Exciton scattering approach for branched conjugated molecules and complexes. IV. Transition dipoles and optical spectra.
The electronic excitation energies and transition dipole moments are the essential ingredients to compute an optical spectrum of any molecular system. Here we extend the exciton scattering (ES) approach, originally developed for computing excitation energies in branched conjugated molecules, to the calculation of the transition dipole moments. The ES parameters that characterize contributions of molecular building blocks to the total transition dipole can be extracted from the quantum-chemical calculations of the excited states in simple molecular fragments. Using these extracted parameters, one can then effortlessly calculate the oscillator strengths and optical spectra of various large molecular structures. We illustrate application of this extended ES approach using an example of phenylacetylene-based molecules. Absorption spectra predicted by the ES approach show close agreement with the results of the reference quantum-chemical calculations.


Precise metabolic flux analysis of coryneform bacteria by gas chromatography-mass spectrometry and verification by nuclear magnetic resonance.
Precise metabolic flux analysis (MFA) by gas chromatography-mass spectrometry (GC-MS) and computer calculation was performed, and the consistency of the estimated results was verified by independently performed nuclear magnetic resonance (NMR) analysis. The precise estimation of flux by the integration method of the mass isotopomer signal, defined as the coefficient of variance (CV) of multiple determination, was investigated, and the results estimated using different data sets with the same magnitude of error were confirmed. The CV of multiple determinations was sufficiently small to discuss and compare the fluxes of a metabolic pathway. The estimated fluxes using the GC-MS data were cross-validated with the NMR data that were independently measured and not used for MFA. The developed method was successfully applied to the MFA of the growth phase of two different glutamate-producing coryneform bacteria, Corynebacterium glutamicum and C. efficiens. The difference in the growth rate between these two bacterial species was discussed while considering the results of MFA, including forward and backward (exchange) fluxes.


Cathepsin B-like and hemoglobin-type cysteine proteases: stage-specific gene expression in Angiostrongy cantonensis.
Three cysteine protease genes, cathepsin B-like enzyme gene 1, 2 (AC-cathB-1, AC-cathB-2) and hemoglobin-type cysteine protease gene (AC-hem) were isolated and described from Angiostrongylus cantonensis adult. The deduced amino acid sequence of Ac-cathB-1 and AC-cathB-2 contain all of the conserved regions of cathepsin B. AC-cathB-2 is similar to a host intrusion-related cysteine protease B from Parelaphostrongylus tenuis, and the AC-hem shares high similarity to legumain from Haemonchus contortus. AC-cathB-1 was expressed significantly higher in L1 as compared with AC-hem, the AC-cathB-2 followed; AC-cathB-2 transcripts in L3 were found increased rapidly and obviously abundant, suggesting that AC-cathB-1 and AC-cathB-2 may play an important role in intermediate and final host invasion, separately. The cysteine protease genes were more or less expressed in adult stage excepted for AC-cathB-2. As the AC-cathB-1 and AC-hem highly expressed in adult worms, suggesting AC-hem may activate AC-cathB-1 which involved in the host invasion and feeding process.


[Variability in invertebrate behavior and the problem of free will].
Behavior in animals, including invertebrates, varies spontaneously. The spontaneous variability results from nonlinear stochastic processes in nervous system. Some researchers believe this stochastic variability to be a basis for free will. Their arguments are as follows. The stochastic variability simultaneously generates different variants of behavior. As a result, animals have an opportunity to choose from possible behaviors. This ability to choose voluntarily is a core of free will. Manifestations of free will in invertebrates and humans differ quantitatively only. We dispute this viewpoint. Stochastic processes do not generate different variants of behavior simultaneously. Therefore, stochasticity does not provide animals with a real choice. This does mean that there is no proof for free will in invertebrates.


[Antibiofilm activity of agents for disinfection of skin, mucosa, and wound on microorganisms isolated from patients with catheter-related infections].
To evaluate the activity of four disinfectious agents used for skin, mucosa and wound disinfection (chlorhexidine digluconate, povidone-iodine, octenidine hydrochloride, super oxygenated water) on the biofilm of Staphylococcus aureus, Escherichia coli and Candida sp. strains, isolated from patients with catheter-related infections. The tested agents were applied on 24-hours biofilm in the microtiter plate wells. After 20-minutes exposition, the wells were washed, and the microbial vitality was tested by regrowth method after 24-hours cultivation in fresh culture medium. Biofilm formation was confirmed in a parallel microtiter plate; the quantity of produced biofilm was measured after crystal violet staining spectrophotometrically at 570 nm. All four tested disinfectious agents inactivated the biofilm of all S. aureus, E. coli, C. albicans, C. krusei and C. glabrata strains, without respect to the intensity of biofilm production. Three strains of C. tropicalis with intensive biofilm production partially preserved their vitality after exposition to chlorhexidine and povidone-iodine, and 2 strains to octenidine. Super oxygenated water had no effect on yeasts associated with massive biofilm of one C. tropicalis strain, and only partially decreased the vitality of additional two strains. The tested disinfectious agents proved in-vitro antibiofilm activity on all microbial strains from catheter-related infections, with exception of three C. tropicalis strains with intensive biofilm production. Octenidine was found to be the most active agent. The results enable to assume, that the tested disinfectious agents, when applied to patients, will inactivate not only the individual microorganisms not protected by biofilm, but also the biofilm on the catheter surfaces approachable by local application. However, C. tropicalis strains producing massive biofilm, protecting them partially from effects of disinfectious agents tested in the present study, still remain a challenge.


Pancreatic Squamous Cell Carcinoma.
Pancreatic squamous cell carcinoma (SCC) is a rare event. Here, we present a 56-year-old man with pancreatic SCC. Imaging methods demonstrated a hypodense mass at the head and trunk of the pancreas. Also, some lymphadenopathy has been seen around the pancreas and para-aorta. The mass created pressure and encasement on the celiac trunk, portal vein, and arteries of the liver and spleen. Endoscopic ultrasound showed a mass lesion of 45-37 mm (mixed echoic) at the trunk of the pancreas. Histological examination of the endoscopic ultrasound-guided fine needle aspiration specimen confirmed the diagnosis of SCC. The disease is highly aggressive, most often locally advanced or metastatic at diagnosis, and poorly responsive to treatment. It also has generally poor survival rates.


New insights into the impact of neuro-inflammation in rheumatoid arthritis.
Rheumatoid arthritis (RA) is considered to be, in many respects, an archetypal autoimmune disease that causes activation of pro-inflammatory pathways resulting in joint and systemic inflammation. RA remains a major clinical problem with the development of several new therapies targeted at cytokine inhibition in recent years. In RA, biologic therapies targeted at inhibition of tumor necrosis factor alpha (TNFα) have been shown to reduce joint inflammation, limit erosive change, reduce disability and improve quality of life. The cytokine TNFα has a central role in systemic RA inflammation and has also been shown to have pro-inflammatory effects in the brain. Emerging data suggests there is an important bidirectional communication between the brain and immune system in inflammatory conditions like RA. Recent work has shown how TNF inhibitor therapy in people with RA is protective for Alzheimer's disease. Functional MRI studies to measure brain activation in people with RA to stimulus by finger joint compression, have also shown that those who responded to TNF inhibition showed a significantly greater activation volume in thalamic, limbic, and associative areas of the brain than non-responders. Infections are the main risk of therapies with biologic drugs and infections have been shown to be related to disease flares in RA. Recent basic science data has also emerged suggesting that bacterial components including lipopolysaccharide induce pain by directly activating sensory neurons that modulate inflammation, a previously unsuspected role for the nervous system in host-pathogen interactions. In this review, we discuss the current evidence for neuro-inflammation as an important factor that impacts on disease persistence and pain in RA.


The Intricacies of Survivor's Guilt: Exploring Its Phenomenon Across Contexts.
Survivor's guilt is the response to an event that some people experience when they survive a traumatic event or situation that others did not. This psychological phenomenon can be associated with post-traumatic stress disorder (PTSD), anxiety disorders, and complicated grief. Survivor's guilt is described as the manifestation of tension, distress, or solitude that is triggered by a celebration of life, references to the deceased, and expressions of sympathy. Survivor's guilt is difficult to treat, and the treatment will depend on the severity of the patient's symptoms and the individual's specific needs. This symptom is often overlooked, as it gets grouped into the broader recognized disorder of PTSD. It has been studied within various contexts, including instances of multiple causality, bereaved populations, and HIV-positive men.


Active transport of 3H-bretylium in the rat vas deferens in vitro.
The uptake and efflux of 3H-bretylium in slices of the rat vas deferens were examined. The uptake of bretylium was temperature, Na+ and Cl- dependent, sensitive to 6-hydroxydopamine but insensitive to reserpine. The uptake was inhibited by desipramine, (+)-amphetamine, imipramine methiodide and cocaine, whereas the local anaesthetics millicaine and lidocaine were poor inhibitors. The spontaneous efflux was very slow at 0 degrees C and slow at 37 degrees. Desipramine accelerated the efflux probably by inhibiting the re-uptake of bretylium. (+)-Amphetamine, low external Na+, high external K+ and ouabain caused a pronounced increase in the efflux at 37 degrees C but was almost without effect at 0 degrees C. The efflux evoked by (+)-amphetamine, low Na+ and ouabain was inhibited by desipramine, imipramine methiodide and cocaine, whereas millicaine and lidocaine had very poor effects. The increase of bretylium efflux by hypertonic K+ was only slightly inhibited by desipramine and partially antagonized by omission of Ca2+ in the medium. The results obtained indicate that bretylium was taken up in noradrenergic neurones by the noradrenaline transport mechanism and that the efflux of bretylium produced by (+)-amphetamine, low external Na+, low external Cl- and by ouabain occurred by the same transport mechanism as the uptake but now working in the outward direction whereas the efflux induced by high K+ seemed to occur mainly with another mechanism.


