Bound thrombin-induced upregulation of myosin heavy chain isoform, SMemb messenger RNA expression in cultured rabbit vascular smooth muscle cells.
To investigate whether bound thrombin can induce modulation of SMemb expression in vascular smooth muscle (VSM) cells, messenger RNA (mRNA) expression was measured by in situ hybridization (ISH) and reverse transcription-polymerase chain reaction (RT-PCR) in cultured rabbit aortic VSM cells. To test the concentration- and time-dependent effect of bound thrombin on the expression of SMemb, confluent VSM cells were incubated for 48 h in 10% FBS-DMEM containing 0, 3, 10 and 30 units/ml of bound thrombin. In addition, the confluent VSM cells were incubated for 6, 12, 24 and 48 h in 10% FBS-DMEM containing 10 units/ml of bound thrombin. Consequently, bound thrombin significantly increased SMemb mRNA in a concentration- and time-dependent manner. When compared with the effect of rabbit fibrinogen (10 microg/ml) and native thrombin (10 units/ml), SMemb mRNA was significantly increased by bound thrombin and was slightly increased by native thrombin, but not by fibrinogen. Other myosin heavy chain (MHC) isoform (SM1 and SM2) mRNA expressions were not changed by fibrinogen, native thrombin or bound thrombin. ISH revealed that there was no significant difference in the expression of MHC mRNAs among fibrinogen, native thrombin or bound thrombin. Western blot analysis demonstrated that the SMemb protein level was significantly increased by 2.5-fold by bound thrombin. When the clot-forming activities in cultured medium containing native thrombin or bound thrombin were measured from 0.5 to 48 h, the activity of bound thrombin declined more slowly than that of native thrombin. In conclusion, bound thrombin could upregulate the expression of SMemb mRNA and protein in cultured VSM cells and the activity of bound thrombin was maintained for longer than that of native thrombin in culture medium.


Does the type of graft affect the outcome of revision anterior cruciate ligament reconstruction? a meta-analysis of 32 studies.
Our aim was to perform a meta-analysis of the outcomes of revision anterior cruciate ligament (ACL) reconstruction, comparing the use of different types of graft. A search was performed of Medline and Pubmed using the terms "Anterior Cruciate Ligament" and "ACL" combined with "revision", "re-operation" and "failure". Only studies that reported the outcome at a minimum follow-up of two years were included. Two authors reviewed the papers, and outcomes were subdivided into autograft and allograft. Autograft was subdivided into hamstring (HS) and bone-patellar tendon-bone (BPTB). Subjective and objective outcome measures were analysed and odds ratios with confidence intervals were calculated. A total of 32 studies met the inclusion criteria. Five studies used HS autografts, eight reported using BPTB autografts, two used quadriceps tendon autografts and eight used various types. Seven studies reported using allografts, while the two remaining used both BPTB autografts and allografts. Overall, 1192 patients with a mean age of 28.7 years (22.5 to 39) and a mean follow-up of 5.4 years (2.0 to 9.6) were treated with autografts, while 269 patients with a mean age of 28.4 years (25 to 34.6) and a mean follow-up of 4.0 years (2.3 to 6.0) were treated with allografts. Regarding allografts, irradiation with 2.5 mrad was used in two studies while the graft was not irradiated in the seven remaining studies. Reconstructions following the use of autografts had better outcomes than those using allograft with respect to laxity, measured by KT-1000/2000 (MEDmetric Corporation) and the rates of complications and re-operations. Those following the use of allografts had better mean Lysholm and Tegner activity scores compared with autografts. If irradiated allografts were excluded from the analysis, outcomes no longer differed between the use of autografts and allografts. Comparing the types of autograft, all outcomes were similar except for HS grafts which had better International Knee Documentation Committee scores compared with BPTB grafts. Autografts had better outcomes than allografts in revision ACL reconstruction, with lower post-operative laxity and rates of complications and re-operations. However, after excluding irradiated allografts, outcomes were similar between autografts and allografts. Overall, the choice of graft at revision ACL reconstruction should be on an individual basis considering, for instance, the preferred technique of the surgeon, whether a combined reconstruction is required, the type of graft that was previously used, whether the tunnels are enlarged and the availability of allograft. Cite this article: Bone Joint J 2017;99-B:714-23.


[Plexiform schwannoma of the delto-pectoral area].
Plexiform schwannoma is a form of schwannoma which usually involves cutaneous tissues. It cannot be easily differentiated from malignant tumors, especially deep or cellular lesions. We report a deep plexiform schwannoma which we place among the various benign or malignant nerve sheath tumors, which may or may not develop within the context of genetic disease. Finally, the differential diagnoses are discussed. Recognition of the lesion is necessary for appropriate treatment.


Formoterol delivered via the dry powder Aerolizer inhaler versus albuterol MDI and placebo in mild-to-moderate asthma: a randomized, double-blind, double-dummy trial.
The objectives of this study were to compare the efficacy and tolerability of twice-daily formoterol dry powder 12 microg and 24 microg (Foradil) delivered via Aerolizer inhaler with four times daily albuterol (salbutamol) 180 microg delivered via metered dose inhaler (MDI) and placebo. A total of 554 adolescents and adults (ages 12-75 years) with mild-to-moderate asthma were randomized to this 12-week, multicenter, double-blind, double-dummy, placebo-controlled, parallel-group study. Twelve-hour spirometry measurements were taken at weeks 0, 4, 8, and 12. A total of 484 patients completed the study (122, 116, 127, and 119 given formoterol 12 microg, formoterol 24 microg, albuterol, and placebo, respectively). For the primary efficacy variable, the forced expiratory volume in 1 second (FEV1), both formoterol 12 microg and 24 microg were statistically superior to placebo at all time points on all test days (p < or = 0.017) and to albuterol at most time points on all test days (p < or = 0.001). The onset of improvement in FEV1 was rapid, with 15% increase within 5 min in 57%, 71%, and 65% of formoterol 12 microg, formoterol 24 microg, and albuterol patients, respectively. Formoterol was also superior to placebo and albuterol in terms of secondary efficacy variables: FEV1 area under the curve, percentage of predicted FEV1, forced vital capacity and forced expiratory flow, asthma symptom scores, and peak expiratory flows. In conclusion, both formoterol doses were superior to placebo in all lung function measurements. Overall, compared with albuterol, both formoterol doses produced superior bronchodilation. Formoterol and albuterol were safe and well-tolerated.


[Analysis of characteristics of types of primary sexual partners and related factors of not being tested for HIV among men who have sex with men].
Objective: To compare the characteristics of MSM with different types of primary sexual partners and to analyze the factors associated with MSM not being tested for HIV in the last six months. Methods: MSM were recruited in nine cities of Shandong Province from April to July 2021, and face-to-face questionnaires were conducted to collect information on sociodemographic characteristics, high-risk behaviors, and HIV testing of MSM. Blood samples were taken for serological tests of HIV and syphilis antibodies. Results: A total of 3 008 men who had anal sex with men in the last six months were divided into three groups according to the type of primary sexual partner in the last six months: the fixed sexual partner group (36.83%, 1 108/3 008), the commercial sexual partner group (3.06%, 92/3 008), and casual sexual partner group (60.11%, 1 808/3 008). There were statistically significant differences in the distribution of age, local residence time, education level, the primary place to find male sexual partners, use of new-type drugs in the last six months, consistent condom use every time during same-sex anal sex in the last six months, group sex in the last six months, no HIV testing in the last six months, having had a sexually transmitted disease in the last year, receiving peer education in the last year, and frequency of syphilis testing in the last year among different groups (P<0.05). Multivariable logistic regression analysis showed that related factors of not being tested for HIV in the last six months in MSM were those aged less than 30 years old (aOR=1.39, 95%CI: 1.06-1.83), married/cohabiting (aOR=1.74, 95%CI: 1.39-2.16), high school education or less (aOR=1.39, 95%CI: 1.15-1.67), had not used new-type drugs in the last six months (aOR=2.27, 95%CI: 1.89-2.71), had not received peer education in the last year (aOR=1.59, 95%CI: 1.28-1.98), had never been tested for syphilis (aOR=11.30, 95%CI: 8.15-15.66), had not been tested in the last year but had been previously tested for syphilis (aOR=5.65, 95%CI: 4.19-7.62), the type of primary sexual partner in the last six months being a commercial sexual partner (aOR=1.80, 95%CI: 1.01-3.20), and the type of primary sexual partner in the last six months being a casual sexual partner (aOR=1.50, 95%CI: 1.26-1.80). Conclusions: The characteristics of MSM with different types of primary sexual partners are different, and the proportion of HIV testing still needs to be improved. In the future, we should make full use of the Internet and peer education to expand the coverage of HIV testing for MSM, targeting the characteristics of MSM with different types of primary sexual partners.


2-Anthryltriazolyl-containing multidentate ligands: zinc-coordination mediated photophysical processes and potential in live-cell imaging applications.
1,2,3-Triazol-4-yl (triazolyl)-containing tetradentate ligand 1 undergoes fluorescence enhancement upon binding to zinc ion (Zn(2+)) in both organic (acetonitrile) and aqueous solutions. A 1:1 complex of 1 with a trigonal bipyramidal Zn(2+) was characterized by X-ray crystallography. The cyclic voltammogram (CV) of 1 suggests that an intramolecular photoinduced electron transfer (PET) process is thermodynamically feasible which would quench the fluorescence of the 2-anthryltriazolyl fluorophore. On the basis of the X-ray and CV data, it was initially postulated that the 1:1 binding between Zn(2+) and ligand 1 shuts down the PET quenching pathway of the free ligand, which leads to the fluorescence enhancement of 1. However, the nuance of the interaction between 1 and Zn(2+) was revealed by isothermal titration calorimetry (ITC) and (1)H NMR titration experiments. A two-step binding process was observed which proceeds through an intermediate species of 2:1 (ligand/Zn(2+)) stoichiometry. Upon close examination of the fluorescence spectra of 1 during the Zn(2+) titration experiment, the fluorescence profile is in fact consistent with a two-step binding process in which a moderate fluorescence enhancement was observed during the early stage of the titration, followed by a bathochromic shift in conjunction with a more pronounced enhancement as Zn(2+) concentration increases. The studies on compounds 2-5 support the amended hypothesis that upon increasing Zn(2+) concentration, compound 1 first undergoes fluorescence enhancement because of the formation of a 2:1 (ligand to Zn(2+)) complex which slows down the PET quenching process. As Zn(2+) concentration increases, the 2:1 complex is converted into a 1:1 complex which facilitates an intramolecular exciplex formation between the excited 2-anthryltriazolyl fluorophore and the Zn(2+)-bound pyridyl moiety. Finally, the potential of compound 1 as an intracellular fluorescent indicator for Zn(2+) was evaluated. HeLa cells loaded with compound 1 grown in Zn(2+)-rich media show stronger fluorescence than those grown under Zn(2+)-deprived conditions, confirming the promise that the triazolyl-containing polyaza fluoroionophores can be developed into intracellular fluorescent indicators targeting biological Zn(2+).


