Flammability of Thick but Thermally Thin Materials including Bio-Based Materials.
The fire reaction of various types of flammable lightweight materials is investigated using a cone calorimeter. The influences of parameters such as sample density, sample mass, effective heat of combustion and heat flux on the mass loss after exposition are discussed. Interpretations of the hemp fibers' tests results lead us to propose a phenomenological model able to calculate the peak of heat release rate (pHRR) of such thermally thin materials, with or without flame retardant. A database gathering the whole results of tests performed on a large set of materials including fibers, bio-resources panels, bio-based concretes and fabrics is used to validate the proposed model. Interestingly, the model is found to be relevant also for denser wood specimens. The model is based on the distinction of the contributions of the exposed top layer and the deeper layer to the combustion. Indeed, in such materials, the heat conduction is limited (either by the intrinsic properties of the material or by the formation of an insulating char) and therefore the pHRR only depends on a limited volume of materials directly absorbing the heat flux from the radiant cone. Accuracy and limitations of the model are discussed.


Prenatal diagnosis of pygopagus tetrapus parasitic twin: case report.
BACKGROUND: Asymmetric and parasitic conjoined twins are rarer anomalies of monochorionic monoamniotic twins, consisting of an incomplete twin attached to the fully developed body of the co-twin. CASE PRESENTATION: A 30-year-old multigravid woman referred to maternal fetal unit due to polyhydramnios at 28th week of gestation. Sonographic examination revealed a single fetus and polyhydramnios with amniotic fluid index 30 cm. The fetus had normal apparent single head, spine, thorax, abdomen, two upper and two lower limbs, and two relatively well developed rudimentary parasitic lower limbs at sacral region. Lower limbs of the autosite were moving freelly but no movement was detected at the parasite. The parasite contained irregular lower limbs and left foot with three toes. Short and deformed long bones were also present in the parasitic limbs. A Cesarean section was performed at 38th week of gestation and a live female infant weighing 3600 g was delivered. The parasitic lower limbs were totally excised. Post-operative period was uneventful and the newborn was discharged as healthy. Post-natal follow-up was normal at nine-month-old. CONCLUSION: Pygopagus tetrapus parasitic twin is a rare form of conjoined twins and in utero diagnosis with ultrasound assists in prenatal management and counselling with parents.


Fibronectin-binding proteins of Clostridium perfringens recognize the III1-C fragment of fibronectin.
The Clostridium perfringens strain 13 genome contains two genes (fbpA, fbpB) that encode putative Fbp. Both rFbpA and rFbpB were purified and their reactivity with human serum Fn was analyzed. To determine the region of the Fn molecule recognized by rFbp, a plate binding assay using N-terminal 70-kDa peptide, III1-C peptide, and 110-kDa peptide containing III2-10 of Fn was performed. Both rFbp bound to the III1-C peptide of Fn but not to the other peptides. However, the III1-C fragment of Fn is known to be cryptic in serum Fn. Then, rFbp-BP from Fn were purified by rFbp-affinity chromatography. The yield of purified proteins was approximately 1% of the applied Fn on a protein basis. Western blotting analysis of the rFbp-BP, using four different anti-Fn monoclonal antibodies, revealed that the rFbp-BP carried partial Fn antigenicity. Bindings of rFbp to rFbp-BP were inhibited by the presence of the III1-C peptide, suggesting that rFbp-BP express the III1-C fragment. The binding of Fn to III1-C was inhibited by the presence of either rFbpA or rFbpB. This result that suggests C. perfringens Fbps may inhibit the formation of Fn-matrix in vivo.


Is the goat a new host for the G3 Indian buffalo strain of Echinococcus granulosus?
Four goats bred in Central Italy (province of Rieti) revealed, in the liver, metacestodes of Echinococcus granulosus. The cysts, unilocular and fertile, were examined by microscopy and molecular diagnostics. Morphological data on the rostellar hooks are in agreement with the original description of the strain found in buffaloes and are largely compatible with those reported in Europe for cattle and humans. Specific PCR followed by DNA sequencing of the mitochondrial cox1 gene revealed for all the isolates 99.5% identity to the reference strain G3 genotype and 99.3% and 99.1% to G2 and G1, respectively. Further genetic markers (nad1 and 12S rRNA) confirmed the identity of the goat isolates to the G3 strain. This genotype, here reported for the first time in goats, proved to have a wider than previously supposed host range, therefore its relevance in human hydatidosis is expected to be more often evidenced.


A 5-year follow-up study of hospital breastfeeding policies in the Philadelphia area: a comparison with the ten steps.
The purpose of this study was to describe the current status of hospital breastfeeding policies and practices in the Philadelphia area, to assess hospitals' current implementation levels of the Ten Steps to Successful Breastfeeding, and to compare current implementation levels with 1994 baseline data. Most surveyed hospitals were fully implementing 5 of the Ten Steps. Thirty-seven percent of the hospitals were classified as high implementers and 63% as partial implementers of the Ten Steps overall. Key factors that affect implementation of each step were identified through in-depth discussions. Areas identified as needing the greatest attention were breastfeeding education of health care professionals and mothers, prenatal and postdischarge outreach to mothers, and the restriction of infant supplementation. Additionally, ethnic diversity and cultural beliefs of the mother-infant couple that influence breastfeeding choices need to be considered.


Purification and Some Characteristics of Extracellular Lipase from Fusarium oxysporum f. sp. lini.
An extracellular lipase was isolated from a culture filtrate of Fusarium oxysporum f. sp. lini SUF 402 by hydrophobic chromatography. Purity of the preparation was 38-fold and recovery yield was 32%. The molecular mass of the isolated enzyme was 30 kDa. The lipase had a sugar chain, and the N-terminal amino acid was modified. The optimun pH at 37°C was 7.0. The enzyme had higher activity toward p-nitrophenyl esters with long and middle chain fatty acids (C8-C18) than with a short chain fatty acid (C4). The enzyme was not inhibited by phenylmethylsulfonyl fluoride or 2-mercaptoethanol. In the case of the lipase, both the hydrolysis rate of tristearin and final concentration of fatty acid content were higher than those of triolein. The lipase was examined with respect to its ability of concentrating the n-3 polyunsaturated fatty acid (n-3 PUFA) content of partially hydrolyzed glycerides (TG and DG) obtained from two kinds of fish oil (cod liver oil and refined sardine oil). The lipase gave increases in n-3 PUFA contents as the hydrolysis progressed. The lipase concentrated only docosahexaenoic acid with little increase in icosapentaenoic acid. Maximal total n-3 PUFA contents were about 30% in both fish oils.


Pleistocene Marine Microfauna in the Bootlegger Cove Clay, Anchorage, Alaska.
Ostracods and Foraminifera, associated with molluscs, indicate a marine depositional environment for part of the Bootlegger Cove Clay. The definite Arctic and North Atlantic affinities of the microfauna suggest a possible migration through the Bering-Chukchi seaway during the late Pleistocene.


Evaluation of a Recombinant Flavobacterium columnare DnaK Protein Vaccine as a Means of Protection Against Columnaris Disease in Channel Catfish (Ictalurus punctatus).
Flavobacterium columnare causes substantial losses among cultured finfish species. The Gram-negative bacterium is an opportunistic pathogen that manifests as biofilms on the host's mucosal surfaces as the disease progresses. We previously demonstrated that the dominant mucosal IgM antibody response to F. columnare is to the chaperone protein DnaK that is found in the extracellular fraction. To establish the efficacy of using recombinant protein technology to develop a new vaccine against columnaris disease, we are reporting on two consecutive years of vaccine trials using a recombinant F. columnare DnaK protein (rDnaK). In year one, three groups of channel catfish (n = 300) were immunized by bath immersion with a live attenuated F. columnare isolate, rDnaK or sham immunized. After 6 weeks, an F. columnare laboratory challenge showed a significant increase in survival (>30%) in both the live attenuated and rDnaK vaccines when compared to the non-immunized control. A rDnaK-specific ELISA revealed significant levels of mucosal IgM antibodies in the skin of catfish immunized with rDnaK at 4- and 6-weeks post immunization. In the second year, three groups of channel catfish (n = 300) were bath immunized with rDnaK alone or with rDnaK after a brief osmotic shock or sham immunized. After 6 weeks a laboratory challenge with F. columnare was conducted and showed a significant increase in survival in the rDnaK (> 25%) and in rDnaK with osmotic shock (>35%) groups when compared to the non-immunized control. The rDnaK-specific ELISA demonstrated significant levels of mucosal IgM antibodies in the skin of catfish groups immunized with rDnaK at 4- and 6-weeks post immunization. To further understand the processes which have conferred immune protection in the rDnaK group, we conducted RNA sequencing of skin samples from the non-immunized (n = 6) and rDnaK treated channel catfish at 1-week (n = 6) and 6 weeks (n = 6) post immunization. Significantly altered gene expression was identified and results will be discussed. Work to further enhance the catfish immune response to F. columnare rDnaK is underway as this protein remains a promising candidate for additional optimization and experimental trials in a production setting.


Isolation of macrophage-like cell mutants resistant to the cytotoxic effect of oxidized low density lipoprotein.
A high concentration of oxidized low density lipoprotein (Ox-LDL) showed a cytotoxic effect on mouse macrophage-derived J774 cells. Mutant cells were selected from these cells that were resistant to the cytotoxic effect of Ox-LDL. One mutant form, named JO21b cells, was characterized in the present study. In spite of a marked resistance to the cytotoxic effect of Ox-LDL, JO21b cells were apparently as sensitive as the parent cells not only to toxic moieties of Ox-LDL, such as 7-ketocholesterol and lysophosphatidylcholine, but also to t-butyl hydroperoxide, an artificial lipid hydroperoxide analog. However, the cellular association of 125I-labeled Ox-LDL with, and subsequent endocytic degradation by JO21b cells was reduced by 70-80% compared with J774 cells. Similarly, accumulation of cholesteryl esters in JO21b cell by Ox-LDL was also reduced by 70%. Northern blot analyses of type I and type II macrophage scavenger receptors (type I and type II MSR) demonstrated that the mRNA levels of JO21b cells were lower than those of J774 cells. Moreover, peritoneal macrophages obtained from MSR-knockout mice showed a higher resistance to the cytotoxic effect of Ox-LDL than those from their wild-type littermates. Our results suggest, therefore, that macrophage scavenger receptor-mediated endocytic uptake of oxidized low density lipoproteins (Ox-LDL) may play an enhancing role in Ox-LDL cytotoxicity to macrophages or macrophage-derived cells.