Moderate Protein Restriction Protects Against Focal Cerebral Ischemia in Mice by Mechanisms Involving Anti-inflammatory and Anti-oxidant Responses.
Food composition influences stroke risk, but its effects on ischemic injury and neurological deficits are poorly examined. While severe reduction of protein content was found to aggravate neurological impairment and brain injury as a consequence of combined energy-protein malnutrition, moderate protein restriction not resulting in energy deprivation was recently suggested to protect against perinatal hypoxia-ischemia. Male C57BL6/j mice were exposed to moderate protein restriction by providing a normocaloric diet containing 8% protein (control: 20% protein) for 7, 14, or 30 days. Intraluminal middle cerebral artery occlusion was then induced. Mice were sacrificed 24 h later. Irrespective of the duration of food modification (that is, 7-30 days), protein restriction reduced neurological impairment of ischemic mice revealed by a global and focal deficit score. Prolonged protein restriction over 30 days also reduced infarct volume, brain edema, and blood-brain barrier permeability and increased the survival of NeuN+ neurons in the core of the stroke (i.e., striatum). Neuroprotection by prolonged protein restriction went along with reduced brain infiltration of CD45+ leukocytes and reduced expression of inducible NO synthase and interleukin-1β. As potential mechanisms, increased levels of the NAD-dependent deacetylase sirtuin-1 and anti-oxidant glutathione peroxidase-3 were noted in ischemic brain tissue. Irrespective of the protein restriction duration, a shift from pro-oxidant oxidative stress markers (NADPH oxidase-4) to anti-oxidant markers (superoxide dismutase-1/2, glutathione peroxidase-3 and catalase) was found in the liver. Moderate protein restriction protects against ischemia in the adult brain. Accordingly, dietary modifications may be efficacious strategies promoting stroke outcome.


Five-year-olds do not show ambiguity aversion in a risk and ambiguity task with physical objects.
Ambiguity aversion arises when a decision maker prefers risky gambles with known probabilities over equivalent ambiguous gambles with unknown probabilities. This phenomenon has been consistently observed in adults across a large body of empirical work. Evaluating ambiguity aversion in young children, however, has posed methodological challenges because probabilistic representations appropriate for adults might not be understood by young children. Here, we established a novel method for representing risk and ambiguity with physical objects that overcomes previous methodological limitations and allows us to measure ambiguity aversion in young children. We found that individual 5-year-olds exhibited consistent choice preferences and, as a group, exhibited no ambiguity aversion in a task that evokes ambiguity aversion in adults. Across individuals, 5-year-olds exhibited greater variance in ambiguity preferences compared with adults tested under similar conditions. This suggests that ambiguity aversion is absent during early childhood and emerges over the course of development.


Oesophageal cancer mortality in Spain: a spatial analysis.
Oesophageal carcinoma is one of the most common cancers worldwide. Its incidence and mortality rates show a wide geographical variation at a world and regional level. Geographic mapping of age-standardized, cause-specific death rates at a municipal level could be a helpful and powerful tool for providing clues leading to a better understanding of its aetiology. This study sought to describe the geographic distribution of oesophageal cancer mortality for Spain's 8077 towns, using the autoregressive spatial model proposed by Besag, York and Mollié. Maps were plotted, depicting standardised mortality ratios, smoothed relative risk (RR) estimates, and the spatial pattern of the posterior probability of RR being greater than 1. Important differences associated with area of residence were observed in risk of dying from oesophageal cancer in Spain during the study period (1989-1998). Among men, excess risk appeared across the north of the country, along a band spanning the length of the Cantabrian coastline, Navarre, the north of Castile & León and the north-west of La Rioja. Excess risk was likewise observed in the provinces of Cadiz and part of Seville in Andalusia, the islands of Tenerife and Gran Canaria, and some towns in the Barcelona and Gerona areas. Among women, there was a noteworthy absence of risk along the mid-section of the Cantabrian seaboard, and increases in mortality, not observed for men, in the west of Extremadura and south-east of Andalusia. These major gender- and area-related geographical differences in risk would seem to reflect differences in the prevalence of some well-established and modifiable risk factors, including smoking, alcohol consumption, obesity and diet. In addition, excess risks were in evidence for both sexes in some areas, possibly suggesting the implication of certain local environmental or socio-cultural factors. From a public health standpoint, small-area studies could be very useful for identifying locations where epidemiological research and intervention measures ought to receive priority, given the potential for reducing risk in certain places.


Familial acromegaly.
An uncle and nephew with acromegaly are described. Two other families with acromegaly have been reported by others and three other possible cases are reviewed. Our patients are unlikely to form part of the multiple endocrine neoplasia (MEN) type 1 syndrome because of the absence of other endocrine disease at an advanced age. A family history of acromegaly should be considered in those presenting with the disease.


Are Systematic Reviews and Meta-Analyses Appropriate Tools for Assessing Evolving Medical Device Technologies?
Systematic reviews and meta-analyses (SRMAs) provide unique insights into comparative effectiveness of diabetes treatments. However, use of these analyses may be inappropriate for assessing the value and utility of technologies that involve significant behavioral interventions and encompass rapidly evolving technologies such as real-time continuous glucose monitoring (RT-CGM). The rapid evolution of RT-CGM, compared with the time required for publication of clinical studies used in SRMAs, may preclude differentiation between past and current generations of devices. In addition, the effect of performance and usability differences between the various commercial devices on possible clinical outcomes associated with the devices are often not clearly discussed, and many of the RT-CGM studies assessed in SRMAs do not provide adequate information regarding whether and/or to what degree study subjects and clinicians were trained to use the RT-CGM and utilize the data to adjust therapy. Although numerous clinical studies have shown that the glycemic benefit of RT-CGM is related to the frequency and duration of use, a disproportionate number of RT-CGM studies included in recent SRMAs are based on the results of the intention-to-treat analyses and do not consider this fundamental behavioral component in their conclusions. Given these limitations, the generalizability of SRMA conclusions may be limited, and findings from these reports may significantly underestimate the potential glycemic benefit of current and future devices, posing challenges for coverage and reimbursement. We reviewed the potential limitations of the recent Cochrane Collaboration report on CGM, focusing on the 12 studies that assessed RT-CGM use in adults, children/adolescents or both.


The potential for linking cohort participants to official criminal records: a pilot study using the Avon Longitudinal Study of Parents and Children (ALSPAC).
Introduction: Linking longitudinal cohort resources with police-recorded records of criminal activity has the potential to inform public health style approaches to policing, and may reduce potential sources of bias from self-reported criminal data collected by cohort studies. A pilot linkage of police records to the Avon Longitudinal Study of Parents and Children (ALSPAC) allows us to consider the acceptability of this linkage, its utility as a data resource, differences in self-reported crime according to consent status for data linkage, and the appropriate governance mechanism to support such a linkage. Methods: We carried out a pilot study linking data from the ALSPAC birth cohort to Ministry of Justice (MoJ) records on criminal cautions and convictions. This pilot was conducted on a fully anonymous basis, meaning we cannot link the identified records to any participant or the wider information within the dataset. Using ALSPAC data, we used summary statistics to investigate differences in socio-economic background and self-reported criminal activity by consent status for crime linkage. We used MoJ records to identify the geographic and temporal concentration of criminality in the ALSPAC cohort. Results: We found that the linkage appears acceptable to participants (4% of the sample opted out), levels of criminal caution and conviction are high enough to support research, and that the majority of crimes occurred in Avon & Somerset (the policing area local to ALSPAC). Those who did not respond to consent requests had higher levels of self-reported criminal behaviour compared to participants who provided explicit consent. Conclusions: These findings suggest that data linkage in ALSPAC provides opportunities to study criminal behaviour and that linked individual-level records could provide robust research in the area. Our findings also suggest the potential for bias when only including participants who have explicitly consented to data linkage, highlighting the limitations of opt-in consent strategies.


The expression of sf-1/Ad4BP is related to the process of luteinization in the marmoset (Callithrix jacchus) ovary.
Expression of the nuclear receptor, steroidogenic factor-1 (SF-1/Ad4BP), was studied in a primate (marmoset) ovary using immunohistochemical, RT-PCR, and immunoblot techniques. The periovulatory phase was compared with the luteal phase. With PCR we found a marmoset homolog of SF-1/Ad4BP to be expressed in ovarian and other steroidogenic tissues. Characteristically, the periovulatory ovaries consisted of growing (non-luteinized) small follicles together with large luteinizing follicles and many corpora lutea accessoria (Clas), which had developed from atretic large follicles. During the luteal phase, true corpora lutea (Cls) were additionally found. In general, we found that small follicles were devoid of any immunoreactivity of SF-1/Ad4BP. In large follicles, the luteinizing theca and granulosa cells express SF-1/Ad4BP. All luteal cells of Clas showed a nuclear staining in both ovary types. In Cls, only a few luteal cells were positive. Large follicles of different sizes showed no differences in expression level, as evidenced by immunoblot analysis. Our results indicate that SF-1/ Ad4BP participates in the activation of genc transcription during the onset of luteinization and that Clas are essential for ovarian luteal function.


A personalized medicine approach for Asian Americans with the aldehyde dehydrogenase 2*2 variant.
Asian Americans are one of the fastest-growing populations in the United States. A relatively large subset of this population carries a unique loss-of-function point mutation in aldehyde dehydrogenase 2 (ALDH2), ALDH2*2. Found in approximately 560 million people of East Asian descent, ALDH2*2 reduces enzymatic activity by approximately 60% to 80% in heterozygotes. Furthermore, this variant is associated with a higher risk for several diseases affecting many organ systems, including a particularly high incidence relative to the general population of esophageal cancer, myocardial infarction, and osteoporosis. In this review, we discuss the pathophysiology associated with the ALDH2*2 variant, describe why this variant needs to be considered when selecting drug treatments, and suggest a personalized medicine approach for Asian American carriers of this variant. We also discuss future clinical and translational perspectives regarding ALDH2*2 research.


Hyperacute synchronous cardiocerebral infarction in a patient with new-onset atrial fibrillation: a case of myocardial infarction with nonobstructive coronary arteries.
Hyperacute synchronous cardiocerebral infarction (CCI) is an extremely rare condition with an incidence of 0.009%. In the acute stage of ischemic stroke, there is a high prevalence of ECG abnormalities. Prolonged QTc, atrial fibrillation (AF) and ECG changes indicative of ischemic heart disease, such as Q waves, ST depression, and T wave inversion, were the most prevalent changes. There are three types of simultaneous CCI: cardiac conditions that cause cerebral infarction, cerebral infarction caused by cardiac conditions, and (c) dysregulation of the brain-heart axis or cerebral infarction causing myocardial infarction. Herein, we present a case of hyperacute synchronous CCI in an elderly patient with new-onset AF and myocardial infarction with nonobstructive coronary arteries (MINOCA).