Restoration of Rod-Derived Metabolic and Redox Signaling to Prevent Blindness.
Vision is initiated by capturing photons in highly specialized sensory cilia known as the photoreceptor outer segment. Because of its lipid and protein composition, the outer segments are prone to photo-oxidation, requiring photoreceptors to have robust antioxidant defenses and high metabolic synthesis rates to regenerate the outer segments every 10 days. Both processes required high levels of glucose uptake and utilization. Retinitis pigmentosa is a prevalent form of inherited retinal degeneration characterized by initial loss of low-light vision caused by the death of rod photoreceptors. In this disease, rods die as a direct effect of an inherited mutation. Following the loss of rods, cones eventually degenerate, resulting in complete blindness. The progression of vision loss in retinitis pigmentosa suggested that rod photoreceptors were necessary to maintain healthy cones. We identified a protein secreted by rods that functions to promote cone survival, and we named it rod-derived cone viability factor (RdCVF). RdCVF is encoded by an alternative splice product of the nucleoredoxin-like 1 (NXNL1) gene, and RdCVF was found to accelerate the uptake of glucose by cones. Without RdCVF, cones eventually die because of compromised glucose uptake and utilization. The NXNL1 gene also encodes for the thioredoxin RdCVFL, which reduces cysteines in photoreceptor proteins that are oxidized, providing a defense against radical oxygen species. We will review here the main steps of discovering this novel intercellular signaling currently under translation as a broad-spectrum treatment for retinitis pigmentosa.


Deep Belief Networks for Electroencephalography: A Review of Recent Contributions and Future Outlooks.
Deep learning, a relatively new branch of machine learning, has been investigated for use in a variety of biomedical applications. Deep learning algorithms have been used to analyze different physiological signals and gain a better understanding of human physiology for automated diagnosis of abnormal conditions. In this paper, we provide an overview of deep learning approaches with a focus on deep belief networks in electroencephalography applications. We investigate the state-of-the-art algorithms for deep belief networks and then cover the application of these algorithms and their performances in electroencephalographic applications. We covered various applications of electroencephalography in medicine, including emotion recognition, sleep stage classification, and seizure detection, in order to understand how deep learning algorithms could be modified to better suit the tasks desired. This review is intended to provide researchers with a broad overview of the currently existing deep belief network methodology for electroencephalography signals, as well as to highlight potential challenges for future research.


Spontaneous Globe Rupture Due to Rapidly Evolving Endogenous Hypermucoid Klebsiella Pneumoniae Endophthalmitis.
In this retrospective report, the authors describe a rare case of spontaneous globe rupture from Klebsiella pneumoniae endophthalmitis in a middle-aged man with poorly controlled type 2 diabetes mellitus. There have been only four previously reported cases of spontaneous globe rupture from endophthalmitis. Out of the now five reported cases, all have been due to endogenous endophthalmitis, four have been due to gram-negative bacteria, and three have been due to K. pneumoniae. K. pneumoniae, especially the hypermucoid variant with a protective polysaccharide capsule, is an emerging pathogen with remarkable virulence. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:600-601.].


Long focal-length measurement using divergent beam and two gratings of different periods.
A new accurate method for long focal-length measurement based on Talbot interferometry is proposed. A divergent beam and two Ronchi gratings of different periods are employed, as the alternative of the collimated beam and two identical gratings, to achieve higher measurement accuracy. Moreover, with divergent beam, lenses of large aperture can be easily measured without scanning, which is required when it comes to traditional collimated beam. Numerical analysis and experiments were carried out. The results demonstrate the proposed method features remarkably high accuracy and repeatability.


Minimally Invasive Transforaminal Lumbar Interbody Fusion in the Outpatient Setting.
Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has been shown to have long-term clinical outcomes similar to those with open TLIF and decreased perioperative morbidity. This study assessed whether this procedure can be safely performed in outpatient settings. Ninety-six consecutive patients undergoing 1- or 2-level MIS-TLIFs were retrospectively reviewed. They were divided into inpatient and outpatient cohorts (36%). All had a minimum of 2 years of follow-up. Patient demographics, comorbidities, complications, and readmissions were examined. Early postoperative complications were stratified into wound related, infection, neurologic, implant related, and vascular injuries. Patients in the outpatient cohort were significantly younger, had lower American Society of Anesthesiologists physical status scores, and had lower Charlson Comorbidity Index scores than patients in the inpatient cohort. There were no statistically significant differences in overall postoperative complication rates, readmission rates, or final Oswestry Disability Index or visual analog scale scores between the 2 cohorts. The clinical outcomes of the outpatient TLIF procedure were similar to those of the inpatient procedure and it had an acceptable complication rate. [Orthopedics. 2016; 39(6):e1218-e1222.].


In utero origin of t(8;21) AML1-ETO translocations in childhood acute myeloid leukemia.
Recent reports have established the prenatal origin of leukemia translocations and resultant fusion genes in some patients, including MLL-AF4 translocations in infants and TEL-AML1 translocations in children. We now report evidence for the prenatal origin of a translocation in childhood acute myeloid leukemia (AML). The t(8;21) AML1-ETO translocations were sequenced at the genomic level in 10 diagnostic leukemia samples from children with available neonatal Guthrie blood spots. Clonotypic genomic AML1-ETO sequences were detected in the Guthrie spots for 5 individuals, providing unambiguous evidence of prenatal origin in these cases. Two of these patients were older than 10 years of age at diagnosis, indicative of a protracted postnatal latency. Three of the patients were assessed for the persistence of genomic fusion sequences in complete clinical remission samples and were found to be positive. These data indicate that t(8;21) in childhood AML can arise in utero, possibly as an initiating event in childhood AML, and may establish a long-lived or stable parental clone that requires additional secondary genetic alterations to cause leukemia.


Prevalence of extended spectrum beta-lactamase producing anaerobic bacteria in chronic periodontitis.
Due to the rampant use of antibiotics bacteria are acquiring resistance to penicillin group of drugs, which results in prescription failure in clinical practice. Beta-lactamase producing organisms are not only more virulent they also cause surrounding bacteria to become resistant. Hence, this study was undertaken to know the prevalence of extended spectrum beta-lactamase (ESBL) producing anaerobic bacteria in chronic periodontitis. The present study was conducted for a period of 1 year from January to December 2010 at a tertiary care teaching hospital. Clinical samples were collected from the sub gingival pockets from cases of chronic periodontitis and transported to the laboratory in fluid thioglycollate medium. Gram's staining was performed and anaerobic culture put up. All the anaerobic bacteria isolated were tested for beta-lactamase production by Nitrocefin disc method. A total of 60 samples yielded 121 isolates, out of which 26% were ESBL producers. Bacteroides fragilis was the most common organism followed by Fusobacterium species. ESBL producing anaerobic bacteria exits in chronic periodontitis cases and the present study identified 26% of the isolates to be ESBL producers. Antibiotic resistance testing is essential before starting the therapy and in emergency cases drugs should be chosen to cover ESBL producers.


Transanal approach in repairing acquired rectovestibular fistula in females.
To summarize the operative experience of the transanal approach in acquired rectovestibular fistula repair. Ninety-six cases of acquired rectovestibular fistula in young females were analyzed retrospectively. The etiology and operative procedure were discussed. Operative essential points were, the patient was laid in prone frog position, with the knees and hips flexed at 90(o); the perineum was elevated; and the anal opening was exposed. Four stay sutures were applied to the margin of the fistular orifice in the anal opening at points 3, 6, 9 and 12 o'clock. A circular incision of mucosa surrounding the stay sutures was made. The fistula was dissected from its anal opening to its vestibular opening. The wound of vestibule was sutured, and the rectoanal wound was then sutured transversely. All the 96 patients recovered uneventfully from operation with a successful rate of 93.75%. The transanal approach in the treatment of the acquired rectovestibular fistula is a simple and feasible technique.


The murine B cell response to TNP-polyacrylamide beads: the relationship between the epitope density of the antigen and the requirements for T cell help and surface IgD.
Spleen cells were cultured with high or low epitope TNP-polyacrylamide beads (TNP-PAB) in order to investigate the effect of epitope density on the requirements for T cell help and surface IgD on responding B cells. The response to low epitope density TNP-PAB was abolished by treatment with anti-Thy-1.2 and complement, whereas approximately 50% of the response to high epitope density TNP-PAB was retained after similar treatment. Thus, an increase in epitope density resulted in a decreased requirement for T cell help. An increase in epitope density was also associated with a decreased requirement for interaction of antigen and surface IgD as determined by "blocking" studies with anti-delta; further, the majority of the T-independent portion of this response was not blocked by anti-delta antibodies. This finding indicate that the T-independent portion of the anti-TNP response does not require interaction of antigen with surface IgD on B cells. These results are discussed in terms of differential cross-linking of IgM and IgD receptors on B cells by multivalent antigens.