Adopting professional values.
Nurses often care for vulnerable people and those who may have a lifestyle that society considers unconventional or unacceptable. To meet the needs of our patients, we should be aware of our own values, beliefs and attitudes, and not impose them on patients. We need to adopt the professional values of our workplace.


Direct myocardial revascularization without extracorporeal circulation. Experience in 700 patients.
Between May 1978 and March 1990, 700 patients were operated on with direct coronary surgery without extracorporeal circulation (ECC): 529 (76 percent) were male and 171 (24 percent) were female. The average age was 64 years (range, 35 to 86 years), 454 (65 percent) had unstable angina, 163 (23 percent) had stable angina, 51 (7 percent) had postmyocardial infarction angina, and 32 (5 percent) had acute myocardial infarction at the moment of the operation. In this series of patients, all branches of the coronary arteries were bypassed; the mammary artery was used in 40 percent of the cases, the average bypass per patient was 2.2 (range, 1 to 5), and 26 percent had associated disease of high risk to undergo ECC. The morbidity was 4 percent and the mortality for this series of patients was 1 percent; the probability of survival at seven years was 90 percent. This experience shows us that this surgery is an alternative in the treatment of coronary disease, especially for aged patients with associated disease, in some cases of acute transmural infarction, and also for patients who need coronary angioplasty. Also, it can improve the relation cost/benefit in coronary surgery.


Hypoxia modulates fibroblastic architecture, adhesion and migration: a role for HIF-1α in cofilin regulation and cytoplasmic actin distribution.
Cells can adapt to hypoxia by various mechanisms. Yet, hypoxia-induced effects on the cytoskeleton-based cell architecture and functions are largely unknown. Here we present a comprehensive analysis of the architecture and function of L929 fibroblasts under hypoxic conditions (1% O2). Cells cultivated in hypoxia showed striking morphological differences as compared to cells cultivated under normoxic conditions (20% O2). These changes include an enlargement of cell area and volume, increased numbers of focal contacts and loss of cell polarization. Furthermore the β- and γ-actin distribution is greatly altered. These hypoxic adjustments are associated with enhanced cell spreading and a decline of cell motility in wound closure and single cell motility assays. As the hypoxia-inducible factor-1α (HIF-1α) is stabilised in hypoxia and plays a pivotal role in the transcriptional response to changes in oxygen availability we used an shRNA-approach to examine the role of HIF-1α in cytoskeleton-related architecture and functions. We show that the observed increase in cell area, actin filament rearrangement, decrease of single cell migration in hypoxia and the maintenance of p-cofilin levels is dependent on HIF-1α stabilisation.


The role of sonography and transhepatic cholangiography in the diagnosis of biliary complications after liver transplantation.
We retrospectively reviewed the results of real-time sonography in 41 patients in whom biliary complications after liver transplantation were documented by percutaneous transhepatic cholangiography. Abnormalities included bile duct stricture (26 cases), occluded internal biliary stent (six cases), common duct redundancy with resultant functional biliary obstruction (three cases), bile leak (three cases), choledocholithiasis (two cases), and an abscess in a cystic duct remnant (one case). Sonography was abnormal in 22 of the 41 cases (sensitivity, 54%). Bile duct dilatation was the positive sonographic finding in 19 (86%) of the 22 abnormal examinations. In the remaining 19 patients, sonography was normal. Sonography is not a reliable test for the early detection of biliary abnormalities after liver transplantation. Percutaneous transhepatic cholangiography should be performed in patients with suspected biliary complications after liver transplantation.


Antibacterial and antibiofilm activities of Chinese propolis essential oil microemulsion against Streptococcus mutans.
To solve the shortcomings of poor solubility, easy volatilization, and decomposition, propolis essential oil microemulsion (PEOME) was prepared. The antibacterial, antibiofilm activities, and action mechanism of PEOME against Streptococcus mutans was analyzed. PEOME was prepared using anhydrous ethanol and Tween-80 as the cosurfactant and surfactant, respectively. The antibacterial activity of PEOME against S. mutans was evaluated using the agar disk diffusion method and broth microdilution method. The effects of PEOME on S. mutans biofilm was detected through the assays of crystal violet (CV), XTT reduction, lactic dehydrogenase (LDH) and calcium ions leaking, live/dead staining and scanning electron microscopy (SEM). And the antibiofilm mechanism of PEOME was elaborated by the assays of extracellular polysaccharide (EPS) production and glucosyltransferase (GTF) activity. The inhibition zone diameter (DIZ) of PEOME against S. mutans was 31 mm, while the minimal inhibitory concentration (MIC) was 2.5 μL mL-1. CV and XTT assays showed that PEOME could prevent fresh biofilm formation and disrupt preformed biofilm through decreasing the activities and biomass of biofilm. The leaking assays for LDH and calcium ions, as well as the live/dead staining assay, indicated that PEOME was able to damage the integrity of bacterial cell membranes within the biofilm. SEM revealed that PEOME had a noticeable inhibitory effect on bacterial adhesion and aggregation through observing the overall structure of biofilm. The assays of EPS production and GTF activity suggested that PEOME could reduce EPS production by inhibiting the activity of GTFs, thus showing an antibiofilm effect. The significant antibacterial and antibiofilm activities against S. mutans of PEOME meant that PEOME has great potential to be developed as a drug to prevent and cure dental caries caused by S. mutans.


Reporting Insulin Pump Accuracy: Trumpet Curves According to IEC 60601-2-24 and Beyond.
Accuracy of insulin pump basal rate delivery, if tested according to the standard IEC 60601-2-24 for infusion pumps, shall be presented as a trumpet curve. This way of graphical presentation is common; however, it is often misunderstood and misinterpreted by people. It is often assumed that a trumpet curve shows the error rate as a function of time, thus implying an increasing accuracy in the course of time. On the contrary, the horizontal axis of a trumpet curve shows increasingly long observation windows. In addition, trumpet curves display only extreme values, that is, those windows with minimal and maximal deviation, which might not be representative for the total deviation. This commentary provides information regarding the calculations and the interpretation of trumpet curves and proposes alternative approaches.


Rapid multislice T1 mapping of mouse myocardium: Application to quantification of manganese uptake in α-Dystrobrevin knockout mice.
The aim of this study was to develop a rapid, multislice cardiac T1 mapping method in mice and to apply the method to quantify manganese (Mn(2+)) uptake in a mouse model with altered Ca(2+) channel activity. An electrocardiography-triggered multislice saturation-recovery Look-Locker method was developed and validated both in vitro and in vivo. A two-dose study was performed to investigate the kinetics of T1 shortening, Mn(2+) relaxivity in myocardium, and the impact of Mn(2+) on cardiac function. The sensitivity of Mn(2+)-enhanced MRI in detecting subtle changes in altered Ca(2+) channel activity was evaluated in a mouse model with α-dystrobrevin knockout. Validation studies showed strong agreement between the current method and an established method. High Mn(2+) dose led to significantly accelerated T1 shortening. Heart rate decreased during Mn(2+) infusion, while ejection ratio increased slightly at the end of imaging protocol. No statistical difference in cardiac function was detected between the two dose groups. Mice with α-dystrobrevin knockout showed enhanced Mn(2+) uptake in vivo. In vitro patch-clamp study showed increased Ca(2+) channel activity. The saturation recovery method provides rapid T1 mapping in mouse hearts, which allowed sensitive detection of subtle changes in Mn(2+) uptake in α-dystrobrevin knockout mice.


Mesectodermal leiomyosarcoma of the ciliary body.
We report a case of low-grade mesectodermal leiomyosarcoma of the ciliary body, an extremely rare tumor of neural crest origin, occurring in a 12-year-old boy. MR imaging showed a well-marginated, ovoid soft tissue mass at the right temporal ciliary body, accompanied by total retinal detachment. The mass was slightly hyperintense relative to contralateral vitreous on T1-weighted images and markedly hypointense on T2-weighted images and enhanced very well. Initial biopsy of the mass suggested a peripheral nerve sheath tumor. The mass grew rapidly after biopsy, and enucleation was performed. The final diagnosis based on histology and immunohistochemistry was a low-grade mesectodermal leiomyosarcoma. To our knowledge, this is the first reported case of a malignant form of mesectodermal leiomyoma of the ciliary body.


Aceclofenac and paracetamol in episiotomal pain.
The analgesic efficacy and safety of a single oral dose of 100 mg of aceclofenac was compared in a double-blind study with a single dose of 650 mg of paracetamol in patients with severe episiotomal pain. The patients were questioned after 30 min and then at hourly intervals for 6 h after medication. A standard format (Huskisson's test) was used to investigate the intensity of the pain throughout the study. The statistically significant results show that the analgesic effect of aceclofenac is superior to that of paracetamol. The tolerance of both compounds is excellent.


Acetate fuels the cancer engine.
Cancer cells have distinctive nutrient demands to fuel growth and proliferation, including the disproportionate use of glucose, glutamine, and fatty acids. Comerford et al. and Mashimo et al. now demonstrate that several types of cancer are avid consumers of acetate, which facilitates macromolecular biosynthesis and histone modification.


Polyphenols intervention is an effective strategy to ameliorate inflammatory bowel disease: a systematic review and meta-analysis.
Whether polyphenols could ameliorate inflammatory bowel disease (IBD) is still conflicting. To explore the efficacy of polyphenols as an adjuvant therapy for IBD, we conducted this systematic review and meta-analysis. Literature search was performed using PubMed, Web of Science, Scopus and Cochrane databases. Finally, 12 randomized controlled trials (RCTs) were included. In contrast to control group, curcumin treatment significantly improved clinical remission in intention-to-treat (ITT) (OR = 3.36, 95% CI: 1.09-10.37) and per-protocol (PP) analysis (OR = 5.13, 95% CI: 1.84-14.27). Meanwhile, curcumin could significantly ameliorate endoscopic remission (OR = 5.69, 95% CI: 1.28-25.27) and clinical response (OR = 4.69, 95% CI: 1.03-21.47) in PP analysis. Heterogeneity was present across the studies. In conclusions, polyphenols might be an effective adjuvant treatment for ameliorating IBD. Considering the relatively few studies included in our present study, further clinical trials are required to verify the effects of polyphenols on IBD.


