Vascular endothelial growth factor-C expression in human gallbladder cancer and its relationship to lymph node metastasis.
Lymph node metastasis is a major prognostic factor in human cancer. Vascular endothelial growth factor C (VEGF-C) is a lymphangiogenic polypeptide that has been implicated in several human solid tumors. However, the clinical significance of VEGF-C has remained unknown in gallbladder carcinoma. Paraffin-embedded tumor specimens of 52 surgically resected gallbladder cancers were immunohistochemically stained for VEGF-C, VEGF, and CD34. The correlations among VEGF-C expression, VEGF expression, microvessel density (MVD), clinicopathologic features, and clinical outcomes were statistically analyzed. Thirty-three (63%) of the 52 gallbladder cancers were highly positive for VEGF-C protein by immunohistochemistry. VEGF-C expression was significantly correlated with lymphatic vessel involvement, lymph node metastasis, and worse outcomes after operation (p<0.001, p<0.001, p<0.001, respectively), but not with MVD. By the Cox regression model, lymphatic vessel involvement emerged as an independent prognostic parameter. These results suggest that VEGF-C may play a role in tumor progression via lymphangiogenesis and lymph node metastasis in human gallbladder cancer.


Relationship between the dietary glycemic load of the adult Polish population and socio-demographic and lifestyle factors - results of the WOBASZ II study.
Cardiovascular disease (CVD) occurs more often among people with a low sociodemographic status, so it is worth knowing if any sociodemographic factor also has an impact on diet quality, defined by glycemic load (GL). Assessment of the relationship between the sociodemographic and lifestyle factors, health status self-assessment and dietary GL of the adult Polish population based on WOBASZ II study results. The study included a representative group of the Polish population aged ≥20 years (2,554 men and 3,136 women). A 24-hour dietary recall was collected to assess the dietary intake. The total GL was calculated by summing the GL values of the consumed food. The average GL/1,000 kcal was significantly higher in women's than in men's diets (74.0 ±15.9 vs 71.2 ±15.7). Dietary GL/1,000 kcal increased with age (men: aged <35 - 70.3 and aged ≥65 - 73.9, women: 73.5 and 76.5, respectively). The lowest dietary GL/1,000 kcal was found among people living in large population centers. Dietary GL/1,000 kcal decreased with education level (men with primary, secondary and higher education: 73.4, 69.5 and 68.9, respectively, and women: 76.7, 73.4 and 70.9, respectively). Dietary GL decreased as an income increased. The highest GL/1,000 kcal was observed in the diets of participants who performed less physical activity. The highest GL/1,000 kcal was observed in the participants who defined their health status as very poor/poor and the lowest among those who defined their health status as good/very good. Nutritional education about the proper selection of products that are sources of carbohydrates in the diet should be addressed mainly to people with low sociodemographic status, such as: people in the older age group, living in small population centers, and with lower levels of education and lower income. It should also be directed to people with a lower level of physical activity. Greater awareness of the choices of carbohydrate products is recommended to improve diet quality in these groups of people.


Relation between body mass index, physical inactivity and use of prescription drugs: the Doetinchem Cohort Study.
Obesity and physical inactivity are associated with several diseases such as diabetes, cardiovascular diseases, musculoskeletal complaints, osteoporosis, certain types of cancer and depression. However, few data are available on the specific types of medication associated with obesity and physical inactivity. The aim of this study was to determine the independent association of body mass index (BMI) and physical inactivity with use of specific classes of prescription drugs, and the interaction between BMI and physical inactivity. The Doetinchem Cohort Study is a population-based longitudinal study. We analyzed cross-sectional data of 1703 men and 1841 women, examined between 1998 and 2002, for whom drug-dispending data were available from the PHARMO database. Drugs were coded according to the WHO Anatomical Therapeutic Chemical (ATC) classification system. Body weight was measured during the physical examination. Physical activity was assessed using an extensive questionnaire. Persons were defined as a user of a certain drug class if they filed at least one prescription in the year around (+/-6 months) the examination. Compared with normal weight persons (BMI 18.5-25 kg m(-2)), obese persons (BMI>30 kg m(-2)) had a higher use of prescription drugs of several drug classes, especially cardiovascular drugs (OR (95% CI): 3.83 (2.61-5.64) in men and 2.80 (2.03-3.86) in women) and diabetes drugs (OR (95% CI): 5.72 (2.32-14.14) in men and 3.92 (1.80-8.54) in women). In women, physical inactivity was also associated with higher use of certain drug classes, such as drugs for blood and blood-forming organs (OR (95% CI): 2.11 (1.22-3.65)) and musculoskeletal drugs (OR (95% CI): 2.07 (1.45-2.97)), whereas in men this was not the case. We found no interaction between BMI and physical inactivity with respect to use of prescription drugs. In both men and women, obesity was associated with a higher use of several types of prescription drugs, whereas physical inactivity was only associated with a higher use of certain drug classes in women.


Primary Sclerosing Cholangitis and Primary Biliary Cirrhosis Overlap Syndrome: A Review.
Primary sclerosing cholangitis (PSC) and primary biliary cirrhosis (PBC) are slow progressive diseases which have been increasing in prevalence. The pathogeneses of PBC and PSC are incompletely understood but the underlying mechanisms appear to be fundamentally autoimmune in origin. Although PBC and PSC appear to be separate entities, overlap has been described. Diagnosis depends on a combination of serological markers, imaging, and pathological criteria. The mainstay of treatment has been ursodeoxycholic acid and in some cases of extrahepatic biliary obstruction and overlap disorder, endoscopic retrograde cholangiopancreatography has been useful.


[Involvement of neuronal nicotinic receptor in psychiatric disorders].
Neuronal nicotinic acetylcholine receptors (nAChR) are a family of ligand-gated ion channels that have a pentameric structure composed of five membrane spanning subunits. Recent progress in clinical and neurochemical studies have shown that neuronal nAChR are involved in some psychiatric disorders such as schizophrenia, depression, and anxiety via its stimulating effect of multiple neurotransmitters. It has been suggested that the high prevalence of smoking in the patients with psychiatric disorders is an attempt to alleviate some psychiatric symptoms using the central stimulatory effect of nicotine (a self-medication effort) or to alleviate the exacerbated symptoms by nicotine withdrawal. Moreover, recent studies with mutant mice lacking specific nAChR subunits and animal models of psychiatric disorders have indicated the psychopharmacological role of individual nAChR subunits in psychiatric disorders. Thus, it is suggested that alpha 7 nAChR is involved in the attention deficit of schizophrenic patients and that alpha 4 beta 2 nAChR is related to nicotine dependence or the withdrawal symptoms.


Association of Patient-Reported Anxiety and Pain After Alveolar Bone Grafting.
To evaluate the role of psychosocial well-being on perioperative pain and opioid use among patients with cleft lip and palate (CLP) undergoing alveolar bone grafting (ABG). Retrospective review. Tertiary level craniofacial clinic. 34 patients with CLP (median age: 11.7 years), including 25 (73.5%) unilateral CLP and 9 (26.5%) bilateral CLP, who underwent ABG from 2015 to 2022. ABG using iliac crest bone graft. Patients were prospectively administered four patient-reported psychosocial instruments from the Patient-Reported Outcomes Measurement Information System. Perioperative opioid use in morphine equivalent dosage/kilogram, patient-reported pain scores, and length of hospital stay after ABG. Patient-reported anxiety (r = 0.41, p = 0.02) and depressive symptoms (r = 0.35, p = 0.04) correlated to higher perioperative opioid usage. Multivariable regression models including psychosocial scores, total acetaminophen usage, length of surgery, and other simultaneous surgeries were developed for total opioid usage, patient-reported pain, and length of hospital stay. Patient-reported anxiety was independently predictive of higher perioperative opioid use (β=0.36, p = 0.01) and higher pain scores (β=0.39, p = 0.02), but not length of hospital stay. We identified an association for patient-reported anxiety and perioperative opioid use and pain in a CLP cohort undergoing ABG. Future considerations in preoperative patient and family consultation may be indicated in patients self-reporting higher anxiety in an effort to minimize perioperative opioid usage.


A fast and cost-effective method for identifying a polymorphism of interleukin 28B related to hepatitis C.
Approximately 170 million people are chronic carriers of hepatitis C virus (HCV). Patients with chronic hepatitis C are currently treated with pegylated interferon and ribavirin (PEG-IFN/RBV). A genome-wide association with PEG-IFN/RBV treatment response and a single nucleotide polymorphism (rs12979860) has been identified near the interleukin 28B gene that encodes interferon-λ-3. In this paper, we describe an innovative, fast, and low-cost multiplex polymerase chain reaction with confronting two-pair primers that detects the rs12979860 polymorphism. The assay is internally controlled and does not require the use of restriction endonucleases or special equipment. Moreover, the assay decreases costs, being about 40% cheaper than direct sequencing methods.


Long-term analysis of clinical outcome and complications in locally advanced cervical cancer patients administered concomitant chemoradiation followed by radical surgery.
Preoperative chemoradiation (CT/RT) has been shown to achieve encouraging results in terms of clinical outcome in locally advanced cervical cancer (LACC). The study aims at analyzing the long-term results of this multimodal approach in a single institution series of 184 cases. Patients underwent whole pelvic irradiation combined with cisplatin and 5-fluorouracil. After evaluation of clinical response, patients were triaged to surgery. Surgical morbidity was classified according to Chassagne grading system. Univariate and multivariate analyses were used to assess the prognostic and predictive role of clinicopathological parameters. Clinical response was observed in 96.1% of cases. A total of 174 cases were submitted to radical surgery: 124 patients (71.3%) showed complete/microscopic pathological response. In multivariate analysis, clinical response, stage of disease, and histotype predicted response to CT/RT. With a median follow-up of 58 months, recurrence and death of disease were observed in 42 and 40 patients, respectively. The 5-year DFS was 75.5%, while the 5-year OS was 77.4%. Patients with no residual disease showed a significant longer DFS than patients with microscopic (p value = 0.0128), and macroscopic (p value = 0.0001) residual tumor after treatment. In multivariate analysis, residual tumor and stage of disease were the two most relevant prognostic factors for DFS and OS. As far as long-term toxicity is concerned, 8 out of 22 complications were grade 3/4. Preoperative CT/RT is worth further investigation in LACC patients, providing encouraging survival outcomes and a favourable long-term toxicity profile.