Outcome comparison between laparoscopic and open appendectomy: evidence from a nationwide population-based study.
Mounting evidence supports the use of laparoscopic techniques for the treatment of simple appendicitis. However, most of the advantages of these techniques are of limited clinical relevance. This study compares the treatment outcomes of laparoscopic appendectomies and open appendectomies performed in Taiwan. This study uses data from the 2007 to 2009 Taiwan National Health Insurance Research Database. The study sample included 65,339 patients, hospitalized with a discharge diagnosis of acute appendicitis (33.8% underwent laparoscopic appendectomy). A generalized estimated equation (GEE) was performed to explore the relationship between the use of laparoscopy and 30-day re-admission. Hierarchical linear regressions were performed to examine the relationship between the use of laparoscopy, the length of stay (LOS), and the cost per discharge. A significantly lower proportion of patients undergoing laparoscopic appendectomies were re-admitted within 30 days of their index appendectomy, in comparison to patients undergoing open appendectomies (0.66% versus 1.925, p<0.001). Compared with patients undergoing open appendectomies, patients undergoing laparoscopic appendectomies had a shorter LOS (4.01 versus 5.33 days, p<0.001) and a higher cost per discharge (NT$40,554 versus NT$38,509, p<0.001. In 2007, the average exchange rate was US$1=NT$31.0). GEE revealed that the odds ratio of 30-day readmission for patients undergoing laparoscopic appendectomy was 0.38 (95% CI=0.33-0.46) that of patients undergoing open appendectomies, after adjusting for surgeon, hospital, and patient characteristics, as well as for the clustering effect of particular surgeons and the propensity score. This study found that laparoscopic appendectomies had a lower 30-day re-admission rate, and a shorter LOS, but a slightly higher cost per discharge than open appendectomies.


Genetic susceptibility to myocardial infarction and coronary artery disease.
Atherosclerotic involvement in the coronary arteries, which can result in heart attack and sudden death, is a common disease and prototypic of a complex human trait. To understand its genomic basis, eight linkage studies of sibling pairs have been performed. Although there was limited inter-study concordance of important loci, two gene variants in the leukotriene pathway (ALOX5AP and LTA4) have emerged as susceptibility factors for myocardial infarction (MI). Genome-wide association studies have also been undertaken, and the pro-inflammatory cytokine lymphotoxin-alpha (LTA), and its key ligand galectin-2 (LGALS2) have been identified as genes implicated in predisposition for heart attack. By cueing into the genomic basis for low serum LDL cholesterol levels, much work has been done to advance the importance of the serine protease PCSK9, which modulates LDL receptor function. Lifelong lowered LDL cholesterol associated with PCSK9 point mutations in 2-3% of individuals have been shown to provide marked protection from coronary artery disease (CAD). Most of the success in this field has been with the phenotype of MI, which is considerably more restrictive than CAD. Four principal and interdependent processes--lipoprotein handling, endothelial integrity, arterial inflammation, and thrombosis--have been supported as important via the clustering of genes, thus far implicated in CAD susceptibility. Of note, connecting genes in a single pathway (leukotriene), of a protein and its ligand (LTAalpha) or from one disease to another [age-related macular degeneration (AMD); complement factor H (CFH)], or even three disease characterized by inflammation (MHC2) have now been reported. Although the population attributable risk for any of the genes identified to date is limited, such discovery is likely to be accelerated in the future.


Anxiety and Depressive Symptoms Are Not Associated With Future Pediatric Crohn's Disease Activity.
Studies of adults with Crohn's disease (CD) suggest that poor mental health precedes worsening disease activity. We evaluated whether depression and/or anxiety forecast worsening pediatric CD disease activity. Through the Inflammatory Bowel Disease Partners Kids & Teens internet-based cohort, children with CD age 9 to 17 completed Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric measures and the short Crohn's disease activity index (sCDAI). Using general linear models, we examined how baseline PROMIS Pediatric anxiety and depressive symptom scores independently associate with subsequent sCDAI scores (average survey interval 6.4 months). Models included baseline PROMIS Pediatric anxiety and depressive symptoms scores, baseline sCDAI, sex, age, parental education, race/ethnicity, and prior IBD-related surgery. We performed a post hoc subanalysis of children in baseline remission (sCDAI <150) with otherwise identical models. We analyzed 159 children with CD (mean age 14 years, 45% female, 84% in baseline remission). We found no association between baseline PROMIS Pediatric anxiety score and subsequent sCDAI (change in sCDAI for 3-point change in PROMIS Pediatric -0.89; 95% CI -4.81 to 3.03). Baseline PROMIS Pediatric depressive symptoms score was not associated with future sCDAI (change in sCDAI for 3-point change in PROMIS Pediatric <0.01; 95% CI -4.54 to 4.53). In a subanalysis of patients in remission at baseline, the lack of association remained. We found that neither anxiety nor depressive symptoms associate with subsequent disease activity in pediatric CD. These findings contrast with adult IBD studies, thus underschoring the unique pathophysiology, natural history, and outcomes of pediatric CD.


Results from a multicentre international registry of familial Mediterranean fever: impact of environment on the expression of a monogenic disease in children.
Familial Mediterranean fever (FMF) is an autoinflammatory disease caused by mutations of the MEFV gene. We analyse the impact of ethnic, environmental and genetic factors on the severity of disease presentation in a large international registry. Demographic, genetic and clinical data from validated paediatric FMF patients enrolled in the Eurofever registry were analysed. Three subgroups were considered: (i) patients living in the eastern Mediterranean countries; (ii) patients with an eastern Mediterranean ancestry living in western Europe; (iii) Caucasian patients living in western European countries. A score for disease severity at presentation was elaborated. Since November 2009, 346 FMF paediatric patients were enrolled in the Eurofever registry. The genetic and demographic features (ethnicity, age of onset, age at diagnosis) were similar among eastern Mediterranean patients whether they lived in their countries or western European countries. European patients had a lower frequency of the high penetrance M694V mutation and a significant delay of diagnosis (p<0.002). Patients living in eastern Mediterranean countries had a higher frequency of fever episodes/year and more frequent arthritis, pericarditis, chest pain, abdominal pain and vomiting compared to the other two groups. Multivariate analysis showed that the variables independently associated with severity of disease presentation were country of residence, presence of M694V mutation and positive family history. Eastern Mediterranean FMF patients have a milder disease phenotype once they migrate to Europe, reflecting the effect of environment on the expression of a monogenic disease.


Comparison of the effects of xenon and halothane on voltage-dependent Ca(2+) fluxes in rabbit T-tubule membranes.
The effects of xenon and halothane on depolarization-induced (45)Ca(2+) fluxes mediated by voltage-dependent Ca(2+) channels were investigated in transverse tubule membrane vesicles from rabbit skeletal muscle. Halothane, in the concentration range of 0.5-2 mM, caused a significant inhibition of (45)Ca(2+) fluxes. Xenon tested in the range of 60%-100% did not affect the (45)Ca(2+) fluxes. Radioligand binding studies indicated that xenon and halothane have different effects on the specific binding of [(3)H]Isradipine to transverse tubule membranes. Halothane caused a significant inhibition on the specific binding of [(3)H]Isradipine. In controls and in presence of 0.5 mM halothane, B(max) values were 26.9 pmole/mg and 15.1 pmole/mg, and K(D) values were 238 pM and 247 pM, respectively. On the other hand, there was no effect of xenon (60%-100%) on the characteristics of [(3)H]Isradipine binding. In conclusion, results indicate that xenon and halothane differ in their effects on the function of voltage-dependent Ca(2+) channels and on the specific binding of [(3)H]Isradipine in skeletal muscle membranes.


Relation of achievement motives, satisfaction with life, happiness and oral health in Romanian university students.
The objective of the present study was to investigate whether achievement motives, satisfaction with life and happiness are associated with oral health behaviour and perceived gingival status. The present study sample consisted of 178 first-year medical students. The questionnaire included information about sociodemographic factors, behavioural variables, perceived oral health status, achievement motives (hope of success and fear of failure), satisfaction with life and subjective happiness scales. It was observed that individuals who presented higher values of satisfaction with life and happiness rated their gingival status as being very good/excellent and that individuals who presented higher values of hope of success reported to brush frequently. When the oral health behaviour was analysed, it was revealed that persons who brushed their teeth more than twice a day reported higher values of hope of success when compared with individuals who reported their toothbrushing frequency to be once a day or less. It was also revealed that persons who visited their clinician for check-ups reported higher values of subjective happiness. Multiple linear regression analyses showed that stress in everyday life and hope of success were positively associated with the toothbrushing frequency and that satisfaction with life was positively associated with the gingival health status. Hope of success and satisfaction with life should be considered as predictors of good oral health behaviour/status.


Liver dysfunction in sepsis.
Despite continuous progress in medicine, sepsis remains the main cause of deaths in the intensive care unit. Liver failure complicating sepsis/septic shock has a significant impact on mortality in this group of patients. The pathophysiology of sepsis-associated liver dysfunction is very complicated and still not well understood. According to the Surviving Sepsis Campaign (SSC) Guidelines, the diagnosis of liver dysfunction during sepsis is based on the increase in bilirubin concentration >2 mg/dL and the occurrence of coagulation disorders with INR > 1.5. The lack of specificity and ability to distinguish acute liver failure from previous liver dysfunction disqualifies bilirubin as a single parameter reflecting the complex liver function. Clinical manifestations of sepsis-associated liver dysfunction include hypoxic hepatitis, sepsis-induced cholestasis and dysfunction of protein synthesis manifesting with, e.g., coagulopathies. Detoxifying liver dysfunction, which is associated with an increase in serum ammonia concentration, manifesting with e.g., confusion, loss of consciousness and hepatic encephalopathy, may be disguised by analgosedation used in the intensive care unit. To determine a liver dysfunction in a critically ill patient, the concept of shock liver may be used. It is a complex syndrome of hemodynamic, cellular, molecular and immunologic changes leading to severe liver hypoxia. In clinical practice, there is no standardized diagnostic panel that would allow for an early, clear diagnosis of acute liver dysfunction, and there is no therapeutic panel enabling the full restoration of damaged liver function. The aim of the article is to present the pathophysiology and clinical manifestations of sepsis-associated liver dysfunction.