Women's critical experiences with the pap smear for the development of cervical cancer screening devices.
Global cervical cancer incidence and mortality have remained a major public health problem. Depending on the quality and coverage of preventive programs, and the capacity of health care systems, different screening tests are used, with the Pap smear being the most widely implemented. Several difficulties have been reported in accessing timely detection, causing late cervical cancer diagnosis. Trying to close these gaps, new screening devices have been developed in recent years; however, there is a lack of knowledge about whether or not women perspective has been included in the design process and technological development of these devices. This scoping review aimed to describe and synthesize scientific literature on women's critical experiences with Pap smears to prospectively contribute to the design, development, and scale-up of cervical cancer screening devices. The electronic databases Web of Science, Scopus, PubMed, PsycINFO and SciELO were searched for relevant studies published between 2012 and 2021; finally, 18 qualitative studies were included. Experiences were classified into four categories: fear and embarrassment, speculum pain and discomfort, outcome distress and health service barriers. Critical experiences before, during, and after the test were analyzed in turn. In particular, during the test, women reported pain associated with the use of the speculum. The acceptability of new screening devices will largely depend on comfort during the test and timely delivery of results. This review provides a useful qualitative synthesis, not only to advance the design of novel devices but also for future implementation research in cervical screening services.


Gastrulation in Drosophila melanogaster: Genetic control, cellular basis and biomechanics.
Gastrulation is generally understood as the morphogenetic processes that result in the spatial organization of the blastomere into the three germ layers, ectoderm, mesoderm and endoderm. This review summarizes our current knowledge of the morphogenetic mechanisms in Drosophila gastrulation. In addition to the events that drive mesoderm invagination and germband elongation, we pay particular attention to other, less well-known mechanisms including midgut invagination, cephalic furrow formation, dorsal fold formation, and mesoderm layer formation. This review covers topics ranging from the identification and functional characterization of developmental and morphogenetic control genes to the analysis of the physical properties of cells and tissues and the control of cell and tissue mechanics of the morphogenetic movements in the gastrula.


Antioxidant Activity of Natural Allylpolyalkoxybenzene Plant Essential Oil Constituents.
Free-radical-scavenging capacity antioxidant and membrane-protective properties of natural and related synthetic allylpolyalkoxybenzenes with different numbers of alkoxy/methoxy groups in the aromatic ring were evaluated using several in vitro models. These included the DPPH assay, inhibition of lipid peroxidation products accumulation, inhibition of H2O2-induced hemolysis, and oxidation of oxyhemoglobin. A synthetic protocol for the synthesis of natural nothoapiol (9) from a parsley seed metabolite, apiol (7), was developed. A structure-activity relationship study revealed that both the methylenedioxy fragment and methoxy groups in the aromatic ring are favorable for antioxidant activity. Hydroxyapiol (14), containing a hydroxy group in the aromatic core, was identified as the most potent compound. The pentaalkoxy-substituted nothoapiol (9) showed antioxidant activity in mouse brain homogenates, whereas in mouse erythrocytes it exhibited a marked pro-oxidant effect. Despite their low free-radical-scavenging capacity, allylpolyalkoxybenzenes can contribute to the total antioxidant potencies of plant essential oils.


Bacteria with Phosphate Solubilizing Capacity Alter Mycorrhizal Fungal Growth Both Inside and Outside the Root and in the Presence of Native Microbial Communities.
Arbuscular mycorrhizal fungi (AMF) and phosphate solubilizing Pseudomonas bacteria (PSB) could potentially interact synergistically because PSB solubilize phosphate into a form that AMF can absorb and transport to the plant. However, very little is known about the interactions between these two groups of microorganisms and how they influence the growth of each other. We tested whether different strains of bacteria, that have the capacity to solubilize phosphate, are able to grow along AMF hyphae and differentially influence the growth of AMF both outside the roots of carrot in in vitro conditions and inside the roots of potato in the presence of a microbial community. We found strong effects of AMF on the growth of the different bacterial strains. Different bacterial strains also had very strong effects on the growth of AMF extraradical hyphae outside the roots of carrot and on colonization of potato roots by AMF. The differential effects on colonization occurred in the presence of a microbial community. Our results show that these two important groups of rhizosphere microorganisms indeed interact with each other. Such interactions could potentially lead to synergistic effects between the two groups but this could depend on whether the bacteria truly solubilize phosphate in the rhizosphere in the presence of microbial communities.


Granulomatosis With Polyangiitis in a Patient on Programmed Death-1 Inhibitor for Advanced Non-small-cell Lung Cancer.
Objectives: To contribute to a precise and thorough knowledge of immune-related adverse events (irAE) induced by immune checkpoint inhibitors (ICI) and to emphasize the importance of this specific form of toxicity in terms of potential predictive value and long-term effects. Materials and Methods: We report the first case of granulomatosis with polyangiitis (GPA) in a patient treated with an anti-Programmed Death protein-1 (PD-1) antibody for advanced non-small-cell lung cancer (NSCLC). Results: After a single dose of this drug the patient showed severe myositis associated with a high anti-PR3 anti-neutrophil cytoplasmic antibody titer. Discontinuation of the anti-PD-1 and introduction of corticoids led to a remission of the irAE. Regarding tumor a partial response was noted. A year later a neutrophilic, sterile pleural exudate and cutaneous lesions appeared with the pathological findings of neutrophilic vasculitis. Retreatment with corticoids induced a new remission of symptoms. It remains unclear whether GPA was preexisting and clinically silent but revealed by the use of ICI or primarily induced by this treatment. Conclusions: irAE are rare when anti-PD-1 antibodies are used in monotherapy. They present with a distinct clinical picture and temporal course and require specific treatment. Patients with irAE usually have a favorable oncological outcome.


Anticancer potential of dietary vitamin D and ascorbic acid: A review.
Cancers have been the leading cause of death worldwide and poor diet and physical inactivity are major risk factors in cancer-related deaths. Micronutrients such as vitamins and minerals appear to have preventive properties against cancer. One important mechanism by which dietary changes can exert preventive effects on cancer is via the modulation of micronutrient concentrations in target tissues. Many of these micronutrients are available in the form of dietary supplements, and the intake of these supplements is prevalent in various parts of the world. However, in most cases, it is not known which micronutrient (or combination of micronutrients) is best when it comes to lowering the risk of cancer. The present review illustrates the effect of vitamin D and ascorbic acid intake on preventing cancer.


Gold-catalyzed intermolecular nitrene transfer from 2H-azirines to ynamides: a direct approach to polysubstituted pyrroles.
An effective gold-catalyzed intermolecular nitrene transfer by the reaction of 2H-azirines and ynamides is reported, which provides highly substituted pyrroles in a straightforward manner. This transformation proceeds under mild conditions and gives the polysubstituted pyrroles in good-to-excellent yields. Preliminary results indicate that a nongold carbenoid pathway is preferred for current pyrrole synthesis.


Evaluating the fate and behaviour of cyclic volatile methyl siloxanes in two contrasting North American lakes using a multi-media model.
The behaviour of cyclic volatile methyl siloxanes (cVMS) in lakes was explored using a fugacity-based steady-state non-equilibrium multimedia fate and transport model (a modified version of QWASI). Three substances were investigated: Octamethylcyclotetrasiloxane (D4), Decamethylcyclopentasiloxane (D5) and Dodecamethylcyclohexasiloxane (D6) in two contrasting North American lakes: Lake Ontario and Lake Pepin (a natural shallow lake on the Mississippi river between Minnesota and Wisconsin). Values for the principal partition coefficients and the hydrolysis rate constant were adjusted for the mean annual temperatures of each lake. Hydrolysis rate constants were also adjusted for the fraction of chemical calculated to be in the freely dissolved phase. Half-lives in sediment were calculated from partitioning theory, assuming hydrolysis can occur only in the dissolved phase. Best estimates of substance-specific emissions were obtained by combining current per capita approximations of usage and fraction lost to domestic waste water, the population of the lake catchment and cVMS removal in waste water treatment. Concentrations were generally lower and chemical residence times longer in Lake Ontario than in Lake Pepin, owing to greater depth, a higher hydraulic retention time and a higher degree of dilution. Overall persistence in Lake Pepin is significantly influenced by the high rate of sediment burial assumed in the model, as well as by a relatively high rate of water discharge. Despite the many similarities of the compounds considered, the dominant loss mechanisms vary significantly and are not the same in each lake system. This highlights the pitfalls of subjective evaluation of chemical fate and illustrates the important role which models have to play in providing a quantitative framework for assessing chemical behaviour objectively under the influence of a complex and interacting set of factors.


Accurate Backbone 13 C and 15 N Chemical Shift Tensors in Galectin-3 Determined by MAS NMR and QM/MM: Details of Structure and Environment Matter.
Chemical shift tensors obtained from solid-state NMR spectroscopy are very sensitive reporters of structure and dynamics in proteins. While accurate 13 C and 15 N chemical shift tensors are accessible by magic angle spinning (MAS) NMR, their quantum mechanical calculations remain challenging, particularly for 15 N atoms. Here we compare experimentally determined backbone 13 Cα and 15 NH chemical shift tensors by MAS NMR with hybrid quantum mechanics/molecular mechanics/molecular dynamics (MD-QM/MM) calculations for the carbohydrate-binding domain of galectin-3. Excellent agreement between experimental and computed 15 NH chemical shift anisotropy values was obtained using the Amber ff15ipq force field when solvent dynamics was taken into account in the calculation. Our results establish important benchmark conditions for improving the accuracy of chemical shift calculations in proteins and may aid in the validation of protein structure models derived by MAS NMR.


Endovascular therapy of intracranial arteriovenous malformations. Materials and techniques.
Endovascular therapy can be an integral part of the treatment plan for patients with brain AVMs Safe and successful AVM embolization requires familiarity with the devices and techniques used and keen awareness of the potential pitfalls and complications. This article reviews the technical aspects of endovascular therapy of brain AVMs, with reference to specific therapeutic goals.


Cisplatin or not in advanced gastric cancer: a systematic review and meta-analysis.
Cisplatin-based chemotherapy is frequently used to treat advanced gastric cancer (GC). Although it leads to increased overall survival (OS) when added to single agents or chemotherapy doublets, toxicity is also generally increased. The purpose of this meta-analysis study was to compare the efficacy of chemotherapy with and without cisplatin in patients with advanced GC. Randomised trials that compared first-line cisplatin-based chemotherapy with regimens in which cisplatin was replaced by other agents were identified by electronic searches of PubMed, EMBASE, the Web of Science, and the Cochrane Central Register of Controlled Trials. Meta-analysis was performed using a fixed or random effects model. OS, reported as a hazard ratio (HR) and a 95% confidence interval (CI), was the primary outcome measure. Fourteen trials (5 phase III and 9 phase II), including 2,981 patients, were identified. Overall, chemotherapy regimens without cisplatin significantly improved OS (HR, 0.79; 95% CI, 0.68-0.92; p = 0.003), progression-free survival (PFS) (HR, 0.77; 95% CI, 0.66-0.90; p = 0.001), and response rate (RR) (OR, 1.25; p = 0.004) when compared to cisplatin-containing regimens. A subgroup analysis according to histology, site of the primary tumour and extent of disease was not possible due to lack of data. Compared with cisplatin-based doublets and triplets, combinations in which cisplatin was replaced by new drugs improved outcome and RRs in randomised trials for advanced GC and therefore should be strongly considered in the metastatic setting. A limitation of this meta-analysis is that we cannot identify a subgroup of patients (according to histology, site of primary tumour or burden of metastatic disease) which could derive greater benefit from cisplatin-free chemotherapy.