Prevention of atherosclerosis progression by 9-cis-β-carotene rich alga Dunaliella in apoE-deficient mice.
β-Carotene-rich diet has been shown to be inversely associated with the risk of coronary heart disease. However, clinical trials using synthetic all-trans-β-carotene failed to demonstrate a beneficial effect. We therefore sought to study the effect of natural source of β-carotene, the alga Dunaliella, containing both all-trans and 9-cis-β-carotene on atherosclerosis. In a previous study we showed that 9-cis-β-carotene-rich powder of the alga Dunaliella inhibits early atherogenesis in low-density lipoprotein receptor knockout mice. The aims of the current work were to study whether diet enriched with Dunaliella powder would inhibit the progression of established atherosclerosis in old male apoE-deficient mice and to compare the effect of Dunaliella on lipid profile and atherosclerosis in a low-versus high-fat diet fed mice. In the first experiment, young mice (12 weeks old) were allocated into 3 groups: (1) low-fat diet; (2) low-fat diet + Dunaliella powder (8%); (3) low-fat diet + β-carotene-deficient Dunaliella. In the second experiment, old mice (7 months old) with established atherosclerotic lesions were allocated into 4 groups: (1) low-fat diet; (2) low-fat diet + Dunaliella; (3) high fat-diet; (4) high-fat diet + Dunaliella. In young mice fed a low-fat diet, a trend toward lower atherosclerotic lesion area in the aortic sinus was found in the Dunaliella group compared with the control group. In old mice with established atherosclerotic lesion, Dunaliella inhibited significantly plasma cholesterol elevation and atherosclerosis progression in mice fed a high-fat diet. The results of this study suggest that a diet containing natural carotenoids, rich in 9-cis-β-carotene, has the potential to inhibit atherosclerosis progression, particularly in high-fat diet regime.


Unusual biclonal plasma cell dyscrasia with crystallike inclusions producing colonic tumors (plasma cell polyposis) and terminating in T-cell lymphoma.
A 62-year-old man underwent a partial colectomy for persistent rectal bleeding. Multiple submucosal lesions up to 7 cm in diameter were identified and were composed of plasmacytoid and histiocytoid cells with crystallike inclusions. Ultrastructurally, inclusions were bounded by rough endoplasmic reticulum. Immunohistochemical studies demonstrated a monoclonal population of IgA kappa-positive plasma cells. Immunofixation using a saline extract of the tumor revealed two distinct bands: one for IgG kappa and another for IgA kappa. Southern blotting revealed a germline configuration for the immunoglobulin heavy-chain gene and the T-cell antigen receptor beta-chain gene. A bone marrow aspirate contained 12% plasma cells, some of which had cytoplasmic inclusions. Eight months after surgery, the patient developed a large mediastinal mass. Histologic and immunohistochemical studies indicated that this mass was an undifferentiated neoplasm. However, gene rearrangement studies indicated a T-cell lymphoma. This patient illustrates a rare association between a plasma cell neoplasm and a T-cell lymphoma.


Cancer patients and awareness of venous thromboembolism.
Cancer-associated thrombosis leads to morbidity and mortality in cancer patients. We sought to ascertain awareness of venous thromboembolism (VTE) and receptiveness to thromboprophylaxis amongst ambulatory cancer patients. In all 190 patients completed the survey over a three-week period. Of these, 100 patients (53%) reported unawareness of the increased risk of thrombosis with malignancy. Of the examined patients, 161 (86%) were willing to use oral anticoagulant for prophylaxis, and 86 (46%) were willing to perform daily anticoagulant injections. This study reveals an alarming lack of knowledge amongst patients regarding the increased risk of thrombosis. Informed patients are willing to use prophylaxis, if its effectiveness is established.


[Isolated ileal perforation after blunt abdominal trauma].
Perforating injuries to the small bowel due to a blunt abdominal trauma are rare. Especially in the case of an isolated injury where diagnostic investigations have failed, it may result in delayed therapy and a prolonged clinical course. Here, we report on an isolated ileal perforation caused by a blunt abdominal trauma in setting of a domestic accident.


Diagnostic and prognostic significance of hepatic steatosis in patients with chronic hepatitis C.
Knowing that hepatic steatosis (HS) is a common occurrence in patients with chronic hepatitis C (CHC), it is essential to establish what are the factors that predispose to its occurrence and what is the role of HS in the evolution and prognosis of patients with CHC who develop this feature. To achieve these aims, we performed a retrospective clinical study in 33 patients with CHC hospitalized, diagnosed, and monitored in the 2nd Medical Department of the Emergency County Hospital, Craiova, Romania, in a period of two years (2011-2012). Following clinical, hematological, biochemical, immunological, and pathological investigations of the 33 patients with CHC selected, only 14 patients showed pathological changes of the HS. The appearance of steatosis in patients with CHC results from a complex interaction between the particularities of the host and viral factors. The main risk factors of the host, which contributed to the appearance of HS were sex, age, body mass index (BMI), body weight, and personal history of pathology (obesity, metabolic syndrome). Virus-related factors involved in HS were viremia and viral genotype. In conclusion, HS is a common finding (42.42%) in patients with CHC, particularly genotypes 1 and 2. Early detection of HS by invasive or non-invasive methods is an important objective of monitoring patients with CHC, because HS is correlated with a high degree of fibrosis. Therefore, early correction of metabolic factors and early introduction of antiviral therapy are important targets for treating of patients with CHC.


Revealing Clonal Responses of Tumor-Reactive T-Cells Through T Cell Receptor Repertoire Analysis.
CD8+ T cells are the key effector cells that contribute to the antitumor immune response. They comprise various T-cell clones with diverse antigen-specific T-cell receptors (TCRs). Thus, elucidating the overall antitumor responses of diverse T-cell clones is an emerging challenge in tumor immunology. With the recent advancement in next-generation DNA sequencers, comprehensive analysis of the collection of TCR genes (TCR repertoire analysis) is feasible and has been used to investigate the clonal responses of antitumor T cells. However, the immunopathological significance of TCR repertoire indices is still undefined. In this review, we introduce two approaches that facilitate an immunological interpretation of the TCR repertoire data: inter-organ clone tracking analysis and single-cell TCR sequencing. These approaches for TCR repertoire analysis will provide a more accurate understanding of the response of tumor-specific T cells in the tumor microenvironment.


BACILLARY LAYER DETACHMENT IN A KOREAN COHORT WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION.
To evaluate the incidence and characteristics of bacillary layer detachment (BALAD) in neovascular age-related macular degeneration. This retrospective study was performed at Kim's Eye Hospital in South Korea. Patients who were diagnosed with neovascular age-related macular degeneration between January 2017 and December 2017 were included. The incidence of BALAD was compared among different types of macular neovascularization (MNV). The best-corrected visual acuity and central retinal thickness at diagnosis were compared between patients showing BALAD at diagnosis and those who did not. Among the 442 patients included, BALAD was observed in 20 patients (4.5%). There was a significant difference in the incidence of BALAD between Type 1 MNV (2.7%), Type 2 MNV (12.5%), and Type 3 MNV (0%) (P < 0.001). The best-corrected visual acuity was significantly worse (mean 1.26 ± 0.79 vs. 0.62 ± 0.50, P = 0.001), and the central retinal thickness was significantly greater (mean 648.2 ± 211.1 µm vs. 464.0 ± 175.5 µm, P < 0.001) in patients with BALAD than in those without it. After antivascular endothelial growth factor therapy, all BALADs resolved. This study first reported the incidence of the BALAD in neovascular age-related macular degeneration in a Korean population. The incidence of BALAD was the highest in Type 2 MNVs. Bacillary layer detachment generally develops in eyes with great macular thickness and poor visual acuity.


A case review of the MRI features in alternating Tolosa-Hunt syndrome.
Tolosa-Hunt syndrome (THS) consists of a painful ophthalmoplegia with typical features in magnetic resonance imaging (MRI). The recurring nature of this affliction has been known since its first description. However, compromise of the contralateral cavernous sinus, known as alternating THS, is very rare and has never been examined using MRI. We report clinical data, laboratory data and imaging features of a patient with alternating THS. According to our literature review, this is the first MRI study of THS.


Triplet repeat gene sequences in neuropsychiatric diseases.
The human genome has many nucleotide repeat sequences. These range from a single repeating base to entire duplicated genes. Expansion of repeating triplets of nucleotides in the genome has recently been associated with nine degenerative and developmental neuropsychiatric diseases: fragile X syndrome, fragile X-linked mental retardation, myotonic dystrophy, Friedreich's ataxia, spinal and bulbar muscular atrophy, Huntington's disease, spinocerebellar ataxia type 1, dentatorubral-pallidoluysian atrophy, and Machado-Joseph disease. These diseases are all conditions of the central nervous system; in all of them, the inheritance pattern usually exhibits the phenomenon of anticipation (defined as progressively earlier age of onset or a worsening disease severity over successive generations), and the severity of the phenotypic expression and penetrance appears to be related to the extent of the triplet expansion. Identification of this pathological genetic phenomenon solves several of the mysteries that surrounded these conditions but raises many important questions regarding pathogenic mechanisms that may be shared. There is some indication that triplet expansions may also underlie other neuropsychiatric conditions such as schizophrenia or bipolar disorder.


Cerebral vasculitis mimicking migraine with aura in a patient with Crohn's disease.
Whereas extraintestinal manifestations of inflammatory bowel disease in general are quite common, cerebral vasculitis is considered a very rare condition. We present a case of Crohn's disease-associated vasculitis mimicking migraine with aura. A 28-year-old woman with Crohn's disease and known migraine with aura had suffered from daily migraine attacks with recurrent focal neurological deficits for 6 weeks. Cerebral magnetic resonance imaging showed multiple acute, subacute, and chronic ischemic lesions in different vascular territories. Magnetic resonance and computed tomography angiography demonstrated vessel changes consistent with cerebral vasculitis. Laboratory investigations revealed systemic inflammation and lymphomonocytic pleocytosis of cerebrospinal fluid, supporting the diagnosis of Crohn's disease-associated vasculitis. Symptoms and inflammatory parameters quickly normalized after high-dose prednisolone treatment. During immunosuppressive therapy, migraine recurred only once in 11 months. Cerebral vasculitis is a very rare but severe complication in Crohn's disease and should be excluded in case of comorbidity with migraine with aura. In our patient, migraine with aura may have been the only symptom of cerebral vasculitis for several years.


Arsenic release from pyrite ashes: kinetic studies.
Arsenic mobility in pyrite ashes was studied because of the possible effects on water systems. The batch extraction method was used to assess kinetics and extent of As release induced by contact of the material either with rainwater or groundwater. Self-established pH-Eh range of pyrite ashes/water mixtures brought both As(III) and As(V) to be present in the water phase, as neutral arsenite H3AsO3 and anionic arsenate HAsO42-, respectively. Tests in reagent water showed both rate and extent of arsenite release higher than arsenate; total As concentration ([As] = 12 µg/L) at equilibrium little exceeded its EU Maximum Concentration Level (MCL) for surface and groundwater ([As] = 10 µg/L). Tests in groundwater, instead, showed a much higher release rate and extent for arsenate than for arsenite and the chemistry of groundwater mainly influenced arsenate mobility; total As almost instantly exceeded its MCL and it was markedly higher ([As] = 31 µg/L) at equilibrium. Overall, the study has shown the environmental implications of As mobility in the pyrite ashes, also casting light on some limits of the environmental representativeness of leaching tests in reagent water.