Collapsin response mediator protein 5-associated optic neuropathy: clinical characteristics, radiologic clues, and outcomes.
Collapsin response mediator protein 5-associated optic neuropathy (CRMP5-ON) is a rare entity of autoimmune optic neuropathy. This study aimed to review the neuro-ophthalmic findings and outcomes in a series of patients with CRMP5-ON to further characterize its clinical phenotype, radiologic clues, and outcomes. This was a retrospective case series and a single-center medical chart review of all patients with CRPM5-seropositive ON at the Department of Neurology, Beijing Tongren Hospital, from December 1, 2020, to March 31, 2023. The main outcome measures were neuro-ophthalmic manifestations, radiologic characteristics, and clinical outcomes of CRMP5-ON; coexisting neural autoantibody, paraneoplastic associations, and the impact of immunosuppressant therapy. Five patients were identified. Four (80%) were female, and the average age at onset was 59.4 years (range 53-69 years), with an average follow-up of 15.3 months (range 1.4-28.7 months). The average best-corrected visual acuity (BCVA) at nadir was 20/120 (range 20/20 to count fingers). Seven of ten affected eyes (70%) showed diffuse defects of the central field. Painless bilateral involvement and optic disk edema occurred in 100% of patients, combined with vitritis, uveitis, or retinitis in four (80%). Four patients (80%) had MRI abnormalities along the optic nerve (one patient with optic nerve enhancement and three patients had optic nerve sheath enhancement or peribulbar fat enhancement). Three patients (60%) had optic neuropathy with other neurologic symptoms. Four patients (80%) had confirmed cancer (two were small-cell lung carcinoma, one was papillary thyroid carcinoma and another was thymoma and invasive pulmonary adenocarcinoma). All cancers were identified after the presentation of the optic neuropathy. The intervention included IVIG, IVMP, surgery and chemotherapy. The average BCVA at the last follow-up was 20/50 (range 20/20 to count fingers). Three patients had surgery during the initial hospitalization, and were stable during the follow-up. Among two patients who received IVMP, both had improvement after treatment, although one patient had worsening non-ocular neurologic symptoms during the steroid taper. CRMP5-ON presented with optic disc edema, often bilateral involved and combined with vitreitis, retinitis, or uveitis. CRMP5-ON can present with MRI optic nerve or perineural optic nerve enhancement, especially in the optic nerve sheath. CRMP5-ON is closely related to paraneoplastic neurologic syndrome. Cancer screening and intervention are crucial to prognosis.


Virulence-related Mycobacterium avium subsp hominissuis MAV_2928 gene is associated with vacuole remodeling in macrophages.
Mycobacterium avium subsp hominissuis (previously Mycobacterium avium subsp avium) is an environmental organism associated with opportunistic infections in humans. Mycobacterium hominissuis infects and replicates within mononuclear phagocytes. Previous study characterized an attenuated mutant in which the PPE gene (MAV_2928) homologous to Rv1787 was inactivated. This mutant, in contrast to the wild-type bacterium, was shown both to have impaired the ability to replicate within macrophages and to have prevented phagosome/lysosome fusion. MAV_2928 gene is primarily upregulated upon phagocytosis. The transcriptional profile of macrophages infected with the wild-type bacterium and the mutant were examined using DNA microarray, which showed that the two bacteria interact uniquely with mononuclear phagocytes. Based on the results, it was hypothesized that the phagosome environment and vacuole membrane of the wild-type bacterium might differ from the mutant. Wild-type bacterium phagosomes expressed a number of proteins different from those infected with the mutant. Proteins on the phagosomes were confirmed by fluorescence microscopy and Western blot. The environment in the phagosome of macrophages infected with the mutant differed from the environment of vacuoles with M. hominissuis wild-type in the concentration of zinc, manganese, calcium and potassium. The results suggest that the MAV_2928 gene/operon might participate in the establishment of bacterial intracellular environment in macrophages.


[The influence of occupational lead exposure on transmural repolarization dispersion].
The parts of QT interval: time from Q wave to the peak of T wave (QTp) representing the de- and repolarization of subepicardial layer and the time from the peak of T wave to its end (QTp-e) building the transmural dispersion of repolarization enable more exact assessment of repolarization period of the heart muscle. Occupational exposure to lead influences the electrophysiologic properties of the heart. The aim of our study was to assess the QTp and QTp-e interval in workers occupationally exposed to lead. The study was carried out in 22 copper smelters aged 41.8 +/- 8.7 years, occupationally exposed to lead. The control group consisted of 14 healthy men. In all studied subjects blood lead concentration (Pb) and the concentration of free protoporphyrins in erytrocytes were assessed. 24-hour ECG holter monitoring was done to study rhythm disturbances and the duration in lead CM5 of QT interval, QTp interval, RR interval preceding the assessed QT interval (pRR) during sleep, rest during the awake state and moderate daily activity. The QTp-e interval is the difference between the duration of QT and QTp interval. The duration of QTp and QTp-e in occupationally exposed workers and healthy persons did not differ significantly. These parameters were significantly lower in both groups during moderately physical activity comparing to the values during sleep. The QTp-e/ QTp ratio in occupationally exposed workers during night hours was significantly lower than during daily activity what was not the case in control persons. Occupational exposure to lead do not change significantly the transmural dispersion of repolarization. Occupational exposure to lead diminishes the QTp-e/QTp ratio during the night.


Effects of surgery on survival of elderly patients with gallbladder cancer: A propensity score matching analysis of the SEER database.
Surgery is the sole curative therapy for gallbladder cancer (GBC) patients. Confronting an aging society, the demand to treat elderly patients with GBC is increasing. But there are few reports on survival benefit in elderly GBC patients treated with surgery. Therefore, we designed this population-based study to assess the survival benefit of surgery in GBC patients aged 70 years or older. GBC patients aged 70 years or older were identified in the surveillance, epidemiology, and end results cancer (SEER) database from 2010 to 2017. A 1:1 propensity score matching (PSM) analysis was conducted to balance the baseline data of patients. Overall survival (OS) and cancer-specific survival (CSS) of patients were evaluated by Kaplan-Meier analysis and compared with log-rank test. Independent risk factors associated with OS and CSS were determined by univariate and multivariate Cox proportional hazard regression analyses and subgroup analysis were performed. A total of 2055 GBC patients aged 70 years or older were included in our study, with 1734 patients underwent surgery. Before PSM, the age, AJCC stage, TNM stage, and chemotherapy were significantly different between the surgery and no-surgery group (all P<0.05). Patients with surgery had significantly longer OS and CSS than those without surgery (P<0.0001). After 1:1 PSM, the differences in clinicopathological characteristics were reduced (all P>0.05). Kaplan-Meier analysis also showed patients received surgery had significantly better OS and CSS (P<0.0001). Subgroup analysis further indicated that almost all subgroups received surgery had OS and CSS advantage, especially patients aged 70-84 years old. Finally, univariate and multivariate COX regression analyses showed that age, AJCC stage and T stage were independent prognostic factors for OS and CSS in patients undergoing surgery. Our study found that surgery significantly improved OS and CSS in GBC patients aged 70-84 years, but more prospective studies are needed to prove our findings.


Adrenalectomy in a Patient With Recurrent Hepatocellular Carcinoma in the Adrenal Gland: A Case Report.
Hepatocellular carcinoma recurrence in the adrenal gland is clinically rare, for which there are no clear criteria for examination or treatment. A 70-year-old man underwent laparoscopic low anterior resection seven years prior and was diagnosed with rectal cancer stage 1 (T2N0). Right hepatic resection for suspected hepatocellular carcinoma in his liver six years and nine months prior was performed. Thereafter, the patient was diagnosed with hepatocellular carcinoma stage 3 (T3N0). During the follow-up period, elevated alpha-fetoprotein levels were detected, indicating hepatocellular carcinoma recurrence. Follow-up computed tomography in the delayed phase detected a heterogeneous 5 cm mass in the left adrenal gland. Therefore, we diagnosed the patient with recurrent hepatocellular carcinoma in the adrenal gland, for which we performed an adrenalectomy with a favorable prognosis.


A new PCR assay for the detection and differentiation of Babesia canis and Babesia vogeli.
Babesia spp. are globally distributed tick-borne protozoan parasites that infect the red blood cells of a wide range of vertebrate hosts, including humans. Diagnosis of babesiosis is often impeded by the transient presence of the parasites in peripheral blood, as well as by their pleomorphic nature. Given the reports of an expanding and, in some cases, sympatric geographical distribution of Babesia canis and Babesia vogeli in dogs and associated vectors, in Europe, the development of time-efficient and cost-effective diagnostic tools to detect and differentiate these two species is warranted. In this study, we designed and developed a novel polymerase chain reaction (PCR) assay targeting the parasite cytochrome c oxidase subunit 1 (cox1) gene, for the simultaneous detection and differentiation of B. canis and B. vogeli. The analytical sensitivity of the PCR was evaluated using serial dilutions of genomic DNA extracted from individual and artificially mixed canine blood samples infected by B. canis (3×102 infected erythrocytes/ml, ie/ml) and B. vogeli (2.1×101 ie/ml). The analytical specificity of the assay was assessed using blood samples positive for Hepatozoon canis, Ehrlichia canis, Anaplasma platys, Babesia microti, Babesia rossi and Theileria annae (syn. Babesia vulpes). The clinical specificity of the PCR assay was evaluated on 147 blood samples from dogs and 128 tick specimens (Dermacentor reticulatus and Rhipicephalus sanguineus sensu lato). Species-specific bands of the expected sizes (i.e., 750bp for B. canis and 450bp for B. vogeli), and two bands in the mixed blood samples were obtained. The PCR assay developed herein detected a low number of infected erythrocytes (i.e., 3×10-2B. canis, 2.1×10-2B. vogeli ie/ml). Of the 147 blood samples, nine (6.1%) were positive for B. canis and six (4.1%) for B. vogeli, whereas only one tick (D. reticulatus) was positive for B. canis. This PCR assay represents a rapid and reliable tool for the diagnosis of B. canis and B. vogeli in areas where these species occur in sympatry, and will assist future epidemiological investigations aimed to track the expanding range of these parasites.


