochondria play a pivotal role in the induction of apoptosis in many cell types. The effects of selenite on mitochondrial function were therefore investigated. Selenite induced the oxidation and cross-linking of protein thiol groups, mitochondrial permeability transition (MPT), a decrease in the mitochondrial membrane potential, and the release of cytochrome c in mitochondria isolated from rat liver. Induction of the MPT by selenite was prevented by cyclosporin A, EGTA, or N-ethylmaleimide. These results thus indicate that selenite induces the MPT as a result of direct modification of protein thiol groups, resulting in the release of cytochrome c and a loss of mitochondrial membrane potential.


Production of Monoclonal Antibody Against Excretory-Secretory Antigen of Fasciola hepatica and Evaluation of Its Efficacy in the Diagnosis of Fascioliasis.
Parasitological methods are not helpful for the diagnosis of fascioliasis in acute and invasive periods of the disease. Detection of coproantigens seems to be a suitable alternative approach in the diagnosis of fascioliasis. The present study aimed to develop a reliable antigen detection system, using monoclonal antibodies raised against excretory-secretory (ES) antigen of Fasciola hepatica, for the diagnosis of fascioliasis. Fasciola adult worms were collected from the bile ducts of infected animals. Species of the fluke was determined by polymerase chain reaction-restriction fragment length polymorphism (RFLP-PCR). ES antigen of F. hepatica was prepared. For production of monoclonal antibodies, mice were immunized with ES antigens of F. hepatica. Spleen cells from the immunized mice were fused with NS-1 myeloma cells, using polyethylene glycol. Hybridoma cells secreting specific antibody were expanded and cloned by limiting dilution. Moreover, polyclonal antibody was produced against F. hepatica ES antigen in rabbits. A capture enzyme-linked immunosorbent assay (ELISA) system, using produced monoclonal antibody, was designed and stool samples of infected animals along with control samples were tested by the system. The capture ELISA detected the coproantigen in 27 of 30 (90%) parasitologically confirmed fascioliasis cases, while 4 of 39 (10.25%) samples infected with other parasitic infections showed a positive reaction in this system. No positive reactivity was found with healthy control samples. Accordingly, sensitivity of 90% and specificity of 94.2% were obtained for the capture ELISA system. The results were compared with those obtained with commercial BIO-X ELISA, and a very good (kappa = 0.9) agreement was found between the commercial kit and the developed capture ELISA. Findings of this study showed that the produced monoclonal antibody has appropriate performance for the detection of Fasciola coproantigen in stool samples and can be appropriately used for the diagnosis of fascioliasis.


[The taxonomic diversity of the rodents within the limits of the Asian ecological transect].
The diversity of rodents is considered at various taxonomic levels within the limits of the Asian ecological transect, which crosses Asia from the Taimyr Peninsula in the north to the southern coast of Indostan and embraces territories of seven countries: Russia, Kazakhstan, Kyrgyzstan, Mongolia, China, Nepal, and India. The highest diversity of rodents is observed in the south of West Siberia and in mountains of Middle Asia. The least number of all taxa was noted in the Taimyr Peninsula and in the Tibet region.


Hemoglobinopathy Screening in a 15-Year-old Patient With Anemia.
Identification of hemoglobinopathies in pediatric patients can be challenging and has important implications for the patient, as well as family members. Laboratory identification of uncommon hemoglobin (Hb) variants can pose a significant problem. Although many Hb variants can be largely identified using conventional electrophoresis and HPLC, confirmatory Hb DNA analysis may be necessary. This report provides an example of a pediatric patient with a complex heterozygous Hb by electrophoresis and HPLC, which necessitated identification by DNA analysis. Clinical and laboratory scenarios warranting Hb DNA analysis are additionally discussed.


Preoperative coping mechanisms have no predictive value for postoperative pain in breast cancer.
This study evaluated the relationship between psychological coping mechanisms and symptoms of anxiety and depression in the preoperative and postoperative periods in relation to the intensity of postoperative pain among patients undergoing breast cancer surgery. Female patients who were scheduled to receive immediate surgical treatment for breast cancer were invited to participate, and answered the following questionnaires: The Hospital Anxiety and Depression Scale (HADS), the Self Report Questionnaire (SRQ-20), the Coping Strategies Questionnaire (CSQ), and the visual analogue scale (VAS). Of the 139 patients, 122 (87.8%) had an aggressive procedure. Eighty-five patients (61.2%) had a history of preoperative pain while 54 (38.7%) had not. There was no difference in VAS scores between patients subjected to aggressive or non-aggressive surgery. Only the CSQ subscale catastrophizing showed correlation with VAS at 24 hours and with HADS/D postoperatively. The HADS scores indicated both anxiety and depression, but did not distinguish patients subjected to aggressive or non-aggressive surgery. The majority of patients did not exhibit depression and anxiety. Coping mechanisms and pain in the preoperative period did not have a strong predictive value for additional postoperative pain, but those with a higher anxiety score had greater pain.


Lack of clinical-pathological correlation in the diagnosis of congenital naevi.
Congenital naevocellular naevi (CNN) have classical histological criteria that are thought to allow distinction from acquired naevi. These criteria are mainly the horizontal distribution of melanocytes, forming 'Indian files', and a prominent adnexotropism. In order to check whether the previously described criteria were reliable, we analysed 1349 unselected consecutive cases of naevocellular naevi excised in children under 16 years, during a 54-month period. The slides were analysed in order to determine by histological analysis only if they could be classified as CNN. These results were then compared with the clinical files, in which only the most reliable data from parental and/or medical observations were included. Of the 1349 naevi, 659 had the typical histological criteria of CNN, 32 of them being deep CNN, characterized by massive involvement of the lower dermis and hypodermis. The comparison with clinical data showed that 32 naevi with the histological criteria of congenital naevi were actually acquired, and that 179 naevi present at birth did not fulfil these criteria. This study shows that the classic histological criteria are not absolutely specific and are poorly sensitive as 36% of naevi present at birth lacked the classic criteria. The most specific criteria of true CNN were the involvement of eccrine glands and presence of melanocytes in the septae. In the case of deep CNN which corresponded to large or very large naevi, the clinicopathological correlation was 100%. Deep CNN could easily be distinguished from superficial CNN and often exhibited many histological changes consistent with a complex hamartoma, such as presence of brown fat tissue, abnormal vessels and numerous large terminal follicles. In conclusion, our study suggests that it is not possible to predict, by histological analysis alone, that a naevus was present at birth, except in deep CNN which are likely to be a separate entity among all congenital naevi. Studies dealing with congenital naevus-associated melanoma should take into account the lack of sensitivity of these criteria.


Asthma, asthma control and risk of acute myocardial infarction: HUNT study.
Asthma, a chronic inflammatory airway disease, shares several common pathophysiological mechanisms with acute myocardial infarction (AMI). Our aim was to assess the prospective associations between asthma, levels of asthma control and risk of AMI. We followed 57,104 adults without previous history of AMI at baseline from Nord-Trøndelag health study (HUNT) in Norway. Self-reported asthma was categorised as active asthma (i.e., using asthma medication) and non-active asthma (i.e., not using asthma medication). Levels of asthma control were defined as controlled, partly controlled, and uncontrolled based on the Global Initiative for Asthma guidelines. AMI was ascertained by linking HUNT data with hospital records. A total of 2868 AMI events (5.0%) occurred during a mean (SD) follow-up of 17.2 (5.4) years. Adults with active asthma had an estimated 29% higher risk of developing AMI [adjusted hazard ratio (HR) 1.29, 95% CI 1.08-1.54] compared with adults without asthma. There was a significant dose-response association between asthma control and AMI risk, with highest risk in adults with uncontrolled asthma (adjusted HR 1.73, 95% CI 1.13-2.66) compared to adults with controlled asthma (p for trend < 0.05). The associations were not explained by smoking status, physical activity and C-reactive protein levels. Our study suggests that active asthma and poor asthma control are associated with moderately increased risk of AMI. Further studies are needed to evaluate causal relationship and the underlying mechanisms and to clarify the role of asthma medications in the risk of AMI.


Distributed Containment Control for Multiple Unknown Second-Order Nonlinear Systems With Application to Networked Lagrangian Systems.
In this paper, we consider the distributed containment control problem for multiagent systems with unknown nonlinear dynamics. More specifically, we focus on multiple second-order nonlinear systems and networked Lagrangian systems. We first study the distributed containment control problem for multiple second-order nonlinear systems with multiple dynamic leaders in the presence of unknown nonlinearities and external disturbances under a general directed graph that characterizes the interaction among the leaders and the followers. A distributed adaptive control algorithm with an adaptive gain design based on the approximation capability of neural networks is proposed. We present a necessary and sufficient condition on the directed graph such that the containment error can be reduced as small as desired. As a byproduct, the leaderless consensus problem is solved with asymptotical convergence. Because relative velocity measurements between neighbors are generally more difficult to obtain than relative position measurements, we then propose a distributed containment control algorithm without using neighbors' velocity information. A two-step Lyapunov-based method is used to study the convergence of the closed-loop system. Next, we apply the ideas to deal with the containment control problem for networked unknown Lagrangian systems under a general directed graph. All the proposed algorithms are distributed and can be implemented using only local measurements in the absence of communication. Finally, simulation examples are provided to show the effectiveness of the proposed control algorithms.