The effects of a physiotherapist-led exercise intervention on peripheral neuropathy among people living with HIV on antiretroviral therapy in Kigali, Rwanda.
HIV-associated peripheral neuropathy (PN) is common in people living with HIV. Its management is mostly symptomatic utilising pharmacological approaches. This study determined the effects of an exercise intervention on PN among Rwandan people living with HIV receiving antiretroviral therapy (ART). A 12-week single-blinded randomised controlled trial using the Brief Peripheral Neuropathy Screen (BPNS) as the assessment tool tested the effects of an exercise intervention on PN, followed by a 12-week non-intervention period. A total of 120 people with HIV- associated PN on ART were randomised to an exercise or no exercise group. Both groups continued receiving routine care. A bivariate analysis using Pearson's chi-square test for significant differences in PN symptoms and signs, between groups, at baseline, after the 12 weeks intervention and 12 weeks post-intervention using generalised linear regression models to determine predictors of treatment outcomes was undertaken, utilising an intention-to-treat analysis (alpha p ≤ 0.05). At 12 weeks, the intervention group compared to the control: neuropathic pain 70% versus 94% (p < 0.005), PN symptoms severity - mild and/or none in 85% versus 60% (p < 0.001) and radiation of PN symptoms reduced, 80% versus 37% (p < 0.001). There were no differences in PN signs at 12 weeks intervention and at 12 weeks post-intervention. Having changed the antiretroviral (ARV) and having developed PN symptoms after the start on ARVs predicted treatment improvement, while demographic factors did not predict any treatment outcome. A physiotherapist-led exercise intervention improved PN symptoms, but with non-significant improvement in PN signs. Factors related to early diagnosis and treatment of PN were facilitators for the improvement of PN symptoms. Physiotherapist-led exercises should be integrated into the routine management of people living with HIV on ART with PN symptoms.


Tunable, high-power, continuous-wave dual-polarization Yb-fiber oscillator.
We demonstrate a high-power, dual-polarization Yb-fiber oscillator, by separately locking the two linear polarization states defined by slow and fast axis of a polarization-maintaining gain fiber with volume Bragg gratings. Dual-line lasing is achieved with a tunable wavelength separation from 0.03 to 2 THz, while exceeding output powers of 78 W over the entire tuning range, maintaining a high beam-quality with M(2)<1.2. With this laser configuration we achieve a peak-to-peak power variation of <1% for the dual-line signal and <3% for the individual signals.


Awareness regarding contraception and population control among school going adolescents.
Growing sexuality among adolescents increases their risk of getting reproductive tract infections and pregnancy. This Cross sectional survey was done to assess the knowledge and attitude of higher secondary school children regarding contraception and population control. Majority of students (94.4%) were aware of contraceptives and their easy availability on chemist shop. However very few were aware of name and how to use them and 60% of them considered that condom is an emergency contraceptive. Lack of employment facilities as a consequence of uncontrolled population growth was the main concern of both boys and girls. The two children norm was acceptable to most, with one son and one daughter. All perceived that there is need to be informed about contraceptives. Most of the adolescents are misinformed about contraceptives and their attitude is not favorable as far as responsibility is concerned. There is an unmet need of contraceptive & population control knowledge and attitude among school adolescents and require urgent intervention.


Association of virulence plasmid and antibiotic resistance determinants with chromosomal multilocus genotypes in Mexican Salmonella enterica serovar Typhimurium strains.
Bacterial genomes are mosaic structures composed of genes present in every strain of the same species (core genome), and genes present in some but not all strains of a species (accessory genome). The aim of this study was to compare the genetic diversity of core and accessory genes of a Salmonella enterica subspecies enterica serovar Typhimurium (Typhimurium) population isolated from food-animal and human sources in four regions of Mexico. Multilocus sequence typing (MLST) and macrorestriction fingerprints by pulsed-field gel electrophoresis (PFGE) were used to address the core genetic variation, and genes involved in pathogenesis and antibiotic resistance were selected to evaluate the accessory genome. We found a low genetic diversity for both housekeeping and accessory genes. Sequence type 19 (ST19) was supported as the founder genotype of STs 213, 302 and 429. We found a temporal pattern in which the derived ST213 is replacing the founder ST19 in the four geographic regions analyzed and a geographic trend in the number of resistance determinants. The distribution of the accessory genes was not random among chromosomal genotypes. We detected strong associations among the different accessory genes and the multilocus chromosomal genotypes (STs). First, the Salmonella virulence plasmid (pSTV) was found mostly in ST19 isolates. Second, the plasmid-borne betalactamase cmy-2 was found only in ST213 isolates. Third, the most abundant integron, IP-1 (dfrA12, orfF and aadA2), was found only in ST213 isolates. Fourth, the Salmonella genomic island (SGI1) was found mainly in a subgroup of ST19 isolates carrying pSTV. The mapping of accessory genes and multilocus genotypes on the dendrogram derived from macrorestiction fingerprints allowed the establishment of genetic subgroups within the population. Despite the low levels of genetic diversity of core and accessory genes, the non-random distribution of the accessory genes across chromosomal backgrounds allowed us to discover genetic subgroups within the population. This study provides information about the importance of the accessory genome in generating genetic variability within a bacterial population.


A linear lesion in a child with atopic dermatitis: Not a coincidence.
A blaschkolinear lesion in a patient with atopic dermatitis can be a superimposed segmental manifestation of this polygenic disorder. Knowledge of this phenomenon, presence of less severe, disseminated, symmetrically distributed lesions of the same disorder and, if necessary, histology are helpful in the differential diagnosis from other linear inflammatory diseases.


(2-Chloroethyl)phosphonic Acid Promotes Germination of Immature Spores of Ceratopteris richardii Brongn.
Freshly collected spores of strain Hn-n of Ceratopteris richardii Brongn. require storage for several months before attaining maximum germination rate. Treatments using (2-chloroethyl)phosphonic acid increased germination rate in freshly collected spores and decreased germination rate in older spores.


Mineral nutrient requirements of cucumber seedlings.
Mineral nutrient requirements for maximum growth rate of cucumber (Cucumis sativus L.) seedlings are estimated on the basis of three criteria. 1. The optimal weight proportions among the nutrients present in the seedlings. In relation to N = 100, close to 75 K, 13 P, 9 Ca, and 9 Mg are required. 2. The optimal ratio between the nitrogen sources NH(4) and NO(3) in the solution. The best growth is recorded with about equivalent amounts. Nitrate alone is also highly productive. Cucumber prefers nitrate and is sensitive to high ammonium concentrations. 3. The optimal total concentration in the solution corresponds to 200 to 300 milligrams of nitrogen per liter, with the proportions of the nutrients according to criterion 1. Simple growth methods are suggested in which the three criteria are fulfilled.Calcium, especially, is found to accumulate in older leaves. It is proposed that this is not an expression for a physiological requirement for calcium but a mechanism for deposition of excess uptake important in adaptation to calcareous soils. This mechanism also operates at low calcium uptake rates, causing deficiency in the young parts, despite relatively high contents in the old leaves. Cucumber is therefore interpreted to be an obligate calcicole. The results are discussed in relation to similar experiments with birch (Betula verrucosa Ehrh.) seedlings, a species able to grow on very acid soils.


Heme histidine ligands within gp91(phox) modulate proton conduction by the phagocyte NADPH oxidase.
The membrane subunit of the phagocyte NADPH oxidase, gp91(phox), possesses a H(+) channel motif formed by membrane-spanning histidines postulated to coordinate the two heme groups forming the redox center of the flavocytochrome. To study the role of heme-binding histidines on proton conduction, we stably expressed the gp91(phox) cytochrome in human embryonic kidney 293 cells and measured proton currents with the patch clamp technique. Similar to its shorter homologue, NADPH oxidase homologue 1, which is predicted not to bind heme, gp91(phox) generated voltage-activated, pH-dependent, H(+)-selective currents that were reversibly blocked by Zn(2+). The gp91(phox) currents, however, activated faster, deactivated more slowly, and were markedly affected by the inhibition of heme synthesis. Upon heme removal, the currents had larger amplitude, activated faster and at lower voltages, and became sensitive to the histidine reagent diethylpyrocarbonate. Mutation of the His-115 residue to leucine abolished both the gp91(phox) characteristic 558-nm absorbance peak and voltage-activated currents, indicating that His-115 is involved in both heme ligation and proton conduction. These results indicate that the gp91(phox) proton channel is activated upon release of heme from its His-115 ligand. During activation of the oxidase complex, changes in heme coordination within the cytochrome might increase the mobility of histidine ligands, thereby coupling electron and proton transport.


Interprofessional education at Laval University: Building an integrated curriculum for patient-centred practice.
The Laval University Faculty of Medicine, Faculty of Nursing, and School of Social Work, in partnership with the Vieille-Capitale Health and Social Services Centre in Quebec City, obtained funding from Health Canada to design, implement, and evaluate an integrated interprofessional education (IPE) program for family medicine, nursing, and social work students and for professionals from those professions working in primary care. The program was developed around four components and produced the following outcomes: a 45-hour undergraduate curriculum; IPE practical training for professionals, supervisors, residents and trainees in primary care teaching settings; a continuing education model for professionals based on a coaching approach, and; information and communication technology resources. After briefly describing the implementation process, educational content, and evaluation highlights of each component, the integrated program is discussed with respect to the inter-area complementarities and coherence with the conceptual dimensions that have guided the development of the program: IPE, collaboration, and collaborative patient-centered practice. The positive evaluation outcomes, the sustainability of the educational activities, and the enthusiasm of the different partners led to the creation of the Collaborative Network on Interprofessional Practices at Laval University and its affiliated health and social services clinical network.


