Enhanced nutrient supply to very low birth weight infants is associated with improved white matter maturation and head growth.
Extrauterine growth restriction is common among very low birth weight infants (VLBW, BW <1,500 g). Optimal postnatal nutrient supply is essential to limit growth restriction and ensure adequate growth and neurodevelopment. We compared an enhanced postnatal nutrient supply to a standard supply and evaluated the effects on growth velocity, head circumference growth and cerebral maturation - the latter by magnetic resonance diffusion tensor imaging (DTI). We hypothesized increased growth velocity, head circumference growth and decreased mean diffusivity (MD) in cerebral white matter (WM) areas, suggesting improved cerebral maturation among infants on the enhanced nutrient supply. In this randomized controlled trial, infants on the enhanced nutrient supply received increased amounts of energy, protein, fat, essential fatty acids and vitamin A until discharge. DTI was performed close to term equivalent age. Outcomes were growth velocity, head circumference growth and WM mean diffusivity. Among the 50 included infants, 14 in the intervention group and 11 controls underwent a successful DTI. Infants on the enhanced diet achieved improved growth velocity (16.5 vs. 13.8 g/kg/day, p = 0.01) and increased head circumference (Δz score: 0.24 vs. -0.12, p = 0.15). A significantly lower MD was seen in a large WM area such as the superior longitudinal fasciculi (1.19 × 10(-3) vs. 1.24 × 10(-3) mm(2)/s, p = 0.04, adjusted for age when scanned). Enhanced nutrient supply to VLBW infants is associated with improved growth velocity, increased head circumference growth and decreased regional WM mean diffusivity, suggesting improved maturation of cerebral connective tracts.


[Two cases of recurrence of breast cancer at the chest wall wherein chest wall complications were treated by ablation].
Case 1 involves a 60-year-old woman who underwent surgery (breast total resection[Bt]plus axillary lymph node resection [Ax]) for the treatment of carcinoma of the right breast when she was 37 years of age. She underwent another surgery due to cancer recurrence in the right musculus pectoralis major when she was 50 years of age. The right fourth rib and the sternum showed high fluorodeoxyglucose (FDG) accumulation on positron electron tomography (PET)-computed tomography (CT) scans. Thus, we diagnosed the patient with recurrence of breast cancer at the chest wall. Lumpectomy was performed at the right chest wall, whereas ablation was performed for the right fourth and fifth rib and sternal complications. However, mediastinal lymph node metastasis developed 1 year and 2 months after the surgery. Subsequently, the patient developed lymphangitic carcinomatosis and died at 4 years and 2 months after the surgery. Case 2 involves an 80-year-old woman who underwent surgery (Bt+Ax) for the treatment of carcinoma of the left breast when she was 62 years of age. She had the swelling of the left chest wall in the 18th year from surgery, and was diagnosed recurrence of breast cancer at the chest wall, lumpectomy was performed at the left chest wall, whereas ablation was performed for the left third and fourth rib and sternal complications. No signs of recurrence have been observed for 1 year and 7 months after the surgery. Thus, ablation was performed for the treatment of chest wall complications and local recurrence of the breast cancer at the chest wall, and pharmacotherapy and radiotherapy were administered subsequently. We thereby report our experience with these 2 cases wherein local control was eventually achieved.


IL-37 attenuates allergic process via STAT6/STAT3 pathways in murine allergic rhinitis.
Allergic rhinitis (AR) is a common upper airway allergic disease caused by allergens triggering a type 2 immune response. The imbalance of CD4+ T cell subsets is the essential immunological feature of AR, which is mainly characterized by the predominance of T helper (Th) 2 cells. Recent studies indicated that the anti-inflammatory factor interleukin (IL)-37 is involved in the immune regulation of AR. However, the mechanism of IL-37 acts on AR has not been fully elucidated. Thus, we sought to assess the protective role of IL-37 in AR and further explore the possible mechanism. An ovalbumin (OVA)-induced AR murine model was established. After IL-37 treatment, the allergic symptoms (sneezes and nasal rubbings), nasal mucosal infiltration with eosinophils, and serum IgE production were found significantly attenuated. For CD4+ T cell subsets, the proliferation and differentiation of Th2 and Th17 cells were restrained. The relevant effector cytokines of IL-4, IL-5, IL-6, and IL-17a protein expression and transcription factors GATA3 and RORγt mRNA levels were obviously decreased. However, IL-37 had no significant effect on Th1 and Treg response including in IFN-γ, IL-10, T-bet, and Foxp3 expression. Furthermore, IL-37 was found down-regulated the STAT6, STAT3, phospho-STAT6, and phospho-STAT3 expression. In conclusion, IL-37 alleviates allergic inflammation in AR possibly through repressing STAT6 and STAT3 signaling pathways.


Being with virtual others: studying social cognition in temporal lobe epilepsy.
Social cognitive neuroscience has highlighted the importance of frontotemporal neurocircuitry for social cognition. Temporal lobe epilepsy (TLE) impacts these brain areas and their functional connections and might therefore specifically affect social perceptual and cognitive skills. In the study described here, an established paradigm was used to evaluate the social cognitive skills of female patients with left TLE. Study participants were shown dynamic animations in which virtual characters either looked at the human observer directly or looked away toward someone else, thus manipulating self-involvement. The virtual characters then exhibited different facial expressions that were either socially relevant or arbitrary. Participants were asked to rate the communicative intentions of the virtual character. Patients' ratings of communicative intent appeared to be linked to their own self-involvement in the interaction, whereas healthy volunteers' ratings of facial expressions were independent of self-involvement. Potential mechanisms for the observed differences are discussed.


Investigating coping and stigma in people living with HIV through narrative medicine in the Italian multicentre non-interventional study DIAMANTE.
Antiretroviral therapy (ART) significantly reduced Human Immunodeficiency Virus (HIV) morbidity and mortality; nevertheless, stigma still characterises the living with this condition. This study explored patients' coping experience by integrating narrative medicine (NM) in a non-interventional clinical trial. From June 2018 to September 2020 the study involved 18 centres across Italy; enrolled patients were both D/C/F/TAF naïve and previously ART-treated. Narratives were collected at enrolment (V1) and last visit (V4) and then independently analysed by three NM specialist researchers through content analysis. One-hundred and fourteen patients completed both V1 and V4 narratives. Supportive relationships with clinicians and undetectable viral load facilitated coping. Conversely, lack of disclosure of HIV-positive status, HIV metaphors, and unwillingness to narrate the life before the diagnosis indicated internalised stigma. This is the first non-interventional study to include narratives as patient reported outcomes (PROs). Improving HIV awareness and reducing the sense of guilt experienced by patients helps to overcome stigma and foster coping.


Where the patient and technology meet.
From the back office to the operating room, technology is transforming hospitals, making them more efficient and able to deliver leading-edge care. But one area remains stubbornly low tech: the nonclinical, routine interactions with patients. From registration to food service, some pioneering hospitals are now using IT to improve the patient experience.


A force plate and display system for studying ground reaction forces in dogs.
We have developed and implemented a low cost system for measuring ground reaction forces in dogs with normal and abnormal ambulation as they walk or trot over a floor mounted plate that measures vertical and horizontal forces. Orthogonally mounted strain gages measure the forces imposed. A bridge amplifier conditions the signals which are sampled and converted to digital form for display on an operator initiated graphical user interface (GUI) which displays the forces as a function of time on the screen of a Macintosh computer. The system also allows the input of timing of the velocity of approach to the plate and the foot strike can be monitored (via tap reply) on the computer screen to verify the fidelity of the foot strike on the active surface of the plate. The data gathered on a particular strike is stored as a "raw" signal, analyzed and recorded in a spread sheet text format for later analysis.


Ubiquitin of Entamoeba histolytica induces antibody response in patients with invasive amoebiasis.
Entamoeba histolytica causes amoebic liver abscess (ALA) in humans. The injury of target cells by E. histolytica includes processes controlled by the ubiquitin Ehub. Previously, we found immunodominance of Ehub glycan moieties using immunized rabbits. In this work, we analysed dominance of antibodies to the glycoprotein Ehub in the sera from 52 patients with ALA. Controls were sera from 20 healthy people living in endemic areas with a high seroprevalence of antibodies to amoebas, and 20 patients with alcoholic hepatitis (AH) to rule out the cross-reaction of Ehub with autoantibodies induced by liver damage. Antigens were trophozoite extract, glycoprotein Ehub and the recombinant protein E. histolytica recombinant ubiquitin (rEhub). The sera from healthy volunteers and patients with AH do not have antibodies to glycoprotein Ehub. Surprisingly, only the antibodies from patients with ALA recognized the glycoprotein Ehub, and some sera gave a faint reaction with the recombinant protein, especially because evolutionarily, the ubiquitin is conserved between species. This is the first report demonstrating that antibodies to ubiquitin Ehub are induced exclusively in patients with invasive amoebiasis, and the antibody response is mainly to the glycoprotein, indicating glycans are immunodominant. Inhibitors of the Ehub glycans could be potential treatment for amoebiasis by selectively damaging trophozoites.


A mathematical model for examining growth and sporulation processes of Bacillus subtilis.
A mathematical model for the growth process of the bacterium Bacillus subtilis is described. The model is a highly structured one. The driving motivation for development of the model and explicit accounting of major interactions of metabolic networks in the model is related to our eventual goal that the model will be used in the analysis of complex biological patterns. Bacillus subtilis was chosen in our study due to the interesting sporulation process that these cells undergo in response to adverse environmental conditions including nutrient limitation. Sporulation process in B. subtilis represents a primordial prototype of cellular differentiation in higher cellular systems. Thus a model for the B. subtilis growth process should prove extremely useful for understanding questions of developmental biology. The model is capable of simulating the transition between the exponential and stationary phase of growth in a batch culture. Since during the transition period the growth process and the metabolism become decoupled and many transient processes are taking place, such predictions are a severe test for the validity of any model. A strategy to examine the leading hypothesis on B. subtills sporulation implementing GTP as a component which signals sporulation initiation is described.