Comparison of a unified analysis approach for family and unrelated samples with the transmission-disequilibrium test to study associations of hypertension in the Framingham Heart Study.
Population stratification is one of the major causes of spurious associations in association studies. A unified association approach based on principal-component analysis can overcome the effect of population stratification, as well as make use of both family and unrelated samples combined to increase power (family-case-control, or FamCC). In this study, we compared FamCC and the transmission-disequilibrium test (TDT) using data on hypertension, systolic blood pressure, and diastolic blood pressure in the Framingham Heart Study. Our study indicated FamCC has reasonable type I error for both the unrelated sample and the family sample for all three traits. For these three traits, we found results from FamCC were inconsistent with those from the TDT. We discuss the reasons for this inconsistency. After correcting for multiple tests, we did not detect any significant single-nucleotide polymorphisms by either FamCC or the TDT.


Molecular and Genetic Mechanisms Involved in the Pathogenesis of Cardiorenal Cross Talk.
The term 'cardiorenal syndrome' (CRS) encloses a scenario of clinical interactions in which cardiac and renal dysfunctions coexist. The cross talk between the heart and the kidney is clearly evidenced but not fully understood. Indeed, different factors have been shown to be involved in the pathogenesis of CRS, such as systemic inflammation, oxidative stress, apoptosis and immune dysregulation. Recently, considerable attention has been paid to the role of new alternative mechanisms which may be implicated in the pathogenesis of cardiorenal cross talk. In this review, we will focus on epigenetics, prenatal programming, small noncoding RNAs and extracellular vesicles, aiming to elucidate their possible role in heart and kidney diseases.


Extracellular lipids of Camelina sativa: Characterization of cutin and suberin reveals typical polyester monomers and unusual dicarboxylic fatty acids.
Camelina sativa is relatively drought tolerant and requires less fertilizer than other oilseed crops. Various lipid- and phenolic-based extracellular barriers of plants help to protect them against biotic and abiotic stresses. These barriers, which consist of solvent-insoluble polymeric frameworks and solvent-extractable waxes, include the cuticle of aerial plant surfaces and suberized cell walls found, for example, in periderms and seed coats. Cutin, the polymeric matrix of the cuticle, and the aliphatic domain of suberin are fatty acid- and glycerol-based polyesters. These polyesters were investigated by base-catalyzed transesterification of C. sativa aerial and underground delipidated tissues followed by gas chromatographic analysis of the released monomer mixtures. Seed coat and root suberin had similar compositions, with 18-hydroxyoctadecenoic and 1,18-octadecenedioic fatty acids being the dominant species. Root suberin presented a typical lamellar ultrastructure, but seed coats showed almost imperceptible, faint dark bands. Leaf and stem lipid polyesters were composed of fatty acids (FA), 1,ω-dicarboxylic fatty acids (DCA), ω-hydroxy fatty acids (HFA) and hydroxycinnamic acids (HCA). Dihydroxypalmitic acid (DHP) and caffeic acid were the major constituents of leaf cutin, whereas stem cutin presented similar molar proportions in several monomers across the four classes. Unlike the leaf cuticle, the C. sativa stem cuticle presented lamellar structure by transmission electron microscopy. Flower cutin was dominated by DHP, did not contain aromatics, and presented substantial amounts (>30%) of hydroxylated 1,ω-dicarboxylic acids. We found striking differences between the lipid polyester monomer compositions of aerial tissues of C. sativa and that of its close relatives Arabidopsis thaliana and Brassica napus.


In vitro testing of antimicrobial activity of bone cement.
The purpose of this study was to establish a reliable and cost-effective microplate proliferation assay for in vitro antimicrobial testing of bone cement samples. Cement samples devoid of antimicrobial agents, loaded with 2% gentamicin or with different concentrations of high-porosity silver, were incubated in a 96-well microplate with several staphylococcal, Pseudomonas aeruginosa, and Enterococcus faecium isolates exhibiting different susceptibilities to gentamicin. After being rinsed, the samples were brought into a soy medium in which adherent cells on the cement surface either were killed by the antimicrobial surface or started to release clonal counterparts. The medium was monitored in real time by recording a time proliferation curve for each well. Microplate testing revealed no antibacterial effect of plain bone cement. The antibacterial activity of gentamicin-loaded bone cement was shown by the microplate test to depend on the gentamicin susceptibilities of the strains. The effect of high-porosity silver was dose dependent. Bactericidal activity against all tested strains was found for bone cement loaded with 1% high-porosity silver. The accuracy of this new proliferation assay was shown by the high correlation between the types of proliferation curves and antibiotic susceptibility. In contrast to routine agar diffusion testing, it assesses the dynamic response of microorganisms to antimicrobial agents in biomaterials and allows high-throughput screening and detection of antimicrobial properties of poorly water-soluble compounds like silver.


Risk predictors of early recurrence in women with epithelial ovarian cancer in Lagos, Nigeria.
epithelial ovarian cancer (EOC) is the most lethal gynaecological cancer with a recurrence rate as high as 85% after an initial treatment. However, there are currently no reliable means of predicting the risk of recurrence after first-line treatment. This study investigated the risk factors that predict early recurrence of EOC after primary treatment among women in Lagos, Nigeria. this was a retrospective cohort study involving the review of all histologically confirmed EOC patients managed at the Lagos University Teaching Hospital, Lagos, Nigeria over a 7-year period from January 2010 to December 2016. A study proforma was used to retrieve relevant information and descriptive statistics were computed for all data. The associations between variables were tested and multivariate analysis was done to adjust for all the possible characteristics that predict early EOC recurrence. the rate of recurrence of EOC was 76.4%. Suboptimal debulking surgery is the only independent predictor of early tumour recurrence. women should be adequately counselled and encouraged to report their symptoms early to ensure optimal primary treatment. Strategic efforts should also be made to further improve subspecialty training programs and skills development in gynaecological oncology in Nigeria and sub-Saharan Africa.


Axial computed tomography of pilon fractures.
Computed tomography (CT) is used in the preoperative planning of many fractures. It is particularly helpful in anatomic regions with complex anatomy and in fractures with complicated patterns. The authors evaluated the use of CT scans in the preoperative planning of pilon fractures. Twenty-two patients were studied with plain radiographs and with CT scans. The fracture pattern, number of fragments, comminution, impaction, and location of the major fracture line were recorded. The CT scan revealed an increased number of fragments in 12 patients, increased impaction in 6 patients, and increased comminution in 11 patients. The operative plan was changed in 14 (64%) patients, and additional information was gained in 18 (82%) patients.


Analgesic effects of 1,2,3,4,6-penta-O-galloyl-β-D-glucose in an animal model of lipopolysaccharide-induced pain.
We examined the analgesic effects of 1,2,3, 4,6-penta-O-galloyl-β-D-glucose (β-PGG), a prototypical gallotannin, in an animal model of lipopolysaccharide (LPS)‑induced pain. To evaluate the analgesic activity of β-PGG, we assessed the potential of β-PGG to inhibit the generation of nitric oxide (NO) in LPS-stressed RAW 264.7 cells, and found that β-PGG inhibits NO generation in a dose-dependent manner. Furthermore, the effects of β-PGG on the voluntary movements of LPS-exposed animals were evaluated. The results showed that the voluntary movements of animals were markedly recovered after β-PGG treatment. The mRNA expression of interleukin (IL)-1β (1.33±0.38-fold) and IL-6 (0.64±0.40-fold) in the brain tissue of β-PGG-treated animals markedly decreased compared with that observed in the control groups (3.86±0.91 and 2.45±1.12-fold, respectively) and in the other LPS-administered groups. The results showed that β-PGG has potential to alleviate pain, not only by decreasing cellular NO generation in RAW 264.7 cells but also by the recovery of voluntary movement lost owing to inflammatory pain. This suggests that β-PGG is comparable to ibuprofen, which was used as a positive control in this study. Collectively, these findings suggest that β-PGG is a valuable natural compound which possesses analgesic activity.


Comprehensive molecular profiling of the B7 family of immune-regulatory ligands in breast cancer.
The B7 gene family has crucial roles in the regulation of adaptive cellular immunity. In cancer, deregulation of co-inhibitory B7 molecules is associated with reduced antitumor immunity and cancer immune evasion. FDA approval of cancer immunotherapy antibodies against cytotoxic T lymphocyte-associated protein 4 (CTLA-4) and programmed cell death-1 (PD-1)-both ligands of the B7 family-demonstrate the impact of these checkpoint regulators in cancer. Using data from cBioPortal, we performed comprehensive molecular profiling of the 10 currently known B7 family proteins in 105 different cancers. B7 family members were amplified in breast cancer: with B7 mRNA levels upregulated in a cohort of 1,098 patients with all types of breast cancer and in 82 patients with triple-negative breast cancer. Promoter methylation analysis indicated an epigenetic basis for deregulation of certain B7 family genes in breast cancer. Moreover, patients with B7-H6 genomic alterations had significantly worse overall survival, and certain clinical attributes were associated with B7-H6 expression, which indicates that B7-H6 may be a potential target for breast cancer immunotherapy. Finally, using network analysis (based on data from cBioportal), we identified BTLA, MARCH8, PLSCR1 and SMAD3 as potentially involved in T cell signaling under regulation of B7 family proteins.