Not all elderly people benefit from vitamin D supplementation with respect to physical function: results from the Osteoporotic Fractures in Men Study, Hong Kong.
To examine vitamin D status and its association with physical performance and muscle mass in older Chinese men. Cross-sectional and prospective cohort study design. Hong Kong, People's of Republic of China. Nine hundred thirty-nine community-dwelling men aged 65 and older for cross-sectional analysis and 714 for longitudinal analysis. Baseline serum 25-hydroxyvitamin D (25OHD) was measured using a competitive radioimmunoassay kit. Baseline and 4-year physical performance measures (grip strength, 6-m walking speed, step length in a 6-m walk, time to complete five chair stands) were measured, and appendicular skeletal muscle mass (ASM) was assessed using dual-energy X-ray absorptiometry. Data were collected for confounding factors: demographic, number of diseases, smoking, alcohol use, body mass index, physical activity, diet, season of blood sampling, and serum parathyroid hormone (PTH) level. Multivariate regression analyses were performed with adjustments for confounding factors. Mean ± standard deviation serum 25OHD level of this sample of Chinese community-dwelling older men who had a high level of baseline physical function was 77.9 ± 20.5 nmol/L; 94.1% of participants had serum 25OHD levels of 50 nmol/L or greater. Median (interquartile range) serum PTH level was 4.1 pmol/L (3.1-5.5 pmol/L). After adjustment for potential confounding factors, serum 25OHD levels were not associated with baseline or 4-year change in physical performance measures and ASM. In Chinese older men who are vitamin D replete and have a high level of baseline physical function, vitamin D may not have an important role in physical function and muscle mass.


Defining the role of phosphomethylethanolamine N-methyltransferase from Caenorhabditis elegans in phosphocholine biosynthesis by biochemical and kinetic analysis.
In plants and Plasmodium falciparum, the synthesis of phosphatidylcholine requires the conversion of phosphoethanolamine to phosphocholine by phosphoethanolamine methyltransferase (PEAMT). This pathway differs from the metabolic route of phosphatidylcholine synthesis used in mammals and, on the basis of bioinformatics, was postulated to function in the nematode Caenorhabditis elegans. Here we describe the cloning and biochemical characterization of a PEAMT from C. elegans (gene, pmt-2; protein, PMT-2). Although similar in size to the PEAMT from plants, which contain two tandem methyltransferase domains, PMT-2 retains only the C-terminal methyltransferase domain. RNA-mediated interference experiments in C. elegans show that PMT-2 is essential for worm viability and that choline supplementation rescues the RNAi-generated phenotype. Unlike the plant and Plasmodium PEAMT, which catalyze all three methylations in the pathway, PMT-2 catalyzes only the last two steps in the pathway, i.e., the methylation of phosphomonomethylethanolamine (P-MME) to phosphodimethylethanolamine (P-DME) and of P-DME to phosphocholine. Analysis of initial velocity patterns suggests a random sequential kinetic mechanism for PMT-2. Product inhibition by S-adenosylhomocysteine was competitive versus S-adenosylmethionine and noncompetitive versus P-DME, consistent with formation of a dead-end complex. Inhibition by phosphocholine was competitive versus each substrate. Fluorescence titrations show that all substrates and products bind to the free enzyme. The biochemical data are consistent with a random sequential kinetic mechanism for PMT-2. This work provides a kinetic basis for additional studies on the reaction mechanism of PEAMT. Our results indicate that nematodes also use the PEAMT pathway for phosphatidylcholine biosynthesis. If the essential role of PMT-2 in C. elegans is conserved in parasitic nematodes of mammals and plants, then inhibition of the PEAMT pathway may be a viable approach for targeting these parasites with compounds of medicinal or agronomic value.


Bronchoprotective effect of simulated deep inspirations in tracheal smooth muscle.
Deep inspirations (DIs) taken before an inhaled challenge with a spasmogen limit airway responsiveness in nonasthmatic subjects. This phenomenon is called bronchoprotection and is severely impaired in asthmatic subjects. The ability of DIs to prevent a decrease in forced expiratory volume in 1 s (FEV1) was initially attributed to inhibition of airway narrowing. However, DIs taken before methacholine challenge limit airway responsiveness only when a test of lung function requiring a DI is used (FEV1). Therefore, it has been suggested that prior DIs enhance the compliance of the airways or airway smooth muscle (ASM). This would increase the strain the airway wall undergoes during the subsequent DI, which is part of the FEV1 maneuver. To investigate this phenomenon, we used ovine tracheal smooth muscle strips that were subjected to shortening elicited by acetylcholine with or without prior strain mimicking two DIs. The compliance of the shortened strip was then measured in response to a stress mimicking one DI. Our results show that the presence of "DIs" before acetylcholine-induced shortening resulted in 11% greater relengthening in response to the third DI, compared with the prior DIs. This effect, although small, is shown to be potentially important for the reopening of closed airways. The effect of prior DIs was abolished by the adaptation of ASM to either shorter or longer lengths or to a low baseline tone. These results suggest that DIs confer bronchoprotection because they increase the compliance of ASM, which, consequently, promotes greater strain from subsequent DI and fosters the reopening of closed airways.


A Green Route for High-Yield Production of Tetramethylpyrazine From Non-Food Raw Materials.
2,3,5,6-Tetramethylpyrazine (TMP) is an active pharmaceutical ingredient originally isolated from Ligusticum wallichii for curing cardiovascular and cerebrovascular diseases and is widely used as a popular flavoring additive in the food industry. Hence, there is a great interest in developing new strategies to produce this high-value compound in an ecological and economical way. Herein, a cost-competitive combinational approach was proposed to accomplish green and high-efficiency production of TMP. First, microbial cell factories were constructed to produce acetoin (3-hydroxy-2-butanone, AC), an endogenous precursor of TMP, by introducing a biosynthesis pathway coupled with an intracellular NAD+ regeneration system to the wild-type Escherichia coli. To further improve the production of (R)-AC, the metabolic pathways of by-products were impaired or blocked stepwise by gene manipulation, resulting in 40.84 g/L (R)-AC with a high optical purity of 99.42% in shake flasks. Thereafter, an optimal strain designated GXASR11 was used to convert the hydrolysates of inexpensive feedstocks into (R)-AC and achieved a titer of 86.04 g/L within 48 h in a 5-L fermenter under optimized fermentation conditions. To the best of our knowledge, this is the highest (R)-AC production with high optical purity (≥98%) produced from non-food raw materials using recombinant E. coli. The supernatant of fermentation broth was mixed with diammonium phosphate (DAP) to make a total volume of 20 ml and transferred to a high-pressure microreactor. Finally, 56.72 g/L TMP was obtained in 3 h via the condensation reaction with a high conversion rate (85.30%) under optimal reaction conditions. These results demonstrated a green and sustainable approach to efficiently produce high-valued TMP, which realized value addition of low-cost renewables.


HPLC/DAD Screening Method for Selected Psychotropic Drugs in Blood.
The influence of experimental conditions on gradient high-performance liquid chromatography/diode array detector separation and identification of 13 psychotropic drugs belonging to two groups--phenothiazines and tricyclic antidepressants--was examined. The main interaction effects of three experimental factors were determined according to a 2 3 factorial design, and the optimum conditions of analysis were searched for. The degree to which the chromatographic peaks overlap is taken into account in a proposed criterion for separation quality. The screening analysis proposed was tested on whole blood samples spiked with mixtures of the examined drugs. The method was characterized by such validation parameters as relative retention times, absorbance ratios at two wavelengths, detection limits, linearity ranges, and extraction recoveries. The method proved to be a suitable tool for the identification of psychotropic drugs tested for forensic purposes.


Anti-oxidative response of carbonic anhydrase III in skeletal muscle.
We propose that carbonic anhydrase III (CAIII) functions as an anti-oxidant agent in skeletal muscle. To explore this hypothesis, we analyzed the gene expression profile of skeletal muscle in mice deficient in CAIII gene utilizing the murine genome U74Av2 set microarray. Pairwise comparison between CAIII knockout mice and their wild-type littermates revealed that more than 500 of 12,000 genes in the array showed an altered level of transcription. Of particular note were transcriptional alterations among genes associated with the glutathione redox cycle, suggesting a possible involvement of CAIII in the glutathione-mediated anti-oxidant activity. We therefore investigated S-glutathiolation and irreversible oxidation of the 2 reactive sulfhyryls of CAIII in skeletal muscle under oxidative stresses of ischemia, or exhaustive exercise. Analysis by isoelectric focusing followed by Western blot revealed that the two sulfhydryls were differentially and progressively oxidized. Brief ischemia of 10-20 min provoked partial (one of the suflhydryls) modification of CAIII via reversible S-glutathiolation. Protracted 60 min ischemia yielded equal amounts of both partially and completely (both sulfhydryls) modified CAIII due to irreversible oxidization. Twenty minutes of repetitive electrical stimulation, simulating exhaustive exercise, produced a mixed yield: partial modification by reversible S-glutathiolation and complete modification by irreversible oxidation. Thus CAIII responds to oxidative stress with a distinctive sulfhydryl oxidation patterns reflecting duration and severity that may prove sensitive indices of extent and type of damage in muscle injury.


Nanoparticle Enhanced Laser-Induced Breakdown Spectroscopy for Microdrop Analysis at subppm Level.
In this paper, nanoparticle enhanced laser-induced breakdown spectroscopy (NELIBS) was applied to the elemental chemical analysis of microdrops of solutions with analyte concentration at subppm level. The effect on laser ablation of the strong local enhancement of the electromagnetic field allows enhancing the optical emission signal up to more than 1 order of magnitude, enabling LIBS to quantify ppb concentration and notably decreasing the limit of detection (LOD) of the technique. At optimized conditions, it was demonstrated that NELIBS can reach an absolute LOD of few picograms for Pb and 0.2 pg for Ag. The effect of field enhancement in NELIBS was tested on biological solutions such as protein solutions and human serum, in order to improve the sensitivity of LIBS with samples where the formation and excitation of the plasma are not as efficient as with metals. Even in these difficult cases, a significant improvement with respect to conventional LIBS was observed.


[2-DG enhances TRAIL-induced apoptosis of leukemia HL-60 cells].
This study was purposed to investigate the effects of 2-deoxy-D-glucose (2-DG) on sensitizing HL-60 cells to tumor necrosis factor-related apoptosis-inducing ligand (TRAIL)-induced apoptosis and its possible mechanism. The proliferative inhibition of HL-60 cells treated with different concentrations of 2-DG and TRAIL was measured by MTT assay. The cells were treated with 2-DG, TRAIL, and 2-DG combined with TRAIL at the concentration < IC50 value, i.e. 10 mmol/L for 2-DG and 100 ng/ml for TRAIL. Apoptosis was analyzed by flow cytometry with PI staining; the expression of RIP1, GRP78, and PARP was analyzed by Western blot; the activity of caspase-3 was detected by special detection kit. The results showed that the combined treatment of HL-60 cells for 48 h induced an apoptotic rate of (45.1 ± 4.3)%, which was significantly higher than that of treated with 2-DG or TRAIL alone; at the same time, the combined treatment potentiated the expression of GRP78 and caspase-3 activity, and down-regulated the expression of RIP1. It is concluded that 2-DG can sensitize HL-60 cells to TRAIL-induced apoptosis, which may be correlated with excessive endoplasmic reticulum stress response, down-regulation of RIP1, and increase of caspase-3 activity.