Synergistic effects of prenatal exposure to fine particulate matter (PM2.5) and ozone (O3) on the risk of preterm birth: A population-based cohort study.
There is some evidence that prenatal exposure to low-level air pollution increases the risk of preterm birth (PTB), but little is known about synergistic effects of different pollutants. We assessed the independent and joint effects of prenatal exposure to air pollution during the entire duration of pregnancy. The study population consisted of the 2568 members of the Espoo Cohort Study, born between 1984 and 1990, and living in the City of Espoo, Finland. We assessed individual-level prenatal exposure to ambient air pollutants of interest at all the residential addresses from conception to birth. The pollutant concentrations were estimated both by using regional-to-city-scale dispersion modelling and land-use regression-based method. We applied Poisson regression analysis to estimate the adjusted risk ratios (RRs) with their 95% confidence intervals (CI) by comparing the risk of PTB among babies with the highest quartile (Q4) of exposure during the entire duration of pregnancy with those with the lower exposure quartiles (Q1-Q3). We adjusted for season of birth, maternal age, sex of the baby, family's socioeconomic status, maternal smoking during pregnancy, maternal exposure to environmental tobacco smoke during pregnancy, single parenthood, and exposure to other air pollutants (only in multi-pollutant models) in the analysis. In a multi-pollutant model estimating the effects of exposure during entire pregnancy, the adjusted RR was 1.37 (95% CI: 0.85, 2.23) for PM2.5 and 1.64 (95% CI: 1.15, 2.35) for O3. The joint effect of PM2.5 and O3 was substantially higher, an adjusted RR of 3.63 (95% CI: 2.16, 6.10), than what would have been expected from their independent effects (0.99 for PM2.5 and 1.34 for O3). The relative risk due to interaction (RERI) was 2.30 (95% CI: 0.95, 4.57). Our results strengthen the evidence that exposure to fairly low-level air pollution during pregnancy increases the risk of PTB. We provide novel observations indicating that individual air pollutants such as PM2.5 and O3 may act synergistically potentiating each other's adverse effects.


Darier's Disease.
Fifteen cases of Darier's disease were studied. Males and females were in the ratio of 3:2. The disease appeared between the ages of 5 and 16 in majority (80%) of the patients. Family history was positive in only 60% cases. Itching was the main symptom in 2/3rd (66.6%) of cases. Seven cases experienced aggravation of the disease in summer. Recurrent skin infection and eczematisation were present in 5 cases. Majority of patients had typical lesions. Severity of the disease was directly related to its duration. Acrokeratosis verruciformis like lesions over the hands and feet were present in all the cases and 86.6% of cases had palmoplantar keratoderma. Mucosal lesions were seen in 73.3 % of cases. These unusual findings are not often stressed in clinical practice and need to be highlighted. Leucoderma guttate yet another unusual finding was seen in 20% of cases.


Influence of air pollutants on circulating inflammatory cells and microRNA expression in acute myocardial infarction.
Air pollutants increase the risk and mortality of myocardial infarction (MI). The aim of this study was to assess the inflammatory changes in circulating immune cells and microRNAs in MIs related to short-term exposure to air pollutants. We studied 192 patients with acute coronary syndromes and 57 controls with stable angina. For each patient, air pollution exposure in the 24-h before admission, was collected. All patients underwent systematic circulating inflammatory cell analyses. According to PM2.5 exposure, 31 patients were selected for microRNA analyses. STEMI patients exposed to PM2.5 showed a reduction of CD4+ regulatory T cells. Furthermore, in STEMI patients the exposure to PM2.5 was associated with an increase of miR-146a-5p and miR-423-3p. In STEMI and NSTEMI patients PM2.5 exposure was associated with an increase of miR-let-7f-5p. STEMI related to PM2.5 short-term exposure is associated with changes involving regulatory T cells, miR-146a-5p and miR-423-3p.


Dimension-Controllable Microtube Arrays by Dynamic Holographic Processing as 3D Yeast Culture Scaffolds for Asymmetrical Growth Regulation.
Transparent microtubes can function as unique cell culture scaffolds, because the tubular 3D microenvironment they provide is very similar to the narrow space of capillaries in vivo. However, how to realize the fabrication of microtube-arrays with variable cross-section dynamically remains challenging. Here, a dynamic holographic processing method for producing high aspect ratio (≈20) microtubes with tunable outside diameter (6-16 µm) and inside diameter (1-10 µm) as yeast culture scaffolds is reported. A ring-structure Bessel beam is modulated from a typical Gaussian-distributed femtosecond laser beam by a spatial light modulator. By combining the axial scanning of the focused beam and the dynamic display of holograms, dimension-controllable microtube arrays (straight, conical, and drum-shape) are rapidly produced by two-photon polymerization. The outside and inside diameters, tube heights, and spatial arrangements are readily tuned by loading different computer-generated holograms and changing the processing parameters. The transparent microtube array as a nontrivial tool for capturing and culturing the budding yeasts reveals the significant effect of tube diameter on budding characteristics. In particular, the conical tube with the inside diameter varying from 5 to 10 µm has remarkable asymmetrical regulation on the growth trend of captured yeasts.


Radiographic assessment of small finger metacarpal neck fractures.
Treatment recommendations for metacarpal neck fractures of the small finger are generally based on the degree of apex dorsal angulation at the fracture site. We evaluated the variability of measurement of fracture angulation and the effect this variability has on treatment recommendations for these injuries. A total of 96 radiographs (anteroposterior, lateral, oblique views) of 32 patients with fractures of the small finger metacarpal neck were evaluated independently by 3 fellowship-trained orthopedic hand surgeons. Treatment recommendations for each fracture were tabulated. This process was repeated 6 weeks later to evaluate intraobserver variability. Kappa coefficients of inter- and intraobserver reliability of fracture angulation measurement and treatment plans were generated. The mean reliability coefficient of the measurement of fracture angulation between the 3 different observers was slight. Similarly, the reproducibility of fracture angulation measurement within observers was fair. Agreement between observers for appropriate treatment recommendations for each fracture was fair and agreement within observers for treatment was only slightly better. The measurement of fracture angulation of small finger metacarpal neck fractures seems to be subject to a high degree of inter- and intraobserver variability.


Detection of Salmonella enterica serotype typhimurium DT104 in Mozambique.
The spread of Salmonella enterica serotype Typhimurium definitive phage type DT104 in sub-Saharan Africa is a public health concern. We obtained two isolates of S. typhimurium DT104 from blood cultures of infants with malaria in Mozambique. Both isolates contained Salmonella genomic island 1A and had the same pulsed-field gel electrophoresis PulseNet pattern (STYMXB.0005). Results showed the need for continuous surveillance of Salmonella spp. serotypes circulating in this area.


Averages of glutamine synthetase molecules as obtained with various skin and electron dose conditions.
Averaged projections of individual glutamine synthetase molecules have been obtained by using electron microscopy and image processing. The methodology of correlation averaging under low dose conditions is described in detail. Because of their low signal-to-noise ratio, images made under low dose conditions cannot be directly interpreted in terms of high resolution features. Computer averaging of these images reveals a division of the subunit projection into two domains whose sizes agree with results of Lei et al [2] limited proteolysis experiments.


Sedation for magnetic resonance imaging using propofol with or without ketamine at induction in pediatrics-A prospective randomized double-blinded study.
Deep sedation using propofol has become a standard technique in children. This double-blinded randomized clinical trial aims to compare the clinical effects of propofol-mono-sedation vs a combination of propofol and ketamine at induction and a reduced propofol infusion rate for maintenance in children undergoing diagnostic magnetic resonance imaging. Children aged from 3 months to 10 years scheduled as outpatients for elective magnetic resonance imaging with deep sedation were included. They were randomized into 2 groups, receiving either 1 mg/kg ketamine at induction, then a propofol infusion rate of 5 mg/kg/h or a propofol infusion rate of 10 mg/kg/h without prior ketamine. Time to full recovery (modified Aldrete score = 10) was the primary outcome. Further outcomes were quality of induction, immobilization during image acquisition, recovery, postoperative nausea and vomiting, emergence delirium using the Pediatric Anesthesia Emergence Delirium scale, vital signs and adverse cardiorespiratory events. All patients and parents as well as anesthetists, imaging technicians, and postsedation personnel were blinded. Data are given as median (range). In total, 347 children aged 4.0 (0.25-10.9) years, weighing 15.6 (5.3-54) kg, ASA classification I, II, or III (141/188/18) were included. The ketamine-propofol group showed significantly shorter recovery times (38 (22-65) vs 54 (37-77) minutes; median difference 14 (95% CI: 8, 20) minutes; P < .001), better quality of induction, and higher blood pressure, but higher incidence of movement requiring additional sedative drugs. There were no significant differences in respiratory side effects, cardiovascular compromise, emergence delirium, or postoperative nausea and vomiting. Both sedation concepts proved to be reliable with a low incidence of side effects. Ketamine at induction with a reduced propofol infusion rate leads to faster postanesthetic recovery.


Sporotrichosis: Part I.
Sporotrichosis is the most common subcutaneous mycosis in South America. Classic infection is associated with traumatic inoculation of soil, vegetables, and organic material contaminated with Sporothix schenckii. Animals of various species, including humans, are affected by this disease. This subcutaneous mycosis is an infection of implantation. The most frequent clinical form is the lymphocutaneous form. The fixed cutaneous form is characterized by infiltrated nodular, ulcerated, or erythematosquamous lesions located on exposed areas where fungal inoculation occurred. The disseminated cutaneous forms have mainly been observed among immunosuppressed patients, especially human immunodeficiency virus-positive individuals. Sporotrichosis is the only subcutaneous mycosis for which direct examination or histology is of little or no value for diagnosis. The diagnosis rests solely on the isolation of S schenckii in culture. Since 1998, researchers from Brazil suggested that feline transmission of sporotrichosis was associated with a large and long-lasting outbreak of the disease in the city of Rio de Janeiro.


The Alu-insertion progesterone receptor gene polymorphism is not associated with breast cancer: a meta-analysis.
The role of progesterone receptor (PGR) gene polymorphisms in breast cancer is still controversial. Here, we performed a meta-analysis to determine whether the Alu insertion is associated with an increased risk of breast cancer and, further, whether the Alu insertion contributes to the development of breast cancer. Using database searches, we selected 10 controlled case studies that met a rigorous set of inclusion criteria; these studies included 2106 cases and 1660 controls. We generated odds ratios and 95% confidence intervals in order to determine the strength of the relationship between the Alu insertion and breast cancer incidence. We also performed additional subgroup analyses and sensitivity analyses to further clarify the relationship. Using a random effects model, we concluded that the Alu insertion was not associated with the risk of breast cancer under the dominant genetic model; the pooled OR was 1.025 (95% CI = 0.526-1.994, p = 0.943). When a subgroup analysis was performed according to ethnicity, we found that the Alu insertion was associated with breast cancer incidence in Indians and Indo-European mixed racial groups, but the association disappeared for patients of Caucasian or Latino decent. Our meta-analysis showed that the Alu-insertion progesterone receptor gene polymorphism was not associated with breast cancer. These results provide further information regarding the association between the Alu insertion in the PGR gene and the incidence of breast cancer.


