Tissue oxygen saturation and finger perfusion index in central hypovolemia: influence of pain.
Tissue oxygen saturation and peripheral perfusion index are proposed as early indirect markers of hypovolemia in trauma patients. Hypovolemia is associated with increased sympathetic nervous activity. However, many other stimuli, such as pain, also increase sympathetic activity. Since pain is often present in trauma patients, its effect on the indirect measures of hypovolemia needs to be clarified. The aim of this study was, therefore, to explore the effects of hypovolemia and pain on tissue oxygen saturation (measurement sites: cerebral, deltoid, forearm, and thenar) and finger photoplethysmographic perfusion index. Experimental study. University hospital clinical circulation and research laboratory. Twenty healthy volunteers. Central hypovolemia was induced with lower body negative pressure (-60 mm Hg) and pain by the cold pressor test (ice water exposure). Interventions were performed in a 2×2 fashion with the combination of lower body negative pressure or not (normovolemia), and ice water or not (sham). Each subject was thus exposed to four experimental sequences, each lasting for 8 minutes. Measurements were averaged over 30 seconds. For each person and sequence, the minimal value was analyzed. Tissue oxygenation in all measurement sites and finger perfusion index were reduced during hypovolemia/sham compared with normovolemia/sham. Tissue oxygen saturation (except cerebral) and perfusion index were reduced by pain during normovolemia. There was a larger reduction in tissue oxygenation (all measurement sites) and perfusion index during hypovolemia and pain than during normovolemia and pain. Pain (cold pressor test) reduces tissue oxygen saturation in all measurement sites (except cerebral) and perfusion index. In the presence of pain, tissue oxygen saturation and perfusion index are further reduced by hypovolemia (lower body negative pressure, -60 mm Hg). Thus, pain must be considered when evaluating tissue oxygen saturation and perfusion index as markers of hypovolemia in trauma patients.


Androgen Activity Is Associated With PD-L1 Downregulation in Thyroid Cancer.
Thyroid cancer is the most prevalent endocrine malignancy in the United States with greater than 53,000 new cases in 2020. There is a significant gender disparity in disease incidence as well, with women developing thyroid cancer three times more often than men; however, the underlying cause of this disparity is poorly understood. Using RNA-sequencing, we profiled the immune landscape of papillary thyroid cancer (PTC) and identified a significant inverse correlation between androgen receptor (AR) levels and the immune checkpoint molecule PD-L1. The expression of PD-L1 was then measured in an androgen responsive-thyroid cancer cell line. Dihydrotestosterone (DHT) treatment resulted in significant reduction in surface PD-L1 expression in a time and dose-dependent manner. To determine if androgen-mediated PD-L1 downregulation was AR-dependent, we treated cells with flutamide, a selective AR antagonist, and prior to DHT treatment to pharmacologically inhibit AR-induced signaling. This resulted in a > 90% restoration of cell surface PD-L1 expression, suggesting a potential role for AR activity in PD-L1 regulation. Investigation into the AR binding sites showed AR activation impacts NF-kB signaling by increasing IkBα and by possibly preventing NF-kB translocation into the nucleus, reducing PD-L1 promoter activation. This study provides evidence of sex-hormone mediated regulation of immune checkpoint molecules in vitro with potential ramification for immunotherapies.


Cultivation of hybridoma cells in continuous cultures: kinetics of growth and product formation.
Mouse hybridoma cells were grown in suspension in continuous stirred bioreactors. Cell growth, substrate utilization, and monoclonal antibody (MAb) production were studied using serum-free medium. Steady-state data were obtained at different dilution rates, between 0.012 and 0.039 h(-1) Viability was profoundly affected by dilution rate, particularly near the lower end of the dilution-rate range investigated. MAb concentration and productivity went through a maximum with respect to dilution rate. Lactate yield on glucose declined with increasing dilution rate. Experiments were carried out to study the effects of medium glucose concentration on cell growth, product formation, and lactate yield on glucose. Reduction of glucose concentration in the feed medium did not considerably affect cell density and MAb concentration in the culture, but lactate levels dropped sharply; lactate yield on glucose declined substantially, indicating alterations in cell metabolic path ways for energy metabolism. Optimization strategy for continuous cell culture is discussed.


[Age and transformation dynamics of rectal vains and their alteration during hemorrhoid development].
Section and operative materials in persons of various age groups (108 cases in the norm and 197 cases with hemorrhoids) were investigated. Histometrically and macromicroscopically there were revealed veins of a trabecular structure and cavernous bodies in places of the most numerous contacts of the initial roots of the superior, middle and posterior rectal veins in the submucous base of anal columellas. At different stages of formation of hemorrhoids in various forms of phlebectasis (simple, varicous, and cavernous) most pronounced were histostructural changes in the form of endophlebitis and characteristic hypertrophic-atrophic processes of the media. In the process of varicous phlebectasis and formation of hemorrhoids in the cavernous form the ratio of the venous sinus wall thickness to the diameter of the lumen of the venous sinuses are drastically changed at the expense of enlargement of the latter.


Cuffed tracheal tubes in children: past, present and future.
This article reviews recent developments and core topics in the use and design of pediatric cuffed tracheal tubes. A concept for an appropriate pediatric cuffed tracheal tube is introduced. The main points in this concept are evidence-based tracheal tube size recommendation, continuous cuff pressure monitoring and a pediatric tracheal tube with an anatomically-based intubation depth mark and a short distally placed high-volume-low pressure cuff made from an ultra-thin polyurethane membrane with markedly improved tracheal sealing performance. The main points in proper handling of cuffed tracheal tubes in children are highlighted. Finally, an outlook on future developments in the design of pediatric cuffed tracheal tubes and an overview of tasks to be performed in evaluating them is given.


Expression of the theta class GST isozyme, YdfYdf, in low GST dogs.
We have reported the existence of low glutathione S-transferase (GST) dogs whose GST activity to 1,2-dichloro-4-nitrobenzene (DCNB) as a substrate (GST-D activity) is quite low, and have also reported significant individual differences in dog liver GST-D activity. The dogs were classified as "low", "middle", or "high" GST dogs based on their GST-D activity. In the present study, in order to investigate the causes of quite low GST-D activity in low GST dogs and the individual differences in dog GST-D activity, glutathione (GSH) conjugation of DCNB was kinetically analyzed. Moreover, liver cytosolic proteins whose expression levels were significantly lower in low GST dogs than in high GST dogs were identified by two-dimensional difference gel electrophoresis (2D-DIGE) and LC tandem mass spectrometry (LC/MS/MS). Interestingly, Vmax values for this reaction well reflected their GST-D activities in all groups, i.e. they were 3.8, 80.6, and 169.2 nmol/min/mg protein in the low, middle, and high GST dogs, respectively. However, Km values were almost the same (260.0-283.7 microM) among these groups. These suggest that GSH conjugation of DCNB should be catalyzed by the same enzyme in all the dogs, and individual differences in the GST-D activity should be the result of individual differences in the expression level of the GST isozyme, which catalyzes conjugation of DCNB. In 2D-DIGE, the expression levels of the two protein spots were significantly lower in the low GST dogs than in the high GST dogs. Positive good correlation (r > 0.800) was observed between GST-D activity and expression levels of these two protein spots. Moreover, expression levels were quite low in low GST dogs. These two proteins were both identified as the theta class GST isozyme, YdfYdf, which specifically catalyzes GSH conjugation of DCNB in dog livers. In the present study, we present two novel findings based on an enzyme kinetic study and protein-expression analysis: (1) GSTYdfYdf is expressed at quite a low level in the liver of low GST dogs, and (2) individual differences in dog liver GST-D activity would be due to individual differences in the expression level of GSTYdfYdf. Considering these findings, low GST dogs might have high susceptibility, including an unexpected toxicity at abnormal exposure to chemicals metabolized by GSTYdfYdf.


Estimating the effect of different work practices and technologies on labor efficiency within pasture-based dairy systems.
Herd size expansion combined with the seasonal workload on pasture-based dairy farms has led to an increased focus on techniques that can improve farm labor efficiency such as work practices and technologies. The objective of this study was to identify the work practices and technologies associated with labor efficiency of particular tasks, and estimate the time savings that could be made through their implementation during the period of peak labor input on spring-calving dairy farms. Data from an existing labor time-use study, completed from February 1 to June 30, 2019 (150 d), on 76 Irish dairy farms was used in conjunction with a survey on work practice and technology implementation. One hundred ten work practices and technologies were included in the initial survey, and of these, 59 were found to have an association with labor efficiency for their respective tasks. Best practice, regarding labor efficiency, was identified for the 59 work practices and technologies. An accumulation score was compiled for work practice and technology implementation; each farm received one point for each work practice or technology implemented. On average, farms implemented 31 labor-efficient work practices and technologies (ranging from 10-45). The most labor-efficient 25% of farms implemented a greater number of work practices and technologies (n = 37) than the least labor-efficient 25% of farms (n = 25). Multiple regression models estimated that each additional work practice or technology implemented would improve farm labor efficiency by 0.6 h/cow. Additionally, backward-regression models were used to predict the labor-savings associated with the most important work practices and technologies. Labor-savings were estimated for 12 significant individual work practices and technologies, of which 5 were related to milking, 4 to calf care, 2 to cow care, and one to grassland management. The work practices and technologies that offered the largest labor-savings included having one person in the milking pit during the mid-lactation period (-3.04 h/cow), having automatic cluster removers present (-2.55 h/cow) and contracting slurry spreading (-1.78 h/cow). This study focused on the variety of labor-efficient work practices and technologies available and highlighted those that farmers should focus on to improve labor efficiency. The results indicated that there is scope for improvement in the adoption of labor-saving work practices and technologies on many farms. The positive effect of implementing the identified labor-saving techniques on labor efficiency could be used to support future adoption.


A field trial of back belts to reduce the incidence of acute low back injuries in New York City home attendants.
To determine the effect of black belt use on the incidence of low back injury in home attendants, a cluster-randomized trial involving employees of nine home attendant agencies in New York City was conducted. Nine agencies employing 12,772 home attendants between June 1997 and September 1999 were randomized into three groups-one group received back belts with use instruction, one group received lifting advice only, and one group served as a control. Low back injury rates per 100 full-time equivalents and rate ratios adjusted for potential confounders were estimated with random-effects Poisson regression. The back-belt group had a lower rate of low back injury than did those in both the advice-only and control groups, though the differences were marginally significant. Age, body mass index, history of back injury, years worked as a home attendant, and level of exercise were associated with risk of low back injury. The findings suggest that use of back belts is associated with some reduction in risk of low back injury.