[The effect of hallucinogenic drugs on the development of psychoses].
Psychotic behavior and suicide which occurred after it induced us to study a connections among LSD use, psychotic behavior and suicidal risk ones again. Hereby we have a case of a young man who showed a psychotic behavior a week after taking LSD which ended tragically with suicide. What was the cause of this action, was it a late consequence of drug intake, flush-back or the first episode of a dissociative process which possibly started by change of behavior and sphere of interest? It is hard to answer this question by psychological autopsy. The dilemma remains constant, but we still think that this case report is of importance because we must not neglect such a clinical picture after taking LSD. It is particularly important now as drug addition is abruptly increasing in our society.


Pro-Con Debate: Nitrous Oxide for Labor Analgesia.
This Pro-Con debate will provide the practitioner with an evidence-based knowledge approach to assist the clinician in determining whether to employ (Pro) or not to employ (Con) this technique in the obstetrical suite for labor analgesia. Nitrous oxide has been used safely in dentistry and medicine for many centuries. However, accumulating preclinical and clinical evidence increasingly suggests previously unrecognized adverse maternal and fetal effects of nitrous oxide, which warrants reconsideration of its use in pregnant women and a more detailed informed consent. Nitrous oxide is associated with metabolic, oxidative, genotoxic, and transgenerational epigenetic effects in animals and humans that may warrant limiting its usefulness in labor. This debate will discuss and review the clinical uses, advantages, and disadvantages of nitrous oxide on occupational effects of nitrous oxide exposure, neuroapoptosis, FDA warning on inhalational anesthetics and the developing brain, research limitations, occupational exposure safety limits, effects on global warming, and potential for diversion.


Intracytoplasmic Expression of IL-6 and IL-17A in Circulating CD4+ T Cells Are Strongly Associated with and Predict Disease Activity in Rheumatoid Arthritis: A Case-Control Study in Ghana.
T cell cytokines play important roles in the development and progression of rheumatoid arthritis (RA). Loss of Th1/Th2 and Th17/Treg balance has been reported in several inflammatory autoimmune diseases. However, their role in RA within hitherto rare Ghanaian context has not been explored. Here, we evaluated the intracytoplasmic CD4+ T cell cytokine patterns in rheumatoid arthritis patients in Ghana and determined their relationship with disease activity. This case-control study included 48 newly diagnosed RA patients and 30 apparent healthy controls from two major hospitals in Ghana. Validated structured questionnaires were administered to obtain demographic data; blood samples were collected and processed for flow cytometric analysis. IFN-γ, TNF-α, IL-4, IL-6, IL-10, IL-17A, IL-6/IL-4, and IL-17/IL-10 expressions were significantly higher in RA cases compared to the healthy controls. The expression of IL-6 (0.00 (0.00-0.98) vs. 0.82 (0.34-1.10) vs. 1.56 (1.39-1.68), p < 0.0001), IL-17A (0.00 (0.00-0.02) vs. 0.19 (0.09-0.30) vs. 0.99 (0.64-1.25), p < 0.0001), and IL-17A/IL-10 (0.00 (0.00-0.39) vs. 0.15 (0.09-0.26) vs. 0.88 (0.41-1.47), p < 0.0001) increased significantly from the healthy controls through RA patients with low DAS scores to RA patients with moderate DAS scores. IL-6 (β = 0.681, r 2 = 0.527, p < 0.0001), IL-17A (β = 0.770, r 2 = 0.593, p < 0.0001), and IL-17A/IL-10 (β = 0.677, r 2 = 0.452, p < 0.0001) expressions were significantly directly associated with DAS28 scores. IL-6 (cutoff = 1.32, sensitivity = 100.0%, specificity = 100.0%, accuracy = 100.0%, and AUC = 1.000) and IL-17A (cutoff = 0.58, sensitivity = 100.0%, specificity = 100.0%, accuracy = 100.0%, and AUC = 1.000) presented with the best discriminatory power in predicting moderate DAS scores from low DAS scores. Th1- and Th17-related cytokines predominate in the pathophysiology of RA, with IL-6 and IL-17 being principally and differentially expressed based on the severity of the disease. IL-6 and IL-17A could serve as useful prognostic and disease-monitoring markers in RA in the African context.


5-Aminolevulinic acid-induced protoporphyrin IX fluorescence in meningioma: qualitative and quantitative measurements in vivo.
The use of 5-aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) fluorescence has shown promise as a surgical adjunct for maximizing the extent of surgical resection in gliomas. To date, the clinical utility of 5-ALA in meningiomas is not fully understood, with most descriptive studies using qualitative approaches to 5-ALA-PpIX. To assess the diagnostic performance of 5-ALA-PpIX fluorescence during surgical resection of meningioma. ALA was administered to 15 patients with meningioma undergoing PpIX fluorescence-guided surgery at our institution. At various points during the procedure, the surgeon performed qualitative, visual assessments of fluorescence by using the surgical microscope, followed by a quantitative fluorescence measurement by using an intraoperative probe. Specimens were collected at each point for subsequent neuropathological analysis. Clustered data analysis of variance was used to ascertain a difference between groups, and receiver operating characteristic analyses were performed to assess diagnostic capabilities. Red-pink fluorescence was observed in 80% (12/15) of patients, with visible fluorescence generally demonstrating a strong, homogenous character. Quantitative fluorescence measured diagnostically significant PpIX concentrations (cPpIx) in both visibly and nonvisibly fluorescent tissues, with significantly higher cPpIx in both visibly fluorescent (P < .001) and tumor tissue (P = .002). Receiver operating characteristic analyses also showed diagnostic accuracies up to 90% for differentiating tumor from normal dura. ALA-induced PpIX fluorescence guidance is a potential and promising adjunct in accurately detecting neoplastic tissue during meningioma resective surgery. These results suggest a broader reach for PpIX as a biomarker for meningiomas than was previously noted in the literature.


Appropriate but not cost effective ceftazidime use in a university hospital.
An evaluation of ceftazidime use at a university hospital was performed. Drug utilization evaluations usually categorize therapies as appropriate or inappropriate, with the inappropriate category including all regimens which are not cost effective. This may be misleading since therapy which is therapeutically appropriate may be labeled as inappropriate. Therefore, ceftazidime use was classified as appropriate, appropriate but not cost effective, or inappropriate. Clinical pharmacists reviewed the charts of 72 patients over a 1 month period. Courses of therapy were first categorized as empiric or definitive and as appropriate or inappropriate. Those that were appropriate were further analyzed to determine cost effectiveness. When a more cost effective regimen was available, the difference in cost was calculated; the cost of inappropriate therapy was compared to that of an appropriate alternative regimen. Ceftazidime use was appropriate and cost effective in 22% of courses, appropriate but not cost effective in 66%, and inappropriate in 11%. Annual savings of up to $72,000 could be realized in our 550 bed hospital by intervention into appropriate but not cost effective therapy and inappropriate therapy.


Marrow uptake of galactosyl-containing neoglycoproteins: implications in stem cell homing.
Tissue distribution of synthetic neoglycoproteins was studied after intravenous injection of 125I-labeled galactosyl-, mannosyl- and fucosyl-BSA. The highest uptake of all three reagents occurred in the bone marrow. Spleen also took up considerable proportions of galactosyl and mannosyl reagents, while liver only took up galactosyl-BSA. Implication of these findings in the recognition and homing of intravenously transplanted hemopoietic cells to bone marrow is discussed.


Fixed exanthema from systemic tobramycin.
Eye drops contain several ophthalmic medications which can produce allergic reactions. We report the case of a patient with contact dermatitis from neomycin and a probable fixed exanthema after parenteral administration of tobramycin who tolerated topical tobramycin and other aminoglycosides.


Doxorubicin cardiomyopathy.
Established doxorubicin cardiomyopathy is a lethal disease. When congestive heart failure develops, mortality is approximately 50%. Extensive research has been done to understand the mechanism and pathophysiology of doxorubicin cardiomyopathy, and considerable knowledge and experience has been gained. Unfortunately, no effective treatment for established doxorubicin cardiomyopathy is presently available. Extensive research has been done and is being done to discover preventive treatments. However an effective and clinically applicable preventive treatment is yet to be discovered.


Joint Commission, HCFA restraint regs are at odds.
The restraint standards from the Joint Commission on Accreditation of Healthcare Organizations and restraint regulations from the Health Care Financing Administration (HCFA) differ in key areas. HCFA requires a physician or other licensed practitioner to perform a face-to-face evaluation within one hour, while the Joint Commission requires the evaluation within 12 hours. HCFA doesn't permit the use of physician-developed protocols for restraints, while the Joint Commission allows protocols to be used. HCFA requires that restraints can be used only in emergency situations, unless it's documented that all other types of interventions have failed, while the Joint Commission permits restraint use for some behavioral management situations.


Analysis and treatment of hemifacial microsomia.
Our experience over the past 25 years leads us to conclude that hemifacial microsomia is a progressive skeletal and soft-tissue deformity with the earliest skeletal manifestations in the mandible. We find that not only does the mandibular asymmetry become worse with time, but as the contralateral side grows, the deformed mandible also increases ipsilateral secondary deformation of the maxilla, nose, and orbit. We also find that there is virtually no "catch up" growth on the affected side of the face and that these patients always become more deformed with age. The psychological problems also increase with time and progression of the facial deformity. Based on our experience with correction of end-stage deformities, we now treat these patients at the earliest possible age, as determined by the patient's skeletal classification. We treat the mandible first in the hope that this repositioning in a more physiologic position will unlock the growth potential of the adjacent structures, minimize secondary deformity, and improve function and appearance to the greater benefit of the skeletal and psychological growth of the patient.