Team Resource Management Perception Under Managerial Coaching Skills and Organizational Climate: Cross-Level Analysis in Taiwan's Hospitals.
There is growing recognition of the importance of teamwork and integration of resources in the health care industry. This article studied the influence of organizational climate and managerial coaching skills on team perception of team resource management (TRM) and coaching techniques in selected hospitals in Taiwan. Structural survey method was used to measure the relationship between organizational climate, managerial coaching skills, and team perception of TRM. The participants of this research were 530 administrative staff from 12 hospitals in Taiwan. Cross-level relationship between organizational climate (group level), managerial coaching skills (individual level), and team perception of TRM (individual level) was examined. The results revealed that organizational climate had a significant influence on team perception of TRM. Second, recognition of managerial coaching skills shaped team perception during TRM implementation. Third, organizational climate had a moderating effect on the relationship between managerial coaching skills and team perception of TRM. The study concluded that positive organizational climate and good managerial coaching skills contribute to effective team management and development. Thus, it is important for health care organizations to understand the importance of coaching and mentoring and create a workplace that makes learning, growth, and adaptation possible across different departments and functional teams.


[Serum amylase determination : automated continuous flow method (author's transl)].
A simple automated assay was described for the determination of serum amylase using a chromogenic substrate. The reaction was stopped by filtration across a cellulose nitrate membrane. The analytic parameters of this method were studied. Repeatability, reproducibility and precision were convenient. The calibration curve was linear up to 850 U/I. An excellent correlation was obtained after comparison with the manual method (Phadebas amylase test). The effects of haemolysis and very high ascorbic concentrations of bilirubin, glucose, uric acid and ascorbic acid were negligible on the value measured. The serum turbidity was alone to induce a variation by excess.


Rational design and evaluation of new lead compound structures for selective betaARK1 inhibitors.
Beta-adrenergic receptor kinase 1 (betaARK1) and cyclic adenosine 5'-monophosphate-dependent protein kinase A (PKA) have structurally similar adenine-binding pockets but have different physiologic functions. To obtain specific betaARK1 inhibitors, a two step rational drug design process was used. First, a search was conducted on three-dimensional models of commercially available compounds to find compounds that fit the adenine-binding pocket of betaARK1. Second, a comparative docking study that focused on the differences between the adenine-binding pockets of the two enzymes was used to evaluate the binding specificity of each compound that inhibited betaARK1 activity. The results of these analyses yielded three betaARK1-selective inhibitor leads from 11 candidates, a hit rate for selectivity of 27%. Although the IC50 values of these compounds for betaARK1 ranged from only 1.3 x 10(-4) M to 5.6 x 10(-4) M, the compounds did not inhibit PKA at concentrations up to 1.0 x 10(-3) M. Thus, the present study shows the usefulness of a rational drug design strategy in finding specific kinase inhibitors for proteins with similar drug target binding sites.


[The effects of aorto-coronary bypass grafting on left ventricular diastolic function in patients with left ventricular dysfunction].
To determine the effects of aorto-coronary bypass grafting on left ventricular diastolic function in patients with low ejection fraction (EF less than or equal to 0.40), 17 patients were studied. They were divided into two groups, Group I: 8 patients without previous myocardial infarction, Group II: 9 patients with previous myocardial infarction. Left ventricular diastolic function was assessed by maximum negative dp/dt, constant T, diastolic compliance and 1/3 functional filling. In conclusions, when ejection fraction is depressed (EF less than or equal to 0.40), myocardial revascularization improves left ventricular diastolic function in patients without previous myocardial infarction, but not with previous myocardial infarction.


Reducing Morning Hypoglycemia Among Children Undergoing Treatment for Acute Lymphoblastic Leukemia.
Hypoglycemia has been observed in children receiving acute lymphoblastic leukemia (ALL) therapy, and it can negatively affect patient outcomes. We documented a 4%-6% prevalence of hypoglycemia among patients in the two clinics in this study. We aim to reduce morning hypoglycemia in children on chemotherapy for ALL at two community pediatric oncology clinics (A and B) by 50% in 9 months. We used the Institute for Healthcare Improvement (IHI) Model for Improvement as the framework. Prolonged hours of fasting for procedural sedation, gaps in the caregivers' knowledge of hypoglycemia risk, and a lack of awareness of the new mercaptopurine administration guidelines were the most likely contributing factors for hypoglycemia. We developed a hypoglycemia prevention educational program for staff and caregivers followed by a knowledge assessment tool. Each month, the average number of patients seen in both clinics was 43. The monthly average of blood glucose tests in these patients was 94. After implementing the intervention, the percentage of caregivers who received hypoglycemia education reached 88%. Of those, 78% scored ≥ 75% in the knowledge reassessment resurvey. The combined average hypoglycemic episodes in the two clinics decreased by 46%. A higher reduction in hypoglycemic episodes was observed in clinic A (75%) compared with clinic B (17%). Implementing hypoglycemia education led to a significant drop in hypoglycemic episodes among children on ALL therapy. Despite using a similar approach, one of the two clinics showed a more than fourfold improvement compared with the other.


Sum-of-harmonics method for improved narrowband and broadband signal quantification during passive monitoring of ultrasound therapies.
Passive Acoustic Mapping (PAM) enables real-time monitoring of ultrasound therapies by beamforming acoustic emissions emanating from the ultrasound focus. Reconstruction of the narrowband or broadband acoustic emissions component enables mapping of different physical phenomena, with narrowband emissions arising from non-linear propagation and scattering, non-inertial cavitation or tissue boiling, and broadband (generally, of significantly lower amplitude) indicating inertial cavitation. Currently, accurate classification of the received signals based on pre-defined frequency-domain comb filters cannot be guaranteed because varying levels of leakage occur as a function of signal amplitude and the choice of windowing function. This work presents a time-domain parametric model aimed at enabling accurate estimation of the amplitude of time-varying narrowband components in the presence of broadband signals. Conversely, the method makes it possible to recover a weak broadband signal in the presence of a dominant harmonic or other narrowband component. Compared to conventional comb filtering, the proposed sum-of-harmonics method enables PAM of cavitation sources that better reflect their physical location and extent.


The autoimmune susceptibility gene, PTPN2, restricts expansion of a novel mouse adherent-invasive E. coli.
Inflammatory bowel disease (IBD) pathogenesis involves significant contributions from genetic and environmental factors. Loss-of-function single-nucleotide polymorphisms (SNPs) in the protein tyrosine phosphatase non-receptor type 2 (PTPN2) gene increase IBD risk and are associated with altered microbiome population dynamics in IBD. Expansion of intestinal pathobionts, such as adherent-invasive E. coli (AIEC), is strongly implicated in IBD pathogenesis as AIEC increases pro-inflammatory cytokine production and alters tight junction protein regulation - suggesting a potential mechanism of pathogen-induced barrier dysfunction and inflammation. We aimed to determine if PTPN2 deficiency alters intestinal microbiome composition to promote expansion of specific bacteria with pathogenic properties. In mice constitutively lacking Ptpn2, we identified increased abundance of a novel mouse AIEC (mAIEC) that showed similar adherence and invasion of intestinal epithelial cells, but greater survival in macrophages, to the IBD-associated AIEC, LF82. Furthermore, mAIEC caused disease when administered to mice lacking segmented-filamentous bacteria (SFB), and in germ-free mice but only when reconstituted with a microbiome, thus supporting its classification as a pathobiont, not a pathogen. Moreover, mAIEC infection increased the severity of, and prevented recovery from, induced colitis. Although mAIEC genome sequence analysis showed >90% similarity to LF82, mAIEC contained putative virulence genes with >50% difference in gene/protein identities from LF82 indicating potentially distinct genetic features of mAIEC. We show for the first time that an IBD susceptibility gene, PTPN2, modulates the gut microbiome to protect against a novel pathobiont. This study generates new insights into gene-environment-microbiome interactions in IBD and identifies a new model to study AIEC-host interactions.


Immediate implant placement and restoration in the esthetic zone: a prospective study with 18 months of follow-up.
This clinical study aimed to assess the dimensional stability of peri-implant soft tissues around immediately placed and restored implants in the maxillary esthetic zone. Twelve systemically healthy patients presenting with a hopeless maxillary central incisor were selected. Provisional restorations were delivered immediately after tooth extraction and implant placement. Periimplant soft tissue dimensions were measured either by direct clinical examination or evaluation of study casts. Measurements were performed before extraction; immediately after implant and restoration placement; and 6 weeks, 3 months, 6 months, 12 months, and 18 months postoperatively. The distances assessed were: tip of the mesial papilla to the mesioincisal edge of the adjacent central incisor, tip of the distal papilla to the mesioincisal edge of the adjacent lateral incisor, and the length of the clinical crown of the definitive restoration. All patients completed the study, and no implants failed within the 18-month follow-up period (100% survival rate). No statistical differences were observed in the distances between the incisal edge of the adjacent teeth and the mesial and distal papilla tips (P = .303 and .099, respectively) at any follow-up appointment. Likewise, there were no alterations in the definitive clinical crown dimensions during the follow-up period (P = .406). The findings of this 18-month prospective study indicate that, within the selection criteria and technique presented in this study, immediate implants with immediate restorations can be a predictable option for the replacement of teeth in the esthetic zone, providing stability to the peri-implant soft tissue.


Critical parameters in the microcarrier culture of animal cells.
The successful culture of over 60 different cell types on Cytodex TM1 microcarriers has enabled identification of parameters critical for obtaining high cell yields from microcarrier cultures. Careful control of the initial phase of microcarrier culture was found to be critical. Increasing cell density, reducing culture volume and reducing stirring rate during the initial phase all assisted in improving cell yields. Control of pH, inoculum condition, nutrient supply and serum quality, and elimination of mycoplasma were all vital for high cell yields. Knowledge of the in vitro growth properties of the cells made it easier to arrive at optimal conditions for microcarrier culture of each cell type.