A cis-acting element present within the Gag open reading frame negatively impacts on the activity of the HIV-1 IRES.
Translation initiation from the human immunodeficiency virus type-1 (HIV-1) mRNA can occur through a cap or an IRES dependent mechanism. Cap-dependent translation initiation of the HIV-1 mRNA can be inhibited by the instability element (INS)-1, a cis-acting regulatory element present within the gag open reading frame (ORF). In this study we evaluated the impact of the INS-1 on HIV-1 IRES-mediated translation initiation. Using heterologous bicistronic mRNAs, we show that the INS-1 negatively impact on HIV-1 IRES-driven translation in in vitro and in cell-based experiments. Additionally, our results show that the inhibitory effect of the INS-1 is not general to all IRESes since it does not hinder translation driven by the HCV IRES. The inhibition by the INS-1 was partially rescued in cells by the overexpression of the viral Rev protein or hnRNPA1.


Atrial systole and ineffective pacemaker stimuli.
An unusual case of pacemaker failure induced by atrial activity is presented. The pacemaker stimulus was ineffective for ventricular capture not only with low energy output (decreased pulse duration) of the generator, but also with pulse width two to three times the stimulation threshold. The two possible mechanisms of this phenomenon, one electrotonic and the other mechanical, are discussed. This report strongly supports the mechanical hypothesis.


Bioactive phenylpropanoid analogues from Piper betle L. var. birkoli leaves.
Phytochemical analyses of the chloroform extract of Piper betle L. var. birkoli, Piperaceae, leaves led to the isolation of two new phenylpropanoid analogues: bis-chavicol dodecanoyl ester (2) and bis-hydroxychavicol dodecanoyl ester (3), along with one known compound: allyl-3-methoxy-4-hydroxybenzene (1) on the basis of spectroscopic data 1D (1H and 13C) and 2D (1H-1H COSY and HMBC) NMR, as well as ESI-MS, FT-IR, HR-ESI-MS and LC-ESI-MS. Compound 2 and 3 exhibited excellent antioxidant DPPH radical scavenging activity with IC50 values of 12.67 μg/mL and 1.08 μg/mL compared to ascorbic acid as a standard antioxidant drug with IC50 value of 6.60 μg/mL. Evaluation of cytotoxic activity against two human oral cancer cell lines (AW13516 and AW8507) showed significant effect with GI50 values of 19.61 and 23.01 μg/mL for compound 2 and 10.25 and 13.12 μg/mL for compound 3, compared to Doxorubicin® as a standard cytotoxic drug with GI50 value of < 10 μg/mL.


Systemic sclerosis-associated interstitial lung disease in a Vietnamese adult female: Case report and literature review.
Systemic sclerosis-associated interstitial lung disease (SSc-ILD) is a rare disease in the Asian population and might be overlooked in clinical practice. Early diagnosis is crucial to initiate treatment and to prevent disease progression. Chest high-resolution computed tomography (HRCT) is the modality of choice for diagnosing and assessing this disorder. SSc-ILD should be included in the list of differential diagnoses of ILD. Familiarity with HRCT findings and thorough clinical examination are crucial for diagnosis and treatment.


Stochastic dynamics of Type-I interferon responses.
Interferon (IFN) activates the transcription of several hundred of IFN stimulated genes (ISGs) that constitute a highly effective antiviral defense program. Cell-to-cell variability in the induction of ISGs is well documented, but its source and effects are not completely understood. The molecular mechanisms behind this heterogeneity have been related to randomness in molecular events taking place during the JAK-STAT signaling pathway. Here, we study the sources of variability in the induction of the IFN-alpha response by using MxA and IFIT1 activation as read-out. To this end, we integrate time-resolved flow cytometry data and stochastic modeling of the JAK-STAT signaling pathway. The complexity of the IFN response was matched by fitting probability distributions to time-course flow cytometry snapshots. Both, experimental data and simulations confirmed that the MxA and IFIT1 induction circuits generate graded responses rather than all-or-none responses. Subsequently, we quantify the size of the intrinsic variability at different steps in the pathway. We found that stochastic effects are transiently strong during the ligand-receptor activation steps and the formation of the ISGF3 complex, but negligible for the final induction of the studied ISGs. We conclude that the JAK-STAT signaling pathway is a robust biological circuit that efficiently transmits information under stochastic environments.


Making healthy baby contests more objective.
To assess the objectivity of the criteria chosen to judge a healthy baby contest. Cross-sectional study design. Urban Health Centre, Pune. Of the 998 children attending twelve anganwadis, who were screened preliminarily, 32 were chosen for the healthy baby contest. The contest was assessed using a specified scoring system in which due weightage was given to personal hygiene, growth, development, immunisation status and mother's knowledge about nutrition and vaccination. There was a significant intraobserver correlation (rs = 0.85, p < 0.05) and intraobserver correlation (rs = 0.92, p < 0.05). The scores were age independent. The criteria chosen were objective in nature. The objectivity of the criteria can make the assessment of the participants more unbiased, quick and easy. The results of the contests can be explained more easily and are more readily accepted. Thus, the healthy baby contests can be made more successful.


Te Whiringa Ora: person-centred and integrated care in the Eastern Bay of Plenty, New Zealand.
Te Whiringa Ora is a community-based programme in New Zealand that facilitates interdisciplinary care for patients and their family. It targets those with a chronic disease whom have high inpatient admissions or emergency department presentations. It is based in a rural part of New Zealand that has a large indigenous population, and a relatively high level of social deprivation. The programme makes use of culturally appropriate care coordinators, and uses telephone support and tele-monitoring to aid self-management. The programme has been running for three years and has shown a reduction on hospital presentations, as compared to an equivalent population (not enrolled in the programme). This case study outlines the programme, and focuses specifically on the implementation processes, and lessons learnt.


CINCH: an urban coalition for empowerment and action. Consortium for the Immunization of Norfolk's Children.
CINCH (Consortium for the Immunization of Norfolk's Children) is an urban coalition that was developed in 1993 to improve childhood immunization rates in Norfolk, Virginia. CINCH involves diverse citizens and institutions in effective community-based assessment, planning, and action. A needs assessment from 1993 found that only 49% of Norfolk 2-year-olds were adequately immunized. Using this data, CINCH developed a plan focused on education and communication, support for at-risk families, increased access to immunizations, and improved immunization delivery. After federal funding ended in 1995, members voted to expand the scope of the coalition to address additional child health needs and to broaden the membership. CINCH is a model for a sustainable city-citizen learning environment that intervenes to "help families help themselves to better health." The coalition is presented as an organization that focuses on community empowerment and development. The stages of coalition development and implications for coalition implementation in other sites are discussed.


Taxonomic study of the genus Evergestis Hübner, 1825 (Lepidoptera: Crambidae: Glaphyriinae) in Iran with description of a new species.
The Iranian species of the genus Evergestis were reviewed taxonomically and as a result, Evergestis pazukii sp. n. is described as a new species, E. comealis Amsel stat. n. is raised to species level from the subspecies E. caesialis comealis, and four species, namely E. flavifuscalis Rebel, E. limbata (Linnaeus), E. pechi (Bethune-Baker), and E. serratalis Staudinger are newly reported from Iran. Furthermore, the females of Evergestis africalis (Guenée), and E. nomadalis (Lederer), and the male of E. elbursalis Amsel are described and illustrated for the first time. A redescription of the male of E. hyrcanalis Amsel is provided mainly based on the genital structure, and the male and female genitalia of E. boursini Amsel and E. flavifuscalis Rebel are redescribed, respectively due to their poor descriptions. Additional remarks on the previousely reported species and new data on their distribution in Iran are also provided.


Natural selection and the emergence of a mutation phenotype: an update of the evolutionary synthesis considering mechanisms that affect genome variation.
Most descriptions of evolution assume that all mutations are completely random with respect to their potential effects on survival. However, much like other phenotypic variations that affect the survival of the descendants, intrinsic variations in the probability, type, and location of genetic change can feel the pressure of natural selection. From site-specific recombination to changes in polymerase fidelity and repair of DNA damage, an organism's gene products affect what genetic changes occur in its genome. Through the action of natural selection on these gene products, potentially favorable mutations can become more probable than random. With examples from variation in bacterial surface proteins to the vertebrate immune response, it is clear that a great deal of genetic change is better than "random" with respect to its potential effect on survival. Indeed, some potentially useful mutations are so probable that they can be viewed as being encoded implicitly in the genome. An updated evolutionary theory includes emergence, under selective pressure, of genomic information that affects the probability of different classes of mutation, with consequences for genome survival.


The radiation therapy of early stage cutaneous T-cell lymphoma.
Results of different radiotherapy schedules used for early stage (T1-2, N0-1, M0) cutaneous T-cell lymphoma (CTCL) are compared in a series of 45 patients (22 patients treated with high dose total skin electron beam therapy (TSEB) with curative intent, 18 patients treated with palliative radiotherapy, and 5 patients treated with high dose local electron beam). At 3, 5, and 10 years after diagnosis the high dose TSEB treatment group had a probability of overall survival of 91%, 86%, and 75%, respectively, compared with 94%, 88%, and 88% for the palliative treatment group. The complete response (CR) rate for the high dose TSEB treatment group was 82% (18/22), compared with a 57% (4/7) complete response rate for seven patients in the palliative group who received low dose TSEB (less than 25 Gy in 6-7 weeks) followed by daily application of topical mechlorethamine hydrochloride (HN2). However, the probability of continued remission at 3, 5, and 10 years was 44%, 44%, and 33%, respectively, for the high dose TSEB group and 25%, 25%, and 0%, respectively, for the low dose TSEB + HN2 group. The median disease-free survival was 17.5 months for the high dose TSEB group versus 5.5 months for the low dose TSEB + HN2 group. The five patients who were treated with high doses of local electrons to a single local field had an overall survival rate of 80%, a median survival rate of 64 months, and a median length of continued remission of 31 months. These results indicate that high-dose electron beam can result in long-term disease-free survival in patients with localized and limited extent skin involvement with cutaneous T-cell lymphoma.


