Effect of 1-week fasting on some blood values in man.
Fifty-eight voluntary and healthy subjects (mean age 42.3 +/- 11.2 years) participated in 7-day supervised fasting trial during which only fruit and berry juices, tea and water were consumed. Venous blood was drawn before and after 1-week fasting and 3 months after the termination of the trial. The subjects' body weight and blood pressure values were also recorded. The results showed a statistically significant decrease in blood thrombocyte counts after 1-week fasting (p < 0.05), while a significant increase was observed in serum beta-hydroxybutyrate and alanine aminotransferase activities (p < 0.001). All other blood values, including glucose and creatinine, remained stable throughout the trial.


Relative efficiencies of the maximum-parsimony and distance-matrix methods of phylogeny construction for restriction data.
The relative efficiencies of the maximum-parsimony (MP), UPGMA, and neighbor-joining (NJ) methods in obtaining the correct tree (topology) for restriction-site and restriction-fragment data were studied by computer simulation. In this simulation, six DNA sequences of 16,000 nucleotides were assumed to evolve following a given model tree. The recognition sequences of 20 different six-base restriction enzymes were used to identify the restriction sites of the DNA sequences generated. The restriction-site data and restriction-fragment data thus obtained were used to reconstruct a phylogenetic tree, and the tree obtained was compared with the model tree. This process was repeated 300 times. The results obtained indicate that when the rate of nucleotide substitution is constant the probability of obtaining the correct tree (Pc) is generally higher in the NJ method than in the MP method. However, if we use the average topological deviation from the model tree (dT) as the criterion of comparison, the NJ and MP methods are nearly equally efficient. When the rate of nucleotide substitution varies with evolutionary lineage, the NJ method is better than the MP method, whether Pc or dT is used as the criterion of comparison. With 500 nucleotides and when the number of nucleotide substitutions per site was very small, restriction-site data were, contrary to our expectation, more useful than sequence data. Restriction-fragment data were less useful than restriction-site data, except when the sequence divergence was very small. UPGMA seems to be useful only when the rate of nucleotide substitution is constant and sequence divergence is high.


Innate affairs of allergens.
Activation of receptors of the innate immune system is a critical step in the initiation of immune responses. It has been shown that dominant allergens have properties that could allow them to interact with toll-like and C-type lectin receptors to favour Th2-biased responses and many bind lipids and glycans that could associate with ligands to mimic pathogen-associated microbial patterns. In accord with the proposed allergen-specific innate interactions it has been shown that the immune responses to different allergens and antigens from the same source are not necessarily coordinately regulated.


Laboratory observations on Toxorhynchites splendens Wiedemann in Thailand.
The biology of Toxorhynchites splendens predaceous larvae which breed in domestic containers like Aedes aegypti was studied. Egg stage lasts 52.64 +/- 0.13 hours. There are four larval instars lasting 2.38 +/- 0.04, 1.24 +/- 0.26, 8.09 +/- 1.6 and 28.78 +/- 5.39 days respectively. Pupal development lasts 5.18 +/- 1.06 days. The adult life span is 29.55 +/- 8.06 days. Growth increment was by measuring the size of head capsule. Number of second instar prey larvae consumed by 1 to 4 instars predaceous larvae were 9.32 +/- 1.77, 5.94 +/- 1.11, 37.03 +/- 7.05 and 273.06 +/- 50.69 respectively. The fourth instar was very aggressive especially 2-3 days before pupation when it killed without eating them. The construction of biological life table indicated net reproductive of increase (R0) of 16.3, capacity for increase (rc) of 0.094, finite rate of increase (lambda) of 1.08 and mean duration of a generation (Tc) of 44.445 days. The mortality at the first and second larval instar was high and the calculated population index (I) was 14.81.


Range, range modulation, and field radius requirements for proton therapy of prostate cancer.
The Loma Linda University Proton Treatment Facility has treated over 5,000 patients for prostate cancer. Other institutions may find information regarding field size and range requirements for this population of patients useful for designing new proton beamlines. The maximum range, range modulation, and maximum field radius for 240 fields of prostate patients undergoing treatment were sampled and analyzed. Most fields required a range less than 290 mm of water, a modulation width less than or equal to 120 mm, and a radius less than 75 mm.


Investigating the effect of forestry on leaf-litter arthropods (Algonquin Park, Ontario, Canada).
Arthropods are the most diverse taxonomic group of terrestrial eukaryotes and are sensitive to physical alterations in their environment such as those caused by forestry. With their enormous diversity and physical omnipresence, arthropods could be powerful indicators of the effects of disturbance following forestry. When arthropods have been used to measure the effects of disturbance, the total diversity of some groups is often found to increase following forestry. However, these findings are frequently derived using a coarse taxonomic grain (family or order) to accommodate for various taxonomic impediments (including cryptic diversity and poorly resourced taxonomists). Our intent with this work was to determine the diversity of arthropods in and around Algonquin Park, and how this diversity was influenced by disturbance (in this case, forestry within the past 25 years). We used DNA barcode-derived diversity estimates (Barcode Index Number (BIN) richness) to avoid taxonomic impediments and as a source of genetic information with which we could conduct phylogenetic estimates of diversity (PD). Diversity patterns elucidated with PD are often, but not always congruent with taxonomic estimates-and departures from these expectations can help clarify disturbance effects that are hidden from richness studies alone. We found that BIN richness and PD were greater in disturbed (forested) areas, however when we controlled for the expected relationship between PD and BIN richness, we found that cut sites contained less PD than expected and that this diversity was more phylogenetically clustered than would be predicted by taxonomic richness. While disturbance may cause an evident increase in diversity, this diversity may not reflect the full evolutionary history of the assemblage within that area and thus a subtle effect of disturbance can be found decades following forestry.


Multiple fragment ligation on glass surface: a novel approach.
Binding of DNA to pure silicon dioxide involving formation of hydrogen bonds by disruption of the hydration shell of DNA using chaotropic agents can be easily reversed with water or buffers of low ionic strength. When powdered glass was used instead of pure silicon dioxide the binding of DNA to glass was less easily reversed. DNA bound to glass permits digestion by restriction enzyme, ligation and transformation. The method opens up the possibility of enhancing transformation efficiency especially for DNA digests containing more than two pieces.


Total synthesis of neurymenolide A based on a gold-catalyzed synthesis of 4-hydroxy-2-pyrones.
Treat me gently: for a selective synthesis of the unusually sensitive cyclophanic α-pyrone neurymenolide A, the chosen catalysts must be able to distinguish between six different sites of unsaturation, without scrambling any of the skipped π systems. This challenge was met with a new gold-catalyzed pyrone synthesis in combination with a molybdenum-catalyzed ring-closing alkyne metathesis.


Advanced analytical techniques for the extraction and characterization of plant-derived essential oils by gas chromatography with mass spectrometry.
In recent years, essential oils have received a growing interest because of the positive health effects of their novel characteristics such as antibacterial, antifungal, and antioxidant activities. For the extraction of plant-derived essential oils, there is the need of advanced analytical techniques and innovative methodologies. An exhaustive study of hydrodistillation, supercritical fluid extraction, ultrasound- and microwave-assisted extraction, solid-phase microextraction, pressurized liquid extraction, pressurized hot water extraction, liquid-liquid extraction, liquid-phase microextraction, matrix solid-phase dispersion, and gas chromatography (one- and two-dimensional) hyphenated with mass spectrometry for the extraction through various plant species and analysis of essential oils has been provided in this review. Essential oils are composed of mainly terpenes and terpenoids with low-molecular-weight aromatic and aliphatic constituents that are particularly important for public health.


Self-determination vs. family-determination: two incommensurable principles of autonomy: a report from East Asia.
Most contemporary bioethicists believe that Western bioethical principles, such as the principle of autonomy, are universally binding wherever bioethics is found. According to these bioethicists, these principles may be subject to culturally-conditioned further interpretations for their application in different nations or regions, but an 'abstract content' of each principle remains unchanged, which provides 'an objective basis for moral judgment and international law'. This essay intends to demonstrate that this is not the case. Taking the principle of autonomy as an example, this essay argues that there is no such shared 'abstract content' between the Western bioethical principle of autonomy and the East Asian bioethical principle of autonomy. Other things being equal, the Western principle of autonomy demands self-determination, assumes a subjective conception of the good and promotes the value of individual independence, whilst the East Asian principle of autonomy requires family-determination, presupposes an objective conception of the good and upholds the value of harmonious dependence. They differ from each other in the most general sense and basic moral requirement.


Research progress and perspectives of N-methyl-D-aspartate receptor in myocardial and cerebral ischemia-reperfusion injury: A review.
There is an urgent need to find common targets for precision therapy, as there are no effective preventive therapeutic measures for combined clinical heart-brain organ protection and common pathways associated with glutamate receptors are involved in heart-brain injury, but current glutamate receptor-related clinical trials have failed. Ischemia-reperfusion injury (IRI) is a common pathological condition that occurs in multiple organs, including the heart and brain, and can lead to severe morbidity and mortality. N-methyl-D-aspartate receptor (NMDAR), a type of ionotropic glutamate receptor, plays a crucial role in the pathogenesis of IRI. NMDAR activity is mainly regulated by endogenous activators, agonists, antagonists, and voltage-gated channels, and activation leads to excessive calcium influx, oxidative stress, mitochondrial dysfunction, inflammation, apoptosis, and necrosis in ischemic cells. In this review, we summarize current research advances regarding the role of NMDAR in myocardial and cerebral IRI and discuss potential therapeutic strategies to modulate NMDAR signaling to prevent and treat IRI.


Social Interpretation Bias in Children and Adolescents with Anxiety Disorders: Psychometric Examination of the Self-report of Ambiguous Social Situations for Youth (SASSY) Scale.
Anxiety disorders are among the most common mental health problems in youth, and faulty interpretation bias has been positively linked to anxiety severity, even within anxiety-disordered youth. Quick, reliable assessment of interpretation bias may be useful in identifying youth with certain types of anxiety or assessing changes on cognitive bias during intervention. This study examined the factor structure, reliability, and validity of the Self-report of Ambiguous Social Situations for Youth (SASSY) scale, a self-report measure developed to assess interpretation bias in youth. Participants (N=488, age 7 to 17) met diagnostic criteria for Social Phobia, Generalized Anxiety Disorder, and/or Separation Anxiety Disorder. An exploratory factor analysis was performed on baseline data from youth participating in a large randomized clinical trial. Exploratory factor analysis yielded two factors (Accusation/Blame, Social Rejection). The SASSY full scale and Social Rejection factor demonstrated adequate internal consistency, convergent validity with social anxiety, and discriminant validity as evidenced by non-significant correlations with measures of non-social anxiety. Further, the SASSY Social Rejection factor accurately distinguished children and adolescents with Social Phobia from those with other anxiety disorders, supporting its criterion validity, and revealed sensitivity to changes with treatment. Given the relevance to youth with social phobia, pre- and post-intervention data were examined for youth social phobia to test sensitivity to treatment effects; results suggested that SASSY scores reduced for treatment responders. Findings suggest the potential utility of the SASSY Social Rejection factor as a quick, reliable, and efficient way of assessing interpretation bias in anxious youth, particularly as related to social concerns, in research and clinical settings.