Clinical significance of a hearing and imaging workup in a child with cochlear nerve aplasia and a normal internal auditory canal.
Modern magnetic resonance imaging has significantly improved the diagnosis of cochlear nerve deficiencies. A careful assessment of all clinical, imaging, and auditory data is of utmost importance in such cases in order to properly establish the site of the abnormality. We report the case of a 3-year-old girl with unilateral cochlear nerve aplasia, normal middle and inner ear anatomy, and an absence of otoacoustic emissions, all of which erroneously suggested cochlear damage. We also briefly review the embryogenesis of the inner ear and auditory pathway. A patient with similar findings in the setting of a bilateral hearing loss and insufficient imaging would be at risk of inappropriate cochlear implantation.


Chromium(III) beta, gamma-bidentate guanine nucleotide complexes as probes of the GTP-activated cGMP cascade of retinal rod outer segments.
The exchange-inert Cr(III) beta, gamma-bidentate guanine nucleotide complexes Cr(III)GTP and Cr(III)Gpp(NH)p were used to probe the role of transducin in activating the retinal cGMP cascade. The Cr(III) nucleotide complexes were found to have lower binding affinity for transducin as compared to the Mg2+ complexes. However, the rate of hydrolysis of the transducin-bound Cr(III)GTP was similar to that of Mg(II)GTP. Cr(III)Gpp(NH)p activated the cGMP phosphodiesterase of photolyzed rod outer segment membranes up to 75% of the Mg(II)Gpp(NH)p level but lacked the ability to dissociated the transducin subunits from the rod outer segment membrane. This result implies that the activation of the phosphodiesterase by transducin-GTP complex is a membrane-associated event and the formation of a soluble complex of transducin-GTP with the inhibitory peptide of the phosphodiesterase may not be an obligatory step. Both the delta and lambda screw sense stereoisomers of Cr(III)Gpp(NH)p were capable of activating the cGMP cascade with no apparent stereoselectivity. The nature of the interaction of the metal ion and GTP at the nucleotide-binding site of transducin is discussed together with the results from previous studies using the phosphorothioate GTP analogues [Yamanaka, G., Eckstein, F., & Stryer, L. (1985) Biochemistry 24, 8094-8101] and is compared to the site found in homologous GTP-binding proteins such as elongation factor Tu [Jurnak, F. (1985) Science (Washington, D.C.) 230, 32-36; la Cour, T.F.M., Nyborg, J., Thirup, S., & Clark, B.F.C. (1985) EMBO J. 4, 2385-2388]. The implications of the observed results on the molecular mechanism of visual signal transduction are discussed.


[Alcohol embryopathy. Review and case example].
Fetal alcohol syndrome is a disorder that occurs in children of alcoholic mothers and is characterized by typical craniofacial dysmorphia and retardation of mental and physical growth. Semiquantitative evaluation of the most common symptoms permits clinical classification into three stages. Although numerous hypotheses have been suggested, the pathogenetic mechanism is not yet well understood. Prevention through medical advice and counselling still remains the most successful form of therapy. A case of fetal alcohol syndrome caused by excessive maternal drinking accompanied by high nicotine consumption during pregnancy is reported.


Brain executive laterality and hemisity.
Brain laterality refers to the asymmetric location of functional elements within the bilateral brain of animals and humans. Thus far, five lateralized functions have been recognized in humans: handedness, language ability, spatial skills, facial recognition, and emotion recognition. Recently, a sixth asymmetric functional element bearing on personality has been discovered. It is the larger side of the split bilateral anterior cingulate cortex (ACC). This appears to be the final output element of the executive system of which, by logic, there can be only one. Which side is somewhat larger varies among the general population in a seemingly idiosyncratic manner, yet with a genetic basis because true-breeding lineages exist. Here, hemisity is binary measure where a person is inherently born either right brain or left brain oriented. This is determined by nine statistically robust sets of four biophysical tests, none of which depend upon personality, and five behavioral questionnaires. Crucially these hemisity methods have been validated by the Magnetic Resonance Imaging (MRI)-based discovery that the larger side of the ACC is on the same side as one's hemisity, making MRI the primary standard for hemisity determination (r = 0.96). There are at least 30 measurable differences in individual characteristics and behaviors between those persons whose hemsity is on the right compared to those with it on the left. The hemisity of 2929 individuals was determined by these methods. Large groups included 1428 junior and senior high schools students both in Hawaii and Utah. There were somewhat comparable numbers present for both types of hemisity. Hemisity of individuals was found stable from infancy to old age. There was no relation between hemisity and handedness. Larger corpus callosum (CC) size of male or female subjects was larger in right brainer that in left brainers. Twin studies demonstrate that CC size is inherited. Thirty-eight percent of individuals of both sexes were right brain oriented, while 62% of individuals of both sexes were left brain oriented. In pairings, there were more than twice as many couples with opposite hemisity. Of these couples, the right brain male and females were dominant. Reproductive outcomes of these were "Like father like son, Like mother like daughter."


Caffeine Supplementation or Carbohydrate Mouth Rinse Improves Performance.
Training volume is one of the critical variables required to promote resistance training benefits (e. g., hypertrophy, muscular strength). Thus, strategies to improve training volume are required. We tested the hypothesis that there is an increase in performance and reduction in the rate of perceived exertion in strength training with caffeine supplementation, carbohydrate mouth rinse, and a synergistic effect of caffeine supplementation plus carbohydrate mouth rinse. We recruited 29 physically active women: 24±4 years, 60.0±7.9 kg, 161.0±6.0 cm. This study was a double-blind, randomized, placebo-controlled, and crossover one. The subjects performed all sessions of strength training under different conditions: caffeine (6.5 mg·kg-1 body mass); carbohydrate (6 g of maltodextrin rinsed for 10 s); caffeine plus carbohydrate; or placebo. We applied the ANOVA for repeated measures through the null-hypothesis statistical test, and the Bayes factors analyses approach. The subjects showed significant improvement in the total repetitions (P<0.01; BF10 ~99%) for both lower and upper limb exercises in all conditions compared to placebo without difference among interventions. The rate of perceived exertion (P>0.05) did not differ among interventions. However, BF10 analyses showed a higher probability of lower RPE for CAF intervention. We conclude that either caffeine supplementation or carbohydrate mouth rinse can improve performance in resistance training. There is no additional effect of caffeine plus carbohydrate.


[Trends in the prevalence of risk factors of noncommunicable diseases during 1987-1999].
The trends in the prevalence of hypertension, hypercholesterolemia, overweight and smoking among Lithuanian rural population were assessed from 1987 to 1999. Three independent surveys in 1987, 1993 and 1999 were carried out in five rural regions of Lithuania in random samples of men and women aged 25-64 involving 2695, 1550 and 1838 persons respectively. The risk factors were defined according to the WHO criteria. During the 13 years the prevalence of hypercholesterolemia and overweight has significantly decreased among men (by 23.2% and 4.9% respectively) as well as among women (by 19.9% and 10.7% respectively). The prevalence of hypertension among women has decreased by 9.1%, with no significant changes among men. The prevalence of smoking has increased by 8.9% among women and has not changed among men. Age was positively correlated with the prevalence of all risk factors, except smoking. Younger persons smoked more often than elderly did. Prevalence of risk factors varied by educational level. Hypertension and overweight have been more prevalent among women with incomplete secondary education, than among those with university education. The prevalence of overweight and hypercholesterolaemia has been higher among highly educated men compared to low educated. The inverse relationship between smoking and education has been observed in men. In conclusion, the decreasing trends in the prevalence of some risk factors have been estimated in Lithuania within last decade. Sociodemographic differences in the prevalence of risk factors should be taken into account while developing health promotion and diseases prevention programmes.


[Creation of an assistive technology for validation among blind people: focus on breastfeeding].
This study aimed to construct an assistive technology about breastfeeding for validation among blind people. This technology is a string that will be sung by street musicians, and then evaluated by blind people. It was performed in May and June 2008 and comprises 32 units of six lines, distributed in categories: 1. Composition of mother's milk; 2. Myths and taboos; 3. Professional, family and breastfeeding; 4. Advantages of breastfeeding for the child; 5. Advantages of breastfeeding for the mother and family; 6. Communication in health. By elaborating the string the importance of nurses in health promotion and disease prevention and it can use the string as a means for communication and encouragement of breastfeeding is highlighted.


Highly stereoselective cyclopropanation of various olefins with diazosulfones catalyzed by Ru(ii)-Pheox complexes.
A highly stereoselective cyclopropanation of various olefins with diazosulfones catalyzed by chiral Ru(ii)-Pheox complexes was developed to give chiral cyclopropyl sulfones in high yields (up to 99%) with excellent trans-selectivity and enantioselectivity (up to 98% ee).


COVID-19 vaccine-related axillary lymphadenopathy in breast cancer patients: Case series with a review of literature.
Lymphadenopathy (LAP) after COVID-19 vaccination in patients with a diagnosis of cancer has been challenging. We analyzed imaging and clinical features from early cases of axillary LAP in six COVID-19 vaccine recipients with a history of breast cancer. Among the patients with a history of breast cancer and recent COVID-19 vaccine administration, six patients who showed isolated axillary LAP were gathered. Radiologic features were reviewed from breast ultrasound, chest computed tomography, and breast magnetic resonance imaging. Clinical and pathological information were obtained for analysis. The interval between ultrasound detection of LAP and last COVID-19 vaccine administration ranged from 14 to 28 days (mean 21.67 days). Round shape of the lymph node and irregular cortex were noted in 2 and 0 cases, respectively. Mean maximum cortical thickness, length to width ratio and interval aggravation in maximum cortical thickening were 4.2 mm, 1.34, and 2.81-fold with cut-off value of 3 mm, 1.5, 2.0-fold, respectively. We observed axillary LAP ipsilateral to a recent vaccine administration persisting longer than what the Centers for Disease Control and Prevention announced. In our patients, COVID-19 vaccine-related LAP tended to show increased cortical thickness without cortical irregularity. Oncologist as well as radiologist should be familiar with the fact that COVID-19 vaccines, regardless of vaccine type or dosage, can frequently cause ipsilateral axillary LAP, showing some suspicious features more often than others, and can persist longer than anticipated so that both over- and underdiagnosis can be avoided. We report our observations in six patients and provide an exhaustive review of the published literature.