Cortical activations in sequential bilateral cochlear implant users.
This study aimed to examine auditory and visual cortical activations in bilateral cochlear implant recipients using [(18)F]-FDG positron emission tomography. We aimed to compare the activations from use of the first implant alone, the second implant alone, and both implants together. When both implants were activated simultaneously, summation of cortical activity did not occur. The first and second implants demonstrated evidence of developing distinct neural networks. The first implants show stronger bilateral recruitment of the auditory areas than the second implants. Visual cortical activations occur in response to stimulation of the second but not the first implants. When both implants were activated together, there were no visual activations suggesting interaction between the first- and second-implant networks. These findings add to the existing knowledge of plasticity following cochlear implantation and demonstrate a variability of these processes that was previously unreported.


A Systematic Review and Meta-Analysis Investigating Head Trauma in Boxing.
Although physical trauma has been reported in boxing since its inception, boxing still appeals to athletes and spectators. This systematic review and meta-analysis assess both acute and chronic neurological and neuropsychological effects that boxing has on the brain. Further assessments in terms of comparisons of the concussion ratio in boxing to other combat sports, as well as the efficiency of wearing headguards, are also performed. This systematic review and meta-analysis used the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The outcomes incorporated included physical chronic abnormalities of the brain, neuropsychiatric, and neurological disorders sustained in amateur or professional boxing, in addition to the safety benefits of boxing headguards. Odds ratios, descriptive statistics, and inferential statistics are also reported. From the 84 articles reviewed, the 35 included articles suggested that boxers have a significantly elevated risk of sustaining a concussion compared with other combat sports (risk ratio [RR]: 0.253 vs RR: 0.065, P < 0.001). From the 631 amateur and professional boxers analyzed, 147 (23.30%) had cavum septum pellucidum, whereas 125 of 411 amateur and professional boxers (30.41%) presented with some form of brain atrophy. Dementia or amnesia was observed in 46 of 71 boxers (61.79%), 36 of 70 (51.43%) had various forms and severities of cognitive disorders, and 57 of 109 (52.29%) displayed abnormal computed tomography or electroencephalogram scan results. Utilization of headguards significantly increased the risk for stoppages in amateur bouts, compared with boxers not wearing a headguard (OR: 1.75 vs 0.53, P < 0.050). Boxing is a hazardous sport that has the potential to have fatal and negative life-changing results. Because of the limited reliable data regarding the efficiency of boxing headguards, future research should focus on the overall significance that headguards may have for reducing head trauma.


[E-health and the GP as gatekeeper; are the two compatible?].
Within the Dutch healthcare system the general practitioner functions as a "gatekeeper", deciding whether or not to refer the patient for specialist care. The introduction of e-health makes it easier for medical specialists to inform patients about their abilities in their own field. When they also offer to help the patient via e-health consultation they are, in practical terms, bypassing the gatekeeper. At the moment the Dutch healthcare system has no way of regulating payment for these services. Irrespective of the many advantages of e-health in the collaboration between primary and specialist care, we should carefully consider whether we want the gatekeeper to be bypassed in this way. This will be even more important if it results in extra costs for the healthcare system.


[Population based data in North Baden on malignant tumors of the gastrointestinal tract].
Population-based data of malignomas of the gastro-intestinal tract were evaluated from the regional cancer registry North-Baden for the period of 1971-1980. The age standardized incidence of oesophagus carcinomas shows a steady level of 4.5/100,000 (males) and 0.5/100,000 (females); the age standardized incidence of stomach carcinomas increased from 1971 to 1974, then shows a decline for both males and females, where the colon carcinomas show an increase of 80% for the same time period, also the cancer of the small intestines and of the rectum, increased slightly. Compared to data of other cancer registries the world standardized incidence of rectum carcinomas is of the same level as the data from the cancer registry of Bas-Rhin and is with an incidence of 25.8/100,000 males; 16.2/100,000 females above the incidence of all other cancer registries. The post-operative TNM-stage differs for the different primary topographies. Especially patients with colon carcinomas were operated when the carcinoma was in an advanced stage, patients with rectum carcinomas were operated at a less advanced stage. Male patients with an oesophagus carcinoma showed in a significant percentage an advanced smoking and alcohol consumption, compared to patients suffering from stomach, colon or rectum carcinomas. The specialized organisation of the cancer registry shows a high efficiency due to the requirements of the public health system, and is very useful in the evaluation of descriptive and analytic population-based cancer data.


Minority stress, depression, and cigarette smoking among Chinese gay versus bisexual men: a two-group structural equation model analyses.
Literature in the West suggested that bisexual men have a higher smoking rate compared to gay men. Data on patterns of smoking among gay and bisexual men are limited in Eastern Asian countries like China. This study examined the cigarette smoking prevalence for gay versus bisexual men in China and their unique minority stress - smoking pathways. Between September 2017 and November 2018, we surveyed a convenience sample of 538 gay men and 138 bisexual men recruited from local sexual minority organizations in four metropolitan cities in China (i.e., Beijing, Wuhan, Nanchang, and Changsha). Measures included sexual orientation, sociodemographics, theory-based minority stressors, depressive symptoms, and past 30-day cigarette smoking. Two-group (gay men vs. bisexual men) structural equation modeling (SEM) was used to test possible distinct mechanisms between theory-based stressors, depressive symptoms, and cigarette smoking among gay men and bisexual men, respectively. The mean age of participants was 26.51 (SD = 8.41) years old and 76.3% of them had at least a college degree. Bisexual men reported a higher rate of cigarette smoking compared to gay men (39.9% vs. 27.3%). Two-group SEM indicated that the pathways for cigarette smoking were not different between gay and bisexual men. Higher rejection anticipation was associated with greater depressive symptoms (standardized β = 0.32, p < .001), and depressive symptoms were not associated with cigarette smoking. Minority stress, specifically rejection anticipation, may be critical considerations in addressing depressive symptoms, but not smoking, among both gay and bisexual men in China.


Anthracene-Based Receptors with a Turn-on Fluorescence Response for Nitrate.
Herein we describe the design, synthesis, and anion binding properties of bicyclic receptors with two or three anthracenes, which show a turn-on fluorescence response in the presence of nitrate and chaotropic anions in a buffered aqueous solution. The receptor with two anthracenes binds nitrate with 103 M-1 affinity and stabilizes it in the inner cavity though electrostatic, hydrogen bonding, and anion-π interactions.


Prediction of 1500-m freestyle swimming times for older masters all-American swimmers.
Age-related changes in times of elite swimmers have indicated marked slowing at about age 70 - suggesting a discontinuity in aging processes related to physical performance. Overrepresentation of younger swimmers in United States Masters Swimming (USMS) data may also explain this shift. This study determined if age representation in USMS All-American records influenced predicted swimming times for older ages in 1500-m freestyle. Results indicated no influence. Thus, age-related changes in swimming times were predicted accurately using data from either all swimmers or just older swimmers, suggesting that different rates of slowing before and after age 70 represent biological or behavioral factors affecting physical performance and not simply a problem related to disproportionate sampling across age groups.


Controlling the type 1 error rate in non-inferiority trials.
Two different approaches have been proposed for establishing the efficacy of an experimental therapy through a non-inferiority trial: The fixed-margin approach involves first defining a non-inferiority margin and then demonstrating that the experimental therapy is not worse than the control by more than this amount, and the synthesis approach involves combining the data from the non-inferiority trial with the data from historical trials evaluating the effect of the control. In this paper, we introduce a unified approach that has both these approaches as special cases and show how the parameters of this approach can be selected to control the unconditional type 1 error rate in the presence of departures from the assumptions of assay sensitivity and constancy. It is shown that the fixed-margin approach can be extremely inefficient and that it is always possible to achieve equivalent control of the unconditional type 1 error rate, with higher power, by using an appropriately chosen synthesis method.


Investigation of the impacts of climate change and rising temperature on food poisoning cases in Malaysia.
This study is an attempt to investigate climate-induced increases in morbidity rates of food poisoning cases. Monthly food poisoning cases, average monthly meteorological data, and population data from 2004 to 2014 were obtained from the Malaysian Ministry of Health, Malaysian Meteorological Department, and Department of Statistics Malaysia, respectively. Poisson generalised linear models were developed to assess the association between climatic parameters and the number of reported food poisoning cases. The findings revealed that the food poisoning incidence in Malaysia during the 11 years study period was 561 cases per 100 000 population for the whole country. Among the cases, females and the ethnic Malays most frequently experienced food poisoning with incidence rates of 313 cases per 100,000 and 438 cases per 100,000 population over the period of 11 years, respectively. Most of the cases occurred within the active age of 13 to 35 years old. Temperature gave a significant impact on the incidence of food poisoning cases in Selangor (95% CI: 1.033-1.479; p = 0.020), Melaka (95% CI: 1.046-2.080; p = 0.027), Kelantan (95% CI: 1.129-1.958; p = 0.005), and Sabah (95% CI: 1.127-2.690; p = 0.012) while rainfall was a protective factor in Terengganu (95% CI: 0.996-0.999; p = 0.034) at lag 0 month. For a 1.0°C increase in temperature, the excess risk of food poisoning in each state can increase up to 74.1%, whereas for every 50 mm increase in rainfall, the risk of getting food poisoning decreased by almost 10%. The study concludes that climate does affect the distribution of food poisoning cases in Selangor, Melaka, Kelantan, Sabah, and Terengganu. Food poisoning cases in other states are not directly associated with temperature but related to monthly trends and seasonality.


Short-term clinical outcomes in delirious older patients: a study at general medical wards in a university hospital in Thailand.
Delirium, a common disorder in hospitalized older patients, frequently results in unfavorable consequences. Previous studies in different settings have provided conflicting results regarding clinical outcomes and mortality. We aimed to study three clinical outcomes--length of stay (LOS), in-hospital mortality and 3-month mortality--among delirious Thai older patients. A prospective observational study was carried out in a university hospital in Thailand. All patients aged older than 70 years admitted to general medical wards were included. Delirium assessments were undertaken within the first 24 h of admission and serially until discharge. Subsequent assessments were carried out at 3 months after discharge. Delirium was diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders fourth edition criteria. Factors associated with mortality were determined by using logistic regression models. LOS was significantly longer in the delirium group (10 and 8 days, P = 0.001). Furthermore, the delirium group had higher in-hospital and 3-month mortality (P < 0.001). Factors significantly associated with in-hospital mortality in multivariate analysis were age more than 80 years (AOR 2.74, 95% CI 1.05-7.15), malignancy (AOR 3.11, 95% CI 1.16-8.33), severe illness (AOR 3.75, 95% CI 1.38-10.20) and delirium (AOR 7.34, 95% CI 1.51-35.69). Delirium remained a strong predictor for 3-month mortality in multivariate analysis with AOR of 3.33 (95% CI 1.45-7.62) CONCLUSIONS: Delirium was associated with prolonged hospital-stay and was the strongest predictor for mortality among older hospitalized patients. It requires serious attention from physicians, healthcare administrators and policy makers to implement an appropriate management plan for this high-burden issue.