[Chemotherapy for Malignancy During Pregnancy - Literature Review.]
In today's dynamic development of modern life, we can unfortunately see more and more often cases of malignant diseases during pregnancy. Therapy of these conditions in pregnant women is a challenge to the doctors, due to concerns for the mother's health, but also the possible risks for the foetus. An additional difficulty is the fact that there are no common algorithms for the treatment. Of great importance is the ges'tation period, because in its different parts, the risks vary in grade. It is believed that up to 10-12th ges.tation week chemotherapy should not be included. The optimal time for the last course is 35th gestation week or three weeks to the due date. The purpose of this review is to examine the benefits and risks of the treatment of malignant diseases during pregnancy for both the mother and the fetus.


Are sainfoin or protein supplements alternatives to control small strongyle infection in horses?
The spread of anthelmintic resistance in equine strongyle nematodes has become a major problem, advocating for the development of alternative control for strongyles. Our study consisted of both in vivo and in vitro experiments. We investigate for the first time the efficacy of a short-term consumption of tannin-rich sainfoin (Onobrychis viciifolia) or extra proteins in naturally infected horses. We used 30 horses allocated into three groups of 10 individuals that received for 18 days either (i) a tannin-rich diet with 70% DM sainfoin pellets (Sd), (ii) a protein-rich diet with 52% DM Italian rye-grass pellets and 18% DM grinded linseed expeller (Pd), or (iii) a control diet with 45% DM barley and 25% DM cereal-based pellets (Cd). The three diets were isoenergetic, covering 94% of animal energy requirements on average, and the Sd and Pd diets were isoproteic and provided extra proteins (227% of protein requirements v. 93% for the Cd diet). Pd and Cd were compared to test for benefits of receiving extra proteins, while Sd and Pd were compared to account for the effect of sainfoin secondary metabolites. There were no between-diet differences in faecal egg counts (FEC) or in worm burden evaluated from worm counts in faeces of drenched horses at the end of the experiment. However, coprocultures from the faeces collected in each group at the beginning and at the end of the experiment suggested a lower rate of strongyle larval development in the Sd group at the end of the experiment (Sd=8.1%, Pd=30.5%, Cd=22.6%). In vitro tests using sainfoin solutions evidenced the influence of sainfoin on strongyle larval development: adding 29% of sainfoin pellets to faeces reduced the strongyle egg development into infective larvae by 82% (P<0.001) and using solutions with sainfoin concentrations higher than 7.5 mg/ml reduced egg hatching by 37% (P<0.05). The short-term use of tannin-rich plants in horse diet could thus constitute a promising strategy to reduce the risk of infection by strongyles at pasture.


Rotate-on-Retract Procedural Automation for Robotic-Assisted Percutaneous Coronary Intervention: First Clinical Experience.
The advent of percutaneous coronary intervention (PCI) has dramatically changed the outlook for patients with cardiovascular disease. However, room for improvement and advancement remains in the safety, speed, and efficiency of manually guided PCI. In recent years, the CorPath robotic platform (Corindus Inc., Waltham, MA) has been approved to aid the interventionalist during PCI and other endovascular interventions. Favorable results in several clinical studies suggest that robotic-assisted PCI may further improve patient outcomes while also benefiting the interventionalist through reduced orthopedic strain and less exposure to ionizing radiation. In this report, we communicate our experience with the first-in-human use of a new, optional automation feature that has been added to the platform's guidance software. This "Rotate-on-Retract" feature is designed to facilitate faster and more precise maneuvering of the guidewire through tortuous vessels by automatically rotating the guidewire whenever it is retracted by the operator. This movement changes the tip's orientation in preparation for the next advancement. We evaluated this feature in a patient undergoing PCI to treat a severe (90% stenotic), long, diffuse, and calcified lesion of the proximal to mid LAD segments.


BACI design reveals the decline of the seagrass Posidonia oceanica induced by anchoring.
The key species Posidonia oceanica is the dominant endemic seagrass in the Mediterranean Sea and its meadows are considered as one of the most important and productive ecosystems in coastal waters. Covering the seabed from the surface down to about 40 m, meadows of P. oceanica are often affected by mechanical direct damages caused by boat anchoring and mooring activities. Negative effects of these activities have been shown to be recorded by P. oceanica at two different levels: the individual level (phenology of the plant) and the population level (structure of the meadow). We investigated the effect of an anchoring chain system on the P. oceanica meadow of Prelo cove (NW Mediterranean Sea) at two different depths (shallow, deep) and at three different situations of P. oceanica bottom cover (high, medium, low). Several standardized descriptors of the meadow health, working either at the individual or at the population level, were analysed in order to quantify the impact of the deployment of the chain system. A symmetrical BACI design was adopted to detect the impact, where multiple disturbed sites were contrasted with multiple controls in two distinct times, i.e. right few days after the chain settling (early) and 4 months later the disturbance (late). The anchoring chain system has been shown to strongly affect the meadow in terms of shoot density decline and rhizome baring, especially in the deep portions and where the cover of the meadow was low. All descriptors working at the population level proved effective in detecting the impact of the anchoring system. In contrast, descriptors working at the individual level did not show a consistent response to the impact. Our results pointed out the imperative necessity to proper regulate the boat anchoring and mooring activities on the P. oceanica meadows and the adoption of seagrass friendly mooring technology is thus recommended.


Biological predictors of response to radiotherapy in head and neck cancer: recent advances and emerging perspectives.
The study of new biological parameters has received considerable attention in radiotherapy during the last decade due to their potential value in predicting treatment response in squamous cell carcinoma of the head and neck (SCC-HN) and the foreseen possibility of selecting altered fractionation radiotherapy for the individual patient. Although there are established clinical parameters in SCC-HN patients that relate to radiation response (extent of disease, hemoglobin level), recent advances with direct measurement of tumor oxygenation, inherent radiosensitivity and proliferation rate have increased the promise of individualization of treatment strategy according to these radiobiologically based parameters. Molecular research has now identified a host of new biological parameters with potential predictive utility; oncogenes, tumor suppressor genes, cell-cycle control genes, apoptosis genes and angiogenesis genes have been extensively studied and correlated with radiation response. Moreover, study of the epidermal growth factor receptor signal-transduction system as a possible response modulator has recently fostered molecular strategies which employ blockade of the receptor to down-regulate tumor growth. This article briefly reviews and analyzes the main controversial issues and drawbacks that hinder the general use of biological parameters for predicting tumor response to radiotherapy. It highlights the future perspectives of radiotherapy predictive assay research and the need to shift from single-parameter analysis to multiparametric studies which take into account several potential predictors that together are involved in different biological and clinical pathways.


The relationship between problematic internet use and attention deficit, hyperactivity and impulsivity: A meta-analysis.
This study aimed to investigate the relationship between problematic internet use (PIU) and ADHD-related symptoms of attention deficit, impulsivity and hyperactivity. We chose a meta-analytical approach and searched for relevant studies in different databases (Pubmed, PsycInfo, Google scholar). We identified 24 studies with 18 859 participants (mean age = 18.40 (SD = 5.51)) published between 2004 and 2021 which were applicable for our research. We calculated 21, 7, and 9 effect sizes for attention deficit, hyperactivity and impulsivity, respectively. We found significant associations between PIU and attention deficit (r = 0.36, 95% confidence interval = [0.28 to 0.43]), hyperactivity (r = 0.44, 95% confidence interval = [0.33 to 0.53]), and impulsivity (r = 0.41, 95% confidence interval = [0.30 to 0.51]), p < .001 for all three. The effect sizes of attention deficit and hyperactivity were significantly higher in male compared to female participants. Additionally, higher attention deficit effects were found in adults compared to children/adolescents. Our meta-analysis indicates that ADHD-related symptoms are associated with PIU. Although cross-sectional analyses cannot explain cause-and-effect relationships, we hypothesize that attention deficit, hyperactivity and impulsivity constitute a vulnerability towards PIU.


Comparative Analysis Of Anterior Knee Pain In Transpatellar And Medial Parapatellar Tendon Approaches In Tibial Interlocking Nailing.
Anterior knee pain is the most common complaint after intramedullary nail of the tibia. The incidence of anterior knee pain ranges from 10-86% and the exact ethology is unclear. Transpatellar tendon approach is commonly used for tibial intramedullary interlocking nailing but it can also be done through medial parapatellar tendon approach. The objective of the study was to compare post-operative anterior knee pain after intramedullary nailing technique by transpatellar approach compared to medial parapatellar approach. This randomized controlled trial was carried out in Department of Orthopaedic and Spine Surgery, Ghurki trust teaching hospital, Lahore from 20th February to 19th Nov 2015. Sixty patients who presented at emergency department for the treatment of simple tibial shaft fractures were included in the study. They were divided into two groups with 30 patients in each group, Group A containing patients operated through transpatellar tendon approach while group B containing patients operated through medial parapatellar tendon approach. In Group A, 27 patients were male and 3 patients were female with a mean age of 28.667±9.63 while in Group B, 28 were male and 2 were female with a mean age of 34.63±15.82. The main causes of tibial shaft fractures were RTA followed by fall. In Group A mean anterior knee pain was 4.4 while in Group B, it was was 2.5 with a p-value of .000. This study shows that medial parapatellar tendon approach causes less pain as compared to transpatellar approach.