Time-course transcriptome and WGCNA analysis revealed the drought response mechanism of two sunflower inbred lines.
Drought is one of the most serious abiotic stress factors limiting crop yields. Although sunflower is considered a moderate drought-tolerant plant, drought stress still has a negative impact on sunflower yield as cultivation expands into arid regions. The extent of drought stress is varieties and time-dependent, however, the molecular response mechanisms of drought tolerance in sunflower with different varieties are still unclear. Here, we performed comparative physiological and transcriptome analyses on two sunflower inbred lines with different drought tolerance at the seedling stage. The analysis of nine physiological and biochemical indicators showed that the leaf surface area, leaf relative water content, and cell membrane integrity of drought tolerance inbred line were higher than those of drought-sensitive inbred line under drought stress, indicating that DT had stronger drought resistance. Transcriptome analyses identified 24,234 differentially expressed genes (DEGs). Gene ontology (GO) analysis showed the up-regulated genes were mainly enriched in gibberellin metabolism and rRNA processing, while the down-regulated genes were mainly enriched in cell-wall, photosynthesis, and terpene metabolism. Kyoto Encyclopedia of Genes and Genomes(KEGG) pathway analysis showed genes related to GABAergic synapse, ribosome biogenesis were up-regulated, while genes related with amino sugar and nucleotide sugar metabolism, starch and sucrose metabolism, photosynthesis were down-regulated. Mapman analysis revealed differences in plant hormone-signaling genes over time and between samples. A total of 1,311 unique putative transcription factors (TFs) were identified from all DEGs by iTAK, among which the high abundance of transcription factor families include bHLH, AP2/ERF, MYB, C2H2, etc. Weighted gene co-expression network analysis (WGCNA) revealed a total of 2,251 genes belonging to two modules(blue 4, lightslateblue), respectively, which were significantly associated with six traits. GO and KEGG enrichment analysis of these genes was performed, followed by visualization with Cytoscape software, and the top 20 Hub genes were screened using the CytoHubba plugin.


Mesoporous LixMn2O4 Thin Film Cathodes for Lithium-Ion Pseudocapacitors.
Charge storage devices with high energy density and enhanced rate capabilities are highly sought after in today's mobile world. Although several high-rate pseudocapacitive anode materials have been reported, cathode materials operating in a high potential range versus lithium metal are much less common. Here, we present a nanostructured version of the well-known cathode material, LiMn2O4. The reduction in lithium-ion diffusion lengths and improvement in rate capabilities is realized through a combination of nanocrystallinity and the formation of a 3-D porous framework. Materials were fabricated from nanoporous Mn3O4 films made by block copolymer templating of preformed nanocrystals. The nanoporous Mn3O4 was then converted via solid-state reaction with LiOH to nanoporous LixMn2O4 (1 < x < 2). The resulting films had a wall thickness of ∼15 nm, which is small enough to be impacted by inactive surface sites. As a consequence, capacity was reduced by about half compared to bulk LiMn2O4, but both charge and discharge kinetics as well as cycling stability were improved significantly. Kinetic analysis of the redox reactions was used to verify the pseudocapacitive mechanisms of charge storage and establish the feasibility of using nanoporous LixMn2O4 as a cathode in lithium-ion devices based on pseudocapacitive charge storage.


Two Cases of SARS-CoV-2-Positive Mothers and Their Newborns in Korea.
It is unclear how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affects pregnant women and their fetuses or newborns. We report two infants born to mothers with coronavirus disease 2019 (COVID-19) in Korea. The first case was a healthy female baby born at 39+3 weeks' gestation from a mother diagnosed with COVID-19. The second case was a female baby born at 38+0 weeks' gestation. The newborn in the second case had symptoms of respiratory distress immediately after birth, and nasal continuous positive airway pressure support was applied for 8 hours. Real-time polymerase chain reaction test results for SARS-CoV-2 using amniotic fluid, neonatal nasopharyngeal and oropharyngeal swabs, blood, urine, stool, and rectal swab were all negative in the 1st and 2nd days of life in both cases. Placental pathology showed acute necrotizing deciduitis and intervillous fibrin deposition with acute intervillositis. Although clinical evidence of vertical transmission was not found in our cases, with the possibility of placental inflammation, close monitoring of SARS-CoV-2 positive mothers and their newborn is required.


[Inhaled nitric oxide for the treatment of ARDS].
Acute respiratory distress syndrome (ARDS) is characterized by perfusion in favor of non-ventilated areas of the lungs as the main cause of intrapulmonary right-to-left shunt and hypoxemia. Therapeutic interventions to selectively influence pulmonary perfusion in ARDS became possible with the introduction of inhaled nitric oxide (iNO), which provided a way not only to reduce pulmonary hypertension, but also to acutely improve ventilation-perfusion mismatch, and thus to treat severe hypoxemia. Clinical studies in ARDS demonstrated that the combination of iNO with other interventions, such as positive end-expiratory pressure (PEEP) and prone positioning, yielded beneficial and additive effects on arterial oxygenation. Although randomized controlled trials of this concept have up to now failed to show an improved outcome, iNO is a valuable option for the treatment of severe refractory hypoxemia in ARDS patients.


A radionuclide method of evaluating shunt function and CSF circulation in hydrocephalus. Technical note.
A simple technique for the evaluation of shunt function and cerebrospinal fluid (CSF) circulation in hydrocephalic patients is described. The method utilizes clearance rates of a radionuclide tracer injected into the lateral ventricle via an indwelling frontal catheter which is separate from the shunt apparatus. This permits an accurate assessment of drainage of ventricular CSF via the shunt, or the patency of normal or alternative CSF pathways where the shunt is malfunctioning.


Neurocognitive similarities between severe chronic schizophrenia and behavioural variant frontotemporal dementia.
This study focuses on a group of patients with chronic schizophrenia who have a more severe form of the disorder, as indicated by socio-functional decline, treatment resistance, and recurrent hospitalisation. Previous research has suggested that the pattern and severity of cognitive deficits in people with severe chronic schizophrenia is similar to that observed in behavioural variant frontotemporal dementia (bvFTD). In the current study, we compared neurocognitive performance in 16 cognitive domains in 7 inpatients with severe chronic schizophrenia, 13 community-dwelling outpatients with chronic schizophrenia, 12 patients with bvFTD, and 18 healthy controls. Our findings revealed more similar cognitive profiles between the schizophrenia inpatient and bvFTD groups compared to the schizophrenia outpatient group, who outperformed the former groups. The current results provide preliminary evidence for a distinct schizophrenia subgroup, distinguishable from other chronic schizophrenia patients by poorer clinical and functional status, who have levels of cognitive impairment comparable to those seen in bvFTD patients.


Taking a Systems Approach to Chronic Illness in Old Age.
We are living through a demographic transition from a world in which there were lots of young people and very few older adults to one in which the numbers in these age groups are becoming more evenly balanced. One reason for this is that more of us are living into our seventies, eighties, nineties, and beyond. That is the good news. Unfortunately, the chance of developing chronic illnesses (including diabetes, arthritis, and dementia) is typically higher for people in these older age groups than for those who are younger. Because we do not know how to cure these illnesses, many of us will spend at least some of this extra time with one or more chronic illness. While we are more likely than in the past to live into older age, we are likely to be living with illness when we get there. That raises a challenge: how should we respond to this change?


Salivary Metabolomic Signatures and Body Mass Index in Italian Adolescents: A Pilot Study.
Obesity surveillance is scarce in adolescents, and little is known on whether salivary metabolomics data, emerging minimally invasive biomarkers, can characterize metabolic patterns associated with overweight or obesity in adolescents. This pilot study aims to identify the salivary molecular signatures associated with body mass index (BMI) in Italian adolescents. Saliva samples and BMI were collected in a subset of n = 74 young adolescents enrolled in the Public Health Impact of Metal Exposure study (2007-2014). A total of 217 untargeted metabolites were identified using liquid chromatography-high resolution mass spectrometry. Robust linear regression was used to cross-sectionally determine associations between metabolomic signatures and sex-specific BMI-for-age z-scores (z-BMI). Nearly 35% of the adolescents (median age: 12 years; 51% females) were either obese or overweight. A higher z-BMI was observed in males compared to females (P = .02). One nucleoside (deoxyadenosine) and 2 lipids (18:0-18:2 phosphatidylcholine and dipalmitoyl-phosphoethanolamine) were negatively related to z-BMI (P < .05), whereas 2 benzenoids (3-hydroxyanthranilic acid and a phthalate metabolite) were positively associated with z-BMI (P < .05). In males, several metabolites including deoxyadenosine, as well as deoxycarnitine, hyodeoxycholic acid, N-methylglutamic acid, bisphenol P, and trigonelline were downregulated, while 3 metabolites (3-hydroxyanthranilic acid, theobromine/theophylline/paraxanthine, and alanine) were upregulated in relation to z-BMI (P < .05). In females, deoxyadenosine and dipalmitoyl-phosphoethanolamine were negatively associated with z-BMI while deoxycarnitine and a phthalate metabolite were positively associated (P < .05). A single energy-related pathway was enriched in the identified associations in females (carnitine synthesis, P = .04). Salivary metabolites involved in nucleotide, lipid, and energy metabolism were primarily altered in relation to BMI in adolescents.


Fluid management in Acute Respiratory Distress Syndrome: A narrative review.
Acute Respiratory Distress Syndrome remains a major source of morbidity and mortality in the modern intensive care unit (ICU). Major advances in the understanding and management of this condition were made in the last two decades. The use of low tidal ventilation is a well-established therapy. Conservative fluid management is now another cornerstone of management. However, much remains to be understood in this arena. Assessing volume status in these patients may be challenging and the tools available to do so are far from perfect. Several dynamic measures including pulse pressures variation are used. Ultrasound of the lungs and the vascular system may also have a role. In addition, the type of fluid to administer when needed is still open to debate. Finally, supportive measures in these patients, early during their ICU stay and later after discharge continue to be crucial for survival and adequate recovery.


Soft tissue tumors of the sinonasal tract.
Primary soft tissue tumors arising in the sinonasal tract are rare. While many mesenchymal neoplasms have been reported in the nasal cavity, sinuses, and nasopharynx, few are distinctive to this anatomic region. Some tumor types are relatively more common in this area, such as schwannoma and rhabdomyosarcoma. Nasopharyngeal angiofibroma and sinonasal hemangiopericytoma are unique entities of the sinonasal tract, as well as the recently characterized biphenotypic sinonasal sarcoma. This review discusses the clinical, morphologic, and immunohistochemical features and currently known molecular data of the more frequently encountered soft tissue tumors of the sinonasal tract.