[Prognostic value of maximum standard uptake on pretreatment 18F-FDG PET/CT scan in newly diagnosed diffuse large B cell lymphoma].
To evaluate the prognostic value of maximum standard uptake (SUVmax) on pretreatment (18)F-fluoro-2-deoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) scan in patients with newly diagnosed diffuse large B cell lymphoma (DLBCL). The clinical data of 39 DLBCL patients undergoing a PET/CT scan at pre-treatment from December 2009 to October 2011 were analyzed retrospectively. SUVmax on PET/CT was evaluated by SPSS 13.0 for the associations with patient characteristics, prognostic factors, treatment efficacy and survival time. The median SUVmax was higher in non-germinal center B cell-like (non-GCB) patients than that in GCB ones (18.0(2.2 - 40.5) vs 11.6 (5.3 - 18.7), P = 0.039). No difference of SUVmax was observed between the patients with and without bulky disease (P = 0.539). SUVmax was not associated with such patient characteristics as international protein index, age, stage, Eastern Cooperative Oncology Group performance status, lactate dehydrogenase, number of extranodal involvement and Ki-67 (all P > 0.05). No significant difference in median SUVmax existed between complete remission (CR) and non-CR patients (P = 0.312). The difference of SUVmax was insignificant for the patients with efficacy and no efficacy (P = 0.243). With the cut-off values of 10, 15, 20, the CR rate, response rate, 2-year progression-free survival (PFS) rate and 2-year overall survival (OS) rate were not different between the patients with SUVmax below and above cut-off value (all P > 0.05). The prognostic value of SUVmax on PET/CT is indeterminate. And it can not be used to predict the patient prognosis.


Hypo- and hyperthermia in clinical auditory brain stem response measurement: two case reports.
Two case reports are presented to highlight the important effects of body temperature in clinical auditory brain stem response (ABR) measurement. Case 1 is an 11 year old boy in coma secondary to severe head injury. High dose barbiturate therapy suppressed brain stem neurologic signs and the ABR was relied on as a monitor of CNS status. Hypothermia during this period of intensive care was a crucial factor for meaningful interpretation of ABR findings. The second case was a 26 year old male undergoing hyperthermic therapy for advanced cancer. As body temperature increased from 38 to 42 degrees Centigrade (107.6 degrees Fahrenheit), there was a systematic decrease in latency for waves III and V. An overall hyperthermia-related decrease in the wave I-V latency interval of 0.5 to 0.6 milliseconds was observed on two test dates. ABR results for these two cases are discussed in the context of basic knowledge on body temperature and auditory electrophysiology.


Preparation, characterization, and complete heteronuclear NMR resonance assignments of the glutaredoxin (C14S)-ribonucleotide reductase B1 737-761 (C754S) mixed disulfide.
The first committed step in de novo DNA biosynthesis involves the conversion of ribonucleotides to the corresponding deoxyribonucleotides catalyzed by the enzyme ribonucleotide reductase. Reduction of disulfides in ribonucleotide reductase is essential and is catalyzed by the protein disulfide reductants glutaredoxin or thioredoxin. The interaction region between Escherichia coli glutaredoxin-1 and E. coli ribonucleotide reductase has been localized to the C-terminal end of the B1 subunit of ribonucleotide reductase. We have demonstrated that a 25-residue peptide corresponding to this C-terminal sequence is a very good substrate for glutaredoxin via a fluorescence assay and that this peptide binds in a specific manner via isothermal titration calorimetric measurements. By selectively mutating the two cysteines in the peptide, we have identified the electrophilic cysteine as C759 (B1 numbering) and prepared a mixed disulfide between E. coli glutaredoxin-1 (C14 --> S) and the C759 monothiol form of the peptide. The peptide and the protein have been labeled with 13C and 15N, and complete heteronuclear NMR resonance assignments have been completed for both the peptide and the protein in the complex. By using half-filtered NOESY spectra, intermolecular NOEs between the protein and the peptide have been identified and the binding site on glutaredoxin has been mapped. The electrostatic charge distribution of the protein in this region is very positive, thus providing an excellent match for the highly negatively charged peptide. In addition, the electrostatic potential of the peptide provides a rationale for the observed cysteine selectivity in the reaction between glutaredoxin and the B1 peptide.


Assessment of the criteria for elective surgery in screen-detected abdominal aortic aneurysms.
Apart from aortic diameter, two other widely used criteria for considering surgery in screen-detected abdominal aortic aneurysms (AAAs)--annual aortic expansion > or =1.0 cm and presence of symptoms attributable to the AAA--are based on accepted practice and AAA expansion rates, rather than direct evidence. The Multi-centre Aneurysm Screening Study (MASS) enables assessment of their contribution to this risk reduction. MASS employs three criteria for referral for considering elective open surgery: maximum aortic diameter > or =5.5 cm, rapid aortic expansion (> or =1.0 cm/year), and/or the presence of symptoms attributable to the AAA. Data from MASS are used to examine the value of these criteria in practice. No patients were referred for symptoms alone. Of those referred for rapid expansion, 88% were returned to surveillance, compared with only 12% of those referred for diameter > or =5.5 cm at initial scan, and 34% of those referred for diameter > or =5.5 cm at a follow-up scan. Return to surveillance following referral for rapid expansion was strongly associated with aortic diameter (age-adjusted odds ratio for return 0.89 per mm, 95% confidence interval 0.79-1.00). Of those 5.0-5.4 cm at the time of referral for rapid expansion who were returned, 31% reached 5.5 cm during a median post-referral follow-up of 0.9 years. Among those referred for expansion, the rupture rate was only 8 per 1000 person-years of follow-up prior to reaching 5.5 cm. A single criterion for considering elective surgery is recommended in screen-detected AAA, based on a maximum aortic diameter of > or =5.5 cm. This criterion detects the majority of those at risk from rupture, and is simple to assess.


[Four-year changes in ganglion cell complex thickness in homonymous hemianopia].
Aquired transsynaptic retrograde degeneration of the human visual system can be identified using magnetic resonance imaging (MRI) and optical coherence tomography (OCT), which can reveal optic tract atrophy, retinal nerve fiber layer loss, and ganglion cell complex (GCC) thinning. We investigated GCC changes in the first 4 years following post-geniculate lesions. Nine patients with congruous homonymous hemianopia were scanned with OCT. A 6-mm circle centered on the macula was divided vertically into hemianopia (H) and unaffected (U) sides. GCC and retinal thicknesses were calculated using an average for both eyes and compared with the hemianopia/unaffected side (H/U) ratio. The relationship between the H/U ratio of GCC and time elapsed since occipital damage was evaluated. The average GCC thicknesses was 89.1 and 96.6 microm, and of the retina 295.7 microm and 292.7 microm in the H and U sides, respectively. The H/U ratio of GCC at 0.92 was significantly lower than of the retina at 0.99 (p=0.042). Regression analysis revealed a negative linear relationship (linear regression r= -0.868, p= 0.012) described by the equation: H/U ratio of GCC = 0.99 - 0.004 x elapsed time (months). For 4 years following post-geniculate damage, GCC on the hemianopia side decreased approximately 5% per year while the retinal thickness was almost unchanged.


Operation mode selection of NIMBY facility Public Private Partnership projects.
Construction of not in my back yard (NIMBY) facility Public Private Partnership (PPP) projects are feasible measures to realize sustainable urbanization. In order to ensure the smooth development of the NIMBY facility PPP projects, the problem of choosing the most suitable operation mode among many PPP modes is still scarce and unscientific. In order to select the operation mode of the PPP projects that best fits the characteristics of the project, this paper constructs the operation mode selection of the NIMBY facility PPP project. Firstly, the index system of operation mode selection of the NIMBY facility PPP project is determined. G1 subjective weighting method and information entropy objective weighting method are introduced to solve the optimal weight of each index. Grey correlation theory is used to improve TOPSIS method, and the calculation form of relative proximity degree is optimized to determine the most suitable operation mode for the project. In this paper, combined weighting and TOPSIS method are applied to the research of NIMBY facility PPP project, and the operation mode selection of NIMBY facility PPP project is established, which makes up the blank of this part. Finally, a PPP project in Qingdao, Shandong Province, China, is taken as an example to verify the applicability of the model. The effectiveness of this model was tested by comparing the results of TOPSIS method, Grey target model, Extended matter-element mode and GRA-TOPSIS. It is hoped to provide useful reference for the operation mode selection of NIMBY facility PPP project.


Prophylaxis and treatment of chronic synovitis in haemophilia patients with inhibitors.
Prophylaxis is paramount to try to avoid the development of haemophilic synovitis. The best treatment for synovitis in patients with inhibitors is radioactive synoviorthesis (rhenium for ankle and elbows, yttrium for knees). With both methods (prohylaxis and radioactive synoviorthesis), we can delay the development of severe haemophilic arthropathy, that eventually will require major orthopaedic surgery.


Cystine-dependent antiporters buffer against excess intracellular reactive sulfur species-induced stress.
Reactive sulfur species (RSS) play a role in redox homeostasis; however, adaptive cell responses to excessive intracellular RSS are not well understood. Therefore, in this study, we generated transgenic (Tg) mice overexpressing cystathionine gamma-lyase (CSE) to produce excessive RSS. Contrary to expectations, tissue concentrations of RSS, such as cysteine persulfide (CysSSH), were comparable in both wild-type and CSE Tg mice, but the plasma concentrations of CysSSH were significantly higher in CSE Tg mice than in wild-type mice. This export of surplus intracellular RSS was also observed in primary hepatocytes of CSE Tg mice. Exposure of primary hepatocytes to the RSS generator sodium tetrasulfide (Na2S4) resulted in an initial increase in the intracellular concentration of RSS, which later returned to basal levels after export into the extracellular space. Interestingly, among all amino acids, cystine (CysSSCys) was found to be essential for CysSSH export from primary mouse hepatocytes, HepG2 cells, and HEK293 cells during Na2S4 exposure, suggesting that the cystine/glutamate transporter (SLC7A11) contributes, at least partially, to CysSSH export. We established HepG2 cell lines with knockout and overexpression of SLC7A11 and used them to confirm SLC7A11 as the predominant antiporter of CysSSCys and CysSSH. We observed that the poor efflux of excess CysSSH from the cell enhanced cellular stresses induced by Na2S4 exposure, such as polysulfidation of intracellular proteins, mitochondrial damage, and cytotoxicity. These results suggest the presence of a cellular response to excess intracellular RSS that involves the extracellular efflux of excess CysSSH by a cystine-dependent transporter to maintain intracellular redox homeostasis.