Wild game as a reservoir of Anaplasma phagocytophilum in north-western Poland.
The aim of the study was to determine the role of game animals as reservoirs of Anaplasma phagocytophilum, a bacteria species transmitted by Ixodes ricinus ticks, from north-western Poland (Zachodniopomorskie vovoidship). The area under question is endemic for A. phagocytophilum. Blood and spleen samples were taken from 72 roe deer between April and December 2003. Animals culled during winter did not harbour ticks, on the other hand 155 individuals of Ixodes ricinus were collected from 35 of 43 animals taken during spring. We tested all samples for A. phagocytophilum by PCR amplification of the msp2 gene. An individual was considered infected if pathogens were detected in at least one isolate (blood or a tissue sample). DNA from A. phagocytophilum was not found in isolates from ticks collected from the animals. The general level of infection for the roe deer was 31.94% (23/72). DNA of A. phagocytophilum was most commonly detected in blood samples; only in three cases was anaplasma DNA detected in spleen and not in blood. Ruminants seem to be the most competent reservoir for A. phagocytophilum in north-western Poland.


Contrasting chemistry of cis- and trans-platinum(II) diamine anticancer compounds: hydrolysis studies of picoline complexes.
cis-[PtCl2(NH3)(2-picoline)] (AMD473) is currently on clinical trials as an anticancer drug. The trans isomer, AMD443 (1), is also cytotoxic in a variety of cancer cell lines. The X-ray crystal structure of the trans isomer (1) shows that the pyridine ring is tilted by 69 degrees with respect to the platinum square-plane in contrast to the cis isomer in which it is almost perpendicular (103 degrees ). In the 3-picoline (2) and 4-picoline (3) trans isomers, the ring is tilted by 58 degrees /60 degrees (2 molecules/unit cell) and by 56 degrees , respectively. Hydrolysis may be an important step in the intracellular activation and anticancer mechanism of action of these complexes. The first hydrolysis step is relatively fast even at 277 K, with rate constants (determined by 1H,15N NMR) of k1 = 2.6 x 10(-5) s(-1), 12.7 x 10(-5) s(-1), and 5.2 x 10(-5) s(-1) (I = 0.1 M) for formation of the monoaqua complexes of 1-3, respectively. Although the hydrolysis of 3 is slower than 2, it is hydrolyzed to a greater extent. No formation of the diaqua complex was observed for any of the three complexes at 277 K, and it accounts for <3% of the platinum species at 310 K. In general the extent of hydrolysis of the trans complexes is much less than for their cis analogues. The pK(a) values for the monoaqua adducts of 1-3 were determined to be 5.55, 5.35, and 5.39, respectively, suggesting that they would exist largely as the monohydroxo complex at physiological pH. The pKa values for the diaqua adducts were determined to be 4.03 and 7.01 for 1, 3.97 and 6.78 for 2, and 3.94 and 6.88 for 3, the first pK(a) being >1 unit lower than for related cis complexes.


Spontaneous fracture of a titanium mesh cranioplasty implant in a child: A case report.
Titanium mesh cranioplasty is often performed after decompressive craniectomy. Spontaneous fracture of the titanium prosthesis is an extremely rare postoperative complication. Here, we report a 10-year-old boy who presented with a spontaneous fracture of titanium mesh without antecedent head trauma. A 10-year-old boy presented with a 1-wk history of a tender bulge over the left temporo-parieto-occipital scalp. He had undergone a temporo-parieto-occipital titanium mesh cranioplasty 26 mo previously. He denied antecedent head trauma. Computerized tomography disclosed a perpendicular fissure in the titanium mesh, suggesting a diagnosis of spontaneous titanium mesh fracture. He underwent a second temporo-parieto-occipital cranioplasty and made an uneventful recovery. Three-dimensional modeling and finite element analyses were used to explore potential risk factors of titanium mesh fracture. We report a case of spontaneous fracture of a titanium mesh cranioplasty implant. The current case and literature review indicate that titanium mesh implants should be well-anchored to the base of bony defects to prevent fatigue-induced fractures.


DUSP2 methylation is a candidate biomarker of outcome in head and neck cancer.
Biomarkers predictive of response to chemoradiotherapy (CRT) regimens for locally advanced head and neck squamous cell carcinoma (LA-HNSCC) are urgently required to identify patients in whom this approach is likely to be effective. TP53 mutations and epidermal growth factor (EGFR) overexpression are common markers of disease. Dual-specificity-phosphatase-2 (DUSP2) has an essential role in cell proliferation, cancer and immune responses. Aberrant DUSP2 methylation was investigated by pyrosequencing in 5 HNSCC cell lines, 112 LA-HNSCC tumours. EGFR was investigated by immunohistochemistry and TP53 was analysed by sequencing. We demonstrate methylation-dependent transcriptional silencing of DUSP2 in HNSCC cell lines. In LA-HNSCC patients, aberrant methylation in the DUSP2 CpG island was present in 51/112 cases (45.5%). LA-HNSCC cases with wild-type TP53, overexpression of EGFR and unmethylated DUSP2 had the worst overall survival (P≤0.001). DUSP2 methylation, when combined with EGFR and TP53, is a candidate biomarker of clinical outcome in LA-HNSCC treated with CRT.


Effect of teaching on primiparas' perceptions of their newborn.
To determine if a relationship exists between structured, informative in-home teaching concerning infant behavior and primiparous mothers' perceptions of their newborn, 30 primiparas completed Broussard's Neonatal Perception Inventories I and II. The sample--30 women between the ages of 18 and 30 who had had no chronic disorders and had experienced normal pregnancy, labor, delivery, and postpartal course--was deliberately selected from a 489-bed community teaching hospital; 15 women were assigned randomly to a control group and 15 to an experimental group. All participants completed NPI I on their first or second postpartum day. Experimental participants received structured, informative teaching concerning infant behavior two to four days after discharge. All subjects were again visited at one month to complete NPI II. Data were analyzed by t test; significance was set at p = .05. No significant difference was found between the groups in NPI I perceptions. On NPI II a significantly positive change in perception was found for the experimental group, but not for the control group.


Pathway-Activity Likelihood Analysis and Metabolite Annotation for Untargeted Metabolomics Using Probabilistic Modeling.
Motivation: Untargeted metabolomics comprehensively characterizes small molecules and elucidates activities of biochemical pathways within a biological sample. Despite computational advances, interpreting collected measurements and determining their biological role remains a challenge. Results: To interpret measurements, we present an inference-based approach, termed Probabilistic modeling for Untargeted Metabolomics Analysis (PUMA). Our approach captures metabolomics measurements and the biological network for the biological sample under study in a generative model and uses stochastic sampling to compute posterior probability distributions. PUMA predicts the likelihood of pathways being active, and then derives probabilistic annotations, which assign chemical identities to measurements. Unlike prior pathway analysis tools that analyze differentially active pathways, PUMA defines a pathway as active if the likelihood that the path generated the observed measurements is above a particular (user-defined) threshold. Due to the lack of "ground truth" metabolomics datasets, where all measurements are annotated and pathway activities are known, PUMA is validated on synthetic datasets that are designed to mimic cellular processes. PUMA, on average, outperforms pathway enrichment analysis by 8%. PUMA is applied to two case studies. PUMA suggests many biological meaningful pathways as active. Annotation results were in agreement to those obtained using other tools that utilize additional information in the form of spectral signatures. Importantly, PUMA annotates many measurements, suggesting 23 chemical identities for metabolites that were previously only identified as isomers, and a significant number of additional putative annotations over spectral database lookups. For an experimentally validated 50-compound dataset, annotations using PUMA yielded 0.833 precision and 0.676 recall.


Calibration of the axial stiffness of a single-beam acoustic tweezers.
Single-beam acoustic tweezers have recently been demonstrated to be capable of selective three-dimensional trapping. This new contactless manipulation modality has great potential for many scientific applications. Its development as a scientific tool requires precise calibration of its radiation force, specifically its axial component. The lack of calibration for this force is mainly due to its weak magnitude compared to competing effects such as weight. We investigate an experimental method for the calibration of the axial stiffness of the radiation force by observing the axial oscillations of a trapped bead in a microgravity environment. The stiffness exhibits a linear relationship with the acoustic intensity and is of the mN/m order. Then, a predictive model, loaded with the experimental acoustic field, is compared to the measured stiffness with very good agreement, within a single amplitude coefficient. This study paves the way for the development of calibrated acoustic tweezers.


New high- and low-temperature apparatus for synchrotron polycrystalline X-ray diffraction.
A high-temperature furnace with an induction heater coil and a cryogenic system based on closed-cycle refrigeration have been assembled to enhance the non-ambient powder diffraction facilities at the Synchrotron Radiation Source, Daresbury Laboratory. The commissioning of the high- and low-temperature devices on the high-resolution powder diffractometer of Station 2.3 is described. The combined temperature range provided by the furnace/cryostat is 10-1500 K. Results from Fe and NH(4)Br powder samples are presented to demonstrate the operation of the apparatus. The developments presented in this paper are applicable to a wide range of other experiments and diffraction geometries.


Short report: plasma somatostatin concentrations in the irritable bowel syndrome.
The description of a patient with the irritable bowel syndrome whose symptoms were completely relieved by the administration of somatostatin raised the possibility that a deficiency of somatostatin may be involved in the pathogenesis of the disorder. We have examined this possibility by studying 11 healthy controls (35 +/- 12 years; mean +/- S.D. 8 female) and 10 irritable bowel syndrome patients (39 +/- 14 years; 7 female) complaining of frequency of defaecation of 4 or more times a day. Plasma somatostatin concentrations were determined by specific radioimmunoassay, fasting and at 15, 30, 45, 60, 90, 120 and 180 min after a standard breakfast. Irritable bowel syndrome patients and controls had similar fasting (27.4 +/- 5.1 vs. 35.2 +/- 4.3 pg/ml; mean +/- S.E.M. and integrated increment of post-prandial (5105 +/- 858 vs. 3885 +/- 793 pg.min/L) plasma concentrations of somatostatin, as assessed by student's t-test. These observations do not support the idea that a state of somatostatin deficiency exists in the irritable bowel syndrome.