Regulator of Calcineurin 1 Gene Isoform 4, Down-regulated in Hepatocellular Carcinoma, Prevents Proliferation, Migration, and Invasive Activity of Cancer Cells and Metastasis of Orthotopic Tumors by Inhibiting Nuclear Translocation of NFAT1.
Individuals with Down syndrome have a low risk for many solid tumors, prompting the search for tumor suppressor genes on human chromosome 21 (HSA21). We aimed to identify and explore potential mechanisms of tumor suppressors on HSA21 in hepatocellular carcinoma (HCC). We compared expression of HSA21 genes in 14 pairs of primary HCC and adjacent noncancer liver tissues using the Affymetrix HG-U133 Plus 2.0 array (Affymetrix, Santa Clara, CA). HCC tissues and adjacent normal liver tissues were collected from 108 patients at a hospital in China for real-time polymerase chain reaction and immunohistochemical analyses; expression levels of regulator of calcineurin 1 (RCAN1) isoform 4 (RCAN1.4) were associated with clinical features. We overexpressed RCAN1.4 from lentiviral vectors in MHCC97H and HCCLM3 cells and knocked expression down using small interfering RNAs in SMMC7721 and Huh7 cells. Cells were analyzed in proliferation, migration, and invasion assays. HCC cells that overexpressed RCAN1.4 or with RCAN1.4 knockdown were injected into livers or tail veins of nude mice; tumor growth and numbers of lung metastases were quantified. We performed bisulfite pyrosequencing and methylation-specific polymerase chain reaction analyses to analyze CpG island methylation. We measured phosphatase activity of calcineurin in HCC cells. RCAN1.4 mRNA and protein levels were significantly decreased in primary HCC compared with adjacent noncancer liver tissues. Reduced levels of RCAN1.4 mRNA were significantly associated with advanced tumor stages, poor differentiation, larger tumor size, and vascular invasion. Kaplan-Meier survival analysis showed that patients with HCCs with lower levels of RCAN1.4 mRNA had shorter time of overall survival and time to recurrence than patients whose tumors had high levels of RCAN1.4 mRNA. In HCC cell lines, expression of RCAN1.4 significantly reduced proliferation, migration, and invasive activity. HCC cells that overexpressed RCAN1.4 formed smaller xenograft tumors, with fewer metastases and blood vessels, than control HCC cells. In HCC cells, RCAN1.4 inhibited expression of insulin-like growth factor 1 and vascular endothelial growth factor A by reducing calcineurin activity and blocking nuclear translocation of nuclear factor of activated T cells (NFAT1). HCC cells incubated with the calcineurin inhibitor cyclosporin A had decreased nuclear level of NFAT1. HCC cells had hypermethylation of a CpG island in the 5' regulatory region of RCAN1.4, which reduced its expression. RCAN1.4 is down-regulated in HCC tissues, compared with non-tumor liver tissues. RCAN1.4 prevents cell proliferation, migration, and invasion in vitro; overexpressed RCAN1.4 in HCC cells prevents growth, angiogenesis, and metastases of xenograft tumors by inhibiting calcineurin activity and nuclear translocation of NFAT1.


Rhodopseudomonas acidophila, sp. n., a new species of the budding purple nonsulfur bacteria.
A succinate-mineral salts medium of pH 5.2 provided selective enrichment conditions for Rhodomicrobium vannielii and for a new species belonging to the Athiorhodaceae, described herein as Rhodopseudomonas acidophila. Seven strains of the new species have been isolated from different sources in the United States and Germany. The cells are rod-shaped or ovoid, 1.0 to 1.3 mum wide and 2 to 5 mum long, and motile by means of polar flagella. Multiplication occurs by budding. The photopigments consist of bacteriochlorophyll a and carotenoids of the spirilloxanthin series, together with new carotenoids. All strains can grow either under anaerobic conditions in the light or under microaerophilic to aerobic conditions in the dark. No growth factors are required. The range of simple organic substrates photo-assimilated resembles that characteristic of Rhodomicrobium. Good photolithotrophic growth is possible at the expense of molecular hydrogen; thiosulfate and sulfide are not utilized.


Synthesis of Amylose-b-P2 VP Block Copolymers.
A new class of rod-coil block copolymers is synthesized by chemoenzymatic polymerization. In the first step, maltoheptaose, which acts as a primer for the synthesis of amylose, is attached to poly(2-vinyl pyridine) (P2 VP). The enzymatic polymerization of maltoheptaose is carried out by phosphorylase to obtain amylose-b-P2 VP block copolymers. The block copolymer is characterized by Fourier transform infrared spectroscopy, nuclear magnetic resonance, gel permeation chromatography, and wide-angle X-ray scattering techniques. The designed molecules combine the inclusion complexation ability of amylose with the supramolecular complexation ability of P2 VP and therefore this kind of rod-coil block copolymers can be used to generate well-organized novel self-assembled structures.


Gene expression analyses support fallopian tube epithelium as the cell of origin of epithelial ovarian cancer.
Folate receptor alpha (FOLR1/FRA) is reported to be overexpressed in epithelial ovarian cancers (EOC), especially the serous histotype. Further, while dysregulation of the folate-dependent 1-carbon cycle has been implicated in tumorogenesis, little is known relative to the potential mechanism of action of FOLR1 expression in these processes. We therefore investigated the expression of FOLR1, other folate receptors, and genes within the 1-carbon cycle in samples of EOC, normal ovary and fallopian tube on a custom TaqMan Low Density Array. Also included on this array were known markers of EOC such as MSLN, MUC16 and HE4. While few differences were observed in the expression profiles of genes in the 1-carbon cycle, genes previously considered to be overexpressed in EOC (e.g., FOLR1, MSLN, MUC16 and HE4) showed significantly increased expression when comparing EOC to normal ovary. However, when the comparator was changed to normal fallopian tube, these differences were abolished, supporting the hypothesis that EOC derives from fallopian fimbriae and, further, that markers previously considered to be upregulated or overexpressed in EOC are most likely not of ovarian origin, but fallopian in derivation. Our findings therefore support the hypothesis that the cell of origin of EOC is tubal epithelium.


Targeted delivery of siRNA to cell death proteins in sepsis.
Immune suppression is a major cause of morbidity and mortality in the patients with sepsis. Apoptotic loss of immune effector cells such as CD4 T and B cells is a key component in the loss of immune competence in sepsis. Inhibition of lymphocyte apoptosis has led to improved survival in animal models of sepsis. Using quantitative real-time polymerase chain reaction of isolated splenic CD4 T and B cells, we determined that Bim and PUMA, two key cell death proteins, are markedly upregulated during sepsis. Lymphocytes have been notoriously difficult to transfect with small interfering RNA (siRNA). Consequently a novel, cyclodextrin polymer-based, transferrin receptor-targeted, delivery vehicle was used to coadminister siRNA to Bim and PUMA to mice immediately after cecal ligation and puncture. Antiapoptotic siRNA-based therapy markedly decreased lymphocyte apoptosis and prevented the loss of splenic CD4 T and B cells. Flow cytometry confirmed in vivo delivery of siRNA to CD4 T and B cells and also demonstrated decreases in intracellular Bim and PUMA protein. In conclusion, Bim and PUMA are two critical mediators of immune cell death in sepsis. Use of a novel cyclodextrin polymer-based, transferrin receptor-targeted siRNA delivery vehicle enables effective administration of antiapoptotic siRNAs to lymphocytes and reverses the immune cell depletion that is a hallmark of this highly lethal disorder.


Infant cochlear implantation and anesthetic risk.
In light of the strong trends toward performing cochlear implantation in infants, it is necessary to consider anesthetic issues. Just as anesthetic risk may play an important role in surgical candidacy in the elderly population, anesthesia is also of special consideration in infants. Even healthy infants are known to be at increased risk for anesthetic complications; for this reason, most elective surgical procedures are not routinely done within the first year of life. Therefore, it is necessary to consider anesthetic issues when contemplating the use of cochlear implants in infants less than 12 months of age.


The biomimetic surface topography ofRubus fruticosusleaves stimulate the induction of osteogenic differentiation of rBMSCs.
The interaction between cells and biomaterials is essential for the success of biomedical applications in which the implantation of biomaterials in the human body is necessary. It has been demonstrated that material's chemical, mechanical, and structural properties can influence cell behaviour. The surface topography of biomaterials is a physical property that can have a major role in mediating cell-material interactions. This interaction can lead to different cell responses regarding cell motility, proliferation, migration, and even differentiation. The combination of biomaterials with mesenchymal stem cells (MSCs) for bone regeneration is a promising strategy to avoid the need for autologous transplant of bone. Surface topography was also associated with the capacity to control MSCs differentiation. Most of the topographies studied so far involve machine-generated surface topographies. Herein, our strategy differentiates from the above mentioned since we selected natural surface topographies that can modulate cell functions for regenerative medicine strategies.Rubus fruticosusleaf was the selected topography to be replicated in polycaprolactone (PCL) membranes through polydimethylsiloxane moulding and using soft lithography. Afterwards, rat bone marrow stem cells (rBMSCs) were seeded at the surface of the imprinted PCL membranes to characterize the bioactive potential of our biomimetic surface topography to drive rBMSCs differentiation into the osteogenic lineage. The selected surface topography in combination with the osteogenic inductive medium reveals having a synergistic effect promoting osteogenic differentiation.


BK virus associated with small cell carcinoma of bladder in a patient with renal transplant.
A man in his 70s with a complex medical history, including cadaveric renal transplant, presented with recurrent urinary tract infections. Investigation revealed recurrent urinary pathogens, including Enterobacter cloacae and persistent BK viruria. Cystoscopy revealed a pedunculated mass in the right posterior-lateral wall, inferior to the transplant urethral orifice, and biopsy of this mass showed invasive small cell carcinoma with a prominent adenocarcinoma component. The tumour was treated with complete transurethral resection followed by carboplatin, etoposide and radiation. Laboratory analysis of biopsied samples showed immunostaining and molecular evidence of BK virus DNA in the cancer cells. Follow-up cystoscopies have shown no recurrence of the cancer.


Nesting one-against-one algorithm based on SVMs for pattern classification.
Support vector machines (SVMs), which were originally designed for binary classifications, are an excellent tool for machine learning. For the multiclass classifications, they are usually converted into binary ones before they can be used to classify the examples. In the one-against-one algorithm with SVMs, there exists an unclassifiable region where the data samples cannot be classified by its decision function. This paper extends the one-against-one algorithm to handle this problem. We also give the convergence and computational complexity analysis of the proposed method. Finally, one-against-one, fuzzy decision function (FDF), and decision-directed acyclic graph (DDAG) algorithms and our proposed method are compared using five University of California at Irvine (UCI) data sets. The results report that the proposed method can handle the unclassifiable region better than others.