Methimazole-induced hepatotoxicity.
To present the case of a patient with Graves' hyperthyroidism in whom treatment with methimazole led to severe cholestasis. A detailed case report and an overview of previously published cases of methimazole- and carbimazole-induced hepatotoxicity, found in a MEDLINE search with use of methimazole, carbimazole, thionamides and antithyroid agents as subject headings, are provided. In a 36-year-old woman with severe hyperthyroidism, treatment with methimazole (20 mg twice daily) was initiated. Nineteen days later, pruritus, scleral icterus, dark urine, and abdominal discomfort prompted discontinuation of the therapy. Laboratory investigations and abdominal ultrasonography showed findings consistent with a cholestatic reaction to methimazole. Recovery was slow but complete. Of the 30 previously published cases of hepatotoxicity related to treatment with methimazole or carbimazole in which the nature of the hepatic injury was described, 19 were also cholestatic. Physicians should be aware that thionamide drugs can be associated with hepatotoxicity. Analysis of the known cases suggests that older age of the patient and higher dose of the drug are risk factors for cholestatic injury.


[Detection of hepatitis A virus RNA with an improved loop-mediated isothermal amplification assay].
To establish a novel improved loop-mediated isothermal amplification (LAMP) technique to detect hepatitis A virus (HAV). A novel improved LAMP assay based on the addition of an acceleration primer was developed for hepatitis A virus nucleotide acid detection. Precision and reproducibility analysis proved its high stability and reliability. Comparison between the improved and conventional LAMP assays revealed that the former was more sensitive with a detection limit of 5 TCID50/ml. The novel detection method displayed 100% consistency with the TaqMan real-time PCR assay when applied to clinical specimens collected from patients with confirmed acute HAV infection. This novel technique is widely applicable as a simple diagnostic tool in the clinical field as well as for the surveillance and investigation of the infectious disease in developing countries where HAV is endemic.


[Influence of taking aristolochic acid-containing Chinese drugs on occurrence of urinary transitional cell cancer in uremic uremic patients undergoing dialysis].
To investigate the prevalence and clinical characteristics of urinary transitional cell cancer (TCC) in uremic patients undergoing dialysis who have history of taking aristolochic acid (AA)-containing Chinese drugs. A questionnaire survey was conducted among 283 uremic patients with history of taking aristolochic acid (AA)-containing Chinese drug who were undergoing dialysis, 118 males and 165 females, aged 59 +/- 13 (22-88), to understand the drug-taking history, nephropathy-related situation, and prevalence and clinic TCC pathological features of TCC. Twenty-four of the 283 were suffering concomitant TCC with a prevalence rate of 8.48%. Sixty-six of the 283 patients had a history of taking AA-containing Chinese drugs, 22 of which had developed TCC with a prevalence rate of 33.3%, significantly higher than that among the 198 patients without a history of taking AA-containing Chinese drugs (1.0%, P < 0.01). Seventeen (94.4%) of the 18 TCC patients with a clear AA-taking history reported took the drug at routine doses for a long time, and 1 of the 18 patients took overdose of AA-containing drug. The average time between the beginning of taking AA-containing drugs and the occurrence of TCC was 10 years. TCC was found only in the patients with remnant urine > 100 ml after dialysis (8/38, 21.0%) and was not found in those with anuria after dialysis. The first symptom in the 18 TCC cases was intermittent painless hematuria. The positive rates of imageology and nuclear matrix protein (NMP)-22 detection were both more than 90%. Tumor was found in the urinary bladder or ureter (11/18, 61.2%). The relapse rate after routine surgery was 27.8%. With a very high prevalence of TCC, the patients with a history of taking AA-containing Chinese drugs should be monitored closely.


Physical activity, diet, adiposity and female breast cancer prognosis: a review of the epidemiologic literature.
Given the increasing numbers of long-term survivors of breast cancer, research specific to prevention of recurrence, new breast cancer events, and mortality is of considerable public health importance. The objective of this report is to present a review of the published epidemiologic research on lifestyle and breast cancer outcomes among women with a history of breast cancer. This review focused on physical activity, diet, and adiposity; and the primary outcomes were additional breast cancer events and mortality. The most consistent finding from observational studies was that adiposity was associated with a 30% increased risk of mortality. Although the observational data were not as consistent (or abundant), physical activity appeared to be associated with a 30% decreased risk of mortality. These data do not indicate that alcoholic drinks are a risk factor. Based only on the observational studies, total dietary fat appeared to be a risk factor, fiber was protective, and information on micronutrients and specific foods was sparse. However, the null results of 2 dietary intervention trials in survivors suggests that lowering fat intake or increasing consumption of fruits, vegetables, and fiber will not lead to improved prognosis in breast cancer survivors. Given that a high proportion of breast cancer patients appear to be both sedentary and obese/overweight, clinical trials are needed to investigate whether the combination of increased physical activity and reduced adiposity can improve breast cancer prognosis.


[Adult-onset Still's disease revealed by a pericardial tamponade: report of two cases].
Adult onset Still's disease is a systemic inflammatory disorder of unknown etiology characterized by the association of a high spiking fever, an evanescent skin rash, arthritis, and hyperleukocytosis. Pericarditis is amongst the most common systemic manifestations of adult onset Still's disease. We report on two patients with a pericardial tamponade revealing an adult onset Still's disease in a 52-year-old female and a 31-year-old male. Pericardial fluid was bloody in the two cases, and histopathology only disclosed non specific inflammatory changes. Both patients received corticosteroids and outcome was uneventful with a follow-up of 8 years and 12 months, respectively. Pericardial tamponade is an uncommon clinical feature of adult-onset Still's disease and usually occurs at disease onset. It makes the diagnosis of adult-onset Still's disease difficult as the other disease manifestations are commonly neglected. Adult onset Still's disease should be added to the differential of acute pericarditis and tamponade.


A Giant Adrenal Mass in a Super Obese Patient.
Giant pheochromocytomas (Pheo) are rare entities requiring clinical suspicion coupled with strategic diagnostic evaluation to confirm the diagnosis. The majority of cases are discovered incidentally. The diagnosis consists of biochemical evaluation and imaging study to localize the mass. Pathological examination confirms the diagnosis. The female patient in this case report presented with chest pain, palpitation of three weeks duration and was found on evaluation to have an abdominal mass concerning for pheochromocytoma. She was treated with surgical resection. The pheo measured 20.5 x 18 x 10 cm and weighed 2,582 grams. Pathological examination confirmed the diagnosis of pheochromocytoma.


[Relation between chronic respiratory diseases in children and secretory IgA and IgM].
In 1981-1984 from a total of 288 children aged 6-36 months, suffering from acute and relapsing respiratory disease, in 52 children in the nasopharyngeal secretion IgM was detected in average amounts of 11.3 +/- 9.7 mg/100 ml. In 13 of the children in the course of 1-2 years after the first examination the IgM values in the nasopharyngeal secretion doubled or increased several times (20-50 mg/100 ml). The values in saliva at the age of 5-9 years were in seven of these children lower than the mean physiological values of SIgA in saliva (34.3 +/- 15.9 mg/100 ml). In 12 children in the course of 5-9 years chronic respiratory disease developed--obstructive bronchitis. In six children, where during school age in saliva mean SIgA values lower than normal were recorded, more frequent relapses and complications were recorded (pneumonia, sinobronchial syndrome, otitis media). Elevated values of SIgM in the nasopharyngeal secretion of infants and toddlers with acute and relapsing bronchitis can be considered a risk factor for the development of chronic disease, in particular in case of a permanently reduced SIgA formation also in saliva.


[The CNS in AIDS and in asymptomatic HIV positive patients].
Neuropathological investigations were carried out on 166 autopsies of HIV-seropositive patients, with and without AIDS. Opportunistic infections and lymphomas were present in about 50% of cases; 65 patients were bearers of HIV-encephalopathy. HIV core protein p24 was detected in few mono- and multinucleated macrophages (HIV-cells), only in cases with HIV-encephalopathy. In the CNS of HIV-positive, asymptomatic patients no histological or immunohistochemical abnormalities were seen. These findings let suppose that AIDS-Dementia is a result of a late infiltration of HIV-infected macrophages from the bloodstream into the brain and not due to an impairment of neuronal or glial cells infected by HIV in the early stages of the disease.