If you have taught--have the child and family learned?
The decade of the 1990s produced significant and, in some instances, irreversible changes in the delivery of health care. Patient and family educational processes did not escape this process. Gone is the luxury of developing, initiating, and completing a teaching plan that allows multiple, brief teaching sessions. Economic realities require nurses to use both their time with patients and their teaching opportunities more efficiently. The text of this article addresses key concepts that nurses must consider in order to effectively educate the child and family. Issues considered are: identifying individual learning styles, determining readiness to learn, accommodating individual learning needs/abilities, determining essential content, and evaluating what has been learned. Several examples of clinically appropriate, easy-to-use assessment tools are included to assist the nurse-teacher in determining ... if you have taught--have the child and family learned?


High Surface-Enhanced Raman Scattering (SERS) Amplification Factor Obtained with Silver Printed Circuit Boards and the Influence of Phenolic Resins for the Characterization of the Pesticide Thiram.
In this work, low-cost substrates with rough silver surfaces were prepared from commercial copper foil-covered phenolic board (CPB) and an aqueous solution of AgNO3, and were used for surface-enhanced Raman scattering (SERS) and surface-enhanced resonance Raman scattering (SERRS) measurements. A maximum SERS amplification factor of 1.2 × 10(7) was obtained for Rhodamine 6G (R6G), and use of the CPB resulted in a detection limit for Thiram pesticide of 0.5 µmol L(-1) The minimum detection level was limited by residual traces of phenolic groups that originated from the substrate resin, which became solubilized in the aqueous Ag(+) solution. It was found that the bands corresponding to the impurities had less influence in the Thiram analysis, which could be explained by the high affinity of sulfur for Ag surfaces. The influence of impurities in the SERS analyses therefore depended on the linkage between the rough silver surface and the analyte. The findings demonstrated the ease and effectiveness of using CPB to prepare a nanostructured surface for SERS.


Nerve entrapment syndromes in the upper limb.
Nerve entrapment in the upper limb usually presents as pain, sensory disturbance and motor loss; the most common diagnosis is carpal tunnel syndrome. A high index of suspicion with some anatomical knowledge aid the recognition of clinical patterns and diagnosis. Treatment of patients with intermittent or early progressive changes has an excellent prognosis; most with constant sensory or motor loss will show at least partial response to treatment.


Development of pullulan/carboxylated cellulose nanocrystal/tea polyphenol bionanocomposite films for active food packaging.
In this study, novel active films based on pullulan and carboxylated cellulose nanocrystal (C-CNC) incorporated with tea polyphenol (TP) was prepared by solution casting method. The effect of TP addition on the microstructural, mechanical, barrier, optical, functional properties of the resultant pullulan/C-CNC/TP (PC-TP) bionanocomposite films was systematically evaluated. Scanning electron microscopy showed that an appropriate TP adding was well distributed within the PC-TP bionanocomposite matrix. Fourier-transform infrared further revealed that new hydrogen bond was formed among the pullulan, C-CNC, TP. Addition of TP at an appropriate level (3%, w/w, on a dry basis of the weight of pullulan and C-CNC) led to stronger intermolecular interactions and more compact microstructure, and thus enhanced the water barrier properties, thermal stability and tensile strength of the resultant bionanocomposite films. Nevertheless, overloading of TP in the bionanocomposite films might produce some aggregations and thus have negative effects on their performance. In addition, the incorporation of TP significantly improved the UV-barrier properties, antioxidant activity and antimicrobial activity of PC-TP bionanocomposite films, while induced a decrease in the transmittance. These results revealed that PC-TP bionanocomposite films with TP at appropriate levels had potential to be used as active food packaging.


Grieving in the digital era: Mapping online support for grief and bereavement.
To describe the landscape of digital resources available for grief and bereavement, and to explore cultural variations through the analysis of patterns in three languages with a multinational repartition (English, French and Spanish). For each language, websites were collected through a systematized approach and classified according to their category (governmental, health, educational, social media, conventional media, spiritual), their country of origin, and the type of support they offered (practical support, services, peer support, informational support, resources). A total of 2587 websites (English: 1003; French 678; Spanish: 906) were analyzed. Cultural variations were observed both for the websites' categories and the types of support. Half of the websites presented at least one type of support, informational support being the most prevalent, followed by practical support. English websites presented significantly more support than Spanish websites, with French websites in between. By using an extensive survey, our results allow for a general mapping of online websites that is comparable across languages, but also unveil digital dynamics unknown to date. These results further the multicultural understanding of digital support for grief and bereavement, propose an innovative and operational typology for online support and raise awareness of the current support landscape.


A modification of the adenosine triphosphatase method to demonstrate epidermal Langerhans cells.
Epidermal Langerhans cells are most commonly demonstrated by utilizing their adenosine triphosphatase reactivity. Although this is one of the best methods available to the light microscopist, it is a capricious technique which does not always permit optimal demonstration of this cell population. Prolonged fixation in cacodylate formalin and incubation in 1.32 X 10-3 molar adenosine triphosphatase permits reliable reproduction and good definition of these dendritic cells.


Lost in the chaos: Flawed literature should not generate new disorders.
The paper by Kuss, Griffiths, and Pontes (2016) titled "Chaos and confusion in DSM-5 diagnosis of Internet Gaming Disorder: Issues, concerns, and recommendations for clarity in the field" examines issues relating to the concept of Internet Gaming Disorder. We agree that there are serious issues and extend their arguments by suggesting that the field lacks basic theory, definitions, patient research, and properly validated and standardized assessment tools. As most studies derive data from survey research in functional populations, they exclude people with severe functional impairment and provide only limited information on the hypothesized disorder. Yet findings from such studies are widely used and often exaggerated, leading many to believe that we know more about the problem behavior than we do. We further argue that video game play is associated with several benefits and that formalizing this popular hobby as a psychiatric disorder is not without risks. It might undermine children's right to play or encourage repressive treatment programs, which ultimately threaten children's right to protection against violence. While Kuss et al. (2016) express support for the formal implementation of a disorder, we argue that before we have a proper evidence base, a sound theory, and validated assessment tools, it is irresponsible to support a formal category of disorder and doing so would solidify a confirmatory approach to research in this area.


All roads lead to weediness: Patterns of genomic divergence reveal extensive recurrent weedy rice origins from South Asian Oryza.
Weedy rice (Oryza spp.), a weedy relative of cultivated rice (O. sativa), infests and persists in cultivated rice fields worldwide. Many weedy rice populations have evolved similar adaptive traits, considered part of the 'agricultural weed syndrome', making this an ideal model to study the genetic basis of parallel evolution. Understanding parallel evolution hinges on accurate knowledge of the genetic background and origins of existing weedy rice groups. Using population structure analyses of South Asian and US weedy rice, we show that weeds in South Asia have highly heterogeneous genetic backgrounds, with ancestry contributions both from cultivated varieties (aus and indica) and wild rice. Moreover, the two main groups of weedy rice in the USA, which are also related to aus and indica cultivars, constitute a separate origin from that of Asian weeds. Weedy rice populations in South Asia largely converge on presence of red pericarps and awns and on ease of shattering. Genomewide divergence scans between weed groups from the USA and South Asia, and their crop relatives are enriched for loci involved in metabolic processes. Some candidate genes related to iconic weedy traits and competitiveness are highly divergent between some weed-crop pairs, but are not shared among all weed-crop comparisons. Our results show that weedy rice is an extreme example of recurrent evolution, and suggest that most populations are evolving their weedy traits through different genetic mechanisms.


Photocatalytic Alkyl Radical Addition Tandem Oxidation of Alkenyl Borates.
Photocatalytic oxidation is a popular transformation way for organic synthesis and is widely applied in academia and industry. Herein, we report a blue light-induced alkylation-oxidation tandem reaction for the synthesis of diverse ketones by combining alkyl radical addition and oxidation of alkenyl borates. This reaction shows excellent functional group compatibility in acceptable yields, and diversity of radical precursors is applicable.


Floral scent in food-deceptive orchids: species specificity and sources of variability.
One third of all orchid species are deceptive and do not reward their pollinators. Such deceptive orchids are often characterised by unusually high variation in floral signals such as colour and scent. In this study, we investigated the scent composition of two Mediterranean food-deceptive orchids Orchis mascula, Orchis pauciflora, and their hybrid, O. x colemanii. Scent was collected IN SITU by headspace sorption and was subsequently analysed with gas chromatography and gas chromatography-mass spectrometry. We compared variation of odour compounds within and between populations as well as species. We identified 35 floral scent compounds, mainly monoterpenes, which were shared by both species. Both quantitative and qualitative variability within and among populations was high. Many individuals within species could be classified to different "odour-types". In spite of high qualitative and quantitative intra- and inter-population variability, the species were clearly differentiated in their scent bouquets, whereas most hybrid individuals emitted an intermediate scent.


SPAG6 silencing inhibits the growth of the malignant myeloid cell lines SKM-1 and K562 via activating p53 and caspase activation-dependent apoptosis.
SPAG6, which is a novel cancer-testis antigen, is overexpressed in myeloid malignancies. Previously, SPAG6 was found in UPD (uniparental disomy) region of myeloid cell DNA from MDS patients and reported that SPAG6 may be a predictive marker of minimal residual disease in pediatric acute myeloid, but the biological role of SPAG6 in myeloid malignancies remains unclear. The present study was undertaken to determine the expression and functional significance of SPAG6 in malignant myeloid hematologic cell lines. A short hairpin RNA (shRNA) targeting SPAG6 was designed that could specifically inhibit SPAG6 expression at the mRNA and protein levels when introduced into the malignant myeloid hematologic cell lines SKM-1 and K562. The results from flow cytometry and CCK-8 assays showed that SPAG6 silencing inhibited the proliferation of SKM-1/K562 by inducing apoptosis. Furthermore, SPAG6 silencing resulted in activation of caspase-3, -9 and -8 and upregulated the mRNA and protein expression of p53 and PTEN. Then, we subcutaneously inoculated the monoclonal cells into NOD/SCID mice to establish xenograft models, and we found that the SPAG6-shRNA lentivirus dramatically inhibited tumor growth and increased apoptosis in vivo. These findings demonstrate that SPAG6 might have a role in malignant myeloid hematologic cell proliferation and apoptosis by regulating caspase proteins and p53, suggesting that SPAG6 may be a potential therapeutic target.