Hepatic arterial infusion for liver metastases from colon cancer: comparison of mitomycin C(NSC-26980) and 5-fluorouracil (NSC-19893).
This study compares the effectiveness of hepatic arterial infusion of mitomycin C with that of 5-fluorouracil in the management of carcinoma of the colon metastatic to the liver. A higher tumor response rate was obtained with 5-FU (ten of 12 patients) than with mitomycin C (six of 13 patients). The patients treated with mitomycin C had a median survival time of 9.5 months compared to 12 months for those receiving 5-FU, but this survival is not much different from that of the untreated historical controls. Femoral artery thrombosis requiring surgical thrombectomy developed in five of the 30 catheterized patients.


Effects of recombinant erythropoietin therapy on circulating endothelial markers in hemodialysis patients.
Effects of a 4-week course of recombinant human erythropoietin (rHuEpo) therapy on four circulating endothelium-derived cardiovascular risk markers were studied in 20 patients receiving maintenance hemodialysis in relation to surrogates of chronic inflammation, liver function, and arterial blood pressure. Soluble intercellular adhesion molecule-1 (sICAM-1), antigens of plasminogen activator inhibitor-1 (PAI-1:Ag) and von Willebrand factor (vWF:Ag), and soluble thrombomodulin (sTM) were determined by immunoenzymatic assays. C-reactive protein; alpha1 acid-glycoprotein; alpha1-antitrypsin; immunoglobulin M, A, and G; interleukin-6; lipoprotein(a); fibrinogen; total protein; albumin; total cholesterol; hepatitis B and C markers; liver enzymes; prothrombin time; and phosphorus were measured by routine methods. The rHuEpo treatment resulted in a 25% increase in sICAM-1 (Wilcoxon's p = 0.001), a 50% increase in PAI-1:Ag (p = 0.004), a 15% increase in sTM (p = 0.002), and did not change vWF:Ag levels. The increase in sICAM-1 concentration directly correlated with that of PAI-1:Ag (Spearman's rho = 0.483, p = 0.031). The rHuEpo-induced increases in hemoglobin, platelets, and pre-dialysis diastolic blood pressure levels did not correlate with the increments in the endothelial markers studied. In conclusion, short-term rHuEpo therapy activates vascular endothelium in patients receiving maintenance hemodialysis. This specific effect may influence cardiovascular risk.


Contribution of altered signal transduction associated to glutamate receptors in brain to the neurological alterations of hepatic encephalopathy.
Patients with liver disease may present hepatic encephalopathy (HE), a complex neuropsychiatric syndrome covering a wide range of neurological alterations, including cognitive and motor disturbances. HE reduces the quality of life of the patients and is associated with poor prognosis. In the worse cases HE may lead to coma or death. The mechanisms leading to HE which are not well known are being studied using animal models. The neurological alterations in HE are a consequence of impaired cerebral function mainly due to alterations in neurotransmission. We review here some studies indicating that alterations in neurotransmission associated to different types of glutamate receptors are responsible for some of the cognitive and motor alterations present in HE. These studies show that the function of the signal transduction pathway glutamate-nitric oxide-cGMP associated to the NMDA type of glutamate receptors is impaired in brain in vivo in HE animal models as well as in brain of patients died of HE. Activation of NMDA receptors in brain activates this pathway and increases cGMP. In animal models of HE this increase in cGMP induced by activation of NMDA receptors is reduced, which is responsible for the impairment in learning ability in these animal models. Increasing cGMP by pharmacological means restores learning ability in rats with HE and may be a new therapeutic approach to improve cognitive function in patients with HE. However, it is necessary to previously assess the possible secondary effects. Patients with HE may present psychomotor slowing, hypokinesia and bradykinesia. Animal models of HE also show hypolocomotion. It has been shown in rats with HE that hypolocomotion is due to excessive activation of metabotropic glutamate receptors (mGluRs) in substantia nigra pars reticulata. Blocking mGluR1 in this brain area normalizes motor activity in the rats, suggesting that a similar treatment for patients with HE could be useful to treat psychomotor slowing and hypokinesia. However, the possible secondary effects of mGluR1 antagonists should be previously evaluated. These studies are setting the basis for designing therapeutic procedures to specifically treat the individual neurological alterations in patients with HE.


A six months' prospective follow-up of 65+-y-old patients from general practice classified according to nutritional risk by the Mini Nutritional Assessment.
To assess the prevalence of old people at risk of undernutrition according to the Mini Nutritional Assessment (MNA), characterise the at risk group with regard to nutritional state, energy intake, and physical and mental functioning, and to assess the consequences of the MNA score over a 6 month period. A cross-sectional prospective study. The clinic of a general practitioner. Ninety-four patients 65+-y-old with no acute illness contacted at the clinic. Sixty-one subjects (65%) agreed to participate at baseline and 34 (56%) showed up at the follow-up 6 months later. At baseline, 23 (38%) participants were assessed as being at risk of undernutrition (17-23.5 MNA points). The remaining were classified as well-nourished (>23.5 MNA points). The 23 participants at risk had a higher prevalence of body mass index (BMI) <20 kg/m(2) (44 vs 11%, P<0.001) and insufficient energy intake (36 vs 9%, P<0.05), compared with the well-nourished group. Also, they had a higher need of meals-on-wheels (39 vs 8%, P<0.01) and home-care for shopping (48 vs 18%, P<0.05) at baseline. At the 6 months' follow-up, there was a tendency to a higher non-participation rate among the participants assessed at risk of undernutrition at baseline (44 vs 18%, 0.05<P<0.1), compared with the well-nourished group. There was a tendency to a higher prevalence of hospitalisation (38 vs 19%, 0.05<P<0.1) in the at risk group. MNA seems to be a useful tool to identify old people who need help from the public sector. However, many in the group at risk of undernutrition already have low BMI values. This might have influenced the findings.


Fluorescein angiography of degenerative lesions of the peripheral fundus and rhegmatogenous retinal detachment.
Since the number of cases for each of the conditions in our study was small, only preliminary conclusions can be made; in order to establish the fluorescein pattern of each of these peripheral retinal lesions, additional studies will be required. The following summarizes our preliminary observations. 1. Areas of retinal white-with-pressure or without and peripheral retinal cystoid degeneration did not reveal remarkable fluorescein angiographic findings. One exception was in an area of pigment epithelial disturbance characterized by atrophy and proliferation, which showed a "window and masking" effect of choroidal fluorescence. 2. Fluorescein angiography of areas of the fundus with lattice retinal degeneration showed little or no findings in early or mild cases. In severe or advanced cases, the affected retina revealed poor or absent perfusion caused by vascular occlusion. The retinal and choroidal circulation was devoid of fluorescein leakage. Advanced lesions displayed choroidal hypofluorescence in areas of pigment proliferation and hyperfluorescence in areas of pigment atrophy. 3. In advanced cases, occlusive vascular changes over areas of acquired retinoschisis were observed. There was intraretinal leakage of the dye from deep capillaries and pooling of the dye in cystic cavities near the margin of the retinoschisis. 4. There was no perfusion of the choroid and retina in the area of the hole and in the retina surrounding it. This finding suggests choroidal and retinal ischemia in the pathogenesis of a retinal hole. 5. Fluorescein angiography of retinal tears revealed fluorescein leakage along the edge of the tear and absent perfusion of the retinal flap. The retinal and choroidal circulation-around the tear was otherwise unremarkable. The choroidal fluorescein underlying the retinal flap was not visible, perhaps because it was masked by the retinal flap. 6. Our fluorescein angiographic findings in cases of rhegmatogenous retinal detachment confirmed those of others [7, 8, 10]. Transit of fluorescein through the retinal circulation was sluggish. The retinal capillaries were dilated. 7. In cases of rhegmatogenous retinal detachment which had become reattached surgically, areas treated with diathermy or cryoapplications showed absent or diminished choroidal and retinal perfusion. Leakage of the fluorescein from capillaries in the optic disc and retina in the posterior pole was sometimes persistent several months postoperatively.


Recent development of synthetic preparation methods for guanidines via transition metal catalysis.
Multisubstituted guanidines have received much attention because of important applications in many fields, such as pharmaceutics, organometallic and coordination chemistry, and organic synthesis. Although classical methods are available for the preparation of guanidines, synthetic preparation approaches to guanidines are still in great demand. In this review, we summarize recent developments on synthetic methods via the C-N bond formation. Three aspects are included: transition-metal-catalyzed guanidine synthesis based on classical methods; catalytic guanylation reaction of amines with carbodiimides; and tandem catalytic guanylation/cyclization reactions.


Fluorescence spectroscopy of PTCDA molecules on the KCl(100) surface in the limit of low coverages: site selection and diffusion.
We performed fluorescence (FL) and fluorescence excitation (FLE) spectroscopy on the model molecule perylene-3,4,9,10-tetracarboxyl acid dianhydride (PTCDA) for very low coverages (below 1% of a monolayer) on thin (100) oriented KCl films. Two different states of PTCDA molecules can be distinguished in the spectra: an initial state, which is observed directly after deposition of the molecules onto the cold sample at 20 K, and a final state, which is found after intensive optical excitation or thermal annealing of the sample. The spectrum of the final state is blue-shifted with respect to that of the initial state by 130 ± 15 cm(-1) and exhibits lines with significantly reduced widths. This can be explained by diffusion of molecules from initially populated terrace sites to energetically favoured step edge sites. Polarization dependent spectroscopy reveals the same azimuthal orientation of the molecules on both adsorption sites and leads to a model of the adsorption geometry of PTCDA at the KCl step sites. Our experiment demonstrates how optical spectroscopy can be used to investigate kinetic processes of fluorescent molecules on surfaces.


Mental Health Promotion in School: Schoolchildren's and Families' Viewpoint.
While developing mental health work in schools, it is very important to consider the viewpoint of pupils. Parents can also give remarkable information on their children's viewpoint. The purpose of this study was to produce a description of the concepts used by schoolchildren aged 12-16 years and their families associated with promoting mental health in schools. The research material comprised interviews with schoolchildren and mothers, and verbal answers from the school well-being profile survey (n = 426). The analysis was conducted by applying the grounded theory method as introduced by Strauss. The study was conducted in a Finnish comprehensive school.


[Information and evocation. Materials toward a sociopsychologically oriented psychopathology].
Psychopathology is always science of interaction, because mental illness is recognizable only in interaction. It will be useful for psychopathology to have a critical look on ideas and models of modern linguistic science. This is especially true for those tendencies which are interested in the concept of a theory of speaking and acting and work out the social implications of communicational processes beyond the formal examination of language structure. From this point of view new basic knowledge of psychopathology may accumulate. Tendencies going in that direction are examined in detail, especially the meaning of evocation, which was introduced by Lacan and which might prove to be a key conception of psychiatry.