Nitric oxide synthase inhibition versus norepinephrine in ovine sepsis: effects on regional blood flow.
Hypotension is a serious problem in septic patients. We investigated regional perfusion in several organs during treatment of hyperdynamic sepsis in sheep. Sepsis was induced and maintained for the entire experiment with a continuous infusion of live Pseudomonas aeruginosa. Treatment with either norepinephrine or the nitric oxide synthase inhibitor L omega-mono-methyl-arginine (L-NMMA) was begun after 24 h of sepsis and continued for 24 h. The norepinephrine dosage was adjusted to achieve the same increase in mean arterial pressure as that obtained by a fixed dose of L-NMMA (7 mg/kg/h). Blood flows were analyzed by the microsphere technique. Both compounds restored blood pressure effectively, but only L-NMMA caused a significant increase in systemic vascular resistance, concomitant with a significant fall in cardiac output. Sepsis caused an increase in myocardial blood flow and a redistribution of blood flow away from the pancreas and the stomach. Renal blood flow was not significantly elevated. During treatment with either compound, renal blood flow remained unchanged, despite a fall in cardiac output in the L-NMMA group. Unchanged renal blood flow combined with the restoration of arterial blood pressure caused a significant increase in urine output. Both L-NMMA and norepinephrine caused a redistribution of blood flow to the colon. Pancreatic blood flow was further reduced by L-NMMA but the oxygen extraction improved simultaneously, so that oxygen availability in the pancreas might have been unchanged. Because ischemic pancreatitis in sepsis is likely to trigger multiorgan failure, further investigations in that area are desirable.


The outcome of surgical intervention for early deformity in young ambulant children with bilateral spastic cerebral palsy.
We reviewed the outcome in 24 children with bilateral spastic cerebral palsy aged seven years or younger for whom surgery was recommended between 1999 and 2005 following gait analysis. A total of 13 children (operative group) had surgery and the remaining 11 (control group) did not, for family or administrative reasons. The operative group had at least two post-operative gait analyses at yearly intervals, with eight children having a third and six children a fourth. The control group had a second analysis after a mean interval of 1.5 years (95% confidence interval 1.1 to 1.9). In the operative group, the Gillette gait index, the ranges of movement in the lower limb joint and knee extension in stance improved following surgery, and this was maintained overall at the second post-operative analysis. The minimum knee flexion in stance in the control group increased between analyses. These results suggest that surgical intervention in selected children can result in improvements in gait and function in the short to medium term compared with non-operative management.


Effect of Chromium Carbide Addition on the Microstructures and Properties in Dual Carbide Phases Reinforced Ni-Based Composite Coatings by Plasma Cladding.
Cr3C2-modified NiCr-TiC composite coatings were prepared using the plasma spraying technique for different Cr3C2 contents on the microstructure and the properties of the Ni-based TiC cladding layer were investigated. The microstructures of the coatings were characterized using scanning electron microscopy, and the friction and wear performance of the coating was evaluated by the wear tests. The results revealed that the surfaces of the Cr3C2-modified NiCr-TiC composite coatings with varying Cr3C2 contents were dense and smooth. TiC was uniformly distributed throughout the entire coating, forming a gradient interface between the binder phase of the Ni-based alloy and the hard phase of TiC. At high temperatures, Cr3C2 decomposes, with some chromium diffusing and forming complex carbides around TiC, some chromium solubilizes with Fe, Ni, and other elements. An increase in chromium carbide content leads to an upward trend in hardness. The measured hardness of the coatings ranged from 600 to 850 HV3 and tended to increase with increasing Cr3C2 content. When the mass fraction of Cr3C2 reached 30%, the hardness increased to 850 HV3, and the cracks and defects were observed in the coating, resulting in a wear resistance decline.


Temporal Trends in Adverse Events After Everolimus-Eluting Bioresorbable Vascular Scaffold Versus Everolimus-Eluting Metallic Stent Implantation: A Meta-Analysis of Randomized Controlled Trials.
Bioresorbable coronary stents have been introduced into clinical practice to improve the outcomes of patients treated with percutaneous coronary intervention. The everolimus-eluting bioresorbable vascular scaffold (BVS) is the most studied of these stent platforms; however, recent trials comparing BVS with everolimus-eluting metallic stents (EES) raised concerns about BVS safety. We aimed to assess the efficacy and safety of BVS versus EES in patients undergoing percutaneous coronary intervention. We searched Medline, Embase, the Cochrane Central Register of Controlled Trials, scientific sessions abstracts, and relevant Web sites for randomized trials with a follow-up of ≥2 years investigating percutaneous coronary interventions with BVS versus EES. The primary outcomes of our analysis were definite/probable stent thrombosis (ST) and target lesion failure (TLF; device-oriented composite end point of cardiac death, target vessel myocardial infarction, or ischemia-driven target lesion revascularization [TLR]). Secondary outcomes were target vessel myocardial infarction, TLR, and cardiac death. We calculated the risk estimates for main outcomes according to a fixed-effect model. We included 7 trials comprising data for 5583 patients randomized to receive either a BVS (n=3261) or an EES (n=2322). Median follow-up was 24 months (range, 24-36 months). Patients treated with BVS had a higher risk of definite/probable ST compared with patients treated with EES (odds ratio, 3.33; 95% confidence interval, 1.97-5.62; P<0.00001). In particular, patients with BVS had a higher risk of subacute, late, and very late ST, whereas the risk of acute ST was similar. Patients treated with BVS compared with EES had a higher risk at 2 years of TLF (odds ratio, 1.47; 95% confidence interval, 1.14-1.90; P=0.003), driven mainly by an increased risk of target vessel myocardial infarction (odds ratio, 1.73; 95% confidence interval, 1.31-2.28; P=0.0001; I2=0%) and of TLR (odds ratio, 1.27; 95% confidence interval, 1.00-1.62; P=0.05). Of importance, the risk of TLF and TLR for patients with BVS was higher between 1 and 2 years, whereas there was no difference in the first year. Risk of cardiac death was similar between the 2 groups. Our meta-analysis of randomized trials with a follow-up of ≥2 years demonstrated a higher risk of ST and of TLF in patients treated with BVS compared with EES. Of note, BVS had a higher risk of subacute, late, and very late ST, whereas the risk of TLF and TLR was higher between 1 and 2 years.


Physical growth and changes in intermittent endurance run performance in young male Basque soccer players.
The present 4-year longitudinal study examined physical growth and development of intermittent endurance run performance in young Basque soccer players aged 10-15 years applying multilevel regression modeling. Anthropometry, predicted adult stature and Yo-Yo Intermittent Recovery level 1 test (Yo-Yo IR1) of players from the under-11 teams from the Athletic Club of Bilbao were measured at pre- and end-season (two measurements per year of study, n = 33 considered for analysis). A non-linear effect of age on intermittent endurance run was observed, with significantly higher increases in Yo-Yo IR1 between 10-11 year-old and 14-15 year-old players. The development of Yo-Yo IR1 performance in all the years of the study was influenced positively by training exposure during the seasons (P < 0.01) and independent of maturity status and body size (P > 0.05). The steady development of intermittent endurance run performance during pubertal years in adolescent Basque soccer players is partially influenced by training exposure.


Osmotic stress and membrane phase changes during freezing of stallion sperm: mode of action of cryoprotective agents.
The aim of this study was to determine how different membrane-permeable and -impermeable cryoprotective agents modulate tolerance of stallion sperm to osmotic stress and stabilize membranes during cryopreservation. Special emphasis was on hydroxyl ethylene starch (HES), which exposes cells to minimal osmotic stress due to its large molecular weight. Percentages of motile sperm post-thaw were found to be similar when glycerol, sucrose, and HES were used at their optimal concentrations. Percentages of plasma membrane intact sperm after return to isotonic medium were highest for HES. Fourier transform infrared spectroscopy studies were carried out to study subzero membrane phase and permeability behavior. Cryoprotectants were shown to decrease the initial rate of membrane dehydration during freezing, decrease the activation energy for water transport, and increase the total extent of freezing-induced dehydration. Freezing studies with liposomes as a model system showed that only the membrane-permeable cryoprotective agents glycerol and ethylene glycol protected membranes against leakage, whereas egg yolk, sucrose, and HES did not. Differential scanning calorimetry studies showed that sucrose and HES raise the glass transition temperature of the freezing extender and the difference in heat capacity associated with the glass transition. This indicates that these compounds enable formation of a stable glassy matrix at higher subzero temperatures. Sperm cryosurvival rates can be increased by combining different cryoprotectants with different protective functions; membrane permeable cryoprotective agents stabilize membranes and modulate the rate of cellular dehydration, whereas di- and polysaccharides increase the glass transition temperature and facilitate storage and handling at higher subzero temperatures.


Subsidence following anterior lumbar interbody fusion (ALIF): a prospective study.
Anterior lumbar interbody fusion (ALIF) is a widely used surgical technique for disorders of the lumbar spine. One potential complication is the subsidence of disc height in the post-operative period. Few studies have reported the rate of subsidence in ALIF surgery prospectively. We prospectively evaluated the rate of subsidence in adult patients undergoing ALIF. Results were obtained by reviewing scans of 147 patients. Disc heights were measured on radiographic scans taken pre-operatively in addition to post-operatively immediately, at 6 weeks and at 18 months. The anterior and posterior intervertebral disc heights were measured. Subsidence was defined as greater than or equal to 2 mm loss of height. A total of 15 patients (10.2%) had subsidence, with 7 being male. Each case was of delayed cage subsidence (DCS) >6 weeks postoperatively. The mean subsidence was 4.7 mm (range, 2.4-7.8). Mean anterior disc height was 8.6±0.4 mm preoperatively, which improved to 15.1±0.5 mm at latest follow-up. Mean posterior disc height was 4.7±0.2 mm preoperatively, which improved to 8.7±0.4 mm at latest follow-up. The mean lumbar lordosis (LL) angle was 42.5°±10.8° and the mean local disc angle (LDA) was 6.7°±4.0°. The 91.2% (n=114/125) of patients with appropriate radiological follow-up demonstrated fusion by latest follow-up. There was no correlation between subsidence rate with patient reported outcomes [Visual Analog Scale (VAS), Oswestry Disability Index (ODI) and Short Form 12 Item survey (SF-12)] and fusion rates. There was a significant negative correlation between LL and extent of subsidence (Pearson correlation =-0.754, P=0.012). In conclusion, we found that the subsidence rate at follow-up was generally low following standalone ALIF for this patient series. Patient clinical outcomes and bony fusion rates were not significantly influenced by subsidence.