Determination of cardiac output using acoustic quantification in critically ill patients.
The reliability of automated acoustic quantification (AQ) in yielding real-time left ventricular (LV) area, volume, and ejection fraction has been validated. The purpose of this study was to explore the potential of AQ in providing accurate immediate determination of cardiac output in critically ill patients. A total of 48 patients were studied. One group consisted of 37 critically ill patients with indwelling Swan-Ganz catheters. In these patients, cardiac output by AQ, manual tracing of end-diastolic and end-systolic frames of 2-dimensional images, and thermodilution were measured. AQ was also compared with Doppler calculation of flow through the left and right ventricles in 11 additional patients. Adequate data for calculation of cardiac output with AQ were obtained in 78% of critically ill patients. There was an excellent correlation between AQ and off-line manual analysis for LV volumes (r = 0.94 and 0.91 for end-diastole and end-systole), ejection fraction (r = 0.85), and cardiac output (r = 0.93). AQ also correlated well with Doppler analysis (r = 0.97) and thermodilution technique (r = 0.95) in the determination of cardiac output. However, AQ slightly underestimated thermodilution measurements, with rather wide limits of agreement (-0.3 +/- 1.1 liter/min). There was a similar underestimation of cardiac output with manual analysis when compared with thermodilution. Given the absence of significant differences between AQ and manual analysis, this observation suggests that the bias is related to the echocardiographic determination of stroke volume, and not to errors from the automated border detection. It is concluded that AQ, besides providing information on LV volumes and ejection fraction, also can yield rapid measurements of cardiac output in most patients who are acutely ill.


A Low-Cost Measurement Methodology for LiDAR Receiver Integrated Circuits.
This paper presents a test methodology to facilitate the measuring processes of LiDAR receiver ICs by avoiding the inherent walk error issue. In a typical LiDAR system, a costly laser diode driver emits narrow light pulses with fast rising edges, and the reflected pulses from targets enter an optical detector followed by an analog front-end (AFE) circuit. Then, the received signals pass through the cascaded amplifiers down to the time-to-digital converter (TDC) that can estimate the detection range. However, this relatively long signal journey leads to the significant decline of rising-edge slopes and the output pulse spreading, thus producing inherent walk errors in LiDAR receiver ICs. Compensation methods requiring complex algorithms and extra chip area have frequently been exploited to lessen the walk errors. In this paper, however, a simpler and lower-cost methodology is proposed to test LiDAR receiver ICs by employing a high-speed buffer and variable delay cells right before the TDC. With these circuits, both START and STOP pulses show very similar pulse shapes, thus effectively avoiding the walk error issue. Additionally, the time interval between two pulses is easily determined by varying the number of the delay cells. Test chips of the proposed receiver IC implemented in a 180-nm CMOS process successfully demonstrate easier and more accurate measurement results.


Proportional decline of Anopheles quadriannulatus and increased contribution of An. arabiensis to the An. gambiae complex following introduction of indoor residual spraying with pirimiphos-methyl: an observational, retrospective secondary analysis of pre-existing data from south-east Zambia.
Across most of sub-Saharan Africa, malaria is transmitted by mosquitoes from the Anopheles gambiae complex, comprising seven morphologically indistinguishable but behaviourally-diverse sibling species with ecologically-distinct environmental niches. Anopheles gambiae and An. arabiensis are the mostly widely distributed major malaria vectors within the complex, while An. quadriannulatus is sparsely distributed. Indoor residual spraying (IRS) with the organophosphate pirimiphos-methyl (PM) was conducted four times between 2011 and 2017 in the Luangwa Valley, south-east Zambia. Anopheles mosquitoes were repeatedly collected indoors by several experiments with various objectives conducted in this study area from 2010 onwards. Indoor mosquito collection methods included human landing catches, Centres for Disease Control and Prevention miniature light traps and back pack aspirators. Anopheles gambiae complex mosquitoes were morphologically identified to species level using taxonomic keys, and to molecular level by polymerase chain reaction. These multi-study data were collated so that time trends in the species composition of this complex could be assessed. The proportion of indoor An. gambiae complex accounted for by An. quadriannulatus declined from 95.1% to 69.7% following two application PM-IRS rounds with an emulsifiable concentrate formulation from 2011 to 2013, while insecticidal net utilisation remained consistently high throughout that period. This trend continued after two further rounds of PM-IRS with a longer-lasting capsule suspension formulation in 2015 and 2016/2017, following which An. quadriannulatus accounted for only 4.5% of the complex. During the same time interval there was a correspondingly steady rise in the proportional contribution of An. arabiensis to the complex, from 3.9 to 95.1%, while the contribution of nominate An. gambiae remained stable at ≤ 0.9%. It seems likely that An. arabiensis is not only more behaviourally resilient against IRS than An. gambiae, but also than An. quadriannulatus populations exhibiting indoor-feeding, human-feeding and nocturnal behaviours that are unusual for this species. Routine, programmatic entomological monitoring of dynamic vector population guilds will be critical to guide effective selection and deployment of vector control interventions, including supplementary measures to tackle persisting vectors of residual malaria transmission like An. arabiensis.


Computer graphics for digitally formatted images.
The increasing use of digitally formatted imaging systems requires high-quality interactive gray-scale computer raster graphics systems for the management, display, and analog film recording of digital image and alphanumeric information. These systems are a combination of computer hardware and software and implement a set of graphics protocols. This paper describes a set of interactive graphics protocols that has been developed for clinical use.


The transition from synchronization to continuation tapping.
The present study examined changes in timing at the transition from synchronization to continuation tapping and the role played by knowledge of the transition. Three experiments employed a pseudo-synchronization paradigm: At the transition, the pacing tones were replaced by identical feedback tones. In Experiment 1, participants were not informed when the transition would occur. Immediately following the transition, an acceleration of tapping was observed. In Experiment 2, participants were informed about the exact position of the transition, which was in addition marked by a pitch change. Nonetheless, the same acceleration occurred. Experiment 3 dissociated the actual from the expected position of the transition, without changing the results. In addition, the delay of the feedback tones was manipulated and was found to affect the rate of tapping in the continuation phase. A single delayed tone at the transition had no lasting effect, however. The results are interpreted in light of the synchronization-continuation model of Vorberg and Wing [Vorberg, D., & Wing, A. (1996). Modelling variability and dependence in timing. In H. Heuer, & S. W. Keele (Eds.), Handbook of perception and action, Vol. 2 (pp. 181-262). San Diego: Academic Press], with the added assumption that the synchronization tapping strategy is maintained in the continuation phase.


Teichoic acids of Streptococcus agalactiae: chemistry, cytotoxicity, and effect on bacterial adherence to human cells in tissue culture.
The ratio of teichoic acid to lipoteichoic acid (LTA) in a strain of Streptococcus agalactiae type III was found to be 8:1, with the total amount of LTA being 0.1% of the dry weight of the organism. Purified teichoic acid contained D-alanine and possibly a small amount of D-glucose and was approximately 22 glycerol phosphate units in length. The linkage between each of these units was 1-3. In addition, LTA contained a complex lipid, more glucose, and an unusually high content of a short-chain fatty acid, tridecanoic acid. This LTA was cytotoxic for a variety of human cell monolayers in tissue culture, including one derived from the human central nervous system. Established human cells were more sensitive than primary cell monolayers to this LTA, with as little as 12.5 micrograms of LTA per ml being cytotoxic for HeLa cells. Teichoic acid (250 micrograms/ml) was nontoxic under identical conditions. These cytotoxicity results suggest an LTA involvement in group B streptococcal pathogenesis. Also, the first model system for the study of group B streptococcal adherence to primary human embryonic amnion cells in tissue culture is detailed. This system was used to quantitate pronounced differences in tissue tropism between S. agalactiae and Streptococcus pyogenes and showed enhanced binding by this group A coccus over that of S. agalactiae for amnion cell monolayers. The adherence of both streptococcal species to only a portion (40%) of these amnion cells suggested that host cell receptor expression may vary for primary cells in vitro. Finally, this strain of S. agalactiae was shown to adhere to amnion cells by a non-LTA-mediated mechanism. The possibility of an LTA-mediated versus a protein-mediated adherence mechanism for host cells that is related to the virulence of S. agalactiae is discussed.


Rhizobial Volatiles: Potential New Players in the Complex Interkingdom Signaling With Legumes.
Bacteria release a wide range of volatile compounds that play important roles in intermicrobial and interkingdom communication. Volatile metabolites emitted by rhizobacteria can promote plant growth and increase plant resistance to both biotic and abiotic stresses. Rhizobia establish beneficial nitrogen-fixing symbiosis with legume plants in a process starting with a chemical dialog in the rhizosphere involving various diffusible compounds. Despite being one of the most studied plant-interacting microorganisms, very little is known about volatile compounds produced by rhizobia and their biological/ecological role. Evidence indicates that plants can perceive and respond to volatiles emitted by rhizobia. In this perspective, we present recent data that open the possibility that rhizobial volatile compounds have a role in symbiotic interactions with legumes and discuss future directions that could shed light onto this area of investigation.


[Surgical repair of bladder rupture associated with the pelvic fracture without suprapubic tube--a case report].
The authors are presenting a case of 42-year-old polytraumatized man with pelvic fracture associated with extraperitoneal urinary bladder rupture. This was verified by intraoperative retrograde cystography and treated with suture without making suprapubic tube drainage. Urinary draining was assured with a transurethral permanent urinary catheter. Conversion from external fixation to internal osteosynthesis of pelvic fracture was performed as far as 26 days after admission for significantly poor overall condition of the patient. Injury of the bladder and pelvic fracture healed without any complications. This case review points to the possibility of surgical repair of bladder rupture without epicystostomy, which is an obstacle or an increased risk of infection for internal fixation of anterior part of the pelvic ring. Suprapubic tube is not beneficial in surgical repair of urinary bladder rupture. However, it is normal practice that the suprapubic tube associated with bladder suture is indicated according to urology department tradition or by an individual physician - urologist himself. In the choice of surgical treatment tactics in these types of injuries proper communication between the urologist and the surgeon dealing with complex pelvic trauma is important.


Discrete mathematics in deaf education: a survey of teachers' knowledge and use.
The study documents what deaf education teachers know about discrete mathematics topics and determines if these topics are present in the mathematics curriculum. Survey data were collected from 290 mathematics teachers at center and public school programs serving a minimum of 120 students with hearing loss, grades K-8 or K-12, in the United States. Findings indicate that deaf education teachers are familiar with many discrete mathematics topics but do not include them in instruction because they consider the concepts too complicated for their students. Also, regardless of familiarity level, deaf education teachers are not familiar with discrete mathematics terminology; nor is their mathematics teaching structured to provide opportunities to apply the real-world-oriented activities used in discrete mathematics instruction. Findings emphasize the need for higher expectations of students with hearing loss, and for reform in mathematics curriculum and instruction within deaf education.