Dual-system Involvement: Exploring the Overlap Between Domestic and Family Violence and Child Maltreatment Perpetration.
This longitudinal population-based study aimed to understand the dual-system involvement of males who engage in domestic and family violence (DFV) and child maltreatment perpetration. Specifically, this study investigates the prevalence of male perpetration of DFV, child maltreatment, and dual-system involvement, and compares the frequency and nature of perpetration by males with single-system contact and males with dual-system contact. The effect of race (Indigenous Australian/non-Indigenous Australian) and parental status on dual-system involvement is also examined. This study utilizes data from the Queensland Cross-sector Research Collaboration repository. These data contain each contact an individual male born in 1983 or 1984 had with the Queensland civil court system as a respondent to a domestic violence order (DVO) and the Queensland statutory child protection system, where, after an investigation, they were identified as the person responsible for substantiated harm to a child. The results from the study show a high level of overlap between males who perpetrate DFV and child maltreatment. Of males identified as being responsible for substantiated harm to a child, 58% have also been a respondent of a DVO, and approximately 16% of male DVO respondents were identified as being responsible for substantiated harm to a child. Differences were found in the frequency and nature of perpetration by males with dual-system involvement compared to those with single-system contact for either DFV or child maltreatment. Our results also show differences for Indigenous status, parental status, number of maltreatment events, harm type, number of DVOs, and number of breaches of a DVO. The implications of this study for both policy and practice are discussed.


The burden of cardiovascular disease risk factors: A current problem.
The pandemic of COVID-19, which in Poland raised all-cause and cardiovascular disease (CVD) death rates by over 15% only in 2020, naturally decreased the attention to the prevention of CVD. Nevertheless, the reports on the characteristics of COVID-19 patients and especially on factors related to the severe or fatal outcome of the disease included information on more frequent CVD risk factors and atherosclerotic CVD. This article reviews the evidence on the exposure to CVD risk factors in the Polish adult population and discusses evidence on the associations between CVD risk factors and COVID-19. CVD and CVD risk factors, obesity and diabetes, in particular, are related to the severe course or fatal outcome of COVID-19. High prevalence of CVD risk factors with an increasing prevalence of obesity and diabetes could make the Polish population more sensitive to COVID-19 incidence and put infected persons at higher risk of serious complications and fatal outcome. Likely, the increased number of CVD deaths observed during the pandemic could be explained partially by the high prevalence of CVD risk factors and atherosclerotic CVD, as well as by the direct cardiac complications of COVID-19, short-term higher risk of myocardial infarction (MI) and stroke, and possibly by the underuse of lifesaving procedures in acute and chronic CVD.


The effect of coating patterns with spinel-based investment on the castability and porosity of titanium cast into three phosphate-bonded investments.
This study evaluated the effect of pattern coating with spinel-based investment Rematitan Ultra (RU) on the castability and internal porosity of commercially pure (CP) titanium invested into phosphate-bonded investments. The apparent porosity of the investment was also measured. Square patterns (15 × 15 × 0.3 mm(3)) were either coated with RU, or not and invested into the phosphate-bonded investments: Rematitan Plus (RP), Rema Exakt (RE), Castorit Super C (CA), and RU (control group). The castings were made in an Ar-arc vacuum-pressure machine. The castability area (mm(2) ) was measured by an image-analysis system (n = 10). For internal porosity, the casting (12 × 12 × 2 mm(3) ) was studied by the X-ray method, and the projected porous area percentage was measured by an image-analysis system (n = 10). The apparent porosity of the investment (n = 10) was measured in accordance with the ASTM C373-88 standard. Analysis of variance (One-way ANOVA) of castability was significant, and the Tukey test indicated that RU had the highest mean but the investing technique with coating increased the castability for all phosphate-bonded investments. The analysis of the internal porosity of the cast by the nonparametric test demonstrated that the RP, RE, and CA with coating and RP without coating did not differ from the control group (RU), while the CA and RE casts without coating were more porous. The one-way ANOVA of apparent porosity of the investment was significant, and the Tukey test showed that the means of RU (36.10%) and CA (37.22%) were higher than those of RP (25.91%) and RE (26.02%). Pattern coating with spinel-based material prior to phosphate-bonded investments can influence the castability and the internal porosity of CP Ti.


Development of the caudal exoskeleton of the pliomerid trilobite Hintzeia plicamarginis new species.
The later juvenile ontogeny of the caudal plate of the early Ordovician pliomerid trilobite Hintzeia plicamarginis new species likely comprised an initial phase during which the rate of appearance of new segments subterminally exceeded that of segment release into the thorax, a short phase of constant segment numbers, and a later phase during which release occurred but in which no new segments appeared. A distinct terminal region became manifest in the second phase. During the second and third phases growth coefficients for individual segments were about 1.1--1.2 per instar. Although the shapes of segments varied during growth, the pattern of ontogenetic shape change appears to have been broadly similar among segments. This suggests an homonomous trunk segment morphology regardless of thoracic or caudal identity in maturity. These results imply that control of trunk exoskeletal segment appearance and articulation were decoupled in this trilobite, and that the terminal region had a distinct mature morphology. H. plicamarginis is described as a new species.


Tetra-aqua-bis-{5-[4-(imidazol-1-yl-κN)phen-yl]tetra-zolido}manganese(II).
In the title complex, [Mn(C(10)H(7)N(6))(2)(H(2)O)(4)], the Mn(2+) cation is located on a twofold rotation axis and is coordinated by two N atoms from two 5-[4-(imidazol-1-yl)phen-yl]tetra-zolide ligands and four O atoms from four water mol-ecules, displaying a distorted MnN(2)O(4) octa-hedral geometry. The crystal structure is stabilized by intermolecular O-H⋯N hydrogen bonds involving the coordinated water mol-ecules and the N atoms of the tetra-zolide group.


Density functional estimations of Heisenberg exchange constants in oligonuclear magnetic compounds: Assessment of density functional theory versus ab initio.
Modern density functionals were assessed for the calculation of magnetic exchange constants of academic hydrogen oligomer systems. Full-configuration interaction magnetic exchange constants and wavefunctions are taken as references for several H(n) model systems with different geometrical distributions from Ciofini et al. [Chem. Phys. 309, 133 (2005)]. Regression analyses indicate that hybrid functionals (B3LYP, O3LYP, and PBE0) rank among the best ones with a slope of typically 0.5, i.e., 100% overestimation with a standard error of about 50 cm(-1). The efficiency of the highly ranked functionals for predicting the correct "exact states" (after diagonalization of the Heisenberg Hamiltonian) is validated, and a statistical standard error is assigned for each functional. The singular value decomposition approach is used for treating the overdetermination of the system of equations when the number of magnetic centers is greater than 3. Further discussions particularly about the fortuitous success of the Becke00-x-only functional for treating hydrogenic models are presented.


Genetic variation in flowering phenology and avoidance of seed predation in native populations of Ulex europaeus.
The genetic variation in flowering phenology may be an important component of a species' capacity to colonize new environments. In native populations of the invasive species Ulex europaeus, flowering phenology has been shown to be bimodal and related to seed predation. The aim of the present study was to determine if this bimodality has a genetic basis, and to investigate whether the polymorphism in flowering phenology is genetically linked to seed predation, pod production and growth patterns. We set up an experiment raising maternal families in a common garden. Based on mixed analyses of variance and correlations among maternal family means, we found genetic differences between the two main flowering types and confirmed that they reduced seed predation in two different ways: escape in time or predator satiation. We suggest that this polymorphism in strategy may facilitate maintain high genetic diversity for flowering phenology and related life-history traits in native populations of this species, hence providing high evolutionary potential for these traits in invaded areas.


[Arthroscopic anatomy and diagnosis of posterior cruciate ligament injuries].
Basic problems of arthroscopically assisted diagnostics of posterior cruciate ligament injuries are presented. Anatomic "three-part" concept and arthroscopic postero-medial approach are recommended in visual judging of ligament competence. "Sloppy ACL" is considered as most valuable sign in diagnosis of posterior cruciate ligament injuries.


Intravascular immunity: the host-pathogen encounter in blood vessels.
The immune system provides an essential defence against invading pathogens. However, bacteria have evolved numerous strategies to overcome this defence, many of which facilitate systemic dissemination of the pathogen. Nevertheless, the host has evolved many mechanisms to detect and protect against pathogens in the vasculature. Recent studies using new imaging approaches and new mouse models are revealing previously unappreciated functions of this intravascular aspect of the immune system. In this Review, we summarize recent work in this field, highlighting in vivo imaging studies that examine the behaviour of both the immune system and bacteria in the highly dynamic microvasculature.


Is the knowledge and attitude of physicians in Nigeria adequate for the diagnosis and management of obstructive sleep apnea?
The knowledge and attitude of doctors in Nigeria towards obstructive sleep apnea is not known. We evaluated the level of knowledge and attitude regarding OSA among resident doctors in Internal Medicine and general practitioners in Nigeria. A cross-sectional survey among doctors during continuing medical education programs was conducted. The Obstructive Sleep Apnea Knowledge and Attitude (OSAKA) questionnaire was used to obtain information. Two hundred seventy-three doctors (235 resident doctors and 38 general practitioners) participated in the study. The mean knowledge score was 10.7 ± 2.6 (out of a maximum possible of 18) for all participants corresponding to 59 ± 14.4 % knowledge. There was no significant difference in the mean score of resident doctors (10.8 ± 2.5) compared to general practitioners (10.0 ± 2.8), (t = 2.6, p = 0.10). Over 70 % of the participants wrongly responded that uvuloplasty was an effective treatment and less than 40 % correctly answered that continuous positive airway pressure treatment was first line for severe obstructive sleep apnea. The mean score on the attitude segment was 3.4 ± 0.6 (maximum possible score of 5) for all participants and 3.4 ± 0.6 and 3.3 ± 0.5, respectively, for the residents and the general practitioners (p = 0.47). Increasing age was negatively associated with level of knowledge, while increasing number of years in medical practice and higher level of residency training was positively associated with higher knowledge scores. The knowledge of obstructive sleep apnea among resident doctors and general practitioners in Nigeria is inadequate. There is need to improve training on sleep disorders in Nigeria both at continuing medical education programs and during residency training.