Growth of Infants with Intestinal Failure or Feeding Intolerance Does Not Follow Standard Growth Curves.
Objective. Infants with intestinal failure or feeding intolerance are nutritionally compromised and are at risk for extrauterine growth restriction. The aim of the study was to evaluate growth velocities of infants with intestinal failure and feeding intolerance for the first three months of age and to determine growth percentiles at birth and at 40-week postmenstrual age (PMA). Methods. A chart review of infants followed by the Texas Children's Hospital Intestinal Rehabilitation Team was conducted from April 2012 to October 2014. Weekly weight, length, and head circumference growth velocities were calculated. Growth data were compared to Olsen growth curves to determine exact percentiles. Results. Data from infants (n = 164) revealed that average growth velocities of 3-month-old infants (weight gain, 19.97 g/d; length, 0.81 cm/week; head circumference, 0.52 cm/week) fluctuated and all were below expected norms. At discharge or death, average growth velocities had further decreased (length, 0.69 cm/week; head circumference, 0.45 cm/week) except for weight, which showed a slight increase (weight, 20.56 g/d). Weight, length, and head circumference percentiles significantly decreased from birth to 40-week PMA (P < 0.001). Conclusions. Growth of infants with intestinal failure or feeding intolerance did not follow standard growth curves.


Studies on the mutagenicity of a zinc oxide-hexachloroethane smoke.
1. A suitable method has been developed for generating atmospheres of zinc oxide/hexachloroethane smoke (ZnHCE). 2. The smoke was investigated using the Ames test and the micronucleus assay. 3. It was weakly mutagenic to the bacteria, but in the bone marrow no increases in micronuclei were detected up to toxic levels of the smoke. 4. The method used here could be applied to other pyrotechnic mixtures which give rise to complex mixtures of products.


Negativity about the outcomes of extreme prematurity a persistent problem - a survey of health care professionals across the North Queensland region.
Extremely preterm babies are at risk of significant mortality and morbidity due to their physiological immaturity. At periviable gestations decisions may be made to either provide resuscitation and intensive care or palliation based on assessment of the outlook for the baby and the parental preferences. Health care professionals (HCP) who counsel parents will influence decision making depending on their individual perceptions of the outcome for the baby. This paper aims to explore the knowledge and attitudes towards extremely preterm babies of HCP who care for women in pregnancy in a tertiary, regional and remote setting in North Queensland. A cross sectional electronic survey of HCP was performed. Perceptions of survival, severe disability and intact survival data were collected for each gestational age from 22 to 27 completed weeks gestation. Free text comment enabled qualitative content analysis. Almost all 113 HCP participants were more pessimistic than the actual outcome data suggests. HCP caring for women antenatally were the most pessimistic for survival (p = 0.03 at 23 weeks, p = 0.02 at 25,26 and 27 weeks), severe disability (p = 0.01 at 24 weeks) and healthy outcomes (p = 0.01 at 24 weeks), whilst those working in regional and remote centres were more negative than those in tertiary unit for survival (p = 0.03 at 23,24,25 weeks). Perception became less negative as gestational age increased. Pessimism of HCP may be negatively influencing decision making and will negatively affect the way in which parents perceive the chances of a healthy outcome for their offspring.


Comment on gas phase infrared spectrum and ab initio calculations of phosphorus(III) thiocyanide, SPCN.
We show that two of the three bands assigned to SPCN are assignable to cyanogen and that the bands assigned to SPCl are done so in error, with the 712 cm(-1) band in the spectrum of Allaf and Odeh assignable to HCN. There is no evidence for either ClPS or SPCN in the spectra shown. Finally low resolution IR spectroscopy by itself, whilst useful in assisting in the identification of pyrolysis products does not provide unambiguous identification and requires support by rigorous computation, band modelling and correct use of the literature. None of these are evidenced in the present paper of Allaf and Odeh nor indeed in the work that was the subject of our previous criticism and re-analysis.


Effects of renal denervation on atrial arrhythmogenesis.
Atrial fibrillation is the most common sustained arrhythmia and is associated with significant morbidity and mortality. In addition to mechanisms such as atrial stretch and atrial remodeling, the activity of the autonomic nervous system has also been suggested to contribute to the progression from paroxysmal to persistent atrial fibrillation. Catheter-based renal denervation was introduced as a minimally invasive approach to reduce renal and whole body sympathetic activation with accompanying blood pressure reduction and left-ventricular morphological and functional improvement in drug-resistant hypertension. This review focuses on the potential effects of renal denervation on different arrhythmogenic mechanisms in the atrium and discusses potential anti-remodeling effects in atrial fibrillation patients with hypertension, heart failure and sleep apnea.


Acute coronary artery occlusion likely due to thrombus occurring during coronary angiography: report of a case.
Twenty-five years ago, fatalities due to acute thrombotic coronary occlusion occurring during coronary angiography were reported not infrequently, but are thought to have been eliminated by changes in technique and equipment. We present a case with documentation of a normal coronary arterial tree just before the time of an abrupt occlusion, which had the angiographic features of clot. The likely source of the thrombus was the arterial sheath. Measures for prevention of this complication are discussed.


Immunization of Pigs by DNA Prime and Recombinant Vaccinia Virus Boost To Identify and Rank African Swine Fever Virus Immunogenic and Protective Proteins.
African swine fever virus (ASFV) causes an acute hemorrhagic fever in domestic pigs, with high socioeconomic impact. No vaccine is available, limiting options for control. Although live attenuated ASFV can induce up to 100% protection against lethal challenge, little is known of the antigens which induce this protective response. To identify additional ASFV immunogenic and potentially protective antigens, we cloned 47 viral genes in individual plasmids for gene vaccination and in recombinant vaccinia viruses. These antigens were selected to include proteins with different functions and timing of expression. Pools of up to 22 antigens were delivered by DNA prime and recombinant vaccinia virus boost to groups of pigs. Responses of immune lymphocytes from pigs to individual recombinant proteins and to ASFV were measured by interferon gamma enzyme-linked immunosorbent spot (ELISpot) assays to identify a subset of the antigens that consistently induced the highest responses. All 47 antigens were then delivered to pigs by DNA prime and recombinant vaccinia virus boost, and pigs were challenged with a lethal dose of ASFV isolate Georgia 2007/1. Although pigs developed clinical and pathological signs consistent with acute ASFV, viral genome levels were significantly reduced in blood and several lymph tissues in those pigs immunized with vectors expressing ASFV antigens compared with the levels in control pigs.IMPORTANCE The lack of a vaccine limits the options to control African swine fever. Advances have been made in the development of genetically modified live attenuated ASFV that can induce protection against challenge. However, there may be safety issues relating to the use of these in the field. There is little information about ASFV antigens that can induce a protective immune response against challenge. We carried out a large screen of 30% of ASFV antigens by delivering individual genes in different pools to pigs by DNA immunization prime and recombinant vaccinia virus boost. The responses in immunized pigs to these individual antigens were compared to identify the most immunogenic. Lethal challenge of pigs immunized with a pool of antigens resulted in reduced levels of virus in blood and lymph tissues compared to those in pigs immunized with control vectors. Novel immunogenic ASFV proteins have been identified for further testing as vaccine candidates.


Leptin's Immune Action: A Review Beyond Satiety.
The adipose tissue is an endocrine organ that secretes adipokines such as leptin, which is one of the most important hormones for controlling satiety, metabolism, and energy homeostasis. This hormone acts in the regulation of innate and adaptive immune responses since immune cells have leptin receptors from which this hormone initiates its biological action. These receptors have been identified in hematopoietic stem cells in the bone marrow and mature immune cells, inducing signaling pathways mediated by JAK/STAT, PI3K, and ERK 1/2. It is known that the bone marrow also contains leptin-producing adipocytes, which are crucial for regulating hematopoiesis through largely unknown mechanisms. Therefore, we have reviewed the roles of leptin inside and outside the bone marrow, going beyond its action in the control of satiety.


Expanded Paramedian Forehead Flaps for Nasal Defects: Beyond Aesthetic Subunits.
Reconstruction of nasal tip defects presents a significant challenge for plastic surgeons. The form, function, and aesthetic appeal of all nasal subunits must be addressed. The expanded paramedian forehead flap is a good choice for nasal reconstruction, providing similar texture, structure, and skin color, and high reliability. This article discusses the authors' modification of the expanded paramedian forehead flap in reconstructing defects on or around the nasal tip. Twenty-two patients with nasal defects located on or around the nasal tip were treated in our institution. Sixteen patients underwent nasal reconstruction with expanded forehead flaps. The other 6 cases with cartilage defect underwent reconstruction with expanded forehead flaps and autogenous rib cartilage grafts. Functional and cosmetic results were assessed by surgeon, patient, and patient's relatives using a scale from 1 to 10. The aesthetic appearance of all patients was significantly improved after surgery. Two cases had mild hyperpigmentation. Two patients considered the flaps too thick. Three cases had minor brow elevation at the donor site. There were no obvious scars at the donor sites. There were no serious complications, such as infection, flap necrosis, deviation, or collapse. The expanded paramedian forehead flap is a safe and effective method for reconstructing defects located on or around the nasal tip. Moreover, this technique can result in good functional and cosmetic outcomes with very few complications.


Sugar, alternative sweeteners and meal frequency in relation to caries prevention: new perspectives.
In the last 20 years, mainly due to optimum fluoride exposure, and practice of good oral hygiene procedures, an important reduction in caries has been observed, despite the fact that sugar consumption was maintained and/or was increasing during the same lapse of time. A sugar-caries relationship cannot be established in most of the industrialized countries and the dietary factor is not as preponderant in the caries process as it used to be two decades ago. The factors which seem to contribute the most significantly to the cariogenicity of the diet are the frequency of carbohydrate ingestion and eating patterns. The relative cariogenicity of food is not correlated with the amount of carbohydrate it contains. Even if sucrose remains the most important sugar consumed in sweets, beverages and confectionery products, all fermentable-carbohydrate foods can be involved in the caries process. The use of chewing gum and other xylitol-containing products have resulted in defined reduction in caries and represent interesting alternatives for high-caries-risk populations. Caries risk and oral health assessments as well as the evaluation of oral hygiene procedures and fluoride exposure should become essential tools in dietary counselling. People who receive optimum fluoride exposure and follow regular oral hygiene measures can safely use dietary carbohydrates, preferably during meals and two to three times daily in snacks or drinks.