[Long-term follow up of acute and chronic pancreatitis during insulin and peptide C secretion and carbohydrate tolerance].
The aim of the study was to evaluate the function of pancreatic the B-cell and carbohydrate tolerance after and during pancreatitis. Forty patients (30 men and 10 women) in mean age 41.6 +/- 11.6 years (mean +/- SD) were studied. Analysis of the results was performed in four groups: 1) normal controls, 2) patients after biliary acute pancreatitis (AP) in anamnesis, 3) patients with chronic pancreatitis (ChP) and normal carbohydrate tolerance and 4) patients with chronic pancreatitis and impaired of glucose tolerance (ChP + IGT, WHO classification). Pancreatitic B-cell activity was evaluated by the measurement insulin (IRI) and C-peptide (CP) serum concentrations in fasting state and after 75 g oral glucose and after intravenous glucagon injection (1 mg). Hepatic insulin extraction was estimated from of the serum IRI/CP molar ratio. This study demonstrated impaired function of the pancreatic B-cell in groups after acute pancreatitis and with chronic pancreatitis at normal levels of glycaemia. A progressive reduction of stimulated serum IRI and CP concentrations in groups (2), (3) and (4) was observed. In those groups the increase of serum IRI/CP ratio was found. Impaired function of the B-cell after pancreatitis is a frequent complication and to improve metabolic control a mechanism of hepatic insulin clearance reduction is involved.


Texture analysis as a predictor of radiation-induced xerostomia in head and neck patients undergoing IMRT.
Image texture analysis (TA) is a heterogeneity quantifying approach that cannot be appreciated by the naked eye, and early evidence suggests that TA has great potential in the field of oncology. The aim of this study is to evaluate parotid gland texture analysis (TA) combined with formal dosimetry as a factor for predicting severe late xerostomia in patients undergoing radiation therapy for head and neck cancers. We performed a retrospective analysis of patients treated at our Radiation Oncology Unit between January 2010 and December 2015, and selected the patients whose normal dose constraints for the parotid gland (mean dose < 26 Gy for the bilateral gland) could not be satisfied due to the presence of positive nodes close to the parotid glands. The parotid gland that showed the higher V30 was contoured on CT simulation and analysed with LifeX Software©. TA parameters included features of grey-level co-occurrence matrix (GLCM), neighbourhood grey-level dependence matrix (NGLDM), grey-level run length matrix (GLRLM), grey-level zone length matrix (GLZLM), sphericity, and indices from the grey-level histogram. We performed a univariate and multivariate analysis between all the texture parameters, the volume of the gland, the normal dose parameters (V30 and Mean Dose), and the development of severe chronic xerostomia. Seventy-eight patients were included and 25 (31%) developed chronic xerostomia. The TA parameters correlated with severe chronic xerostomia included V30 (OR 5.63), Dmean (OR 5.71), Kurtosis (OR 0.78), GLCM Correlation (OR 1.34), and RLNU (OR 2.12). The multivariate logistic regression showed a significant correlation between V30 (0.001), GLCM correlation (p: 0.026), RLNU (p: 0.011), and chronic xerostomia (p < 0.001, R2:0.664). Xerostomia represents an important cause of morbidity for head and neck cancer survivors after radiation therapy, and in certain cases normal dose constraints cannot be satisfied. Our results seem promising as texture analysis could enhance the normal dose constraints for the prediction of xerostomia.


Intercropping of aromatic crop Pelargonium graveolens with Solanum tuberosum for better productivity and soil health.
Farmers in hilly regions experience low production potential and resource use efficiency due to low valued crops and poorsoil health. Geranium (Pelargonium graveolens L.) is a vegetatively propagated initially slow growing, high value aromatic crop. Potato (Solanum tuberosum L.) is also vegetatively propagated high demand cash crop. A field experiment was carried out in temperate climate to investigate the influence of geranium intercropping at different row strips (1:1 and 1:2) and plant density (60 x 45, 75 x 45 and 90 x 45 cm) with potato intercrop on biomass, oil yield, monetary advantage and soil quality parameters. The row spacing 60x45cm and row strip 1:1 was found to be superior and produced 92 t ha(-1) and 14 kg ha(-1) biomass and oil yield, respectively. The row strip 1:2 intercrop earned a maximum $2107, followed by $1862 with row strip 1:1 at 60 x 45 cm plant density. Significant variations were noticed in soil organic carbon (Corg), total N (Nt), available nutrients, soil microbial biomass (Cmic) and nitrogen (Nmic) content. Maximum improvement of Corg (41.0%) and Nt (27.5%)with row strip 1:1 at 75 x 45 cm plant density. While higher soil respiration rate, Cmic, Nmic, and qCO2 was found with 1:2 row strip at 60 x 45 plant density. The buildup of Corg and Cmic potato intercrop can promote long term sustainability on productivity and soil health.


Orbital-free density functional theory implementation with the projector augmented-wave method.
We present a computational scheme for orbital-free density functional theory (OFDFT) that simultaneously provides access to all-electron values and preserves the OFDFT linear scaling as a function of the system size. Using the projector augmented-wave method (PAW) in combination with real-space methods, we overcome some obstacles faced by other available implementation schemes. Specifically, the advantages of using the PAW method are twofold. First, PAW reproduces all-electron values offering freedom in adjusting the convergence parameters and the atomic setups allow tuning the numerical accuracy per element. Second, PAW can provide a solution to some of the convergence problems exhibited in other OFDFT implementations based on Kohn-Sham (KS) codes. Using PAW and real-space methods, our orbital-free results agree with the reference all-electron values with a mean absolute error of 10 meV and the number of iterations required by the self-consistent cycle is comparable to the KS method. The comparison of all-electron and pseudopotential bulk modulus and lattice constant reveal an enormous difference, demonstrating that in order to assess the performance of OFDFT functionals it is necessary to use implementations that obtain all-electron values. The proposed combination of methods is the most promising route currently available. We finally show that a parametrized kinetic energy functional can give lattice constants and bulk moduli comparable in accuracy to those obtained by the KS PBE method, exemplified with the case of diamond.


Recurrence and Five -Year Survival in Colorectal Cancer Patients After Surgery.
Colorectal cancer (CRC) is a common malignancyworldwide and its outcome is most closely related to the extent of disease at presentation. Early diagnosis of an asymptomatic recurrence increases the likelihood of a complete surgical resection. The aim of this study was to evaluate the incidence of colorectal cancer recurrence and survival rate within 5 years, after surgery. During the 9-year period since 21st Mar, 2004 to 20th Mar, 2013, patients whose primary colorectal cancer were resected in Taleghani hospital, Tehran, Iran were selected in a historical cohort. The necessary data such as demographic, age, gender, family history of CRC, site and size of tumor, stage of tumor, operation details, histological results, treatment method, histopathologic, etc. were collected. Then the recurrence and survival of colorectal cancer within 5 years after operation and their risk factors were evaluated. P value less than 0.05 were considered significant. All analysis was done using SPSS software. A total of 107 patients underwent resection for colorectal cancer during the study period, with mean age of 53.50 ± 12.68 years (range 24 - 76 years), survival rate of 73.8% (rectum 70.0% and colon 75.9%), and mean survival time of 142.17 ± 21.60 month. The recurrence rate of CRC patients, during five years after surgery was 5.7%. Regional lymph nodes, Distance metastasis and Adjuvant therapy were significant prognosis factors of survival after surgery. The rate of recurrence in Iranian patients was low, which could be due to improvement of exactness and expertise of surgeons or better adjuvant therapy. The significant association between survival and adjuvant therapy clarifies this finding. Early diagnosis and primary detection could increase the rate of survival.


Dose-response relationships for radiation-induced thyroid cancer and thyroid nodules: evidence for the prolonged effects of radiation on the thyroid.
The risk of developing thyroid cancer and other thyroid neoplasms after radiation exposure is well known, but specific modifiers of the dose-response relationship are not. We have identified 4296 subjects who received treatment before their sixteenth birthday with orthovoltage radiation for benign conditions in the head and neck area. Individual thyroid dose estimates were calculated for 3843 subjects. Of the 2634 subjects who have been found, 1043 have developed thyroid nodules of all types, and 309 have developed thyroid cancer. The radiation dose-response relationship was consistent with a linear excess relative risk model for thyroid cancer and thyroid nodules within the range of observed doses. Women developed thyroid cancer and thyroid nodules at a higher rate, but the slopes of the dose-response curves were the same for men and women. Age at radiation exposure was a significant factor of the risk, with a lower age at exposure associated with a higher risk. To determine the effect of the wide publicity and our screening program, which began in 1974, we compared the dose-response relationship for cases diagnosed before and after 1974. The overall rates increased dramatically after 1974, but the estimates of the slopes of the dose-response curves were not statistically different. The slope of the dose-response curve for thyroid neoplasms appears to have reached a maximum 25-29 yr after radiation exposure, but the dose response continued to be elevated at the end of follow-up. These data are consistent with the tumorigenic effects of radiation lasting at least 40 yr.


[Not Available].
E. F. Geoffroy's table of different relations ("rapports") between different chemical substances is mainly based on empirical knowledge accumulated in 16th and 17th century metallurgy and pharmacy. The substances listed in the left half of the table were basic for the formation of salts which were produced for medical ends in the chemical-pharmaceutical practice of the 17th century. The right half of the table refers to substances and operations of metallurgy which had already been described in the metallurgical writings of the 16th century. Even Geoffroy's ordering of the substances within the columns of his table has its origin in metallurgical and pharmaceutical practice. The key concept of the conceptual framework underlying the table and its commentary is the concept of chemical compound which emerged at the end of the 17th century. Geoffroy extends the range of application of this concept, which was first limited to chemical artefacts, to include natural bodies. Eliminating the peripatetical distinction between natural bodies and chemical artefacts he formulates a new research program, consisting in the determination of the "laws" of the relations ("rapports") between different chemical substances.