Spectral and dynamic characteristics of helium plasma emission and its effect on a laser-ablated target emission in a double-pulse laser-induced breakdown spectroscopy (LIBS) experiment.
A systematic study has been performed on the spectral characteristics of the full spectrum of He emission lines and their time-dependent behaviors measured from the He gas plasmas generated by a nanosecond neodymium-doped yttrium aluminum garnet laser. It is shown that among the major emission lines observed, the triplet He(I) 587.6 nm emission line stands out as the most prominent and long-lasting line, associated with de-excitation of the metastable triplet (S = 1) excited state (1s(1) 3d(1)). The role of this metastable excited state is manifested in the intensity enhancement and prolonged life time of the Cu emission with narrow full width half-maximum, as demonstrated in an orthogonal double-pulse experiment using a picosecond laser for the target ablation and a nanosecond laser for the prior generation of the ambient He gas plasma. These desirable emission features are in dire contrast to the characteristics of emission spectra observed with N2 ambient gas having no metastable excited state, which exhibit an initial Stark broadening effect and rapid intensity diminution typical to thermal shock wave-induced emission. The aforementioned He metastable excited state is therefore responsible for the demonstrated favorable features. The advantage of using He ambient gas in the double-pulse setup is further confirmed by the emission spectra measured from a variety of samples. The results of this study have thus shown the potential of extending the existing laser-induced breakdown spectroscopy application to high-sensitivity and high-resolution spectrochemical analysis of wide-ranging samples with minimal destructive effect on the sample surface.


Aircraft and Ship Velocity Determination in Sentinel-2 Multispectral Images.
The Sentinel-2 satellites in the Copernicus program provide high resolution multispectral images, which are recorded with temporal offsets up to 2.6 s. Moving aircrafts and ships are therefore observed at different positions due to the multispectral band offsets, from which velocities can be determined. We describe an algorithm for detecting aircrafts and ships, and determining their speed, heading, position, length, etc. Aircraft velocities are also affected by the parallax effect and jet streams, and we show how the altitude and the jet stream speed can be determined from the geometry of the aircraft and/or contrail heading. Ship speeds are more difficult to determine as wakes affect the average ship positions differently in the various multispectral bands, and more advanced corrections methods are shown to improve the velocity determination.


Anomalies and variations of the middle cerebral artery: a microanatomical study.
The microvascular anatomy of the main trunk and divisions of the middle cerebral artery was studied in 104 unfixed brain hemispheres injected with polyester resin and dissected under the operating microscope. The following anomalies and variations of the middle cerebral artery were found: fenestration (1 case; 1%), located on the first 4 mm of the main trunk of the middle cerebral artery; duplication (1 case; 1%), with vessels arising from the internal carotid artery; accessory middle cerebral artery (2 cases; 2%), originating on the A1 segment of the anterior cerebral artery; single-trunk type of middle cerebral artery (4 cases; 4%), with no division of its main trunk; quadrifurcation (4 cases; 4%), in which the main trunk of the middle cerebral artery divided into four secondary trunks. The clinical implications of these anatomical findings are discussed, and photographs of representative specimens illustrate the anomalies.


The role of neurokinin A and calcitonin gene-related peptide in the mucociliary defence of the rabbit maxillary sinus.
Substance P (SP) released from sensory C-fibres in the airways increases the mucociliary (m.c.) activity in the rabbit maxillary sinus. The purpose of the present study was to investigate the m.c. effects of two other neuropeptides, coexisting with SP in sensory neurones, neurokinin A (NKA) and calcitonin gene-related peptide (CGRP). NKA increased the m.c. activity dose-dependently (dose range 0.1-5.0 micrograms/kg) the maximum increase being 33.6 +/- 6.0%. The effect was inhibited by pretreatment with the tachykinin antagonist (D-Pro2, D-Trp7,9)SP, but not with atropine or hexamethonium. Thus NKA released from sensory C-fibres may contribute to the non-cholinergic increase of m.c. activity observed after C-fibre stimulation. In contrast CGRP did not influence the m.c. activity. Neither did it influence the responses to NKA or SP. It is concluded that CGRP is unlikely to be involved in the control of m.c. function.


Preventing risky driving: A novel and efficient brief intervention focusing on acknowledgement of personal risk factors.
Impulsive personality is an important predictor of risky driving. Acknowledging their impulsive tendencies may help novice drivers to drive more safely. The aim of this study was to evaluate the efficacy of a novel brief intervention targeting novice drivers' risky behavior in traffic, taking into account potential moderator effects. Driving school students (n=1866) were divided into an intervention group and a control group. The intervention consisted of a lecture and group work (1.5h). Subjects' traffic offenses and crashes were monitored during the following year using police and traffic insurance fund databases. The groups were similar in their baseline characteristics. The intervention group had half as many speeding violations in the year following the intervention compared with the controls. The proportion of speeders was significantly lower in the intervention group compared with the control group in subgroups of subjects with medium cognitive abilities and low or medium BIS-11 impulsiveness levels. In alpha(2A)-adrenoceptor gene (ADRA2A) G allele carriers, general traffic risk and speeding decreased in response to the intervention, unlike in subjects with the CC genotype. It is concluded that brief interventions that are integrated into the driving education program and focus on personal psychological risk factors may be effective for improving traffic safety.


Understanding the Dual-Phase Synergy Mechanism in Mn2O3-Mn3O4 Catalyst for Efficient Li-CO2 Batteries.
Rechargeable Li-CO2 batteries have been receiving intense interest because of their high theoretical energy density and environmentally friendly CO2 fixation ability. However, due to the sluggish CO2 reduction/evolution reaction (CRR/CER) kinetics, the current Li-CO2 batteries still suffer from severe polarization and poor cycling stability. Herein, we designed and in situ synthesized sea urchinlike Mn2O3-Mn3O4 nanocomposite and explored the synergistic effect between Mn2O3 and Mn3O4 during charge-discharge process in Li-CO2 batteries. It is found that Mn3O4 can effectively promote the kinetics of CRR process, and Mn2O3 can induce the nucleation of Li2CO3 and promote its decomposition (CER). Benefiting from the dual-phase synergy, the Mn2O3-Mn3O4 cathode combines the respective catalytic advantages of the both and delivers a high full discharge capacity of 19 024 mAh g-1, a low potential gap of 1.24 V, and durable cycling stability (1380 h) at a current density of 100 mA g-1. Moreover, based on experimental results and density functional theory (DFT) calculations, a charge-discharge process model of the Mn2O3-Mn3O4 cathode was established to display the electrochemical reaction mechanism. We hope that this design strategy can encourage further studies for efficient cathode catalysts to accelerate the practical application of Li-CO2 batteries and even the metal-air batteries.


Role of activation-induced cell death in pathogenesis of patients with chronic hepatitis B.
To study and compare the difference of activation-induced cell death (AICD) in peripheral blood T-lymphocytes(PBL-Ts) from patients with chronic hepatitis B (CHB) and the normal people in vitro, and to explore the role of AICD in chronic hepatitis B virus (HBV) infection and the pathogenesis of CHB. Twenty-five patients and fourteen healthy people were selected for isolation of PBL-Ts. During cultivation, anti-CD3 mAb, PMA and ionomycin were used for AICD of PBL-Ts. AICD ratio of PBL-Ts was detected with TdT-mediated dUTP nick end labeling and assessed by flow cytometry. When induced with anti-CD3, PMA and ionomycin in vitro, AICD ratio of PBL-Ts from CHB patients was significantly higher than that from healthy control (17.24+/-1.21 vs. 6.63+/-1.00, P<0.01) and that from CHB patients without induction (17.24+/-1.21 vs. 9.88+/-1.36, P<0.01). There was a similar AICD ratio of PBL-Ts between induction group and without induction group, but no difference was found before and after induction in healthy control. The density of INF-gamma in culture media of induction groups of CHB was lower than that of other groups (P<0.01). There was no difference between these groups in density of IL-10 (P>0.05). When induced during cultivation in vitro, PBL-Ts from CHB have AICD very commonly. This phenomenon has a potentially important relation with pathogenesis of CHB and chronicity of HBV infection.


Second autologous stem cell transplant for multiply relapsed Hodgkin's disease.
Therapeutic options for patients with Hodgkin's disease who relapse after high-dose chemotherapy with autologous stem cell support are limited. Salvage chemotherapy is not curative, and allogeneic stem cell transplantation in this setting is associated with mortality rates of 40-65%. We report our institution's experience with second autologous transplants in this patient population. Five patients (median age 36) with relapsed Hodgkin's disease underwent a second autologous stem cell transplant at a median of 66 months after first transplant. Four patients received CBV, and one patient received BuCy as conditioning. Neutrophil and platelet engraftment occurred by days +10 and +16, respectively. All patients achieved a complete response, and no relapses have occurred after a median follow-up of 42 months. All four patients who received CBV developed interstitial pneumonitis, and two patients died of pulmonary complications 37 and 48 months following second transplant. Three patients remain alive and disease-free 41, 42 and 155 months after second transplant. These data indicate that second autologous transplantation should be considered for selected patients who relapse after a prolonged response to first autologous transplant. However, BCNU pneumonitis is the major toxicity in patients who have undergone previous mantle radiation and received busulfan with first transplant.


Vapor-phase transport of trichloroethene in an intermediate-scale vadose-zone system: retention processes and tracer-based prediction.
Gas-phase transport experiments were conducted using a large weighing lysimeter to evaluate retention processes for volatile organic compounds (VOCs) in water-unsaturated (vadose-zone) systems, and to test the utility of gas-phase tracers for predicting VOC retardation. Trichloroethene (TCE) served as a model VOC, while trichlorofluoromethane (CFM) and heptane were used as partitioning tracers to independently characterize retention by water and the air-water interface, respectively. Retardation factors for TCE ranged between 1.9 and 3.5, depending on water content. The results indicate that dissolution into the bulk water was the primary retention mechanism for TCE under all conditions studied, contributing approximately two-thirds of the total measured retention. Accumulation at the air-water interface comprised a significant fraction of the observed retention for all experiments, with an average contribution of approximately 24%. Sorption to the solid phase contributed approximately 10% to retention. Water contents and air-water interfacial areas estimated based on the CFM and heptane tracer data, respectively, were similar to independently measured values. Retardation factors for TCE predicted using the partitioning-tracer data were in reasonable agreement with the measured values. These results suggest that gas-phase tracer tests hold promise for characterizing the retention and transport of VOCs in the vadose-zone.