Prevention of Bovine Mastitis through Vaccination.
Cow mastitis is one of the main factors of economic damage in modern animal husbandry. It is registered to affect almost everywhere, taking into account the subclinical form from 30% to 50% of the livestock per year. Economic losses of farms from the diseases of cows with mastitis are due to a decrease in milk productivity, precocious cow disposal, a decrease in the grade and sale price of market milk, and treatment costs. This study aimed to use a safer method in the prevention and control of mastitis in cows, and vaccinations could be a solution to this problem. Vaccination promotes acquired immunity to a specific pathogen and also has few side effects. A bacteriological study of clinical and subclinical forms of mastitis was conducted to study the etiology of mastitis in cows in various farms of Kazakhstan. A total of 1,068 milk samples from 767 cows were examined. The studies were carried out according to "Guidelines for bacteriological studies of milk and udder secretions of cows". The primary selection of cultures was carried out based on growth characteristics on media and microscopy of preparations from individual colonies. Morphological, cultural, and biochemical properties of the isolated cultures were studied according to generally accepted schemes. Identification of the selected cultures was carried out using Bergey's determinant. The strain numbers of Staphylococci, Streptococci, Escherichia, Klebsiella, Diplococci, and Protea were 590 (55.2%), 240 (22.4%), 151 (14.1%), 50 (4.7%), 24 (2.3%), and 13 (1.3%), respectively. The greatest strain numbers of Staphylococci (n=351) and Streptococci (n=129) were isolated from cow's milk with subclinical mastitis. The effectiveness of the polyvalent vaccine used was determined by the manifestation of clinical and subclinical forms of mastitis. Out of 600 immunized cows, 9 (1.5%) and 13 (2.3%) animals developed subclinical and clinical mastitis, respectively. Furthermore, out of 150 cows taken into control, 12 (8%) and 10 (6.6%) animals developed subclinical and clinical mastitis, respectively. Furthermore, out of 12 cows with clinical mastitis, 5 cows previously had a subclinical form. Vaccination takes a significant place in the control of infectious diseases. The success of vaccine prevention depends on the quality of vaccines and timely vaccination coverage of threatened populations. Modern immunology and vaccine prevention have summed up the theoretical basis and outlined ways to improve vaccines in the direction of creating new harmless effective vaccines.


Aberrant HOXC expression accompanies the malignant phenotype in human prostate.
Dysregulation of HOX gene expression has been implicated as a factor in malignancies for a number of years. However, no consensus has emerged regarding specific causative genes. Using a degenerate reverse transcription-PCR technique, we show up-regulation of genes from the HOXC cluster in malignant prostate cell lines and lymph node metastases. When relative expression levels of the four HOX clusters were examined, lymph node metastases and cell lines derived from lymph node metastases exhibited very similar patterns, patterns distinct from those in benign cells or malignant cell lines derived from other tumor sites. Specific reverse transcription-PCR for HOXC4, HOXC5, HOXC6, and HOXC8 confirmed overexpression of these genes in malignant cell lines and lymph node metastases. Laser capture microdissection and examination of paired tumor/normal prostate epithelial cells also indicated overexpression of these HOXC genes in primary tumor cells. Our data indicate a possible link between expression of HOXC genes and malignancy in prostate cells. Overexpression of HOXC8 in LNCaP prostate cancer cells suppressed transactivation by androgen receptors. We speculate that HOXC overexpression may predispose tumor cells to androgen independence by necessitating adaptation to diminished androgen signaling.


Expression profiling and functional analysis reveals that TOR is a key player in regulating photosynthesis and phytohormone signaling pathways in Arabidopsis.
Target of rapamycin (TOR) acts as a master regulator to control cell growth by integrating nutrient, energy, and growth factors in all eukaryotic species. TOR plays an evolutionarily conserved role in regulating the transcription of genes associated with anabolic and catabolic processes in Arabidopsis, but little is known about the functions of TOR in photosynthesis and phytohormone signaling, which are unique features of plants. In this study, AZD8055 (AZD) was screened as the strongest active-site TOR inhibitor (asTORi) in Arabidopsis compared with TORIN1 and KU63794 (KU). Gene expression profiles were evaluated using RNA-seq after treating Arabidopsis seedlings with AZD. More than three-fold differentially expressed genes (DEGs) were identified in AZD-treated plants relative to rapamycin-treated plants in previous studies. Most of the DEGs and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways involved in cell wall elongation, ribosome biogenesis, and cell autophagy were common to both AZD- and rapamycin-treated samples, but AZD displayed much broader and more efficient inhibition of TOR compared with rapamycin. Importantly, the suppression of TOR by AZD resulted in remodeling of the expression profile of the genes associated with photosynthesis and various phytohormones, indicating that TOR plays a crucial role in modulating photosynthesis and phytohormone signaling in Arabidopsis. These newly identified DEGs expand the understanding of TOR signaling in plants. This study elucidates the novel functions of TOR in photosynthesis and phytohormone signaling and provides a platform to study the downstream targets of TOR in Arabidopsis.


Enantioselective inhibition of carprofen towards UDP-glucuronosyltransferase (UGT) 2B7.
UDP-glucuronosyltransferases (UGTs)-catalyzed glucuronidation conjugation reaction plays an important role in the elimination of many important clinical drugs and endogenous substances. The present study aims to investigate the enantioselective inhibition of carprofen towards UGT isoforms. In vitro a recombinant UGT isoforms-catalyzed 4-methylumbelliferone (4-MU) glucuronidation incubation mixture was used to screen the inhibition potential of (R)-carprofen and (S)-carprofen towards multiple UGT isoforms. The results showed that (S)-carprofen exhibited stronger inhibition potential than (R)-carprofen towards UGT2B7. However, no significant difference was observed for the inhibition of (R)-carprofen and (S)-carprofen towards other UGT isoforms. Furthermore, the inhibition kinetic behavior was compared for the inhibition of (S)-carprofen and (R)-carprofen towards UGT2B7. A Lineweaver-Burk plot showed that both (S)-carprofen and (R)-carprofen exhibited competitive inhibition towards UGT2B7-catalyzed 4-MU glucuronidation. The inhibition kinetic parameter (Ki ) was calculated to be 7.0 μM and 31.1 μM for (S)-carprofen and (R)-carprofen, respectively. Based on the standard for drug-drug interaction, the threshold for (S)-carprofen and (R)-carprofen to induce a drug-drug interaction is 0.7 μM and 3.1 μM, respectively. In conclusion, enantioselective inhibition of carprofen towards UDP-glucuronosyltransferase (UGT) 2B7 was demonstrated in the present study. Using the in vitro inhibition kinetic parameter, the concentration threshold of (S)-carprofen and (R)-carprofen to possibly induce the drug-drug interaction was obtained. Therefore, clinical monitoring of the plasma concentration of (S)-carprofen is more important than (R)-carprofen to avoid a possible drug-drug interaction between carprofen and the drugs mainly undergoing UGT2B7-catalyzed metabolism.


Using light transmission to watch hydrogen diffuse.
Because of its light weight and small size, hydrogen exhibits one of the fastest diffusion rates in solid materials, comparable to the diffusion rate of liquid water molecules at room temperature. The diffusion rate is determined by an intricate combination of quantum effects and dynamic interplay with the displacement of host atoms that is still only partially understood. Here we present direct observations of the spatial and temporal changes in the diffusion-induced concentration profiles in a vanadium single crystal and we show that the results represent the experimental counterpart of the full time and spatial solution of Fick's diffusion equation. We validate the approach by determining the diffusion rate of hydrogen in a single crystal vanadium (001) film, with net diffusion in the [110] direction.


Coronary artery calcification in patients with CRF not undergoing dialysis.
Coronary artery calcification (CAC) correlates with the extent of coronary atherosclerosis and, consequently, with an increased risk for cardiovascular events. CAC is more frequent in uremic patients than in the general population. Nearly all data about CAC relate to patients on dialysis therapy. This study evaluates the prevalence and extent of CAC in patients with chronic renal failure (CRF) not yet on dialysis therapy. Consecutive outpatients with CRF not on dialysis therapy were enrolled and compared with controls (ie, healthy volunteers and patients with essential hypertension with normal renal function). Patients and controls were asymptomatic and had no previous history of myocardial infarction, coronary bypass surgery, or angioplasty. Patients with diabetes were excluded. Clinical characteristics, biochemical test results (included homocysteinemia and C-reactive protein level), and serum concentrations of calcium, phosphorus, and intact parathyroid hormone (iPTH) were evaluated in patients and controls. CACs were searched for and scored by means of spiral computed tomography (CT). To assess the CAC progression rate, spiral CT was repeated in some patients. Eighty-five patients and 55 controls were studied. Patients were aged 52 +/- 13 years and had a CRF duration of 6.3 +/- 5.6 years, glomerular filtration rate of 33.0 +/- 16.0 mL/min (0.55 +/- 0.27 mL/s), serum calcium level of 9.5 +/- 0.5 mg/dL (2.37 +/- 0.12 mmol/L), serum phosphorus level of 4.1 +/- 0.9 mg/dL (1.32 +/- 0.29 mmol/L), and serum iPTH level of 143 +/- 121 pg/mL (ng/L). CAC was found in 40% of patients and 13% of controls; calcification scores were 422 +/- 634 in patients and 43.9 +/- 33 in controls. Only age ( P < 0.001) was a predictor of CAC. In patients with a repeated score performed (after a mean of 7.9 months), calcification scores increased (from 383 +/- 627 to 682 +/- 890) in 8 of 10 patients. CAC is already present in the early phase of CRF; the prevalence is greater in patients with CRF than in controls, but less than that reported in dialysis patients. Serum concentrations of calcium, phosphorus, iPTH, and inflammation markers do not predict the appearance or progression of CAC.