Psychiatry in Britain, c. 1900.
At this period, British psychiatrists practised in a climate of opinion that was deeply pessimistic, influenced by the views of Henry Maudsley and by the accumulation in asylums of incurable patients. The inflexible Lunacy Act of 1890 tended to encourage chronicity. The terminology both of mental illness and of the doctors who dealt with it was uncertain. Management of these disorders was intimately involved with the operation of the Poor Law. Neurology, on the other hand, carried high prestige and advanced clinically; many patients with neurotic disorders came under the care of neurologists. Postgraduate education and training in psychiatry was practically non-existent, as was academic psychiatry, in contrast notably to Germany, though there was a small professional organization.


Additive coloring of thin, single crystalline MgO(001) films.
Electron bombardment of single-crystalline MgO(001) films has been shown to result in the formation of surface color centers. In this report we present an alternative way to produce surface color centers on single-crystalline MgO(001) films using additive Mg coloring. Electron paramagnetic resonance (EPR) spectroscopy was used to prove the formation of surface paramagnetic color centers upon deposition of small amounts of Mg on MgO(001) films at 50 K. With increasing coverage the number of Mg induced color centers rises up to a coverage of about 0.03 monolayers and thereafter decreases with increasing Mg coverage. At high coverage and low temperatures metallic Mg clusters nucleate on the surface of the MgO(001) film as shown by infrared (IR) spectroscopy using CO as a probe molecule.


Calcitonin increases peripheral plasma somatostatin-like immunoreactivity levels in humans.
Even though the inhibitory effects of CT on both hormone secretion and gastrointestinal functions have been well established, the exact mechanism of action still remains unclear. Since the effects of CT can be reproduced by somatostatin, we studied in man the effect of SCT on peripheral plasma SLI levels. Immediately after the onset of CT infusion SLI rose from its mean basal value of 45 +/- 5.5 pg/ml to a peak value of 91 +/- 11 pg/ml (p less than 0.005). SLI levels were still significantly elevated at 30 (p less than 0.05), 45 (p less than 0.05), 90 (p less than 0.005) and 120 min (p less than 0.02). Our results, in good agreement with the previous report by Chiba et al. on isolated perfused rat stomach, suggest that CT effects may, at least in part, be mediated by endogenous somatostatin release.


Structural analysis of point mutations at the Vaccinia virus A20/D4 interface.
The Vaccinia virus polymerase holoenzyme is composed of three subunits: E9, the catalytic DNA polymerase subunit; D4, a uracil-DNA glycosylase; and A20, a protein with no known enzymatic activity. The D4/A20 heterodimer is the DNA polymerase cofactor, the function of which is essential for processive DNA synthesis. The recent crystal structure of D4 bound to the first 50 amino acids of A20 (D4/A201-50) revealed the importance of three residues, forming a cation-π interaction at the dimerization interface, for complex formation. These are Arg167 and Pro173 of D4 and Trp43 of A20. Here, the crystal structures of the three mutants D4-R167A/A201-50, D4-P173G/A201-50 and D4/A201-50-W43A are presented. The D4/A20 interface of the three structures has been analysed for atomic solvation parameters and cation-π interactions. This study confirms previous biochemical data and also points out the importance for stability of the restrained conformational space of Pro173. Moreover, these new structures will be useful for the design and rational improvement of known molecules targeting the D4/A20 interface.


Highly Tumor-Specific and Long-Acting Iodine-131 Microbeads for Enhanced Treatment of Hepatocellular Carcinoma with Low-Dose Radio-Chemoembolization.
Transarterial radioembolization (TARE) is considered the standard treatment for intermediate-stage hepatocellular carcinoma (HCC). Iodine-131 (131I)-labeled lipiodol TARE is an effective treatment for HCC but has been withdrawn due to its poor retention in tumor lesions and significant distribution in normal tissues with severe side effects. In this work, a highly tumor-specific 131I-TARE agent with long-time retention is developed by simply introducing tyrosine to poly(vinyl alcohol) (PVA) drug-eluting microbeads (Tyr-PVA-DEBs). The labeling efficiency of 131I-labeled microbeads remains above 85% in 50% serum for 31 days. Micro-single-photon emission computed tomography/computed tomography (μSPECT/CT) evidences that the 131I-labeled microbeads accumulate in the orthotopic N1S1 hepatoma of rats for 31 days following intra-arterial injection. The cumulative radiation dose per cubic centimeter of the tumor is at least 13 678-fold higher than that of normal tissues. The highly tumor-selective radiation of the 131I-labeled microbeads allows localized delivery of 345.04 ± 139.16 Gy to the tumor following a single injection dose as low as 0.2 mCi of 131I. Moreover, the 131I-labeled microbeads are loaded with doxorubicin hydrochloride (DOX) through the carboxy groups on tyrosine of the polymer. The 131I-DOX-loaded microbeads present a synergetic antitumor effect without recurrence in comparison with the microbeads labeled with 131I or loading DOX alone, attributed to the sensitization of DOX to 131I-induced ionizing radiation damage to DNA under the embolization-induced hypoxia. Our results demonstrate a high tumor retention of 131I-labeled embolic agent for low-dose transarterial radio-chemoembolization (TARCE) with a synergetic therapeutic effect on treating HCC, showing potential for clinical application.


Clinical descriptors of pneumothorax following chest tube removal in paediatric cardiac surgery.
There is limited data describing the characteristics of paediatric post-operative cardiac surgery patients who develop pneumothoraces after chest tube removal. Patient management after chest tube removal is not standardised across paediatric cardiac surgery programmes. The purposes of this study were to describe the frequency of pneumothorax after chest tube removal in paediatric post-operative cardiac surgical patients and to describe the patient and clinical characteristics of those patients who developed a clinically significant pneumothorax requiring intervention. A single-institution retrospective descriptive study (1 January, 2010-31 December, 2018) was utilised to review 11,651 paediatric post-operative cardiac surgical patients from newborn to 18 years old. Twenty-five patients were diagnosed with a pneumothorax by chest radiograph following chest tube removal (0.2%). Of these 25 patients, 15 (1.6%) had a clinically significant pneumothorax and 8 (53%) did not demonstrate a change in baseline clinical status or require an increase in supplemental oxygen, 14 (93%) required an intervention, 9 (60%) were <1 year of age, 4 (27%) had single-ventricle physiology, and 5 (33%) had other non-cardiac anomalies/genetic syndromes. In our cohort of patients, we confirmed the incidence of pneumothorax after chest tube removal is low in paediatric post-operative cardiac surgery patients. This population does not always exhibit changes in clinical status despite having clinically significant pneumothoraces. We suggest the development of criteria, based on clinical characteristics, for patients who are at increased risk of developing a pneumothorax and would require a routine chest radiograph following chest tube removal.


CA-125 cut-off value as a predictor for complete interval debulking surgery after neoadjuvant chemotherapy in patients with advanced ovarian cancer.
In the present study, we evaluated changes in CA-125 cut-off values predictive of complete interval debulking surgery (IDS) after neoadjuvant chemotherapy (NAC) using receiver operating characteristic (ROC) analysis. This retrospective single-institution study included patients with International Federation of Gynecology and Obstetrics (FIGO) stage III epithelial ovarian cancer and a pre-NAC serum CA-125 level of greater than 40 U/mL who were treated with neoadjuvant platinum-based chemotherapy followed by IDS between 1994 and 2009. Logistic regression analysis was used to evaluate univariate and independent multivariate associations with the effect of clinical, pathological, and CA-125 parameters on complete IDS, and ROC analysis was used to determine potential cut-off values of CA-125 for prediction of the possibility of complete IDS. Seventy-five patients were identified. Complete IDS was achieved in 46 (61.3%) patients and non-complete IDS was observed 29 (38.7%). Median pre-NAC CA-125 level was 639 U/mL (range, 57 to 6,539 U/mL) in the complete IDS group and 1,427 U/mL (range, 45 to 10,989 U/mL) in the non-complete IDS group. Median pre-IDS CA-125 level was 15 U/mL (range, 2 to 60 U/mL) in the complete IDS group and 53 U/mL (range, 5 to 980 U/mL) in the non-complete IDS group (p<0.001). Multivariate analyses performed with complete IDS as the endpoint revealed only pre-IDS CA-125 as an independent predictor. The odds ratio of non-complete IDS was 10.861 when the pre-IDS CA-125 level was greater than 20 U/mL. The present data suggest that in the setting of IDS after platinum-based NAC for advanced ovarian cancer, a pre-IDS CA-125 level less than 20 U/mL is an independent predictor of complete IDS.