[Quantitative study of the reticular-motor neuronal contacts in the spinal cord of the lampern].
The number and location of contacts which are made by two HRP-labelled motoneurons with the individual Müller axons in lamprey was investigated. Each motoneuron had contacting zones with the ventromedial and ventrolateral Müller axons, but had no contacts with the dorsolateral Müller axon. The contacting zones which were extended for 0.5-27 microns were revealed on the motoneuron dendrites at a distance of 42-195 microns from the soma. Each motoneuron made 1 to 3 contacts with a single Müller axon. The specificity of the structure and function of reticular-motor neuronal connections in the spinal cord of lamprey is discussed.


Low temperature-induced DNA hypermethylation attenuates expression of RhAG, an AGAMOUS homolog, and increases petal number in rose (Rosa hybrida).
Flower development is central to angiosperm reproduction and is regulated by a broad range of endogenous and exogenous stimuli. It has been well documented that ambient temperature plays a key role in controlling flowering time; however, the mechanisms by which temperature regulates floral organ differentiation remain largely unknown. In this study, we show that low temperature treatment significantly increases petal number in rose (Rosa hybrida) through the promotion of stamen petaloidy. Quantitative RT-PCR analysis revealed that the expression pattern of RhAG, a rose homolog of the Arabidopsis thaliana AGAMOUS C-function gene, is associated with low temperature regulated flower development. Silencing of RhAG mimicked the impact of low temperature treatments on petal development by significantly increasing petal number through an increased production of petaloid stamens. In situ hybridization studies further revealed that low temperature restricts its spatial expression area. Analysis of DNA methylation level showed that low temperature treatment enhances the methylation level of the RhAG promoter, and a specific promoter region that was hypermethylated at CHH loci under low temperature conditions, was identified by bisulfite sequencing. This suggests that epigenetic DNA methylation contributes to the ambient temperature modulation of RhAG expression. Our results provide highlights in the role of RhAG gene in petal number determination and add a new layer of complexity in the regulation of floral organ development. We propose that RhAG plays an essential role in rose flower patterning by regulating petal development, and that low temperatures increase petal number, at least in part, by suppressing RhAG expression via enhancing DNA CHH hypermethylation of the RhAG promoter.


Association of sleep dysfunction and emotional status with gastroesophageal reflux disease in Korea.
Sleep disturbances and emotional dysfunction are commonly associated with gastroeophageal reflux disease (GERD). The aims of this study were to evaluate GERD symptoms and disturbance in erosive reflux disease (ERD) and nonerosive reflux disease (NERD) patients, and to compare sleep dysfunction, depressive mood, anxiety and quality of life (QOL) among the control, ERD and NERD patients in Korea. The Korean subjects were enrolled between 2010 and 2012, classified into 3 groups; the control group with no symptom and normal endoscopic findings, the ERD group with erosive esophagitis and the NERD group with more than one episode of heartburn or acid regurgitation per week, positive response to proton pump inhibitor, and normal endoscopic findings. Questionnaire included GERD symptoms, GERD impact scale (GIS) and daytime pathological sleepiness (Epworth sleepiness scale), sleep dysfunction (Pittsburgh sleep quality index, PSQI), depression and anxiety (Hospital anxiety and depression scale, HADS) and QOL (WHO quality of life scale abbreviated version, WHOQOL-BREF). A total of 217 subjects were enrolled as follows; control (n = 70), ERD (n = 70) and NERD (n = 77). Impact of symptom of GIS score was higher in the NERD (9.2 ± 0.4) than in the ERD (6.5 ± 0.3) group (P < 0.001). Sleep dysfunctions were more frequent in GERD than the control group (PSQI score [P = 0.021]). Anxiety subscale of HAD score was higher in NERD (7.0 ± 0.5, P = 0.002) and ERD (6.2 ± 0.7, P = 0.004) groups than control (4.3 ± 0.7) group. WHOQOL-BREF scores in NERD (54.9 ± 2.3) and ERD (57.8 ± 2.4) groups were significantly lower than those in the control group (63.8 ± 2.4) (P = 0.002; P = 0.014, respectively). The patients with NERD than ERD suffered more from the symptoms and disturbance in Korea. Sleep dysfunction and anxiety mood were higher and QOL was decreased in GERD, especially in NERD, suggesting that those factors might affect the severity of NERD.


Acute androgen receptor blockade increases luteinizing hormone secretory activity in men.
To investigate the nature of androgen feedback mechanisms in normal men, we studied the hypothalamo-pituitary responses to administration of a potent, highly selective nonsteroidal androgen receptor antagonist, flutamide HCl (1 g/day, orally, for 3 days). The impact of reversible blockade of endogenous androgen action was assessed in 11 normal men by analyzing quantitative alterations in specific pulsatile properties of LH secretion basally (hypothalamic regulation) and after 2 (n = 6) consecutive iv pulses of exogenous GnRH (pituitary responsiveness). Androgen blockade resulted in significant increases in 1) 12-h mean and integrated serum immunoactive LH concentrations (P = 0.01), 2) LH pulse frequency (P = 0.01), and 3) mean interpulse (valley) serum LH concentrations (P = 0.02) and maximal LH peak heights (P = 0.01). Additionally, there were significant decreases in LH interpulse interval (P = 0.02), LH peak duration (P = 0.02), and interpeak valley duration (P = 0.02). The augmented LH pulsatility reflected enhanced hypothalamic activity, since 1) pituitary secretory responses to exogenous GnRH pulses were not altered, and 2) multiple parameter deconvolution disclosed an increased number of computer-resolved LH secretory bursts generated per 12 h, with no changes in the apparent half-duration of LH secretory impulses or the calculated mass of LH released per secretory burst. We conclude that endogenous androgens act selectively to modulate the number of spontaneous LH secretory bursts in man.


The use of an omental pedicle flap in the closure of bronchopleural fistulae.
Two recurrent bronchopleural fistulae in patients in whom previous intercostal myoplasty had failed were successfully closed by an omental pedicle flap and a bucket-handle flap slide over the omentum. The original procedure in both was left lower lobectomy. The advantages of the procedure are its simplicity, the absence of cosmetic defect, and its suitability for left lower or lingular bronchopleural fistulae when other procedures have failed.


[The opinion of patients about quality and accessibility of stomatological care of rural residents].
The implementation of structural reorganization of actual system of medical care of rural population is one of leading organizational tasks of actual reforming of health care. The organizational model of increasing of accessibility and quality of stomatological care in rural districts is to be based on complex approach considering level of stomatological health and satisfaction of population with quality and accessibility of stomatological care.


[Fibrosarcoma: immunohistochemical study of the extracellular matrix].
Immunofluorescent examination of extracellular matrix of 5 fibrosarcomas showed the matrix to contain fibronectin and collagen type I, III, V. Fibrosarcoma matrix is characterized by the absence of collagen type IV and collagen type III predominance over type I differentiating this tumor from synovial sarcoma, neurogenic sarcoma, dermatofibrosarcoma protuberans, malignant fibrous histiocytoma. Their matrices showed the presence of type IV collagen, equal proportion of interstitial collagens or collagen type I predominance over type III typical for synovial sarcoma. The findings can be employed in practical morphologic diagnosis of soft tissue tumors.


[Sun exposure and sun protection behavior and attitudes among the French population].
The number of new skin cancers has constantly increased in France over the past two decades. The role of sun exposure can partly explain this phenomenon and justifies the development of information and prevention campaigns to change peoples' attitude towards sun bathing. To be effective, we need to know how much information and what attitudes the population currently has with regard to the sun. Although several studies in France have targeted children, little data is available regarding adults. This trial was aimed at pinpointing the knowledge, attitude and behavior of adults regarding sun exposure. Data were collected during a randomized multicenter study on the prevention and early diagnosis of cutaneous tumors, conducted in 26 Health Centers from 1998 to 2000. Standardized questionnaires were handed to those consulting to assess their knowledge, attitudes and behavior towards sun bathing. The population was composed of 41 143 adults aged over 30, consulting one of the 26 Health Check-up units. Analysis of the data was made using SAS v 6.12 and STATA 7.0 software. Logistic regression identified the explicative factors of knowledge and behavior. All the statistical analyses were considered significant above a threshold of alpha<5%. A total of 33 021 persons filled-in the self-questionnaire. Forty-nine percent were women and 51% were men, with a mean age of 50 years. Geographically, 25% lived in the North-East, 16% in the North-West, 25 p.cent in the South-East and 34% in the South-West. Thirty percent claimed that they tanned without burning and 2% of the population studied had often suffered from sun burn, generally when they were adult. The risks related to sun burn were known, because 92% knew that the sun increased the risk of skin aging and 89% knew that it increased the risk of skin cancer. Regarding sun screens, knowledge was not so good; 42% thought that all products were the same and 53% that they allowed one to sun bathe longer. This knowledge was better in those with fair skins, in those who had a history of sun burn, in women and in those who lived in the northern areas of France. Conversely, knowledge decreased with age and was limited in those aged over 60. Regarding behavior, those with fair skin and who reddened under the sun without tanning, protected themselves more. The women declared they protected themselves more than the men, but they used less sun protective measures (clothing, hats...), other than sun screens, than men. Subjects aged over 60 protected themselves more than younger subjects. Lastly, a personal cutaneous history increased protective behavior, and those from northern France protected themselves more than those from the South. This analysis of 33 021 adults aged over 30 shows the good global knowledge of the consequences of sun bathing, but also the lack of knowledge on the interest of using external sun protection and the role of physical means of protection. Attitudes varied depending on gender, age and phototype and also depending on the area where they lived. Despite good knowledge, the most frequent behavior of adults aged over 30 is still not appropriate with differences depending on age, gender and area, which must prompt more appropriate targeting of prevention campaigns according to the populations concerned.