Hip resurfacing arthroplasty: the evolution of contemporary designs.
Metal-on-metal hip resurfacing is considered by many as the most significant recent development in hip arthroplasty. It preserves proximal femoral bone stock, optimizes stress transfer to the proximal femur, and offers inherent stability and optimal range of movement. The early results of hip resurfacing in the 1970s and 1980s were poor and the procedure was largely abandoned by the mid-1980s. The expectation that these prostheses would be easy to revise was not often fulfilled. The large diameter of the articulation combined with thin polyethylene cups or liners resulted in accelerated wear and the production of large volumes of biologically active particulate debris, leading to bone loss and implant loosening. Failure has been attributed to other factors, mainly avascular necrosis of the femoral head. However, this concern has not been confirmed by retrieval studies. The failure of early hip resurfacings was essentially a consequence of the use of inappropriate materials, poor implant design, inadequate instrumentation, and crude surgical technique. It was not an inherent problem with the procedure itself. The renaissance of metal-on-metal articulations for total hip arthroplasty enabled the introduction of new hip resurfacings and most of the major implant manufacturers have already introduced such systems. Early results are encouraging and complications commonly seen in the 1970s and 1980s, such as early implant loosening and femoral neck fracture, now appear to be rare. Whilst early results should be regarded with caution, modern metal-on-metal hip resurfacing potentially offers the ultimate bone preservation and restoration of function in appropriately selected young patients.


Weight Loss and Improvement of Metabolic Alterations in Overweight and Obese Children Through the I2AO2 Family Program: A Randomized Controlled Clinical Trial.
Childhood obesity is a major public health concern. We wanted to evaluate the effectiveness of a multidisciplinary program based on healthy eating, exercise, cognitive-behavioral therapy, and health education to achieve weight loss and improve metabolic parameters in overweight and obese children. A randomized, controlled clinical trial with long-term follow-up (24 months) was conducted at a community care center in overweight and obese individuals aged 6-12 years. A sample of 108 children was divided into an experimental and a control group receiving a standard care program. The experimental groups received a 12-month interdisciplinary program; the results were evaluated at 4 months, the end of the intervention, and at follow-up 12 months later. Anthropometric and biological marker measurements related to metabolic alterations, dyslipidemia (based on total cholesterol), hyperglycemia, fasting glycaemia, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol in blood were recorded. The intervention had a significant effect (p < 0.001) in terms of decreased body mass index, skinfolds, and waist and arm circumferences. These changes were accompanied by biochemical changes underlying an improvement in metabolic parameters, such as a significant reduction in total cholesterol, low-density lipoprotein-cholesterol, triglycerides, and hyperglycemia and a significant increase in high-density lipoprotein-cholesterol. These effects were still significant for markers of excess weight or obesity in the experimental group 12 months after the end of the intervention, suggesting that an enduring change in healthy lifestyles had been maintained period. This interdisciplinary, nurse-led program helped to reduce childhood and adolescent excess weight and obesity and had long-lasting effects.


AttR2U-Net: A Fully Automated Model for MRI Nasopharyngeal Carcinoma Segmentation Based on Spatial Attention and Residual Recurrent Convolution.
Radiotherapy is an essential method for treating nasopharyngeal carcinoma (NPC), and the segmentation of NPC is a crucial process affecting the treatment. However, manual segmentation of NPC is inefficient. Besides, the segmentation results of different doctors might vary considerably. To improve the efficiency and the consistency of NPC segmentation, we propose a novel AttR2U-Net model which automatically and accurately segments nasopharyngeal carcinoma from MRI images. This model is based on the classic U-Net and incorporates advanced mechanisms such as spatial attention, residual connection, recurrent convolution, and normalization to improve the segmentation performance. Our model features recurrent convolution and residual connections in each layer to improve its ability to extract details. Moreover, spatial attention is fused into the network by skip connections to pinpoint cancer areas more accurately. Our model achieves a DSC value of 0.816 on the NPC segmentation task and obtains the best performance compared with six other state-of-the-art image segmentation models.


Outer-Sphere 2 e- /2 H+ Transfer Reactions of Ruthenium(II)-Amine and Ruthenium(IV)-Amido Complexes.
A diverse set of 2 e- /2 H+ reactions are described that interconvert [RuII (bpy)(en*)2 ]2+ and [RuIV (bpy)(en-H*)2 ]2+ (bpy=2,2'-bipyridine, en*=H2 NCMe2 CMe2 NH2 , en*-H=H2 NCMe2 CMe2 NH- ), forming or cleaving different O-H, N-H, S-H, and C-H bonds. The reactions involve quinones, hydrazines, thiols, and 1,3-cyclohexadiene. These proton-coupled electron transfer reactions occur without substrate binding to the ruthenium center, but instead with precursor complex formation by hydrogen bonding. The free energies of the reactions vary over more than 90 kcal mol-1 , but the rates are more dependent on the type of X-H bond involved than the associated ΔG°. There is a kinetic preference for substrates that have the transferring hydrogen atoms in close proximity, such as ortho-tetrachlorobenzoquinone over its para-isomer and 1,3-cyclohexadiene over its 1,4-isomer, perhaps hinting at the potential for concerted 2 e- /2 H+ transfers.


[Carcinomatous meningitis in gastric cancer under chemotherapy-two cases].
The development of chemotherapy to treat gastric cancer has prolonged its prognosis, and sometimes extremely rare conditions arise. This report describes two patients with carcinomatous meningitis who rapidly progressed into unconsciousness and died. A 60-year-old woman under second-line chemotherapy for gastric cancer presented with headache and disordered speech. Magnetic resonance imaging (MRI) indicated carcinomatous meningitis, and a lumbar puncture revealed cancer cells in the cerebrospinal fluid. Convulsions rapidly progressed while unconscious, and the patient died two weeks after admission. A 67-year-old man receiving adjuvant chemotherapy after total gastrectomy for gastric cancer was admitted to the emergency department with severe fatigue and appetite loss. Unconsciousness rapidly progressed on the following day and carcinomatous meningitis was diagnosed. The patient died two weeks later. Carcinomatous meningitis is a rare complication of gastric cancer that rapidly progresses often to death, and it should be recalled that it is accompanied by a rapid loss of consciousness.


The Physical Activity and Fitness in Childhood Cancer Survivors (PACCS) Study: Protocol for an International Mixed Methods Study.
Survivors of childhood cancer represent a growing population with a long life expectancy but high risks of treatment-induced morbidity and premature mortality. Regular physical activity (PA) may improve their long-term health; however, high-quality empirical knowledge is sparse. The Physical Activity and Fitness in Childhood Cancer Survivors (PACCS) study comprises 4 work packages (WPs) aiming for the objective determination of PA and self-reported health behavior, fatigue, and quality of life (WP 1); physical fitness determination (WP 2); the evaluation of barriers to and facilitators of PA (WP 1 and 3); and the feasibility testing of an intervention to increase PA and physical fitness (WP 4). The PACCS study will use a mixed methods design, combining patient-reported outcome measures and objective clinical and physiological assessments with qualitative data gathering methods. A total of 500 survivors of childhood cancer aged 9 to 18 years with ≥1 year after treatment completion will be recruited in follow-up care clinics in Norway, Denmark, Finland, Germany, and Switzerland. All participants will participate in WP 1, of which approximately 150, 40, and 30 will be recruited to WP 2, WP3, and WP 4, respectively. The reference material for WP 1 is available from existing studies, whereas WP 2 will recruit healthy controls. PA levels will be measured using ActiGraph accelerometers and self-reports. Validated questionnaires will be used to assess health behaviors, fatigue, and quality of life. Physical fitness will be measured by a cardiopulmonary exercise test, isometric muscle strength tests, and muscle power and endurance tests. Limiting factors will be identified via neurological, pulmonary, and cardiac evaluations and the assessment of body composition and muscle size. Semistructured, qualitative interviews, analyzed using systematic text condensation, will identify the perceived barriers to and facilitators of PA for survivors of childhood cancer. In WP 4, we will evaluate the feasibility of a 6-month personalized PA intervention with the involvement of local structures. Ethical approvals have been secured at all participating sites (Norwegian Regional Committee for Medical Research Ethics [2016/953 and 2018/739]; the Oslo University Hospital Data Protection Officer; equivalent institutions in Finland, Denmark [file H-19032270], Germany, and Switzerland [Ethics Committee of Northwestern and Central Switzerland, project ID: 2019-00410]). Data collection for WP 1 to 3 is complete. This will be completed by July 2022 for WP 4. Several publications are already in preparation, and 2 have been published. The PACCS study will generate high-quality knowledge that will contribute to the development of an evidence-based PA intervention for young survivors of childhood cancer to improve their long-term care and health. We will identify physiological, psychological, and social barriers to PA that can be targeted in interventions with immediate benefits for young survivors of childhood cancer in need of rehabilitation. DERR1-10.2196/35838.


[The trend of clinical characteristics of colorectal cancer during the past 20 years in Guangdong province].
To study the trend of clinical characteristics of colorectal cancer during the past 20 years in Gaungdong province. The clinical data of 3870 cases of colorectal cancers confirmed pathologically who were hospitalized to Nanfang Hospital and Huizhou Municipal Hospital, Guangdong province, 1985 - 2004 were divided into 5-year groups and analyzed. The hospitalization number of colorectal cancer in the 2000 - 20004 5-year period was 102%, higher than that of the 1985 - 1989 period with an annual increase of 5.1%. The median age of incidence 2000 - 2004 was 58.6 years, 8.4 years higher than that in 1985 - 1989. The male to female ratio of the 3870 patients was 1.42:1. The male to female ratio 2000 - 2004 was 1.35:1, lower than that 1985 - 1989 (1.50:1). The proportion of rectal cancer 2000 - 2004 was 49.7%, significantly lower than that in 1985 - 1989 (64.8%), while the proportion of right hemi-colon cancer 2000 - 2004 was 28.7%, significantly higher than that in 1985 - 1989 (18.0%). The proportion of moderately and well differentiated cancer 2000 - 2004 was 80.6%, higher than that in 1985 - 1989 (70.1%), and the proportion of poorly differentiated cancer 2000 - 2004 was 19.4%, lower than that in 1985 - 1989 (29.9%). The proportion of colorectal cancer at Dukes A stage 2000 - 2004 was 9.8%, higher than that in 1985 - 1989 (3.2%). In the past 20 years, the incidence of colorectal cancer has increased in Guangdong province with a n increase of median age of incidence, The male to female ratio has decreased, and the incidence of right hemi-colon cancer, the rates of higher differentiated cancer and Dukes A stage cancer have increased.