Catecholamines-evoked cytosolic Ca2+ rise in endothelial cells from bovine adrenal medulla.
The effects of catecholamines on intracellular Ca2+ concentrations ([Ca2+]i) in single acutely dissociated bovine adrenal medulla endothelial cells (BAMECs) were measured using the intracellular fluorescent probe Fluo-3 AM. 100 microm epinephrine or norepinephrine induced a biphasic [Ca2+]i rise with an initial peak followed by a delayed phase. 10 microm phenylephrine (alpha1-adrenergic agonist) caused a [Ca2+]i rise similar to that evoked by catecholamines. The increase in [Ca2+]i induced by 10 microm phenylephrine was reverted by 10 microm phenoxybenzamine (alpha-adrenergic antagonist). Neither isoproterenol (beta-adrenergic agonist) nor clonidine (alpha2-adrenergic agonist) induced [Ca2+]i rise. The initial peak was insensitive to zero external Ca2+ and it was abolished after Ca2+ internal storages were emptied by 10 mM caffeine. The delayed phase was reduced to near zero by external Ca2+ removal. These results indicate that BAMECs possess alpha1-adrenergic receptors associated to both the release of caffeine-sensitive intracellular Ca2+ stores and the entry of extracellular Ca2+. We suggest that chromaffin cell secretion may activate BAMECs in vivo through an increase in [Ca2+]i which could induce the secretion of vasoactive factors allowing a rapid entry of hormones into the circulation.


Comparison of the persistent efficacy of the injectable and pour-on formulations of doramectin against artificially-induced infection with Dictyocaulus viviparus in cattle.
The persistent efficacy of the injectable and topical formulations of doramectin was compared against experimental challenges with infective larvae of Dictyocaulus viviparus in two separate studies. Four groups of 10 randomly-assigned calves, negative for lungworm larvae by the Baermann technique, were used in each study. Calves were treated subcutaneously in the midline of the neck or poured down the midline of the back with saline (1 ml/50 kg. injection: 1 ml/10 kg. pour-on) on Day 0 or doramectin (200 microg/kg = 1 ml/50 kg. injection: 500 microg/kg = 1 ml/10 kg. pour-on) on Day 0, 7, or 14. Two additional calves from the same pool of animals were randomly assigned as larval-viability monitors and received no treatment. Calves were inoculated daily with a gavage of approximately 100 larvae of D. viviparus from days 35 to 49 for the injectable study and days 28 to 42 for the pour-on study. The two larval viability monitor calves received approximately 3000 infective larvae in the same manner on Day 49 or 42 for the injectable and pour-on studies, respectively. Equal numbers of calves from each treatment group as well as the larval viability monitor calves were necropsied on days 14 and 15 after the last lungworm inoculation to enumerate the worm burden. The worms recovered were quantified and identified. For each study, geometric mean worm recoveries for each treatment group were back transformed from the natural log-transformed data (worm count +1) and were used to estimate percentage reduction. Doramectin injectable solution was 100.0% efficacious against lungworms for up to 49 days and the pour-on formulation was 100.0%, 93.1% and 81.5% effective in reducing lungworm infection resulting from challenge infection for up to 28, 35, and 42 days post-treatment, respectively.


[Analysis of the factors determining the change in cardiac output during administration of catecholamines].
Electromagnetic flow metering was used in acute experiments on cats to study the cardiac output (CO) and venous return (VR) changes under pressor reactions in response to noradrenaline (NA) and adrenaline (A) infusion. The CO increased in 2/3 and decreased in 1/3 of all observations in response to NA infusion. In half of observations, the VR had the same line of changes as the CO. Similar changes in the CO and VR were obtained after A infusion. The blockade of beta- and M-cholinoreceptors did not affect the magnitude of CO changes in response to NA infusion but played a certain role in response to A infusion. The level of the arterial blood pressure under which the increase of the CO in response to NA infusion was mostly recorded has been established.


Concurrent chemoradiation with weekly gemcitabine and cisplatin for locally advanced cervical cancer.
For more than 80 years, the standard treatment of locally advanced cervical cancer was radiotherapy. However, based on several phase III randomized clinical trials in the past decade, concurrent cisplatin-based chemoradiotherapy is the current standard for this disease. Gemcitabine has potent radiosensitizing properties in preclinical and clinical trials, so it can be utilized simultaneously with radiation. Thirty women with untreated invasive squamous cell carcinoma of the cervix of stage IIB to stage IVA were enrolled in the study in the Radiation Oncology Department of Imam Khomeini Hospital in Tehran from September 2009 to September 2010. Sixty mg/m2 gemcitabine followed by 35 mg/m(2) cisplatin were concurrently administered with radiotherapy to the whole pelvic region on day one of each treatment week for five weeks. One and three months after treatment, patients underwent a complete physical examination and MRI to determine the response to treatment. The mean age of patients was 58.1 ± 11.8 (29-78) years. After 3 months of treatment, 73.3%had complete and 26.7% demonstrated partial response to treatment. Grade 3 anemia was seen in 10%, grade 3 thrombocytopenia in 3.3% and grade 3 leukopenia in 10% of the patients. According to the positive results of this study in stage IIB, further phase II and III clinical trials are suggested to evaluate the role of chemoradiation using Gemcitabine for advanced cervical cancers.


Sensor-Based Human Activity Recognition Using Adaptive Class Hierarchy.
In sensor-based human activity recognition, many methods based on convolutional neural networks (CNNs) have been proposed. In the typical CNN-based activity recognition model, each class is treated independently of others. However, actual activity classes often have hierarchical relationships. It is important to consider an activity recognition model that uses the hierarchical relationship among classes to improve recognition performance. In image recognition, branch CNNs (B-CNNs) have been proposed for classification using class hierarchies. B-CNNs can easily perform classification using hand-crafted class hierarchies, but it is difficult to manually design an appropriate class hierarchy when the number of classes is large or there is little prior knowledge. Therefore, in our study, we propose a class hierarchy-adaptive B-CNN, which adds a method to the B-CNN for automatically constructing class hierarchies. Our method constructs the class hierarchy from training data automatically to effectively train the B-CNN without prior knowledge. We evaluated our method on several benchmark datasets for activity recognition. As a result, our method outperformed standard CNN models without considering the hierarchical relationship among classes. In addition, we confirmed that our method has performance comparable to a B-CNN model with a class hierarchy based on human prior knowledge.


Heparin-chitosan complexes stimulate wound healing in human skin.
The effect of heparin ionically linked to chitosan on the stimulation of re-epithelialisation of full thickness wounds in human skin was investigated in an in vitro model. After seven days of incubation, heparin-chitosan gel stimulated 9/10 of the full thickness wounds to re-epithelialise compared with only 3/10 of the wounds that were covered with chitosan gel or membrane, and none of the wounds incubated without gel or membrane or with heparin solution alone. Both dermal and epidermal cells were viable after the incubation time. Furthermore, the stimulatory effect of the heparin-chitosan complexes depended on the concentration of heparin in the complex. We hypothesise that these effects are caused by stabilisation and activation of growth factors that bind to immobilised heparin.


Different sensitivity of blocking effects of alpha-adrenoceptor blocking agents on vascular responses to intraluminal norepinephrine and periarterial stimulation in isolated dog arteries.
The stainless steel cannula inserting method was used to examine the effects of periarterial electrical nerve stimulation and intraluminal norepinephrine in the isolated and perfused mesenteric artery of the dog. The optimum conditions for inducing an increase in perfusion pressure over 50 mmHg to periarterial electrical stimulation were 3-5 msec duration, 40-50 volts and 10-20 Hz. After the treatment with phentolamine or prazosin, the vasoconstrictor response to norepinephrine was readily inhibited completely at a relative small dose of 0.3-3 micrograms. Periarterial stimulation-induced vasoconstriction was also significantly suppressed by a relatively large dose of 100 micrograms of phentolamine or prazosin in concentrations 30 to 100 times larger than that required for blocking the norepinephrine-induced constriction. Yohimbine in relatively small doses potentiated the stimulation-induced vasoconstriction, but rather suppressed it in a large dose. The constrictor response to periarterial stimulation was significantly suppressed by 1 and 10 micrograms of intraluminal tetrodotoxin. It is concluded that periarterial electrical stimulation in the cannula inserting method is useful for studying autonomic pharmacology and physiology in vasculature with due regard to the characteristics.


GRP78 mediates cell growth and invasiveness in endometrial cancer.
Recent studies have indicated that endoplasmic reticulum stress, the unfolded protein response activation and altered GRP78 expression can play an important role in a variety of tumors development and progression. Very recently we reported for the first time that GRP78 is increased in endometrial tumors. However, whether GRP78 could play a role in the growth and/or invasiveness of endometrial cancer cells is still unknown. Here we report that the silencing of GRP78 expression affects both cell growth and invasiveness of Ishikawa and AN3CA cells, analyzed by the (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide) and transwell migration assay, respectively. At variance with Ishikawa cells, AN3CA cells showed, besides an endoplasmic reticulum, also a plasma membrane GRP78 localization, evidenced by both immunofluorescence and cell membrane biotinylation experiments. Intriguingly, flow cytometry experiments showed that the treatment with a specific antibody targeting GRP78 C-terminal domain caused apoptosis in AN3CA but not in Ishikawa cells. Induction of apoptosis in AN3CA cells was not mediated by the p53 pathway activation but was rather associated to reduced AKT phosphorylation. Interestingly, immunofluorescence analysis evidenced that endometrioid adenocarcinoma tissues displayed, similarly to AN3CA cells, also a GRP78 plasma membrane localization. These data suggest that GRP78 and its plasma membrane localization, might play a role in endometrial cancer development and progression and might constitute a novel target for the treatment of endometrial cancer.