A 96-well electrochemical method for the screening of enzymatic activities.
The rapid electrochemical screening of enzyme activities in bioelectronics is still a challenging issue. In order to solve this problem, we propose to use a 96-well electrochemical assay. This system is composed of 96 screen-printed electrodes on a printed circuit board adapted from a commercial system (carbon is used as the working electrode and silver chloride as the counter/reference electrode). The associated device allows for the measurements on the 96 electrodes to be performed within a few seconds. In this work, we demonstrate the validity of the screening method with the commercial laccase from the fungus Trametes versicolor. The signal-to-noise ratio (S/N) is found to be the best way to analyze the electrochemical signals. The S/N follows a saturation-like mechanism with a dynamic linear range of two decades ranging from 0.5 to 75 ng of laccase (corresponding to enzymatic activities from 62 × 10(-6) to 9.37 × 10(-3) μmol min(-1)) and a sensitivity of 3027 μg(-1) at +100 mV versus Ag/AgCl. Laccase inhibitors (azide and fluoride anions), pH optima, and interfering molecules could also be identified within a few minutes.


High levels of hemolysis do not affect measurement of PAPP-A, β-HCG and TRAb on BRAHMS KRYPTOR compact plus.
To assess the impact of high levels of hemolysis on the laboratory results for free β-hCG, PAPP-A, and TRAb performed on the B·R·A·H·M·S KRYPTOR Compact PLUS. Adapted from the CLSI guidelines EP07-A2, paired difference testing was performed on serum samples from the routine laboratory workflow. Three sample pools for each assessed analyte was prepared and subjected to increased levels of added hemolysate. For β-hCG and PAPP-A, the relative difference in the measured analyte concentration between the sample with 0 g/L added Hb and the samples with increasing free Hb concentrations (up to 6 g/L), was well below the pre-set acceptance criterion of 10% at all levels. The TRAb results showed greater variation than the other analytes, likely a consequence of imprecision rather than hemolysis. Hemolysis has a negligible effect on the analysis results of free beta-hCG, PAPP-A and TRAb measured on the B·R·A·H·M·S KRYPTOR Compact PLUS.


Quantification of mycoplasmas in broth medium with sybr green-I and flow cytometry.
Mycoplasmas are the smallest and simplest organisms known. They form a large group of bacteria that can infect humans, animals, and plants. Even though several techniques have been proposed to enumerate mycoplasmas in broth medium, the determination of mycoplasma growth still remains a difficult task. The potential of using flow cytometry (FC) for rapidly estimating several species of mycoplasmas, M. agalactiae (Ma), M. putrefaciens (Mp), M. capricolum subsp. capricolum (Mcc), M. bovis (Mb), M. capricolum subsp. capripneumoniae (Mccp) and M. hyopneumoniae (Mh) in broth medium was examined. The FC analysis was performed by staining the mycoplasma cells with a fluorescent dye, SYBR green-I (SYBR), and the results were compared with plate count (Colony Forming Units--CFU) or Colour Changing Units (CCU) methods, depending on the mycoplasma species. There was a good correlation between mycoplasma counts determined by FC (cells ml(-1)) and by traditional plate count (CFU) or CCU methods. A correlation of 0.841, 0.981, 0.960, 0.913, 0.954, and 0.844 was obtained for Ma, Mp, Mcc, Mb, Mccp and Mh, respectively. FC method allowed results in 20-30 min, while 24-72 h was necessary for plate count method and 15 days for CCU method. FC was found to be a very useful, practical and fast technique to count mycoplasmas. These findings suggest that FC can be a good alternative to replace other time-consuming techniques that are currently used to enumerate mycoplasmas in broth medium.


Five-year study of emergency aeromedical evacuation in the United States.
During the time period, 1 July 1969-30 June 1974, a total of 7056 patients were moved on the C-9A Nightingale on an "urgent" or "priority" basis. In support of the request for urgent airlift, an average of 21 C-9A aircraft were launched monthly. The domestic aeromedical evacuation missions were highly flexible and productive, yet inexpensive when compared with other means of moving patients. A means for determining precedence for the pickup and movement of patients is essential for an aeromedical evacuation system. When the patient is properly evaluated and the urgency for flight movement determined, unnecessary, costly, hazardous, or special flights are avoided. More than 50% of the "urgent" patients airlifted during this 5-year span originated in the central part of the United States. The Northeast and Far West were each responsible for less than 10% of the patients requiring urgent evacuation over the same period. More than 50% of the urgent patients moved were in the categories of newborn complications, burns, and neurological problems. During this period, no patient was moved on an urgent basis for a psychiatric problem--aeromedical evacuation simply becomes a very effective tool in ensuring complete health care for seriously ill patients.


Some effect of metformin on insulin resistance in an infant with leprechaunism.
Leprechaunism was first recognized in 1954 and is characterized by severe intrauterine and postnatal growth retardation, failure to thrive, lipoatrophy, dysmorphic features (globular eyes, large ears, and micrognathia), hirsutism and acanthosis nigricans. The presented infant, a 30 day-old boy, had multiple phenotypic anomalies, including low-set ears, prominent eyes, decreased subcutaneous fat, hirsutism, breast hyperplasia, and penile enlargement. We found persistent hyperglycemia with remarkably high immunoreactive insulin levels. His phenotypic and laboratory features were consistent with a diagnosis of leprechaunism. We observed some effect of treatment with metformin but not with insulin glargine.


Chemical composition and phytotoxicity of volatile essential oil from intact and fallen leaves of Eucalyptus citriodora.
A total of 23 volatile constituents was identified and characterized by GC and GC-MS in the volatile essential oil extracted from intact (juvenile and adult) and fallen (senescent and leaf litter) leaves of lemon-scented eucalyptus (Eucalyptus citriodora Hook.). The leaves differed in their pigment, water and protein content, and C/N ratio. The oils were, in general, monoterpenoid in nature with 18 monoterpenes and 5 sesquiterpenes. However, a great variability in the amount of essential oils and their individual constituents was observed in different leaf tissues. The amount was maximum in the senescent leaves collected from the floor of the tree closely followed by that from juvenile leaves. In all, 19 constituents were identified in oil from juvenile and senescent leaves compared to 23 in adult leaves and 20 in leaf litter, respectively. Citronellal, a characteristic monoterpene of the oil reported hitherto was found to be more (77-78%) in the juvenile and senescent leaves compared to 48 and 54%, respectively, in the adult leaves and leaf litter. In the adult leaves, however, the content of citronellol--another important monoterpene-- was very high (21.9%) compared to other leaf types (7.8-12.2%). Essential oil and its two major monoterpenes viz. citronellal and citronellol were tested for their phytotoxicity against two weeds (Amaranthus viridis and Echinochloa crus-galli) and two crops (Triticum aestivum and Oryza sativa) under laboratory conditions. A difference in the phytotoxicity, measured in terms of seedling length and dry weight, of oil from different leaves and major monoterpenes was observed. Oil from adult leaves was found to be most phytotoxic although it occurs in smaller amount (on unit weight basis). The different toxicity of different oil types was due to the relative amount of individual monoterpenes present in the oil, their solubility and interactive action. The study concludes that oil from senescent and juvenile leaves being rich in citronellal could be used as commercial source of citronellal whereas that from adult leaves for weed management programmes as it was the most phytotoxic.


Phytochemical Profile and Biological Activities of Tendrils and Leaves Extracts from a Variety of Vitis vinifera L.
Winery industry by-products have a great reuse potential in the pharmaceutical and cosmetic fields due to their bioactive compounds. This study investigates the phytochemical profile and the bioactivity of Vitis vinifera variety Fetească neagră tendrils extract (TE) and leaves extract (LE), intended to be used in oral hygiene products recommended in periodontal disease. The evaluation of the phenolic content was performed by colorimetric analysis. Liquid chromatography coupled with mass spectrometry was used to determine the chemical profile of the two extracts obtained from V. vinifera. Moreover, the antioxidant activity of the extracts was determined by spectrophotometric methods, as well as on human gingival fibroblasts (HGF) cell line. The cytocompatibility and cytoprotective effect against nicotine-induced cytotoxicity were tested, as well as the anti-inflammatory and antimicrobial effects. The TE showed higher total polyphenolic content, rich in rutin, compared to the leaves extract that displayed important amounts of isoquercitrin. The antioxidant effect was confirmed by both non-cellular and cellular tests. The cytocompatibility of the extracts was confirmed at a wide range of concentrations. The cytoprotective effect was demonstrated in HGF exposed to cytotoxic doses of nicotine; 300 µg/mL of both tested extracts decreased nicotine toxicity by approximately 20%. When challenged with E. coli polysaccharides, in HGF cells co-exposed to TE and LE, a reduction in the release of proinflammatory cytokines (IL-8, IL-6 and IL-1β) was observed. The extracts were both able to reduce the levels of reactive oxygen species and inflammatory cytokines, and had notable antimicrobial effects on pathogenic bacteria associated with periodontitis.


Functional and transcriptional characterization of complex neuronal co-cultures.
Brain-on-a-chip systems are designed to simulate brain activity using traditional in vitro cell culture on an engineered platform. It is a noninvasive tool to screen new drugs, evaluate toxicants, and elucidate disease mechanisms. However, successful recapitulation of brain function on these systems is dependent on the complexity of the cell culture. In this study, we increased cellular complexity of traditional (simple) neuronal cultures by co-culturing with astrocytes and oligodendrocyte precursor cells (complex culture). We evaluated and compared neuronal activity (e.g., network formation and maturation), cellular composition in long-term culture, and the transcriptome of the two cultures. Compared to simple cultures, neurons from complex co-cultures exhibited earlier synapse and network development and maturation, which was supported by localized synaptophysin expression, up-regulation of genes involved in mature neuronal processes, and synchronized neural network activity. Also, mature oligodendrocytes and reactive astrocytes were only detected in complex cultures upon transcriptomic analysis of age-matched cultures. Functionally, the GABA antagonist bicuculline had a greater influence on bursting activity in complex versus simple cultures. Collectively, the cellular complexity of brain-on-a-chip systems intrinsically develops cell type-specific phenotypes relevant to the brain while accelerating the maturation of neuronal networks, important features underdeveloped in traditional cultures.