Backbone amide dynamics studies of Apo-L75F-TrpR, a temperature-sensitive mutant of the tryptophan repressor protein (TrpR): comparison with the (15)N NMR relaxation profiles of wild-type and A77V mutant Apo-TrpR repressors.
Backbone amide dynamics studies were conducted on a temperature-sensitive mutant (L75F-TrpR) of the tryptophan repressor protein (TrpR) of Escherichia coli in its apo (i.e., no l-tryptophan corepressor-bound) form. The (15)N NMR relaxation profiles of apo-L75F-TrpR were analyzed and compared to those of wild-type (WT) and super-repressor mutant (A77V) TrpR proteins, also in their apo forms. The (15)N NMR relaxation data ((15)N-T(1), (15)N-T(2), and heteronuclear (15)N-{(1)H}-nOe) recorded on all three aporepressors at a magnetic field strength of 600 MHz ((1)H Larmor frequency) were analyzed to extract dynamics parameters, including diffusion tensor ratios (D(∥)/D(⊥)), correlation times (τ(m)) for overall reorientations of the proteins in solution, reduced spectral density terms [J(eff)(0), J(0.87ω(H)), J(ω(N))], and generalized order parameters (S(2)), which report on protein internal motions on the picosecond to nanosecond and slower microsecond to millisecond chemical exchange time scales. Our results indicate that all three aporepressors exhibit comparable D(∥)/D(⊥) ratios and characteristic time constants, τ(m), for overall global reorientation, indicating that in solution, all three apoproteins display very similar overall shape, structure, and rotational diffusion properties. Comparison of (15)N NMR relaxation data, reduced spectral density profiles, and generalized S(2) order parameters indicated that these parameters are quite uniform for backbone amides positioned within the four (A-C and F) core α-helices of all three aporepressors. In contrast, small but noticeable differences in internal dynamics were observed for backbone amides located within the helix D-turn-helix E DNA-binding domain of the apo-TrpR proteins. The significance of these dynamics differences in terms of the biophysical characteristics and ligand binding properties of the three apo-TrpR proteins is discussed.


Endoscopic band ligation for bleeding lesions in the small bowel.
To investigate the safety and efficacy of endoscopic band ligation (EBL) for bleeding lesions in the small bowel. This is a retrospective study evaluating EBL in six consecutive patients (three males, three females, 46-86 years of age) treated between May 2009 and February 2014: duodenal vascular ectasia; 1, jejunal bleeding diverticulum; 1, ileal Dieulafoy's lesion; 1 and ileal bleeding diverticula; 3. The success of the initial hemostasis was evaluated, and patients were observed for early rebleeding (within 30 d after EBL), and complications such as perforation and abscess formation. Follow-up endoscopies were performed in four patients. Initial hemostasis was successfully achieved with EBL in all six patients. Eversion was not sufficient in four diverticular lesions. Early rebleeding occurred three days after EBL in one ileal diverticulum, and a repeat endoscopy revealed dislodgement of the O-band and ulcer formation at the banded site. This rebleeding was managed conservatively. Late rebleeding occurred in this case (13 and 21 mo after initial EBL), and re-EBL was performed. Follow-up endoscopies revealed scar formation and the disappearance of vascular lesions at the banded site in the case with a duodenal bleeding lesion, and unresolved ileal diverticula in three cases. Surgery or transarterial embolization was not required without any complications during the median follow-up period of 45 (range, 2-83) mo. EBL is a safe and effective endoscopic treatment for hemostasis of bleeding lesions in the small bowel.


Isolated Renal Hydatid Cyst in a 6-Year-Old Boy: A Case Report.
Hydatid cyst (HC) is a parasitic infection transmitted by oral ingestion of Echinococcus granulosus eggs. Isolated kidney involvement is extremely rare. It is even less common in children. We present a case of isolated renal HC in a 6-year-old boy from Şanlıurfa, southeast Turkey who complained of abdominal pain and distension. Cystectomy was performed with a flank incision using the extraperitoneal approach. No recurrence was detected in the postoperative 6-month follow-up. There are not enough data about the efficacy of medical treatment in renal HC. Therefore, medical treatment should be considered pre- and post-operatively to prevent dissemination, rather than being used as a primary treatment. Kidney-sparing surgery should be the first choice in patients with isolated renal HC. However, nephrectomy is recommended for nonfunctioning kidneys, large cysts thought to be connected with the collecting system, and cysts with suspicious tumor. In societies where HC disease is endemic, renal HC should be considered in children with cysts located in kidney, even if the indirect hemagglutination test is negative.


Comment on "Metal-Free Triplet Phosphors with High Emission Efficiency and High Tunability".
A series of β-hydroxy-vinylimine boron compounds 1-7 have been reported to exhibit unique dual emission, consisting of fluorescence and room temperature phosphorescence (RTP) in solution. This finding triggered intensive research of RTP in β-hydroxy-vinylimine boron derivatives. Herein, we show clear evidence that the associated dual emission, especially RTP, is caused by the experimental artifact, where bright emission intensity saturates the detection dynamic range of the fluorimeter.


HIV/AIDS and homelessness, Part 2: treatment issues.
Various factors interfere wtih proper access to and initiation of antiretroviral therapy in the HIV-infected homeless population, and it is important for health care providers to explore and address barriers to obtaining antiretroviral therapy and to foster a trusting relationship before offering therapy so that its success may be maximized. Patient education about the multifaceted aspects of antiretroviral therapy is a crucial component of care. Care providers should aggressively identify barriers to adherence and facilitate patient adherence by using multiple strategies, establishing solid lines of communication within the provider team, bringing program services to patients, and educating ancillary service providers about adherence. Comanagement of antiretroviral therapy requires an interdisciplinary approach that includes case managers, mental health and substance abuse counselors, shelter providers, medical specialists, and parole/probation officers. More research is needed to understand the complexities of HIV/AIDS within the homeless population and to develop treatment interventions.


Genetic association studies of tumour necrosis factor alpha and beta and tumour necrosis factor receptor 1 and 2 polymorphisms across the clinical spectrum of multiple sclerosis.
Allelic association studies with microsatellite markers around the tumour-necrosis factor (TNF) genes have demonstrated significantly different allele distributions of TNF markers (a and b) between relapsing-remitting/secondary progressive multiple sclerosis (MS) (RR/SPMS) patients and normal controls. Considering the suspected genetic and immunological heterogeneity in MS, we tested this association in primary progressive MS (PPMS) patients. Elevated levels of serum soluble TNF receptors (sTNF-R) are reported in patients with gadolinium enhancing lesions, and animal models suggest a possible therapeutic role of sTNF-RI in MS. Thus we performed similar association studies using markers for the TNF-R genes. Gene association studies were carried out on 199-216 normal controls, 174 RR/SPMS patients and 102 PPMS patients using polymorphic dinucleotide repeat TNF markers (a, b and d), and separate markers for TNF-RI and TNF-RII. Forward primers were fluorescently labelled, polymerase chain reaction (PCR) products were analysed on a fluorescent fragment analyser, and Genescan 672 software was used for allele sizing. Samples were typed for HLA-DR antigens using PCR technology and sequence-specific oligonucleotide probes. TNFa marker allele distributions differed significantly between PPMS patients and controls (P = 0.028), largely attributable to an increase in the 118-bp TNFa allele in PPMS patients (P = 0.00024). Allele distributions were similar in PPMS and RR/SPMS patients (P = 0.91). Logistic regression analysis, however, indicated that these associations were not independent of that with HLA-DRB1*15. For the TNFb marker, the 127-bp allele showed association with both patient categories (PPMS vs. controls, P = 0.010; RR/SPMS vs. controls, P = 0.027), whilst the 128-bp allele occurred more frequently in controls (PPMS vs. controls, P = 0.036: RR/SPMS vs. controls, P = 0.0009). As with the TNFa 118 bp allele, the association with TNFb was not independent of the HLA association. No association occurred with the TNFd marker, and there were also no significant differences in allele frequencies between MS groups and controls regarding the marker for TNF-RI or TNF-RII. In Northern Irish patients the TNF contribution to MS genetic susceptibility is therefore similar across the clinical spectrum of the disease but is not independent of the association with HLA-DRB1*15.


[Maffucci's syndrome associated with primary brain tumor: report of a case].
A rare case of Maffucci's syndrome associated with astrocytoma at the right frontal lobe and intracranial chondroma is reported in detail with a review of literature. A 24-year-old male who had diagnosed as multiple chondroma at the age of 14 years old was admitted to the hospital with complaint of double vision. Neurological examination revealed no abnormality except for the left abducens palsy. Multiple subcutaneous blue nodules in the left hand was carried for biopsy as cavernous hemangioma. Craniograph showed expansive radiolucent area in the parasellar region. CT scan demonstrated a round shaped low density area in the right frontal lobe, part of which was iso-density and turned out to be enhanced following contrast infusion. Roentgenogram disclosed many well-demarcated radiolucent area in phalanges of the left hand and leg, and right leg and third rib. The frontal tumor was totally extirpated and was histologically fibrillary astrocytoma. This is the ninth case of the Maffucci's syndrome associated with the primary intracranial tumor in the literature. It is emphasized that the Maffucci's syndrome is associated with a high incidence of malignancy. And the reason for tendency to develop malignant tumors is discussed.


Identification of Coinfections by Viral and Bacterial Pathogens in COVID-19 Hospitalized Patients in Peru: Molecular Diagnosis and Clinical Characteristics.
The impact of respiratory coinfections in COVID-19 is still not well understood despite the growing evidence that consider coinfections greater than expected. A total of 295 patients older than 18 years of age, hospitalized with a confirmed diagnosis of moderate/severe pneumonia due to SARS-CoV-2 infection (according to definitions established by the Ministry of Health of Peru) were enrolled during the study period. A coinfection with one or more respiratory pathogens was detected in 154 (52.2%) patients at hospital admission. The most common coinfections were Mycoplasma pneumoniae (28.1%), Chlamydia pneumoniae (8.8%) and with both bacteria (11.5%); followed by Adenovirus (1.7%), Mycoplasma pneumoniae/Adenovirus (0.7%), Chlamydia pneumoniae/Adenovirus (0.7%), RSV-B/Chlamydia pneumoniae (0.3%) and Mycoplasma pneumoniae/Chlamydia pneumoniae/Adenovirus (0.3%). Expectoration was less frequent in coinfected individuals compared to non-coinfected (5.8% vs. 12.8%). Sepsis was more frequent among coinfected patients than non-coinfected individuals (33.1% vs. 20.6%) and 41% of the patients who received macrolides empirically were PCR-positive for Mycoplasma pneumoniae and Chlamydia pneumoniae.