A six-year follow-up of infected total hip replacements managed by Girdlestone's arthroplasty.
Thirty-three Girdlestone's arthroplasties used to salvage infected total hip replacements were followed for a mean of 6.2 years to assess the efficacy of this procedure. Subjective and objective assessment was obtained at the time of review. Gram-negative organisms, retained cement, bony sequestra and secondary healing were common features of the five patients (15%) whose wounds discharged for more than four weeks after operation. Girdlestone's arthroplasty provided satisfactory pain relief in 91% of patients, and control of infection in 97%. Although leg-length discrepancy (mean 4 cm) and a Trendelenburg gait made walking difficult and tiring , 42% were satisfied with their functional ability; 85% needed walking aids, and 3 patients could not walk at all and were confined to bed or a chair. Overall, 79% were satisfied. Objectively, the mean Harris hip rating was 60; however, if patients with multiple joint problems were excluded, this score increased to 77. Girdlestone's arthroplasty seems a reasonable salvage procedure in the management of an infected total hip replacement and the results seem to improve with time.


Recent advances in epigenomics in NSCLC: real-time detection and therapeutic implications.
NSCLC is an aggressive disease with one of the poorer prognosis among cancers. The disappointing response to chemotherapy drives the search for genetic biomarkers aimed at both attaining an earlier diagnosis and choosing the most appropriate chemotherapy. In this scenario, epigenomic markers, such as DNA methylation, histone acetylation and the expression of noncoding RNAs, have been demonstrated to be reliable for the stratification of NSCLC patients. Newest techniques with increased sensitivity and the isolation of nucleic acids from plasma may allow an early diagnosis and then monitoring the efficacy over time. However, prospective confirmatory studies are still lacking. This article presents an overview of the epigenetic markers evaluated in NSCLC and discusses the role of their real-time detection in the clinical management of the disease.


[Visual analysis for an early detection of diabetic neuropathy].
Diabetic neuropathy is the most common long-term complication of diabetes mellitus. It comes along with significant nerve dysfunction, which is not reversible. Hence, it is essential to detect nerve fibre abnormalities as early as possible. In this paper, we investigate markers describing degradation of corneal nerves. We apply statistical computations and visual analysis to identify those variables of two clinical studies that separate DN patients from a control group. In this way, the diagnosis of DN patients is supported. The visual analysis is based on different representations visualizing both the statistical results and the gathered multi-variate data. The user can interactively manipulate the views, or select data that will be shown by further displays. In this way, the understanding of the data and its classification is supported. Ambiguous categorisations can be identified and grouped into a so-called "fuzzy group". For this group, further investigations are needed to decide about diabetic neuropathy.


Orbital-ordering-driven multiferroicity and magnetoelectric coupling in GeV₄S₈.
We report here the discovery of multiferroicity and large magnetoelectric coupling in the type I orbital order system GeV₄S₈. Our study demonstrates that this clustered compound displays a para-ferroelectric transition at 32 K. This transition originates from an orbital ordering which reorganizes the charge within the transition metal clusters. Below the antiferromagnetic transition at 17 K, the application of a magnetic field significantly affects the ferroelectric polarization, revealing thus a large magnetoelectric coupling. Our study suggests that the application of a magnetic field induces a metamagnetic transition which significantly affects the ferroelectric polarization thanks to an exchange striction phenomenon.


Acute intervention with captopril during thrombolysis in patients with first anterior myocardial infarction. Results from the Captopril and Thrombolysis Study (CATS).
The study was designed to examine the safety and efficacy of acute interventional use of captopril on left ventricular volumes, ventricular arrhythmias and neurohormones during thrombolysis in patients with a first anterior myocardial infarction, within 6 h of onset of symptoms. Left ventricular dysfunction and prognosis after myocardial infarction can be improved by angiotensin converting enzyme inhibition started after the ischaemic phase. Experimental evidence suggests that intervention during thrombolysis may lead to even further benefit. In a randomized, double-blind placebo-controlled trial, 298 patients with a first anterior myocardial infarction, eligible for thrombolytic therapy were treated with captopril 6.25 mg or placebo, started immediately upon streptokinase infusion and titrated to 25 mg t.i.d.. The efficacy of captopril by an intention-to-treat-analysis to reduce left ventricular volumes, ventricular arrhythmias, neurohumoral activation and enzymatic infarct size was measured. During dose titration, mean blood pressure and heart rate were similar in both groups. However, hypotension after the first dose was reported in 18 patients on placebo and 31 patients on captopril (P < 0.05). At discharge, 80% of patients were on study medication. Left ventricular volumes were significantly increased in both groups at 3 months, but they tended to be lower in the captopril group; however, the differences were not statistically significant. The incidence of accelerated idioventricular rhythm and non-sustained ventricular tachycardia in captopril patients was lower than in placebo patients (P < 0.05), parallelled by transiently lower norepinephrine levels (P < 0.05) upon thrombolysis.(ABSTRACT TRUNCATED AT 250 WORDS)


Quality health care in an era of limited resources. Challenges and opportunities.
Quality health care is a complex phenomenon. The factors contributing to quality in health care are as varied as the strategies needed to achieve this elusive goal. This article examines the impact of medical errors, health finance (insurance), moral hazard, and provider shortages on the quality of health care today in the United States. Emphasis is given to the need to restore public trust and to create a health care system that maximizes scarce physical, fiscal, and human resources.


Spiral wave dynamics in neocortex.
Although spiral waves are ubiquitous features of nature and have been observed in many biological systems, their existence and potential function in mammalian cerebral cortex remain uncertain. Using voltage-sensitive dye imaging, we found that spiral waves occur frequently in the neocortex in vivo, both during pharmacologically induced oscillations and during sleep-like states. While their life span is limited, spiral waves can modify ongoing cortical activity by influencing oscillation frequencies and spatial coherence and by reducing amplitude in the area surrounding the spiral phase singularity. During sleep-like states, the rate of occurrence of spiral waves varies greatly depending on brain states. These results support the hypothesis that spiral waves, as an emergent activity pattern, can organize and modulate cortical population activity on the mesoscopic scale and may contribute to both normal cortical processing and to pathological patterns of activity such as those found in epilepsy.


James Cook University's rurally orientated medical school selection process: quality graduates and positive workforce outcomes.
The regionally based James Cook University (JCU) College of Medicine and Dentistry aims to meet its mission to address the health needs of the region by using a selection policy favouring rural origin applicants and providing students with early and repeated exposure to rural experiences during training. This study seeks to determine if the JCU medical school's policy of preferentially selecting rural and remote background students is associated with differing patterns of undergraduate performance or graduate practice location. Data at application to medical school and during the undergraduate years was retrieved from administrative databases held by the university and the medical school. Postgraduate location data were obtained either from personal contact via email, telephone or Facebook or electronically from the Australian Health Practitioner Regulation Authority website. Practice location was described across Australian Standard Geographical Classification Remoteness Area (ASGC-RA) categories, with 1 being a major city and 5 being a very remote location. The 856 Australian-based students accepted into the JCU medical program between 2000 and 2008 came from all geographical regions across Australia: 20% metropolitan (ASGC-RA 1), 20% inner regional (ASGC-RA 2), 56% outer regional (ASGC-RA 3), and 5% from remote or very remote locations (ASGC-RA 4 and 5). Having a rural or remote hometown at application (ASGC-RA 3-5) was significantly associated with a lower tertiary entrance score (p<0.001), a lower interview score in the medical school selection process (p<0.001), being less likely to be admitted into the Honours program (p=0.001), being an advanced standing student (p=0.025), being awarded a Medical Rural Bonded Scholarship (p=0.005), taking longer to complete the 6-year course (p=<0.009) and having a lower academic achievement across years 1 to 3 (p=0.002, p=0.005 and p=0.025, respectively). Graduates having either a rural or a remote home town at application were more likely to practise in rural (RA 3-5) towns than graduates from metropolitan/inner regional centre across all postgraduate years. For example, the prevalence odds ratios (POR) for graduates practising in a rural town at postgraduate year 1 (PGY 1) having either a rural or remote hometown were 2.6 and 1.8, respectively, times that of graduates having a metropolitan/inner regional hometown, while at PGY 9 the PORs had increased to 4.2 and 9.5, respectively. Bonded medical place students showed many similar trends to rural students in both their pre-medical school and undergraduate performance indicators but lower engagement in rural practice in the 5 years of data available. Some significant differences were noted between rural and remote origin students and metropolitan or inner regional origin students in terms of academic achievement in the first 3 years of the course and length of time taken to complete the course. However, this group of rural and remote-origin students seems to do just as well in the exams in the clinical years (years 4-6) and are much more likely to practise in rural and remote areas. These data suggest that JCU's selection process favouring rural origin applicants does not compromise academic standards, but does produce graduates whose patterns of practice accord with the mission of the school.


Two new species of crickets Adelosgryllus Mesa Zefa, 2004 (Orthoptera, Grylloidea, Phalangopsidae) from the Araripe-Apodi National Forest, State of Ceará, Brazil.
In this paper we describe two new sympatric species of phalangopsid crickets Adelosgryllus from the Araripe-Apodi National Forest, State of Ceará, Brazil, highlighting morphological characters, mainly from male genitalia, tegmina and copulatory papilla. We also present a geographical map for the valid species of the genus, as well as photographs of holotypes and paratypes. The type-material is deposited in the Museu de Zoologia da Universidade de São Paulo (MZUSP).


A comparison of underwater speakers for fish playback studiesa).
Acoustic playback is a key method used to determine the behavioral significance of animal sounds, including fishes. This study presents the first comparison of the acoustic quality of underwater speakers for the playback of fish sounds. Seven underwater acoustic playback systems were tested for their ability to accurately reproduce the low frequency, pulsed, courtship sounds of a small fish, Tramitichromis intermedius (Cichlidae). Results indicated that in an aquarium with low ambient noise and at low amplitude playback levels (<120 dB re 1 μPa), the Clark Synthesis speakers were the best choice for playback at moderate distances (>20 cm), and that the Electro-Voice UW30 was the best speaker for short distance (<20 cm) playback of low frequency fish sounds. However, in aquaria with higher levels of ambient noise and at higher amplitude playback levels, the Clark Synthesis speakers performed best. However, none of these speaker systems reproduced a high-fidelity quality fish sound. It is important when using underwater speakers for behavioral studies that there is a careful assessment of the played back sound and comparison to the original sound.