DNA template sequence control of bacterial RNA polymerase escape from the promoter.
Promoter escape involves breaking of the favourable contacts between RNA polymerase (RNAP) and the promoter to allow transition to an elongation complex. The sequence of DNA template that is transcribed during promoter escape (ITS; Initially Transcribed Sequence) can affect promoter escape by mechanisms that are not yet fully understood. We employed a highly parallel strategy utilizing Next Generation Sequencing (NGS) to collect data on escape properties of thousands of ITS variants. We show that ITS controls promoter escape through a combination of position-dependent effects (most prominently, sequence-directed RNAP pausing), and position-independent effects derived from sequence encoded physical properties of the template (for example, RNA/DNA duplex stability). ITS often functions as an independent unit affecting escape in the same manner regardless of the promoter from which transcription initiates. However, in some cases, a strong dependence of ITS effects on promoter context was observed suggesting that promoters may have 'allosteric' abilities to modulate ITS effects. Large effects of ITS on promoter output and the observed interplay between promoter sequence and ITS effects suggests that the definition of bacterial promoter should include ITS sequence.


Oil, migration, and the political economy of HIV/AIDS prevention in Nigeria's Niger Delta.
In most of sub-Saharan Africa, HIV/AIDS is driven by endemic structural problems such as unemployment, poverty, forced migration, sexual exploitation, and concurrent sexual partnerships. In the Niger Delta of Nigeria, the epidemic is exacerbated by recurring regional conflict and negative environmental externalities resulting from 50 years of oil exploration. This article seeks to identify and analyze potential barriers to HIV/AIDS prevention and treatment from oil pollution and other environmental stressors in Nigeria's Niger Delta. We develop a conceptual framework to understand how oil politics and economic systems affect HIV risks in Nigeria. We then evaluate evidence of how environmental exposures can amplify risks. Using 10 semi-structured interviews, with 85 focus group participants, we test the argument that HIV transmission in the Niger Delta is related to a manipulative "divide and rule" power dynamic that characterizes multinational oil companies' role in shaping conflict contours in oil communities. Oil exploration destroys livelihoods, institutions, and values and forces impoverished and illiterate girls and women to migrate or be trafficked to urban centers as child laborers and sex workers. The elevated HIV/AIDS risk in the Niger Delta brings into focus the political economy of resource extraction, globalization, and indigenous, minority rights and struggles.


Osteoblast and Bacterial Culture from Cryopreserved Skull Flap after Craniectomy: Laboratory Study.
Cranioplasty using a cryopreserved skull flap is a wide spread practice. The most well-known complications of cranioplasty are postoperative surgical infections and bone flap resorption. In order to find biological evidence of cryopreserved cranioplasty, we investigated microorganism contamination of cryopreserved skulls and cultured osteoblasts from cryopreserved skulls. Cryopreserved skull flaps of expired patients stored in a bone bank were used. Cryopreserved skulls were packaged in a plastic bag and wrapped with cotton cloth twice. After being crushed by a hammer, cancellous bone between the inner and outer table was obtained. The cancellous bone chips were thawed in a water bath of 30°C rapidly. After this, osteoblast culture and general microorganism culture were executed. Osteoblast cultures were done for 3 weeks. Microorganism cultures were done for 72 hours. A total of 47 cryopreserved skull flaps obtained from craniectomy was enrolled. Of the sample, 11 people were women, and the average age of patients was 55.8 years. Twenty four people had traumatic brain injuries, and 23 people had vascular diseases. Among the patients with traumatic brain injuries, two had fracture compound comminuted depressed. The duration of cryopreservation was, on average, 83.2 months (9 to 161 months). No cultured osteoblast was observed. No microorganisms were cultured. In this study, neither microorganisms nor osteoblasts were cultured. The biological validity of cryopreserved skulls cranioplasty was considered low. However, the usage of cryopreserved skulls for cranioplasty is worthy of further investigation in the aspect of cost-effectiveness and risk-benefit of post-cranioplasty infection.


The train of four ratio decreases to zero in anesthetized children is the guide to achieve a satisfactory intubation condition.
The purpose of this study is to investigate the satisfactory (excellent or good) intubation conditions attained when the TOF ratio was zero in anesthetized children. Sixty children undergoing elective ophthalmic surgery were allocated randomly into three groups. Anesthesia was induced with thiopentone 4 mg/kg and halothane in combination with 66% N2O and O2 (2 L/min). Patients maintained spontaneous breathing with assisted ventilation to limit the values of end tidal CO2 within the range of 36-44 mmHg, maintained the stable end tidal expiratory 1 MAC halothane concentration for three minutes and followed by 0.1 mg/kg vecuronium in group 1, 0.6 mg/kg rocuronium in group 2, and 0.9 mg/kg rocuronium in group 3. Intubation was attempted as the TOF ratio decreased from 1.0 to 0. The intubation condition was scored by assessing the degree of jaw relaxation, vocal cord opening grades, and cough responses. The overall intubation conditions were graded as excellent, good, fair, and poor on the basis of the scores. Excellent or good intubation conditions were considered satisfactory. After neuromuscular blockade administration, TOF ratio required 160.5 +/- 28.9 seconds in group 1, 70.7 +/- 18.5 seconds in group 2, and 55.7 +/- 13.5 seconds in group 3 to decrease to zero. There is a significant difference between group 1 and group 2 and 3 (p < 0.001, group 1 vs group 2 and group 3). All children were intubated, during which procedures satisfactory intubation conditions were observed in all of the group 3 patients, in 17 of the 20 group 2, and in 16 of the 20 group 1 patients. We concluded that zero of TOF from monitoring the adductor pollicis muscle indicated the proper moment for intubation in anesthetized pediatric patients and it was a reliable guide in adequately anesthetized children to achieve satisfactory intubation conditions following 0.9 mg/kg rocuronium administration.


Hoarding: obsessive symptom or syndrome?
Through media depictions, the public is becoming increasingly aware of the phenomenon of hoarding. Hoarding refers to the excessive acquisition of relatively worthless items, which eventually results in the compromise of living space and/or the daily activities of affected individuals. As a symptom, hoarding is relatively common in a significant minority of individuals with obsessive-compulsive disorder. In the context of obsessive-compulsive disorder, symptoms typically emerge in the teens through the early 20s. However, hoarding also appears to exist as a distinct syndrome, which is characterized by late onset, childhood adversity, various Axis II traits, and a history of alcohol misuse. While the explicit position of hoarding in the psychiatric nomenclature remains undetermined, this behavior is likely to surface in both psychiatric and primary care settings.


Hammerhead ribozymes: importance of stem-loop II for activity.
The activity of several hammerhead ribozyme constructs with constant lengths of stems I and III of 5 nt each but with variously shortened stems II is reported. Stems with 2 bp rather than the conventional 4 bp show essentially unaltered catalytic activity, independent of the composition of the tetraloop. Further reduction in size to 1 bp or 0 bp decreases activity drastically. Inversion of the G10.1.C11.1 bp next to the invariant core leads to a loss in activity, even when the stem consists of 4 bp. Thus, the minimal structural requirement for stem-loop II is a 2-bp stem with a conserved G.C bp. The reduction in catalytic activity is predominantly a result of a decrease of catalytic constant kcat, whereas Km is only slightly affected. Thus, the structural requirement for optimal activity in these constructs where the chemical-cleavage step is rate limiting is determined by the stabilization of the transition state.


Production of transgenic pig as an Alzheimer's disease model using a multi-cistronic vector system.
Alzheimer's disease (AD) is a progressive neurodegenerative disease associated with memory loss and cognitive impairments. An AD transgenic (Tg) pig model would be useful for preclinical testing of therapeutic agents. We generated an AD Tg pig by somatic cell nuclear transfer (SCNT) using a multi-cistronic vector that harbored three AD-related genes with a total of six well-characterized mutations: hAPP (K670N/M671L, I716V, and V717I), hTau (P301L), and hPS1 (M146V and L286P). Four AD Tg cell lines were established from Jeju black pig ear fibroblasts (JB-PEFs); the resultant JB-PEFAD cells harbored transgene integration, expressed transgene mRNAs, and had normal karyotypes. Tg line #2-1, which expressed high levels of the transgenes, was used for SCNT; cleavage and blastocyst rates of embryos derived from this line were lower than those of Non-Tg. These embryos yielded three piglets (Jeju National University AD-Tg pigs, JNUPIGs) revealed by microsatellite testing to be genetically identical to JB-PEFAD. Transgenes were expressed in multiple tissues, and at especially high levels in brain, and Aβ-40/42, total Tau, and GFAP levels were high in brains of the Tg animals. Five or more copies of transgenes were inserted into chromosome X. This is the first report of an AD Tg pig derived from a multi-cistronic vector.


Tissue-specific transcription factors in progression of epithelial tumors.
Dedifferentiation and epithelial-mesenchymal transition are important steps in epithelial tumor progression. A central role in the control of functional and morphological properties of different cell types is attributed to tissue-specific transcription factors which form regulatory cascades that define specification and differentiation of epithelial cells during embryonic development. The main principles of the action of such regulatory systems are reviewed on an example of a network of hepatocyte nuclear factors (HNFs) which play a key role in establishment and maintenance of hepatocytes--the major functional type of liver cells. HNFs, described as proteins binding to promoters of most hepatospecific genes, not only control expression of functional liver genes, but are also involved in regulation of proliferation, morphogenesis, and detoxification processes. One of the central components of the hepatospecific regulatory network is nuclear receptor HNF4alpha. Derangement of the expression of this gene is associated with progression of rodent and human hepatocellular carcinomas (HCCs) and contributes to increase of proliferation, loss of epithelial morphology, and dedifferentiation. Dysfunction of HNF4alpha during HCC progression can be either caused by structural changes of this gene or occurs due to modification of up-stream regulatory signaling pathways. Investigations preformed on a model system of the mouse one-step HCC progression have shown that the restoration of HNF4alpha function in dedifferentiated cells causes partial reversion of malignant phenotype both in vitro and in vivo. Derangement of HNFs function was also described in other tumors of epithelial origin. We suppose that tissue-specific factors that underlie the key steps in differentiation programs of certain tissues and are able to receive or modulate signals from the cell environment might be considered as promising candidates for the role of tumor suppressors in the tissue types where they normally play the most significant role.


Development of a mobile monitoring program for anxiety and depression in pregnancy and evaluation of 3-month results.
The aims of this study were to develop a mobile mental health application (app) to scan the symptoms of anxiety, depression, and related factors during pregnancy; examine the effect of the app on pregnant women; and determine the factors related to using such an app. A software platform called Perinatal Anxiety Depression Monitoring Platform (PADIP) was developed. This study included 320 pregnant women: 160 in the PADIP group and 160 in the control group. The PADIP group was screened monthly for 3 months for depression, anxiety, and sleep quality, and instant feedback was provided on scale scores. During the follow-up period, there was a significant decrease in depression and anxiety scale scores in the PADIP group but no significant difference in scale scores in the control group. The interface used for the app was important for scale scores. It was preferred by pregnant women with a high education level, higher Perinatal Anxiety Screening Scale scores, and lower sleep quality scores. PADIP use was associated with a decrease in depression and anxiety scores of pregnant women. It was more useful for patients with higher education levels and a history of a psychiatric disorder, but further research is needed to develop a more comprehensive model.