Status of Microsurgical Simulation Training in Plastic Surgery: A Survey of United States Program Directors.
Various simulation models for microsurgery have been developed to overcome the limitations of Halstedian training on real patients. We wanted to assess the status of microsurgery simulation in plastic surgery residency programs in the United States. Data were analyzed from responses to a survey sent to all plastic surgery program directors in the United States, asking for type of simulation, quality of facilities, utilization by trainees, evaluation of trainee sessions, and perception of the relevance of simulation. The survey response rate was 50%. Of all programs, 69% provide microsurgical simulation and 75% of these have a laboratory with microscope and 52% provide live animal models. Half share facilities with other departments. The quality of facilities is rated as good or great in 89%. Trainee utilization is once every 3 to 6 months in 82% of programs. Only in 11% is utilization monthly. Formal evaluation of simulation sessions is provided by 41% of programs. All program directors agree simulation is relevant to competence in microsurgery, 60% agree simulation should be mandatory, and 43% require trainees to complete a formal microsurgery course prior to live surgery. There seems to be consensus that microsurgical simulation improves competence, and the majority of program directors agree it should be mandatory. Developing and implementing standardized simulation modules and assessment tools for trainees across the nation as part of a comprehensive competency-based training program for microsurgery is an important patient safety initiative that should be considered. Organizing with other departments to share facilities may improve their quality and hence utilization.


Levosimendan increases bleeding risk after heart valve surgery: a retrospective analysis of a randomized trial.
To investigate whether levosimendan, an inotrope with cardioprotective properties, increases postoperative bleeding after cardiac surgery. Retrospective analysis of a randomized, prospective clinical study. Post-anesthesia care unit (PACU) and surgical ward in a university hospital. Two hundred heart valve surgery patients. The patients were randomized to receive either a 24-hour intravenous infusion of levosimendan or placebo. Infusion was administered as a 24 µg/kg bolus over 30 minutes and then continued at a dose of 0.2 µg/kg/min. Postoperative bleeding was approximately 31% greater in the levosimendan group (1050 mL) compared to the placebo group (880 mL, p = 0.008). Serious bleeding exceeding 1000 mL was more common in the levosimendan group than the placebo group (51 v 38 patients, p = 0.044, risk ratio (RR) 1.37, 95% CI 1.00-1.87). However, the risk of reoperation for bleeding did not increase if patients received levosimendan (RR 1.52, 95% CI 0.77-2.97, p = 0.309). This result did not change after excluding patients who received clopidogrel preoperatively (RR 2.13, 95% CI 0.98-4.65, p = 0.145). The groups did not differ regarding transfused blood products. Eight patients, including seven from the levosimendan group, had delayed (diagnosed>48 hours after the surgery) cardiac tamponade and underwent re-exploration (7 v 1, p = 0.031). Levosimendan increased the risk of postoperative bleeding after cardiac valve surgery. In addition, the risk of postoperative cardiac tamponade was increased in patients who received levosimendan compared to placebo.


Comparing children with and without dyslexia on the Movement Assessment Battery for Children and the Test of Gross Motor Development.
Dyslexia is the most commonly occurring learning disability in the United States, characterized by difficulties with word recognition, spelling, and decoding. A growing body of literature suggests that deficits in motor skill performance exist in the dyslexic population. This study compared the performance of children with and without dyslexia on different subtests of the Test of Gross Motor Development and Movement Assessment Battery for Children and assessed whether there were developmental changes in the scores of the dyslexic group. Participants included 26 dyslexic children (19 boys and 7 girls; 9.5 yr. old, SD = 1.7) and 23 age- and sex-matched typically developing (17 boys and 6 girls; 9.9 yr. old, SD = 1.3) children as a control group. Mann-Whitney U tests indicated that the dyslexic group performed significantly lower than the control group only on the Total Balance subtest of the Movement Assessment Battery for Children. Additionally, the young dyslexic group performed significantly better on the Total Balance subtest, compared to the older dyslexic group. These results suggest that cerebellar dysfunction may account for differences in performance.


Sperm chromosome studies in individuals treated for testicular cancer.
Sperm chromosome studies have shown that patients treated with chemotherapy for testicular cancer have a much higher incidence of chromosome abnormalities than patients treated for other types of cancer or than controls. In two out of four cases, penetration of zona-free hamster eggs was close to zero, indicating that after 2-7 years after treatment the functional capacity of the sperm had not been recuperated. The cytogenetic study of the spermatozoa shows that many of the abnormalities observed corresponded to structural aberrations that may not have a pathogenic effect in the production of abortions or of children with chromosome abnormalities.


The prevalence of Enterobius vermicularis among primary school students in Samut Prakan Province, Thailand.
A prevalence survey of Enterobius vermicularis in primary school students aged 6-10 years in Bang Plee district, Samut Prakarn Province, Thailand was undertaken from January to March 2000. There were 783 subjects, 395 males and 388 females. Diagnosis was done by transparent tape swab technique. It revealed that 1) worms were found in 38.82% of the students, 2) there was a correlation between prevalence of parasite infection and student sex and age and 3) family socio-economic background (income and occupation) had no relationship with the prevalence of the enterobiasis (p < 0.05).


Improvement of product yields by temperature-shifting of Escherichia coli cultures containing plasmid pOU140.
Temperature shifting was investigated as a means of improving cloned-gene product yields form a recombinant Escherichia coli containing the temperature-sensitive plasmid, pOU 140. In a series of shaker flask fermentations recombinant cells were thermally induced for different time periods. The growth, stability, and plasmid product levels were followed, and the results indicate the existence of an induction time period that maximizes product yield. A sustained thermal induction results in recombinant cell death and instability, while exposure to a runaway temperature for minimal time periods does not give sufficiently high product yields. At intermediate cycling times, however, the recombinant cells remain stable, and the plasmid replication region is activated, resulting in higher product yields.


Epidemiological characteristics and survival studies of rhabdomyosarcoma in East egypt: a five-year multicenter study.
Background. Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children, it represents 5-8% of childhood malignancies. Aim of the Work. To evaluate the epidemiological characteristics and treatment outcome in two pediatric oncology centers. Patients and Method. A retrospective analysis was performed on 41 medical records of children with RMS during 6 years period. Results. The median age of patients was 6 years with 80.4% below 10 years. Head and neck was the most common primary site. Embryonal RMS was the most frequent histopathologic subtype. Stage IV was the most frequent stage. According to IRS postsurgical grouping classification, group 4 was the most frequent group. There was a significant relationship between histopathologic subtypes of tumor and metastasis, primary site of tumor and histopathologic subtype, age, metastasis, IRS presurgical stage and IRS postsurgical group and outcome. The overall survival rate was 56.9% ± 8.4 and the failure free survival rate was 68.3% ± 7.6. Conclusion. The epidemiological characteristics of our patients are quite near to the worldwide data, apart from the higher prevalence of stage IV and group 4 with most of the primary tumor site in the extremities. CWS2002 protocol of therapy had led to improvement in the curability of the disease.


Preparation of N-doped CaNb2O6 nanoplates with ellipsoid-like morphology and their photocatalytic activities under visible-light irradiation.
Nitrogen-doped CaNb2O6 nanoplates with an ellipsoid-like morphology were prepared using the hydrothermal method, followed by heat treatment at various temperatures in an NH3 atmosphere. The prepared powders were characterized using X-ray diffraction, field-emission scanning electron microscopy, transmission electron microscopy, X-ray photoelectron spectroscopy, and UV-vis diffuse reflectance spectroscopy. It was found that the nitrogen doping in the CaNb2O6 nanoplates led to the formation of nanoparticles with a size of 10 nm at the surface and the red-shift of the light absorption edge into the visible light region. From the electronic band structure calculation using density functional theory (DFT), this was found to be caused by the broadening of the top of the valence band due to the hybridization of the O 2p and N 2p orbitals induced by the substitution of the nitrogen for the lattice oxygen. Compared to the un-doped powder, the N-doped CaNb2O6 nanoplate powder exhibited higher photocatalytic activities for the degradation of rhodamine B dye solution under visible light irradiation (> 420 nm). This higher photocatalytic activity was attributed to the higher optical absorption (smaller band gap) and higher surface area resulting from the nitridation process.


[Assessment of Negative Response Bias - Development and Validation of the BEVA].
A screening will be developed and validated which measure the negative response bias by inpatients with depressive symptoms. The questionnaire should be appropriate for the claimants for disability pension due to a mental illness. The present study uses for the construction (K) and validation (V) an analog study design. Healthy participants (depression: K: N=58; V=100; pain: K: N=50; V: N=90) obtained a scenario to feign major depression or pain disorder in the BEVA. In addition, a control group (K: N=78; V: N=89), patients with major depression (K: N=58; V: N=162) and patients with pain disorder (K: N=35; V: N=46) completed the survey about their current mental complaints. Using the data of the construction sample the cut-off values were determined. In the validation sample could be analyzed a sensitivity of 0,75, specificity of 0,95, a positive predictive value of 0,90, and a negative predictive value of 0,86 for the study group "depression". For the pain group had a sensitivity of 0,81, specificity of 0,96, a positive predictive value of 0,97 and a negative predictive value of 0,72 resulted. The developed screening has very well values for the validity and reliability. Thus, the method seems suitable to measure negative response bias.


Single base substitution in codon 74 of the MD rat myelin proteolipid protein gene.
The myelin-deficient (md) rat is one of several X-linked animal mutants that have severe dysmyelination in the central nervous system. It appears in all to be the result of mutations in the myelin proteolipid protein gene which is located on the long arm of the X-chromosome. To identify the md rat mutation, we isolated and sequenced cDNAs corresponding to PLP and DM-20 mRNAs from the brain of hemizygous affected males. The only consistent sequence difference between these and normal rat sequences was the substitution of a C for an A at the first position of codon 74, resulting in a threonine to proline amino acid change. The presence of this helix-breaking amino acid in the second hydrophobic alpha-helical segment of the protein might be expected to influence its ability to interact with the membrane. PCR amplification and sequencing of the corresponding genomic regions were used to confirm the presence of the single base change in the hemizygote and both normal and mutant versions in the heterozygotes. It is interesting that this change, like those detected in other X-linked myelin disorders, involves an amino acid replacement within a hydrophobic alpha-helical segment of the PLP protein. Disruption of these structures apparently has severe consequences for the ability of PLP to contribute normally to myelination.