Rational Drug Design of Antineoplastic Agents Using 3D-QSAR, Cheminformatic, and Virtual Screening Approaches.
Computer-Aided Drug Design has strongly accelerated the development of novel antineoplastic agents by helping in the hit identification, optimization, and evaluation. Computational approaches such as cheminformatic search, virtual screening, pharmacophore modeling, molecular docking and dynamics have been developed and applied to explain the activity of bioactive molecules, design novel agents, increase the success rate of drug research, and decrease the total costs of drug discovery. Similarity, searches and virtual screening are used to identify molecules with an increased probability to interact with drug targets of interest, while the other computational approaches are applied for the design and evaluation of molecules with enhanced activity and improved safety profile. In this review are described the main in silico techniques used in rational drug design of antineoplastic agents and presented optimal combinations of computational methods for design of more efficient antineoplastic drugs.


Metagenomics of Bacterial Diversity in Villa Luz Caves with Sulfur Water Springs.
New biotechnology applications require in-depth preliminary studies of biodiversity. The methods of massive sequencing using metagenomics and bioinformatics tools offer us sufficient and reliable knowledge to understand environmental diversity, to know new microorganisms, and to take advantage of their functional genes. Villa Luz caves, in the southern Mexican state of Tabasco, are fed by at least 26 groundwater inlets, containing 300-500 mg L-1 H2S and <0.1 mg L-1 O2. We extracted environmental DNA for metagenomic analysis of collected samples in five selected Villa Luz caves sites, with pH values from 2.5 to 7. Foreign organisms found in this underground ecosystem can oxidize H2S to H2SO4. These include: biovermiculites, a bacterial association that can grow on the rock walls; snottites, that are whitish, viscous biofilms hanging from the rock walls, and sacks or bags of phlegm, which live within the aquatic environment of the springs. Through the emergency food assistance program (TEFAP) pyrosequencing, a total of 20,901 readings of amplification products from hypervariable regions V1 and V3 of 16S rRNA bacterial gene in whole and pure metagenomic DNA samples were generated. Seven bacterial phyla were identified. As a result, Proteobacteria was more frequent than Acidobacteria. Finally, acidophilic Proteobacteria was detected in UJAT5 sample.


Elephantorrhiza elephantina: Traditional Uses, Phytochemistry, and Pharmacology of an Important Medicinal Plant Species in Southern Africa.
Elephantorrhiza elephantina is used in southern Africa as traditional remedy for a wide range of human diseases and ailments including dermatological diseases, gastrointestinal system disorders, sexual dysfunction, sexually transmitted infections, and wounds. The rhizome decoction of E. elephantina is widely used by small-scale farmers in Botswana and South Africa as ethnoveterinary medicine for cattle, goats, horses, pigs, poultry, and sheep. Several classes of phytochemical compounds including anthocyanidins, anthraquinones, esters, fatty acids, phenolic compounds, flavonoids, glycosides, polysterols, saponins, sugars, tannins, and triterpenoids have been isolated from E. elephantina. Scientific studies on E. elephantina indicate that it has a wide range of biological activities including anthelmintic, antibacterial, antifungal, anti-inflammatory and antinociceptive, antiplasmodial, antioxidant, antibabesial, and antirickettsial activities. Elephantorrhiza elephantina is a valuable source of traditional medicine in southern Africa that it is worth additional research attention because of its wide ethnomedicinal applications and promising biological activities. However, the current health-related information on E. elephantina is not sufficiently explored as diverse studies on its chemical and pharmacological activities are required to understand its mechanism of action and to characterize the metabolites responsible for these activities.


Assessment of technological options and economical feasibility for cyanophycin biopolymer and high-value amino acid production.
Major transitions can be expected within the next few decades aiming at the reduction of pollution and global warming and at energy saving measures. For these purposes, new sustainable biorefinery concepts will be needed that will replace the traditional mineral oil-based synthesis of specialty and bulk chemicals. An important group of these chemicals are those that comprise N-functionalities. Many plant components contained in biomass rest or waste stream fractions contain these N-functionalities in proteins and free amino acids that can be used as starting materials for the synthesis of biopolymers and chemicals. This paper describes the economic and technological feasibility for cyanophycin production by fermentation of the potato waste stream Protamylassetrade mark or directly in plants and its subsequent conversion to a number of N-containing bulk chemicals.


Effect of bronchial artery blood flow on cardiopulmonary bypass-induced lung injury.
Cardiovascular surgery requiring cardiopulmonary bypass (CPB) is frequently complicated by postoperative lung injury. Bronchial artery (BA) blood flow has been hypothesized to attenuate this injury. The purpose of the present study was to determine the effect of BA blood flow on CPB-induced lung injury in anesthetized pigs. In eight pigs (BA ligated) the BA was ligated, whereas in six pigs (BA patent) the BA was identified but left intact. Warm (37 degrees C) CPB was then performed in all pigs with complete occlusion of the pulmonary artery and deflated lungs to maximize lung injury. BA ligation significantly exacerbated nearly all aspects of pulmonary function beginning at 5 min post-CPB. At 25 min, BA-ligated pigs had a lower arterial Po(2) at a fraction of inspired oxygen of 1.0 (52 +/- 5 vs. 312 +/- 58 mmHg) and greater peak tracheal pressure (39 +/- 6 vs. 15 +/- 4 mmHg), pulmonary vascular resistance (11 +/- 1 vs. 6 +/- 1 mmHg x l(-1) x min), plasma TNF-alpha (1.2 +/- 0.60 vs. 0.59 +/- 0.092 ng/ml), extravascular lung water (11.7 +/- 1.2 vs. 7.7 +/- 0.5 ml/g blood-free dry weight), and pulmonary vascular protein permeability, as assessed by a decreased reflection coefficient for albumin (sigma(alb); 0.53 +/- 0.1 vs. 0.82 +/- 0.05). There was a negative correlation (R = 0.95, P < 0.001) between sigma(alb) and the 25-min plasma TNF-alpha concentration. These results suggest that a severe decrease in BA blood flow during and after warm CPB causes increased pulmonary vascular permeability, edema formation, cytokine production, and severe arterial hypoxemia secondary to intrapulmonary shunt.


Responses of equine neutrophils to contagious equine metritis organism and its lipopolysaccharides.
Morphology and function of equine neutrophils were evaluated after combination with contagious equine metritis organism (CEMO) or 1 of 2 CEMO lipopolysaccharides (LPS). The 2 LPS (LPS-a; LPS-p) isolated from the CEMO contained 14- and 16-carbon fatty acids, ketodeoxyoctanate, hexose, and heptose, but were morphologically distinct. Neutrophils exposed to LPS had fewer granules, whereas those exposed to CEMO had more granules than did the controls (phosphate-buffered saline solution). Neutrophil iodination was significantly increased with 10 and 25 micrograms of LPS-a, but not significantly altered by LPS-p or CEMO. Staphylococcus aureus ingestion was not influenced by CEMO and was mildly decreased by LPS-a. These results indicate that CEMO may have at least 2 functionally and morphologically distinct, but chemically similar, LPS and that 1 of these LPS (LPS-a) may enhance neutrophil killing by stimulating neutrophil iodinating mechanisms.


Simultaneous hybrid of maxillary Le Fort I halo distraction and mandibular set-back for patients with severe cleft jaw deformity.
One of the surgical tactics and retrospective chart review of clinical cases are described for severe maxillo-mandibular discrepancy. The recently developed Le Fort I Halo distraction combined with mandibular sagittal splitting osteotomy is initially carried out simultaneously. Materials include six adult patients revealing severe jaw deformity with mandibular prognathism somehow ranging from 17-19 years of age. The required adjustment of the maxillo-mandibular discrepancy ranged from 14-23 mm to obtain the preferred occlusion. The simultaneous combination of over 10-mm maxillary Le Fort I Halo distraction with mandibular set-back secured rigidly by sagittal splitting was accomplished. The amount of mandibular set-back ranged from 4-6 mm. The amount of maxillary Le Fort I halo distraction ranged from 10-17 mm (Table I). The retention period of the halo brace was 21-22 days. In addition, the Delair type of face mask was used for 3-4 months as a night splint for consolidation after removal of the halo brace. Satisfactory maxillary distraction and mandibular set-back as planned preoperatively was obtained in all six cases. No particular postoperative complications were noticed. Compared with standard Le Fort I advancement for cleft patients, more advancement can be obtained easily with halo distration, particularly in cases where a large amount of advancement > 10 mm is required. This combination is worthwhile for a severe cleft jaw deformity, and is an alternative for standard double jaw osteotomy.


Recurrence of carcinoma showing thymus-like differentiation (CASTLE) involving the thyroid gland.
Carcinoma showing thymus-like differentiation (CASTLE) in the thyroid gland is a rare disease with generally a favorable prognosis. Treatment with surgery and adjuvant radiotherapy has been shown to improve local control and long-term survival rates. In this report, we present a case of a recurrent thyroid gland CASTLE and review the literature on the diagnosis and treatment of this disease. A 60-year-old woman, who was diagnosed with a CASTLE thyroid tumor in 2015, had a total thyroidectomy and was maintained on thyroid hormone replacement (levothyroxine). After 5 years, the patient had a recurrence, in an advanced stage unsuitable for surgery. As the patient declined to undergo radiotherapy, she was followed up without intervention and is currently stable after 15 months. CASTLE is a rare disease, diagnosed based on postoperative pathology and immunohistochemistry analysis, especially upon CD5 marker. In case of relapse, treatment options include surgery and radiotherapy; however conservative management without intervention is an acceptable alternative in some cases.