Anomalous Screening of Quantum Impurities by a Neutral Environment.
It is a common knowledge that an effective interaction of a quantum impurity with an electromagnetic field can be screened by surrounding charge carriers, whether mobile or static. Here we demonstrate that very strong, "anomalous" screening can take place in the presence of a neutral, weakly polarizable environment, due to an exchange of orbital angular momentum between the impurity and the bath. Furthermore, we show that it is possible to generalize all phenomena related to isolated impurities in an external field to the case when a many-body environment is present, by casting the problem in terms of the angulon quasiparticle. As a result, the relevant observables such as the effective Rabi frequency, geometric phase, and impurity spatial alignment are straightforward to evaluate in terms of a single parameter: the angular-momentum-dependent screening factor.


Microplastics but not natural particles induce multigenerational effects in Daphnia magna.
Several studies have investigated the effects of nano- and microplastics on daphnids as key freshwater species. However, while information is abundant on the acute toxicity of plastic beads, little is known regarding the multigenerational effects of irregular microplastics. In addition, a comparison of microplastics to naturally occurring particles is missing. Therefore, we investigated the effects of irregular, secondary polystyrene microplastics (<63 μm) and kaolin as natural reference particle on the survival, reproduction, and growth of Daphnia magna over four generations under food-limited conditions. Additionally, we tested the sensitivity of the neonates in each generation to a reference compound as a proxy for offspring fitness. Exposure to high concentrations of microplastics (10,000 and 2000 particles mL-1) reduced daphnid survival, resulting in extinction within one and four generations, respectively. Microplastics also affected reproduction and growth. Importantly, an exposure to kaolin at similar concentrations did not induce negative effects. The sensitivity of neonates to potassium dichromate was not affected by maternal exposure to particles. Taken together, our study demonstrates that irregular PS particles are more toxic than natural kaolin in daphnids exposed over multiple generations under food limitation. Thus, our work builds towards more realistic exposure scenarios needed to better understand the impacts of microplastics on zooplankton.


[The relationship of virus load, receptor expression and tumor spectrum in layer chickens infected by ALV-J].
Abstract:Subgroup J avian leukosis virus (ALV-J) infect cells by binding to the chNHE1 receptor protein of the host and causes tumors. The tumor incidence of the ALV-J-infected chickens was observed by histo pathology, and virus was isolated on DF-1 cell line. The ALV-J load and mRNA of chNHElreceptor protein were detected by real time PCR. The relationship between ALV-J load, chNHE1 receptor expression levels and tumor spectrum was analyzed. The results showed that the tumors induced by ALV-J in laying hens and local lines of chicken were different. No significant relationship was observed between ALV-J load and tumor spectrum. ALV-J load was positively correlated with mRNA expression of chNHE1. The mRNA expression of chNHE1 increased when the tumors occurred. Our results suggest the chNHE1 protein is not only the receptor of ALV-J infected host but also play an important role in the process of tumor development. This study provides a scientific basis for further studying of oncogenic mechanism of ALV-J.


Solid-state optical properties of linear polyconjugated molecules: pi-stack contra herringbone.
The intermolecular arrangement in the solid state and the consequences on the optical and photophysical properties are studied on different derivatives of oligophenylenevinylenes by UV/VIS absorption and angular-resolved polarized fluorescence spectroscopy. Unsubstituted distyrylbenzene (DSB) organizes in a herringbone manner, with the long axes of the molecules oriented in parallel, but the short axes almost perpendicular to each other. Fluorinated distyrylbenzene (F(12)DSB) as well as the DSB:F(12)DSB cocrystals prefer cofacial pi-stacking in the solid state. For all structures, the consequence of the parallel alignment of the transition moments is a strongly blueshifted H-type absorption spectrum and a low radiative rate constant k(F). Significant differences are observed for the emission spectra: the perpendicular arrangement of the short axes in DSB crystals leads to only very weak intermolecular vibronic coupling. Hence the emission spectrum is well structured, very similar to the one in solution. For F(12)DSB and DSB:F(12)DSB, the cofacial arrangement of the adjacent molecules enables strong intermolecular vibronic coupling of adjacent molecules. Thus, an unstructured and strongly redshifted excimerlike emission spectrum is observed. The differences in the electronic nature of the excited states are highlighted by quantum-chemical calculations, revealing the contribution of interchain excitations to the electronic transitions.


Amebic osteomyelitis in a child with acquired immunodeficiency syndrome: a case report.
Disseminated Acanthamoeba infection has been described in immunocompromised or debilitated patients. The usual sites of involvement are skin, sinus, and brain. Sporadic reports of Acanthamoeba infection in patients infected with the human immunodeficiency virus are present in recent literature, predominantly in adults, and one case involving an 8-year-old child. We describe a case of amebic osteomyelitis, seen in a 6-year-old child with vertically acquired human immunodeficiency virus and a 6-month history of cutaneous Acanthamoeba infection.


Usefulness of magnetic resonance imaging in the assessment of venoatrial connections, atrial morphology, bronchial situs, and other anomalies in right atrial isomerism.
Multiple complex venous and intracardiac anomalies are frequently seen in patients with right atrial isomerism, and complete anatomic information may not always be obtained from combined echocardiography and angiography. Twenty patients with right atrial isomerism were prospectively studied with use of magnetic resonance imaging (MRI); satisfactory imaging was obtained in 18 patients, aged 6 days to 12 years (median 3 months). All patients had undergone echocardiography, cardiac catheterization, and angiocardiography. The purpose of this study was to assess the usefulness of MRI in the evaluation of venoatrial connections, atrial morphology, bronchial situs, and additional anomalies. Bilateral superior venae cavae were documented in 12 patients and anomalous hepatic venous drainage in 11. The pulmonary venous system was imaged in all 18 patients, of whom 12 had total anomalous pulmonary venous connection: 9 supracardiac, 2 infracardiac, and 1 mixed type. Some obstruction to pulmonary venous return was present in 9 of the 12 patients, and the site of obstruction was demonstrated by MRI in 6. Bilateral morphologic right atrial appendages were imaged in 7 patients. Bilateral morphologic right bronchi were identified in 17 patients, asplenia was confirmed in 17 of 18 patients by the absence of splenic tissue on imaging, and hiatal hernia was imaged in 4. Compared with angiography and echocardiography, MRI more clearly defined the pulmonary venous connections in 10 patients with pulmonary venous obstruction. Anomalous hepatic venous connections were better defined by MRI in 2. Therefore, MRI provided valuable supplementary information on the cardiovascular and visceral anomalies in these patients.


Forming a support group for people affected by inflammatory bowel disease.
Inflammatory bowel disease (IBD) - primarily Crohn's disease and ulcerative colitis - is a debilitating lifelong condition with significant health and economic costs. From diagnosis to management, IBD can cause huge psychosocial concerns to patients and their caregivers. This study reports an experience of a Crohn's patient, leading to the formation of the first IBD patient support group in Singapore and how this group has evolved in the last 4 years in supporting other IBD patients. IBD patient advocacy and/or support groups facilitate open conversations on patients' fears, concerns, preferences and needs, and may potentially improve disease knowledge and quality of life for individuals with the condition or their families.


[Antistressor and analgesic effects of mexidol, diazepam, paracetamol, and their combinations].
Mexidol (100 and 200 mg/kg) and diazepam (1 and 2 mg/kg) exhibit a dose-dependent antistressor effect in the pain expectation stress test in rats (conditional emotional reflex). The effect is manifested by the normalization of both motor and somatovegetative characteristics. Paracetamol in a dose of 50 and 100 mg/kg does not possess antistressor properties. Both mexidol and paracetamol increase the threshold of pain sensitivity in the test with electric stimulation of tail in rats. Diazepam does not reduce the pain threshold in this test. The combined administration of mexidol or diazepam with paracetamol does not change the antistressor effect as compared to that of each drug alone. Mexidol, but not diazepam, enhances the effect of paracetamol on the pain threshold.


[Myocardial bridge of the left anterior descending coronary artery and myocardial infarction: does coronary spasm play a part?].
The association of a myocardial bridge of the left anterior descending (LAD) coronary artery and myocardial infarction is rare. The mechanisms by which the myocardial bridge could predispose to myocardial infarction are tachycardia (reducing the duration of diastolic coronary filling), thrombosis at the site of the myocardial bridge, and coronary spasm which, however, has never been demonstrated in the context of infarction. The aim of this study was to detect coronary spasm by provocative ergometrine testing in 4 patients, all male, aged 21 to 49 years, average 39 years old, who had anterior myocardial infarction associated with myocardial bridging of the LAD artery without atheromatous coronary stenosis. The ergometrine tests were performed during (2 cases) or after coronary angiography (2 cases). The systolic narrowing due to the myocardial bridge ranged from 25 to 95% (average 70%). The ergometrine test was strongly positive in 1 patient and negative in the other 3. Repermeabilisation of a thrombus was suggested in these 3 patients by the recording of an accelerated idioventricular rythm in the acute phase of infarction (2 cases) or by the demonstration of abnormal platelet aggregation (1 case). This is the first report of coronary spasm in a patient with myocardial bridging associated with infarction. However, it is not possible to determine the respective roles of spasm and myocardial bridging in the genesis of the infarct. We suggest systemic provocative ergometrine testing in this situation to orientate the most appropriate treatment.