Effectiveness of essential amino acid supplementation in stimulating whole body net protein anabolism is comparable between COPD patients and healthy older adults.
The development of effective nutritional strategies in support of muscle growth for patients with chronic obstructive pulmonary disease (COPD) remains challenging. Dietary essential amino acids (EAAs) are the main driver of postprandial net protein anabolism. In agreement, EAA supplements in healthy older adults are more effective than supplements with the composition of complete proteins. In patients with COPD it is still unknown whether complete protein supplements can be substituted with only EAAs, and whether they are as effective as in healthy older adults. According to a double-blind randomized crossover design, we examined in 23 patients with moderate to very severe COPD (age: 65±2 years, FEV1: 40±2% of predicted) and 19 healthy age-matched subjects (age: 64±2 years), whether a free EAA mixture with a high proportion (40%) of leucine (EAA mixture) stimulated whole body net protein gain more than a similar mixture of balanced free EAAs and non-EAAs as present in whey protein (TAA mixture). Whole body net protein gain and splanchnic extraction of phenylalanine (PHE) were assessed by continuous IV infusion of L-[ring-2H5]-PHE and L-[ring-2H2]-tyrosine, and enteral intake of L-[15N]-PHE (added to the mixtures). Besides an excellent positive linear relationship between PHE intake and net protein gain in both groups (r=0.84-0.91, P<0.001), net protein gain was 42% higher in healthy controls and 49% higher in COPD patients after intake of the EAA mixture compared to the TAA mixture (P<0.0001). These findings could not be attributed to the high LEU content, as in both groups net protein gain per gram EAA intake was lower for the EAA mixture (P<0.0001). Net protein gain was higher in COPD patients for both mixtures due to a 40% lower splanchnic extraction (P<0.0001), but was similarly related to dietary PHE (i.e. EAA) plasma appearance. In COPD patients, similarly to healthy older adults, free EAA supplements stimulate whole body protein anabolism more than free amino acid supplements with the composition of complete proteins. Therefore, free EAA supplements may aid in the prevention and treatment of muscle wasting in this patient population.


Oxidation of graphene with variable defects: alternately symmetrical escape and self-restructuring of carbon rings.
Variable defects such as vacancies and grain boundaries are unavoidable in the synthesis of graphene, but play a central role in the activation of oxidation. Here, we apply reactive molecular dynamics simulations to reveal the underpinning mechanisms of oxidation in graphene with or without defects at the atomic scale. There exist four oxidation modes generating CO2 or CO in different stages, beginning from a single-atom vacancy, and proceeding until the ordered structure broken down into carbon oxide chains. The oxidation process of the graphene sheets experiences four typical stages, in which alternately symmetrical escape phenomenon is observed. Importantly, disordered rings can self-restructure during the oxidation of grain boundaries. Of all defects, the oxidation of vacancy has the lowest energy barrier and is therefore the easiest point of nucleation. This study demonstrates the crucial role of defects in determining the oxidation kinetics, and provides theoretical guidance for the oxidation prevention of graphene and the production of functionalized graphene.


Machine vision-based automatic lamb identification and drinking activity in a commercial farm.
Using ear tags, farmers can track specific data for individual lambs such as age, medical records, body condition scores, genetic abnormalities; to make data-based decisions. However, automatic reading of ear tags using Radio Frequency Identification requires (a) an antenna, (b) a reader, (c) comparable reading standards; consequently, such a system can be expensive and impractical for a large group of lambs, especially in situations where animals are not required to have a compulsory Electronic identification, contrary to the case in Europe, where it is mandatory. Therefore, this paper proposes a machine vision system for indoor animals to identify individual lambs using existing ear tags. Using a camera that is installed such that the trough is visible, the drinking behaviour of the lambs can be automatically monitored. Data from different lamb groups in two different pens were collected. The identification algorithm includes a number of steps: (1) Detecting the lambs' face, and its ear tags in each image; (2) Cropping each ear tag image and discerning the digits on it to obtain the tag number; (3) Tracking each lamb throughout the visit using a tracking algorithm; (4) Recovering the ear tag number using an algorithm that incorporates a list of the ear tag numbers of the lambs in each pen, and the predictions for each lamb in each frame. The You Only Look Once deep learning object detection algorithm was applied to locate and localise the lamb's face and the digits in an image. The models' datasets contained 1 160 and 2 165 images for the training set, and 325 and 616 images for the validation set, respectively. The algorithm output includes the identity of each lamb that came to drink, and its duration. The identification system resulted in a total accuracy of 93% for the data tested, which consisted of approximately 900 visits to the drinking stations, and was collected in real time in a natural environment. The ground truth of each video of a visit was obtained by human observation by studying the video. We checked if there was indeed a visit to the water trough and if so we registered the ear tag number of each lamb whose head was above the water trough. Thus, identifying lambs in a commercial pen using a relatively inexpensive and easily installed system consisting of a RGB camera and a computer vision-based algorithm has potential for farm management.


Late diagnosis of multiple fibroelastomas in a 41-year-old woman with hypertrophic cardiomyopathy and atrial fibrillation.
A 39 year old woman with hypertrophic cardiomyopathy with severe latent obstruction and mitral regurgitation, presented with symptoms of dyspnea and atrial fibrillation, and developed an acute embolic stroke. After thrombolysis and complete neurologic recovery, a transesophageal echo revealed six mobile densities, on her mitral and aortic valves, and in the outflow tract. Surgical resection of multiple fibroelastomas, with septal myectomy, aortic and mitral valve replacement, and pulmonary vein ablation, led to clinical improvement. The etiology and pathogenesis of fibroelastomas are unknown; we speculate that their formation may be promoted by endocardial injury from surgery, radiation therapy, or the high velocity turbulent flow of valve dysfunction or outflow tract obstruction.


Susceptiveness of Vitamin K epOxide Reductase Complex Subunit 1 Gene Polymorphism in Essential Hypertension.
Essential hypertension (EH) is defined as a worldwide public health problem and one of the important risk factors for development of human coronary artery disease. Increased peripheral arterial resistance is one of the distinguishing characteristics of EH. The extracellular deposition of calcium in the arterial wall is defined as vascular calcification, which results in aortic stiffness and elevation of blood pressure. Regulation of vascular calcification is physiologically limited by γ-carboxylated proteins that regulate mineralization. Any deficiencies related to mineralization influence vascular calcification. As a result of vitamin-K deficiency or any problem associated with the vitamin K epOxide reductase complex subunit 1 (VKORC1) gene, Glu cannot be transformed to Gla and calcification initiates in blood vessels, myocardium, and cardiac. The aim of the study was to investigate the potential association of VKORC1 polymorphisms with the risk of EH. There were 100 individuals diagnosed with EH and 100 healthy individuals involved in the study. 3673G/A (rs9923231) and 9041G/A (rs7294) polymorphisms in the VKORC1 gene were determined by the PCR-restriction fragment length polymorphism method. A significant difference was found between the rs7294 polymorphisms ratios of the case and control groups, but significant differences weren't found in distribution of the rs9923231 alleles. Finally it was determined that the GG genotype provides a 3.97-fold increased risk for EH compared to the AA genotype for the rs7294 polymorphism. Our results suggest that the VKORC1 gene rs7294 polymorphism is important for the development of EH.


Phosphate-water interplay tunes amorphous calcium carbonate metastability: spontaneous phase separation and crystallization vs stabilization viewed by solid state NMR.
Organisms tune the metastability of amorphous calcium carbonates (ACC), often by incorporation of additives such as phosphate ions and water molecules, to serve diverse functions, such as modulating the availability of calcium reserves or constructing complex skeletal scaffolds. Although the effect of additive distribution on ACC was noted for several biogenic and synthetic systems, the molecular mechanisms by which additives govern ACC stability are not well understood. By precipitating ACC in the presence of different PO4(3-) concentrations and regulating the initial water content, we identify conditions yielding either kinetically locked or spontaneously transforming coprecipitates. Solid state NMR, supported by FTIR, XRD, and electron microscopy, define the interactions of phosphate and water within the initial amorphous matrix, showing that initially the coprecipitates are homogeneous molecular dispersions of structural water and phosphate in ACC, and a small fraction of P-rich phases. Monitoring the transformations of the homogeneous phase shows that PO4(3-) and waters are extracted first, and they phase separate, leading to solid-solid transformation of ACC to calcite; small part of ACC forms vaterite that subsequently converts to calcite. The simultaneous water-PO4(3-) extraction is the key for the subsequent water-mediated accumulation and crystallization of hydroxyapatite (HAp) and carbonated hydroxyapatite. The thermodynamic driving force for the transformations is calcite crystallization, yet it is gated by specific combinations of water-phosphate levels in the initial amorphous coprecipitates. The molecular details of the spontaneously transforming ACC and of the stabilized ACC modulated by phosphate and water at ambient conditions, provide insight into biogenic and biomimetic pathways.


Mental health status among Japanese medical students: a cross-sectional survey of 20 universities.
The purposes of this study were to evaluate the mental health status of Japanese medical students and to examine differences based on gender, as well as on university type and location, using the results of a nationwide survey. Between December 2006 and March 2007, we conducted a questionnaire survey among fourth-year medical students at 20 randomly selected medical schools in Japan. The data from 1,619 students (response rate: 90.6%; male: 1,074; female: 545) were analyzed. We used the Japanese version of the 12-item General Health Questionnaire (GHQ-12) to measure mental health status. Poor mental health status (GHQ-12 score of 4 points or higher) was observed in 36.6% and 48.8% of the male and female medical students, respectively. The ratio of the age-adjusted prevalence of poor mental health status in female versus male medical students was 1.33 (95% confidence interval: 1.10-1.62). The universities were categorized into two groups based on the university type (national/public: 15 vs. private: 5) or location (in a large city: 7 vs. in a local city: 13 cities). The prevalence of poor mental health status in both men and women differed between these groups, although not significantly. The GHQ-12 scores in men significantly differed between the categorized groups of universities. These results suggest that adequate attention must be paid to the mental health of medical students, especially females, and that a system for providing mental health care for medical students must be established in the context of actual conditions at each university.