Tensile fatigue in bone: are cycles-, or time to failure, or both, important?
In life, bones are subjected to fatigue loading which has different frequency and amplitude components, as well as various kinds of loading modes like tension, compression, shear and combinations of them. Considerable variability is observed in fatigue results of bone, which may be caused by these experimental variables or by the bone itself. In past studies the effect of magnitude and mode of loading have been examined in standard fatigue strength (stress vs. cycles to failure) diagrams. The effect of frequency is not clear, but there is clear evidence (from Carter & co-workers) that, at least in human bone, tension "fatigue" failure was determined solely by time rather than by cycles. We sought to confirm these results in the same and a different species. We cycled human and bovine bone in tension at two frequencies: 0.5 and 5 Hz. There was no cycle number effect; the results from the tests at the two frequencies were different if plotted and analysed as a function of cycles to failure, but were not separable if plotted and analysed as a function of time to failure. In this respect bone differs from tendon, in which failure in tension is a function of both cycles and time.


Deep lateral orbital decompression for Graves orbitopathy: a systematic review.
To systematically review the literature on the deep lateral orbital decompression (DLD). The authors searched the MEDLINE, Lilac, Scopus, and EMBASE databases for all articles in English, Spanish, and French that used as keywords the terms orbital decompression and lateral wall. Two articles in German were also included. Data retrieved included the number of patients and orbits operated, types of the approach employed, exophthalmometric and horizontal eye position changes, and complications. The 95% confidence intervals (CI) of the mean Hertel changes induced by the surgery were calculated from series with 15 or more data. Of the 204 publications initially retrieved, 131 were included. Detailed surgical techniques were analyzed from 59 articles representing 4559 procedures of 2705 patients. In 45.8% of the reports, the orbits were decompressed ab-interno. Ab-externo and rim-off techniques were used in 25.4% and 28.8% of the orbits, respectively. Mean and 95% CI intervals of Hertel changes, pooled from 15 articles, indicate that the effect of the surgery is not related to the technique and ranges from 2.5 to 4.5 mm. The rate of new onset of diplopia varied from zero to 8.6%. Several complications have been reported including dry eye, oscillopsia, temporal howling, lateral rectus damage, and bleeding. Unilateral amaurosis and subdural hematoma have been described in only one patients each. The low rate of new-onset diplopia is the main benefit of DLD. Prospective studies are needed to compare the rate of complications induced by the 3 main surgical techniques used.


Distribution of magnesium, calcium, sodium and potassium in tissues of the hip joint.
The aim of this study was to determine the distribution of magnesium, calcium, sodium and potassium in tissues of the hip joint and to look for any correlations between these minerals. The study was performed using hip joint samples taken from people living in the Upper Silesian Industrial Region in Poland. Ninety one subjects, 66 women and 25 men, were included in this study. The samples were obtained intra-operatively during hip joint replacement procedures. The concentrations of magnesium, calcium, sodium and potassium were measured by atomic absorption spectrophotometry (AAS). Our results showed that these minerals are most abundant in the cancellous bone of the hip joint. They were found next more abundantly in the cortical bone and the cancellous bone from the intertrochanteric area. Levels of magnesium, potassium and calcium were lower in articular cartilage compared with other parts of the hip joint; however, sodium levels were at their highest in this tissue. The lowest levels of these minerals were found in the articular capsule. Those patients with fractures of the femoral neck had lower levels of magnesium, potassium, and calcium, but higher levels of sodium compared with the group with degenerative changes. We can also confirm that in the population studied, calcium levels in cancellous bone of the head of the femur decreased with age.


Risk of injury associated with attention-deficit/hyperactivity disorder in adults enrolled in employer-sponsored health plans: a retrospective analysis.
Attention-deficit/hyperactivity disorder (ADHD) is linked to an increased risk of injury in children. This retrospective analysis evaluated the risk and type of injury associated with ADHD in adults. Data were taken from the MarketScan databases, which provide details of health care claims and productivity data for individuals and their dependents with access to employer-sponsored health plans. Adults (aged 18-64 years) with ≥ 2 ADHD-related diagnostic claims (using ICD-9-CM codes) between 2002 and 2007 and evidence of ADHD treatment in 2006 (n = 31,752) were matched to controls without ADHD (1:3; n = 95,256) or individuals with a depression diagnosis (using ICD-9-CM codes; 1:1; n = 29,965). Injury claims were compared between cohorts, and multivariate analyses controlled for differences that remained after matching. Injury claims were more common in individuals with ADHD than in non-ADHD controls (21.5% vs 15.7%; P< .0001) or individuals with depression (21.4% vs 20.5%; P= .008). Multivariate analyses indicated that the relative risk of injury claims was higher in individuals with ADHD than in the non-ADHD control (odds ratio [OR] = 1.32; 95% CI, 1.27-1.37; P< .01) and depression (OR = 1.13; 95% CI, 1.07-1.18; P< .01) groups. Injury claims increased total direct health care expenditure; total expenditures for ADHD patients with injuries were $6,482 compared with $3,722 for ADHD patients without injuries (P < .0001). Comparison of injury-related costs were similar between ADHD patients and non-ADHD controls ($1,109 vs $1,041, respectively), but higher for depression patients than for ADHD patients ($1,792 vs $1,084; P < .01). Injury claim was also associated with increased short-term disability expenditures, as ADHD patients with injury incurred higher mean cost than those without injury ($1,303 vs $620; P = .0001), but lower than those with injury in the depression cohort (vs $2,152; P = .0099) Adults with ADHD were more likely to incur injury claims than non-ADHD controls or adults with depression in this sample selected on the basis of claims data rather than clinical referrals. Most injuries were relatively minor; however, individuals with injuries incurred higher total direct health care costs than those without injuries. Furthermore, the ratio of indirect costs due to workplace absence to direct health care costs was higher for adults with ADHD than for adults with depression, demonstrating not only the impact of ADHD in the workplace, but also the importance of accounting for productivity data in calculating the true economic burden of ADHD in adults.


Stem cell autocrine CXCL12/CXCR4 stimulates invasion and metastasis of esophageal cancer.
Esophageal cancer is one of the most common malignant tumors of the digestive tract. The greatest obstacle to the curing of esophageal cancer is its propensity to spread and metastasize. Esophageal cancer stem cells are considered the source for recurrence and metastasis of the tumors. While clinical evidence suggested that continuous up-regulation of CXCL12/CXCR4 was significantly associated with poor prognosis in patients with esophageal cancer, but the role and mechanism of CXCL12/CXCR4 in the invasion and metastasis of esophageal cancer has not been reported by far. This study found that esophageal cancer stem cells not only autocrine a great amount of CXCL12, but also high expression of its corresponding receptor CXCR4. Most importantly, the ability of esophageal cancer stem cells to spread and metastasize could be inhibited by blockage of CXCR4 with inhibitors or shRNA approaches both in vivo and in vitro studies. The important role of CXCL12 in the invasion and metastasis of esophageal cancer stem cells was also confirmed by loss-of-function and gain-of-function strategies. Mechanistically, we demonstrated that CXCL12/CXCR4 activated the ERK1/2 pathway and thereby ultimately maintained the characteristics of high-level invasion and metastasis of esophageal cancer stem cells. Taken together, our findings suggested that autocrine CXCL12/CXCR4 was one of the major mechanisms underlying the metastatic property of esophageal cancer stem cells through ERK1/2 signaling pathway, and might serve as a therapeutic target for esophageal cancer patients.


Comparative Analysis of Skeletal Muscle DNA Methylation and Transcriptome of the Chicken Embryo at Different Developmental Stages.
DNA methylation is a key epigenetic mechanism involved in embryonic muscle development and plays an important role in early muscle development. In this study, we sought to investigate the effects of genome-wide DNA methylation by combining the expression profiles of the chicken embryonic muscle. Genome-wide DNA methylation maps and transcriptomes of muscle tissues collected from different embryonic development points (E7, E11, E17, and D1) were used for whole-genome bisulfite sequencing (WGBS) and RNA sequencing, respectively. We found that the differentially methylated genes (DMGs) were significantly associated with muscle organ development, regulation of skeletal muscle satellite cell proliferation, and actin filament depolymerization. Furthermore, genes TBX1, MEF2D, SPEG, CFL2, and TWF2 were strongly correlated with the methylation-caused expression switch. Therefore, we chose the CFL2 gene to explore its function in skeletal muscle satellite cells, and the in vitro experiments showed that CFL2 acts as a negative regulator of chicken skeletal muscle satellite cell proliferation and can induce cell apoptosis. These results provide valuable data for future genome and epigenome studies of chicken skeletal muscle and may help reveal the molecular mechanisms of potential economic traits.


sym 13-A Gene Conditioning Ineffective Nodulation in Pisum sativum.
Treatment of Pisum sativum (L.) cv. ;Sparkle' with ethyl methanesulfonic acid (EMS) produced a stable mutant, E135F, which forms small, white, ineffective nodules. These nodules exhibit histological zonation typical of an indeterminant nodule, e.g. meristematic, early symbiotic, late symbiotic, and senescent zones. Compared with the nitrogen fixing nodules of the parent, the zones are smaller and the nodules senesce prematurely. Bacteroids in E135F are less elongated and less differentiated than those in ;Sparkle.' The E135F mutant forms ineffective nodules when inoculated with nine different effective strains of Rhizobium leguminosarum and also when grown in a soil containing effective strains. The ineffective phenotype of E135F is under monogenic recessive control; the gene is designated sym 13. sym 13 was located on chromosome 2 by linkage with genes for shikimic dehydrogenase and esterase-2. The original selection E135F carried another mutation in heterozygous form at a separate locus, yielding some homozygous recessive nonnodulating progeny, E135N, in later generations. This indicates that EMS treatments may cause mutations at more than one sym gene. The gene conditioning non-nodulation in E135N was designated sym 14. It mapped to a locus on a different part of chromosome 2 by linkage to the gene for fumarase. The data demonstrate that sym genes are not necessarily closely linked.


Evaluation of bacterial biofilms in chronic rhinosinusitis.
We investigated the presence of biofilms in patients with chronic rhinosinusitis. Prospective study. Thirty patients with chronic rhinosinusitis scheduled for endoscopic sinus surgery were enrolled in this study. Nasal swab cultures were taken at the time of surgery. Samples were cultured using conventional methods for Haemophilus influenzae, Pseudomonas aeruginosa, Streptococcus pneumoniae, and Staphylococcus aureus. Culture-positive samples were evaluated for slime-forming ability. Qualitative detection of biofilm formation by all slime-producing strains was studied by culturing the strains on Congo red agar plates. Twenty-three of 30 patients' samples were culture positive (76.6%). Thirteen S. aureus and 10 P. aeruginosa cultures were identified on 23 specimens. Bacterial biofilms were present on 15 of 23 (65.2%) culture-positive specimens. Nine of 13 (69.2%) S. aureus cultures and 6 of 10 (60%) P. aeruginosa cultures produced bacterial biofilms. This conventional method is capable of demonstrating biofilm-forming ability in bacteria recovered from patients with chronic rhinosinusitis. The biofilm-forming ability was higher in S. aureus compared with P. aeruginosa.