Novel thermosensitive hydrogel for preventing formation of abdominal adhesions.
Adhesions can form after almost any type of abdominal surgery. Postoperative adhesions can be prevented by improved surgical techniques, such as reducing surgical trauma, preventing ischemia, and avoiding exposure of the peritoneal cavity to foreign materials. Although improved surgical techniques can potentially reduce formation of adhesions, they cannot be eliminated completely. Therefore, finding more effective methods to prevent postoperative adhesions is imperative. Recently, we found that a novel thermosensitive hydrogel, ie, poly(ε-caprolactone)-poly(ethylene glycol)-poly(ε-caprolactone) (PCEC) had the potential to prevent postoperative adhesions. Using the ring-opening polymerization method we prepared a PCEC copolymer which could be dissolved and assembled at 55°C into PCEC micelles with mean size of 25 nm. At body temperature, a solution containing PCEC micelles could convert into a hydrogel. The PCEC copolymer was biodegradable and had low toxicity in vitro and in vivo. We found that most animals in a hydrogel-treated group (n = 10) did not develop adhesions. In contrast, 10 untreated animals developed adhesions that could only be separated by sharp dissection (P < 0.001). The hydrogel could adhere to peritoneal wounds and degraded gradually over 7-9 days, transforming into a viscous fuid that was completely absorbed within 12 days. The injured parietal and visceral peritoneum remesothelialized over about seven and nine days, respectively. This study confirms that PCEC hydrogel has potential application in the prevention of postoperative adhesions.


Efficacy of abatacept in patients with rheumatoid arthritis, as assessed by magnetic resonance imaging of bilateral hands.
To examine the efficacy of abatacept in patients with rheumatoid arthritis (RA) using magnetic resonance imaging (MRI) of bilateral hands. This prospective study included 35 RA patients. MRI of bilateral hands was performed at baseline and after 12 months of treatment with intravenous abatacept. MRI images were scored for synovitis, osteitis, erosion and joint space narrowing (JSN) according to the RA MRI Scoring System (RAMRIS). The primary endpoint was the change in RAMRIS score from baseline. Repair of erosion was defined as a negative change in the erosion score that was greater than the smallest detectable changes (SDCs). Thirty-one patients completed the study. Median synovitis and osteitis scores showed statistically significant reductions at Month 12 when compared to baseline (synovitis score, -5.5 [P < 0.0001]; osteitis score, -0.5 [P = 0.03]). However, median erosion and JSN scores did not significantly change. At Month 12, 83% of patients showed no progression of erosion scores and repair of erosion was observed in 11% of patients. All patients with repair of erosion achieved functional remission (Health Assessment Questionnaire-Disability Index ≤ 0.5). The Simplified Disease Activity Index response rate at Month 1 was identified as an independent factor predicting changes in the erosion scores at Month 12. Abatacept treatment reduced synovitis and osteitis scores and did not worsen erosion and JSN scores at Month 12. Over 10% of patients experienced repair of erosion.


Inhibition of clot formation process by treatment with the low-molecular-weight heparin nadroparin in patients with carotid artery disease undergoing angioplasty and stenting. A thromboelastography study on whole blood.
Low-molecular-weight heparins (LMWHs) have become the corner stone of antithrombotic treatment but their administration protocol needs to be optimized for certain groups of patients. In this paper, we studied the influence of nadroparin treatment on clot formation process assessed by thromboelastography in patients with carotid artery disease undergoing angioplasty and stenting. Standard thromboelastography assays (in-TEM and ex-TEM) and minimal TF-triggered thromboelastography assay in citrated whole blood were performed in normal volunteers (n = 20), in patients with carotid artery disease receiving only antiplatelet treatment (n = 30), and in patients undergoing angioplasty receiving nadroparin 5750 anti-Xa IU s.c. twice daily (n = 60). Blood samples were collected four hours after a second injection of nadroparin. In a subgroup of LMWH-patients (n = 18) blood samples were also obtained prior to first injection of LMWH. Antiplatelet treatment had no effect on any parameter of the thromboelastographic pattern. Nadroparin treatment resulted in significant prolongation of clotting time (CT) and clot formation time (CFT) and significantly reduced a -angle in minimal TF-triggered thromboelastography and 30 - 38% of nadroparin treated patients had thromboelastographic parameters beyond the normal maximum limit. In-TEM test revealed a significant prolongation of clotting time while ex-TEM was not modified, and 20 to 30% of the patients had thromboelastographic parameters beyond the normal maximum limit. Anti factor-Xa activity in platelet-poor plasma (PPP) was also measured, and statistical analysis showed that prolongation of CFT of minimal TF-triggered TEM was significantly correlated to the levels of anti-Xa activity in patients ' plasma (p = 0.04; r (2) = 0.7). There was no statistical correlation for any other parameter in all tests. In conclusion, the present study shows that nadroparin treatment in patients with carotid artery disease undergoing endovascular procedures induces significant modification of the thrombus kinetics assessed by minimal TF-triggered whole blood thromboelastography. The clinical relevance of these findings has to be evaluated in future studies.


Telemonitoring for the Management of Patients with Heart Failure.
Advances in technology now make it possible to manage heart failure (HF) from a remote to a telemonitoring approach using either noninvasive solutions or implantable devices. Nowadays, it is possible to monitor at-home parameters that can be recorded, stored and remotely transmitted to physicians, allowing them to make decisions for therapeutic modification, hospitalization or access to the emergency room. Standalone systems are available that are equipped with self-intelligence and are able to acquire and elaborate data that can inform the remote physician of impending decompensation before it results in additional complications. The development of miniature implantable devices, which could measure haemodynamic variables and transmit them to a monitor outside the body, offers the possibility for the physician to obtain more frequent evaluations of HF patients and the opportunity to take these data into account in management decisions. At present, several telemonitoring devices are available, but the only Food and Drug Administration-approved system is the cardio-microelectromechanical system, which is an implantable pulmonary arterial pressure (PAP) monitoring device that allows a direct monitoring of the PAP via a sensor implanted in the pulmonary artery. This information is then uploaded to a web-based interface from which healthcare providers can track the results and manage patients. At present, the challenge point for telemedicine management of HF is to find the more relevant biological parameter to monitor the clinical status.


Gastrointestinal mucosal toxicities from immune checkpoint inhibitors: Current understanding and future directions.
Immune checkpoint inhibitor (ICI) therapy has revolutionized the field of oncology over the past decade, leading to durable remissions in some patients but also producing a wide spectrum of treatment-limiting inflammatory toxicities that are referred to as immune-related adverse events (irAEs). Although irAEs can involve any organ system in the body, they most commonly affect the barrier tissues, including the gastrointestinal tract with colitis and enterocolitis affecting a significant fraction of patients on ICIs. We are beginning to understand the mechanisms that drive ICI colitis, with early experiments indicating a role for CD8+ resident memory T cells (TRMs) in the gut, which become activated and differentiate into cytotoxic cells in response to ICI therapy. The risk factors that define who will develop ICI colitis are not understood and substantial efforts are underway to identify potential biomarkers for risk of this and other toxicities. Optimal management of ICI colitis is also an area of active investigation. Current standard treatments are based largely on small, retrospective analyses, and while drugs like systemic glucocorticoids or the TNFα inhibitor infliximab do appear to be highly active in ICI colitis, the impact of these therapies on antitumor responses is poorly understood. As discussed in this review, future work will have to define the immune mechanisms driving ICI colitis in more detail and in comparison to antitumor responses in order to identify candidate pathways that can be targeted to improve ICI colitis without interfering in antitumor immunity. Studying these interventions will require randomized, controlled trials with both tumor and colitis endpoints, a goal that will necessitate collaboration across institutions and funding agencies. We are at a point where such collaborative trials are feasible, and have the potential to greatly improve the care of patients with ICI colitis as well as other irAEs.


Therapy assessment for sustained ventricular tachyarrhythmias: how many electropharmacological tests are appropriate?
Surgery, implantable devices or catheter ablations offer therapeutic choices for the treatment of malignant ventricular tachyarrhythmias (VT) resistant to antiarrhythmic drugs. The number of electropharmacological (EP) tests that should precede consideration of a nonpharmacological therapy has not been defined. We performed serial EP tests in 94 patients with inducible sustained VT until an effective drug was identified or all available drugs had failed to suppress VT induction. With up to 11 tests in individual patients, suppression of VT inducibility was finally achieved in 66 patients (70%). In 47 of these 66 patients (70%), only one or two tests were necessary to identify an effective regimen. However, in 40%, 28%, 18%, and 9% of the patients still inducible after 2, 3, 4, and 5 drug tests, respectively, an effective agent could be identified during subsequent tests. No critical number of unsuccessful EP tests clearly separated responders and nonresponders to medical therapy. During follow-up (34 +/- 11 months), 14 patients placed on antiarrhythmic drugs predicted to be effective had symptomatic VT recurrence. VT recurrence was unrelated to the type or the number of unsuccessful EP tests preceding identification of the prescribed drug. Extensive EP testing with all available agents might therefore be worthwhile in selected patients. An "appropriate" number of EP studies has to be determined individually for each patient, based on the chance of finding an effective drug during subsequent studies and the risk and benefit of the therapeutic choices.


Identification of key genes and pathways for peri-implantitis through the analysis of gene expression data.
The present study attempted to identify potential key genes and pathways of peri-implantitis, and to investigate the possible mechanisms associated with it. An array data of GSE57631 was downloaded, including six samples of peri-implantitis tissue and two samples of normal tissue from the Gene Expression Omnibus (GEO) database. The differentially expressed genes (DEGs) in the peri-implantitis samples compared with normal ones were analyzed with the limma package. Moreover, Gene Ontology annotation and the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses for DEGs were performed by DAVID. A protein-protein interaction (PPI) network was established using Cytoscape software, and significant modules were analyzed using Molecular Complex Detection. A total of 819 DEGs (759 upregulated and 60 downregulated) were identified in the peri-implantitis samples compared with normal ones. Moreover, the PPI network was constructed with 413 nodes and 1,114 protein pairs. Heat shock protein HSP90AA1 (90 kDa α, member 1), a hub node with higher node degrees in module 4, was significantly enriched in antigen processing, in the presentation pathway and nucleotide-binding oligomerization domain (NOD)-like receptor-signaling pathway. In addition, nuclear factor-κ-B1 (NFKB1) was enriched in the NOD-like receptor-signaling pathway in KEGG pathway enrichment analysis for upregulated genes. The proteasome is the most significant pathway in module 1 with the highest P-value. Therefore, the results of the present study suggested that HSP90AA1 and NFKB1 may be potential key genes, and the NOD-like receptor signaling pathway and proteasome may be potential pathways associated with peri-implantitis development.


Efficiency and Suitability when Exploring the Conformational Space of Phase-Transfer Catalysts.
In this study, a complete exploration of the conformational space of different phase-transfer catalysts by means of computational method benchmarking is presented. For this particular research work, only the most significant and relevant conformational analysis approaches have been chosen to characterize the main Cinchona alkaloid-based phase-transfer catalysts. This particular guiding study aims to rigorously compare the performance of different conformational methods, determining the strengths of each method and providing recommendations regarding suitable and efficient choices of methods for analysis.