Candidate drugs against SARS-CoV-2 and COVID-19.
Outbreak and pandemic of coronavirus SARS-CoV-2 in 2019/2020 will challenge global health for the future. Because a vaccine against the virus will not be available in the near future, we herein try to offer a pharmacological strategy to combat the virus. There exists a number of candidate drugs that may inhibit infection with and replication of SARS-CoV-2. Such drugs comprise inhibitors of TMPRSS2 serine protease and inhibitors of angiotensin-converting enzyme 2 (ACE2). Blockade of ACE2, the host cell receptor for the S protein of SARS-CoV-2 and inhibition of TMPRSS2, which is required for S protein priming may prevent cell entry of SARS-CoV-2. Further, chloroquine and hydroxychloroquine, and off-label antiviral drugs, such as the nucleotide analogue remdesivir, HIV protease inhibitors lopinavir and ritonavir, broad-spectrum antiviral drugs arbidol and favipiravir as well as antiviral phytochemicals available to date may limit spread of SARS-CoV-2 and morbidity and mortality of COVID-19 pandemic.


Continuous dopaminergic stimulation therapy for Parkinson's disease - recent advances.
We aim to review the most interesting recent advances on the clinical aspects of continuous dopaminergic stimulation in Parkinson's disease. Several large, open-label studies have presented data that are in line with the randomized controlled trial on L-dopa-carbidopa intestinal gel infusion, which shows that a continuous drug delivery can improve motor fluctuations and dyskinesia in patients with advanced Parkinson's disease. Furthermore, new extended-release formulations of L-dopa aim to stabilize plasma concentrations and thus reduce the degree of motor complications - despite a reduced number of daily doses. Transdermal rotigotine has been shown to be effective for specific subgroups of patients, although the general effect on nonmotor symptoms is still unclear. New products for L-dopa infusion are also at different stages of development, but the routes of administration are widely different: intrajejunal, subcutaneous, and oral. The understanding of the mechanisms behind the complications of long-term L-dopa treatment is still not complete, but therapies aiming for continuous dopaminergic stimulation are already widely used in clinical practice and the evidence strength is improving. However, there is still an urgent need for both less invasive and less costly options in order to increase access to these therapies.


Multimorbidity in older women: the negative impact of specific combinations of chronic conditions on self-rated health.
Chronic diseases are considered major threats to self-rated health (SRH). In many elderly people multimorbidity is present, in elderly women more than in elderly men. This study aims at establishing the impact of multimorbidity and specific disease combinations on SRH in elderly women. To study the relationship between the number of chronic diseases and SRH and explore possible effects of combinations of chronic conditions on SRH in elderly women. Health interview data used for this study originated from the second Dutch National Survey of General Practice, a study with a response rate of 64.5%. From the 12 699 respondents, 315 were females between 70 and 74 years old. Of the women, 87% reported one or more chronic condition. Women without any chronic condition rated their health significantly better than those with one or more chronic conditions. Either severe back pain or severe headache was included in return the most prevalent combinations of two chronic conditions with a significantly higher negative impact on SRH than expected. All combinations including severe headache and some combinations including severe back pain and another chronic condition had a significantly more negative impact on SRH than expected in women aged 70-74 years. General practitioners should be alert on severe headache and severe back pain in elderly women to improve proactive the quality of care and thus add to the quality of later years of life.


Urticaria associated with parenteral nutrition.
We report a 53-year-old female patient with short bowel syndrome who developed urticaria after administration of cyclic parenteral nutrition (PN). The urticaria occurred 2 hours into the 12-hour nocturnal infusion and resolved completely 1 hour after discontinuation of the PN infusion. The urticaria occurred despite removing lipids from the 3-in-1 PN solution. The urticaria did not occur when the multivitamin preparation was removed from the PN. Upon rechallenge with a PN solution containing a multivitamin, the urticaria reoccurred. Prick skin testing using the multivitamin in increasing aliquots was negative. Serum tryptase and 12-hour urinary histamine level during PN infusion containing the multivitamin was unchanged compared with baseline measurements. The patient had no allergic reaction using a similar dose of an oral multivitamin. This case illustrates that allergic reactions from PN infusion may occur and that the multivitamin preparation can be the cause.


[Long-term effectiveness of vascularized capitate osteotomy transposition for advanced Kienböck's disease].
To evaluate the long-term effectiveness of lunate excision and vascularized capitate osteotomy transposition for advanced Kienböck's disease. Between June 2004 and January 2008, 16 patients with Kienböck disease in Lichtman stages IIIB-IV were treated with lunate excision and vascularized capitate osteotomy transposition. There were 10 males and 6 females at the age of 27-59 years (mean, 38.8 years). The disease was caused by trauma in 10 cases, and unknown reason in 6 cases. The main clinical symptoms were pain and limited activity of the wrist joint, and the disease duration was 5-32 months (mean, 26.5 months). The carpal height index was 0.88 ± 0.05; the radioscaphoid angle was (63.8 ± 9.1)degrees. The visual analogue scale (VAS) score, range of motion (ROM), grip strength, Evans score, and radiographic changes were used to assess the effectiveness during follow-up. All patients obtained healing of incision by first intention and were followed up 5 years and 4 months to 9 years (mean, 5.8 years). VAS score was 2.0 ± 1.5 at the final follow-up. The ROM of the flexion and extension of the wrist joint at the affected side were significantly less than those at the normal side (P < 0.05). However, no significant difference was found in the grip strength and Evans score between the affected side and normal side (t = -0.997, P = 0.327; t = -1.852, P = 0.077). Postoperative radiographs showed that the carpal height index was 0.94 ± 0.03, and the radioscaphoid angle was (48.4 ± 4.8) degrees, which were improved significantly when compared with preoperative ones (t = -3.927, P = 0.000; t = 5.987, P = 0.000). Osteophyte at the dorsal side of the radius and scaphoid rotation occurred in 6 cases and 2 cases, respectively. Lunate excision and vascularized capitate osteotomy transposition is a reliable method for advanced Kienböck's disease, with favorable improvement in wrist pain and grip strength for long-term follow-up.


Glial processes at the Drosophila larval neuromuscular junction match synaptic growth.
Glia are integral participants in synaptic physiology, remodeling and maturation from blowflies to humans, yet how glial structure is coordinated with synaptic growth is unknown. To investigate the dynamics of glial development at the Drosophila larval neuromuscular junction (NMJ), we developed a live imaging system to establish the relationship between glia, neuronal boutons, and the muscle subsynaptic reticulum. Using this system we observed processes from two classes of peripheral glia present at the NMJ. Processes from the subperineurial glia formed a blood-nerve barrier around the axon proximal to the first bouton. Processes from the perineurial glial extended beyond the end of the blood-nerve barrier into the NMJ where they contacted synapses and extended across non-synaptic muscle. Growth of the glial processes was coordinated with NMJ growth and synaptic activity. Increasing synaptic size through elevated temperature or the highwire mutation increased the extent of glial processes at the NMJ and conversely blocking synaptic activity and size decreased the presence and size of glial processes. We found that elevated temperature was required during embryogenesis in order to increase glial expansion at the nmj. Therefore, in our live imaging system, glial processes at the NMJ are likely indirectly regulated by synaptic changes to ensure the coordinated growth of all components of the tripartite larval NMJ.


Therapeutic trials for systemic sclerosis: an update.
The pathogenesis of systemic sclerosis (SSc) is complex, and the final story is yet to be elucidated. The clinical heterogeneity of the disease, its various autoimmune and antibody profiles, its long course and tendency for spontaneous cure makes the design of clinical trials difficult. The overwhelming need in this disease is to diagnose it early and identify those patients who will benefit most from early, aggressive treatment. We attempt to review data from recent clinical trials and the lessons derived.


[Arthritis of the thumb (rhizarthrosis) in the elderly].
Osteoarthritis of the base of the thumb is a common and painful condition, mostly observed in post menopausal women. This paper proposes a critical review of the recent papers in the point of view of geriatric medicine. The basal joint of the thumb is formed by the trapeziometacarpal joint and the carpometacarpal joint of the thumb. The trapeziometacarpal joint is a saddle joint with a wide mobility. The trapezium is most important bone which authorizes movement of rotation towards every finger of the hand. Carpometacarpal allows the strength of the hand. Antalgesic drugs are the first treatments. NSAIDs can be applied and reduced pain. Resting hand splint have a significant pain relief, without any side effects. This advantage is appropriate to treatment in elderly subjects. Flexible orthosis is adapted to maintaining activities of daily living in moderate pain. Chirurgical ligament reconstruction tendon interposition is the most common technics used. In elderly subject, trapeziectomy achieved pain relief and adapted to frail elderly.


Exploring barriers and facilitators to participation of male-to-female transgender persons in preventive HIV vaccine clinical trials.
Observed seroincidence and prevalence rates in male-to-female (MTF) transgender individuals highlight the need for effective targeted HIV prevention strategies for this community. In order to develop an effective vaccine that can be used by transgender women, researchers must understand and address existing structural issues that present barriers to this group's participation in HIV vaccine clinical trials. Overcoming barriers to participation is important for ensuring HIV vaccine acceptability and efficacy for the MTF transgender community. To explore barriers and facilitators to MTF transgender participation in preventive HIV vaccine clinical trials, the HIV Vaccine Trials Network conducted focus groups among transgender women in four urban areas (Atlanta, Boston, Philadelphia, and San Francisco). Barriers and facilitators to engagement of transgender women in preventive HIV vaccine clinical trials led to the following recommendations: (a) transgender cultural competency training, (b) creating trans-friendly environments, (c) true partnerships with local trans-friendly organizations and health care providers, (d) protocols that focus on transgender specific issues, and (e) data collection and tracking of transgender individuals. These results have implications for the conduct of HIV vaccine trials, as well as engagement of transgender women in research programs in general.