Trisomy 8 mosaicism in chorionic villus sampling: case report and counselling issues.
We report an unusual case involving chorionic villus sampling (CVS) and trisomy 8 mosaicism. CVS showed a normal direct preparation while the culture showed mosaicism for trisomy 8. Subsequent amniocentesis revealed only normal chromosomes. A peripheral blood culture after birth revealed low-level trisomy 8 mosaicism. The patient appeared phenotypically and developmentally normal at 30 months of age. We conclude that prenatal counselling for similar cases needs to include the rare but real possibility that chromosome mosaicism detected prenatally may be found postnatally with largely unknown consequences. Secondly, low-level chromosomal mosaicism may be more common than previously recognized. Thirdly, very low-level trisomy 8 mosaicism may be compatible with a normal phenotype but long-term follow-up is required. And lastly, the use of fetal blood sampling is questionable in these cases because the phenotype may not be accurately predicted. Further studies of such cases are needed to address these important and unanswered issues, including the potential implication of mosaicism on academic performance and cognitive functioning.


High expression levels in cones of RGS9, the predominant GTPase accelerating protein of rods.
RGS9 is a member of the RGS family of GTPase accelerating proteins (GAPs) for heterotrimeric G proteins. We have explored its contribution to GTPase acceleration in mammalian rod and cone photoreceptors. When RGS9 was specifically removed from detergent extracts of rod outer segments by immunodepletion, the extracts lost nearly all of their GAP activity stimulatable by the inhibitory subunit of cGMP phosphodiesterase. Immunolocalization using monoclonal antibodies and confocal microscopy revealed that RGS9 is present in cones at significantly higher levels than in rods. Thus, RGS9 is the predominant source of GAP activity in rod outer segments, and RGS9 concentration emerges as a potentially important determinant of the faster response kinetics and lower sensitivity of mammalian cones, as compared with rods.


Supporting Breastfeeding in Infants Hospitalized for Jaundice.
Infants readmitted for neonatal hyperbilirubinemia requiring phototherapy are less likely to exclusively breastfeed than infants who are not readmitted for phototherapy. Our aim for this study was to increase breastfeeding exclusivity for infants admitted for neonatal hyperbilirubinemia. Using the Model for Improvement, we conducted 3 plan-do-study-act cycles to improve exclusive breastfeeding (EB). Our outcome measure was to increase the percentage of EB for infants hospitalized for phototherapy from 30% to 80% in 12 months. Our process measure was to increase lactation consultations from 60% to 80%. Balancing measures included the development of >10% weight loss, acute bilirubin encephalopathy, readmissions, and length of stay. Interventions involved staff breastfeeding education, automated orders for lactation consultations, and use of bilirubin blankets during breastfeeding. Data were analyzed by using run charts and statistical process control. A total of 92 infants with neonatal hyperbilirubinemia were admitted from December 2016 to August 2019, with 61 in the postintervention period. After implementation of an automated order for lactation consultation, EB improved from 30% to 60% and completed lactation consultations increased from 60% to 90%. Infants who received a lactation consultation within the first shift during their hospitalization were 4 times more likely to have EB during hospitalization than infants who did not (odds ratio 3.8; confidence interval: 1.17-12.39.) No infant experienced >10% weight loss, acute bilirubin encephalopathy, or a readmission, and length of stay did not significantly change. Early involvement of trained lactation consultants safely improves rates of EB for infants hospitalized with neonatal hyperbilirubinemia.


[Efficacy and tolerability of cisapride in a new formula of 10 mg effervescent capsules for the treatment of functional dyspepsia].
The efficacy and tolerability of Cisapride effervescent granules and a metoclopramide-dimethicone combination were compared double-blind in two comparable groups of 15 patients each with dyspepsia. All patients received three sachets daily of either drug for 6 consecutive weeks. As for efficacy, Cisapride effervescent granules was found to reduce 85% (11/13) of symptoms to a statistically significant extent, as against 42% (5/12) in the reference group. Statistical analysis showed Cisapride effervescent granules to be more effective than the reference drug for 6 out of 11 evaluable symptoms. Mean global improvement was 86% for Cisapride effervescent granules vs 41% for the reference combination. Final judgment by the physician was more favorable for Cisapride effervescent granules than for the reference drug (p < 0.0001). Treatment withdrawal was never necessary and no significant changes of laboratory values were observed. No statistically significant difference between the two treatments as to tolerability was observed. In conclusion, Cisapride effervescent granules was found to have a better risk/benefit ratio than the reference combination.


Development of technical skills in simulated cerebral aneurysm coiling.
Endovascular surgical procedures require visual-spatial coordination in workspaces with restricted motions and temporally limited imaging. The development of the skills needed for these procedures can be facilitated by 3D simulator-based training. Cerebral angiography (CA) has lagged behind in this training approach due to the lack of validated, realistic training models, relying strictly on clinical case exposure frequency ("number of hours logged") as a means of assessing proficiency. The ANGIO Mentor visual-haptic simulator is regarded as an effective training tool, however, this simulator has not been tested thoroughly in its ability to train interventional skills. In particular, the details of the aneurysm coiling process during simulation-based training have not been assessed. In this study, 12 novice medical students were given simulation-based diagnostic CA training until a procedural plateau in performance, established in our previous work. Subsequently, they were trained using video tutorials and written instructions to identify, measure and intervene with cerebral aneurysms using endovascular coils. Over the span of 6 sessions, participants were assessed on their procedural task time, coiling quantity and quality, and perforation rates. Prior to commencing the study, participant spatial ability was assessed using a mental rotation test (MRT) and used as a comparative baseline for the performance analysis. We found that all individuals were able to perform the procedure faster after 6 sessions, reducing their average time from 42 to 24 minutes. Coil success rate improved over from 82% to 88% and coil packing rate remained consistent at 30% throughout testing. High perforation rate seen at the start of the study showed a trend of decreasing over the latter sessions, however, over half of aneurysms were still being perforated by the novice participants. No change in aneurysm coiling quality was found, with a slight decrease in number of parent artery coil protrusions. High MRT individuals were better able to establish necessary tools prior to coiling, however, no other MRT-specific changes were seen. This work identifies the utility of simulation-based CA training in identifying the particular difficulties trainees experience in learning procedural skills, including prevention of perforations, proper positioning and success of coils within the aneurysm.


Local and global regulators linking anaerobiosis to cupA fimbrial gene expression in Pseudomonas aeruginosa.
The cupA gene cluster of Pseudomonas aeruginosa encodes components and assembly factors of a putative fimbrial structure that enable this opportunistic pathogen to form biofilms on abiotic surfaces. In P. aeruginosa the control of cupA gene expression is complex, with the H-NS-like MvaT protein functioning to repress phase-variable (on/off) expression of the operon. Here we identify four positive regulators of cupA gene expression, including three unusual regulators encoded by the cgrABC genes and Anr, a global regulator of anaerobic gene expression. We show that the cupA genes are expressed in a phase-variable manner under anaerobic conditions and that the cgr genes are essential for this expression. We show further that cgr gene expression is negatively controlled by MvaT and positively controlled by Anr and anaerobiosis. Expression of the cupA genes therefore appears to involve a regulatory cascade in which anaerobiosis, signaled through Anr, stimulates expression of the cgr genes, resulting in a concomitant increase in cupA gene expression. Our findings thus provide mechanistic insight into the regulation of cupA gene expression and identify anaerobiosis as an inducer of phase-variable cupA gene expression, raising the possibility that phase-variable expression of fimbrial genes important for biofilm formation may occur in P. aeruginosa persisting in the largely anaerobic environment of the cystic fibrosis host lung.


Nonequilibrium simulations of model ionomers in an oscillating electric field.
We perform molecular dynamics simulations of a coarse-grained model of ionomer melts in an applied oscillating electric field. The frequency-dependent conductivity and susceptibility are calculated directly from the current density and polarization density, respectively. At high frequencies, we find a peak in the real part of the conductivity due to plasma oscillations of the ions. At lower frequencies, the dynamic response of the ionomers depends on the ionic aggregate morphology in the system, which consists of either percolated or isolated aggregates. We show that the dynamic response of the model ionomers to the applied oscillating field can be understood by comparison with relevant time scales in the systems, obtained from independent calculations.


Health Care Access and Utilization by Nepalese Adults in Connecticut.
Introduction Access to healthcare and the utilization of health services at both the state and national levels are frequent areas of study, specifically in major ethnic populations such as White, Black, and Hispanic/Latino. However, there are few studies assessing healthcare access and utilization in the Nepalese communities in the United States (U.S.), despite the rapidly growing population of Nepalese immigrants. Methods To explore this issue, we conducted a questionnaire-based survey of Nepalese adults in Connecticut (CT). Results When compared to the reporting of the general CT population, a greater percentage of this survey's respondents report having trouble accessing necessary care (21.1% vs 11.0% in CT). Despite this, more Nepalese adults report satisfaction with the provider in terms of time spent during the visit (81.8% vs 76.0% in CT) and a consideration of values and beliefs during treatment (86.2% vs 70.0% in CT). In comparison with previous national reporting of the general U.S. population, Nepalese adults in the survey tend to have fewer total health care visits annually (87.1% reporting between zero and three visits vs. 64.7% in the U.S.). They also reported fewer dental visits (60.6% vs 71.0% in the U.S.). Conclusion While this novel study is one of the few examining health in the Nepalese population in the U.S., it serves as a foundation for future research in this area. Additionally, the results of the study highlight important disparities that local Nepalese organizations can use to design initiatives to improve this population's health.


AUDIOMAT: an electronic newspaper for visually impaired people.
Electronic newspapers are now becoming available via wide-area computer networks, such as the internet. Unfortunately, the Windows-based graphical user interface of the client programs makes it difficult for visually impaired people to use such services. Furthermore, few visually impaired people have a PC. The AUDIOMAT project was designed to provide a reading system for the visually impaired, thus giving this community in the Campania region of southern Italy the opportunity to read their local newspaper. In a pilot trial, three blind subjects used the AUDIOMAT system daily for two months. Despite some minor technical problems the system performed well and a wider validation phase is now planned.