[Rational lymphadenectomy in patients with cervical nodes metastasis for carcinoma of the lower third esophagus].
Prognostic value of removing cervical nodes in patients with carcinoma of the lower third esophagus is extremely controversial. Of 93 patients with curative esophagectomy via trans-thoracic approach, cervical nodes were involved in five patients (13%), upper mediastinal nodes in 12 patients (30%), and para-aortic nodes in only one patients (3%) for 40 patients whose proximal part of the tumor invading the mid-esophagus from below. Of the remaining 53 patients with tumor extent confined to the lower third esophagus, cervical nodes were involved in only one patients (2%), upper mediastinal nodes in five patients (9%), and paraaortic nodes in six patients (11%). Three of the five patients with cervical metastasis whose proximal part of the tumor invading the mid-esophagus survived for at least 22 months or more following three-field lymphadenectomy. Removing the cervical nodes in patients with carcinoma of the lower third esophagus may have some role to improve the survival if the tumor invades the mid-esophagus from below.


Emulsion Interfacial Synthesis of Polymer/Inorganic Janus Particles.
We report a method to prepare polymer/inorganic Janus particles by transferring self-assembled membranes of copolymers such as PS- b-PAA at an emulsion interface when the amine-capped particles such as paramagnetic Fe3O4@SiO2 core/shell particles are preferentially adsorbed by specific interactions. While the particles are protected, the exposed side can be further modified to conjugate aldehyde-capped polyethylene oxide (PEO). Both connections become robust by covalent bonds. The hydrophilic PEO and hydrophobic PS chains are distinctly compartmentalized onto the opposite sides of the Fe3O4@SiO2 particles. As a magnetic responsive solid surfactant, the stabilized emulsions can be driven with a magnet for directional movement and coalescence with increasing magnetic strength. This method can be extended to other Janus particles with tunable organic materials and solid particles.


[Squamous cell carcinoma of the nail bed].
A 85-year-old woman presented clinically with paronychia. Treatment for this was uneffective, however. Finally, the diagnosis was Bowen's disease of the nail bed with underlying invasive squamous cell carcinoma. Treatment consisted of a subcapital amputation through the middle phalanx. Subungual tumors often appear to be a diagnostic problem because of their benign presentation. Every longstanding nail bed disease that does not respond to therapy needs to be biopted.


The differential expression of myometrial connexin-43, cyclooxygenase-1 and -2, and Gs alpha proteins in the upper and lower segments of the human uterus during pregnancy and labor.
There is evidence from many studies indicating that a number of specific quiescent and contractile associated proteins are temporally regulated in the myometrium during pregnancy. In this present investigation we provide data that strongly suggest that myometrial connexin-43, cyclooxygenase-1 and -2 (COX-1 and -2), and Gs alpha proteins are also spatially expressed within the human uterus during pregnancy and labor. Using paired lower and upper segment myometrial samples taken from individual women at term and during spontaneous labor, we have measured the expression of these proteins by immunoblotting with specific antibodies. We report that the myometrial gap junction connexin-43 protein is expressed at much greater levels in the upper uterine compared to the lower uterine segment and that this difference is even more pronounced during the course of labor. Conversely, myometrial COX-1 and -2 proteins appear to be expressed at much greater levels in the lower compared to the upper uterine segment. Moreover, the level of expression of both proteins is unaffected by the onset of parturition. In contrast, myometrial Gs alpha protein appears to be uniformly expressed in both lower and upper segments and is similarly down-regulated during parturition, as previously reported. The differential expression of COX-1 and -2 and connexin-43 in the uterus may allow cervical ripening before and dilatation during labor and facilitate effective propagation of contractions from fundus to cervix, which may be further facilitated by the down-regulation of Gs alpha at the onset of parturition.


Pulmonary ossifying carcinoid - MEN in a male?
Pulmonary carcinoid tumors are considered as low-grade neoplasms, seen as centrally located endobronchial masses or as peripheral circumscribed nodules. Calcification or ossification is a known phenomenon, but presentation as large bony mass is extremely uncommon. Herein, we report a case of ossifying bronchial carcinoid along with nodular Hashimoto's thyroiditis as incidental autopsy findings in a 32-year-old patient with a prior recent excision of pituitary macroadenoma. This association suggests the possibility of multiple endocrine neoplasia in this young male.


The implications of the Canadian Stroke Best Practice Recommendations for design and allocation of rehabilitation after hospital discharge: a problematization.
Introduction: Implementation of the Canadian Stroke Best Practice Recommendations has improved inpatient rehabilitation. As attention is turned to the design and allocation of rehabilitation after hospitalization, examination of their implications for post-discharge rehabilitation could help optimize service planningMethods: Critical discourse analysis modeled on Alvesson and Sandberg's method of problematization was conducted to determine how the Canadian Stroke Best Practice Recommendations envision and shape post-discharge rehabilitation, and identify any tensions and potential ways to resolve them.Results: Within the Canadian Stroke Best Practice Recommendations post-discharge rehabilitation is implicitly viewed as a continuation of inpatient rehabilitation. Rehabilitation is largely envisioned as a set of biomedical procedures aimed at normalization through correction of impairment. There is potential tension between this implicit goal and the explicit goal of providing patient and family-centered care and promoting reengagement in valued activities and roles.Conclusion: An alternate vision of post-discharge rehabilitation could help resolve this tension. Post-discharge rehabilitation could be envisioned as a self-management intervention. Rather than primarily an expert-driven process of measuring impairment and applying procedures aimed at normalization, rehabilitation would be considered facilitation of self-management with the goal of reengaging in forms of participation that comprise a satisfying life.Implications for RehabilitationImplicit assumptions within best practice guidelines powerfully influence recommendations. These ideas are difficult to examine because they seem self-evident.Implicit assumptions in the Canadian Stroke Best Practice Guidelines envision post-discharge stroke rehabilitation as an expert-driven, impairment-focused biomedical procedure.This biomedical image makes it difficult to provide care that meets the guideline's explicit goals of client- and family-centeredness.Reimagining post-discharge stroke rehabilitation as a chronic self-care management intervention aimed at developing a satisfying life after stroke could improve patient care.


Effects of Pectus Excavatum on the Spine of Pectus Excavatum Patients with Scoliosis.
There is high risk in the correction surgery of pectus excavatum with scoliosis because of the lack of the correction mechanism of pectus excavatum with scoliosis. This study performed a comprehensive analysis about the impact that pectus excavatum had on scoliosis and elaborated its biomechanical mechanism in pectus excavatum patients with scoliosis. 37 pectus excavatum patients were selected. According to age, Haller index of pectus excavatum, offset coefficient, vertical position, sternal torsion angle, and asymmetric index, 37 patients were, respectively, divided into 2 compared groups. The result was statistically calculated. The scoliosis incidence and severity did not correlate with Haller index, offset coefficient, vertical position, sternal torsion angle, and asymmetric index of pectus excavatum, and there was no statistical significance between the two compared groups. The incidence and severity of scoliosis in PE patients with scoliosis have nothing to do with the geometric parameters of pectus excavatum but correlate with age. The scoliosis will aggravate with the increase of age. The heart may provide an asymmetric horizontal force to push the spines to the right. The mechanism of how the biomechanical factors exert influences on spines needs to be further investigated to keep the spine stable.


Implementing Asset-Based Integrated Care: A Tale of Two Localities.
To date, few studies have examined the implementation of asset-based integrated care in the UK. This paper aims to address this gap in knowledge through examining the implementation of one model of asset-based integrated care, Local Area Coordination (LAC), within two localities in England. This paper draws upon data collected from two local authorities (site A and site B), which had both implemented LAC. Using a case study approach, qualitative data was collected from interviews with relevant stakeholders both internal and external to the local authorities. Data was analysed thematically. The findings demonstrate the marked differences between the two sites' approaches to LAC, especially in relation to: the implementation process; impact; and their collaboration with other agencies and communities. The evidence presented in this paper demonstrates that the implementation of LAC, as with most complex service innovations, is dependent on the interplay of organisational and people-based components. In particular, successful implementation depends on maintaining a common vision of what an intervention will achieve and how it will work in practice, continual engagement with the political and organisational leaders of influence, positively addressing the anxieties of existing services and professions, and working with community groups.


Are Recycling People Also Saving? Costliness Matters.
In view of the fact that vigorously promoting recycling has become a viable means to promote sustainable development, it is important to better understand the impact of recycling efforts on subsequent resource saving behavior. This research empirically examines the effects of recycling efforts on subsequent resource saving by analyzing the survey data of 356 college students in China. The recycling efforts, environmental self-identity and feeling of pride were measured using existing scales while saving behaviors and recycling cost were measured by developing new scales. Partial least squares structural equation modeling was performed to test the structural relationships among recycling efforts, environmental self-identity, feeling of pride, and saving behaviors. Further, the moderation role of recycling cost was tested. The results showed that (1) saving behaviors could be classified into two types based on their costliness; (2) recycling efforts have a positive effect on costless saving behaviors, while having a negative effect on costly saving behaviors; (3) both the positive and negative effect of recycling efforts on resource saving is mediated by pride feeling and environmental self-identity; and (4) recycling cost negatively moderates the effects of recycling efforts on pride feeling. We discuss the theoretical and managerial implications of the findings.