[[Changing patterns and projections of headship rates in Korea]].
"The purpose of this study was to calculate the headship rate for time-series analysis,...to review the patterns of changing headship rates and related factors and to estimate the headship rates to 2010 [for the Republic of Korea].... The data used for this study were derived from the Population and Housing Census Reports from 1960 through 1990, U.N. Manual VII and household-related literature....[The authors predict that] the total headship rate will maintain a uniform pattern of decrease and increase by specific age and peak headship rates will gradually extend to younger people.... Rural headship rates will decrease steadily and be greatly influenced by age structure.... In addition, the difference in headship rates between male and female will be great....Lastly, both the divorced and the single will have increasing headship rates for all ages [with] the single [having] the most rapid increase rate after their thirties." (SUMMARY IN ENG)


"Written Formative Assessments with Peer-Assisted Learning" an Innovative Teaching Program for Postgraduate Students in Community Medicine.
There is a paucity of research on conducting written formative assessment with constructive feedback for theory paper writing for postgraduates of Community Medicine in India. The concept of "Written Formative assessments with Peer-Assisted Learning Program" was implemented to improve the first 2 levels of Miller's Pyramid and assess its impact on the summative assessment. The program was conducted for 2 batches of postgraduate students in the Community Medicine enrolled for the academic session of 2016-2019 and 2017-2020. The written formative assessment was conducted every Saturday for 1 h from August to March month in 2018 and 2019. After each test, answer papers were evaluated by the peer and faculty from the department. Written and oral feedback was given by the peer. After IEC approval, we planned to assess the program's effect on level 1 and level 2 Kirkpatrick's framework. The data were analyzed using SPSS statistical package version 24 (SPSS Inc., Chicago, IL, USA). P < 0.05 was considered statistically significant. Total 23 formative written assessments were conducted per year. The proportions of knowledge, comprehension, and analytical type of questions asked were 47%, 32%, and 21%, respectively. The mean attendance rate was 76.28% ±16.4%. There was no statistically significant difference in the average percentage of marks in formative (weekly test) and summative assessment (university final examination). There was a statistically significant positive co-relation of projected mean marks and summative assessment marks with the co-efficient of the determination being 22.6%. There was overall positive feedback of the formative and peer-assisted learning (PAL) from post graduate students. Written Formative Assessment with PAL program is one of the effective programs for postgraduate students to gain confidence in writing and presentation skills and to score higher in theory examination.


Does Digital Detox Work? Exploring the Role of Digital Detox Applications for Problematic Smartphone Use and Well-Being of Young Adults Using Multigroup Analysis.
The constant availability of social networking sites (SNSs) on smartphones has an enormous distracting potential and may lead to problematic usage behavior, especially among younger age groups. In this context, an emerging trend of using so-called digital detox applications (apps; e.g., iOS Screen Time) can be witnessed, which allows users to monitor and limit their smartphone use as well as to consciously disconnect for a certain period of time. However, it remains unclear whether digital detox apps can indeed reduce negative consequences of using SNSs such as problematic smartphone use (PSU) and decreased well-being. Drawing from self-regulation theory, we investigated the relationships between using SNSs, PSU, and well-being among a sample of 500 young adults between 18 and 35 years of age. We used multigroup analysis to compare digital detox app users and nonusers. Results revealed that a high proportion of young adults use digital detox apps (41.7 percent). Among those who did not use such apps, using SNSs was positively associated with PSU, which was negatively related to well-being. Among digital detox app users, we found no such relationship. Thus, digital detox apps seem to be a valuable tool to prevent harmful effects of using SNSs on well-being among young people by reducing the risk of using the smartphone compulsively.


Detection of internal carotid artery stenosis. Comparison of 2D-MR angiography, duplex scanning, and arteriography.
The purpose of this study was to compare digital subtraction angiography (DSA) and duplex scanning with 2D-Magnetic Resonance Angiography (MRA) to evaluate the accuracy of MRA in determining carotid stenosis. All three methods were applied to 101 carotid arteries in 51 patients. Diameter stenosis of the internal carotid artery was categorized as follows: 0 to 39%, 40% to 59%, 60% to 94%, 95% to 99%, and occlusion (100%). All images were read in blind fashion by different physicians. DSA is still considered the "gold standard" investigation. In 78 arteries the degree of stenosis according to MRA correlated exactly with that of conventional angiography. In the remaining 23, carotid arteries MRA upgraded the stenosis in 13 and downgraded it in 8. The principal problem is the overestimation of the lesion, which was particularly revealing in lesions of more than 60%. Furthermore to date MRA is not able to evaluate the presence of ulceration. For this reason 2D-MRA alone is not a reliable method for evaluating the presence of carotid artery stenosis.


Mentors' competence in mentoring culturally and linguistically diverse nursing students during clinical placement.
To describe mentors' competence in mentoring culturally and linguistically diverse nursing students during clinical placement and identify the factors that affect mentoring. Healthcare education is confronted by several challenges in a time characterized by globalization and increasing international migration. Nursing students from diverse backgrounds continue to experience difficulties during clinical placement. Students can overcome these difficulties and assume responsibility for their learning when mentored by supportive and competent mentors. A cross-sectional, descriptive explorative study design was used. Data were collected during spring 2016 through a survey sent to mentors (n = 3,355) employed at five university hospitals in Finland. Mentors' competence in mentoring culturally and linguistically diverse nursing students was measured with the self-assessment Mentors' Competence Instrument and the Cultural and Linguistic Diversity in Mentoring scale. The analysis included descriptive statistics, non-parametric tests and binary logistic regression analysis. Mentors with experience mentoring nursing students from diverse backgrounds rated their overall competence in mentoring as good. However, the results show continued challenges related to competence in linguistic diversity in mentoring. Seven factors that affect mentors' competence in linguistic diversity were identified. Despite high evaluations by mentors of competence related to cultural diversity in mentoring, there are still opportunities for improvement in this area. Innovative and effective strategies are needed to develop mentors' competence in mentoring culturally and linguistically diverse nursing students. Educational and healthcare organizations should strive to enhance collaboration and increase the competence of both mentors and nursing students to work in increasingly diverse healthcare environments.


Optokinetic nystagmus as related to neonatal position.
The objective of this study was to assess the role of the newborn vestibular system on the infant's preferred position. Neonatal electronystagmography was recorded from 80 full-term healthy neonates in the prone and supine positions. Records were analyzed by the clinical ranking of dysmetria and dysrhythmia and computerized fractal analysis. A significantly (P < .002) decreased organization of the electronystagmography signal was observed in the prone compared with the supine position. These results concur with the previously documented, more optimal physiologic functioning in the supine compared with prone position in infancy. It is possible that the vestibular system, among other factors, plays a role in the more protective supine position in infancy.


Risk factors for age-related macular degeneration: an update.
Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss in the United States and other western nations. Limited treatment is available, and there are no established means of prevention. The detection of modifiable risk factors is important to suggest preventive behaviors that can reduce disease occurrence or prevent the progression to the late stages of AMD. Results of recent studies suggest that the etiology and pathogenesis of AMD are a complex interaction of genetic and external factors. Although a number of factors seem promising, only age and cigarette smoking are confirmed as increasing AMD risk. Other factors that most likely play a significant role in AMD are nutritional factors, e.g., antioxidants, and hypertension or other underlying atherosclerotic disease processes. The results of the Age-Related Eye Disease Study suggest a moderate beneficial effect of antioxidant, vitamin, and zinc supplementation in reducing progression to severe AMD.


The Effects of Chromium and Vanadium on Biomarkers of Carbohydrate and Lipid Metabolism in Workers Exposed to Coal Fly Ash.
Chromium (Cr) and vanadium (V) are micronutrients playing a role in carbohydrate and lipid metabolism but can be toxic at high concentrations, especially in specific forms. The study documents the effect of Cr and V concentrations on glucose and lipid metabolism in workers exposed to coal fly ash. We quantified selected metals (Cr, V) in the blood and serum of workers from a thermal power plant in Kosovo and compared them with the reference biological values. We determined fasting serum glucose and lipid profiles using a biochemical analyzer Synchron CX7 (Beckman Coulter). We quantified blood and serum Cr and V by inductively coupled plasma mass spectrometry. We also evaluated the association between carbohydrate and lipid metabolism biomarkers (glucose, cholesterol, and triglycerides) and co-exposure to coal fly ash. Power plant workers had significantly higher blood Cr and V levels (p < 0.0001) and significantly lower serum Cr and V levels (p < 0.0001) than the controls. We also found statistically significant (p < 0.0001) correlations between high blood Cr levels and low glucose/blood Cr ratios as well as between high serum Cr levels and low glucose/serum Cr ratios. Finally, in power plant workers, high blood V levels significantly correlated with low triglycerides/blood V and cholesterol/blood V ratios (p < 0.0001), while high serum V levels correlated with low cholesterol/serum V ratios (p = 0.005). Based on these findings, we concluded that the glucose/Cr, triglycerides/V and cholesterol/V ratios should be considered when evaluating carbohydrate and lipid metabolism disorders in occupationally-exposed workers.


Quality in perspective.
Quality and accreditation have taken great strides in recent years. If you are one of the many who find the subject confusing then blame the relentless changes in concepts and terminology that swept into health care. To put this in perspective, I will look at where we have been, where we are, and where we are headed.


Air stacking: effects of Pilates mat exercises on muscle strength and on pulmonary function in patients with cystic fibrosis.
To analyze the effects of Pilates mat exercises in patients with cystic fibrosis (CF). This was a clinical trial involving 19 CF patients recruited from either the CF Outpatient Clinic of the State University at Campinas Hospital de Clínicas or the Children's Institute of the University of São Paulo School of Medicine Hospital das Clínicas. All of the patients performed Pilates mat exercises for four months (one 60-min session per week). The variables studied (before and after the intervention) were respiratory muscle strength, MIP, MEP, FVC, and FEV1. After the intervention, MIP was significantly higher in the male patients (p = 0.017), as were MIP and MEP in the female patients (p = 0.005 and p = 0.007, respectively). There were no significant differences between the pre- and post-intervention values of FVC or FEV1, neither in the sample as a whole nor among the patients of either gender. Our results show that Pilates mat exercises have beneficial effects on respiratory muscle strength in CF patients.


Analysis of Current Fluctuation Due to Trap and Percolation Path in Nano-Scale Bulk FinFET.
An electron in the channel can be trapped into the trap inside gate oxide and detrapped into the channel, resulting in the fluctuation in drain current. To investigate the drain current fluctuation (ΔI(D)) caused by trapping/detrapping of an electron in 22 nm bulk FinFET, 3-D device simulation was performed extensively. The ΔI(D) is changed by changing the position of the trap in the gate oxide along the surface of fin body. In the bulk FinFET, the trap located near the center of side surface of the fin body gives the larger ΔI(D) compared to those of the traps located at the top center, top corner, and side bottom. At a fixed trap position, the shallower trap depth (x(T)) from the interface between the gate oxide and the fin body gives the lager ΔI(D). With decreasing fin width (W(fin)) and fin height (H(fin)), the ΔI(D) increases. Especially, decreasing H(fin) increases ΔI(D) significantly. As the trap is close to a percolation path, the ΔI(D) also increases.