A novel concept for the surgical anatomy of the perineal body.
Perineal body is considered by investigators as a fibromuscular structure that is the site of insertion of perineal muscles. We investigated the hypothesis that perineal body is the site across which perineal muscles pass uninterrupted from one side to the other. Perineal body was studied in 56 cadaveric specimens (46 adults, 10 neonatal deaths) by direct dissection with the help of magnifying loupe, fine surgical instruments, and bright light. Perineal body consisted of three layers: 1) superficial layer, which consisted of fleshy fibers of the external anal sphincter extending across perineal body to become the bulbospongiosus muscle; 2) tendinous extension of superficial transverse perineal muscle crossing perineal body to contralateral superficial transverse perineal muscle, with which it formed a criss-cross pattern; and 3) tendinous fibers of the deep transverse perineal muscle; the fibers crossing perineal body decussated in criss-cross pattern with the contralateral deep transverse perineal muscle. A relation of levator ani or puborectalis muscles to perineal body could not be identified. Perineal body (central perineal tendon) is not the site of insertion of perineal muscles but the site along which muscle fibers of these muscles and the external anal sphincter pass uninterrupted from one side to the other. Such a free passage from one muscle to the other seems to denote a "digastric pattern" for the perineal muscles. Perineal body is subjected to injury or continuous intra-abdominal pressure variations, which may eventually result in perineocele, enterocele, or sigmoidocele.


Health Effects of Asian Dust: A Systematic Review and Meta-Analysis.
Potential adverse health effects of Asian dust exposure have been reported, but systematic reviews and quantitative syntheses are lacking. We reviewed epidemiologic studies that assessed the risk of mortality, hospital admissions, and symptoms/dysfunction associated with exposure to Asian dust. We performed a systematic search of PubMed and Web of Science to identify studies that reported the association between Asian dust exposure and human health outcomes. We conducted separate meta-analyses using a random-effects model for mortality and hospital admissions for a specific health outcome and assessed pooled estimates for each lag when at least three studies were available for a specific lag. We identified 89 studies that met our inclusion criteria for the systematic review, and 21 studies were included in the meta-analysis. The pooled estimates (percentage changes) of mortality from circulatory and respiratory causes for Asian dust days vs. non-Asian dust days were 2.33% [95% confidence interval (CI): 0.76, 3.93] increase at lag 0 and 3.99% (95% CI: 0.08, 8.06) increase at lag 3, respectively. The increased risk for hospital admissions for respiratory disease, asthma, and pneumonia peaked at lag 3 by 8.85% (95% CI: 0.80, 17.55), 14.55% (95% CI: 6.74, 22.94), and 8.51% (95% CI: 2.89, 14.44), respectively. Seven of 12 studies reported reduced peak expiratory flow, and 16 of 21 studies reported increased respiratory symptoms associated with Asian dust exposure. There were substantial variations between the studies in definitions of Asian dust, study designs, model specifications, and confounder controls. We found evidence of increased mortality and hospital admissions for circulatory and respiratory events. However, the number of studies included in the meta-analysis was not large and further evidences are merited to strengthen our conclusions. Standardized protocols for epidemiological studies would facilitate interstudy comparisons. https://doi.org/10.1289/EHP5312.


Association of polymorphisms G(-174)C in IL-6 gene and G(-1082)A in IL-10 gene with traditional cardiovascular risk factors in patients with coronary artery disease.
Interleukin-6 (IL-6) polymorphism has been associated with the genetic susceptibility to coronary artery disease (CAD) and also with the lipid profile in different populations. The present work aimed at studying the association, if any between the IL-6 (174) G/C and IL-10 (1082) G/A genes with hypertension or hyperlipidimia in Egyptian patients with CAD and the association of the IL-6 -174 G/C polymorphism with serum IL-6 levels. 108 Egyptian patients with CAD and 143 unrelated healthy subjects were included in the study. The different genotypes of IL-6 and IL-10 were detected by polymerase chain reaction. Serum levels of lipoprotein(a) [Lp(a)] and IL-6 were estimated in the patients, as well as in the healthy subjects. Increased frequency of G allele, GG and GC genotypes in IL-6, as well as decreased frequency of C allele and CC genotype were found in CAD patients, compared to healthy subjects [P = < 0.0001, OR = 3.95, 95% CI (2.16-7.22) for GG and GC vs CC genotype], [P = < 0.0001, OR = 3.44, 95% CI (2.26-5.23) for G allele]. There was an increased frequency of G allele vs A allele in IL-10 genotype in CAD patients, compared to healthy subjects [P = 0.005, OR = 1.866, 95% CI (1.2-2.9]. Higher levels of both Lp(a) and IL-6 were observed in CAD patients, compared to control subjects (P = 0.0012, P = 0.0346, respectively). Increased frequency of IL-6 -174 G-allele was implicated in a greater cardiovascular risk and the presence of G allele or homozygosity for G allele of IL-10 G/A (1082) was associated with an increased prevalence of CAD. The GC genotype and G allele in IL-6 had significant correlation with hyperlipidimic CAD patients; however, G allele in IL-6 and IL-10 showed significant association with hypertension. Thus, G allele in IL-6 and IL-10 was considered as an independent risk factor in hypertensive CAD patients.


[Not Available].
Determination is made of the chronological limits and authorship of the widely known and popular during the Middle Ages treatise "De viribus herbarum", containing extensive medicamentous references. The author of the paper proceeds from the critical analyses of opinions and commentaries made by his predecessors, compares various editions of the translations of the poem, resorts to the linguistical method and determines with greater precision a number of additional indirect evidence and documental data. A discussion is made of the influence of the poem exerted upon the school of Salerno and the "Salernian Health Code".


A transformation of ritual: The nisei 60th birthday.
Rituals are enactments of shared meanings, norms, and values. The kanreki, a traditional Japanese rite of passage to old age at 60, is now being celebrated by Nisei (second generation Japanese Americans). This paper examines the transformation of the Japanese rite of passage to a collective response among the Nisei to the dilemmas of growing older in urban America.


Fiber tractography using machine learning.
We present a fiber tractography approach based on a random forest classification and voting process, guiding each step of the streamline progression by directly processing raw diffusion-weighted signal intensities. For comparison to the state-of-the-art, i.e. tractography pipelines that rely on mathematical modeling, we performed a quantitative and qualitative evaluation with multiple phantom and in vivo experiments, including a comparison to the 96 submissions of the ISMRM tractography challenge 2015. The results demonstrate the vast potential of machine learning for fiber tractography.


Dyella lipolytica sp. nov., a lipolytic bacterium isolated from lower subtropical forest soil.
A Gram-stain-negative, aerobic, yellow-pigmented, non-spore-forming, non-motile, rod-shaped bacterium, designated strain DHOB07T, was isolated from a soil sample collected from the lower subtropical forest of the Dinghushan Biosphere Reserve, Guangdong Province, PR China (23° 10' N 112° 31' E). Strain DHOB07T grew at 10-37 °C, pH 4-7 and 0-0.5 % (w/v) NaCl, with an optimum at 28 °C, pH 5-5.5 and 0% (w/v) NaCl on R2A medium. Phylogenetic analyses based on 16S rRNA gene sequences showed that the strain formed a clade with Dyella jejuensis JP1T, Dyella nitratireducens DHG59T, Dyella koreensis BB4T, Dyella marensis CS5-B2Tand Dyellasoli JS12-10T, with sequence similarities of 98.9, 98.0, 97.9, 97.9 and 97.8 %, respectively. Multilocus sequence analysis based on the concatenated sequences of partial housekeeping genes gyrB, lepA and recA confirmed that strain DHOB07T belongs to thegenus Dyella but is distinct from all currently known species of the genus Dyella. The G+C content of the genomic DNA was 58.2 mol%. The DNA-DNA relatedness value between strain DHOB07T and D. jejuensis JP1T was 41.8 %. Iso-C16 : 0, iso-C15 : 0 and iso-C17 : 1ω9c were the major fatty acids, and ubiquinone-8 was the only respiratory quinone detected, all of which supported the affiliation of strain DHOB07T to the genus Dyella. On the basis of the polyphasic characterization results presented above, strain DHOB07T represents a novel species of the genus Dyella, for which the name Dyella lipolytica sp. nov. is proposed. The type strain is DHOB07T (=NBRC 111473T=KCTC 52132T).


Cumulative advantages and social capabilities in scientific mobility in the Health Sciences: The Spanish case.
The big problem in global public health, arising from the international migration of physicians from less-developed to more-developed countries, increases if this migration also affects scientists dedicated to health areas. This article analyzes critical variables in the processes of Spanish scientific mobility in Health Sciences to articulate effective management policies for the benefit of national public health services and the balance between local and global science. This study develops a survey to measure and analyze the following crucial variables: research career, training, funding, working with a world-class team, institutional prestige, wages, facilities/infrastructure, working conditions in the organization of the destination country, fringe benefits in the organization of the destination country and social responsibility in the organization of the departure country. A total of 811 researchers have participated in the survey, of which 293 were from the health sector: Spanish scientists abroad (114), scientists that have returned to Spain (32) and young researchers in Spain (147). The most crucial variables for Spanish scientists and young researchers in Spain in Health Sciences moving abroad are the cumulative advantages (research career, training, funding and institutional prestige) plus wages. On the other hand, the return of Spanish scientists in the Health Sciences is influenced by cumulative variables (working with a world-class team, research career and institutional prestige) and also by other variables related to social factors, such as working conditions and fringe benefits in the destination country. Permanent positions are rare for these groups and their decisions regarding mobility depend to a large extent on job opportunities. Spanish health organizations can influence researchers to return, since these decisions mainly depend on job opportunities. These organizations can complement the cumulative advantages offered by the wealthier countries with the intensification of social factors.