Diosmin induces genotoxicity and apoptosis in DU145 prostate cancer cell line.
Plant-derived dietary polyphenolic compounds, such as flavonoids, with cancer cell-specific pro-apoptotic activity and chemopreventive potential are thought to be promising anticancer agents. In the present study, we were interested in determining if flavonoid-induced genotoxicity may also provoke cancer cell death. Cyto- and genotoxicity of three selected flavonoid glycosides (naringin, diosmin and hesperidin) in DU145 prostate cancer cell line were investigated. Flavonoid glycosides decreased cancer cell number and proliferative activity in a different manner. Flavonoid glycosides induced oxidative stress: intracellular total ROS and superoxide production were augmented after flavonoid treatment. Flavonoid glycosides stimulated DNA double strand breaks (DSBs) and micronuclei production. Diosmin was found the most potent genotoxic agent in DU145 cells, which, in turn, resulted in its pro-apoptotic activity. The more robust recruitment of 53BP1 was correlated with lower DNA and chromosomal damage after naringin and hesperidin treatment compared with diosmin treatment. Flavonoid glycosides were also found to be DNA hypomethylating agents with an ability to modulate cancer cell epigenome leading to changes in the gene expression patterns. Taken together, diosmin, a dietary flavonoid glycoside, was found active against DU145 cells by promoting genotoxic events and a concomitant apoptotic cell death. Thus, a comprehensive analysis of biological activity of diosmin against cancer cells both in vitro and in vivo deserves further investigation.


Change in the Contents of Arginine, Ornithine, and Urea in the Muscle of Marine Invertebrates Stored in Ice.
To investigate the usefulness of ornithine and urea as freshness indices for marine invertebrates, the muscle tissue from freshly caught samples was stored in ice for 15 days and the free amino acid concentration was measured. The total amount of free amino acids decreased slightly after 1 day in most of the samples. The arginine concentration also decreased in most of the samples, especially in kuro shrimp during ice storage, while the ornithine and urea levels increased markedly in arrow squid and kuro shrimp, and increased considerably in kuruma prawn. Based on these results, it is proposed to use urea and ornithine as freshness indices for kuro shrimp and arrow squid, while only urea is proposed for kuruma prawn.


Purification and crystallization of Shiga toxin from Shigella dysenteriae.
The protein toxin produced by Shigella dysenteriae consists of one enzymatically active A subunit of 293 amino acid residues and five B subunits of 69 amino acid residues that are involved with cell attachment. The holotoxin has been purified by blue Sepharose and chromatofocusing column chromatography. Two crystal forms of purified holotoxin have been grown by vapor diffusion. One grows as fine needles, hexagonal in cross-section, which do not diffract well enough to characterize crystallographically. The second grows as thin plates that diffract to at least 3 A resolution. Their space group is P2(1)2(1)2(1) with unit cell dimensions of a = 132.0 A, b = 146.0 A and c = 82.5 A. The asymmetric unit of the crystals is likely to contain two AB5 units.


Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension.
Chronic thromboembolic pulmonary hypertension (CTEPH) is thought to result from incomplete resolution of pulmonary thromboemboli that undergo organisation into fibrous tissue within pulmonary arterial branches, filling pulmonary arterial lumina with collagenous obstructions. The treatment of choice is pulmonary endarterectomy (PEA) in CTEPH centres, which has low post-operative mortality and good long-term survival. For patients ineligible for PEA or who have recurrent or persistent pulmonary hypertension after surgery, medical treatment with riociguat is beneficial. In addition, percutaneous balloon pulmonary angioplasty (BPA) is an emerging option, and promises haemodynamic and functional benefits for inoperable patients. In contrast to conventional angioplasty, BPA with undersized balloons over guide wires exclusively breaks intraluminal webs and bands, without dissecting medial vessel layers, and repeat sessions are generally required. Observational studies report that BPA improves haemodynamics, symptoms and functional capacity in patients with CTEPH, but controlled trials with long-term follow-up are needed. Complications include haemoptysis, wire injury, vessel dissection, vessel rupture, reperfusion pulmonary oedema, pulmonary parenchymal bleeding and haemorrhagic pleural effusions. This review summarises the available evidence for BPA, patient selection, recent technical refinements and periprocedural imaging, and discusses the potential future role of BPA in the management of CTEPH.


Brain effects of cognitive remediation therapy in schizophrenia: a structural and functional neuroimaging study.
Cognitive remediation therapy positively affects cognition and daily functioning in patients with schizophrenia. However, studies on the underlying neurobiological mechanisms of this treatment are scarce. The aim of the current study was to investigate functional and structural connectivity brain changes in schizophrenia patients after cognitive remediation therapy using a whole-brain approach that combined functional magnetic resonance imaging and diffusion tensor imaging. A randomized controlled trial with 30 schizophrenia outpatients and 15 healthy volunteers. A strategy-learning-based treatment was used as a cognitive remediation therapy. A social skills training that provides useful information about illness management was used as an active control. We investigated changes in the pattern of functional connectivity assessed during an n-back task by tensorial independent component analysis as implemented in the multivariate exploratory linear decomposition into independent components and in the fractional anisotropy index of white matter integrity using tract-based spatial statistics. Brain networks activation pattern significantly changed in patients exposed to the cognitive treatment in the sense of normalizing toward the patterns observed in healthy control subjects. Additionally, in white matter, they showed an increase in fractional anisotropy index in the anterior part of the genu of the corpus callosum. Cognitive improvement, functional, and also structural changes showed statistically significant correlations. Improvement in brain functioning detected after cognitive remediation therapy in schizophrenia patients might be based on an increase of the interhemispheric information transfer between the bilateral prefrontal cortexes via the corpus callosum.


Acute Myelogeneous Leukemia (M0/M1) with novel chromosomal abnormality of t(14;17) (q32; q11.2).
Acute Myelogeneous Leukemia (AML) is a heterogeneous disease with respect to morphology, immunophenotype, and genetic rearrangements. Multiple recurrent chromosomal aberrations have been identified by conventional cytogenetic analysis. In this study, we report a case whose clinical features were suggestive of AML-M1 subtype with t(14;17) (q32; q11.2) karyotype involving rearrangement of chromosomal segments 17q11.2 and 14q32. This is the first report of novel chromosomal translocation in this subset of AML and has not yet been reported elsewhere. This rearrangement may include certain cancer associated oncogene(s) or genes involved in the differentiation like retionic acid receptor alpha (RARA), which may confer differentiation blockage and/or proliferation advantage.


[Open stent implantation for ascending aorta aneurysm with severe calcification].
A 77-year-old woman had an ascending aortic aneurysm and aortic regurgitation due to aortitis syndrome. Computed tomography showed that ascending aorta was 55 mm in diameter and had severe calcification between the ascending aorta and distal aortic arch involves neck vessels. We performed open stent implantation and aortic valve replacement with bioprostheses valve. No adverse event occurred after the operation and the patient was discharged on the 28th postoperative day. The open stent implantation was useful for the treatment of the aneurysm in high risk patients.


Acute anorectic response to cannabinoid CB1 receptor antagonist/inverse agonist AM 251 in rats: indirect behavioural mediation.
Despite a large and consistent literature on the suppressant effects of cannabinoid CB1 receptor antagonists/inverse agonists (e.g. rimonabant, AM 251) on food intake and weight gain in rodents, surprisingly little is known about the behavioural selectivity of such effects. In this study, ethological scoring was used to characterize the acute behavioural effects of the rimonabant analogue AM 251 (1.5 and 3.0 mg/kg, intraperitoneally) in nondeprived male rats during a 1-h test with palatable mash. Data were also collected on daily weight gain and on retest food intake 7 days after dosing. Results showed that the higher dose of AM 251 significantly inhibited mash consumption (32% decrease relative to vehicle control), reduced time spent feeding during the test and suppressed body weight gain over the 48-h period that followed acute dosing. No effects on mash consumption were observed when the animals were retested drug-free 1 week after drug treatment. Detailed video analysis of the test sessions showed that, over the dose range tested, AM 251 did not significantly interfere with the vast majority of noningestive behaviours. Both doses of the compound, however, significantly increased the incidence of and the time spent on scratching, whereas the higher dose additionally increased both the number and duration of grooming episodes. The latter effect in particular disrupted the normal structure of behaviour (behavioural satiety sequence) with atypically high levels of grooming displacing feeding during the middle part of the test session. Overall, the behavioural profile of AM 251 in a free-feeding context is very similar to (but approximately two-fold less potent than) that recently reported for the parent molecule, rimonabant. Together, these data strongly suggest that the acute anorectic response to CB1 receptor antagonists/inverse agonists is indirectly mediated via major alterations to other components of the behavioural repertoire.


Maternal serum uric acid: a reliable prognostic indicator of foetal outcome among pre-eclamptic patients in a low resource setting.
Pre-eclampsia is a major cause of maternal and fetal morbidity and mortality in both developed and developing countries. Hyperuricemia is often associated with pre-eclampsia and when this occurs, fetal outcome may become worse. We evaluated the role of maternal serum uric acid as a prognostic indicator of fetal outcome in pre-eclamptic mothers. A prospective case-control study in which 55 eligible pre-eclamptic patients at term were matched in maternal age and gestational age with 55 consecutive normotensive pregnant women. Venous blood samples were obtained and analyzed for serum uric acid. Following delivery, the fetal outcomes in the pre-eclamptic group and controls were determined. Data analysis was carried out using SPSS (version 21) and the level of statistical significance was set at p-value <.05. The mean serum uric acid levels of the pre-eclamptic subjects was significantly higher compared to their normotensive counterparts (12.7 ± 7.8 vs. 4.9 ± 1.2 mg/dL, p = .000). Babies with low birth weight, poor Apgar scores (at 1st and 5th minute of life) and those who required neonatal unit admission occurred more significantly among the pre-eclamptic women when compared with the controls (p = .000). However, the live birth rate of the case and control groups was comparable (94.5% vs. 100%, p = .079), Binary logistic regression analysis revealed a positive association between hyperuricemia and pre-eclampsia (OR = 18.8; 95% CI = 1.22-289.35, p = .035). Pre-eclamptic mothers with hyperuricemia had 4.41 odds of delivering babies with low birth weight when compared with pre-eclamptics without hyperuricemia (OR = 4.41; 95% CI = 0.76-25.5, p = .097); but Apgar scores and need for neonatal admission showed no association with maternal serum uric acid levels. This study therefore suggests that hyperuricemia is a strong prognostic indicator of LBW babies among women with pre-eclampsia.