Reducing stereotyped behaviour: a comparison of two methods of programming differential reinforcement.
Differential Reinforcement of Other behaviours (DRO) has proven to be successful in reducing challenging behaviour, although the need for staff vigilance can limit its applicability in applied settings. The present study compared the effectiveness of whole-interval DRO with momentary DRO, a less intensive schedule. In a multiple-baseline design, two participants who exhibited high-rate stereotyped behaviours were presented with the two schedules. Momentary DRO was more effective than whole-interval DRO in reducing the targeted stereotypies of one participant, and as effective with the second. Momentary DRO was also more effective in reducing a second (non-consequated) stereotyped behaviour.


Trace metal levels in uncontaminated groundwater of a coastal watershed: importance of colloidal forms.
Groundwater and surface water were collected using trace metal clean techniques from the upper glacial aquifer of West Neck Bay (Shelter Island) in eastern Long Island, NY, during the late spring and summer of 1999. The collection sites on Shelter Island are located in an area that is primarily residential and believed to have uncontaminated groundwater. Ultrafiltration was used to size-fractionate the dissolved (<0.45 microm) fraction into colloidal (1 kDa - 0.45 microm) and low molecular weight (<1 kDa) size pools. These fractions were analyzed for trace metals (Al, Ag, Cd, Cu, Mn, Pb, and Zn), organic carbon, and inorganic nutrients (NH4, NO3, PO4). The levels of metals and organic carbon in the groundwater were as low as those found in the open ocean, far removed from anthropogenic inputs. These findings corroborate the need to apply trace metal clean techniques in the determination of metal levels in uncontaminated groundwater. A significant fraction of dissolved metals (22-96%) and organic carbon (approximately 40%) in the groundwater and in surface waters of the Bay was found to be associated with colloids. The significance of the metal association with the colloidal fraction decreased in the order of Al > Cu > Ag > Zn = Cd = Mn and appeared to be dependent on the affinities of these metals for humic substances. In contrast, NO3 and NH4 were found to be almost entirely (approximately 98-99%) in the low molecular weight size fraction. Metal/aluminum and metal/carbon ratios measured in the colloids were similar to those reported for humic substances and significantly different from those of soils. This suggests that colloidal particles might originate from humic materials as opposed to purely inorganic minerals. These results indicate the need to consider the colloidal fraction in the fate and mobility of metals in groundwater and that, despite the low levels of organic matter (<50 microM of DOC) measured in groundwater, some groundwater colloids appear to be organic in nature.


Development of a rapid "fingerprinting" system for wine authenticity by mid-infrared spectroscopy.
This paper reports on the development of a rapid and simple method for red wine authenticity confirmation during transport and processing; namely, a wine "fingerprinting" system. When wine is transported between two sites, a sample is taken and a mid-infrared (MIR) spectrum is obtained. One hundred sixty-one (n = 161) samples of three main red wine varieties grown in Australia, Shiraz, Cabernet Sauvignon, and Merlot, were collected from six commercial wineries across Australia and scanned in transmission on two MIR spectrophotometers located at The Hardy Wine Company's main site at Reynella, South Australia (Foss WineScan FT 120) (926-5012 cm-1). A similarity index (SI) method was used as a tool to classify wine samples on the basis of their spectral data. The results showed that high rates of classification were obtained when wine samples scanned in different instruments were analyzed. The SI has been proven to provide an acceptable measurement for authentication of red wine integrity during transportation. In five of the six winery data sets, the SI correctly classified 98% of the wines. It was also observed that less than 1% of wines were misclassified between the different wineries investigated. Further studies are needed in order to test the applicability of the SI in a commercial situation and to evaluate its potential as a rapid quality control tool for routine use to authenticate wine samples during transport.


Time course changes of scratching counts, dermatitis symptoms, and levels of cutaneous prostaglandins in NC/Nga mice.
NC/Nga (NC) mice are known to develop dermatitis resembling atopic dermatitis (AD) in conventional (Conv) conditions, but not in specific pathogen-free (SPF) conditions. We reported that the ability of skin prostaglandin D(2) (PGD(2)) production, which might be the endogenous inhibitor of itching, was attenuated in skin-lesioned Conv-NC mice. We examined the age-related change in scratching, dermatitis symptoms, and skin PGs of SPF- and Conv-NC mice. In Conv-NC, PGD(2) increased at 7 weeks, at which scratching counts increased, but dermatitis did not develop. PGE(2), PGI(2) and PGF(2alpha) increased at 10 and 13 weeks, at which dermatitis developed. The ability to produce skin PGs was examined by measuring PGs after application of arachidonic acid or after mechanical scratching using a wire brush. In Conv-NC, PGD(2) production at 13 weeks was lower than at 7 weeks. In Conv-NC, hematopoietic PGD synthase (hPGDS) expression in the skin at 13 weeks was lower than at 7 weeks by Western blotting and immunohistochemical analysis. The increase of skin PGD(2) level in the early phase of the development of dermatitis is due to the stress of extensive scratching, but did not increase in spite of the stress of extensive scratching in the late phase, due to decreasing capacity of PGD(2) production attributable to decreasing hPGDS expression in Conv-NC mice. These results suggest that a decreased ability to produce skin PGD(2) production could enhance scratching and aggravate dermatitis in Conv-NC mice.


Linguistic validation of the Greek M.D. Anderson Symptom Inventory - Head and Neck Module.
BACKGROUND: Our goal is to linguistically validate the Greek translation of the M.D. Anderson Symptom Inventory Index - Head and Neck Module. PATIENTS & METHODS: Following forward and backward translation of the previously validated head and neck cancer specific items of the English MDASI-HN into Greek (G-MDASI-HN), it was administered along with a cognitive debriefing to head and neck cancer patients able to read and understand Greek. Individual and group responses are presented using descriptive statistics. RESULTS: From 02/2009 through 06/2009 30 subjects with head and neck cancer completed the G-MDASI-HN followed by completion of the accompanying cognitive debriefing. Ninety-eight percent of the individual G-MDASI-HN items were completed. "Voice" item was not completed by 5 patients. Average time to complete the G-MDASI-HN was 13.3 minutes. Average ease of completion was rated at 1.21 on a 0 to 10 scale with "0" being "very easy" and "10" being "very hard". Only 10% of patients reported trouble completing any item, namely "distress" and "numbness". CONCLUSIONS: The Greek-MDASI-HN is linguistically valid and a patient-reported instrument that can be used both in outcomes research and as a clinical tool.


SKINTED: an uncommon cutaneous complication of total knee replacement.
Surgery of the knee, injury to the infrapatellar branch of the saphenous nerve, traumatic eczematous dermatitis (SKINTED) involving the skin lateral to the surgical incision/scar area is a site- and procedure-specific diagnosis associated with total knee replacement surgery. It results from autonomic denervation following surgical trauma to the nerve and occurs months to years after surgical trauma. It needs to be differentiated from post traumatic eczema/dermatitis, neuropathic dermatitis and contact dermatitis/sensitization due to topical therapies or implant material. Herein, we report a case of 70-year-old woman having no preexisting medical or dermatological disorder of significance presenting with eczematous lesions around both knees lateral to the incision site developing few months after bilateral total knee replacement surgery. Treatment with twice daily application of betamethasone dipropionate 0.05% cream, gabapentine 100 mg/d PO and liberal use of bland emollient cream given over 2 months was remittive without recurrence during more than one year of follow up. Since its exact prevalence, pathophysiology and clinical course remain uncertain its awareness remains relevant to both dermatologists and orthopedic surgeons to address unnecessary anxiety and dissatisfaction of the patient.


Source and item memory for odors and objects in children and young adults.
Recall and recognition memory for odors are poorer in children than in adolescents. In addition, children perform worse than young adults on source memory tasks using visual and auditory stimuli. However, source memory for odor stimuli has not been examined in children. This study investigated source and item memory for odors and objects in children (7-10 years old) and young adults (18-24 years old). During the study phase, 1 male and 1 female experimenter (sources) randomly presented either 16 odors or 16 objects to the participant. Presentation alternated between sources so that each source presented 8 stimuli. Once the 16 stimuli were presented, the sources exited and a third experimenter began the test phase. To assess item recognition memory, a stimulus from the study phase and a novel stimulus were presented to the participant who was asked to choose the stimulus presented during the study phase. Source memory was assessed with the 8 stimuli from the study phase not used in the item memory task. The experimenter presented a stimulus and asked whether the male or female experimenter had presented the stimulus during the study phase. Results indicate that difference scores between item and source memory for odors were significantly larger for children than for young adults, indicating poorer source memory for children than adults. Difference scores for objects did not distinguish between groups. It has been suggested that the frontal lobes play a critical role in source memory and odor memory--a brain region that continues to develop into adolescence. Poor performance among children on the source memory task for odors may be due in part to immaturity of the frontal lobes.


gp340 (SAG) binds to the V3 sequence of gp120 important for chemokine receptor interaction.
Human saliva contains multiple components that inhibit HIV-1 infection in vitro, which may contribute to low oral HIV-1 transmission. Salivary agglutinin (SAG) is a high-molecular-weight glycoprotein encoded by DMBT-1 and identical to gp340, a member of the lung scavange receptor, cysteine-rich receptor family. gp340 binds to surfactants A and D, which is believed to function in the clearance of microorganisms from the lung, as part of the innate immune response. Previously we reported that SAG (gp340) specifically inhibits HIV-1 infection with broad activity against diverse HIV-1 isolates. This gp340 inhibitory activity is mediated by binding to viral gp120 and involves a region different from the CD4-binding site on gp120. Here, we report that the gp340-binding region is localized to a linear, highly conserved sequence near the stem of the V3 loop that is critical for chemokine receptor interaction during viral binding and infection. The interaction of gp340 with gp120 is enhanced by prebinding of sCD4 to gp120, suggesting that gp340 inhibitory activity is mediated by blocking access of the gp120 to the chemokine receptor.


[Development of jurisprudence concerning the medical contract in esthetic surgery].
The authors report a study of 60 years of French Jurisprudence in relation to the medical contract in cosmetic surgery. Although the obligation can only be in the form of means in the case of surgery of living tissues, a special obligation nevertheless applies when the operation is not performed as a therapeutic procedure but at the patient's wishes. It is an obligation of caution and diligence, respecting the role of proportionality in the indications and the means applied to obtain the desired objective and the safety of the patient. The application of these means will be judged by the magistrate more severely than in therapeutic surgery. A certain degree of laxity in the investigation of a causal relationship in civil law has led to the use of the concept of decreased chance of survival for the compensation of victims of serious complications occurring during cosmetic surgical operations.