Posttransplant lymphoproliferative disorders: a fine-needle aspiration biopsy study.
Fine-needle aspiration biopsy (FNAB) has been used with high sensitivity and specificity in the diagnosis of both Hodgkin's and non-Hodgkin's lymphoma. However, studies of FNAB of posttransplant lymphoproliferative disorders (PTLDs) are rare. The clinical course of 593 allograft recipients (cardiac, 288; renal, 250; lung, 50; and heart/lung, 5) was reviewed. Twenty-six patients developed PTLD with an overall incidence of 4.4%. Of these patients, 12 underwent FNAB. Their age ranged from 33-67 yr (mean, 55 yr). The interval between transplantation and FNAB ranged between 2-14 mo (average, 8.4 mo). The lungs were the most common site aspirated (7 cases), followed by lymph nodes (3 cases) and other extranodal sites (2 cases, liver and paraspinal mass). The cytologic features of these aspirates could be classified into two categories: a polymorphous smear composed of a spectrum of mature and immature lymphocytes with scattered plasma cells and histiocytes; and a monotonous population of large lymphoid cells consistent with malignant lymphoma, large-cell type. Surgical biopsies were available in 10 (83.3%) cases and confirmed the FNAB diagnosis. In summary, FNAB appears to be a highly sensitive and specific diagnostic tool in patients with PTLD.


One-dimensional approach to study kinetics of reversible binding of protein on capillary walls.
We introduce a method for kinetic characterization of reversible binding of protein onto the inner capillary wall. In essence, a short plug of the protein solution is propagated through the capillary by pressure, and the protein is detected at the distal capillary end. The signal versus time profile is fitted with a numerical model which uses the rate constants of adsorption, kad, and desorption, kde, as fitting parameters. The values of kad and kde which result in the best fit are considered to be the sought ones. We first used COMSOL multiphysics software to develop a numerical model with two-dimensional (2D) equations of mass transfer. Although 2D models in general can describe experiments more accurately than one-dimensional (1D) models, computing 2D models takes much more time (many hours to find two parameters: kad and kde). We used the fact that the capillary is narrow and long to develop a simplified model with 1D equations of mass transfer. Our comparison of the 1D and 2D models showed that the errors of the 1D approximation were less than 5%, whereas the computation of the 1D model was 100 times faster. We finally used the 1D approach to study kinetics of reversible binding of conalbumin to the uncoated fused-silica capillary walls. We determined kad, kde, and a diffusion coefficient, D. The obtained value of D is in excellent agreement with literature data which suggests that the values of kad and kde (for which there are no literature data) are also calculated correctly. Our approach for finding kad and kde will facilitate quantitative characterization of protein adsorption on capillary walls as well as properties of passivating materials used for capillary coating.


Vago-glossopharyngeal neuralgia: a literature review of neurosurgical experience.
Glossopharyngeal neuralgia (GPN), or better named vago-glossopharyngeal neuralgia (VGPN), is a rare disorder amounting to 1 % of the incidence of trigeminal neuralgia (TN). Pain is paroxysmal, of the electrical shooting type, and mainly provoked by stimulation of the pharynx or deep throat, especially during swallowing. Due to its rarity, VGPN is often misdiagnosed. The front line of medical treatment is based on anticonvulsants. Surgery should be considered when the pain is refractory to medications. In most patients, the cause is neurovascular conflict on root entry zone (REZ) or midcistern portion, of the IXth and/or Xth cranial nerves. Compressive vessels can be evidenced by means of a high sensibility and a high specificity resolution MR imaging in most centers. Present consensus is that the first option of neurosurgical treatment be microvascular decompression. In patients with precarious general conditions, stereotactic radiosurgery may be considered. Also, thermo-rhizotomy at the pars nervosa of foramen jugularis or tractotomy-nucleotomy at brainstem may be alternatives, but these methods entail a significant risk of deficits. In this article, the authors reviewed the main literature series on neurosurgical treatments of this disease.


Echocardiography guidance of atrial septal defect closure.
Transcatheter procedures offer less invasive approaches allowing rapid recovery and earlier hospital discharge. A number of international guidelines have defined the role of echocardiography spanning diagnosis, detailed anatomical assessment, device sizing and selection, peri-procedure guidance and post device surveillance. This review discusses the role of echocardiography in transcatheter atrial septal defect (ASD) closure. It describes a systematic approach to assessment including the crucial role of three dimensional echo and provides the reader with key information required during device sizing and procedure guidance.


Development and Validation of Embedded Device for Electrocardiogram Arrhythmia Empowered with Transfer Learning.
With the emergence of the Internet of Things (IoT), investigation of different diseases in healthcare improved, and cloud computing helped to centralize the data and to access patient records throughout the world. In this way, the electrocardiogram (ECG) is used to diagnose heart diseases or abnormalities. The machine learning techniques have been used previously but are feature-based and not as accurate as transfer learning; the proposed development and validation of embedded device prove ECG arrhythmia by using the transfer learning (DVEEA-TL) model. This model is the combination of hardware, software, and two datasets that are augmented and fused and further finds the accuracy results in high proportion as compared to the previous work and research. In the proposed model, a new dataset is made by the combination of the Kaggle dataset and the other, which is made by taking the real-time healthy and unhealthy datasets, and later, the AlexNet transfer learning approach is applied to get a more accurate reading in terms of ECG signals. In this proposed research, the DVEEA-TL model diagnoses the heart abnormality in respect of accuracy during the training and validation stages as 99.9% and 99.8%, respectively, which is the best and more reliable approach as compared to the previous research in this field.


Morphometric variation in bluegill Lepomis macrochirus and green sunfish Lepomis cyanellus in lentic and lotic systems.
Bluegill Lepomis macrochirus and green sunfish Lepomis cyanellus were examined using geometric morphometrics to evaluate the variation in morphology between fishes that reside in lentic (e.g. lakes) and lotic (e.g. streams) ecosystems. Live fishes were collected from reservoirs and rivers in central Indiana, while additional fishes were sampled from museum collections at Ball State University and the Illinois Natural History Survey. Male and female L. macrochirus and female L. cyanellus from lentic systems display a deeper body than those from lotic systems, while no differences were found in male L. cyanellus morphometry. A deeper body promotes greater manoeuverability, typically desirable in lentic systems. In contrast, the more streamlined body of the fishes found in lotic systems reduces drag as it contends with flowing water, ultimately maximizing energy efficiency. The absence of morphological differences, such as those found in male L. cyanellus, may be caused by fish occupying both lentic and lotic systems, from the population not having been present in the body of water long enough to display any adaptations, or from a lack of statistical power caused by the small sample size.


Anaphylaxis with delayed appearance of skin manifestations during general anesthesia: two case reports.
Anaphylaxis is difficult to diagnose in the absence of skin or mucosal signs and symptoms. We report two cases of anaphylaxis under general anesthesia, in which the initial presentation was in the form of respiratory signs, followed by skin manifestations 10-15 min later. Diagnosis of anaphylaxis was delayed because skin symptoms were absent early on in the presentation. In the first case, a 23-year-old male patient with jaw deformity was scheduled to undergo maxillary alveolar osteotomy. After intubation, auscultation indicated a sudden decrease in breath sounds, together with severe hypotension. Approximately 10 min later, flushing of the skin and urticaria on the thigh appeared and spread widely throughout the body. In the second case, a 21-year-old female patient with jaw deformity was scheduled to undergo maxillomandibular osteotomy. Twenty minutes after the start of dextran infusion, her lungs suddenly became difficult to ventilate, and oxygen saturation decreased to 90%. Approximately 15 min later, flushing of the skin and urticaria were observed. In both cases, there was a time lag between the appearance of respiratory and skin symptoms, which resulted in a delay in the diagnosis, and hence, treatment of anaphylaxis. Our experience highlights the fact that it is difficult to diagnose anaphylaxis under general anesthesia.


Study on invadopodia formation for lung carcinoma invasion with a microfluidic 3D culture device.
Invadopodia or invasive feet, which are actin-rich membrane protrusions with matrix degradation activity formed by invasive cancer cells, are a key determinant in the malignant invasive progression of tumors and represent an important target for cancer therapies. In this work, we presented a microfluidic 3D culture device with continuous supplement of fresh media via a syringe pump. The device mimicked tumor microenvironment in vivo and could be used to assay invadopodia formation and to study the mechanism of human lung cancer invasion. With this device, we investigated the effects of epidermal growth factor (EGF) and matrix metalloproteinase (MMP) inhibitor, GM6001 on invadopodia formation by human non-small cell lung cancer cell line A549 in 3D matrix model. This device was composed of three units that were capable of achieving the assays on one control group and two experimental groups' cells, which were simultaneously pretreated with EGF or GM6001 in parallel. Immunofluorescence analysis of invadopodia formation and extracellular matrix degradation was conducted using confocal imaging system. We observed that EGF promoted invadopodia formation by A549 cells in 3D matrix and that GM6001 inhibited the process. These results demonstrated that epidermal growth factor receptor (EGFR) signaling played a significant role in invadopodia formation and related ECM degradation activity. Meanwhile, it was suggested that MMP inhibitor (GM6001) might be a powerful therapeutic agent targeting invadopodia formation in tumor invasion. This work clearly demonstrated that the microfluidic-based 3D culture device provided an applicable platform for elucidating the mechanism of cancer invasion and could be used in testing other anti-invasion agents.


Dose-dependent QTc interval prolongation under haloperidol and pipamperone in the management of delirium in a naturalistic setting.
Delirium is an acute, life-threatening neuropsychiatric disorder frequently occurring among hospitalized patients. Antipsychotic medications are often recommended for delirium management but are associated with cardiovascular risks. This study aimed to investigate the frequency and magnitude of QTc interval prolongation and clinically relevant side effects occurring in delirium patients managed with haloperidol and/or pipamperone. This descriptive retrospective cohort study evaluated 102 elderly (mean age: 73.2 years) inpatients with delirium treated with either haloperidol, pipamperone, a combination of both, or neither in a naturalistic setting over the course of up to 20 days or until the end of delirium. A total of 86.3% of patients were treated with haloperidol and/or pipamperone at a mean daily haloperidol-equipotent dose of 1.2 ± 1 mg. Non-cardiovascular side effects were registered in 2.9% of all patients and correlated with higher scores on the Delirium Observation Screening Scale. They did not occur more frequently under antipsychotic treatment. The frequency of QTc interval prolongation was comparably common among all groups, but prolongation magnitude was higher under antipsychotic treatment. It was positively correlated with antipsychotic dosage and the total number of QTc interval-prolonging substances administered. Critical QTc interval prolongation was registered in 21.6% (n = 19) of patients in the group treated with antipsychotics compared to 14.3% (n = 2) of patients in the unmedicated group; however, the difference was not statistically significant. Polypharmacy was associated with a higher risk of critical QTc interval prolongation and increased mortality during delirium. Delirium treatment with haloperidol and/or pipamperone was not associated with a higher risk of QTc-interval prolongation in this naturalistic patient sample but was greater in magnitude and correlated with equipotent dosage and the number of QT interval-prolonging substances used. Polypharmacy was associated with higher mortality and increased risk of critical QTc prolongation.