A non-derivative, non-surgical tracheostomy: the translaryngeal method.
To present a new technique for non-surgical tracheostomy. An open, clinical trial on patients requiring elective tracheostomy. Intensive care unit of a community hospital. 95 adults, mean age 60 years, and 14 infants and children, mean age 26 months (2 months-7 years) with common indications for tracheostomy. Through a needle inserted in the trachea, a guidewire is pushed out of the mouth against the usual direction and attached to a special device formed by a flexible plastic cone with a pointed metal tip joined to an armoured tracheal cannula. This device is then pulled back through the oral cavity, larynx and trachea and outwards across the neck wall by the operator applying traction on the wire with one hand and counterpressure on the neck wall with the fingers of the other hand. When the cone and a part of the cannula have emerged, the cannula is cut off from the cone, straightened perpendicular to the skin, rotated and advanced caudally to its final position. The cone-cannula passed smoothly through the vocal cords. The metallic point perforated the neck easily. The dilation did not present any risk of tracheal wall damage because the direction of the manoeuvre was from the inside to the outside of the neck. The tissues tightly adhered to the cannula, thus avoiding infection and bleeding. The use of ventilation systems permitted utilization of translaryngeal tracheostomy (TLT) even in patients for whom apnoea might have carried some risk, because there is no interruption of respiratory assistance during the procedure. Follow-up showed no late obstructive complication at the level of the tracheostoma. By virtue of its greater safety and less trauma to tissues than percutaneous techniques, TLT can also be carried out in infants and children (an important benchmark for any tracheostomy technique) and in very difficult patients from whom other techniques have serious drawbacks.


An update to tranexamic acid trends during the peripartum period in the United States, 2019 to 2021.
Results from the 2017 World Maternal Antifibrinolytic trial found that patients who received tranexamic acid during delivery had significantly lower rates of death and hysterectomy. Several months after the World Maternal Antifibrinolytic trial publication, American College of Obstetricians and Gynecologists endorsed the consideration of tranexamic acid usage when traditional uterotonics fail during postpartum hemorrhage. Since then, tranexamic acid usage has become more mainstream for the treatment of postpartum hemorrhage. This study aimed to evaluate tranexamic acid trends in obstetrics both temporally and geographically within the United States. Additional outcomes included patient demographics and perinatal outcomes. This retrospective cohort study included 19 hospitals divided into East, Central, and West geographic regions within the Universal Health Services, Incorporated network. Rates of tranexamic acid use were compared from July 2019 through June 2021. Patient demographics and perinatal outcomes were analyzed for tranexamic acid recipients. During the two-year study period, 3.2% (1580/50,150) of patients received tranexamic acid during delivery. The western region of the United States demonstrated increased tranexamic acid use over the 2-year study period. Recipients of tranexamic acid were more likely to have a history of postpartum hemorrhage (P<.0001), chronic hypertension (P<.0001), preeclampsia (P<.0001), and/or diabetes (P=.004). Patients who received tranexamic acid did not have an increased likelihood of venous thromboembolism in comparison with those who did not receive tranexamic acid (8 [0.5%] vs 226 [0.5%]; P=.77). Of those who received tranexamic acid, 53.2% (840/1580) had an estimated blood loss <1000 mL. Nationally, a higher percentage of patients received tranexamic acid without a postpartum hemorrhage diagnosis compared with previous studies, and the western region of the United States had an overall increased use of tranexamic acid during delivery compared with previous years. There was no increased risk of venous thromboembolism in those who received tranexamic acid, regardless of postpartum hemorrhage diagnosis.


Exploring the role of growth factors as potential regulators in psoriatic plaque formation.
Psoriasis is a chronic inflammatory skin disease in which growth activity is more prominent than inflammatory activity at the centre of lesional skin (CE skin). This growth activity is partly influenced by growth factors (GFs) that play an important role in cell growth and inflammation during the plaque development. In this study, we identified potential GFs in CE skin and predicted their regulatory functions and biological activity in mediating transcripts in the plaques. Samples of uninvolved skin (UN skin) and CE skin were biopsied from patients with psoriasis vulgaris for RNA-sequencing analysis in order to identify differentially expressed genes (DEGs). Our finding revealed that epidermal growth factor (EGF), fibroblast growth factor (FGF), platelet-derived growth factor (PDGF) and hepatocyte growth factor (HGF) signalling were enriched by CE/UN skin-derived DEGs. Additionally, several EGFR ligands, namely EGF, heparin-binding EGF like growth factor (HB-EGF), amphiregulin (AREG) and transforming growth factor (TGF)-α, as well as TGF-β1, TGF-β2, vascular endothelial growth factor-A, FGFs, PDGF-B and HGF, were predicted to be GF regulators. The regulatory pattern and biological activity of these GF regulators on mediating the CE/UN skin-derived DEGs was demonstrated. This study provides a novel hypothesis regarding the overall regulatory function of GFs, which appear to modulate the expression of the transcripts involved in inflammation and growth in the CE skin. In addition, some GFs may exert anti-inflammatory effects. Further investigations on the mechanisms underlying this regulation may contribute to a deeper understanding of psoriasis and the identification of potential therapeutic targets for patients with psoriasis.


Association of VASP with TRPC4 in PKG-mediated inhibition of the store-operated calcium response in mesangial cells.
We tested the hypotheses that the NO-cGMP-PKG pathway mediates inhibition of the store-operated cation channel (SOC) in human glomerular mesangial cells (HMC) and that TRPC4, a molecular component of SOC in HMC, is associated with PKG-phosphorylated vasodilator-stimulated phosphoprotein (VASP). Using fura 2 ratiometry, we measured intracellular Ca(2+) concentration [Ca(2+)](i) to determine whether sodium nitroprusside (SNP), an NO donor, and 8-Br-cGMP affected SOC-TRPC4 via PKG. We found that the SOC response in HMC was attenuated in the presence of 100 microM SNP, an NO donor, or 100 microM 8-Br-cGMP. Addition of DT-3 (2.5 microM), a specific PKG-1alpha inhibitor, reversed the effects of 8-Br-cGMP on the SOC response. Application of 100 microM cAMP did not significantly inhibit the SOC response. RT-PCR and Western blotting revealed PKG-1alpha transcript and protein in HMC. Immunocytochemical analysis localized PKG-1alpha to the cytoplasm and plasma membrane of HMC. Previous studies have shown that PKG-mediated phosphorylation of VASP attenuates cellular Ca(2+) entry, resulting in altered growth and proliferation. Therefore, we used Western blotting and immunocytochemistry to determine whether PKG-phosphorylated VASP associates with TRPC4. Western blot analysis revealed that 8-Br-cGMP enhanced the phosphorylation of VASP at serine 239 (Ser239), a known PKG phosphorylation site, in HMC within 5 min. Coimmunoprecipitation and coimmunostaining showed that P-Ser239-VASP associated with TRPC4. However, VASP that was unphosphorylated at Ser239 was not associated with TRPC4. These results indicate that VASP has a role in the NO/PKG-1alpha-mediated inhibition of the TRPC4-SOC response in HMC.


Profiles of physician practice and patient severity of illness.
We report on a study that examined physician practice profiles using two methods of patient classification: the Severity of Illness Index and diagnosis-related groups (DRGs). When used together with conventional management information and DRGs, the Severity of Illness Index permitted useful comparisons to be made among physicians; differences in both case-mix and severity could be estimated. In 37 per cent of the physicians studied, we found differences of more than $10,000 in the apparent impact of a physician on the hospital's financial position, depending on whether one controlled for severity or not. The extent to which these differences in impact could be due to quality of care differences is an area for future research. However, the findings that 37 per cent of the physicians in the study may be wrongly identified as over- or under-utilizers suggest long-term public health consequences of preparing physician profiles based on unadjusted DRGs.


Volumetric changes following barrier regeneration procedures for the surgical management of grade II molar furcation defects in baboons: II. Bone, cementum, epithelium, and connective tissue.
In Part I, a computer imaging technique was used to measure the volumetric fill that occurred in surgically created grade II molar furcation defects after they had been treated using the principles of guided tissue regeneration. In Part II, the volumetric fill for each of the specific tissues comprising the defect fill (epithelium, connective tissue, bone, and cementum) was compared. The histologic material consisted of defects treated using one of three types of surgical treatment as well as untreated control sites. All volumetric measurements were expressed as a percentage of the original surgically created defect size, with 100% indicating complete healing of the defect. The results indicate that none of the defects achieved complete healing. Teeth receiving flap debridement had the most overall defect fill (79.50% comprised of 17.13% bone, 35.81% connective tissue, 37.35% epithelium, and 9.71% cementum). Teeth that received a biodegradable barrier showed a mean overall defect fill of 74.98% (7.41% bone, 47.13% connective tissue, 36.20% epithelium, and 9.26% cementum. Sites treated with an exclusion barrier showed 70.75% overall fill (9.63% bone, 40.89% connective tissue, 39.00% epithelium, and 10.48% cementum). The untreated control teeth showed a mean overall fill of 78.70% (5.56% bone, 59.11% connective tissue, 31.06% epithelium, and 4.27% cementum). No significant differences were found among teeth within the same animal and between treatment and controls. The following conclusions were drawn: (1) connective tissue comprised nearly one half of the total fill of the surgically created defects; (2) the percentage of new bone growth was significantly lower than anticipated; and (3) no significant differences were found among the treatment modalities and the untreated control sites for each of the specific tissue types.


Cultivation of Mycobacterium tuberculosis from pleural tissue and its histopathology in suspected cases of tuberculous pleural effusion.
The majority of idiopathic pleural effusion are considered to be of tuberculous etiology. The culture of bacilli provide most authentic evidence of disease process. This study was carried out on 21 cases of suspected tuberculous pleural effusion. The pleural fluid and tissue was subjected for smear examination, and cultivation of tubercle bacilli along with pleural biopsy. Overall the diagnosis could be made out of 8 (38.09%) cases. The cultivation of Mycobacterium tuberculosis from pleural tissue was more sensitive (33.33%) as compared to histopathology (19.05%). However, the triad of cultivation of Mycobacterium tuberculosis from pleural tissue, pleural histopathology and pleural fluid smear examination or culture should be done in each suspected case of tuberculous effusion.