Trends in sepsis-related neonatal mortality in the United States, 1985-1998.
In the United States, bacterial sepsis affects up to 32,000 live births annually. In the 1990s, intrapartum antibiotic prophylaxis (IAP) was recommended to prevent maternal-infant transmission of group B Streptococcus (GBS), a leading cause of sepsis occurring in the first week of life (early onset sepsis). Since IAP has been used, early onset GBS disease declined 70%; however, increased antibiotic use associated with IAP might lead to more severe or antimicrobial resistant etiologies of sepsis. To understand the influence of IAP on neonatal sepsis, in general, we evaluated neonatal mortality from sepsis before and after IAP recommendations were issued. Using the National Center for Health Statistics Linked Birth/Infant Death Datasets, we compared trends in sepsis-related early neonatal mortality (<7 days) and late neonatal mortality (7-27 days) among singleton United States births from 1985 through 1991 to 1995 through 1998 [data beyond 1998 not included because of International Classification of Diseases (ICD)-10/ICD-9 coding differences]. We compared trends in mortality between the 2 time periods by estimating the average annual percent change in mortality using log linear regression and stratified by gestational age. Combined early and late neonatal mortality from sepsis averaged 39.6/100,000 live births from 1985 through 1991 and 31.8/100,000 live births from 1995 through 1998. Early neonatal mortality from sepsis averaged 24.9/100,000 live births from 1985 through 1991 and 15.6 from 1995 through 1998; late neonatal mortality averaged 14.8/100,000 live births from 1985 through 1991 and 16.2 from 1995 through 1998. Early neonatal mortality declined more steeply after IAP recommendations were issued, 5.0% annually from 1995 through 1998 versus 3.0% annually from 1985 through 1991. Late neonatal mortality increased more from 1995 through 1998, 5.0% annually compared with 0.5% from 1985 through 1991. Lower mortality rates and greater declines in early neonatal mortality from sepsis during 1995-1998 indicate greater survival of infants beyond 7 days of life and suggest an association with GBS disease prevention efforts. Thus these findings provide some evidence for continuing IAP for GBS-colonized women. Our findings of apparent increasing trends in late neonatal mortality from sepsis necessitate follow-up with clinical studies.


Density and diameter of dentinal tubules of first and second primary human molars--comparative scanning electron microscopy study.
The aim of the present survey was to evaluate tubule density and diameter of dentin of first and second primary human molars and compare the two dental categories. These evaluations were done solely at the middle third of the crowns of twenty extracted noncarious teeth separated in two groups (first molars and second molars). The tubule diameters observed were 0. 794 microm and 1.0 microm for first and second molars, respectively (measurements done at 35-65% from the pulp-chamber walls). Regarding tubular density, the measurements indicated 17,997.594 tubules/mm2 and 25,211.317 tubules/mm2 for first and second molars, respectively. Comparisons between-groups indicated that tubule diameter and density of dentin were higher in second molars, being the difference highly significant (P<0.01).


Nutrition and oral health.
The link between nutrition and oral health can be overt (vitamin B deficiency) or subtle (exacerbation of already existing periodontal disease). Medical, social, and clinical examinations can be useful tools for uncovering those patients at risk for nutrition deficiencies and can be used to guide these patients to healthy eating. Along with routine home care instruction, the practicing dentist and hygienist can provide a service for patients through nutrition counseling and by pointing out reputable sources of nutrient supplements.


CT volumetric measurement of colorectal cancer helps predict tumor staging and prognosis.
To evaluate feasibility of CT colonography (CTC) volumetry of colorectal cancer (CRC) and its correlation with disease stage and patients' survival. CTC volumetry was performed for 126 patients who underwent preoperative CTC. Reproducibility of tumor volume (Tvol) between two readers was assessed. One-way ANOVA and ROC analysis evaluated correlation between Tvol and pTNM staging. ROC analysis compared diagnostic performance to predict pTNM staging between Tvol and radiologist. Kaplan-Meier test compared overall survival. Reproducibility among readers was excellent (interclass correlation = 0.9829). Mean Tvol showed an incremental trend with T stage and Tvol of pT4b stage was significantly larger than other stages (P<0.0001). Az value (0.780) of Tvol to predict pT4b stage was significantly larger than that (0.591) of radiologist (P = 0.004). However, Tvol was not significantly different according to pN stage. Az values (0.723~0.857) of Tvol to predict M1 or M1b were comparable to those (0.772~0.690) of radiologist (P>0.05). Smaller tumor burden (≤12.85cm3), ≤T3, N0, M0 stages, and curative surgery were significantly associated with patients' longer survival (P<0.05). CT volumetry has a limited value to predict N stage; however, it may outperform the radiologist's performance when predicting pT4b and M1b stage and can be a useful prognostic marker.


Global regression model for moisture content determination using near-infrared spectroscopy.
Near-infrared (NIR) global quantitative models were evaluated for the moisture content (MC) determination of three different freeze-dried drug products. The quantitative models were based on 3822 spectra measured on two identical spectrometers to include variability. The MC, measured with the reference Karl Fischer (KF) method, were ranged from 0.05% to 4.96%. Linear and non-linear regression models using Partial Least Square (PLS), Decision Tree (DT), Bayesian Ridge Regression (Bayes-RR), K-Nearest Neighbors (KNN), and Support Vector Regression (SVR) algorithms were created and evaluated. Among them, the SVR model was retained for a global application. The Standard Error of Calibration (SEC) and the Standard Error of Prediction (SEP) were respectively 0.12% and 0.15%. This model was then evaluated in terms of total error and risk-based assessment, linearity, and accuracy. It was observed that MC can be fastly and simultaneously determined in freeze-dried pharmaceutical products thanks to a global NIR model created with different medicines. This innovative approach allows to speed up the validation time and the in-lab release analyses.


[Photodynamic diagnosis of urothelial neoplasms after intravesicular instillation of 5-aminolevulinic acid].
Following transurethral resection of bladder cancer, the fate of patients is clearly related to the presence or absence of precancerous or malignant lesions in the remaining mucosa. We report on a new procedure for in situ diagnosis of these flat, hardly visible urothelial lesions. The method is based on tumor-selective accumulation of endogenous protoporphyrin IX following intravesical instillation of 5-aminolevulinic acid. On excitation with violet light even tiny papillary tumors, dysplastic lesions and carcinoma in situ are bright fluorescing red. In 15 patients 26 neoplastic lesions had been diagnosed only by protoporphyrin IX fluorescence. False-negative results have not yet been observed. In 84% of 285 evaluable specimens the fluorescence findings corresponded correctly with the microscopic findings. It is expected that photodynamic diagnosis will become a matter of routine in detection of bladder cancer.


WHO and national lists of essential medicines in Mexico, Central and South America, and the Caribbean: are they adequate to promote paediatric endocrinology and diabetes care?
Paediatric endocrinology and diabetes is a paediatric specialty with less common conditions and higher cost medicines. Access to medicines for our specialty in low and middle income countries remains limited. We analysed the content of the WHO (children and adults) and of all available national Model Lists of Essential Medicines (EMLs) for Mexico, the Caribbean, Central and South America from a paediatric endocrinology and diabetes standpoint. A master list of medicines deemed necessary in paediatric endocrinology and diabetes was established and compared with the WHO and national EMLs, taking into account the gross national income. The WHO EMLs, which are largely recognised as an international benchmark and drive the content of the national EMLs, included many but not all medicines present on our master list. Interestingly, several national EMLs from richer countries included medicines that were not present in the WHO EMLs. Our analysis suggests that these medicines could be considered by the WHO for inclusion in their EMLs, which may promote the adoption of more medicines by individual countries. We also propose several changes to the WHO and national EMLs that could facilitate access to medicines in our specialty: age cut-off for a child using physical maturity rather than a set age limit; greater standardisation of the formatting of the national EMLs for easier comparison and collaborations between countries; greater emphasis on age-specificity and population-specificity for some medicines; and formatting of the EMLs in a disease-focused manner rather than as individual medicines.


Secondary health care: best practices in the health services network.
to understand the organization of health practices, based on the interactions at the secondary care level, and to analyze how the actions and services at this level of care contribute to the development of best practice in health. a qualitative approach, based in Grounded Theory. Data was obtained from individual interviews, with managers, health care professionals and health service users making up the sample group representing the secondary level of healthcare. The theoretical model was formulated based on four categories, analyzed based in the elements of the network modeling of health care theoretical framework. The organization of health practices at a secondary level is in the process of consolidation and is contributing to the development of best practices in the locale studied. The broadening of access to consultations and specialized procedures, and the articulation of the network's points, are aspects of this level of care which are considered essential for care which is effective and integral. This study contributes to the analysis of health practices from the perspective of network modeling, based on the interactions between secondary care and the health system's other health facilities, which are shown as going through a process of consolidation in the locale studied.


The pecked cross symbol in ancient mesoamerica.
Attention is directed to a design, possibly of Teotihuacan origin, carved both in rock and in the floors of ceremonial buildings throughout ancient Mesoamerica. Consisting generally of a double circular pattern centered on a set of orthogonal axes, the so-called pecked cross or quartered circle figure is shown to exhibit a remarkable consistency in appearance throughout its 29 reported locations, thus suggesting that it was not perfunctory. The metric properties of the symbols gleaned from field surveys are delineated, and several interpretations of their possible functions are discussed. These symbols may have been intended as astronomical orientational devices, surveyor's bench marks, calendars, or ritual games. Evidence is presented which implies that more than one and perhaps all of these functions were employed simultaneously, a view which is shown to be consistent with the cosmological attitude of the pre-Columbian people.


Combined in situ Physical and ex-situ Biochemical Approaches to Investigate in vitro Deconstruction of Destarched Wheat Bran by Enzymes Cocktail Used in Animal Nutrition.
Wheat bran is a foodstuff containing more than 40% of non-starch polysaccharides (NSPs) that are hardly digestible by monogastric animals. Therefore, cocktails enriched of hydrolytic enzymes (termed NSPases) are commonly provided as feed additives in animal nutrition. However, how these enzymes cocktails contribute to NSPs deconstruction remains largely unknown. This question was addressed by employing an original methodology that makes use of a multi-instrumented bioreactor that allows to dynamically monitor enzymes in action and to extract in-situ physical and ex-situ biochemical data from this monitoring. We report here that the deconstruction of destarched wheat bran by an industrial enzymes cocktail termed Rovabio® was entailed by two concurrent events: a particles fragmentation that caused in <2 h a 70% drop of the suspension viscosity and a solubilization that released <30 % of the wheat bran NSPs. Upon longer exposure, the fragmentation of particles continued at a very slow rate without any further solubilization. Contrary to this cocktail, xylanase C alone caused a moderate 25% drop of viscosity and a very weak fragmentation. However, the amount of xylose and arabinose from solubilized sugars after 6 h treatment with this enzyme was similar to that obtained after 2 h with Rovabio®. Altogether, this multi-scale analysis supported the synergistic action of enzymes mixture to readily solubilize complex polysaccharides, and revealed that in spite of the richness and diversity of hydrolytic enzymes in the cocktail, the deconstruction of NSPs in wheat bran was largely incomplete.


Determination of aldicarb, carbofuran and some of their main metabolites in groundwater by application of micellar electrokinetic capillary chromatography with diode-array detection and solid-phase extraction.
This paper describes a UV detection method for the pesticides aldicarb and carbofuran, and some of their main metabolites, aldicarb-sulfoxide, aldicarb-sulfone and 3-hydroxy-carbofuran, in ground waters. Micellar electrokinetic chromatography (MEKC) with diode-array detection was developed for their determination at 210 nm. The experimental study was performed using sodium dodecyl sulfate (SDS) at a concentration level of 140 mM, and a buffer of borax/HCl 20 mM at pH 8 which gives the best resolution with an analysis time of less than 20 min. Different instrumental parameters such as voltage (23 kV), injection time (12 s) and temperature (25 degrees C) were optimized. The detection limits were in the range 2-7.4 microg glitre(-1) by solid-phase extraction (SPE) with a subsequent evaporation step. Groundwater spiked samples were pre-concentrated off-line with graphite carbon and subsequently analyzed by MEKC with diode-array detection yielding average recoveries between 77 and 97% (n = 4) with RSD between 2-7%.


Assessing the impact of a fistula after a pancreaticoduodenectomy using the Post-operative Morbidity Index.
The Post-operative Morbidity Index (PMI) is a quantitative utility measure of a complication burden created by severity weighting. The Fistula Risk Score (FRS) is a validated model that predicts whether a patient will develop a post-operative pancreatic fistula (POPF). These novel tools might provide further discrimination of the ISGPF grading system. From 2001 to 2012, 1021 pancreaticoduodenectomies were performed at four institutions. POPFs were categorized by ISGPF standards. PMI scores were calculated based on the Modified Accordion Severity Grading System. FRS scores were assigned according to the relative influence of four recognized factors for developing a clinically relevant POPF (CR-POPF). In total, 231 patients (22.6%) developed a POPF, of which 54.1% were CR-POPFs. The PMI differed significantly between the ISGPF grades and patients with no or non-fistulous complications (P < 0.001). 64.9% of POPFs and 84.0% of CR-POPFs contributed the highest Accordion grade to the PMI. Overall, the FRS correlated well with PMI (R(2) = 0.81, P < 0.001). These data quantitatively reinforce the ISGPF grades that were developed qualitatively around the concept of clinical severity. CR-POPFs usually reflect the patient's highest Accordion score whereas biochemical POPFs are often superseded. The correlation between FRS and PMI indicates that risk factors for a fistula contribute to overall pancreaticoduodenectomy morbidity.


Serum growth hormone-binding protein (GHBP) in domestic animals as measured by ELISA.
This research was conducted to develop and characterize a competitive ELISA for bovine serum growth hormone-binding protein (GHBP) using recombinant bovine GHBP and a polyclonal rabbit antiserum. In addition to bovine, however, the assay was found to measure some activity in equine, chicken, porcine, ovine, and human sera. The reference standard curve had an effective range of 3 to 200 ng/mL. Recovery of increasing amounts of GHBP added to ovine serum was 103% but seemed to overestimate the amount of GHBP at low concentrations (intercept = 2.5 ng/mL). Recovery from bovine and porcine serum was near ideal but seems to be overestimated at concentrations higher than 50 ng/microL. Within and between assay coefficients of variation were 12.1 and 18.9%, respectively, for a sheep serum pool. Neither exogenous GH (20 ng/mL) nor prolactin (100 ng/mL) interfered with the measurement of GHBP in serum. The GHBP activity measured in increasing doses of serum from ovine, porcine, and bovine inhibited the assay in a parallel manner. This observation suggests that the GHBP antiserum contains antibodies that are directed toward epitopes of GHBP, which are common among these species. Serum GHBP concentrations were similar among samples from a line of miniature Brahman and normal stature Brahman and Angus cattle. In mature ewes, there were no differences in serum GHBP among three different breed types. An increase (P < .0001) in serum GHBP was observed in pigs between 1 and 6 mo of age but no sex effect was observed.(ABSTRACT TRUNCATED AT 250 WORDS)


Autonomous surgical robotic systems and the liability dilemma.
Advances in machine learning and robotics have allowed the development of increasingly autonomous robotic systems which are able to make decisions and learn from experience. This distribution of decision-making away from human supervision poses a legal challenge for determining liability. The iRobotSurgeon survey aimed to explore public opinion towards the issue of liability with robotic surgical systems. The survey included five hypothetical scenarios where a patient comes to harm and the respondent needs to determine who they believe is most responsible: the surgeon, the robot manufacturer, the hospital, or another party. A total of 2,191 completed surveys were gathered evaluating 10,955 individual scenario responses from 78 countries spanning 6 continents. The survey demonstrated a pattern in which participants were sensitive to shifts from fully surgeon-controlled scenarios to scenarios in which robotic systems played a larger role in decision-making such that surgeons were blamed less. However, there was a limit to this shift with human surgeons still being ascribed blame in scenarios of autonomous robotic systems where humans had no role in decision-making. Importantly, there was no clear consensus among respondents where to allocate blame in the case of harm occurring from a fully autonomous system. The iRobotSurgeon Survey demonstrated a dilemma among respondents on who to blame when harm is caused by a fully autonomous surgical robotic system. Importantly, it also showed that the surgeon is ascribed blame even when they have had no role in decision-making which adds weight to concerns that human operators could act as "moral crumple zones" and bear the brunt of legal responsibility when a complex autonomous system causes harm.


Survivability of freeze- and spray-dried probiotics and their effects on the growth and health performance of broilers.
Many strains of probiotics have been exploited and used as animal dietary supplements for broiler production. The efficacy and survival of probiotics during production may reflect better activities of the probiotics in the host. This study investigated the effects of freeze- and spray-drying on the survivability and properties of probiotics and their ability to improve the growth and health performance of broilers. Probiotic powders of four strains of lactic acid bacteria, Enterococcus faecium CA4, Enterococcus durans CH33, Ligilactobacillus salivarius CH24, Pediococcus acidilactici SH8, and Bacillus subtilis KKU213, were prepared using rice bran/chitosan/carboxy methyl cellulose as the carrier. The survival of each probiotic strain was investigated under stress conditions, including freeze-drying, spray-drying, and simulated gastrointestinal conditions. The body weight gain (BWG) and intestinal histomorphology were determined to assess broiler growth performance. All dried probiotics yielded a high survival rate during freeze-drying (95.8-98.6%) and spray-drying (94.4-98.2%). In addition, an analysis of the main effect revealed that the effectiveness of freeze-drying was higher than that of spray-drying in minimizing the loss of cell viability. The antimicrobial activity of all immobilized dried probiotic strains against Salmonella was maintained. The immobilized probiotics tolerated a low pH value of 2.0 and 0.5% (w/v) bile salt. Probiotic administration of a mixture of the five dried probiotics to 1-day-old hatched male broilers at early and late ages resulted in potential colonization in the broiler intestine, and enhancements in the BWG, lipid metabolism, and gut health (villus height and cryptal depth) were observed in the probiotic-treated groups. The administration of three doses of the spray-dried probiotic mixture at days 15, 17, and 19 after hatching was sufficient to achieve long-term growth and health benefits in broilers. This finding might provide a cost-effective alternative to the administration of commonly used antibiotics in broiler production.


PLS performance analysis of the vertical UWOC system with perfect and imperfect CSI.
Although underwater wireless optical communication (UWOC) receives much interest lately, security issues associated with it get little attention. In this work, it is the first attempt to investigate the physical layer security (PLS) performance of the vertical UWOC system with perfect and imperfect channel state information (CSI). Specifically speaking, the communication between two legitimate peers in the presence of an external eavesdropper is studied from the information-theoretic security perspective. Assuming that turbulence-induced fading over the vertical UWOC links is respectively subject to cascaded lognormal (LN) and Gamma-Gamma (GG) distributions for weak and moderate/strong turbulence conditions, and the angular pointing error is randomized by the Beckmann distribution, the composite cascaded statistical fading models are derived with the comprehensive effects of path loss, underwater turbulence, angular pointing errors, and channel estimation error. On the basis of these models, analysis frameworks of the probability of strictly positive secrecy capacity (SPSC), secrecy outage probability (SOP), and average secrecy capacity (ASC) are further obtained for this UWOC system, which are confirmed by Monte Carlo (MC) simulations. Furthermore, the effects including the number of layers, the level of channel estimation error, the link distance, the location of the eavesdropper, the quality of the main and eavesdropping channels on this system are analyzed for different water conditions. The presented results give valuable insights into the practical aspects of deployment of UWOC networks.


Placental Lipid and Fatty Acid Transfer in Maternal Overnutrition.
The increasing incidence of childhood obesity is a significant public health challenge, the consequences of which extend across the life course. Diet and exercise are clearly the major contributors to childhood obesity, but the factors predisposing to obesity may become established in the womb. Worryingly maternal overnutrition, in particular when it leads to obesity and diabetes, perpetuate an intergenerational cycle of obesity through its effects on placental function and fetal metabolism. This review will address the ways in which the placental lipid and fatty acid transfer may lay the foundations for obesity in the context of maternal overnutrition. Key Messages: (1) Metabolic changes associated with maternal obesity affect placental nutrient handling. (2) Altered placental nutrient handling may induce pro-adipogenic changes in the fetus, in particular increased fetal insulin. (3) Understanding the effects of maternal obesity on the placenta will aid the development of effective interventions to optimise pregnancy outcomes.


Uterine anomalies associated with unilateral renal agenesis.
Six cases of concomitant uterine anomalies and absent kidney are reported. Five of these were obstructive in type, 2 representing a mother and daughter relationship. The importance of investigation of the genitourinary system in the presence of uterine anomaly is emphasized. Fertility is unimpaired but obstetric complications are common, especially premature delivery and breech presentation. Treatment can be simple--drainage of unilateral hematocolpos--but excision of the septum may be necessary. The abnormal embryonic development is reviewed.